Background: Atopic dermatitis (AD) contributes to substantial social and financial costs in public health care systems. Antibiotic exposure during pregnancy has been proposed as a risk factor, but findings remain inconsistent. The aim of this study was to investigate the association between prenatal antibiotic use and childhood AD. Methods: We performed a population-based cohort study using data collected from the Taiwan Maternal and Child Health Database from 2009 to 2016. Associations were determined using Cox proportional hazards model and were adjusted for several potential covariates, including maternal atopic disorders and gestational infections. Subgroup analyses evaluated the influence of postnatal infant antibiotic/acetaminophen use on the association between prenatal antibiotic exposure and childhood AD diagnosed after 1 year of age. Results: A total of 1288343 mother-child pairs were identified and 39.5% received antibiotics prenatally. Maternal antibiotic use during pregnancy was slightly positively associated with childhood AD (aHR 1.05, 95% CI 1.04-1.06), especially in the first and second trimesters. An apparent dose-response pattern was observed with an 11% increased risk when the exposure was ≥5 courses prenatally (aHR 1.11, 95% CI 1.09-1.14). Subgroup analysis showed the positive association remained significant regardless of postnatal antibiotic use; however, a negative association was found in children without postnatal infant acetaminophen use (aHR 1.02, 95% CI 0.97-1.07). Conclusion: Maternal antibiotic use during pregnancy was associated with increased risk of childhood AD in a dose-related manner. Possible confounders existed between prenatal antibiotics and postnatal infant acetaminophen use in the subgroup analysis. Further research may be warranted to investigate this variable using a prospectively designed study, and also to examine whether or not this association is specifically related to pregnancy.

Backgrounds Appendectomy is one of the most commonly performed surgeries worldwide. Sepsis is an major etiology of morbidity and mortality in children. Our preliminary research revealed a positive correlation among appendectomy and future risk of sepsis in adults. However, to date, the relationship among appendectomy and future risk of sepsis in children remains unknown. The aim of this research was to investigate the relationship among appendectomy and hazard of future sepsis in children. Methods We applied a nationwide population-based cohort to assess whether children who received appendectomy were at increased risk of subsequent sepsis. Overall, 57261 subjects aged below 18 undergoing appendectomy as appendectomy group and 57261 matched controls were identified as non-appendectomy group from the National Health Insurance Research Database in Taiwan. We use propensity score analysis to match age, sex, urbanization level, and parental occupation at the ratio to 1:1. Multiple Cox regression and stratified analyses were used to appraise the adjusted hazard ratio (aHR) for developing sepsis in children. Results Children who received appendectomy had a 2.63 times higher risk of developing sepsis than those who did not, and the risk was even higher in children aged under 6 years. Patients with <1 year follow-up showed a 5.64-fold risk of sepsis in the appendectomy cohort. Patients with 1–4 and ≥5 years’ follow-up showed a 2.41- and 2.02-times risk of sepsis. Conclusion Appendectomy was correlative to a 2.63-fold increased future sepsis risk in children, and the risk in younger patients aged <6 years was even higher. More studies to interpret the possible biological mechanisms of the associations among sepsis and appendectomy are warrant

Background Among respiratory diseases, asthma is one of the most burdensome disorder worldwide. Growing evidence disclose gut dysbiosis may contribute to asthma via the gut-lung axis. Constipation can lead to alteration of the gut microflora. The clinical impact of constipation on asthma has not been researched. Therefore, we aim to assess the risk of asthma in constipated patients by a nationwide population-based cohort study. Methods We analyzed 82421 constipated patients and 82421 individuals without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Analysis of propensity score was utilized to match age, gender, comorbidities, and medications at a ratio of 1:1. Besides, multiple Cox regression analysis was performed to evaluate the adjusted hazard ratio of asthma. Furthermore, sensitivity tests and a stratified analysis were conducted. Results The incidence of asthma was 10.8 per 1,000 person-years in the constipation group, which was higher than the rate of 5.6 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, and medications, constipated patients had a 1.91-fold greater risk of asthma compared to those without constipation (adjusted hazard ratio [aHR]: 1.91 (95% C.I. 1.84-1.99). In subgroup analyses, patients aged 20-39 years had a 2.04-fold highest risk of asthma in the constipation cohort (aHR:2.04, 95% CI, 1.84-2.26). Besides, the severity of constipation is associated with an increased risk of asthma; the aHR was 1.76 (1.69-1.85), 2.15(2.03-2.27), and 2.29(2.10-2.49) for < 3 times, 3-12 times, and ≥12 times of laxatives prescription within one year, respectively. (p<0.001) Moreover, constipated patients had a higher likelihood of asthma, regardless of gender, comorbidities, and medications. Conclusion Constipation relates to a significantly increased risk of asthma. Physicians should be aware of the possibility of asthma in constipated people. Further research is warranted to investigate the possible pathological mechanisms of this association.

Atopic dermatitis (AD) is the chronic relapsing inflammatory skin disorder that affects both in childhood and adulthood. Mounting evidence indicates that gut dysbiosis contributes to AD via the gut-skin axis. Constipation could result in alteration of the gut microflora. The clinical impact of constipation on AD has not been researched. Therefore, we aim to assess the risk of AD in constipated patients by the longitudinal nationwide population-based cohort study. We collected 87015 people with constipation and 87015 patients without constipation between 1999 and 2013 from the Longitudinal Health Insurance Database, which is the subset of Taiwanese National Health Insurance Research Database. Propensity score analysis was administrated to match age, gender, comorbidities, and medications at a ratio of 1:1. Multiple Cox regression analysis was utilized to evaluate the adjusted hazard ratio of AD. In addition, sensitivity tests and a stratified analysis were conducted. The incidence of AD was 4.7 per 1,000 person-years in the constipation group, which was higher than the rate of 2.2 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, corticosteroids, and antihistamine, people with constipation had a 2.11-fold greater risk of AD compared to those without constipation (adjusted hazard ratio [aHR]: 2.11 (95% C.I. 1.98-2.24). In subgroup analyses, people aged 12-19 years had a 2.34-fold higher risk of AD in the constipation cohort (aHR; 95% CI, 1.84-2.98). Moreover, people with constipation had a higher likelihood of AD, regardless of gender, and with or without comorbidities, as well as the usage of corticosteroids, and antihistamines. Constipation is connected with a significantly risk factor of AD. Clinicians should be careful of the possibility of AD in people with constipation. Further study is warranted to investigate the possible pathological mechanisms of underlying this relationship.

Background Atopic dermatitis (AD) is the chronic inflammatory disorder that affects both in childhood and adulthood. Mounting evidence indicates that gut dysbiosis contributes to AD via the gut-skin axis. Constipation can result in alteration of the gut microflora. The clinical impact of constipation on AD has not been researched. Therefore, we aim to assess the risk of AD in constipated patients by the population-based cohort study. Methods We collected 87015 constipated people and 87015 people without constipation between 1999 and 2013 from the Taiwanese National Health Insurance Research Database. Propensity score analysis was administrated to match age, gender, comorbidities, and medications at a ratio of 1:1. Multiple Cox regression analysis was utilized to evaluate the adjusted hazard ratio of AD. In addition, sensitivity tests and a stratified analysis were conducted. Results The incidence of AD was 4.7 per 1,000 person-years in the constipation group, which was higher than the rate of 2.2 per 1,000 person-years observed in the non-constipation group. After adjustment for age, gender, comorbidities, corticosteroids, and antihistamine, constipated people had a 2.11-fold greater risk of AD compared to those without constipation (adjusted hazard ratio [aHR]: 2.11 (95% C.I. 1.98-2.24). Moreover, constipated people had a higher likelihood of AD, regardless of gender, comorbidities, as well as the usage of corticosteroids, and antihistamines. Conclusion Constipation is associated with a significantly risk factor of AD. Clinicians should be careful of the possibility of AD in constipated people. Further study is warranted to investigate the possible pathological mechanisms of this relationship.