ㄧ、Zolpidem使用與車禍住院危險性增加:個案交叉研究 二、台灣更年期婦女中醫藥使用情況分析

Abstract

Part1 背景: 許多道路駕駛研究(On-the-road driving studies)和流行病學研究指出苯二酚類藥物和zopiclone 的使用會影響駕駛能力以及增加交通意外的發生率。相對的，道路駕駛研究顯示前一天晚上使用zolpidem 並不會造成明顯的駕駛能力缺損。然而目前並沒有相關的流行病學研究在探討有關於前一天使用zolpidem 與隔天車禍住院的相關性。 目標:探討前一天zolpidem 的使用與隔一天車禍發生之間的相關性。 方法: 我們從全民健保資料庫1998-2004 年一百萬抽樣歸人檔中選出12,989 個車禍的研究對象。利用個案交叉研究設計的方式，我們挑選車禍前一天的藥物暴露作為case period，再往回分別挑選第91、182、273 天當做control period， 另外我們利用Conditional logistical regression model 去計算前一天zolpidem 處方與隔一天車禍之間的勝算比(odds ratio).我們利用每日定義劑量(defined daily dose (DDD))去計算苯二酚（Benzodiazepine）跟非苯二酚（non-benzodiazepine）的使用劑量。 結果: 在校正所有相關的危險因子之後，每暴露一個每日定義劑量的zolpidem，隔天發生車禍的勝算比則是1.74 (95％信賴區間: 1.25-2.43)。而對於zopiclone 而言，每暴露一個每日定義劑量隔天發生車禍的勝算比則是1.55 (95％信賴區間:0.98-2.45)。在前一天每服用一個每日定義劑量的長半衰期苯二酚藥物後，隔天與車禍住院之前的勝算比是1.74(95％信賴區間: 1.26-2.40)，短半衰期苯二酚藥物則是1.13 (95％信賴區間:1.04-1.23)。 結論:前一天使用zolpidem 可能會增加隔天發生車禍的危險性。 Part2 背景: 輔助與另類醫學(Complementary and alternative medicine)被更年期的婦女廣泛的用來治療更年期相關症狀。中醫藥也是其中一部分。目前關於更年期婦女使用中醫藥的研究仍然非常有限。本研究的目標就是分析台灣更年期婦女中醫藥使用的情況。 方法: 利用健保資料庫二十萬抽樣歸人檔1997-2004 去分析45-55 歲婦女中醫藥的使用情況，並依照不同的疾病分類去分析中醫處方的使用。另外我們應用資料探勘技術(data mining techniques)去研究更年期症候群相關的中醫處方組合模式。 結果: 肌肉骨骼系統及結締組織疾病是更年期婦女中醫門診最常見的診斷疾病分類，而針灸跟傷科推拿是他們最常用來治療此類疾病的中醫藥模式。症狀、症候及診斷欠明之各種病態為是中醫門診開立中藥處方時最常見之診斷分類，而加味逍遙散是最常開立的處方。 結論: 台灣的更年期婦女中醫藥使用情況與一般民眾使用中醫或是西醫的情況不一樣。肌肉骨骼系統及結締組織疾病和症狀、症候及診斷欠明之各種病態的比例較一般民眾來的高。有可能是因為下列兩個原因: 1.更年期婦女有許多跟更年期相關的症狀。2.民眾對於中西醫優缺點的觀念有可能會影響他們的就醫選擇。安全性議題應該是未來研究的重點之一，此外我們需要更多的臨床試驗來評估中醫藥對於更年期症候群的療效。

Part1 Background: Epidemiological and experimental studies indicated that prescriptions of benzodiazepines (BZDs) and zopiclone are associated with increased risk of motor vehicle crash (MVC). In contrast, there was limited evidence on the use of zolpidem one day before and the risk of MVC. Objectives: To determine whether the use of zolpidem one day before is associated with increased risk of MVC. Methods: We identified 12,929 subjects ever hospitalized due to MVC from the data of 1,000,000 people randomly sampled from the reimbursement database 1998-2004 of national health insurance of Taiwan. By case-crossover design, we selected the day before MVC as the case period and retrospectively 91st, 182nd, and 273rd days prior to the case period as the three control periods for each subject. The dosage of different medications were summed up based on per defined daily dose (DDD) .Conditional logistical regression model were constructed to calculate the odds ratio of having MVC and prescription of zolpidem, BZDs, and zopiclone one day before after control of potential confounding by other medications with suspected hypnotic effects. Results: After adjustment for related risk factors, the odds ratios (ORs) of having MVC for taking zolpidem per DDD one day before was 1.74 (95% CI 1.25-2.43) while that of zopiclone was 1.55 (95% CI 0.98-2.45). And those for per DDD of taking long half-life and short half-life of BZDs one day before were 1.74 (95% confidence interval (CI) 1.26-2.40) and 1.13 (95% CI 1.04-1.23), respectively. Conclusions: Use of zolpidem one day before might be associated with increased risk of MVC. Part2 Introduction: Complementary and alternative medicine (CAM) has become more popular as therapies for symptom relief among menopause-age women. Traditional Chinese medicine (TCM) is an important part of CAM which is also widely used by menopausal women. However, there is still lack information on TCM utilization for climacteric women. The aim of our study was to conduct an analysis of TCM utilization for climacteric women in Taiwan. Methods: This study used the 200,000 random sampling cohort from national health insurance (NHI) Database 1997-2004 and drug registration numbers to analyze TCM utilization, including disease categories of visiting OPD, using frequencies and percentage of herbal formula (HF) for each disease category. We also applied data mining techniques to explore co-prescription patterns for menopausal and postmenopausal disorders. Result: Diseases of the musculoskeletal system and connective tissue were the most frequent diagnosis of disease category for climacteric women, acupuncture and traumatology manipulative therapies were the most common TCM modality to treat diseases of the musculoskeletal system and connective tissue. Diagnoses of symptoms, signs, and ill-defined conditions are most common in TCM visits with prescription of Chinese herbal remedies and Jia-wei-xiao-yao-san was the most common HF prescribed in TCM visits. Conclusions: The pattern of TCM utilization of climacteric women is different from whole population in both TCM and WM. Diseases of the musculoskeletal system and connective tissue, Symptoms, signs, and ill-defined conditions were much more frequent. It might due to two reasons: First, climacteric women have more symptoms or signs which related to menopausal syndrome. Second, the concept of advantage and disadvantage of TCM and WM might influence patients’ choice of using TCM or WM. Safety issues should be a priority for future research and more clinical trial is needed to assess the effects of TCM for menopausal syndrome during climacteric period.