{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T17:43:42Z","timestamp":1765734222325,"version":"3.48.0"},"reference-count":28,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,4,30]]},"published-print":{"date-parts":[[2014,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the utilisation of eye disorder-related ambulatory medical services prior to the diagnosis of primary Sj\u00f6gren's syndrome in female Taiwanese patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A nationwide, population-based case\u2013control study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Taiwan's National Health Insurance Research Database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 347 patients with a diagnosis of primary Sj\u00f6gren's syndrome from 2005 to 2010 and 1735 controls frequency matched on 10-year age interval and index year were identified from Taiwan's National Health Insurance Research Database. Diagnoses of eye disorder (International Classification of Diseases, Ninth Revision, clinical modification (ICD-9-CM) codes from 360 to 370) were retrospectively screened to 1997.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measure<\/jats:title>\n                    <jats:p>The utilisation of eye disorder-related medical service over different intervals prior to diagnosis of Sj\u00f6gren's syndrome between cases and controls were compared using generalised estimating equations with negative binomial distribution and log link function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A significantly higher proportion of patients with Sj\u00f6gren's syndrome (7.5%) utilised eye disorder-related ambulatory medical services over an 8-year interval prior to the diagnosis of the disease compared with controls (4.8%). The annual frequency of utilisation of eye disorder-related ambulatory medical services increased significantly faster when closer to the index date in patients with Sj\u00f6gren's syndrome compared with controls (interaction effect, p=0.010). Subgroup analyses indicated that the changes over time in the utilisation of services related to disorders of lacrimal system (interaction effect, p=0.019) and conjunctiva (interaction effect, p=0.066) were significantly greater in patients with Sj\u00f6gren's syndrome compared with controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An increase in the utilisation of eye disorder-related ambulatory medical services was observed in patients with Sj\u00f6gren's syndrome several years prior to the diagnosis of the disease. General practitioners and ophthalmologists can play an important role by including Sj\u00f6gren's syndrome in the diagnostic evaluation of their patients afflicted with relevant symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2013-003862","type":"journal-article","created":{"date-parts":[[2014,5,21]],"date-time":"2014-05-21T01:35:36Z","timestamp":1400636136000},"page":"e003862","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Increased utilisation of eye disorder-related ambulatory medical services prior to the diagnosis of Sj\u00f6gren's syndrome in female patients: a longitudinal population-based study in Taiwan"],"prefix":"10.1136","volume":"4","author":[{"given":"Ming-Chi","family":"Lu","sequence":"first","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan"},{"name":"School of Medicine, Tzu Chi University, Hualien, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Hsiung","family":"Fa","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien, Taiwan"},{"name":"Department of Ophthalmology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzung-Yi","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan"},{"name":"Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan"},{"name":"Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9242-9167","authenticated-orcid":false,"given":"Malcolm","family":"Koo","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan"},{"name":"Dalla Lana School of Public Health, University of Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ning-Sheng","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan"},{"name":"School of Medicine, Tzu Chi University, Hualien, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,5,20]]},"reference":[{"key":"2025121409402525000_4.5.e003862.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2008.05.016"},{"key":"2025121409402525000_4.5.e003862.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2011.01.030"},{"key":"2025121409402525000_4.5.e003862.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.05.029"},{"key":"2025121409402525000_4.5.e003862.4","doi-asserted-by":"crossref","first-page":"285851","DOI":"10.1155\/2012\/285851","article-title":"The role of medications in causing dry eye","volume":"2012","author":"Fraunfelder","year":"2012","journal-title":"J Ophthalmol"},{"key":"2025121409402525000_4.5.e003862.5","doi-asserted-by":"publisher","DOI":"10.1016\/S1542-0124(12)70081-2"},{"key":"2025121409402525000_4.5.e003862.6","first-page":"533","article-title":"Ocular manifestations of systemic inflammatory diseases","volume":"76","author":"Mohsenin","year":"2012","journal-title":"Conn Med"},{"key":"2025121409402525000_4.5.e003862.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e3821"},{"key":"2025121409402525000_4.5.e003862.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1834-7819.2010.01197.x"},{"key":"2025121409402525000_4.5.e003862.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(98)98033-2"},{"key":"2025121409402525000_4.5.e003862.10","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2012-301767"},{"key":"2025121409402525000_4.5.e003862.11","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-007-8008-3"},{"key":"2025121409402525000_4.5.e003862.12","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/j.ophtha.2010.12.016","article-title":"Treatment of Sj\u00f6gren's syndrome-associated dry eye an evidence-based review","volume":"118","author":"Akpek","year":"2011","journal-title":"Ophthalmology"},{"key":"2025121409402525000_4.5.e003862.13","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1097\/ICU.0b013e32833a8c15","article-title":"Impact of dry eye disease and treatment on quality of life","volume":"21","author":"Friedman","year":"2010","journal-title":"Curr Opin Ophthalmol"},{"key":"2025121409402525000_4.5.e003862.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.2010.01993.x"},{"key":"2025121409402525000_4.5.e003862.15","unstructured":"Bureau of National Health Insurance. National Health Insurance in Taiwan. 2012\u20132013 Annual Report. http:\/\/www.nhi.gov.tw\/resource\/Webdata\/22955_1_NHI_2012\u20132013%20ANNUAL%20REPORT.pdf (accessed 25 Feb 2014)."},{"key":"2025121409402525000_4.5.e003862.16","unstructured":"Directorate General of Budget, Accounting and Statistics, Executive Yuan, Republic of China. Statistical Yearbook of Republic of China 2011. Insured persons of social insurance. http:\/\/eng.stat.gov.tw\/public\/data\/dgbas03\/bs2\/yearbook_eng\/y087.pdf (accessed 25 Feb 2014)."},{"key":"2025121409402525000_4.5.e003862.17","unstructured":"Directorate General of Budget, Accounting and Statistics, Executive Yuan, Republic of China. Statistical Yearbook of Republic of China 2011. Population by sex, rate of population increase, average persons per household, density and natural increase rate. http:\/\/eng.stat.gov.tw\/public\/data\/dgbas03\/bs2\/yearbook_eng\/y008.pdf (accessed 25 Feb 2014)."},{"key":"2025121409402525000_4.5.e003862.18","unstructured":"National Health Insurance Research Database, Taiwan. http:\/\/nhird.nhri.org.tw\/en\/index.htm (accessed 25 Feb 2014)."},{"key":"2025121409402525000_4.5.e003862.19","doi-asserted-by":"publisher","DOI":"10.1136\/ard.61.6.554"},{"key":"2025121409402525000_4.5.e003862.20","first-page":"1","article-title":"Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey","volume":"4","author":"Liu","year":"2006","journal-title":"J Health Manag"},{"key":"2025121409402525000_4.5.e003862.21","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-6-54"},{"key":"2025121409402525000_4.5.e003862.22","doi-asserted-by":"crossref","unstructured":"Hardin JW Hilbe JM . Generalized estimating equations. 2nd edn. Boca Raton, FL: Chapman and Hall\/CRC, 2012.","DOI":"10.1201\/b13880"},{"key":"2025121409402525000_4.5.e003862.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2009.09.013"},{"key":"2025121409402525000_4.5.e003862.24","first-page":"53","article-title":"Ophthalmic manifestations of rheumatologic disease: diagnosis and management","volume":"109","author":"Petris","year":"2012","journal-title":"Mo Med"},{"key":"2025121409402525000_4.5.e003862.25","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e31818d3846"},{"issue":"(Suppl 4)","key":"2025121409402525000_4.5.e003862.26","first-page":"S61","article-title":"Prevalence of dry eye syndrome and Sjogren's syndrome in patients with rheumatoid arthritis","volume":"95","author":"Kosrirukvongs","year":"2012","journal-title":"J Med Assoc Thai"},{"key":"2025121409402525000_4.5.e003862.27","doi-asserted-by":"publisher","DOI":"10.3109\/09273948.2011.610023"},{"key":"2025121409402525000_4.5.e003862.28","doi-asserted-by":"publisher","DOI":"10.1002\/acr.21591"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2013-003862","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T17:40:33Z","timestamp":1765734033000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2013-003862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,5]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2014,5,20]]},"published-print":{"date-parts":[[2014,5]]}},"alternative-id":["10.1136\/bmjopen-2013-003862"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2013-003862","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2014,5]]}}}