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ABSTRACT: AIM: To determine the incidence rate and characteristics in patients with testicular torsion in Taiwan using a nationwide insurance database. METHODS: This study utilizes a subset of National Health Insurance Research Database, which contains the data of all paid medical benefit claims over the period 1997-2010 for in 1,000,000 beneficiaries in 2005. We analyzed claims data for all male subjects younger than 25 years with the diagnosis of testicular torsion. RESULTS: A total of 86 subjects younger than 25 years old with the diagnosis of testicular torsion. Among them, 22 (25.6%) underwent orchiectomies and 64 (74.4%) underwent orchiopexies. The estimated incidence of testicular torsion was 3.5 per 100,000 person-years. There are two peaks in the age-specific incidence rates: the first in men aged 10-14 years (at 7.7 per 100,000 person-years) and the second in men aged under one year (at 7.6 per 100,000 person-years). There was significant difference between orchiectomy and orchiopexy group in the Insurance fee (p=0.032). CONCLUSION: The incidence of testicular torsion in Taiwan was similar with previous report in the United States. It's important to improve the medical access to achieve better outcomes of testicular torsion. This article is protected by copyright. All rights reserved.
Acta Paediatrica 04/2013; · 2.07 Impact Factor
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ABSTRACT: OBJECTIVE: To investigate the frequency and characteristics of newly diagnosed vesicoureteral reflux (VUR) in children younger than 18 years based on a nationwide database in Taiwan. METHODS: The present study utilizes a subset of the Taiwan's National Health Insurance Research Database, known as the Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over 1997-2007 for a subset of 1,000,000 beneficiaries randomly drawn from the population of 22.72 million individuals during any part of the 2005 calendar year. Our analysis includes the data of all pediatric patients with the diagnosis of VUR. RESULTS: A total of 738 subjects with VUR diagnosis were identified, including 412 (55.8%) boys and 326 (44.2%) girls. The peak age of VUR occurrence was the first year for males and 1-4 years for females. Approximately 49.7% of all subjects presented with urinary tract infection (UTI); moreover, there were significant differences between genders concerning the presence of UTI (RR = 0.8; p = 0.002). The occurrence rate of VUR in the pediatric population ranged from 2.63 in 1998 to 3.94 in 2003 per 10,000 children during 1998-2005. The frequency of newly-diagnosed VUR in the pediatric population was significantly correlated with urbanization levels of residence. CONCLUSION: The nationwide, population-based study of pediatric VUR shows there were gender differences in age distribution and presence of UTI. Further studies are warranted to clarify the correlations between urbanization level of residence and occurrence of VUR.
Journal of pediatric urology 04/2013; · 1.38 Impact Factor
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ABSTRACT: PURPOSE: To investigate the epidemiology of upper urinary tract stone disease in Taiwan utilizing a nationwide population-based database. MATERIALS AND METHODS: This study is based on Taiwan's National Health Insurance Research Database (NHIRD), which contains the data of all medical beneficiary claims from 22.72 million enrollees, accounting for nearly 99% of Taiwan's population. The Longitudinal Health Insurance Database (LHID) 2005, a subset of NHIRD, contains the data of all medical benefit claims from 1997 through 2010 for a subset of one million beneficiaries who were randomly sampled from the 2005 enrollment file. We selected subjects whose claims records included the diagnosis of upper urinary tract urolithiasis for epidemiologic analysis. RESULTS: The age-adjusted rate of medical care visits for upper urinary tract urolithiasis decreased by 6.5% from 1,367 in 1998 to 1,278 in 2010 per 100,000 subjects. There was a significantly declining trend over the 13-year period in visits from the female and total subjects (r(2)=0.86; p=0.001 and r(2)=0.52; p=0.005, respectively). In contrast, a rising trend was noted among the male subjects (r(2)=0.45; p=0.012). The age-adjusted prevalence in 2010 was 9.01%, 5.79% and 7.38% in male, female and total subjects, respectively. The overall recurrence rates at one year and five years were 6.12% and 34.71%. Male subjects had a higher recurrence rate than female subjects. CONCLUSIONS: The present study provides important information on the epidemiology of upper urinary tract stone disease in Taiwan, helping to quantify the burden of urolithiasis and to establish the strategies to reduce the risk of urolithiasis.
The Journal of urology 01/2013; · 4.02 Impact Factor
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ABSTRACT: BACKGROUND/PURPOSE: Current guidelines recommend that hypospadias repair should be performed before age 18 months. This study aims to investigate the trends of surgical timing and to determine what factors are associated with age at surgery. METHODS: The present study utilized a subset of the National Health Insurance Research Database, known as Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over the period from 1997 to 2007 for a subset of one million beneficiaries randomly drawn from the population of 22.72 million individuals in NHI program during any part of calendar year 2005. We analyzed claims data for all subjects with the diagnoses of hypospadias. RESULTS: Among 52,705 live male newborns, 218 were diagnosed with hypospadias and thus were included as subjects in our study. Among them, 89 received repair surgery. Approximately 60.6% of the study subjects received repair after the age of 18 months. Multivariate analysis showed that several factors were significantly associated with age at hypospadias surgery: specialty of clinics where first diagnosis was made; specialty of physician making the first diagnosis, age of physician making the first diagnosis; specialty of surgeon performing the surgery; number of years since surgeon's board certification; urbanization level of subject's residence; modality of surgery; concomitant cryptorchidism; concomitant prematurity and low birth weight; age at diagnosis; and number of well-baby clinic visits. CONCLUSION: This study addresses an important issue of delayed hypospadias surgery in Taiwan, which provides a potential opportunity for improvement in quality of care.
Journal of the Formosan Medical Association 01/2013; 112(1):48-53. · 1.13 Impact Factor
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ABSTRACT: To investigate the prevalence, incidence, associated risk factors, and treatment of pediatric urolithiasis in Taiwan.
The present study used a subset of the National Health Insurance Research Database, known as the Longitudinal Health Insurance Database 2005, which contains the data for all paid medical benefit claims from 1997 to 2006 for a subset of 1 million beneficiaries randomly drawn from the population of 22.72 million individuals during any part of the calendar year 2005. Our analysis included the data of all newly diagnosed pediatric patients with an "International Classification of Disease, 9th revision," diagnosis of urolithiasis from 1997 through 2006.
A total of 1679 pediatric subjects who had newly diagnosed urolithiasis without a previous attack were identified from 1997 to 2006 as the study sample. Of the 1679 patients, 808 were boys (48.1%) and 871 were girls (51.9%). The incidence rate of urolithiasis in 2005 was 0.047%. The peak age of pediatric stone occurrence in the study sample was 15-18 years (49.6%). The most common associated disease was urinary tract infection (34.1% of all subjects). The occurrence rate of pediatric urolithiasis correlated significantly with the urbanization level of the residence and geographic area.
Using a nationwide, population-based study provides important clinical and epidemiologic information regarding pediatric urolithiasis. Additional studies are warranted to determine the effect of geographic area and urbanization level on the occurrence of pediatric stone disease.
Urology 03/2012; 79(6):1355-9. · 2.43 Impact Factor
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ABSTRACT: We investigated the rate of diagnosis and treatment trends of hypospadias in Taiwan within the first 3 years of life.
We used a subset of the Taiwan National Health Insurance Research Database, which contains data on all inpatient and outpatient medical benefit claims, for the period 1997 through 2008 for a sample of 1 million individuals randomly drawn from the population of 25.68 million who held membership in the National Health Insurance program during any part of the calendar year 2005. We analyzed claims data for all subjects who were diagnosed with hypospadias through age 3 years.
Among 52,705 newborns (individuals whose claims included live birth) 178 were diagnosed with hypospadias within 3 years of birth. Thus, mean incidence was 33.8 per 10,000 live male births. The hypospadias repair rate was 14.3 per 10,000 live male births. There was no significant tendency toward increase or decrease in rates of diagnoses or repairs, or proportion of severe hypospadias. There were significant associations between rates of hypospadias diagnoses and urbanization level of the community where the diagnosis was made. Approximately 54% of patients who underwent surgical repair did so after age 18 months.
The nationwide incidence of hypospadias in children younger than 3 years in Taiwan is similar to that reported in previous studies. Delayed diagnosis and treatment of hypospadias are important clinical concerns that warrant further investigation.
The Journal of urology 02/2011; 185(4):1449-54. · 4.02 Impact Factor
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ABSTRACT: Brain MR perfusion imaging is used to evaluate local perfusion in patients with cerebral vascular disease. Quantitative measurements on the hemodynamic parameters and volume of brain with abnormal perfusion provide an estimation of the severity of the brain perfusion defect. However, quantitative measurements of these focal cerebral hemodynamic parameters are limited by the presence of cerebrospinal fluid (CSF) pixels. We noticed that the CSF has a higher signal than other tissue types on the first perfusion image, which is usually discarded in routine parametric image calculations. This signal difference, however, can be used to segment CSF pixels on the perfusion images. An image division was used to generate ratio images to compensate for spatially dependent signal variation caused by the inhomogeneity of excitation radiofrequency field. By applying an appropriate signal threshold to the ratio images, CSF pixels can be identified and removed from the parametric images. With the removal of CSF pixels, the volume of delayed-perfusion brain parenchyma can be better visualized and the interference from the CSF can be avoided. The proposed technique is simple, fast, automatic, and effective, and no extra scanning is needed to use this technique.
Magnetic Resonance in Medicine 09/2010; 64(3):743-8. · 2.96 Impact Factor
