Chun-An Cheng

Background: Fabry disease (FD) is a lysosomal storage disorder leading to α-galactosidase A deficiency and glycosphingolipid accumulation. Neurological manifestations of FD, such as central nervous system involvement, peripheral neuropathy, and vestibular dysfunction that results in postural and cognitive impairment, may predispose individuals to injuries. However, the associations between the risk of injury and FD remains underexplored.

Background and Objectives: The epidemiological characteristics of Candida species have changed worldwide, with an increasing number of reports on co-infections with non-albicans Candida species (NACs) and multidrug-resistant bacteria. A longer length of hospital stay, more severely ill patients, and empirical antimicrobial use in intensive care units (ICUs) increased the prevalence of Candida healthcare-associated infections (HAIs). If the diagnosis or treatment of invasive candidiasis is delayed, the morbidity and mortality of patients will significantly increase. Materials and Methods: We conducted a nationwide surveillance study to analyze data on HAIs in the ICUs of medical centers and regional hospitals between 2018 and 2023. We assessed the temporal trends of Candida species (including Candida albicans and NACs) across all HAIs, bloodstream infections (BSIs), and urinary tract infections (UTIs), and simultaneously assessed the corresponding trends of Enterococcus faecium (Efm). A linear trend for the proportions of microorganisms from 2018 to 2023 was noted according to the Mantel–Haenszel chi-square test. Spearman’s rank correlation coefficients were used to analyze the correlations between pathogen proportions, systemic antimicrobial agent consumption, and length of ICU stay. Results: The overall proportion of all Candida species in HAIs in the ICUs increased significantly from 15.13% to 16.74% (p < 0.001); this increase was driven mainly by NACs (increasing from 6.84% to 7.91%, p < 0.001) from 2018 to 2023. The proportion of Efm increased significantly, from 7.7% to 11.11% (p < 0.001). The proportions of all Candida species significantly increased in UTIs (from 24.63% to 28.13%, p < 0.001), especially NACs, while the proportion of Efm also increased significantly in UTIs (from 9.47% to 15.32%, p < 0.001). With respect to the UTIs, the proportion of all the Candida species, C.albicans, and NACs were positively correlated with the amount of systemic antibiotics used. A longer hospital stay was strongly correlated with all Candida HAIs and UTIs, especially NACs. Significantly ecological associations between all the Candida strains and Efm were observed for UTIs. Conclusions: This study revealed that a persistent expansion of NAC infections was associated with increased Efm infections and rising antibiotic consumption. The changes in the proportions of different Candida species in UTIs were most pronounced. These findings support an ecological model in which antibiotic stress and chronic critical illness contribute to the expansion of fungal–bacterial co-infections in the ICU setting and underscore the need for integrated antibiotic management and multi-infection surveillance.

Background: Patients with benign prostatic hyperplasia (BPH) have an increased risk of developing cardiovascular disease. Taking alpha-1 blockers is associated with an increased risk of major adverse cardiovascular events. Patients suffering from ischemic stroke (IS) may develop baroreflex and parasympathetic dysfunction-induced cerebral autoregulation impairment. The relationship between pharmacotherapy for BPH and the risk of recurrent IS remains unclear. The purpose of this study was to determine whether medications for BPH increase the risk of recurrent IS. Methods: This is a retrospective cohort study. Data from patients diagnosed with IS between 2000 and 2015 was collected from Taiwan National Health Insurance Database. Newly diagnosed IS patients were identified (International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM): 433–437). BPH patients with an ICD-9-CM of 600 were identified. The event observed was recurrent IS after the firstever IS. The factors associated with recurrent IS were assessed via Cox proportional hazards regression. Results: Recurrent IS was associated with BPH with an adjusted hazard ratio (HR) of 1.505 and a 95% confidence interval (CI) of 1.112–1.829, p < 0.001), and a competing risk model showed an adjusted HR of 1.544 (95% CI: 1.128–1.896, p < 0.001). The adjusted HR for treatment with alpha-1 blockers was 1.581 (95% CI: 1.16–1.915, p < 0.001), and increased risk with adjusted HR for treatment with high doses of 5-alpha reductase inhibitors over a long period of time are also at risk of recurrent IS. Conclusions: These findings highlight the association between BPH incidence and the risk of recurrent IS. The pharmacotherapy for BPH in IS patients should take great care.

Background and Objectives: Changes in the incidence of healthcare-associated infections (HAIs) during the coronavirus disease 2019 (COVID-19) pandemic and during periods with fewer or more COVID-19 cases have been inconclusively studied. Compared with 2015, in 2019, the abundances of the microorganisms Klebsiella pneumoniae and Enterococcus faecium increased in intensive care units (ICUs) in Taiwan. The trend in the incidence of HAIs in ICUs in Taiwan during the emergence of new infectious diseases is worth studying. Materials and Methods: We surveyed the incidence densities of different types of HAIs, device-associated HAIs, pathogens, and antimicrobial resistance in a dataset from the Taiwan Healthcare-associated Infection and Antimicrobial Resistance Surveillance System from 2015 to 2022. The change in incidence density trends was evaluated via Poisson regression, and the change in proportion trends was checked via the Mantel–Haenszel chi-square test. Results: The incidence of HAIs decreased from 5.7 to 5.17 episodes per 1000 person-days from the pre-COVID-19 period to the post-COVID-19 period. The incidences of healthcare-acquired pneumonia (HAP), device-associated HAIs decreased. However, the incidences of bloodstream infections (BSIs) increased. The percentages of patients with Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii infections significantly decreased. The percentage of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection decreased, but that of patients with carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus faecium infections increased. The antimicrobial consumption related to CRKP increased and MRSA decreased. Conclusions: Overall, HAIs, HAP, and VAP decreased in incidence after the COVID-19 pandemic. These results revealed decreases in MRSA infection incidence under infection control protocols with more antimicrobial use. However, the proportion of CRKP among HAIs increased with broad-spectrum antimicrobial agent use. Based on the recent incidence of HAIs in ICUs, the quality of infection control in medical units can be enhanced to decrease HAI incidence.

(1) Background: Human exposure to air pollution may induce inflammation and oxidative stress. In addition, extreme air temperatures and relative humidity cause vasoconstriction and abnormal blood cell function. These harmful effects may increase cardiovascular disease mortality. The effects of air pollution and climatic factors on mortality in patients with acute myocardial infarction (AMI) are relatively unknown. (2) Methods: We used AMI mortality data collected from Taiwan’s Medical Quality Indicator. Air pollutant data were collected from the Taiwanese Environmental Protection Administration, and air temperature and relative humidity data were obtained from the Taiwanese Central Weather Administration. The effects were estimated using Poisson regression to analyze the relative risk (RR) of mortality from AMI associated with exposure to air pollutants and climatic factors. (3) Results: The RR for every 4.7 μg/m³ increase in particulate matter with a diameter less than 2.5 μm (PM_2.5) was 1.086 (95% CI: 1.033–1.142, p = 0.001). The RR for every 10.3 ppb increase in ozone concentration was 1.095 (95% CI: 1.011–1.185, p = 0.025). The RR for every 6.5 °C decrease in air temperature was 1.087 (95% CI: 1.024–1.154, p = 0.006) for AMI mortality. (4) Conclusions: This study revealed that higher PM_2.5 and ozone concentrations, along with cold weather, are associated with mortality in individuals with AMI. The government must develop policies to promote air pollution prevention, mitigate air pollution, and alert residents about poor air quality and cold weather, thereby promoting sustainable human health.

Background: Atrial fibrillation (AF) and ischemic stroke (IS) are intricately linked to chronic obstructive pulmonary disease (COPD). Patients who suffer from both COPD and AF demonstrate a 2.85-fold greater risk of IS. However, the long-term risk remains insufficiently explored. Methods: This study utilized data from the Taiwanese National Health Insurance dataset spanning 2000 to 2015. Patients who were newly diagnosed with COPD, identified using the International Classification of Disease, Ninth Revision, Clinical Modification [ICD-9-CM] codes of 491, 492, and 496 and diagnosed with AF (ICD-9-CM code 427.3), were included in the study. The measured events included ISs (ICD-9-CM codes 433–437). Multivariate Cox proportional hazard models were employed to evaluate IS risk factors in this longitudinal analysis. Results: The combined presence of COPD and AF increased the risk of IS, with an adjusted hazard ratio of 5.722 (95% CI: 2.737–8.856, p < 0.001), AF without COPD with an adjusted HR of 3.506 (95% CI: 1.459–5.977, p < 0.001), and COPD with AF with an adjusted HR of 2.215 (95% CI: 1.099–3.538, p < 0.001) compared with patients without COPD and AF. Elderly patients exhibited a greater burden of cardiovascular comorbidities, including obstructive sleep apnea, thus further compounding the risk of IS. Conclusions: The coexistence of COPD and AF was associated with a markedly elevated risk of IS. The result highlights the additive and synergistic contributions of COPD and AF to the risk for IS. Aggressive treatment may mitigate the risk of IS.

(1) Background: Diabetes mellitus (DM) induces oxidative stress and inflammation with negative effect on pregnancy outcomes. This study aimed to determine whether DM increases the risk of pregnancy loss and to identify other potential risk factors; (2) Methods: We identified female patients diagnosed with DM from 2000–2015 in the Taiwanese National Health Insurance Research Database according to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9 CM) code 250. The event was pregnancy loss, defined as ICD-9 CM codes 630–639, which was tracked until 31 December 2015. The control group included 4-fold more non-DM female patients who were matched for age and disease severity. Multivariate Cox regression was employed to determine the risk factors associated with pregnancy loss; (3) Results: The hazard ratio (HR) for the risk of pregnancy loss due to DM was 1.407 (95% confidence interval: 1.099–1.801, p = 0.007), and the risk factors for older age, gynecological disorders and inflammation disorders were included. (4) Conclusions: The study concluded that women with DM have a greater risk of experiencing pregnancy loss. Healthcare providers should proactively manage and educate diabetic patients to reduce their risk of pregnancy loss. Understanding other probable risk factors can help in developing targeted interventions and support systems for women to improve pregnancy outcomes.

(1) Background: Children are the most vulnerable to pollution due to their decreased stature, heightened respiratory rate, and frequent outdoor engagement. PM_2.5, nitrogen dioxide (NO₂), ozone, and cold weather are associated with pediatric asthma. In this study, we investigated the nexus between air pollution, climate factors, and pediatric asthma emergency room visits (ERVs). (2) Method: Pediatric asthma ERV data for healthcare quality from the Taiwanese National Insurance in the Taipei area were obtained from 2015 to 2019. Air pollution and climate factor data were also collected. Poisson regression was employed to determine the relationships with relative risks (RRs). (3) Results: The incidence of pediatric asthma ERVs decreased, with a crude RR of 0.983 (95% CI: 0.98–0.986, p < 0.001). Fine particulate matter (PM_2.5) had an adjusted RR of 1.102 (95% CI: 1.037–1.172, p = 0.002) and a 7.7 µg/m³ increase, and air temperature had an adjusted RR of 0.813 (95% CI: 0.745–0.887, p < 0.001) comparing between the highest and lowest quarter air temperature associated with pediatric asthma ERVs. (4) Conclusions: This inquiry underscores the positive associations of PM_2.5 and cold weather with pediatric asthma ERVs. The findings could guide the government to establish policies to reduce air pollution and promote children’s health.

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic originated in Wuhan, China, in December 2019, the first case diagnosed since January 2020 in Taiwan. The study about the potential impact of the COVID-19 pandemic on event, location, food source, and pathogens of foodborne disease (FBD) is limited in Taiwan. Our aim in this study is to investigate FBD in the context of the COVID-19 pandemic. Materials and Methods: We collected publicly available annual summary data from the FBD dataset in the Taiwan Food and Drug Administration and Certifiable Disease on reported FBD in Taiwan from 2019 to 2020. We used logistic regression to evaluate changes in the occurrence or likelihood of FBD cases and Poisson regression to examine the relative risk (RR) between FBD and climate factors. Results: Similar events occurred in 2019 and 2020, but the total number of FBD cases decreased from 6935 in 2019 to 4920 in 2020. The places where FBD decreased were in schools, hospitals, outdoors, vendors, and exteriors. The top place in FBD shifted from schools to restaurants. The top food source for FBD has changed from boxed food to compound food. Bacillus cereus and Salmonella emerged as the top two observed bacterial pathogens causing FBD. The risk of FBD cases increased with a higher air temperature, with an RR of 1.055 (1.05–1.061, p < 0.001) every 1 °C. Conclusion: The incidence of FBD decreased significantly during the COVID-19 pandemic in Taiwan. This decline may be attributed to protective measures implemented to control the spread of the virus. This shift in locations could be influenced by changes in public behavior, regulations, or other external factors. The study emphasizes the importance of understanding the sources and effectiveness of severe infection prevention policies. The government can use these findings to formulate evidence-based policies aimed at reducing FBD cases and promoting public health. Consumers can reduce the risk of FBD by following safe food handling and preparation recommendations.

(1) Background: An asthma exacerbation that is not relieved with medication typically requires an emergency room visit (ERV). The coronavirus disease 2019 (COVID-19) pandemic began in Taiwan in January of 2020. The influence of the COVID-19 pandemic on pediatric ERVs in Taiwan was limited. Our aim was to survey pediatric asthma ERVs in the COVID-19 era; (2) Methods: Data were collected from the health quality database of the Taiwanese National Health Insurance Administration from 2019 to 2021. Air pollution and climatic factors in Taipei were used to evaluate these relationships. Changes in the rates of pediatric asthma ERVs were assessed using logistic regression analysis. Poisson regression was used to evaluate the impact of air pollution and climate change; (3) Results: The rate of pediatric asthma ERVs declined in different areas and at different hospital levels including medical centers, regional and local hospitals. Some air pollutants (particulate matter ≤ 2.5 µm, particulate matter ≤ 10 µm, nitrogen dioxide, and carbon monoxide) reduced during the COVID-19 lockdown. Ozone increased the relative risk (RR) of pediatric asthma ERVs during the COVID-19 period by 1.094 (95% CI: 1.095–1.12) per 1 ppb increase; (4) Conclusions: The rate of pediatric asthma ERVs declined during the COVID-19 pandemic and ozone has harmful effects. Based on these results, the government could reduce the number of pediatric asthma ERVs through healthcare programs, thereby promoting children’s health.