BACKGROUND & AIMS:

Long-term protection against hepatitis B virus (HBV) after vaccination remains widely debated. We evaluated the efficacy of a modified 3-dose booster protocol in neonatally vaccinated university students in Taiwan.

METHODS:

Changes in the levels of antibodies to the hepatitis B surface antigen (anti-HBs) were examined in 250 university students over a 3-year period. Group A (n=39) lacked seroprotective levels of anti-HBs, and declined to receive a booster dose of the HBV vaccine. Group B (n=128) lacked seroprotective levels of anti-HBs, and received booster doses of the HBV vaccine according to a modified 3-dose booster protocol. Group C (n=83) possessed seroprotective levels of anti-HBs, and did not receive a booster dose.

RESULTS:

The levels of seroprotective anti-HBs increased in 12.8% of Group A and 14.5% of Group C, suggesting that our entire cohort had experienced booster effects from natural HBV exposure. However, no new HBV infections were observed, and 53.9% of Group B maintained protective levels of anti-HBs during the follow-up period.

CONCLUSIONS:

The use of the modified 3-dose booster protocol induced significant long-term increases in the titer of anti-HBs in over 50% of the neonatally vaccinated participants with previously non-protective titers. However, in the absence of a vaccine booster, some neonatally vaccinated people with low anti-HBs titers may nonetheless produce anamnestic responses to HBV upon exposure, suggesting that protection from neonatal vaccination may persist, despite low titers of anti-HBs.

BACKGROUND:

Western breast cancer survivors have an increased risk of osteoporosis and bone fracture. Breast cancer occurs 10 to 20 years earlier in Asian women than in Western women. We investigated if younger Asian women with breast cancer also have increased risk of fracture.

METHODS:

We used the universal insurance claims data from 2000 to 2003 to identify 22,076 patients with breast cancer and 88,304 women without cancer, frequency matched with age and index date (the date for a health care visit). The incidence of fracture in both cohorts and the hazard ratios (HRs) of fracture in the cancer cohort were estimated by the end of 2009.

RESULTS:

The incidence of all types of fracture was higher in the breast cancer cohort than in the comparison cohort (46.72 vs. 42.52 per 10,000 person-years), with adjusted HRs (aHRs) of 1.18 (95% confidence intervals [CI], 1.03-1.35) for hip fractures, 1.12 (95% CI, 0.98-1.28) for forearm fractures and 1.24 (95% CI, 1.04-1.48) for vertebral fractures. The aHRs were significant in both non-traumatic fractures (1.29; 95% CI, 1.11-1.51) and traumatic fractures (1.12; 95% CI, 1.01-1.23). The age-specific aHR was higher for younger breast cancer patients, and was significant for <50 years old patients in both traumatic (aHR 1.35; 95% CI 1.08-1.68) and non-traumatic (aHR, 1.72; 95% CI, 1.21-2.44) fractures.

CONCLUSION:

This study suggests that Asian women with breast cancer might have an increased risk of fracture.

BACKGROUND:

The causal association between diabetes and pancreatic cancer remains unclear in Asian populations. This studyexamined whether gallstones, a cholecystectomy, chronic pancreatitis and the treatment of antidiabetic agents affect the risk of subsequent pancreatic cancer for patients with diabetes in a Taiwanese population.

METHODS:

Using claims data from the universal health insurance program in Taiwan, 449,685 newly diagnosed diabetic cases among insured people from 2000 to 2003 were identified as the case group. The comparison group, matched for gender, age, and the index year of the diabetes cohort, consisted of 325,729 persons without diabetes. Pancreatic cancer incidence was measured in both groups until the end of 2008. Other risk factors associated with this cancer were also measured.

RESULTS:

The incidence of pancreatic cancer in the diabetic cohort was 2-fold greater than that in the comparison group (1.46 vs. 0.71 per 10,000 person-years) with an adjusted hazard ratio (HR) of 1.75 [95 % confidence interval (CI) 1.45-2.10]. The risk slightly increased for diabetic patients with gallstones, cholecystitis, and a cholecystectomy (HR 1.92, 95% CI 1.18-3.11), but greatly increased for those with comorbidity of chronic pancreatitis (HR 22.9, 95% CI 12.6-41.4). Pancreatic cancer risk also increased significantly for those patients who used more insulin for treating diabetes (OR 2.20, 95% CI 1.40-3.45).

CONCLUSION:

Our data suggest that the risk of pancreatic cancer is moderately increased in patients with diabetes, especially those using insulin therapy. The risk is greatly increased for diabetic patients with chronic pancreatitis.

BACKGROUND:

People with visual disabilities have increased health needs but face worse inequity to preventive health examinations. To date, only a few nationwide studies have analyzed the utilization of preventive adult health examinations by the visually disabled population. The aim of this study was to investigate the utilization of health examinations by the visually disabled population, and analyze the factors associated with the utilization.

METHODS:

Visual disability was certified by ophthalmologists and authenticated by the Ministry of the Interior (MOI), Taiwan. We linked data from three different nationwide datasets (from the MOI, Bureau of Health Promotion, and National Health Research Institutes) between 2006 and 2008 as the data sources. Independent variables included demographic characteristics, income status, health status, and severity of disability; health examination utilization status was the dependent variable. The chi-square test was used to check statistical differences between variables, and a multivariate logistic regression model was used to examine the associated factors with health examination utilization.

RESULTS:

In total, 47,812 visually disabled subjects aged 40 years and over were included in this study, only 16.6% of whom received a health examination. Lower utilization was more likely in male subjects, in those aged 65 years and above, insured dependents and those with a top-ranked premium-based salary, catastrophic illness/injury, chronic diseases of the genitourinary system, and severe or very severe disabilities.

CONCLUSION:

The overall health examination utilization in the visually disabled population was very low. Lower utilization occurred mainly in males, the elderly, and those with severe disabilities.

Hip fracture is a major public health concern due to its poor outcome and serious socioeconomic burden in older people (1). Evidence has shown that many factors are related to increased risk of hip fracture, but psychiatric diseases are not confirmatory (2, 3). A case-control study by Howard et al. in the United Kingdom has shown that schizophrenia is associated with increased risk of hip fracture in univariate analysis (odds ratio [OR]=1.73, 95% CI=1.32–2.28), but association is no longer found in multivariate analysis (3). To date, no clinical study has focused on the relationship between schizophrenia and the risk of hip fracture in older people in Taiwan. In order to clarify this issue, we used the database from the Taiwan National Health Insurance program to conduct this population-based cohort study. The details of the insurance program can be found in previous studies (4–6).