Bidirectional associations between hyperopia, myopia, astigmatism, and strabismus, and attention-deficit/hyperactivity disorder in children: a national population-based cohort study

Objectives: The present study analyzed the reciprocal relationships between four common pediatric ophthalmic diseases (i.e., hyperopia, myopia, astigmatism, and strabismus) and attention‐deficit/hyperactivity disorder (ADHD) in children. Methods: This study enrolled 86,028 children with ADHD and 1,798,673 children without ADHD in the Taiwan Maternal and Child Health Database who were born at any time from 2004 to 2017. Cox proportional hazards regression models were used to estimate the bidirectional relationships of the four ophthalmic diseases with ADHD in children after adjusting for age, sex, and gestational age at birth. Survival curves for time-to-event variables were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the curves. Results: The results indicated that ADHD significantly predicted the occurrence of hyperopia, myopia, astigmatism, and strabismus. Furthermore, hyperopia, myopia, astigmatism, and strabismus significantly predicted the occurrence of ADHD. The time between enrollment and ADHD diagnosis was shorter for patients with ophthalmic diseases than for the control group, and the time between enrollment and ophthalmic disease diagnosis was also shorter for ADHD patients than for the control group. Sex differences were found in the associations between ADHD and ophthalmic diseases. Conclusion: Clinicians should monitor children with ADHD for hyperopia, myopia, astigmatism, and strabismus to ensure appropriate treatment, and vice versa.

Bidirectional associations between hyperopia, myopia, astigmatism, and strabismus, and attention-deficit/hyperactivity disorder in children: a national population-based cohort study.

OBJECTIVES: The present study analyzed the reciprocal relationships between four common pediatric ophthalmic diseases (i.e., hyperopia, myopia, astigmatism, and strabismus) and attention-deficit/hyperactivity disorder (ADHD) in children. METHODS: This study enrolled 86,028 children with ADHD and 1,798,673 children without ADHD in the Taiwan Maternal and Child Health Database who were born at any time from 2004 to 2017. Cox proportional hazards regression models were used to estimate the bidirectional relationships of the four ophthalmic diseases with ADHD in children after adjusting for age, sex, and gestational age at birth. Survival curves for time-to-event variables were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the curves. RESULTS: The results indicated that ADHD significantly predicted the occurrence of hyperopia, myopia, astigmatism, and strabismus. Furthermore, hyperopia, myopia, astigmatism, and strabismus significantly predicted the occurrence of ADHD. The time between enrollment and ADHD diagnosis was shorter for patients with ophthalmic diseases than for the control group, and the time between enrollment and ophthalmic disease diagnosis was also shorter for ADHD patients than for the control group. Sex differences were found in the associations between ADHD and ophthalmic diseases. CONCLUSION: Clinicians should monitor children with ADHD for hyperopia, myopia, astigmatism, and strabismus to ensure appropriate treatment, and vice versa.

Effects of heart rate variability biofeedback (HRVBFB) on sleep quality and depression among methamphetamine users.

Methamphetamine is garnering concern due to its increasing use worldwide. Depression and sleep quality are major mental health issues in substance users. Heart rate variability biofeedback (HRVBFB) has shown promising results in terms of reducing depression and increasing sleep quality. The present study aimed to explore the effects of HRVBFB on these two issues in methamphetamine users. Sixty-one methamphetamine users were enrolled and allocated randomly into a treatment as usual (TAU) group and a HRVBFB plus TAU group. The levels of depressive symptoms and sleep quality were assessed at intake, end of the intervention, and end of follow-up. Compared with baseline, the levels of depressive symptoms and poor sleep quality were decreased at the end of the intervention and follow-up in the HRVBFB group. The HRVBFB group exhibited a greater decrease in depressive symptoms and a better improvement in sleep quality than the TAU group. The associations of HRV indices with levels of depressive symptoms and poor sleep quality were different in the two groups. Our results showed that HRVBFB is a promising intervention for reducing depressive symptoms and improving sleep quality in methamphetamine users. The benefits with respect to depressive symptoms and poor sleep quality can extend beyond the end of HRVBFB intervention.

Functional impairment, insight, and comparison between criteria for gaming disorder in the International Classification of Diseases, 11 Edition and internet gaming disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Aim: This study evaluated the consistency between the International Classification of Diseases, 11th Edition (ICD-11) for gaming disorder (ICD-11-GD) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for internet gaming disorder (DSM-5-IGD). Moreover, the functional impairment of participants and their insight of their GD were evaluated. Methods: We recruited 60 participants with GD, 45 participants who engaged in hazardous gaming (HG), and 120 controls based on a diagnostic interview. Their operationalization of functional impairment and stage of change were evaluated by interviews and questionnaires, including the Brief Gaming Negative Consequence Scale (BGNCS). Results: We observed satisfactory consistency (kappa value = 0.80) with a diagnostic accuracy of 91.5% between the ICD-11-GD and DSM-5-IGD criteria. Furthermore, 16 participants with IGD in DSM-5 were determined to have HG based on the ICD-11 criteria. Participants of GD group experienced impaired functioning in their health (96.7%), career (73.3%), social life (61.6%), academic performance (36.7%), and job performance (35%). Moreover, a proportion of them were in the pre-contemplation (25.0%), contemplation (61.7%), preparation (10%), and action stages (3.3%). Conclusion: There is a good consistency between ICD-11-GD and DSM-5-IGD criteria. The ICD-11 criteria have a high threshold for diagnosing GD. HG criteria could compensate for this high threshold and identify individuals with a gaming-related functional impairment who require help. Most of the participants with GD were in the early stage of change. Interventions to promote their insight are essential. The BGNCS can be used to examine the negative consequences of gaming and aid mental health professionals in assessing functional impairment.

Association of Internet gaming disorder with catechol-O-methyltransferase: Role of impulsivity and fun-seeking.

Dopamine functioning is an essential mechanism underlying addictive behaviors. This paper evaluates the association of Internet gaming disorder (IGD) with the catechol-O-methyltransferase (COMT) val158met polymorphism and examines the roles of impulsivity and reinforcement sensitivity in this association. Using diagnostic interviews, this study recruited 69 participants with IGD and 138 participants without. All participants underwent diagnostic interviews for IGD and an evaluation for the COMT val158met polymorphism, impulsivity, and reinforcement sensitivity. Among participants with the Val/Val genotype, the odds ratio (95% confidence interval) for IGD was 2.09 (1.15-3.80). The IGD-Val/Val genotype association was mediated by impulsivity and fun-seeking. The Val/Val genotype is indicative of low frontal functioning and is a predictive factor of IGD, with this effect being confounded by impulsivity and fun-seeking. Interventions targeting impulsivity and fun-seeking might attenuate the risk of IGD, particularly among individuals with the Val/Val genotype. Additional studies are necessary to elucidate the possible role of dopamine functioning.

Effects of harassment on psychological inflexibility/experiential avoidance among Taiwanese emergent adult gay and bisexual men.

BACKGROUND/PURPOSE: Gay and bisexual men are at a higher risk of mental and physical health problems than heterosexual men, reporting higher frequencies of harassment and discrimination in both housing and employment domains. Psychological inflexibility/experiential avoidance (PI/EA) refers to behaviors that are rigidly guided by psychological reactions rather than direct contingencies or personal values; PI/EA referring to a key psychopathology behavior related to greater mental illness. The objective of the study was to examine the association of various types of harassment with PI/EA and the effects of multiple types and site harassment on PI/EA among Taiwanese emergent adult gay and bisexual men. METHODS: A total of 305 gay and bisexual men aged between 20 and 25 years were recruited into this study. The level of PI/EA and types of harassment were evaluated and further analysis the effect of harassment on PI/EA. RESULTS: Findings indicated that various types of harassment exerted significant effects on PI/EA in emergent adult gay and bisexual men; furthermore, the effect was cumulative. The result also revealed that victims of verbal ridicule and relational exclusion, victims of physical aggression and theft of belongings, and victims of cyber harassment had significantly higher PI/EA. CONCLUSION: Harassment experiences appeared to be significantly associated with PI/EA, and the effects could be cumulative. It would be beneficial to construct a friendly world for emergent adult gay and bisexual men. Evaluation and intervention with PI/EA improvement should be considered for emergent adult gay and bisexual men with traditional and cyber harassment experiences.

Roles of Hostility and Depression in the Association between the MAOA Gene Polymorphism and Internet Gaming Disorder.

The metabolism of bioamine in the central nervous system contributes to the development of addiction. We examined the roles of hostility and depression in the association between internet gaming disorder (IGD) and monoamine oxidase-A (MAOA) EcoRV polymorphism (rs1137070). A total of 69 adults with IGD and 138 without IGD were recruited through diagnostic interviewing. We evaluated participants for rs1137070, depression, and hostility. The participants with the TT genotype of rs1137070 had a higher odds ratio of 2.52 (1.37-4.64) for IGD compared with the C carriers. Expressive hostility behavior and hostility cognition mediated the association between rs1137070 and IGD. Indicating lower MAOA activity, the TT genotype predicted IGD and higher expressive hostility behavior and hostility cognition. Expressive hostility behavior and hostility cognition may underline the association between rs1137070 and IGD. Assessment of and intervention for hostility behavior and cognition should be provided to attenuate the risk of IGD, particularly in those with the TT genotype. Further brain imaging or neurobiological studies are required to elucidate the possible mechanism underlying the association between MAOA activity and IGD.

Coping, Resilience, and Perceived Stress in Individuals with Internet Gaming Disorder in Taiwan.

AIM: Gaming escapism is an essential factor for developing internet gaming disorder (IGD). We evaluated coping strategies, resilience, stress, and depression in individuals with IGD. METHODS: We included 69 participants with IGD and 138 controls (69 regular gamers and other non-gamers) in Taiwan. The self-reported coping strategies, coping stress with gaming, resilience, perceived stress, and depression were assessed. RESULTS: Participants with IGD had higher dysfunctional coping, coping stress by gaming, perceived stress, and depression, as well as lower problem-focused coping and resilience. Regression analysis revealed that coping by gaming was associated with dysfunctional coping mechanisms, particularly venting and self-distraction. Compared with participants with adequate resilience, those with lower resilience had higher perceived stress, depression, and coping by gaming, and lower problem-focused and emotion-focused coping. Dysfunctional coping and coping by gaming were associated with perceived stress and depression in both IGD and control groups. Problem-focused coping was negatively associated with perceived stress and depression in controls. CONCLUSION: Individuals with IGD had higher perceived stress and depression, as they were more likely to cope with stress by dysfunctional coping and gaming and less likely to try problem-focused coping, particularly those with lower resilience. Interventions for IGD should promote problem-focused coping, such as active coping and planning strategies, particularly among those with lower resilience.

Risk Perception, Protective Behaviors, and General Anxiety during the Coronavirus Disease 2019 Pandemic among Affiliated Health Care Professionals in Taiwan: Comparisons with Frontline Health Care Professionals and the General Public.

This study aimed to compare risk perception, information sources, adoption of protective behaviors against coronavirus disease 2019 (COVID-19), and levels of general anxiety among affiliated health care professionals, frontline health care professionals, and the general public in Taiwan. We recruited participants via a Facebook advertisement. We determined the risk perception, information sources, adoption of protective behaviors against COVID-19, and levels of general anxiety among 1954 respondents. In total, 269 affiliated healthcare workers, 371 frontline healthcare workers, and 1314 members of the general public were recruited into this study. The results indicated that both affiliated and frontline health care professionals had a higher level of risk perception of COVID-19, and more adopted protective behaviors against COVID-19 than the general public. No significant differences in risk perception or the adoption of protective behaviors were identified between affiliated, and frontline, health care professionals. Affiliated health care professionals had a lower level of general anxiety than the general public, whereas frontline health care professionals exhibited no significant difference in level of general anxiety compared with the general public or affiliated health care professionals. As important members of COVID-19 treatment teams, the need for psychological and educational support in affiliated health care professionals should receive attention.

Voluntary Reduction of Social Interaction during the COVID-19 Pandemic in Taiwan: Related Factors and Association with Perceived Social Support.

This study aimed to determine the proportion of individuals who voluntarily reduced interaction with their family members, friends, and colleagues or classmates to avoid coronavirus disease 2019 (COVID-19) infection and the associations of reduced social interaction with perceived social support during the COVID-19 pandemic in Taiwan. Moreover, the related factors of voluntary reduction of social interaction were examined. We recruited participants via a Facebook advertisement. We determined the reduced social interaction, perceived social support, cognitive and affective constructs of health belief and demographic characteristics among 1954 respondents (1305 women and 649 men; mean age: 37.9 years with standard deviation 10.8 years). In total, 38.1% of respondents voluntarily reduced their social interaction with friends to avoid COVID-19 infection, 36.1% voluntarily reduced their interaction with colleagues or classmates, and 11.1% voluntarily reduced interaction with family members. Respondents who voluntarily reduced interaction with other people reported lower perceived social support than those who did not voluntarily reduce interaction. Respondents who were older and had a higher level of worry regarding contracting COVID-19 were more likely to voluntarily reduce interaction with family members, friends, and colleagues or classmates to avoid COVID-19 infection than respondents who were younger and had a lower level of worry regarding contracting COVID-19, respectively. The present study revealed that despite strict social distancing measures not being implemented in Taiwan, more than one-third of respondents voluntarily reduced their interaction with friends and colleagues or classmates. The general public should be encouraged to maintain social contacts through appropriately distanced in-person visits and telecommunication.

Association between Generalized Anxiety Disorder and Premenstrual Dysphoric Disorder in a Diagnostic Interviewing Study.

BACKGROUND: Premenstrual dysphoric disorder (PMDD) demonstrates predictable, cyclic, affective and somatic symptoms that are aggravated in the late luteal phase and are resolved by menstruation. Generalized anxiety disorder (GAD) is characterized by excessive and persistant worry. The present study aims to evaluate the association between PMDD and GAD. The fluctuations of behavior inhibition, anxiety, depression, and irritability were also evaluated during the menstrual cycle among women with PMDD and healthy women. Methods: There were 100 women diagnosed with PMDD based on a psychiatric interview and on a prospective evaluation in three menstrual cycles. A total of 96 healthy women were recruited as controls. Each individual's GAD diagnosis, behavior inhibition, behavior activation, depression, anxiety, and irritability were assessed in both luteal and follicular phases. Results: The odds ratio of women with GAD having PMDD was 7.65 (95% CI: 1.69-34.63) in relation to those without it. This association was partially mediated by behavior inhibition and irritability and was completely mediated by depression. Women with PMDD and GAD had higher anxiety during the luteal phase and higher PMDD severity, depression, and irritability than those without GAD in the follicular phase. There is no difference in anxiety, depression, or irritability between the luteal and follicular phases among women with PMDD and GAD. Conclusions: Women with GAD were more likely to have PMDD. Anxiety, depression, and irritability symptoms in women with PMDD and GAD were not relieved in the follicular phase. Thus, GAD should be assessed for women with PMDD. Their anxiety, depression, and irritability should be intervened not only in the luteal phase, but also in the follicular phase. Depression, irritability and behavior inhibition mediated the association between PMDD and GAD. Intervening with these mediators to attenuate GAD and PMDD comorbidity should be researched in the future.

Associations Among Resilience, Stress, Depression, and Internet Gaming Disorder in Young Adults.

Background and Aims: Using gaming to escape emotional difficulty has been suggested to be a candidate mechanism contributing to Internet gaming disorder (IGD). This study evaluated the associations among resilience, perceived stress, depression, and IGD. Methods: A total of 87 participants in an IGD group and 87 participants in a control group were recruited into this study. IGD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. Stress levels, resilience, and depression were measured by a self-reported questionnaire. Results: The IGD group had a lower resilience, higher perceived stress, and depression than the control group. Hierarchical regression analysis demonstrated that resilience was associated with IGD when perceived stress was controlled. After depression was controlled, resilience and perceived stress were not associated with IGD. Among the IGD group, those with low resilience had higher depression. Furthermore, discipline was the resilience characteristic associated with IGD. Conclusions: Low resilience was associated with a higher risk of IGD. IGD individuals with low resilience had higher depression. Depression was more associated with IGD than resilience. Depression assessments and stress coping interventions should be provided for individuals with IGD who exhibit low resilience or high stress.

Thiamine for preventing dementia development among patients with alcohol use disorder: A nationwide population-based cohort study.

OBJECTIVE OF STUDY: Alcohol use disorder is one of the most important factors contributing to dementia. This study examined the protective effect of thiamine administration on the incidence of dementia among patients with alcohol use disorder in Taiwan by evaluating a nationwide database. METHODS: We retrieved data for this retrospective cohort study from the Longitudinal Health Insurance Database 1995-2000. Patients receiving thiamine therapy after the diagnosis of alcohol use disorder were recruited as the thiamine therapy (TT) group, and the comparison group without TT (NTT group) included randomly assigned and age-, sex-, and index year-matched individuals with alcohol use disorder. Demographic data, comorbid medical disorders, and psychotropic medication use were evaluated and controlled. The cumulative defined daily dose (DDD) was analyzed to demonstrate the dose effect. RESULTS: Each group had 5059 patients. The TT group had a lower crude hazard ratio (0.76; 95% confidence interval: 0.60-0.96) of dementia than the NTT group. After adjusting for demographic data, comorbidity, and psychotropic medication use, the adjusted hazard ratio was 0.54 (95% confidence interval: 0.43-0.69). The significance existed among TT subjects with cumulative DDD higher than 23. The Kaplan-Meier analysis demonstrated a lower cumulative incidence of dementia in the TT group than in the NTT group. CONCLUSION: The results indicated that thiamine therapy could be a protective factor for dementia development in patients with alcohol use disorder. Thiamine therapy should be a crucial part of the treatment plan and health policies to prevent dementia development or progression among patients with alcohol use disorder.

Predicting Effects of Psychological Inflexibility/Experiential Avoidance and Stress Coping Strategies for Internet Addiction, Significant Depression, and Suicidality in College Students: A Prospective Study.

The aims of this study were to evaluate the predicting effects of psychological inflexibility/experiential avoidance (PI/EA) and stress coping strategies for Internet addiction, significant depression and suicidality among college students during the follow-up period of one year. A total of 500 college students participated in this study. The level of PI/EA and stress coping strategies were evaluated initially. One year later, 324 participants were invited to complete the Chen Internet Addiction Scale, Beck Depression Inventory-II and the questionnaire for suicidality to evaluate depression symptoms and internet addiction and suicidality. The predicting effects of PI/EA and stress coping strategies were examined by using logistic regression analysis controlling for the effects of gender and age. The results indicated that PI/EA at the initial assessment increased the risk of Internet addiction (OR = 1.087, 95% CI: 1.042–1.135), significant depression (OR = 1.125, 95% CI: 1.081–1.170), and suicidality (OR = 1.099, 95% CI: 1.053–1.147) at the follow-up assessment. Less effective coping at the initial assessment also increased the risk of Internet addiction (OR = 1.074, 95% CI: 1.011–1.140), significant depression (OR = 1.091, 95% CI: 1.037–1.147), and suicidality (OR = 1.074, 95% CI: 1.014–1.138) at the follow-up assessment. Problem focused and emotion-focus coping at the initial assessment was not significantly associated with the risks of Internet addiction, significant depression, and suicidality at the follow-up assessment. College students who have high PI/EA or are accustomed to using less effective stress coping strategies should be the target of prevention programs for IA (internet addiction), depression, and suicidality.

Relationship between psychological inflexibility and experiential avoidance and internet addiction: Mediating effects of mental health problems.

Internet addiction became a major mental health problem in college student. Our objective was to examine the relationship between psychological inflexibility and experiential avoidance (PIEA) and Internet addiction (IA) and the mediating effects of mental health problem indicators. 500 college students (238 men and 262 women) participated in this study. The level of PIEA was examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The levels of depression, anxiety, interpersonal sensitivity, and hostility were evaluated using the Symptom Checklist-90 item-Revised Scale. The relationship among PIEA, mental health problems, and IA was examined using structural equation modeling. The severity of PIEA was positively associated with the severity of IA as well as positively associated with the severity of mental health problems. In addition, the severity of mental health problem indicators was positively associated with the severity of IA. These results provide the severity of PIEA is directly related to the severity of IA and indirectly related to the severity of IA through increasing the severity of mental health problems. The PIEA should be one of the target objectives when administer cognitive-behavioral therapy to college students with IA and mental health problems.

Association of stress coping strategies with Internet addiction in college students: The moderating effect of depression.

BACKGROUND: This study examined the association between stress-related coping strategies and Internet addiction and the moderating effect of depression in a sample of Taiwanese college students. METHOD: A total of 500 college students (238 men and 262 women) participated in this study. Internet addiction was assessed using the Chen Internet Addiction Scale. Participants' stress coping strategies and depressive symptoms were measured using the Coping Orientation to Problems Experienced and the Beck Depression Inventory-II, respectively. We used t and chi-square tests to examine differences in demographic characteristics, depression, and stress coping strategies between participants with and without Internet addiction. Significant variables were used in a logistic regression model to examine the association between stress coping strategies and Internet addiction and the moderating effect of depression on the association. RESULTS: Results indicated that use of restraint coping was negatively associated with Internet addiction (odds ratio [OR]=0.886, 95% confidence interval [CI]: 0.802-0.977), whereas denial (OR=1.177, 95% CI: 1.029-1.346) and mental disengagement (OR=2.673, 95% CI: 1.499-4.767) were positively associated with Internet addiction. Depression had a moderating effect on the association between denial and Internet addiction (OR=0.701, 95% CI: 0.530-0.927). CONCLUSIONS: Stress coping strategies and depression are important factors to evaluate when developing intervention programs targeting college undergraduate students with Internet addiction.

Newly diagnosed erectile dysfunction and risk of depression: a population-based 5-year follow-up study in Taiwan.

INTRODUCTION: Depression might increase the risk of erectile dysfunction (ED), and ED might further exacerbate depression. The causal relationship between these two diseases remains controversial. In addition, limited evidence is available regarding the age-dependent and time-dependent effects on the association of depression and ED. AIM: We investigated the hypothesis that ED increases the risk of depression by using a nationwide Taiwanese population-based claims database. In addition, we assessed the age-dependent and time-dependent effects on the association of depression and ED. METHODS: A longitudinal cohort study was conducted to determine the association between patients with ED and depression development during a 5-year follow-up period, using claims data from the Taiwanese National Health Insurance Research Database. MAIN OUTCOME MEASURES: The study cohort comprised patients who were diagnosed with ED during 1997 to 2005 (N = 2,527). For a comparison cohort, 5 age- and sex-matched patients for every patient in the study cohort were selected using random sampling (N = 12,635). All of the patients were followed-up for 5 years from the date of cohort entry to identify the development of depression. RESULTS: The main finding of this study was that patients with ED are at an increased risk of developing depression. The adjusted hazard ratio (AHR) for depression was 2.24-fold higher in the patients with ED than in the comparison cohort (95% confidence interval [CI]: 1.83-2.74; P < 0.001). Regarding the time-dependent effect, the incidence of depression was highest during the first year of follow-up (AHR: 3.03, 95% CI = 2.08-4.40; P < 0.001). CONCLUSIONS: This study demonstrates that patients with ED are at a higher longitudinal risk of developing depression in Asian men, particularly within the first year after the diagnosis of ED.

Osteoporosis and the risk of symptomatic nephrolithiasis: a population-based 5-year follow-up study in Taiwan.

This study estimates the risk of symptomatic nephrolithiasis within 5 years of newly diagnosed osteoporosis in a Taiwan population. This cohort study consisted of patients with a diagnosis of osteoporosis between Jan. 2003 and Dec. 2005 (N = 1634). Four age- and gender- matched patients for every patient in the study cohort were selected using random sampling as the comparison cohort (N = 6536). All patients were tracked for 5 years from the date of cohort entry to identify whether they developed symptomatic nephrolithiasis. Cox proportional hazard regressions were performed to evaluate the 5-year nephrolithiasis-free survival rates. During the 5-year follow-up period, 60 osteoporosis patients (3.7%) and 165 non- osteoporosis patients (2.5%) developed symptomatic nephrolithiasis. The adjusted HR of symptomatic nephrolithiasis was 1.38 times greater risk for patients with osteoporosis than for the comparison cohort (95% confidence interval (CI) 1.03-1.86; P < .05). Osteoporosis is very likely to be an independent risk factor for subsequent diagnosis of symptomatic nephrolithiasis.

Increased risk of benign prostate hyperplasia in sleep apnea patients: a nationwide population-based study.

BACKGROUND: Sleep apnea (SA) is a common sleep disorder characterized by chronic intermittent hypoxia (IH). Chronic IH induces systemic inflammatory processes, which can cause tissue damage and contribute to prostatic enlargement. The purpose of this study was to evaluate the association between benign prostate hyperplasia (BPH) and SA in a Taiwanese population. METHODS: The study population was identified from Taiwan's National Health Insurance Research Database (NHIRD) and contained 202 SA patients and 1010 control patients. The study cohort consisted of men aged ≥ 30 years who were newly diagnosed with SA between January 1997 and December 2005. Each patient was monitored for 5 years from the index date for the development of BPH. A Cox regression analysis was used to calculate the hazard ratios (HRs) for BPH in the SA and control patients. RESULTS: During the 5-year follow-up, 18 SA patients (8.9%) and 32 non-SA control patients (3.2%) developed BPH. The adjusted HR for BPH was 2.35-fold higher in the patients with SA than in the control patients (95% confidence interval (CI) 1.28-4.29, P<.01). We further divided the SA patients into 4 age groups. After adjusting for potential confounding factors, the highest adjusted HR for BPH in the SA patients compared with the control patients was 5.59 (95% CI = 2.19-14.31, P<.001) in the patients aged between 51 and 65 years. CONCLUSION: Our study results indicate that patients with SA are associated with increased longitudinal risk of BPH development, and that the effects of SA on BPH development are age-dependent.

Comparison of secondary signs as shown by unenhanced helical computed tomography in patients with uric acid or calcium ureteral stones.

Unenhanced helical computed tomography (UHCT) has evolved into a well-accepted diagnostic method in patients with suspected ureterolithiasis. UHCT not only shows stones within the lumen of the ureter, it also permits evaluation of the secondary signs associated with ureteral obstruction from stones. However, there we could find no data on how secondary signs might differ in relation to different compositions of ureteral stones. In this study, we compared the degree of secondary signs revealed by UHCT in uric acid stone formers and in patients forming calcium stones. We enrolled 117 patients with ureteral stones who underwent UHCT examination and Fourier transform infra-red analysis of stone samples. Clinical data were collected as follows: age, sex, estimated glomerular filtration rate (eGFR), urine pH, and radiological data on secondary signs apparent on UHCT. The uric acid stone formers had significantly lower urine pH and eGFR in comparison to calcium stone formers, and on UHCT they also had a higher percentage of the secondary signs, including rim sign (78.9% vs. 60.2%), hydroureter (94.7% vs. 89.8%), perirenal stranding (84.2% vs. 59.2%) and kidney density difference (73.7% vs. 50.0%). The radiological difference was statistically significant for perirenal stranding (p=0.041). In conclusion, we found that UHCT scanning reveals secondary signs to be more frequent in patients with uric acid ureteral stones than in patients with calcium stones, a tendency that might result from an acidic urine environment.