Pregnancy outcome of women in the vicinity of nuclear power plants in Taiwan

[[abstract]]The purpose of the study was to investigate whether proximity to nuclear power plants may increase the risk of abnormal pregnant outcomes among the resident women. In this ecological study, data were used from the Health Services Birth Reports Database established by the Bureau of Health Promotion, National Department of Health, Taiwan, in 2001-2004. Chi-square-tests were carried out to investigate the "Plant-vicinity" and "Non plant-vicinity" group in terms of pregnancy outcome. Additionally, logistic regression was performed to investigate whether residence in the vicinity of a nuclear power plant was related to any abnormal pregnancy results. Based on data from 5,679 included subjects, no difference was observed between pregnancy outcomes of the "Plant-vicinity" and "Non plant-vicinity" groups. After accounting for possible confounders, the adjusted odds ratios were 1.20 (95% CI = 0.56-2.56) for stillbirth, 1.21 (95% CI = 0.95-1.53) for premature birth, 1.04 (95% CI = 0.79-1.37) for low birth weight, and 1.58 (95% CI = 0.85-2.93) for congenital deficiencies, respectively, when comparing the "Plant-vicinity" with the "Non plant-vicinity" group. The results of the study indicate that residence in the vicinity of a nuclear power plant is not a significant factor which will cause abnormal health situations during pregnancy

Associations between COVID-19 outcomes and asthmatic patients with inhaled corticosteroid

Background: The impact of inhaled corticosteroid (ICS) in the interaction between asthma, COVID-19 and COVID-19 associated outcomes remain largely unknown. The objective of this study is to investigate the risk of COVID-19 and its related outcomes in patients with asthma using and not using inhaled corticosteroid (ICS).Methods: We used the TriNetX Network, a global federated network that comprises 55 healthcare organizations (HCO) in the United States, to conduct a retrospective cohort study. Patients with a diagnosis of asthma with and without ICS between January 2020 and December 2022 were included. Propensity score matching was used to match the case cohorts. Risks of COVID-19 incidence and medical utilizations were evaluated.Results: Out of 64,587 asthmatic patients with ICS and without ICS, asthmatic patients with ICS had a higher incidence of COVID-19 (Hazard ratio, HR: 1.383, 95% confidence interval, CI: 1.330–1.437). On the contrary, asthmatic patients with ICS revealed a significantly lower risk of hospitalization (HR: 0.664, 95% CI: 0.647–0.681), emergency department visits (HR: 0.774, 95% CI: 0.755–0.793), and mortality (HR:0.834, 95% CI:0.740–0.939). In addition, subgroup or sensitivity analyses were also conducted to examine the result of different vaccination status, disease severity, or COVID-19 virus variants.Conclusion: For asthmatic patients using ICS, risk of COVID-19 was significantly higher than non-users. The observed association could provide potential guidance for primary care physicians regarding the risk of COVID-19 in asthmatic patients

Prescription patterns for tuberculosis treatment and adherence to treatment guidelines: a population-based study in Taiwan

[[abstract]]Purpose Tuberculosis is a health threat in Taiwan. Previous research is mainly focused on patients' compliance, and research on medicines prescribed by physicians is limited. This study endeavors to present the prescription patterns of Tuberculosis treatment and its adherence to the guidelines. Methods Newly diagnosed Tuberculosis patients in 2008 were selected from the National Health Insurance claims database. We divided prescriptions into standard prescriptions, non‐standard prescriptions, and second‐line medicines on the basis of the fourth edition of Taiwan's guidelines for the diagnosis and treatment of Tuberculosis. We first described the distribution of these prescriptions of TB regimen in the first 2 months among the new patients. Furthermore, a graphical presentation was used to visualize physician's complex prescription behavior. Results In total, 11,164 patients were included in this analysis; 28,291 prescriptions were prescribed during the first 2 months after diagnosis. Among these prescriptions, 53.34% were standard prescriptions, 45.81% were non‐standard prescriptions, and 0.84% were second‐line medicines. Prescribing medicines for 28 days at the first visit was the most common scenario. Approximately 35 patterns can be derived from the prescriptions in Taiwan. Conclusions The prescriptions suggested in the guideline are considered to have better therapeutic effects. However, this study revealed that approximately 55% prescriptions adhered to the regimen recommended by the guidelines. The Pharmacoepidemiology and Drug Safety results of this study can help to explore possible reasons to the poor control of the disease. Copyright © 2014 John Wiley & Sons, Ltd

Construct a needs-based formula to allocate regional ambulatory global budgets

[[abstract]]Scarcity is the mother of allocation. Therefore, allocating healthcare resources to satisfy need is always a persistent challenge for health policy planners. The principle of distribution according to need has gained generally recognition in the health care field. The purpose of present study is to construct a needs-based formula to allocate regional ambulatory budget of National Health Insurance in Taiwan. The results can provide some evidences to modify the existing allocating mechanism for the best interest.We defined health need from preventive and treatment dimensions. According to the subjects and frequency of preventive services currently covered by National Health Insurance, we calculated preventive health need based on the geographic popularity in six medical regions. Using National Health Insurance claim data, we present regional morbidity rates and national average expenditures by diseases, gender-age groups to demonstrate the treatment health need of popularity in six regions. The study results showed that people in six medical regions have different health needs with unique health problems. Needs-based allocations and the actual declared expenditures were significantly different. Needs-based allocations ranged from 9.18% higher than actual expenditures in Kaoping Division to 9.13% lower in Northern Division. It reveals that current mechanism to allocate ambulatory global budget under the national health insurance system does not reflect the rational situation based on health needs.The contents of the resource allocation formula should be tested or amend over time. Establishing health policies to meet the needs of the local people, and rationing resource according to health needs would improve equity in the distribution of healthcare services and result in an achievement of goals that everyone can enjoy the highest level of health

Evaluation of Prevention and Control measures of SARS in Taiwan

[[abstract]]This study focuses on the prevention and control measures of SARS in Taiwan. The following four criteria: effectiveness, efficiency, equity and responsiveness are applied to Resource Mobilization, Quarantine, Medical Care and Health Education four dimensions. Under each criterion, concrete indicators were built so as to evaluate the nation?s epidemic control of SARS. The evaluation of the studied subject, dated from March 14,2003 to July 5, 2003, is conducted with the indicator approach of the policy evaluation method. Results? 1. Mobilization of medical resources: The essential infection control supplies are facilitated mainly in medical centers and regional hospitals or areas around Taipei and Kao-Ping branch of Bureau of National Health Insurance. The provision failed not only to reach an ample amount but also to be distributed fairly according to the hospitalizing and spreading of the probable SARS cases. The setup of the SARS referral hospitals wasn?t carried out efficiently. The public generally considered the mobilization should?ve been speeded up. 2. Isolation and infection control: The management and supervision of people under home quarantine worked poorly. The regulation-adjusted measures for arrival have already perverted justice. Though the public was positive to the policy actions, our society still paid dearly. However, the cost-benefit is not analyzed in this study. 3. Measures for health care: Our nation?s response to the crisis was under the public?s expectation as compared with other affected areas. The Fever Screening Centers functioned properly. Hospitals which joined in the prevention and control of SARS, were constituted only 24.09% of the nation?s. The medical resource was not utilized efficiently. The islanders haven?t been provided with equal medical attention. The media?s opinions of healthcare workers diverged but the public is positive of their contribution. 4. Public health education: Ten to twenty percent of the general public did not aware about the conducting lectures of SARS and started to lose their confidence in the promotional materials in May. The different spoken languages in Taiwan were greatly considered when providing guidelines and recommendations. The government coordinated with the media to make public announcements to promote SARS awareness in the relatively early stage. This study provided a framework and indicators for epidemic control, to apply in the nation?s prevention and control measures of SARS evaluation. The following suggestions are advanced for a better epidemic control: 1. A specific and neutral unit should be designed to provide an overall evaluation when encountering heath issues nationwide. 2.Work out an effective mechanism of determining the administrative level activation when any health issue occurs. 3. Set up a single organ to be responsible to make the distribution of medical resources uniform throughout the country. 4. Reexamine the funds for prevention and control of SARS and bring forward the report of spending and the result. 5. Establish a mechanism to collect and preserve data concerning the epidemic control systematically. 6. Adopt the system of hospital assessment to strengthen the infection control in hospitals. 7. Build up a disease-prevention pamphlet to take necessary precautions

Cancer incidence in the vicinity of nuclear power plants in Taiwan: A population-based study

[[abstract]]Numerous antinuclear demonstrations reveal that the public is anxious about the potential health effects caused by nuclear power plants. The purpose of this study is to address the question “Is there a higher cancer incidence rate in the vicinity of nuclear power plants in Taiwan?” The Taiwan Cancer Registry database from 1979 to 2003 was used to compare the standardized incidence rate of the top four cancers with strong evidence for radiation risks between the “plant-vicinity” with those “non-plant-vicinity” groups. All cancer sites, five-leading cancers in Taiwan, and gender-specific cancers were also studied. We also adopted different observation time to compare the incidence rate of cancers between two groups to explore the impact of the observation period. The incidences of leukemia, thyroid, lung, and breast cancer were not significantly different between two groups, but cervix uteri cancer showed higher incidence rates in the plant-vicinity group. The incidence of cervical cancer was not consistently associated with the duration of plant operation, according to a multiyear period comparison. Although there was higher incidence in cervix cancer in the plant-vicinity group, our findings did not provide the crucial evidence that nuclear power plants were the causal factor for some cancers with strong evidence for radiation risks

Pregnancy Outcome of Women in the Vicinity of Nuclear Power Plants in Taiwan

The purpose of the study was to investigate whether proximity to nuclear power plants may increase the risk of abnormal pregnant outcomes among the resident women. In this ecological study, data were used from the Health Services Birth Reports Database established by the Bureau of Health Promotion, National Department of Health, Taiwan, in 2001- 2004. Chi- square-tests were carried out to investigate the " Plant-vicinity" and " Non plant-vicinity" group in terms of pregnancy outcome. Additionally, logistic regression was performed to investigate whether residence in the vicinity of a nuclear power plant was related to any abnormal pregnancy results. Based on data from 5,679 included subjects, no difference was observed between pregnancy outcomes of the "Plant-vicinity" and "Non plant -vicinity" groups. After accounting for possible confounders, the adjusted odds ratios were 1.20 (95% CI = 0.56-2.56) for stillbirth, 1.21 (95% CI = 0.95-1.53) for premature birth, 1 .04 (95% CI = 0.79-1.37) for low birth weight, and 1.58 (95% CI = 0.85-2.93) for congenital deficiencies, respectively, when comparing the "Plant-vicinity" with the "Non plant- vicinity" group. The results of the study indicate that residence in the vicinity of a nuclear power plant is not a significant factor which will cause abnormal health situations during pregnancy

Prescription patterns for tuberculosis treatment and adherence to treatment guidelines: a population-based study in Taiwan

[[abstract]]Purpose: Tuberculosis is a health threat in Taiwan. Previous research is mainly focused on patients' compliance, and research on medicines prescribed by physicians is limited. This study endeavors to present the prescription patterns of Tuberculosis treatment and its adherence to the guidelines. Methods: Newly diagnosed Tuberculosis patients in 2008 were selected from the National Health Insurance claims database. We divided prescriptions into standard prescriptions, non-standard prescriptions, and second-line medicines on the basis of the fourth edition of Taiwan's guidelines for the diagnosis and treatment of Tuberculosis. We first described the distribution of these prescriptions of TB regimen in the first 2 months among the new patients. Furthermore, a graphical presentation was used to visualize physician's complex prescription behavior. Results: In total, 11,164 patients were included in this analysis; 28,291 prescriptions were prescribed during the first 2 months after diagnosis. Among these prescriptions, 53.34% were standard prescriptions, 45.81% were non-standard prescriptions, and 0.84% were second-line medicines. Prescribing medicines for 28 days at the first visit was the most common scenario. Approximately 35 patterns can be derived from the prescriptions in Taiwan. Conclusions: The prescriptions suggested in the guideline are considered to have better therapeutic effects. However, this study revealed that approximately 55% prescriptions adhered to the regimen recommended by the guidelines. The Pharmacoepidemiology and Drug Safety results of this study can help to explore possible reasons to the poor control of the disease

Outpatient-Shopping Behavior and Survival Rates in Newly Diagnosed Cancer Patients

[[abstract]]Objectives: To evaluate the appropriateness of the definition of outpatient-shopping behavior in Taiwanese patients. Study Design: Linked study of 3 databases (Taiwan Cancer Registry, National Health Insurance [NHI] claim database, and death registry database). Methods: Outpatient shopping behavior was defined as making at least 4 or 5 physician visits to confirm a cancer diagnosis. We analyzed patient-related factors and the 5-year overall survival rate of the outpatient-shopping group compared with a nonshopping group. Using the household registration database and NHI database, we determined the proportion of outpatient shopping, characteristics of patients who did and did not shop for outpatient therapy, time between diagnosis and start of regular treatment, and medical service utilization in the shopping versus the nonshopping group. Results: Patients with higher incomes were significantly more likely to shop for outpatient care. Patients with higher comorbidity scores were 1.4 times more likely to shop for outpatient care than patients with lower scores. Patients diagnosed with more advanced cancer were more likely to shop than those who were not. Patients might be more trusting of cancer diagnoses given at higher-level hospitals. The nonshopping groups had a longer duration of survival over 5 years. Conclusions: Health authorities should consider charging additional fees after a specific outpatient- shopping threshold is reached to reduce this behavior. The government may need to reassess the function of the medical sources network by shrinking it from the original 4 levels to 2 levels, or by enhancing the referral function among different hospital levels