The Utilization of Rehabilitation in Patients with Hemophilia A in Taiwan: A Nationwide Population-Based Study

<div><p>Introduction</p><p>Rehabilitation plays an important role in the physical health of patients with hemophilia. However, comprehensive information regarding the utilization of rehabilitation for such patients remains scarce.</p><p>Aim</p><p>This population-based study aimed to examine the characteristics, trends, and most important factors affecting rehabilitation usage in patients with hemophilia A using a nationwide database in Taiwan.</p><p>Methods</p><p>Data from 777 patients with hemophilia A who were registered in the National Health Insurance Research Database between 1998 and 2008 were analyzed using SAS 9.0.</p><p>Results</p><p>Musculoskeletal or nervous system-related surgical procedures and clotting factor VIII concentrate costs were identified as factors affecting rehabilitation usage; musculoskeletal or nervous system-related surgical procedures (odds ratio = 3.788; P < 0.001) were the most important predictor of whether a patient with hemophilia A would use rehabilitation services. Joint disorders, arthropathies, bone and cartilage disorders, intracranial hemorrhage, and brain trauma were common diagnoses during rehabilitation use. The costs of physical therapy (physiotherapy) comprised the majority (71.2%) of rehabilitation therapy categories. Increasingly, rehabilitation therapy was performed at physician clinics. The total rehabilitation costs were <0.1% of the total annual medical costs.</p><p>Conclusion</p><p>Musculoskeletal or nervous system-related surgical procedures and increased use of clotting factor VIII concentrate affect the rehabilitation utilization of patients with hemophilia A the most. The findings in this study could help clinicians comprehensively understand the rehabilitation utilization of patients with hemophilia A.</p></div

Logistic regression analysis of factors that might affect rehabilitation usage in patients with hemophilia A.

<p>Logistic regression analysis of factors that might affect rehabilitation usage in patients with hemophilia A.</p

Distributions of total number of hemophilia A cases and number of rehabilitation users in terms of the number of rehabilitation therapy sessions received.

<p>Distributions of total number of hemophilia A cases and number of rehabilitation users in terms of the number of rehabilitation therapy sessions received.</p

Patient selection flow chart.

<p>Patient selection flow chart.</p

Annual rehabilitation costs and total medical costs in patients with hemophilia A from 1998 to 2008.

<p>Annual rehabilitation costs and total medical costs in patients with hemophilia A from 1998 to 2008.</p

Individual characteristics according to variables in patients with hemophilia A from 1998 to 2008.

<p>Individual characteristics according to variables in patients with hemophilia A from 1998 to 2008.</p

Adjusted odds ratios and confidence intervals of probiotic supplement use.

†<p>Reference group.</p>*<p><i>P</i><0.05.</p>**<p><i>P</i><0.01.</p>***<p><i>P</i><0.001.</p

Probiotic supplement use according to different characteristic variables.

<p><i>P</i><0.05 is significantly different.</p

Predictors of probiotic supplement usage between 7 and 18 months.

†<p>Reference group.</p>*<p><i>P</i><0.05.</p>**<p><i>P</i><0.01.</p>***<p><i>P</i><0.001.</p

Increased Risk of Urinary Tract Cancer in ESRD Patients Associated with Usage of Chinese Herbal Products Suspected of Containing Aristolochic Acid

<div><p>Introduction</p><p>Both end-stage renal disease (ESRD) and urothelial cancer (UC) are associated with the consumption of Chinese herbal products containing aristolochic acid (AA) by the general population. The objective of this study was to determine the risk of UC associated with AA-related Chinese herbal products among ESRD patients.</p><p>Methods</p><p>We conducted a cohort study using the National Health Insurance reimbursement database to enroll all ESRD patients in Taiwan from 1998–2002. Cox regression models were constructed and hazard ratios and confidence intervals were estimated after controlling for potential confounders, including age, sex, residence in region with endemic black foot disease, urinary tract infection, and use of non-steroidal anti-inflammatory drugs and acetaminophen.</p><p>Results</p><p>A total of 38,995 ESRD patients were included in the final analysis, and 320 patients developed UC after ESRD. Having been prescribed Mu Tong that was adulterated with Guan Mu Tong (<i>Aristolochia manshuriensis</i>) before 2004, or an estimated consumption of more than 1–100 mg of aristolochic acid, were both associated with an increased risk of UC in the multivariable analyses. Analgesic consumption of more than 150 pills was also associated with an increased risk of UC, although there was little correlation between the two risk factors.</p><p>Conclusion</p><p>Consumption of aristolochic acid-related Chinese herbal products was associated with an increased risk of developing UC in ESRD patients. Regular follow-up screening for UC in ESRD patients who have consumed Chinese herbal products is thus necessary.</p></div