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Evidence on sex-specific incidence and comorbidity risk factors of suicide among patients with bipolar disorder is scarce. This study investigated the sex-specific risk profiles for suicide among the bipolar disorder population in terms of incidence, healthcare utilization and comorbidity.
Using data from the Taiwan National Health Insurance Research Database between 1 January 2000 and 31 December 2016, this nationwide cohort study included patients with bipolar disorder (N = 46 490) and individuals representative of the general population (N = 185 960) matched by age and sex at a 1:4 ratio. Mortality rate ratios (MRRs) of suicide were calculated between suicide rates of bipolar disorder cohort and general population. In addition, a nested case–control study (1428 cases died by suicide and 5710 living controls) was conducted in the bipolar disorder cohort to examine the sex-specific risk of healthcare utilization and comorbidities.
Suicide risk was considerably higher in the cohort (MRR = 21.9) than in the general population, especially among women (MRR = 35.6). Sex-stratified analyses revealed distinct healthcare utilization patterns and physical comorbidity risk profiles between the sexes. Although female patients who died by suicide had higher risks of nonhypertensive cardiovascular disease, pneumonia, chronic kidney disease, peptic ulcer, irritable bowel syndrome, and sepsis compared to their living counterparts, male patients who died by suicide had higher risks of chronic kidney disease and sepsis compared to the living controls.
Patients with bipolar disorder who died by suicide had sex-specific risk profiles in incidence and physical comorbidities. Identifying these modifiable risk factors may guide interventions for suicide risk reduction.
Urinary Na excretion is a potential risk factor for CVD. However, the underlying biological mechanisms and effects of salt sensitivity are unclear. The purpose of this study was to characterise the relative contribution of biological factors to the Na–CVD association. A total of 2112 participants were enrolled in this study. Structured questionnaires and blood and urine samples were obtained. Twenty-four-hour Na excretion was estimated using a single overnight urine sample. Hypertension, the metabolic syndrome and overweight status were considered to indicate salt sensitivity. Cox proportional hazard models were used to investigate the effects of salt sensitivity on urinary Na excretion and CVD risk. The traditional mediation approach was used to calculate the proportion of mediation. The mean age (sd) of the 2112 participants was 54·5 (sd 12·2) years, and they were followed up for a mean of 14·1 (sd 8·1) years. Compared with those in the lowest quartile, the highest baseline urinary Na excretion (>4·2 g/24 h) was associated with a 43 % higher CVD risk (hazard ratio, 1·43; 95 % CI 1·02, 1·99). Participants with high urinary Na excretion, hypertension or the metabolic syndrome had a significantly high risk of CVD. The carotid intima-media thickness had the largest mediating effect (accounting for 35 % of the Na–CVD association), followed by systolic blood pressure (BP) (33 %), left ventricular mass (28 %) and diastolic BP (14 %). Higher urinary Na excretion increased the risk of CVD, which was explained largely by carotid media-thickness and systolic BP.
To evaluate age-related differences in the independent/combined association of added sugar intake from soda and body adiposity with hyperuricaemia in gender-stratified US adults.
Consumption of added sugar from soda was calculated from 24-h dietary interviews and categorised into none, regular and excessive consumption. Hyperuricaemia was defined as serum uric acid levels >417 mmol/l in men and >357 mmol/l in women. Multiple regression models with interaction terms and logistic models adjusted for covariates were conducted under survey-data modules.
National Health and Nutrition Examination Survey during 2007–2016.
15 338 adults without gout, failing kidneys, an estimated glomerular filtration rate < 30 or diabetes were selected.
The age-stratified prevalence rate of hyperuricaemia was 18·8–20·4 % in males and 6·8–17·3 % in females. Hyperuricaemia prevalence of approximately 50 % was observed in young and middle age males who consumed excessive added sugar from soda. Excessive added sugar intake was observed to be associated with 1·5- to 2·0-fold and 2·0- to 2·3-fold increased risk of the probability of hyperuricaemia in young and middle age males and middle age females, respectively. Study participants, regardless of age or gender, who were obese and consumed excessive added sugar from soda had the highest risk of having hyperuricaemia.
Our study revealed that the association between hyperuricaemia and consumption of excessive added sugar from soda may vary by age and gender. Obese adults who consumed excessive added sugar from soda had the highest risk of hyperuricaemia, a finding that was found across all age-specific groups for both genders.
Lysosomes are integration hubs for several signaling pathways, such as autophagy and endocytosis, and also crucial stores of ions, including Zn2+. Lysosomal dysfunction caused by changes in their morphology by fusion and fission processes can result in several pathological disorders. However, the role of Zn2+ in modulating the morphology of lysosomes is unclear. The resolution of conventional epifluorescence microscopy restricts accurate observation of morphological changes of subcellular fluorescence punctum. In this study, we used a modified epifluorescence microscopy to identify the center of a punctum from a series of z-stack images and calculate the morphological changes. We stained primary cultured rat embryonic cortical neurons with FluoZin3, a Zn2+-sensitive fluorescent dye, and Lysotracker, a lysosome-specific marker, to visualize the distribution of Zn2+-enriched vesicles and lysosomes, respectively. Our results revealed that treating neurons with N,N,N′,N′-tetrakis(2-pyridylmethyl)ethylenediamine, a cell-permeable Zn2+ chelator, shrank Zn2+-enriched vesicles and lysosomes by up to 25% in an hour. Pretreating the neurons with YM201636, a blocker of lysosome fission, could suppress this shrinkage. These results demonstrate the usefulness of the modified epifluorescence microscopy for investigating the homeostasis of intracellular organelles and related disorders.
Deep neural networks (DNN) have solved many tasks, including image classification, object detection, and semantic segmentation. However, when there are huge parameters and high level of computation associated with a DNN model, it becomes difficult to deploy on mobile devices. To address this difficulty, we propose an efficient compression method that can be split into three parts. First, we propose a cross-layer matrix to extract more features from the teacher's model. Second, we adopt Kullback Leibler (KL) Divergence in an offline environment to make the student model find a wider robust minimum. Finally, we propose the offline ensemble pre-trained teachers to teach a student model. To address dimension mismatch between teacher and student models, we adopt a $1\times 1$ convolution and two-stage knowledge distillation to release this constraint. We conducted experiments with VGG and ResNet models, using the CIFAR-100 dataset. With VGG-11 as the teacher's model and VGG-6 as the student's model, experimental results showed that the Top-1 accuracy increased by 3.57% with a $2.08\times$ compression rate and 3.5x computation rate. With ResNet-32 as the teacher's model and ResNet-8 as the student's model, experimental results showed that Top-1 accuracy increased by 4.38% with a $6.11\times$ compression rate and $5.27\times$ computation rate. In addition, we conducted experiments using the ImageNet$64\times 64$ dataset. With MobileNet-16 as the teacher's model and MobileNet-9 as the student's model, experimental results showed that the Top-1 accuracy increased by 3.98% with a $1.59\times$ compression rate and $2.05\times$ computation rate.
Although the relationship between attention-deficit/hyperactivity disorder (ADHD) and transport accidents has been shown, there is limited information on the relationship between medication and dose–response effects and transport accident risk. This study aims to determine whether young people with ADHD, including adolescents, are more prone to transport accidents than those without, and the extent to which methylphenidate (MPH) prescription in these patients reduces the risk.
We identified 114 486 patients diagnosed with ADHD from Taiwan's National Health Insurance Research Database from 1997 to 2013. Using a Cox regression model, we compared the risk of transport accidents between ADHD and non-ADHD groups and estimated the effect of MPH on accidents. Furthermore, we applied a self-control case-series analysis to compare the risk of accidents during the medication periods with the same patients' non-medication periods.
Male ADHD patients had a higher risk of transport accidents than non-ADHD individuals (adjusted hazard ratio [aHR] = 1.24, [95% confidence interval (CI) 1.10–1.39]), especially for those comorbid with epilepsy, oppositional defiant disorder/conduct disorder (ODD/CD), and intellectual disabilities (ID). Female ADHD patients showed no relationship, except for comorbid with autism spectrum disorder (ASD) or ID. We found a reduced risk of transport accidents in patients with ADHD with MPH medication than those without MPH, with a plausible dose–response relationship (aHR of 0.23 to 0.07). A similar pattern was found in self-controlled case-series analysis.
Male patients with ADHD, especially those comorbid with epilepsy, ODD/CD, or ID, were at high risk of transport accidents. Female patients, when comorbid with ASD or ID, also exhibited a higher risk of accidents. MPH treatment lowered the accident risk with a dose–response relationship.
We conduct Eulerian–Lagrangian simulations to study double-diffusive sedimentation in stratified flows. The results show the pattern of double-diffusive sedimentation and the transition to the pattern of Rayleigh–Taylor instability when the size of particles increases. In cases of double-diffusive sedimentation, our simulation results show little variation in the temperature-to-particle flux ratio among cases with various particle sizes and initial concentrations, which is consistent with previous theoretical derivations and experimental observations. The energy budget is analysed to show that the settling enhancement is a result of the thermal effect combined with shear dissipation and that the thermal contribution decreases as the size increases. Based on the balance of the energy budget, velocity scaling was derived for the quasi-steady state in the thermally controlled region, which can be used to characterize the plumes’ final velocity of double-diffusive sedimentation. Moreover, adopting some values from the simulation results yields a velocity criterion with which to distinguish different sedimentation patterns. Finally, we investigate changes in the particle-laden plumes below the region of the apparent temperature gradient at which secondary instabilities occur in the form of significant horizontal flow motion. We show that the resulting initial shift of the dominant modes can be approximated with the existing theoretical analysis of collective instabilities for salt fingers. A simple scaling argument for the change in the total cross-sectional area of particle-laden plumes is presented, which is then used to scale the resulting enhanced sedimentation.
Attention-deficit/hyperactivity disorder (ADHD) is associated with a higher risk of burn injury than in the normal population. Nevertheless, the influence of methylphenidate (MPH) on the risk of burn injury remains unclear. This retrospective cohort study analysed the effect of MPH on the risk of burn injury in children with ADHD.
Data were from Taiwan's National Health Insurance Research Database (NHIRD). The sample comprised individuals younger than 18 years with a diagnosis of ADHD (n = 90 634) in Taiwan's NHIRD between January 1996 and December 2013. We examined the cumulative effect of MPH on burn injury risk using Cox proportional hazards models. We conducted a sensitivity analysis for immortal time bias using a time-dependent Cox model and within-patient comparisons using the self-controlled case series model.
Children with ADHD taking MPH had a reduced risk of burn injury, with a cumulative duration of treatment dose-related effect, compared with those not taking MPH. Compared with children with ADHD not taking MPH, the adjusted hazard ratio for burn injury was 0.70 in children taking MPH for <90 days (95% confidence interval (CI) 0.64–0.77) and 0.43 in children taking MPH for ≥90 days (95% CI 0.40–0.47), with a 50.8% preventable fraction. The negative association of MPH was replicated in age-stratified analysis using time-dependent Cox regression and self-controlled case series models.
This study showed that MPH treatment was associated with a lower risk of burn injury in a cumulative duration of treatment dose-related effect manner.
Given the concerns of health inequality associated with mental illnesses, we aimed to reveal the extent of which general mortality and life expectancy at birth in people with schizophrenia, bipolar disorder and depressive disorder varied in the 2005 and 2010 nationally representative cohorts in Taiwan.
Two nationally representative samples of individuals with schizophrenia, bipolar disorder and depressive disorder were identified from Taiwan's national health insurance database in 2005 and 2010, respectively, and followed-up for consecutive 3 years. The database was linked to nationwide mortality registry to identify causes and date of death. Age-, gender- and cause-specific mortality rates were generated, with the average follow-up period of each age- and gender-band applied as ‘weighting’ for the calculation of expected number of deaths. Age- and gender-standardised mortality ratios (SMRs) were calculated for these 3-year observation periods with Taiwanese general population in 2011/2012 as the standard population. The SMR calculations were then stratified by natural/unnatural causes and major groups of death. Corresponding life expectancies at birth were also calculated by gender, diagnosis of mental disorders and year of cohorts for further elucidation.
The general differential in mortality rates for people with schizophrenia and bipolar disorder remained wide, revealing an SMR of 3.65 (95% confidence interval (CI): 3.55–3.76) for cohort 2005 and 3.27 (3.18-3.36) for cohort 2010 in schizophrenia, and 2.65 (95% CI: 2.55–2.76) for cohort 2005 and 2.39 (2.31-2.48) for cohort 2010 in bipolar disorder, respectively. The SMRs in people with depression were 1.83 (95% CI: 1.81–1.86) for cohort 2005 and 1.59 (1.57-1.61) for cohort 2010. SMRs due to unnatural causes tended to decrease in people with major mental illnesses over the years, but those due to natural causes remained relatively stable. The life expectancies at birth for schizophrenia, bipolar disorder and depression were all significantly lower than the national norms, specifically showing 14.97–15.50 years of life lost for men and 15.15–15.48 years for women in people with schizophrenia.
Compared to general population, the differential in mortality rates for people with major mental illnesses persisted substantial. The differential in mortality for unnatural causes of death seemed decreasing over the years, but that due to natural causes remained relatively steady. Regardless of gender, people with schizophrenia, bipolar disorder and depression were shown to have shortened life expectancies compared to general population.
We conduct numerical simulations to investigate the formation and evolution of drops and vortex rings of particle-laden fingers in double-diffusive convection in stably stratified environments. We show that the temporal evolution can be divided into double diffusion, acceleration and deceleration phases. The acceleration phase is a result of the vanishing temperature perturbation in the drop during the descent in the layer of uniform temperature. The drop decelerates because it transforms into a vortex ring. A theoretical drag model is presented to predict the speed of the spherical drop with the low drop Reynolds number. By formulating the boundary condition based on the vorticity, our drag model gives a more general form of the drag coefficient for small spherical drops and shows good agreement in predicting the drag coefficient. Drops with five particle sizes are compared, and it is found that although the greater vertical settling enhances vertical transport, the final state differs little among the various sizes. Comparison of our drag model with the simulation results under various bulk conditions and previous experimental results shows good model predictability. Finally, a comparison with the salt-finger case shows that the diffusive nature of the dissolved scalar field, along with the wake effect, can result in an apparent loss of mass from the drop and a permanent presence of the connection between the drop and its parent finger. This makes the observed detachment of the particle-laden drop much less likely in the salt-finger case.
In Taiwan, the changes that smallholders have been experiencing differ according to the time period. This chapter looks further into the specificity of situations facing smallholders within Taiwan. By addressing the historical trajectory of Taiwanese smallholders and reviewing their persistence, resistance, and transformations from the past to the present, this chapter reconsiders the future prospects of Taiwanese smallholders and argues for the importance of looking beyond what seems to be a binary opposition between local food movements and conventional agriculture. One the one hand, the ageing and dwindling agricultural labour force in rural Taiwan serves to exacerbate the decline of the rural economy. On the other, younger smallholders have capitalized on their abilities to forge collective action to revitalize smallholdings.
Keywords: ageing labour, conventional agriculture, industrialization, local food movement, new farmers, social movements, Taiwan
It may be generally observed that smallholders or smallholdings have been subject to heightened attention, not just in academic circles, but also in general publics, worldwide. Decreases in social, cultural, and ecological diversity that have been witnessed in rural economies have led to increasing concerns on a global scale. One possible avenue that has been considered for maintaining the sustainability of agrarian society has been the deeper understanding and re-appreciation of the value of smallholdings, a trend that is also evident in Taiwan. Nonetheless, while global awareness of the urgent problems facing smallholders has increased, it is also important to take into account local contexts and diversity within the smallholder sector. Without local contextualization of the various situations faced by smallholders across different spaces and times, we may lose sight of the nuances necessary for understanding the specificity of issues facing smallholders in distinctive places. In practice, one size will never fit all when it comes to understanding smallholdings worldwide.
In Taiwan, the changes that smallholders have been experiencing differ according to the time period. These changes have also affected how smallholders perceive and position themselves in Taiwanese society. Society’s perceptions of smallholders in Taiwan have also shifted in dynamic ways, along with attendant changes in socioeconomic development. To better situate smallholders in Taiwan's context, the first imperative step would be to reconsider the “ hectares” definition of the smallholding, which is at present the standard recognized in many international documents and programmes.
Compared with the general population, individuals with schizophrenia have a higher risk of periodontal disease, which can potentially reduce their life expectancy. However, evidence for the early development of periodontal disease in schizophrenia is scant. The current study investigated risk factors for periodontal disease in patients newly diagnosed with schizophrenia.
We identified a population-based cohort of patients in Taiwan with newly diagnosed schizophrenia who developed periodontal disease within 1 year of their schizophrenia diagnosis. Treatment with antipsychotics and other medications was categorised according to medication type and duration, and the association between medication use and the treated periodontal disease was assessed through logistic regression.
Among 3610 patients with newly diagnosed schizophrenia, 2373 (65.7%) had an incidence of treated periodontal disease during the 1-year follow-up. Female sex (adjusted odds ratios [OR] 1.40; 95% confidence interval [CI] 1.20–1.63); young age (adjusted OR 0.99; 95% CI 0.98–0.99); a 2-year history of periodontal disease (adjusted OR 2.45; 95% CI 1.84–3.26); high income level (adjusted OR 2.24; 95% CI 1.64–3.06) and exposure to first-generation (adjusted OR 1.89; 95% CI 1.54–2.32) and secondary-generation (adjusted OR 1.33; 95% CI 1.11–1.58) antipsychotics, anticholinergics (adjusted OR 1.24; 95% CI 1.03–1.50) and antihypertensives (adjusted OR 1.91; 95% CI 1.64–2.23) were independent risk factors for periodontal disease. Hyposalivation – an adverse effect of first-generation antipsychotics (FGAs) (adjusted OR 2.00; 95% CI 1.63–2.45), anticholinergics (adjusted OR 1.27; 95% CI 1.05–1.53) and antihypertensives (adjusted OR 1.90; 95% CI 1.63–2.22) – was associated with increased risk of periodontal disease. Therefore, hypersalivation due to FGA use (adjusted OR 0.72; 95% CI 0.59–0.88) was considered a protective factor.
The current study highlights that early prevention of periodontal disease in individuals with schizophrenia is crucial. Along with paying more attention to the development of periodontal disease, assessing oral health regularly, helping with oral hygiene, and lowering consumption of sugary drinks and tobacco, emphasis should also be given by physicians to reduce the prescription of antipsychotics to the extent possible under efficacious pharmacotherapy for schizophrenia.
In this article we examine whether and how changes in personal bankruptcy laws, viewed as a shock to employees’ expected personal wealth, affect corporate policies. Following a reform in personal bankruptcy laws that limits individuals’ access to bankruptcy protection, firms more affected by this regulation reform increase labor costs, reduce investment, and engage in less risk taking. The effects are stronger when employees have more bargaining power. Furthermore, firms in industries characterized by high unemployment risk reduce leverage. These results support the view that firms choose more conservative policies to mitigate employees’ expected welfare losses.