Assessment of Changes in Knowledge and Stigmatization Following Tuberculosis Training Workshops in Taiwan

Background/PurposeThere is little understanding of the depth of knowledge of health workers involved in tuberculosis (TB) control programs, and even less is known about health workers attaching stigma to TB patients. This study surveyed health workers enrolled in TB training workshops prior to the execution of the directly observed treatment, short course (DOTS) program.MethodsAll participants attended the training course and completed structured questionnaires before (pre-test) and after training (post-test). The questionnaires were collected immediately following completion and the scores were analyzed.ResultsPair comparison of knowledge scores revealed that all participants made statistically significant improvements in level of TB knowledge, except those who had a history of TB (p = 0.331). Pair comparison of stigmatization scores revealed a reduction in stigmatization, with the DOTS workers attaching less stigma to TB patients. After training, caregivers, including women (p = 0.012), public health workers (p = 0.028), 40–49-year-old subjects (p = 0.035), those with an education of < 12 years (p = 0.024), those who had been a volunteer (p = 0.018), and those who had a history of TB and those who did not (p = 0.034, p = 0.036), were significantly less likely to stigmatize patients. TB knowledge was not found to be significantly correlated with stigmatization (pre-test, p = 0.298; post-test, p = 0.821).ConclusionTraining workshops in TB control were effective for promotion of knowledge and elimination of stigmatization in first-line caregivers. DOTS workers attached less stigma to TB patients than public health workers, and older workers who had been volunteers attached the least stigma

The Incidence, Risk Factors and Consequences of Falling Injury among the Community Elderly in Shihpai, Taiwan=台灣石牌社區老人跌傷發生率危險因子及 其後果

Background and aims: Falls causing injuries among older people and the consequences of those injuries are of increasing concern to public health practitioners. The aims of this study were to determine the incidence, characteristics and risk factors of fall injuries among the community- dwelling elderly in Shihpai, Taiwan; the impact on quality of life and health service utilization was also comprehensively studied. Methods: 1361 community-dwelling elderly who had been enrolled in the Shihpai eye study (1999 -2000) were included. Subjects were interviewed and examined by trained interviewers, and data such as demographics, medical conditions, blood pressure, ophthalmic examination, fall history and quality of life ( SF-36) were collected. Chi -square tests, analyses of covariance and multiple logistic regressions were performed as the main statistical methods. Results: The mean age of the participants was 72.2 (range, 65-91) years old. 16.3% of the elderly persons interviewed had experienced at least one fall; among those, up to 50% had suffered mild injuries, and the incidence of remarkable injury was 27.6%. There were no significant differences in the location or time of falling, but there were different risk factors and consequences in injury severity. Fallers with remarkable injuries had a higher incidence of hospitalization and a greater fear of falling. No statistically significant decline in quality of life with increasing severity of falling injury was identified after a 12-month follow-up period. Conclusions: Gender, visual impairment and orthostatic hypotension were identified as the major risk factors of fall injuries in the elderly. These factors should be emphasized in order to reduce fall injuries in geriatrics

Testing the “Epidemiologic Paradox” of Birth Outcomes Among Asian Immigrant Women in Hsin-Chu County, Taiwan

Taiwan saw an increase in immigration during the last decade. This retrospective study investigated whether immigrant status confers a protective effect on birth outcomes and whether this effect varies across racial/ethnic subgroups in Hsin-Chu County, Taiwan. Methods: A total of 30,770 singleton birth certificates from January 1, 2002 to July 31, 2007 were analyzed using ANOVA and logistic regression. Outcomes included low birth weight (LBW, 4000 g), preterm birth (< 37 weeks) and stillbirth. Covariates included maternal age, year of delivery, mode of delivery, medical care institution, infant sex and congenital birth defects. Five models were designed for various analyses. The reference categories included non-immigrant, non-aboriginal Taiwanese and non-Chinese-speaking immigrants. Results: Preterm rate ranged from 6.3% among mainland Chinese to 13.5% among aboriginal Taiwanese. LBW rate ranged from 4.3% among mainland Chinese to 17.3% among aboriginal Taiwanese. HBW rate ranged from 1.2% among aboriginal Taiwanese to 3.4% among mainland Chinese. Stillbirth rate ranged from 0.2% among Indonesians to 0.7% among aboriginal Taiwanese. Adjusted odds ratio (OR) was lower among mainland Chinese (preterm OR, 0.77; LBW OR, 0.62) but higher among aboriginal Taiwanese (preterm OR, 1.79; LBW OR, 2.68; stillbirth OR, 2.92). HBW rate was significantly higher (OR, 1.84) among mainland Chinese. Chinese-speaking immigrants showed significant differences in LBW (OR, 0.57) and HBW (OR, 1.62) compared with non-Chinese-speaking immigrants. Conclusion: An epidemiologic paradox and heterogeneity of birth outcomes were observed among immigrants in this study. However, aboriginal Taiwanese constituted the subgroup with the highest risk. Further research is needed to identify the determinants of birth outcomes

Comparison of the implementation of extra root canal treatment before and after fee schedule change in the Taiwan National Health Insurance System

Background/purpose: Endodontic treatment success depends on treatment of all root canals, but the implementation status is affected by various factors. We examined whether the fee payment change affected the extra root canal endodontic treatment (EXRCT) in adult teeth in the National Health Insurance (NHI) system of Taiwan since 2008. The effect of hospital level, sex, and age on EXRCT was also examined. Materials and methods: Two longitudinal health insurance databases for 2005 and 2010 were used. Excluding third molars and endodontic retreatment, the EXRCT rate in permanent dentition were compared for different tooth positions, hospital levels, sex and age between 2005 and 2010. Results: In total, 80,995 teeth in 2005 and 76,018 in 2010 underwent root canal filling. The rate of EXRCT increased markedly from 2005 to 2010, particularly for the upper first molar (1.84% to 3.18%), lower first premolar (3.45% to 4.58%), lower first molar (12.4% to 18%), and lower second molar (0.95% to 1.87%). The difference between 2005 and 2010 remained statistically significant after adjustment for hospital level, sex, and age. The lower second molar had the highest adjusted odds ratio for the difference between 2005 and 2010 (1.99; CI: 1.49–2.66), followed by the upper first molar (1.91; CI: 1.55–2.35), lower first molar (1.60; CI: 1.47–1.75), and lower first premolar (1.38; CI: 1.11–1.72). Conclusion: The payment change of Taiwan NHI seems to encourage the use of EXRCT in molars. Hospital level, sex, and age also affected the rate of EXRCT

Comorbidity as a mediator of depression in adults with congenital heart disease: A population-based cohort study

BACKGROUND: The population of adults with congenital heart disease (CHD) has increased dramatically with a high prevalence of acquired cardiac and non-cardiac comorbidities. However, the relationship among congenital heart disease, physical comorbidities, and psychological health in this population is not well studied. AIMS: The purpose of this study was to investigate (a) the association between adult congenital heart disease and the occurrence of depression and (b) whether physical comorbidities mediated the association between congenital heart disease and the occurrence of depression. METHODS: This retrospective cohort study was followed from 1 January 2010-31 December 2013, based on the data from the National Health Insurance Research Database 2010 in Taiwan. We used mediation analysis in survival data to assess the mediated effect. The hazard ratios were adjusted by age, sex, area of residence, and estimated propensity scores. RESULTS: We recruited 2122 adult congenital heart disease patients and 8488 matched controls. Nearly half of patients diagnosed with simple congenital heart disease, 39.0% had complex congenital heart disease, and 11.2% had unclassified congenital heart disease. Adult congenital heart disease patients had a significantly higher risk of depression than matched controls (adjusted hazard ratio = 1.43 and 1.48, for all and complex congenital heart disease, respectively, p<0.05). Coronary artery disease and chronic obstructive pulmonary disease were the significant comorbidities mediating the relationship between adult congenital heart disease and depression, the proportions mediated by coronary artery disease or chronic obstructive pulmonary disease were 35.5% and 12.9%, respectively. CONCLUSIONS: Helping patients to prevent psychological and physical acquired disease is imperative. Coronary artery disease is a potent mediator between congenital heart disease and depression, especially for patients with complex congenital heart disease.status: publishe