HPV is important in a subset of HNSCC. Our meta-analysis determined the clinical characteristics of HPV-related HNSCC.

Background and Purpose—: The studies assessing the impact of insomnia on stroke are still lacking. We aim to investigate insomnia in relation to subsequent stroke during the 4-year follow-up. Methods—: Data from the Taiwan National Health Insurance Research Database were used. Enrollees with International Classification of Diseases, Ninth Revision , Clinical Modification diagnosis code for insomnia were compared with randomly selected, age- and sex-matched noninsomnia enrollees with subsequent hospitalization for stroke during the 4-year follow-up. All enrollees, insomniacs and noninsomniacs, did not have previous diagnosis of stroke, sleep apnea, and insomnia. Individuals with insomnia were further categorized into different subgroups based on their insomnia patterns to explore whether the risk of stroke varies by subtype. The risk of outcomes was assessed with Kaplan–Meier curves and the impact of insomnia was estimated using Poisson regression analysis and Cox proportional hazards models. Results—: The study included 21 438 (mean age, 52±16 years) insomniacs and 64 314 matched noninsomniacs (mean age, 51±16 years). Compared with noninsomniacs, insomniacs had 54% higher risk of developing stroke (adjusted hazard ratio, 1.54; 95% confidence interval, 1.38–1.72). When breaking down into insomnia subgroups, the persistent insomniacs had a higher 3-year cumulative incidence rate of stroke than those in the remission group ( P =0.024). The insomniacs-to-noninsomniacs incidence rate ratio for stroke was highest among those aged 18 to 34 years (incidence rate ratio, 8.06). Conclusions—: Insomnia predisposes individuals to increased risk of stroke and this association is profound among young adults. Our results underscore the clinical importance of identifying and treating insomnia. A novel behavioral intervention targeting insomnia that may prevent stroke should be explored.

Traumatic spinal cord injury (tSCI) may involve new-onset anxiety and depression post-discharge. However, long-term population-based studies have lacked access to follow-up conditions in terms of new-onset anxiety and depression. The objective of this study was to estimate the long-term risk of new-onset anxiety and depression post-discharge. The Longitudinal Health Insurance Database 2000 (LHID2000) from Taiwan’s National Health Insurance Research Database was used in this study. Individuals with tSCI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes of 806 and 952 from 1999–2008. The comparison cohort (other health conditions group) was randomly selected from the LHID2000 and was 1:1 matched by age, sex, index year, and comorbidities to reduce the selection bias. All study participants were retrospectively followed for a maximum of 3 years until the end of follow-up, death, or new-onset anxiety (ICD-9-CM: 309.2–309.4) or depression (ICD-9-CM: 296.2, 296.5, 296.82, 300.4, 309.0–309.1, and 311). Persons who were issued a catastrophic illness card for tSCI were categorized as having a severe level of SCI (Injury Severity Score [ISS] ≥16). Poisson regression was used to estimate the incidence rate ratios of anxiety or depression between patients with tSCI and other health conditions. The relative risk of anxiety or depression was estimated using a Cox regression analysis, which was adjusted for potential confounding factors. Univariate analyses showed that the tSCI patients (n = 3556) had a 1.33 times greater incidence of new-onset anxiety or depression (95% confidence interval [CI]: 1.12–1.57) compared to the other health conditions group (n = 3556). After adjusting for potential risk factors, the tSCI patients had a significant 1.29-fold increased risk of anxiety or depression compared to the group with other health conditions (95% CI: 1.09–1.53). Individuals with tSCI, including patients who were under the age of 35, patients who were males, patients who had a low income, and patients without a Charlson Comorbidity Index score, all had a higher long-term risk of anxiety or depression than the other health conditions group (IRRs: 1.84, 1.63, 1.29, and 1.39, respectively). For all tSCI patients, those with an Injury Severity Score (ISS) ≥16 had an almost 2-fold higher risk of anxiety or depression (adjusted Hazard Ratio: 1.85; 95% CI: 1.17–2.92) compared to those with ISS <16. Our findings indicated that tSCI patients have a high risk of anxiety or depression post-discharge, especially among the younger tSCI patients (age <50 years), compared with the other health conditions group. This information could help physicians understand the long-term risk of new-onset anxiety or depression in tSCI patients post-discharge.

OBJECTIVES: To compare the prognostic performance between different comorbidity assessments of survival in patients with operated lung cancer. METHODS: A total of 4508 lung cancer patients treated by surgery between 2003 and 2012 were identified through Taiwan’s National Health Insurance Research Database. Information on pre-existing comorbidities prior to the cancer diagnosis was obtained and adapted to the Charlson comorbidity index, age-adjusted Charlson comorbidity index (ACCI) and Elixhauser comorbidity index scores. The influence on survival was analysed using a Cox proportional hazard model. The discriminatory ability of the comorbidity indices were evaluated using Akaike information criterion and Harrell’s C-statistic. RESULTS: The mean age of the study cohort was 64.95 ± 11.15 years, and 56.28% of the patients were male. The median follow-up time was 2.59 years, and the 3-year overall survival was 73.94%. Among these patients, 2134 (47.3%) patients received adjuvant therapy. The Charlson comorbidity index and ACCI scores correlate well with survival and higher scores were associated with an increased 3-year mortality risk (hazard ratio = 1.21, 95% confidence interval = 1.03–1.42 and hazard ratio = 1.43, 95% confidence interval = 1.08–1.90, respectively) in multivariate analysis. The ACCI scores provided better discriminatory ability with a smaller Akaike information criterion and greater Harrell’s C-statistic for 3-year overall survival compared with the Charlson comorbidity index or Elixhauser comorbidity index scores. CONCLUSIONS: The operated lung cancer patients with severe comorbidities were associated with worse survival. The ACCI appears to be a more appropriate prognostic indicator and should be considered for use in clinical practice.

The high level of occupational stress and burnout among nurses can lead to insomnia, anxiety, and depression. However, the actual risks for healthcare-seeking for these stress-related mental health problems among nurses are still unclear. The aim of this study was to explore the risks and influencing factors of treated anxiety, depression, and insomnia among nurses. We used claims data obtained from the 2010 National Health Insurance Research Database (NHIRD) in Taiwan. Hospital nurses who had at least 3 coded ambulatory care claims or 1 inpatient claim with a principal diagnosis of anxiety, depression, or insomnia were identified. A cohort of 46,120 nurses and 92,240 matched controls were included. All the study subjects were followed up until the onset of any of the aforementioned outcomes, death, or the end of 2012. Results showed that the adjusted hazard ratios (HRs) for treated anxiety, depression, and insomnia among all the nurses were 0.91 (95% CI, 0.88–0.95), 0.59 (95% CI, 0.55–0.63), and 1.43 (95% CI, 1.38–1.48), respectively. Furthermore, the risks of these psychiatric problems in healthcare-seeking nurses were affected by age, gender, hospital level, and job tenure. Our findings suggest that hospital nurses have lower hazards of treated anxiety and depression than the general population, although they have a higher hazard of treated insomnia. There may be undertreatment in some subgroups of nurses with different demographic and working characteristics.