Increasing evidence supports reciprocal communication between the enteric and the central nervous system in disease, termed the 'gut-brain axis'. Recent findings suggest a connection between IBD and ...development of Parkinson's disease. The role of IBD in dementia, another insidious neurodegenerative disorder, has not been explored.
Using the Taiwanese National Health Insurance Research Database, we performed comparative analysis of 1742 patients with IBD ≥45 years old against 17 420 controls to assess dementia risk following IBD diagnosis. Controls were matched on bases of sex, access to healthcare, income and dementia-related comorbidities. All individuals were followed for dementia diagnosis for up to 16 years. Subanalyses included the relationship between sex, ulcerative colitis (UC) and Crohn's disease (CD), and dementia risk.
Overall incidence of dementia among patients with IBD was significantly elevated (5.5% vs 1.4% among controls). Patients with IBD were diagnosed with dementia at 76.24 years old on average, compared with 83.45 among controls. The HR of developing dementia among patients with IBD was 2.54 (95% CI 1.91 to 3.37). Among dementia types, the risk of developing Alzheimer's dementia demonstrated the greatest increase. Dementia risk did not differ between sex differences nor UC versus CD.
This population-based cohort study demonstrates significant association between IBD and subsequent development of dementia. Dementia was diagnosed at an earlier age among patients with IBD, and disease risk appeared to increase with IBD chronicity. These findings highlight the need for future research to elucidate the relationship between IBD and dementia.
In the early stages of the 2019 novel coronavirus disease (COVID-19) pandemic, containment of disease importation from epidemic areas was essential for outbreak control. This study is based on ...publicly accessible data on confirmed COVID-19 cases in Taiwan extracted from the Taiwan Centers for Disease Control website. We analysed the characteristics, infection source, symptom presentation, and route of identification of the 321 imported cases that were identified from 21 January to 6 April 2020. They were mostly returned Taiwanese citizens who had travelled to one or more of 37 countries for tourism, business, work, or study. Half of these cases developed symptoms before arrival, most of the remainder developed symptoms 1-13 days (mean 4.0 days) after arrival, and 3.4% never developed symptoms. Three-quarters of the cases had respiratory symptoms, 44.9% had fever, 13.1% lost smell or taste, and 7.2% had diarrhoea. Body temperature and symptom screening at airports identified 32.7% of the cases. Of the remainder, 27.7% were identified during home quarantining, 16.2% were identified via contact tracing, and 23.4% were reported by hospitals. Under the strict enforcement of these measures, the incidence of locally acquired COVID-19 cases in Taiwan remains sporadic. In conclusion, proactive border control measures are effective for preventing community transmission of this disease.
Possible association between diabetes mellitus (DM) and Alzheimer's disease (AD) has been controversial. This study used a nationwide population-based dataset to investigate the relationship between ...DM and subsequent AD incidence.
Data were collected from Taiwan's National Health Insurance Research Database, which released a cohort dataset of 1,000,000 randomly sampled people and confirmed it to be representative of the Taiwanese population. We identified 71,433 patients newly diagnosed with diabetes (age 58.74 ± 14.02 years) since January 1997. Using propensity score, we matched them with 71,311 non-diabetic subjects by time of enrollment, age, gender, hypertension, hyperlipidemia, and previous stroke history. All the patients were followed up to December 31, 2007. The endpoint of the study was occurrence of AD.
Over a maximum 11 years of follow-up, diabetic patients experienced a higher incidence of AD than non-diabetic subjects (0.48% vs. 0.37%, p<0.001). After Cox proportional hazard regression model analysis, DM (hazard ratio HR, 1.76; 95% confidence interval CI, 1.50-2.07, p<0.001), age (HR, 1.11; 95% CI, 1.10-1.12, p<0.001), female gender (HR, 1.24; 95% CI, 1.06-1.46, p=0.008), hypertension (HR, 1.30; 95% CI, 1.07-1.59, p=0.01), previous stroke history (HR, 1.79; 95% CI, 1.28-2.50, p<0.001), and urbanization status (metropolis, HR, 1.32; 95% CI, 1.07-1.63, p=0.009) were independently associated with the increased risk of AD. Neither monotherapy nor combination therapy with oral antidiabetic medications were associated with the risk of AD after adjusting for underlying risk factors and the duration of DM since diagnosis. However, combination therapy with insulin was found to be associated with greater risk of AD (HR, 2.17; 95% CI, 1.04-4.52, p=0.039).
Newly diagnosed DM was associated with increased risk of AD. Use of hypoglycemic agents did not ameliorate the risk.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
When assessing ischemic stroke risk in patients with atrial fibrillation (AF), the CHA2DS2-VASc score is calculated based on the baseline risk factors, and the outcomes are determined after a ...follow-up period. However, the stroke risk in patients with AF does not remain static, and with time, patients get older and accumulate more comorbidities.
This study hypothesized that the “Delta CHA2DS2-VASc score,” which reflects the change in score between baseline and follow-up, would be more predictive of ischemic stroke compared with the baseline CHA2DS2-VASc score.
A total of 31,039 patients with AF who did not receive antiplatelet agents or oral anticoagulants, and who did not have comorbidities of the CHA2DS2-VASc score except for age and sex, were studied. The Delta CHA2DS2-VASc scores were defined as the differences between the baseline and follow-up CHA2DS2-VASc scores. During 171,956 person-years, 4,103 patients experienced ischemic stroke. The accuracies of baseline, follow-up, and Delta CHA2DS2-VASc scores in predicting ischemic stroke were analyzed and compared.
The mean baseline CHA2DS2-VASc score was 1.29, which increased to 2.31 during the follow-up, with a mean Delta CHA2DS2-VASc score of 1.02. The CHA2DS2-VASc score remained unchanged in only 40.8% of patients. Among 4,103 patients who experienced ischemic stroke, 89.4% had a Delta CHA2DS2-VASc score ≥1 compared with only 54.6% in patients without ischemic stroke, and 2,643 (64.4%) patients had ≥1 new-onset comorbidity, the most common being hypertension. The Delta CHA2DS2-VASc score was a significant predictor of ischemic stroke that performed better than baseline or follow-up CHA2DS2-VASc scores, as assessed by the C-index and the net reclassification index.
In this AF cohort, the authors demonstrated that the CHA2DS2-VASc score was not static, and that most patients with AF developed ≥1 new stroke risk factor before presentation with ischemic stroke. The Delta CHA2DS2-VASc score, reflecting the change in score between baseline and follow-up, was strongly predictive of ischemic stroke, reflecting how stroke risk in AF is a dynamic process due to increasing age and incident comorbidities.
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Increasing evidence suggests that patients with bipolar disorder are more likely to develop malignant cancer than in the general population. However, the overall cancer risk in the unaffected ...siblings of such patients remains unknown. From the National Health Insurance Research Database of Taiwan, 25 356 patients with bipolar disorder, 25 356 age‐matched unaffected siblings of patients with bipolar disorder and 101 422 age‐matched controls without severe mental disorders between 1996 and 2010 were enrolled in our study. Patients who developed cancer between the time of enrollment and the end of 2011 were identified. Cancers were divided into three subgroups based on the related layer of embryonic development: ectodermal, mesodermal and endodermal cancers. Patients with bipolar disorder (odds ratio OR = 1.22, 95% confidence interval CI: 1.06, 1.40) and unaffected siblings of such patients (OR = 1.17, 95% CI 1.02, 1.34) had greater risk of developing malignant cancer than did controls. Furthermore, only those aged <50 years, for both patients with bipolar disorder (OR = 1.90, 95% CI 1.38, 2.61) and unaffected siblings (OR = 1.65, 95% CI 1.19, 2.28), were more likely to develop the ectodermal cancer, especially breast cancer, than the control group. The associations of bipolar disorder and susceptibility to bipolar disorder with increased cancer risk in the younger population may imply a genetic overlap in neurodevelopment and malignancy pathogenesis. Our findings may encourage clinicians to monitor cancer risk factors and warning signs closely in patients with bipolar disorder and unaffected siblings of such patients.
What's new?
Increasing evidence suggests that patients with bipolar disorder are more likely to develop malignant cancer than the general population. However, the overall cancer risk in the unaffected siblings of such patients remains unknown. This study found that patients with bipolar disorder and their unaffected siblings were more likely to develop cancer than controls without severe mental disorders. Furthermore, only participants aged <50 were more likely to develop ectodermal cancers. The findings imply a genetic overlap in neurodevelopment and malignancy pathogenesis and may encourage clinicians to closely monitor patients with bipolar disorder and their unaffected siblings for cancer warning signs.
Background and Aims
Inflammatory bowel disease (IBD) is a chronic gastrointestinal inflammatory disorder with increasing global prevalence. The risk of IBD in patients with schizophrenia remains ...unclear. We aim to investigate the risk of new‐onset IBD in patients with schizophrenia compared with matched controls.
Methods
We conducted a retrospective, population‐based cohort study utilising patient data from the Taiwan National Health Insurance Research Database collected between January 1, 2001, and December 31, 2011. Patients diagnosed with schizophrenia by board‐certified psychiatrists without prior diagnosis of IBD were enrolled and matched to controls in 1:4 fashion by age, sex, residence, income level and medical comorbidities. Adjusted hazard ratios (HRs) for new‐onset IBD and sub‐analyses were determined using Cox regression analysis with adjustments.
Results
Among 116 164 patients with schizophrenia and 464 656 matched controls, overall incidence of IBD among patients was significantly higher (1.14% vs. 0.25%). Average age of IBD diagnosis was 46.82 among patients with schizophrenia, versus 55.30 among controls. The HR of developing IBD among patients was 3.28, with a 95% confidence interval (95% CI) 2.49–4.33. IBD risk was higher among patients with psychiatric admissions more than once per year (HR 7.99, 95% CI 5.25–12.15) compared to those hospitalised less frequently (HR 2.72, 95% CI 2.03–3.66).
Conclusions
This population‐based cohort study demonstrates a significant association between schizophrenia and subsequent IBD development. Patients with schizophrenia develop IBD at a younger age, and the risk increases with inadequately controlled schizophrenia. Physician vigilance and awareness of this correlation will improve IBD diagnosis and management among this vulnerable patient population.
Patients with schizophrenia are found with higher risk of subsequent inflammatory bowel disease development and earlier onset in a Taiwan nationwide longitudinal study.
ChatGPT is an artificial intelligence model trained for conversations. ChatGPT has been widely applied in general medical education and cardiology, but its application in pharmacy has been lacking. ...This study examined the accuracy of ChatGPT on the Taiwanese Pharmacist Licensing Examination and investigated its potential role in pharmacy education.
ChatGPT was used on the first Taiwanese Pharmacist Licensing Examination in 2023 in Mandarin and English. The questions were entered manually one by one. Graphical questions, chemical formulae, and tables were excluded. Textual questions were scored according to the number of correct answers. Chart question scores were determined by multiplying the number and the correct rate of text questions. This study was conducted from March 5 to March 10, 2023, by using ChatGPT 3.5.
The correct rate of ChatGPT in Chinese and English questions was 54.4% and 56.9% in the first stage, and 53.8% and 67.6% in the second stage. On the Chinese test, only pharmacology and pharmacochemistry sections received passing scores. The English test scores were higher than the Chinese test scores across all subjects and were significantly higher in dispensing pharmacy and clinical pharmacy as well as therapeutics.
ChatGPT 3.5 failed the Taiwanese Pharmacist Licensing Examination. Although it is not able to pass the examination, it can be improved quickly through deep learning. It reminds us that we should not only use multiple-choice questions to assess a pharmacist's ability, but also use more variety of evaluations in the future. Pharmacy education should be changed in line with the examination, and students must be able to use AI technology for self-learning. More importantly, we need to help students develop humanistic qualities and strengthen their ability to interact with patients, so that they can become warm-hearted healthcare professionals.
Background
An association between alopecia areata (AA) and atopic dermatitis (AD) has been reported in previous studies. However, the temporality of this relationship remains unclear based on prior ...cross‐sectional and case‐control studies.
Objective
This study aimed to investigate the bidirectional association between AA and AD.
Methods
Participants were recruited from the National Health Insurance Research Database of Taiwan. In analysis 1, we included 12 022 AA patients and 48 088 matched controls to assess the association between AA and AD risks. In analysis 2, 40 307 AD patients and 161 228 matched controls were included to assess the association between AD and AA risks. A Cox regression model was used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).
Results
Compared with controls, AA patients had a significantly increased risk of developing AD (aHR: 5.47; 95% CI: 4.76‐6.28) after adjustment for potential confounders. Likewise, AD patients had a significantly increased risk of developing AA (aHR: 6.00; 95% CI: 5.04‐7.14).
Conclusions
Our study demonstrated a bidirectional association between AA and AD, suggesting that these two diseases may share common pathogenic mechanisms. This finding has implications for follow‐up and screening of AA patients for AD and vice versa.
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