State Differences in the Reporting of Diabetes-Related Incorrect Cause-of-Death Causal Sequences on Death Certificates

OBJECTIVE To examine state differences in the reporting of diabetes-related incorrect cause-of-death (COD) causal sequences on death certificates in the U.S. RESEARCH DESIGN AND METHODS We conducted a cross-sectional descriptive study to determine the prevalence of two types of incorrect COD causal sequences with data from the Multiple Cause Mortality File of the year 2004. RESULTS Among deaths in which diabetes was reported as the first diagnosis on line a, b, c, or d in Part I of the death certificate in the U.S., 21% had below diabetes placement error (ranged from 30% in Maryland to 7% in Hawaii) and 11% had above diabetes placement error (ranged from 18% in Kentucky to 5% in California). The net effects of the two types of error ranged from −0.7% in Nevada to 19.6% in the District of Columbia. CONCLUSIONS Because the rates of incorrect reporting of diabetes-related COD causal sequence varied across states, the comparability of the diabetes death rate between states may have been compromised

Exploring the Impact of Online Clinical Guidelines on Individual Knowledge Management Behaviors and Individual Net Benefits

Health care is an industry of high knowledge intensity; the knowledge and skills of the medical staff are the key advantages for hospital competitiveness. This research aims to explore how the use of online clinical guidelines influences individual KM behaviors and the net benefits. It investigates the users, including 120 physicians and 80 physician assistants (PAs) who used the online clinical guidelines in a medical center of southern Taiwan. A total of 195 of the 200 questionnaires surveyed including 111 physicians and 70 PA are effective, leading to 97.5% effective response rate.This research uses a structural equation model, partial least squares (PLSs) to verify the research model and hypotheses. The R2 of the overall model is 0.68, which implies good reliability and validity of this model. The results reveal that the use of online clinical guidelines and user satisfactions has positive effects on individual KM behaviors and individual net benefits. Individual KM behaviors have partial effects on the individual net benefits. In addition, there are mediating effects of the individual KM behaviors and user satisfactions on the use of online clinical guidelines and the individual net benefits

Underrecognition and Undertreatment of Atherothrombotic Diseases: Reach Registry Taiwan Baseline Data

Background/Purpose: Atherothrombosis is a generalized disease affecting different vascular beds, making it the leading cause of death worldwide. To evaluate the long-term risk of atherothrombotic risk factors and determine the predictors for atherothrombotic events, an international, prospective, observational study was initiated, in which Taiwan was involved. Methods: The REduction of Atherothrombosis for Continued Health (REACH) Registry recruited outpatients with either symptomatic atherothrombotic diseases or multiple risk factors. Baseline data were collected using a universal standard case report form. All subjects were followed to document future outcomes . In this paper, we analyzed the baseline data of the participants from Taiwan. Results: In the REACH Registry, a total of 67,888 subjects from 44 countries were recruited. Among the 1062 Taiwanese participants, 971 were symptomatic subjects and 91 subjects were with risk factors only (RFO). In comparison with the global participants, the Taiwan patients were younger, with a higher prevalence of males, lower prevalence of hypertension, obesity, hypercholesterolemia, former smokers, and a greater prevalence of non- smokers. The baseline prevalence rates were: hypertension, 46.5%; fasting hyperglycemia, 38.4%; hypercholesterolemia, 45.8%; and hypertriglyceridemia, 42.8% . All these prevalence were higher than the global data, indicating an undertreatment status for the Taiwanese patients. Only 29 (2.7%) peripheral arterial disease (PAD) subjects were recruited in Taiwan, suggesting underrecognition of this disease. The RFO Taiwanese patients had fewer former smokers and more non-smokers than the symptomatic patients, suggesting that smoking may be an important factor contributing to atherothrombotic diseases. Conclusion: In Taiwan, atherothrombotic outpatients were generally undertreated and PAD was under -diagnosed

Epidemiology of treated attention-deficit/hyperactivity disorder (ADHD) across the lifespan in Taiwan: a nationwide population-based longitudinal study.

OBJECTIVES: We used insurance claims of a nationally representative population-based cohort to assess the longitudinal treated prevalence and incidence of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents and adults. METHODS: Participants were identified from among National Health Insurance enrollees in Taiwan from 1999 to 2005. We identified study subjects who had at least one service claim during these years with a principal diagnosis of ADHD. A total of 6,173 patients were recorded in the treated ADHD cohort during the 6-year study. RESULTS: There was a significant increase in the treated prevalence rate of ADHD during the study period, from 64.65 per 100,000 in 2000 to 145.40 per 100,000 in 2005 (p = .001). An increase in the treated incidence rate of ADHD, from 44.67 per 100,000 in 2000 to 81.20 per 100,000 in 2005, was also observed (p = .013). However, the treated prevalence of ADHD was still lower than that of the community data in Taiwan. The peak treated prevalence of ADHD was at age 7-12 years for both males and females, and the peak treated incidence of ADHD was at age 0-6 for females and age 7-12 for males. Overall, the treated incidence and prevalence rates dropped abruptly after age 13-18 (both p<.001) for males and females (p<.001 for both). Male vs. female ratios of treated prevalence and incidence were both above 1 before age 25-30 years, but below 1 thereafter. CONCLUSION: Although an increasing number of people with ADHD sought treatment during 1999-2005 in Taiwan, the treated prevalence of ADHD was still lower than that of the community data. The treated incidence and prevalence of ADHD fell dramatically after age 13-18. However, more women than men sought treatment in adulthood. There may be under-diagnosis and under-treatment of ADHD, especially among females and adults

Overall 6-year healthcare-seeking incidence and prevalence of ADHD by years.

<p>(A) The trend analyses of year tested by linear regression were women (beta = 4.55; P = 0.002), men (beta = 9.29; P = 0.023), and total (beta = 6.85; P = 0.013). (B) The trend analyses of year tested by linear regression were women (beta = 7.61; P<0.001), men (beta = 23.85; P = 0.001), and total (beta = 15.56; P = 0.001).</p

Incidence rate and prevalence rate of ADHD in Taiwan, 1999∼2005.

<p>Incidence rate and prevalence rate of ADHD in Taiwan, 1999∼2005.</p

Healthcare-seeking incidence and prevalence of ADHD by age stratification in 2005.

<p>(A) Chow test (breakpoint age 13∼18) in women (F = 168.64; P<0.001), men (F = 146.24; P<0.001), and total (F = 167.34; P<0.001). (B) Chow test (breakpoint age13∼18) in women (F = 85.19; P<0.001), men (F = 43.48; P<0.001), and total (F = 48.49; P<0.001).</p

Age- and sex-specific incidence (newly diagnosed) of ADHD by age stratification in 2005.

<p>M/F ratio = male-to-female ratio.</p

Male-to-female ratio of incidence and prevalence of ADHD by age stratification in 2005.

<p>M/F ratio = male-to-female ratio.</p

Transient risk of ambient fine particulate matter on hourly cardiovascular events in Tainan City, Taiwan.

BackgroundThe association between daily changes in ambient fine particulate matter (PM2.5) and cardiovascular diseases have been well established in mechanistic, epidemiologic and exposure studies. Only a few studies examined the effect of hourly variations in air pollution on triggering cardiovascular events. Whether the current PM2.5 standards can protect vulnerable individuals with chronic cardiovascular diseases remain uncertain.Methodswe conducted a time-stratified, case-crossover study to assess the associations between hourly changes in PM2.5 levels and the vascular disease onset in residents of Tainan City, Taiwan, visiting Emergency Room of Chi Mei Medical Center between January 2006 and December 2016. There were 26,749 cases including 10,310 females (38.5%) and 16,439 males (61.5%) identified. The time of emergency visit was identified as the onset for each case and control cases were selected as the same times on other days, on the same day of the week in the same month and year respectively. Residential address was used to identify the ambient air pollution exposure concentrations from the closest station. Conditional logistic regression with the stepwise selection method was used to estimate adjusted odds ratios (ORs) for the association.ResultsWhen we only included cases occurring at PM2.5>10 μg/m3 and PM2.5>25 μg/m3, very significant ORs could be observed for 10 μg/m3 increases in PM2.5 at 0 and 1 hour, implying fine particulate exposure could promptly trigger vascular disease events. Moreover, a very clear increase in risk could be observed with cumulative exposure from 0 to 48 hours, especially in those cases where PM2.5>25 μg/m3.ConclusionsOur study demonstrated that transient and low concentrations of ambient PM2.5 trigger adult vascular disease events, especially cerebrovascular disease, regardless of age, sex, and exposure timing. Warning and delivery systems should be setup to protect people from these prompt adverse health impacts