Effects of Tongue-Strengthening Exercise on Tongue Strength Reserve and Detraining Effects among Healthy Adults: A Randomized Controlled Trial.

INTRODUCTION: Tongue strength reserve is the difference between the maximum isometric pressure (MIP) and swallowing pressure of the tongue. People with decreased tongue strength reserve may have a higher risk of presbyphagia or dysphagia. Thus, this study explored the effects of tongue strengthening exercise (TSE) on tongue strength reserve and detraining effects in healthy adults. MATERIALS AND METHODS: In total, 102 healthy volunteers without any reported history of speech or swallowing deficits were recruited and assigned to experimental (n = 50) and control groups (n = 52). Exercises in the experimental group consisted of compressing an air-filled bulb between the tongue and hard palate for 30 min a day, 5 days a week, for 8 weeks. Thereafter, the experimental group underwent a 4-week detraining period. RESULTS: Following the TSE training, posterior tongue strength reserve (F = 4.92, p = 0.029) of the experimental group was significantly higher than that of the control group. No significant detraining effects were observed on the MIP and swallowing pressure from 4 weeks after the completion of TSE training. CONCLUSIONS: According to the study results, TSE may be an effective approach for improving swallowing function.

[Regaining the Dignity of Eating].

Inserting a nasogastric tube is a common clinical management approach to treating patients with chewing and swallowing impairments and those with choking and aspiration issues. Although guidelines recommend that these tubes should not be indwelled for more than 4-6 weeks, they are in practice sometimes indwelled for periods exceeding 36 months (Wong et al., 2019). Long-term nasogastric tube indwelling may cause clients to gradually lose the ability to chew and swallow, resulting in a decrease in the stimulation received by the brain and an increase in the incidence of dementia (Liu et al., 2019). Japan's long-term care insurance payment regulations, amended in 2021, clearly point out that successfully improving enablement, oral training, nutrition, and cognition in clients results in relatively high payments for long-term care service units (Tamiya et al., 2020). This column advocates for using inter-disciplinary collaboration to "enhance physical fitness, improve nutrition status, take care of the mouth, and then smoothly remove the nasogastric tube" in line with the abovementioned philosophy. When people eat, they initially require the coordination of their lower limb and trunk (core) muscles to support their body weight and maintain posture stability, as the upper limb muscles are critical to sending the food into the mouth. Hence, strengthening physical fitness is of primary importance. Based on the results of the medical staff's assessment, even patients with indwelled nasogastric tubes should continue eating by mouth. Providing high-protein / high-calorie texture-modified foods that meet the chewing and swallowing functional needs of clients is essential to facilitating the repair of cellular tissues. In addition, it is necessary to manage the symptoms of chewing and swallowing impairments to prevent dehydration. Clients with chewing and swallowing impairments are prone to food debris / plaque accumulation in the mouth, resulting in significant levels of bacteria breeding. Moreover, during choking, bacteria is propelled by the cough mechanism into the trachea and may cause aspiration pneumonia. Aspiration pneumonia is often managed using a nasogastric tube. Gastric acid and bacteria may migrate upwards along indwelled nasogastric tubes into the pharynx, resulting in reinfection with aspiration pneumonia. Oral hygiene is thus critical to breaking this vicious cycle. The five topics of this column were derived using the above framework. Clients who are successfully liberated of their nasogastric tubes through inter-disciplinary collaboration regain the ability to eat independently and reduce medical care expenditures, while medical professionals experience the value of their own professional existence as part of an inter-disciplinary team (Bauer et al., 2019; Cochrane et al., 2016; Magne & Vilk, 2020).

[Improve Physical Fitness and Reduce Nasogastric Tube Insertions: Working to Achieve a 'No Tube' Life].

It is common in clinical settings for patients to suffer from dysphagia-related malnutrition and coughing-related aspiration pneumonia because of reduced levels of food intake. Nasogastric tube feeding provides nutrition and water and prevents choking related to oral feeding. Although dysphagia is often treated using medical and surgical treatments, degenerative-disease-related dysphagia is currently widely treated using nutritional support and rehabilitation to enhance muscle strength and coordination and reduce the risk of nasogastric tube placement in the future. Generally, the focus of muscle strength training for dysphagia is on muscle training related to swallowing and breathing. However, the process of eating requires the coordinated operation of the muscles of the lower limbs and the trunk to support the body's physical weight and maintain stable posture. When consuming food, an individual must rely on the activities of the upper limb muscles. Therefore, training the relevant muscles may effectively reduce the eating difficulties caused by muscle strength loss. In this article, empirical literature evidence related to improving frailty is collected and principles and practical suggestions are provided for improving physical fitness programs, including breathing muscle strengthening training, sitting and balance training, upper limb muscle strength training, and lower limb muscle strength training. It is hoped that the findings will be used as a guide in clinical practice.

Effects of a Multifaceted Intervention Program on the Eating Ability of Nursing Home Residents.

Oropharyngeal dysphagia is a common problem for nursing home residents that leads to aspiration pneumonia and malnutrition. Musculature surrounding head and neck and tongue strength are crucial for safe and efficient oropharyngeal swallowing. Oral hygiene facilitates the smooth swallowing. The aim of this study was thus to investigate the effects of a multifaceted intervention program which combines the interactive oral activities, tongue strength training and oral cleaning procedure on the eating ability of nursing home residents. A sequential, multiple time series, single-group quasi-experimental research design was used, and 41 residents were recruited to participate in this study. The study was divided into three phases, each lasting two months. In phase 1, the participants were conducting their usual activities, except that the outcome variables were measured on five occasions to obtain baseline data. Phase 2 was a two-month washout period, and phase 3 was the intervention period. Thirty-six residents completed phase 1, and 34 residents completed the phase 3 intervention period. The eight-week phase 3 intervention program comprised three sessions per day, conducted seven days a week, with each session lasting 15-20 min. Outcome variables were measured at weeks 0, 2, 4, 6, and 8 in phases 1 and 3 to evaluate the feasibility of the program. Following the intervention program, controlling for baseline differences, the patients' tongue strength, food consumption, mealtime duration, oral health, and dysphagia severity were significantly improved in phase 3 relative to phase 1. These improvements lasted through to at least 2 months posttest. The study illustrates that this multifaceted intervention program may be an effective approach for improving the eating ability of nursing home residents.

[Creating Nursing Workplaces That Appropriately Manage Legal Risk].

Nursing professionals constitute the largest occupational group in all healthcare system departments, and are the healthcare professionals who work most closely and frequently with patients. The complexity and variability of the human body make nursing a high-risk occupation. The practice behaviors of nursing professionals must be safe, competent, and ethical, and must comply with relevant laws and regulations. Based on statistics published by the Colorado Nurses Association and the Nurses Service Organization (2020), professional conduct (32.5%), scope of practice (2.8%), and documentation error or omission (9.7%) are the three most-common categories of litigation faced by nurse practitioners. Smart medicine, which has emerged in the past decade, poses potential risks to patient privacy, safety, and professional nursing-care standards and holds the potential to significantly transform or even revolutionize the legal industry (Neary & Chen, 2017). Therefore, legal risk management is of particular importance to the nursing profession. Creating a legal-risk-management program in a workplace may start by focusing on one or more workplace aspects (e.g., individuals, teams, organizations, systems). However, the most crucial element is the frontline implementer. Therefore, the beliefs and attitudes of nursing staff and hospital care attendants toward the legal risks that may arise from the process of patient care are critically related to whether these professionals adhere strictly to the code of practice (Fontaine et al., 2019). This column proposes a safety initiative (SAFE) for the nursing-care workplace through special articles such as "Legal Risk Management in Nursing Practice: The Importance of Duty of Care," "Legal Liability for Negligence: Nurse Aides Working in Hospitals," and "The Legal Risks Faced in Nursing and Smart Healthcare." This initiative entails familiarizing nursing staff and care attendants with the legal risks associated with the patient-care profession (Support); setting high standards for patient care in the workplace that address these risks (Arousing); giving positive feedback to strengthen personal motivation, technical operation, and interpersonal interactions (Feedback); and creating a healthy workplace for practitioners while carrying out complex patient care (Environment). Shakespeare's famous drama The Tempest includes the timeless saying: "what's past is prologue." Analyzing litigation cases provides critical evidence to guide the evolution and improvement of nursing workplaces. Learning from past experience enables nurses and hospital care attendants to help others in a safe and dignified manner that will benefit all people.

Age and Sex-Related Differences in the Tongue Pressure Generated during Maximum Isometric and Swallowing Tasks by Healthy Chinese Adults.

The aims of this prospective observational study were to investigate age, sex, and factors related to the tongue pressure generated. A correlational research design was used. A total of 150 Chinese people who had a normal swallowing condition were enrolled by convenience sampling. Pressure was measured for each participant during maximum isometric press tasks, as well as for saliva and water swallows (5 mL) at the anterior and posterior tongue. The results illustrated that age has an impact on anterior tongue pressure (r = -0.22), posterior tongue pressure (r = -0.26); however, it does not have an impact on the swallowing pressure (SP) of the tongue. Sex differences were noted; males demonstrated a greater strength of the anterior tongue. There was a significant correlation between BMI and the maximum isometric pressure of the anterior tongue (MIPant). The pressures between anterior and posterior tongue were not significantly different in the maximum isometric or swallowing tasks. There were significant differences among the maximum isometric pressure (MIP), saliva swallowing pressure, and water swallowing pressure. The MIP generated was greater than the pressure in the swallowing tasks for the younger groups of both sexes. The study supplement the exploration of age-and-sex related differences and the interaction of sex and age in tongue pressure.

Effect of tongue-to-palate resistance training on tongue strength in healthy adults.

OBJECTIVE: Tongue strength is crucial for safe and efficient oropharyngeal swallowing. This study examined the effect of tongue-to-palate resistance training (TPRT) on anterior and posterior tongue strength by conducting a prospective, randomized, parallel allocation trial. METHODS: Ninety-one healthy adults were recruited in this study and were randomly assigned to an experimental group (n = 44) or a control group (n = 47). The experimental group performed TPRT for 8 weeks (5 days per week), whereas the control group performed the usual daily activities. Tongue strength was measured using the Iowa Oral Performance Instrument (IOPI) before and after the practice program was conducted at weeks 2, 4, 6, and 8, to evaluate the feasibility of the developed training protocol. RESULTS: This experimental group demonstrated more improvements in both anterior tongue strength (p < .05) and posterior tongue strength (p < .05). The positive effects of the intervention on tongue strength appeared at 8 weeks for the anterior region and 2 weeks for the posterior region. CONCLUSIONS: These findings illustrate that TPRT can improve tongue strength. It is suggested that people integrate this exercise protocol into their daily life, positive change in tongue strength may prevent or halt presbyphagia.

Analysis of Labial and Lingual Strength among Healthy Chinese Adults in Taiwan.

This study collected 11 parameters regarding the labial and lingual strength for maximum isometric and swallowing tasks among 150 healthy Chinese adults in Taiwan. Measurements were performed using the Iowa Oral Performance Instrument (IOPI). All of the labial and lingual strength parameters were measured three times. The maximal value of three trials represents the pressure of every parameter. The overall mean (±standard deviation) and maximum isometric pressures of the lips, anterior tongue, and posterior tongue were 24.81 ± 5.64, 55.95 ± 14.13, and 53.23 ± 12.24 kPa, respectively. The mean value of posterior tongue strength was less than that of the anterior tongue by approximately 5%. The percentages of maximum isometric tongue pressure during the swallowing of saliva and water were 85% and 80% for the anterior tongue and 90% and 81% for the posterior tongue, respectively. The average endurances for the anterior tongue and posterior tongue were 13.86 ± 7.08 and 10.06 ± 5.40 s, respectively. The maximum isometric pressures were greater than both the saliva and water swallowing pressures, and the saliva swallowing pressures were greater than the water swallowing pressures. A value of 33 kPa in maximum isometric pressure could serve as a demarcation of weak tongue strength for healthy Chinese adults. As for the repeated trials of labial and lingual strength, there were no statistically significant differences for any of the pressures obtained from the 11 labial and lingual strength parameters. The normative data can be used for the objective assessment of labial and lingual strength in healthy Chinese adults.

[Confronting Presbyphagia and Oropharyngeal Dysphagia].

The ability to swallow efficiently and safely is essential to maintaining nutrition, hydration, health status, and quality of life. The process of swallowing requires coordination among a complex series of psychological, sensory, and motor behaviors that are both voluntary and involuntary (Balou, Herzberg, Kamelhar, & Molfenter, 2019). Presbyphagia refers to the changes associated with natural, healthy aging in the head and neck anatomy and in the physiologic and neural mechanisms that underpin the function of swallowing (Cichero, 2018). This progression of change contributes, in part, to a natural decline in the ability of the body to adapt to physiological stress. Chewing impairment and dysphagia are syndromes that are most-often associated with old age. The World Health Organization included oropharyngeal dysphagia in the International Statistical Classification of Diseases and Related Health Problems (ICD) under subordinate codes 787.2 ICD9 and R13.10 ICD10 (Centers for Disease Control and Prevention, 2015). The reported prevalence of oropharyngeal dysphagia among older adults has varied widely among studies, subjects, and locations (Ortega, Cabré, & Clavé, 2014). For example, the reported prevalence of chewing and swallowing disorders among community-healthy elders ranges between 11%~60% (Di Pede, Mantovani, Del Felice, & Masiero, 2016). Oropharyngeal dysphagia is an important factor that causes malnutrition and aspiration pneumonia in the elderly (Imaizumi et al., 2020). In view of the increasing prevalence of chewing and swallowing difficulties, PEACE has been adopted as the theoretical framework for this column "Perspectives on Chewing and Swallowing Care". The ultimate goal is to enable people to live long and enjoy a satisfactory quality of life (Enjoyment). To achieve this goal, people must have the ability to preserve in good condition the muscle groups and mechanisms related to swallowing (Preservation). However, preservation depends on three strategies: (1) Enhancing the knowledge and care skills related to chewing and swallowing difficulties, such as addressed in the four articles in this column: "Chewing screen and interventions for the elders", "The triangular relationship among swallowing disorder, aspiration pneumonia, and poor oral hygiene", "International classification systems of texture-modified foods", and "Innovative development of texture-softened foods for older adults living in residential care". (2) Holding a positive attitude (Attitude), especially regarding the potential for thoroughly implementing oral hygiene to break the vicious cycle of dysphagia-related aspiration pneumonia. Trust that people have the ability to maintain the strength of chewing and swallowing muscle groups and to resolve the comorbidities associated with sarcopenia and presbyphagia. (3) Practicing consistency in knowledge and action. Chewing and swallowing-related knowledge and care skills and positive attitudes may still be insufficient if knowledge and action are not united. When knowledge and action are united, the body may maintain to a good state of function and patients may enjoy peace through their life journey.

[Innovative Development of Texture-Softened Foods for Older Adults Living in Residential Care].

Oropharyngeal dysphagia, a swallowing disorder, is a common problem faced by older adults living in residential care. A direct management strategy for this disorder is to modify the texture of foods prior to serving using techniques such as chopping, mashing, liquid thickening, and reshaping. However, the process of texture modification causes foods to lose a significant amount of their nutritional value and reduces the motivation and fun of eating for diners. Eating is part of the enjoyment of life, and managing the nutrition status of older adults living in residential care is an important issue in aged societies. In this article, issues related to modified-texture foods, including their generally lower nutritional value, are discussed. In addition, combinations of cooking techniques that may increase tenderness in meat are explored to promote the future development of the soft-food meals for older adults living in residential care. One of the described techniques uses fresh fruits to pickle meat and vacuum low-temperature cooking technology that preserves the shape of meat after cooking and makes meat sufficiently soft to be broken up by the tongue. Vacuum low-temperature cooking allows for the precise control of cooking time and temperature, and professional cooking techniques may be used to improve the quality of the texture-softened foods. It is the hope of the authors that this article is used a reference for the future development of texture-softened foods for older adults living in residential care.

The Impact of Chronic Illness on Patients.

The purpose of this study was to assess the impact of chronic illness on patients in relation to its physical, psychological, and social effects, and its effects on activities of daily living. A structured questionnaire was used to interview I77 patients. Chronic illness had the greatest effect on psychological functioning, followed by physical and social functioning. The least affected aspects of a patient's, functioning were related to performing activities of daily living (ADLs). Results indicated that the diagnosis, duration of disease, and developmental stage of the patient S children were useful in predicting the impact of a chronic illness on a patient's physical functioning. Diagnosis, duration of disease, and economic status had a significant impact on a patient's psychological functioning. Diagnosis, duration of disease, age, sex, occupation, education, and marital and economic status were important factors relative to social functioning. Diagnosis, age, marital status, the developmental stage of the children, and the primary caregiver were the most important factors related to the effects of chronic illness on ADLs. The results of the study serve as a guide for a comprehensive assessment of chronically ill patients.

Evaluation of an Oral Hygiene Education Program for Staff Providing Long-Term Care Services: A Mixed Methods Study.

BACKGROUND: Oral hygiene is often neglected in clients receiving long-term care, suggesting that long-term care workers require formal oral hygiene education. Thus, the aim of this study was to investigate the effects of oral hygiene education on long-term care workers. METHODS: This study utilized a mixed methods design. Eighty long-term care workers were recruited for participation in the oral hygiene education program, which employed three teaching methods: narration with multimedia presentation, demonstration, and teach-back. The effect of the education program on the participants' level of oral hygiene knowledge, attitudes, and skills was measured using a structured questionnaire that was administered both pre- and post-delivery of the education program. Three months later, all participants submitted a self-report of their oral hygiene skills, and six participants completed a telephone interview. Quantitative data were analyzed using paired t-tests, and qualitative data were manually analyzed and coded. RESULTS: Scores of oral hygiene knowledge (p < 0.001), attitudes (p = 0.001), and oral cleaning daily frequency for clients (p < 0.001), were significantly higher three months after undertaking the educational program. CONCLUSIONS: This preliminary study suggests that oral hygiene education may be effective in improving oral hygiene knowledge, attitudes, and skills among long-term care staff.

Effects of an Eating Ability Promotion Program for Community-Dwelling Older Adults.

OBJECTIVE: Taiwan is projected to become a super-aged society in 2026. Taiwan's government introduced an innovative preventive care policy to improve aging-related conditions in 2017. In this study, we examine the effectiveness of an eating ability promotion program (EAPP) on the physical and mental performance of community-dwelling older adults. DESIGN: Single-masked, cluster randomized trial. SETTING: Two community care stations in Taichung, Taiwan. PARTICIPANTS: Volunteers were recruited from these 2 community care stations. The 70 participants were aged ≥60 years, able to walk independently and take care of themselves, and understood Mandarin or Taiwanese. INTERVENTION: The volunteers were randomly assigned to an intervention; 40 participated in EAPP training courses (experimental group) and 30 participated in originally scheduled activities only (control group). EAPP training courses were conducted in the care stations 4 hours per week for 12 weeks (for a total of 48 hours). MEASURES: The physical performance outcomes were oral health, nutritional status, and fragility, assessed using the Oral Health Assessment Tool, the Mini Nutritional Assessment, and the Study of Osteoporotic Fractures fragility index, respectively. Cognitive function was evaluated with the Mini-Cog test. Measurements were performed at baseline, at the end of the 12-week intervention, and 1 month later. RESULTS: Following the EAPP intervention, controlling for baseline differences, the oral health (F = 33.29, P < .001), nutritional status (F = 7.30, P = .009), and scale of fragility (F = 19.05, P < .001) of the participants in the experimental group were significantly better than those reported in the control group. CONCLUSIONS AND IMPLICATIONS: Results of this preliminary study suggest that the EAPP intervention may be an effective approach for improving oral health, nutritional status, and fragility in community-dwelling older adults. This training course, which provides clear and concise information regarding eating ability strategies, should undergo further evaluation and, if demonstrated to be effective and cost-effective in broader trials, may be useful in promoting healthy living.

The Feasibility Study of a Revised Standard Care Procedure on the Capacity of Nasogastric Tube Placement Verification Among Critical Care Nurses.

BACKGROUND: Evidence-based studies propose that the aspirate pH test may be easily and reliably conducted to verify the proper placement of nasogastric tubes (NGTs). Nurses rarely implement this procedure because of the lack of related knowledge. PURPOSE: The purpose of this study was to explore the feasibility of implementing a revised standard care procedure to enhance nurses' ability to verify placement of the NGT. METHODS: his study used a quasi-experimental, longitudinal research design. Nurses from two intensive care units were randomly assigned to the experimental group (n = 35) and the control group (n = 31). A revised standard-of-care procedure to confirm the proper placement of an NGT was incorporated into a slideshow presentation, a printed leaflet, and an audit checklist. The experimental group received continuous education and individual teaching on the revised standard-of-care procedure, whereas the control group did not receive additional education and continued to provide conventional care. The study gathered data using scales designed to address knowledge of and attitudes toward verification of NGT placement and the checklist for auditing the NGT care procedure. Scales were implemented before and after the practice program was conducted, in Months 1, 2, and 3, to evaluate the feasibility of the developed improvement measures. RESULTS: This study found significant improvements in the experimental group in terms of knowledge regarding NGT placement verification and the NGT care auditing procedure. The positive improvement of the intervention on the NGT care auditing procedure remained for at least 3 months after the end of the intervention. CONCLUSIONS: The findings suggest that using an aspirate pH test is a feasible approach to verify NGT placement in critical care units, a crucial aspect of care necessary to promote patient safety and quality of care.

[Oral Care for Clients in Long-Term Care].

Oral health impacts the physical and psychological comfort and the quality of life of clients in long-term care. The programs to prevent or delay disability care advocated under Taiwan's Long-Term Care Plan 2.0 address oral health care, highlighting the importance of oral health care for clients in long-term care. This article discusses three concepts of oral health care for clients who are in long-term care. These include: the relationship between oral conditions and general health, oral care and dysphagia, and oral health and hydration. In addition, oral health care strategies for long-term care facilities are discussed. It is hoped that this article will encourage long-term care practitioners to pay close attention to the issue of oral health and to implement appropriate oral health care for their long-term-care clients.

[Nursing Care of Older People With Clostridium Difficile Infection].

The global incidence of Clostridium difficile infection (CDI) has increased in recent decades. The etiology of CDI includes aging as well as the misuse of antibiotics. This highly infectious disease requires that healthcare workers be vigilant and take isolation precautions, particularly in long-term facilities. CDI contributes to the development of severe diarrhea, which may cause imbalance of electrolytes, malabsorption of nutrients, physical disabilities, and psychosocial impacts in older patients. This article explores the pathophysiology, impacts, treatments (e.g., fecal microbiota transplantation [FMT]), and daily care regimens related to CDI with the goal of helping healthcare workers understand this disease and take action during the early stages of CDI.

Feeding experiences of nursing aides for residents with dysphagia.

Dysphagia is a distressing symptom for residents in long-term care facilities, and nursing aides play an important role in feeding the residents with dysphagia. This study evaluated the perceptions of nursing aides about their feeding experiences for residents with dysphagia. This qualitative descriptive study used convenience sampling and recruited 16 nursing aides from six long-term care facilities in Central Taiwan. Data were collected through face-to-face interviews from November 2016 to March 2017. Participants were recruited until the findings reached saturation, and data were analyzed using qualitative content analysis. Analysis of participants' interview data on feeding experiences identified three main categories: recognizing dysphagia, making adjustments to adapt to the residents' dysphagia, and facing the dilemma of dysphagia management. The results may be useful in designing feeding training programs for nursing aides.

[Effects of an Oral Care Program on the Swallowing Function in Post-Operative Patients With Oral Cancer].

BACKGROUND: Oral cancer is the fourth leading cause of death among men in Taiwan. Dysphagia, choking, and aspiration pneumonia are often noted in post-operative patients with oral cancer. Improving patients' swallowing function is an urgent problem that cannot be neglected. PURPOSE: To investigate the effects of an oral care program on the swallowing function of post-operative patients with oral cancer. METHODS: A quasi-experimental research design was conducted and post-operative patients with oral cancer were recruited. The experimental group (n = 20) received 12 weeks of the oral care program intervention, while the control group (n = 20) received standard post-operative care. The modified barium swallow (MBS) study and self-rated degree of dysphagia were compared between the two groups after the intervention period. RESULTS: Post-intervention scores on the MBS test and for the self-rated degree of dysphagia were significantly better in the experimental group than in the control group (p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Performing the oral care program was found to improve the swallowing function of post-operative patients with oral cancer. The results of the present study provide a reference for healthcare providers to improve quality of care.

Comorbidity profiles among women with postcoital bleeding: a nationwide health insurance database.

PURPOSE: Most of the existing studies on postcoital bleeding (PCB) in Western countries. To date, no study has focused on the various PCB-related comorbidities in Taiwan women. This work aims to analyze and compare the presence or absence of PCB among Taiwanese women with gynecological comorbidity. METHODS: This study is a population-based retrospective cohort investigation. Outpatients with PCB after the index date were considered. A total of 2377 female patients with PCB (ICD-9 626.7) were identified using a nationwide outpatient sample from 2001 to 2010. For comparison, 7131 cases were randomly matched with the study group in terms of gender and age. RESULTS: The PCB incidence rate was 39-59 cases/100,000 Taiwanese women, with mean age (±SD) of 36.74 ± 10.79 years, median age of 36 years, and mode age of 29 years. Women with PCB exhibited 1.47-fold risk of cervical dysplasia and 1.59-fold risk for malignant neoplasm of cervix. Young women with PCB showed high risk of cervical cancer. The most common benign diseases among PCB- related comorbidities were cervical erosion and ectropion (20.66%), followed by vaginitis and vulvovaginitis (19.18%). Comparison between PCB and non-PCB groups indicated several significant high-risk comorbidities including cervical polyps, cervical erosion, leukoplakia of cervix, intrauterine contraceptive device, cervicitis, vaginitis, menopause, dyspareunia, and vulvodynia. CONCLUSIONS: This study provides evidence that PCB-related comorbidities manifested benign diseases (51.58%), lower genital tract infection (46.11%), and cervical cancer (2.31%). Thus, healthcare providers must ensure that appropriate routine screening tests and counseling are given to women with PCB.