Household out-of-pocket medical expenditures and national health insurance in Taiwan: income and regional inequality

BACKGROUND: Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income. METHODS: Data used in this study were drawn from the 1994 and 1996 Surveys of Family Income and Expenditure. We pooled the data from 1994 and 1996 and included a year dummy variable (NHI), equal to 1 if the household data came from 1996 in order to assess the impact of NHI on household out-of-pocket medical care expenditures shortly after its implementation in 1995. RESULTS: An individual who was older, female, married, unemployed, better educated, richer, head of a larger family household, or living in the central and eastern areas was more likely to have greater household out-of-pocket medical expenditures. NHI was found to have effectively reduced household out-of-pocket medical expenditures by 23.08%, particularly for more affluent households. With the implementation of NHI, lower and middle income quintiles had smaller decreases in out-of-pocket medical expenditure. NHI was also found to have reduced household out-of-pocket medical expenditures more for households in eastern Taiwan. CONCLUSION: Although NHI was established to create free medical care for all, further effort is needed to reduce the medical costs for certain disadvantaged groups, particularly the poor and aborigines, if equality is to be achieved

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A preliminary report for the touring base model evaluation of the children with developmental delay in Kinmen

Background: The purpose of this study was to analyze the characteristics of the children with developmental delays (DDs) in Kinmen. The methods of evaluation for the children with DDs were also discussed as references for other rural areas in Taiwan. Materials and Methods: There were 73 children recruited into our study in 2003 while starting the project of early evaluation for children with DDs in Kinmen. All the children were classified into 6 functional delay groups: Cognitive, speech, motor, social/emotional, pervasive, and nonspecific DDs. Results: Speech DD (46.7%) was the most frequently seen in all types of DDs. The second was the motor DD type (34.7%). Both the cognitive and pervasive types were the third frequent types of DDs (25.3%). It was shown that the speech DD types were the most frequently seen both in Taiwan and Kinmen, but the motor DD type was more frequent in Kinmen than in Taiwan. Conclusions: Our findings suggested that there are various factors related to the types of DDs. This result of our study could provide the future directions of the early evaluation program for the children with DD in rural areas

Factors associated with PTSD symptoms and quality of life among nurses during the COVID-19 pandemic: A cross-sectional study.

BackgroundHealthcare workers, especially nurses, were one of the most vulnerable groups for developing posttraumatic stress disorder (PTSD) during the coronavirus disease 2019 (COVID-19) pandemic, which also affected their quality of life. However, only limited research has investigated the individual psychological factors as well as the environmental factors responsible for these effects of the pandemic. Demoralization is a state of loss of meaning and anhedonia, which we thought to be an important mediator between fear and PTSD among frontline nurses during the pandemic. This study aimed to explore the role of demoralization in the mechanisms of posttraumatic stress symptoms of nurses facing different infection risks and influencing factors on their well-being.MethodA cross sectional study was conducted from September 16, 2021 to October 8, 2021 in a medical center in Northern Taiwan. Online questionnaires were used to collect data, including age, sex, vaccination status, working years, previous quarantine experiences, psychiatric history, traumatic events and scales for measuring fear of COVID-19, demoralization, symptoms of posttraumatic stress, depression, anxiety and stress, burnout level, teamwork performance and quality of life. Hierarchical regression analysis and mediation analysis were utilized to identify associated risk factors and mechanisms.ResultAmong 351 included nurses, 148 worked in high-risk areas directly exposed to COVID-19 patients or patients with respiratory symptoms, while 203 nurses worked in low-risk areas. Overall, nurses in the low-risk group had greater fear of COVID-19, and greater demoralization and burnout level, along with poorer teamwork and quality of life. Demoralization was found to have mediating effect in both the high-risk group and low-risk group on the relationships between fear of COVID-19 and posttraumatic stress symptoms. Levels of burnout and teamwork may serve as mediators between depression, anxiety, stress and quality of life.ConclusionHospital-based nurses appear to be at high risk for developing posttraumatic stress disorder during the COVID-19 pandemic. Study findings demonstrated specific associated factors that should be the focus of nursing administration and hospital management while employing preventive measures, psychological resilience of nurses or systematic managements. Future longitudinal research is needed to improve management in pandemic conditions

Psychometric Properties of the Chinese Version of the Adult Adhd Self- Report Scale

Although attention deficit/hyperactivity disorder (ADHD) in adulthood has become a topic of considerable interest to psychiatrists over the past decade, little is known about the prevalence or correlates of adult ADHD in the Chinese population. As a first step in addressing this problem, this study presents data on the psychometric properties of the Chinese version of the World Health Organization's Adult ADHD Self-report Scale ( ASRS) in a sample of 1031 young males from an army base and 3298 young adults from two colleges. All participants completed the Chinese ASRS. Participants from an army base also completed a clinical assessment including the Wender Utah Rating Scale (WURS) for assessing childhood ADHD , the Impulsiveness Scale for measuring the severity of current impulsive behaviors, and information about substance use. Results showed good concordance (intraclass correlations = 0.80 similar to 0.85) and internal consistency (Cronbach's alpha = 0.83 similar to 0.91) among the ASRS subscales and moderate to high correlations between these subscales and the WURS (Pearson's correlations = 0.37 similar to 0.66). The Chinese ASRS also demonstrated the ability to predict childhood disruptive problems and habitual use of substances. Our findings suggest that the Chinese ASRS is a reliable and valid instrument to assist in screening for adult ADHD. Copyright( C) 2008 John Wiley & Sons, Ltd

Optimal Expansion Of A Coastal Wastewater Treatment And Ocean Outfall System Under Uncertainty (Ii): Optimisation Analysis

This paper presents an integrated simulation-optimisation assessment of the various physical, chemical, and microbiological processes that determine the transport and fate of key constitutes associated with coastal wastewater treatment and disposal effluents in coastal environments. The well-calibrated and validated ocean mixing simulation model - Cornell mixing zone expert system (CORMIX) - was employed in the first stage as an indispensable tool to simulate the initial dilution factor with respect to two major water quality indicators, biochemical oxygen demand (BOD) and Escherichia coli. The CORMIX outputs, which were obtained in a companion study, were used as the inputs in both deterministic and chanceconstraint based stochastic programming models to evaluate a few alternatives for system planning and design. Such integration allowed the identification of the optimal expansion strategies for a large-scale coastal wastewater treatment and ocean outfall system in the city of Kaohsiung, South Taiwan. Research findings clearly indicate that the original alternative proposed by the city government, which had planned on upgrading the wastewater treatment process directly from the primary to the secondary level, is economically undesirable. Given the technology options of primary or enhanced primary treatment, in the most cost-effective expansion strategy, the optimal length of a newly constructed second ocean outfall pipe is no less than 1260m in order to gain sufficient assimilative capacity in the ocean environment.With this strategy, the BOD standards in the ocean environment are met for both Classes B and A types of ocean waters. The reliability of this system design may be assessed by taking the stochastic characteristics of sewerage inflow and diffusion and dispersion processes into consideration. Such an optimisation analysis could eventually lead to considerable cost savings of up to 75% when compared to the original, officially favoured alternative. © 2011 Taylor & Francis