Paternalistic Leadership in Four East Asian Societies

Paternalistic leadership has been claimed to be one dominant leadership style in Asia. However, research failed to assess its comparability and applicability across East Asian contexts. The triad model of paternalistic leadership entails elements of authoritarian, benevolent, and moral character leadership. This article investigates the triad model of paternalistic leadership in mainland China, Japan, South Korea, and Taiwan. Paternalistic leadership occurs in an equivalent three-factorial structure indicating the applicability of the triad model, whereas some of the item intercepts vary between the four East Asian employee samples. These findings indicate generalizability of the meaning attributed to paternalistic leadership via three components, whereas the different measurement intercepts epitomize culture-specific scales across the four Asian contexts. The assessment of weak and strong measurement invariance is essential for an emerging cross-cultural research on paternalistic leadership by establishing evidence for the applicability and generalizability (including their boundaries) across cultural contexts.

Trend of urban-rural disparities in hospice utilization in Taiwan

AIMS

The palliative care has spread rapidly worldwide in the recent two decades. The development of hospice services in rural areas usually lags behind that in urban areas. The aim of our study was to investigate whether the urban-rural disparity widens in a country with a hospital-based hospice system.

METHODS

From the nationwide claims database within the National Health Insurance in Taiwan, admissions to hospices from 2000 to 2006 were identified. Hospices and patients in each year were analyzed according to geographic location and residence.

RESULTS

A total of 26,292 cancer patients had been admitted to hospices. The proportion of rural patients to all patients increased with time from 17.8% in 2000 to 25.7% in 2006. Although the numbers of beds and the utilizations in both urban and rural hospices expanded rapidly, the increasing trend in rural areas was more marked than that in urban areas. However, still two-thirds (898/1,357) of rural patients were admitted to urban hospices in 2006.

CONCLUSIONS

The gap of hospice utilizations between urban and rural areas in Taiwan did not widen with time. There was room for improvement in sufficient supply of rural hospices or efficient referral of rural patients.

Dosing variability in prescriptions of acetaminophen to children: comparisons between pediatricians, family physicians and otolaryngologists

BACKGROUND

To estimate the extents of dosing variability in prescriptions of acetaminophen to children among pediatricians, family physicians and otolaryngologists.

METHODS

The acetaminophen prescriptions in the systematic sampling datasets from the National Health Insurance Research Database in Taiwan were analyzed. The distribution of dosages was measured and expressed in terms of coefficient of variation (CV). The analyses were stratified by patient's age, prescriber's specialty and preparation form.

RESULTS

From 13,868 prescribed items of acetaminophen in 2009, liquids accounted only for 11.1% (n = 1544). More than half (56.9%) of liquids were prescribed by pediatricians. The median dose (83.3 mg, n = 1683) of acetaminophen prescriptions in infants is around half of that in preschool children (166.7 mg, n = 3921), one-third in children (250.0 mg, n = 4926) and one-sixth in adolescents (500.0 mg, n = 3338). In infants, the prescriptions by pediatricians had the highest CV (86.7%), followed by family physicians (82.3%) and otolaryngologists (70.3%). The patterns were similar in preschool children and children, but the difference of CV among specialties narrowed down with the patient's age.

CONCLUSIONS

In acetaminophen prescriptions to children, pediatricians had a wider variability of dosages and a higher ratio of liquid preparations than family physicians and otolaryngologists. Further investigations can be undertaken to estimate the accuracy of dosing variability as an indicator of prescribing quality. Besides, child-suitable drug preparations should be promoted to ensure patient safety.

The rural - urban divide in ambulatory care of gastrointestinal diseases in Taiwan

BACKGROUND

The utilization of medical care for gastrointestinal diseases increased over the past decade worldwide. The aim of the study was to investigate the difference between rural and urban patients in seeking medical service for gastrointestinal diseases at ambulatory sector in Taiwan.

METHODS

From the one-million-people cohort datasets of the National Health Insurance Research Database, the utilization of ambulatory visits for gastrointestinal diseases in 2009 was analyzed. Rural patients were compared with urban and suburban patients as to diagnosis, locality of visits and choice of specialists.

RESULTS

Among 295,056 patients who had ambulatory visits for gastrointestinal diseases in 2009, rural patients sought medical care for gastrointestinal diseases more frequently than urban and suburban patients (1.60 ± 3.90 vs. 1.17 ± 3.02 and 1.39 ± 3.47). 83.4% of rural patients with gastrointestinal diseases were treated by non-gastroenterologists in rural areas. Rural people had lower accessibility of specialist care, especially for hepatitis, esophageal disorders and gastroduodenal ulcer.

CONCLUSION

The rural-urban disparity of medical care for gastrointestinal diseases in Taiwan highlighted the importance of the well communication between rural physicians and gastroenterologists. Besides the establishment of the referral system, the medical teleconsultation system and the arrangement of specialist outreach clinics in rural areas might be helpful.

Epidemiology of adrenal insufficiency: a nationwide study of hospitalizations in Taiwan from 1996 to 2008

BACKGROUND

Adrenal insufficiency (AI) is an uncommon but life-threatening disorder if it progresses to adrenal crisis. The nationwide trend of AI epidemiology in Taiwan has been infrequently reported.

METHODS

Based on complete hospitalization datasets from the National Health Insurance Research Database, the trend of the annual incidence of AI from 1996 to 2008 in Taiwan was retrospectively analyzed. Special attention was paid to age-specific incidence, contributing factors as well as comorbidity at the time of AI diagnosis.

RESULTS

Of the existing 35,884,231 hospitalization records, there were 52,660 with AI diagnosis in 32,085 patients (15,914 women and 16,163 men). The annual incidence of AI increased over time from 6.4/10(5) (n = 1280) in 1996 to 15.2/10(5) (n = 3494) in 2008. Nearly four-fifths (77%, n = 24,688) of the patients were aged at least 60 years at the time of their first AI diagnosis. The increase of the annual incidence of AI during the study period was largely attributed to disease prevalence in patients aged 60 years and over, with the most marked increase in the population aged 80 years of age from 51.1/10(5) in 1996 to 179.9/10(5) in 2008. Most patients with newly diagnosed AI were treated at internal medicine wards (81.1%, n = 26,032), at academic medical centers (51.9%, n = 16,648) and in southern Taiwan (54%, n = 17,334). The most common comorbidity was pneumonia (6.4%, n = 2051), followed by urinary tract infection (6.4%, n = 2049), diabetes mellitus (6.2%, n = 1985), electrolyte imbalance (4.8%, n = 1551), and chronic obstructive pulmonary disease (4.5%, n = 1428).

CONCLUSION

The annual incidence of AI in Taiwan had continuously increased in recent years, and elderly patients accounted for the majority of the increase. In the face of an increasingly aging population, Taiwanese physicians should pay more attention to this easily overlooked disease.

Sequence of Leptospira santarosai serovar Shermani genome and prediction of virulence-associated genes

Leptospirosis, a widespread zoonosis, is a re-emerging infectious disease caused by pathogenic Leptospira species. In Taiwan, Leptospira santarosai serovar Shermani is the most frequently isolated serovar, causing both renal and systemic infections. This study aimed to generate a L. santarosai serovar Shermani genome sequence and categorize its hypothetical genes, particularly those associated with virulence. The genome sequence consists of 3,936,333 nucleotides and 4033 predicted genes. Additionally, 2244 coding sequences could be placed into clusters of orthologous groups and the number of genes involving cell wall/membrane/envelope biogenesis and defense mechanisms was higher than that of other Leptospira spp. Comparative genetic analysis based on BLASTX data revealed that about 73% and 68.8% of all coding sequences have matches to pathogenic L. interrogans and L. borgpetersenii, respectively, and about 57.6% to saprophyte L. biflexa. Among the hypothetical proteins, 421 have a transmembrane region, 172 have a signal peptide and 17 possess a lipoprotein signature. According to PFAM prediction, 32 hypothetical proteins have properties of toxins and surface proteins mediated bacterial attachment, suggesting they may have roles associated with virulence. The availability of the genome sequence of L. santarosai serovar Shermani and the bioinformatics re-annotation of leptospiral hypothetical proteins will facilitate further functional genomic studies to elucidate the pathogenesis of leptospirosis and develop leptospiral vaccines.

A nation-wide analysis of venous thromboembolism in 497,180 cancer patients with the development and validation of a risk-stratification scoring system

The Asian population is thought to have a low risk of venous thromboembolism (VTE), but the epidemiology of VTE in cancer patients remains unclear. The National Health Insurance Research Database of Taiwan was used to find hospitalised patients newly-diagnosed with cancer to determine the incidence of VTE in cancer patients and to identify the risk factors for VTE. Between 1997 and 2005, 497,180 cancer patients were identified. During a median follow-up of 21.3 months (range 0-119.9 months), 5,296 patients developed VTE. The estimated incidence was 185 events per 100,000 person-years. Patients with a prior history of VTE and female patients between the ages of 40 and 80 carried high risk of VTE. The rate of VTE was relatively high in patients with myeloma, prostate cancer, lung cancer, gynaecologic cancers, sarcoma, and metastasis of unknown origin. We developed a risk-stratification scoring system to divide the cancer patients into four discrete risk groups (very low risk, low risk, intermediate, and high risk). The incidence of VTE in each group was 0.5%, 0.9%, 1.5%, and 8.7%, respectively (p < 0.001). This scoring system was validated in a separate patient cohort. In conclusion, VTE is a distinct burden for cancer patients in Taiwan. The risk scoring system could prove helpful in decision-making concerning thromboprophylaxis in cancer patients.

The influence of the perception of a familial climate on job performance: mediation of loyalty to supervisors and moderation of filial behaviour

With a collectivist cultural perspective, we examined the positive effects of employees' perceptions of a familial climate on loyalty to supervisors, the mediation of loyalty between perception of a familial climate and job performance, and the moderation of employees' filial behaviour on the relationship between perception of a familial climate and loyalty. The participants consisted of 247 supervisor-and-subordinate dyads in Taiwan. The results supported our hypotheses. Through the mechanisms of family behaviour transference, social identification and supervisor-subordinate exchange, perception of an organizational familial climate enhanced loyalty to supervisors. Furthermore, loyalty to supervisors mediated the relationship between perception of a familial climate and job performance. Filial behaviour moderated the relationship between perception of a familial climate and loyalty; thus, the relationship of perception of a familial climate and loyalty was stronger for employees with low levels of filial behaviour and weaker for employees with high levels of filial behaviour. These findings are discussed in terms of their theoretical and practical implications for future research and management practices.

The ecology of medical care in Taiwan

BACKGROUND

In regular administrative statistics for medical services, utilization data are usually presented as aggregate data and lack an individual perspective. The aim of this study was to provide an overview of medical care utilization in Taiwan using a long-established analytical framework, the so-called ecology model.

METHODS

Claims data for a cohort of one million people from the National Health Insurance (NHI) Research Database were used to estimate the yearly and monthly prevalence of health care utilization in Taiwan in 2005. Analyses were extended to different types of healthcare settings and were stratified by age and sex. Results are presented per 1000 of the population.

RESULTS

Per 1000 people, 74 did not utilize any NHI services during the year. In a month, 503 people on average utilized at least once NHI service of any kind, 329 visited a physician's clinic (Western medicine), 152 visited a hospital-based outpatient clinic, 19 visited an emergency department, 10 were hospitalized and 3 were hospitalized in an academic medical center. Women were more likely to utilize NHI services than men (274/504 vs. 229/496 in a month). In a month on average, 40.3% (146/362) of young people, 52.2% (166/318) of middle-aged people, 53.3% (121/227) of children and 75.0% (70/93) of elderly people utilized NHI services. Over the whole year, 22.0% (21/93) of elderly people were hospitalized and nearly one-third of them were hospitalized in academic medical centers.

CONCLUSION

People in Taiwan utilized NHI services frequently and tended to seek medical help in hospitals. Although these features might reflect the higher availability and accessibility of medical care within the NHI in Taiwan, the possibility of overuse deserves further attention.

Application of frequent itemsets mining to analyze patterns of one-stop visits in Taiwan

Background

The free choice of health care facilities without limitations on frequency of visits within the National Health Insurance in Taiwan gives rise to not only a high number of annual ambulatory visits per capita but also a unique “one-stop shopping”phenomenon, which refers to a patient' visits to several specialties of the same healthcare facility in one day. The visits to multiple physicians would increase the potential risk of polypharmacy. The aim of this study was to analyze the frequency and patterns of one-stop visits in Taiwan.

Methodology/Principal Findings

The claims datasets of 1 million nationally representative people within Taiwan's National Health Insurance in 2005 were used to calculate the number of patients with one-stop visits. The frequent itemsets mining was applied to compute the combination patterns of specialties in the one-stop visits. Among the total 13,682,469 ambulatory care visits in 2005, one-stop visits occurred 144,132 times and involved 296,822 visits (2.2% of all visits) by 66,294 (6.6%) persons. People tended to have this behavior with age and the percentage reached 27.5% (5,662 in 20,579) in the age group ≥80 years. In general, women were more likely to have one-stop visits than men (7.2% vs. 6.0%). Internal medicine plus ophthalmology was the most frequent combination with a visited frequency of 3,552 times (2.5%), followed by cardiology plus neurology with 3,183 times (2.2%). The most frequent three-specialty combination, cardiology plus neurology and gastroenterology, occurred only 111 times.

Conclusions/Significance

Without the novel computational technique, it would be hardly possible to analyze the extremely diverse combination patterns of specialties in one-stop visits. The results of the study could provide useful information either for the hospital manager to set up integrated services or for the policymaker to rebuild the health care system.

The Effect of Weather on Peritoneal Dialysis (PD) Prescription: Seasonal Variation in PD Dialysate Utilization

♦ Background

There have been no reports on peritoneal dialysis (PD) solution utilization since this treatment was developed in the 1920s. The aim of the present investigation was to investigate if weather affects PD prescription.

♦ Study Design and Methods

This 10-year observational study used the Taiwan National Health Insurance Research Database. Setting and Participants: Claims for different concentrate PD dialysate were analyzed monthly. 2.5% and 4.25% PD solutes were defined as hypertonic solutions. Predictor: Monthly outdoor mean temperature. Outcome and Measurement: The relationship between monthly mean of PD dialysate utilization and monthly outdoor temperature was analyzed by linear regression. Monthly mean PD dialysate utilization amount in 4 quarters was analyzed by ANOVA.

♦ Results

During the 10-year study period, a clear seasonal variation in PD dialysate was observed. This seasonal variation was present regardless of age, gender, and the presence of hypertension, diabetes, and dyslipidemia. Monthly mean temperature was positively correlated to 1.5% dialysate utilization amount ( r = 0.559, p < 0.001) and negatively correlated to 2.5% ( r = –0.533, p < 0.001) and 4.25% ( r= –0.410, p < 0.001) dialysate utilization amount. In longitudinal follow-up, hypertonic PD fluid utilization was higher in diabetic patients than in nondiabetic patients from the beginning of treatment. Thereafter, it increased rapidly and reached a plateau within 1 year. Limitations: Analysis of ultrafiltration amount, blood pressure, and body weight was unfeasible due to the nature of the database.

♦ Conclusions

The utilization of differential strengths of PD solutions has a seasonal cyclic pattern, with more hypertonic PD solution utilized in winter and more hypotonic PD solution in summer.

Pattern and consequences of first visits to obstetricians/gynecologists by adolescents: a nationwide study in Taiwan

BACKGROUND

Some adolescents have special health care needs. Privacy concerns, unawareness or ethnical/cultural factors are barriers to women visiting obstetricians/gynecologists (OB/GYNs). The utilization of OB/GYN services by adolescent girls is seldom reported. The aim of this study was to investigate the pattern and consequences of first visits to OB/GYNs by adolescent girls within the National Health Insurance in Taiwan.

METHODS

From the 1-million cohort dataset of the National Health Insurance Research Database spanning from 1996 to 2007, adolescent girls visiting OB/GYNs for the first time were identified. The characteristics of first visits were analyzed. Their follow-up visits and admissions within 1 year after their first visits to OB/GYNs were traced.

RESULTS

In 2006, only 5.8% (n = 2,682) of 46,582 adolescent girls in our study cohort had their first visits to OB/GYNs: 46.7% with diagnoses of menstrual disorders and 14.8% with diagnoses related to inflammatory or infectious diseases of the genital organs. The examination most frequently ordered was pregnancy test (for 19.9% of these first visits). Very few (0.4%) first visits were for preventive services. Among the infrequent admissions (85 admissions of 75 girls) to obstetric/gynecology wards within 1 year after first visits, the majority (74 of 85 admissions) were pregnancy-related.

CONCLUSION

The leading motivating factor for first visits to OB/GYNs by adolescent girls was menstrual disorders. The majority of subsequent admissions were pregnancy-related, indicating that adolescent pregnancy deserves further attention.

Use of traditional Chinese medicine among pregnant women in Taiwan

OBJECTIVE

To investigate the patterns of traditional Chinese medicine (TCM) use among pregnant women in the National Health Insurance program in Taiwan.

METHODS

Women who gave birth in Taiwan in 2006 were identified from the National Health Insurance Research Database. Claims for reimbursement following TCM ambulatory visits by these women were analyzed.

RESULTS

In total, 20.9% of women in the study who gave birth in 2006 used TCM during pregnancy, with older women more likely to utilize this form of care (23.9% of women >35 years of age vs 16.2% of women <20 years of age). There was an increase in the use of TCM for pregnancy-related problems such as hypertension (194 women before pregnancy vs 2163 during) and nausea/vomiting (220 women before vs 1648 during). The predominant modality (88.4%) of TCM treatment during pregnancy was herbal preparation.

CONCLUSION

Traditional Chinese medicine, with the exception of acupuncture, is popular among pregnant women in Taiwan. In addition to its efficacy, the safety of TCM during pregnancy requires future investigation.

Medline-based bibliometric analysis of gastroenterology journals between 2001 and 2007

AIM

To analyze the MEDLINE-indexed publications in gastroenterology specialty journals from 2001 to 2007. Special attention was paid to specific types of articles, the number of publications for individual authors and the author count in each journal.

METHODS

The bibliographic entries of papers belonging to journals listed under the subject heading of "gastroenterology" were downloaded from MEDLINE on the PubMed web site. The analysis was limited to journal articles published between January 1, 2001 and December 31, 2007. The analytical dimensions of an article included journal, publication year, publication type, and author name (the last name and initials).

RESULTS

According to MEDLINE, 81 561 articles were published in 91 gastroenterology journals from 2001 to 2007. The number of articles increased from 9447 in 2001 to 13 340 in 2007. Only 12 journals had more than 2000 articles indexed in MEDLINE. The "World Journal of Gastroenterology" had the largest number of publications (5684 articles), followed by "Hepato-Gastroenterology" (3036) and "Gastrointestinal Endoscopy" (3005). Of all the articles published, reviews accounted for 17.2% and case reports for 15.4%. Only 3739 randomized controlled trials (4.6% of all articles) were published and their annual number increased from 442 in 2001 to 572 in 2007. Among 141 741 author names appearing in the articles of gastroenterology journals, 92 429 had published only in one journal, 22 585 in two journals, 9996 in three journals, and 16 731 in more than three journals. The "World Journal of Gastroenterology" had the greatest number of authors (17 838), followed by "Gastroenterology" (12 770), "Digestive Diseases and Sciences" (11 395), "American Journal of Gastroenterology" (10 889), and "Hepatology" (10 588).

CONCLUSION

Global gastroenterology publications displayed a continuous growth in the new millennium. The change was most striking in certain journals. Regular bibliometric analyses on the trends and specific topics would help researchers publish more efficiently and allow editors to adjust the policy more accurately.

Patterns of traditional Chinese medicine use in patients with inflammatory bowel disease: a population study in Taiwan

BACKGROUND/AIMS

Many researchers have reported on the utilization of complementary and alternative medicine by patients with inflammatory bowel disease (IBD). The aim of this study was to investigate the use of traditional Chinese medicine (TCM) by all IBD patients within the National Health Insurance in Taiwan.

METHODOLOGY

The complete ambulatory visits records of TCM in 2004 were obtained from the National Health Insurance Research Database. For all IBD patients identified from the registry for catastrophic illness patients, patterns of TCM visits were analyzed.

RESULTS

The prevalence of IBD in Taiwan was 5.6 per 100,000 persons at the end of 2004. Of 1,206 IBD patients, 440 (37%) patients have in total 3,169 TCM visits in 2004. Women were more likely to use TCM than men (40.5% vs. 34.3%). Among the TCM users of the IBD patients, 200 (45.5%) patients had gastroenterological diagnoses at their TCM visits. Most of their TCM visits contained herbal remedies (90%), followed by manual therapy (11.7%) and acupuncture (9.8%).

CONCLUSIONS

The high utilization rate of TCM among the IBD patients in Taiwan implied that their needs of medical care were not satisfied by the mainstream Western medicine. The TCM herbal regimens deserve further studies.

Intra-articular hyaluronic acid for treatment of osteoarthritis: a nationwide study among the older population of Taiwan

Background

Although intra-articular treatment with hyaluronic acid (HA) for symptomatic osteoarthritis has become widely accepted in recent decades, the pattern of its use has seldom been reported. We have explored the epidemiology of intra-articular HA treatment in Taiwan by using the rich data source from nationwide insurance claims.

Methods

Taiwan's National Health Insurance (NHI), which covers 97% of inhabitants, offers extensive hospitalisation and ambulatory care. We identified the beneficiaries aged 60 years and older who received intra-articular HA within the NHI during 2004. The number of visits in which HA was administered were analysed by patient's age and gender and by the physician's specialty and practice site.

Results

Among the 73,410,777 ambulatory visits by 2,909,219 beneficiaries aged 60 years and older in 2004, 35,782 (1.2%) patients received intra-articular HA treatment in 205,012 (0.3%) visits. The highest prevalence of HA use was in the 70–79 year age group in both sexes. Women received intra-articular HA treatment more frequently than men in all age groups, especially in the 60–69 and 70–79 year groups (1.6% vs. 0.5%, 2.2% vs. 1.0%, respectively). Most intra-articular HA procedures were performed by orthopaedic surgeons (75.1%) and physical medicine and rehabilitation physicians (15.2%), and at metropolitan hospitals (34.5%) and local community hospitals (38.2%).

Conclusion

One out of 100 older patients in Taiwan received intra-articular HA treatment for osteoarthritis of the knee during the course of the year. There were age-gender differences in use of HA treatment. The completion rate of this treatment in our study was high, and thus intra-articular HA might be a good alternative for patients for whom conventional treatment fails. Further research is needed to examine the age-gender differences in use of intra-articular HA in Taiwan.

Functional epitopes on porcine endogenous retrovirus envelope protein interacting with neutralizing antibody combining sites

Porcine cell and organ transplantation provides promise for maintaining normal physiological conditions in patients with end-stage organ failure. The approach however poses serious risk of transmitting pig pathogens to humans. Among many potential pathogens, porcine endogenous retroviruses (PERV) are of particular concern due to their ubiquitous nature in pigs and capability of infecting human cells. Major antigenic determinants and receptor binding domains on PERV remain unclear until now. Two monoclonal antibodies (mAb), named 8E10 and 7C4 capable of neutralizing PERV infection in HEK293 cells are isolated at an IC(50) of 3.0 and 2.7 microg/ml, respectively, in this work. Epitope location for mAb 8E10 was mapped to amino acids 427-434, residing at the C-terminal region of the gp70 component of type A PERV Env protein. The mAb 8E10 bound directly to the PERV indicating that the epitope is exposed on the virion surface. The mAb 7C4 epitope was assigned to the region comprising amino acids 517-537 on the p15E component of PERV. In contrast to mAb 8E10, the 7C4 mAb bound native PERV inefficiently suggesting that its epitope is accessible only after the virus interacts with its receptor. Finally, both mAbs variable regions were cloned and nucleotide sequence determined. All together, these results reveal that both mAbs 8E10 and 7C4 effectively neutralize PERV infection and may be used as a mean to prevent PERV infection in patients receiving xenotransplantation.

World trend of peritoneal dialysis publications

OBJECTIVES

To analyze the trend of global peritoneal dialysis (PD) publications, especially of publications in Peritoneal Dialysis International (PDI), from 1991 to 2005 according to the Institute for Scientific Information databases of the Thomson Corporation.

METHODS

Data were downloaded from the Web of Science, which includes the databases of Science Citation Index Expanded and Social Sciences Citation Index. The searching strategies were key-in of "peritoneal dialysis" in general search and of "SO=Peritoneal Dialysis International" in advanced search. Only articles and reviews were included in the analysis. The analysis was stratified by publication year, journal, author, country of each author's affiliation, and citation count of each paper.

RESULTS

There were 7618 PD papers (6991 articles and 627 reviews) in 887 journals; 15.8% of them (n = 1204) were published in PDI. The annual outputs of global PD publications has been more than 500 papers since 1996, with a peak of 665 articles in 2003. In total, 18531 authors from 102 countries and areas contributed to PD publications. Authors from the USA were present in 30.6% of all papers although their global share decreased with time. A PD paper received an average of 12.7 citations. A review received more citations than an article (17.0 vs 12.3 on average), yet statistical significance was not reached (p = 0.216, Mann-Whitney U test).

CONCLUSIONS

The number of PD research societies in the world has been growing during the past 15 years. More and more research is from countries other than the USA and the United Kingdom. Papers on PD have thus been published in many journals other than PDI, the leading journal in PD. However, the growth rate of PD publications in the world is diminishing. We present here the most likely reasons for the decrease in PD publications and propose suggestions for PDI to keep its leading role in the development of PD.

International collaboration of clinical medicine research in Taiwan, 1990-2004: a bibliometric analysis

BACKGROUND

The number of publications in journals indexed in the Institute for Scientific Information (ISI) database of the Thomson Corporation is generally used to assess the research performance of individuals, institutions and countries in scientific fields. The aim of this study was to analyze the trends in Taiwan's ISI publications in clinical medicine from 1990 to 2004. Special attention was paid to internationally collaborated works that were identified based on the countries of co-authors' affiliations.

METHODS

The bibliographic records of articles with an author's affiliation in Taiwan were downloaded from the Web of Science on the Internet. The analysis was then limited to the journals of clinical medicine defined as such in the ISI Essential Science Indicators. International collaboration was deemed to exist in an article if any co-author's affiliation was located outside Taiwan. The impact factors in the 2004 Journal Citation Reports Science Edition were arbitrarily adopted to estimate the quality of articles.

RESULTS

Taiwan's ISI publications in clinical medicine increased from 315 articles in 1990 to 2,636 in 2004. Only 7.4% (n=1,494) of the 20,207 articles published during the study period were published in journals with an impact factor equal to or greater than 5. The share of articles with international collaboration was 13.6% (n=2,752) on average. Taiwan's researchers collaborated with colleagues in 76 countries. The USA, as the most important collaborating partner of Taiwan's clinical medicine researchers, had contributed to 69.9% of articles with international collaboration. Generally, articles with international collaboration were published in journals with higher impact factors or had more citations than those without international collaboration. The number of articles published in each year, in each of selected subject categories and from each of selected domestic institutions did not correlate with the percentage of articles with international collaboration, respectively.

CONCLUSION

Taiwan has achieved a significant increase in the number of ISI publications in clinical medicine. Yet there exists opportunity for improvement in international collaboration.

Health care utilization of home care patients at an academic medical center in Taiwan

BACKGROUND

Previous surveys of home care patients in Taiwan have primarily concentrated on patients' status and needs. The aim of this study was to review the actual health care utilization of home care patients during the course of 1 year.

METHODS

Home care patients at an academic medical center in Taiwan were selected and their insurance claims data at this hospital in 2001 were analyzed. Analyses included the patients' patterns and diagnoses of visits and admissions, and their drug utilization. For diagnoses made at outpatient departments, the grouping system from the National Hospital Ambulatory Medical Care Survey in the United States was used. The Anatomical Therapeutic Chemical Classification system was applied to drug grouping.

RESULTS

The home care agency of the hospital cared for 165 patients (66 women, 99 men) in 2001. In total, these 165 patients received 1,358 home visits, 2,751 outpatient visits, and 108 inpatient admissions. While the most frequent diagnoses for all visits were cerebrovascular disease, hypertension, diabetes mellitus, chronic and unspecified bronchitis, psychoses, and other disorders of the central nervous system, the most frequent diagnoses at discharge from the hospital were urinary tract infection and pneumonia. In all visits, 12,282 items of drugs were prescribed in 2,337 prescriptions. On average, each prescription contained 5.3 +/- 2.8 items of drugs. The most frequently prescribed drugs were antacids, expectorants, laxatives, selective calcium channel blockers, and antithrombotic agents.

CONCLUSION

The home care agency of the hospital should pay more attention to provision of comprehensive care and review of drug prescribing.

Hospice utilization during the SARS outbreak in Taiwan

BACKGROUND

The severe acute respiratory syndrome (SARS) epidemic threw the world into turmoil during the first half of 2003. Many subsequent papers have addressed its impact on health service utilization, but few have considered palliative (hospice) care. The aim of the present study was to describe changes in hospice inpatient utilization during and after the SARS epidemic in 2003 in Taiwan.

METHODS

The data sources were the complete datasets of inpatient admissions during 2002 and 2003 from the National Health Insurance Research Database. Before-and-after comparisons of daily and monthly utilizations were made. Hospice analyses were limited to those wards that offered inpatient services throughout these two years. The comparisons were extended to total hospital bed utilization and to patients who were still admitted to hospice wards during the peak period of the SARS epidemic.

RESULTS

Only 15 hospice wards operated throughout the whole of 2002 and 2003. In 2003, hospice utilization began to decrease in the middle of April, reached a minimum on 25 May, and gradually recovered to the level of the previous November. Hospices showed a more marked reduction in utilization than all hospital beds (e.g. -52.5% vs. -19.9% in May 2003) and a slower recovery with a three-month lag. In total, 566 patients were admitted to hospice wards in May/June 2003, in contrast to 818 in May/June 2002. Gender, age and diagnosis distributions did not differ.

CONCLUSION

Hospice inpatient utilization in Taiwan was indeed more sensitive to the emerging epidemic than general inpatient utilization. A well-balanced network with seamless continuity of care should be ensured.

Application of concentration ratios to analyze the phenomenon of “next-door” pharmacy in Taiwan

BACKGROUND

In Taiwan, a policy of separation of prescribing and dispensing practices of practitioners at Western medical and dental clinics was implemented on an incremental basis in 1997. The purpose of this policy was to promote pharmacists' autonomy and increase the transparency and safety of prescribing medications. To avoid profit loss from no longer being able to dispense prescription medications, some clinics opened pharmacies located under the same roof as the clinic ("next-door" pharmacies) or hired an on-site pharmacist. This practice might compromise pharmacists' professional autonomy and patients' benefit in pharmaceutical care.

OBJECTIVE

The aim of the current study was to clarify the relationship between practicing pharmacies and clinics that resulted from contracts between pharmacies and the Bureau of National Health Insurance from 1996 to 2004.

METHODS

The National Health Research Institutes database in Taiwan supplied the complete claims data sets of practicing pharmacies from 1997 to 2004. The prescribing source of every dispensed prescription was used to calculate the 1-firm concentration ratio (CR-1) (ie, the proportion of prescriptions issued by the largest prescribing clinic/hospital in the total number of dispensed prescriptions of a pharmacy in each year). Similar processing was applied to the clinics. We identified each clinic's largest cooperating pharmacy and compared their CR-1s. Pharmacies that dispensed >900 prescriptions/mo during the study period were considered thriving. Pharmacies with a CR-1 > or =0.99 and whose largest cooperating clinic had a CR-1 > or =0.99 were considered to have a close business relationship, possibly indicating a next-door pharmacy.

RESULTS

The total number of prescriptions dispensed at all pharmacies in the database grew from 226,901 in 1996 to 59,785,039 in 2004, and the number of pharmacies, from 481 to 3529. An increasing number of pharmacies had a higher CR-1 after 1999. We found that most prescriptions could be dispensed at only 1 pharmacy during the study period. In 2004, 1429 clinics had >900 prescriptions/mo dispensed externally and a CR-1 > or =0.99. They had released 75.8% of all prescriptions to be dispensed at practicing pharmacies; 811 of these clinics had a cooperating pharmacy with a CR-1 > or =0.99.

CONCLUSIONS

In this data analysis in Taiwan, most prescriptions from practitioners at Western medical and dental clinics could be dispensed at only 1 pharmacy during the study period, suggesting that pharmacists' professional autonomy and the patients' benefit in pharmaceutical care might be compromised in Taiwan.

Patterns of ambulatory care utilization in Taiwan

BACKGROUND

We used the insurance claims of a representative cohort to quantify the patterns of ambulatory care visits, especially the doctor-shopping phenomenon, in Taiwan.

METHODS

The ambulatory visit files of the 200,000-person cohort datasets from the National Health Insurance Research Database in 2002 were analyzed. Only a visit with physician consultation would be considered. We computed the visit patterns both by visit count and by patient count.

RESULTS

In 2002, there were 182,474 eligible people with 2,443,003 physician consultations. During the year, 87.4% of the cohort had visited physician clinics and 57.5% had visited hospital-based outpatient or emergency departments. On average, a person had 13.4 physician consultations and consulted 3.4 specialties, 5.2 physicians, and 3.9 healthcare facilities in a year. In 2002, 17.3% of the cohort had ever visited different healthcare facilities on the same day; 23.5% had ever visited physicians of the same specialty at different healthcare facilities within 7 days and the percentage of second visits was 3.8% of all visits. Besides, 7.6% of the cohort had visited two or more specialties at the same facility on the same day, and such visits make up 2.5% of all visits.

CONCLUSION

The people in Taiwan did visit the physicians and outpatient departments frequently. Many patients not only consulted several physicians of different specialties and at different healthcare facilities during the year, but also switched the physicians and facilities quickly. An effective referral system with efficient data exchange between facilities might be the solution.

The ecology of mental health care in Taiwan

This paper applied the ecology model of general medical care by White et al. to analysis of mental health services utilization within the National Health Insurance in Taiwan. The ambulatory and inpatient claims of a 200,000-person cohort in 2001 were analyzed. The yearly and monthly prevalence estimates included psychotropic drug prescription, diagnosis of mental disorders, psychiatric ambulatory visit and admission, community psychiatric rehabilitation, and certificate of chronic psychosis. The results revealed one-fourth of people had received psychotropic drugs during the year, mostly from non-psychiatrists. Besides, the elderly might be excessively exposed to psychotropic drugs, and community rehabilitation programs were underutilized.

Dynamic analysis of hepatoma spheroid formation: roles of E-cadherin and β1-integrin

A spheroid is an in vitro multicellular aggregate that provides a microenvironment resembling that of normal tissue in vivo. Although cell adhesion molecules such as integrins and cadherins have been implicated in participating in the process of spheroid formation, little is known about the timing of their action. In this study, we have employed an image-based quantitative method to investigate the compactness of cell aggregates during hepatoma spheroid formation in a dynamic fashion. By modulating beta1-integrin and E-cadherin activity with specific blocking antibodies, ion chelators, and RGD-sequence-containing peptides, we show that these cell adhesion molecules mediate the formation of spheroids through the establishment of complex cell-cell and cell-extracellular matrix (ECM) interactions. The dynamics of spheroid formation can be separated into three stages. In the first stage, ECM fibers act as a long-chain linker for the attachment of dispersed single-cells to form loose aggregations through the binding of integrins. This is followed by a delay period in which cell aggregates pause in compaction, presumably because of the accumulation of sufficient amounts of E-cadherins. In the third stage, strong homophilic interaction of E-cadherins is a major factor for the morphological transition from loose cell aggregates to compact spheroids. These findings thus provide comprehensive information on the molecular mechanisms and dynamics of hepatoma spheroid formation.

Estimating medical costs of gastroenterological diseases

AIM: To estimate the direct medical costs of gastroenterological diseases within the universal health insurance program among the population of local residents in Taiwan.

METHODS: The data sources were the first 4 cohort datasets of 200 000 people from the National Health Insurance Research Database in Taipei. The ambulatory, inpatient and pharmacy claims of the cohort in 2001 were analyzed. Besides prevalence and medical costs of diseases, both amount and costs of utilization in procedures and drugs were calculated.

RESULTS: Of the cohort with 183 976 eligible people, 44.2% had ever a gastroenterological diagnosis during the year. The age group 20-39 years had the lowest prevalence rate (39.2%) while the elderly had the highest (58.4%). The prevalence rate was higher in women than in men (48.5% vs. 40.0%). Totally, 30.4% of 14 888 inpatients had ever a gastroenterological diagnosis at discharge and 18.8% of 51 359 patients at clinics of traditional Chinese medicine had such a diagnosis there. If only the principal diagnosis on each claim was considered, 16.2% of admissions, 8.0% of outpatient visits, and 10.1% of the total medical costs (8 469 909 US dollars/ 83 830 239 US dollars) were attributed to gastroenterological diseases. On average, 46.0 US dollars per insured person in a year were spent in treating gastroenterological diseases. Diagnostic procedures related to gastroenterological diseases accounted for 24.2% of the costs for all diagnostic procedures and 2.3% of the total medical costs. Therapeutic procedures related to gastroenterological diseases accounted for 4.5% of the costs for all therapeutic procedures and 1.3% of the total medical costs. Drugs related to gastroenterological diseases accounted for 7.3% of the costs for all drugs and 1.9% of the total medical costs.

CONCLUSION: Gastroenterological diseases are prevalent among the population of local residents in Taiwan, accounting for a tenth of the total medical costs. Further investigations are needed to differentiate costs in screening, ruling out, confirming, and treating.

Patterns and costs of antipsychotic drug use in Taiwan: 1997 to 2001

The advent of atypical antipsychotics greatly changed the treatment pattern for mental illnesses worldwide. This study was designed to determine the trend in prevalence, prescribing pattern, and cost of antipsychotic agents in Taiwan from 1997 to 2001. Data were obtained from claims completed for a random sample of 200,000 people registered with the National Health Insurance program. The antipsychotics monitored included all group N05A drugs in the Anatomical Therapeutic Chemical classification system (version 2000). Conventional and atypical antipsychotics were handled separately. Of the 195,971 eligible registrants, 37,441 (19.1%) received any kind of antipsychotic during this 5-year period, but only 713 (0.4%) used atypical antipsychotics. The prevalence of conventional antipsychotic use during each successive year of this study was 5.2%, 5.7%, 6.6%, 6.2%, and 6.1% and 0.1%, 0.1%, 0.1%, 0.2%, and 0.3% for atypical agents. Although far fewer registrants used them, atypicals comprised 19.1% of all prescribed amounts measured in defined daily doses and 56.1% of the cost for all antipsychotics in 2001. During the 5-year study period, atypical antipsychotics were prescribed for 405 (57%) patients with schizophrenia, 132 (19%) with affective disorder, 128 (18%) with other psychiatric disorders, and 48 (7%) with a nonpsychiatric disorder. With the loosening of reimbursement restrictions in 2002, continued growth of atypical antipsychotic use in Taiwan might be expected.

Application of a data-mining technique to analyze coprescription patterns for antacids in Taiwan

BACKGROUND

Although antacids are popular drugs with a long history of use, their true utilization patterns-including over-the-counter use-have rarely been documented. Because all antacids are reimbursed under the National Health Insurance program in Taiwan, it is possible to access and analyze nationwide data for these drugs.

OBJECTIVES

The purposes of this study were to estimate the scale of antacid prescribing in Taiwan using the national insurance claims for outpatient services and to analyze coprescribing patterns of antacids using modern data-mining techniques.

METHODS

The National Health Insurance Research Database in Taiwan supplied the visit-based sampling data sets, which had a sampling ratio of 0.2% for all claims for outpatient medical services in the year 2000. In addition to the plain statistics (ie, data from simple calculations) for antacid prescriptions, we also analyzed relationships between prescriptions for antacids and nonantacid drugs. A data-mining technique-association rule mining-was applied to identify the drugs prescribed in combination with antacids.

RESULTS

Among a total of 409,049 eligible prescriptions for 1,704,595 drug items to be administered orally, antacids were present in 213,494 prescriptions (52.2%). Antacid users were generally older than nonusers (mean [SD] age, 39.9 [23.4] years vs 32.4 [25.7] years). In all, 88.8% of antacid items (189,531/213,494) were prescribed without claims diagnoses of gastrointestinal disorders. Using association rule mining with a 1.0% minimum support factor, there were 36 strong association rules between prescriptions for antacids and other drug subgroups at the third level of Anatomical Therapeutic Chemical classification. Nonsteroidal anti-inflammatory drugs and drugs for treating upper respiratory infections played dominant roles in the associations with antacid prescriptions; vitamin B complex and antivertigo preparations were also strongly associated with antacids.

CONCLUSIONS

Antacid coprescriptions were common in Taiwan in the year 2000. Further study should investigate whether antacid prescribing patterns are influenced by Taiwanese perceptions that Western drugs injure the stomach.

Utilization of hepatoprotectants within the National Health Insurance in Taiwan

BACKGROUND

Although the hepatoprotectants of Western medicine have centuries of history, their utilization patterns have been seldom documented. Because the National Health Insurance program in Taiwan reimburses hepatoprotectant use, we could estimate the age- and sex-specific prevalence and utilization patterns of hepatoprotectants in Western medicine within the health insurance system in Taiwan.

METHODS

We analyzed the outpatient prescription data of 50000 randomly sampled insured patients in 2000. Only patients using drugs indicated for liver diseases and diagnostic codes related to liver diseases on the same visit were considered to be receiving hepatoprotectants. Drugs involved in Chinese medicine were not included.

RESULTS

Among the valid cohort of 46614 people, 783 (1.7%) were identified as patients with liver disease and receiving hepatoprotectants. Highest prevalence of hepatoprotectant use was 4.9% in the 60-69 years age group. Silymarin, multivitamins, methionine, ursodeoxycholic acid, and liver hydrolysate accounted for 88.8% of the 3215 prescribed items of hepatoprotectants. Patients receiving hepatoprotectants had, on average, visited the clinics more frequently than those not using hepatoprotectants (30 vs 14 times in a year, P < 0.001), and used more insurance benefits (US dollars 1352 vs US dollars 456, P < 0.001).

CONCLUSIONS

The frequency of use of major hepatoprotectants in Taiwan corresponded to the current modalities of treatment under discussion worldwide.

Prevalence of anti-ulcer drug use in a Chinese cohort

AIM: To estimate the age-specific prevalence of anti-ulcer drug use and to calculate the usage of different anti-ulcer drugs over 5 years within the universal health insurance program in Taiwan area.

METHODS: The National Health Insurance Research Database in Taipei supplied the cohort data sets of 200000 people. The ambulatory and inpatient claims of the cohort from 1997 to 2001 were analyzed. The anti-ulcer drugs included all drug items of the group A02B (drugs for treatment of peptic ulcer) in the Anatomical Therapeutic Chemical classification system (version 2000). The amount of drug usage was measured in unit of defined daily dose.

RESULTS: Among the totally 13034393 visits with 56672631 ambulatory prescription items, there were 398150 (0.7%) prescribed items of anti-ulcer drugs in 378855 (2.9%) visits. Among the 107649 admissions with 5762312 inpatient prescription items, there were 24598 (0.4%) prescribed items of anti-ulcer drugs in 11548 (10.7%) admissions. The annual prevalence of anti-ulcer drug use was 9.6% in 1997, 11.6% in 1998, 15.4% in 1999, 14.5% in 2000, and 15.9% in 2001 respectively. The 5-year prevalence was 36.1%. The age-specific prevalence among the people younger than 20 years was 9.2% in 2001 and 23.7% during the 5-year period. Cimetidine not only was the most popular ingredient among anti-ulcer drugs (57634 cimetidine users in 70729 all anti-ulcer drug users during the 5-year period) but also had the largest prescribed amount (42.3% of DDDs for all anti-ulcer drug users during the 5-year period). The annually prescribed amount of anti-ulcer drugs had grown from 4.9 DDDs/1000 inhabitants/day in 1997 to 7.5 in 2001. This increase was largely attributed to H₂-receptor antagonists and the expanding number of users.

CONCLUSION: Prescribing of anti-ulcer drugs is indeed popular among the Chinese population in Taiwan area. The disproportionate use of anti-ulcer drugs by children demands further investigation.

Trends in prescribing proton pump inhibitors in Taiwan: 1997 - 2000

OBJECTIVE

The prescribing of proton pump inhibitors (PPIs) had increased greatly in recent years worldwide. Aim of our study was to analyze the utilization patterns of PPIs within the National Health Insurance program in Taiwan from 1997 - 2000.

MATERIAL AND METHOD

The systemic sampling data-sets from the National Health Insurance Research Database served as data sources. Units of measurement for PPIs were numbers of prescription items and defined daily doses (DDDs). To estimate the proportion of the population treated daily with PPIs, numbers of DDDs per 1,000 inhabitants per day were calculated. In order to realize the role of PPIs in treating Helicobacter pylori-related disorders, we also analyzed various combined prescriptions of PPIs with amoxicillin, clarithromycin, metronidazole, tetracycline and bismuth.

RESULTS

In the study period, PPI prescriptions increased nearly 2-fold at the outpatient sector and more than 3-fold at the inpatient sector. Men received more PPI prescriptions, as a whole, than women. Most PPIs were prescribed at the outpatient sector: 93.9% in 1997, 92.3% in 1998, 90.4% in 1999 and 87.3% in 2000. The numbers of DDDs per 1,000 inhabitants per day for all kinds of PPIs were 0.59, 0.78, 1.07, and 1.13 from 1997 - 2000, respectively. While the percentage of monotherapy increased from 63.6% in 1997 to 75.5% in 2000, the combination therapies did not experience a rapid and sustained growth. Among the combination therapies, PPI + amoxicillin + metronidazole and PPI + amoxicillin were popular in 1997 and 1998, but triple therapy with PPI + amoxicillin + clarithromycin predominated in 1999 and 2000.

CONCLUSIONS

Despite increasing use, prescribing volumes of PPIs in Taiwan were far fewer than those in other developed countries. Treatment of Helicobacter pylori-related disorders in Taiwan followed universal standard.

Prevalence of antilipemic drug use in Taiwan: analysis of a sampling cohort within the national health insurance

BACKGROUND

Hyperlipidemia is a major risk factor of cardiovascular diseases. We investigated the utilization ofantilipemic drugs at the outpatient sector within the National Health Insurance in Taiwan.

METHODS

We obtained the first cohort (n = 50,000) dataset from the National Health Insurance Research Database and analyzed the outpatient claim files of the cohort in 2000. The antilipemic drugs were defined as the drug items belonging to the group C10 (serum lipid reducing agents) of the Anatomical Therapeutic Chemical classification system.

RESULTS

Among the cohort with 46,614 eligible people, 760 patients had ever received antilipemic drugs (prevalence: 1.6%). The group 60-69 years of age had the greatest age-specific prevalence (7.2%), followed by the group over 70 years of age (6.0%). There were more male than female patients, but female patients outnumbered male patients before the age of 49 years. The antilipemic drugs had been prescribed 3,850 times totally with 70,272 defined daily doses (DDDs). On an average, a patient with antilipemic therapy received 5.1 (+/- 4.5) prescriptions of antilipemic drugs in one year and a prescription contained 18.3 (+/- 11.5) DDDs. We measured 4.1 DDDs per 1,000 inhabitants per day for all antilipemic drug use in 2000. The statins and fibrates predominated the antilipemic drug use. While gemfibrozil was most popular in respect of recipients and prescription items, simvastatin had the largest amount of use in unit of DDDs. Diabetes mellitus co-existed in 37.8% of the patients with antilipemic therapy and the standardized morbidity ratio (SMR) was 3.34. The other concomitant diseases included essential hypertension (rate: 48.8%, SMR: 2.40) and other heart disease (rate: 30.7%, SMR: 2.36).

CONCLUSIONS

Statins were the leading antilipemic drugs in Taiwan. The users of antilipemic drugs were more likely to have concomitant diabetes mellitus, hypertension and heart disease.

Utilization of psychotropic drugs in Taiwan: an overview of outpatient sector in 2000

BACKGROUND

Development of pharmacological treatment in mental disorders has risen drastically over the past decade in Taiwan. We performed a survey of the National Health Insurance claims for outpatient psychiatric services to study the utilization of psychotropic drugs. The analysis followed the drug classification and standardized measurements proposed by the World Health Organization.

METHODS

The sampling datasets from the National Health Insurance Research Database served as data sources. They represented 0.2% of the entire claims for outpatient medical services in 2000. The measurement units used for psychotropic drugs were either prescription volumes (drug items) or the number of defined daily doses (DDDs). To estimate the proportion of the population treated daily with psychotropic drugs, numbers of DDDs per 1000 inhabitants per day were also calculated. Beside overall description, the data of psychotropic substance prescriptions were analyzed by stratifying patient's age, physician's specialty, accreditation status of hospital, and chemical subgroup of psychotropic drugs.

RESULTS

Prescription of psychotropic drug items (n = 63,539) was 3.24% of the total drug items (n = 1,958,820) claimed. The psychotropic drugs were prescribed to 9.2% of the total patients and in 9% of the total visits. Major consumers of psychotropic drugs were between 35-74 years of age and there were more women than men. The psychiatrist was the largest group of physicians who had prescribed psychotropic drugs and contributed 18.5% of all drug items and 38.3% of total DDDs of psychotropic drugs. The number of DDDs per 1000 inhabitants per day for all kinds of psychotropic drugs was estimated to be 32.94 in Taiwan, where anxiolytics accounted 14.30, hypnotics and sedatives 10.64, antipsychotics 3.41, antidepressants 3.06 and mood stabilizers 1.43. Ordered by total DDDs, the top 10 most frequently used chemical substances were flunitrazepam, alprazolam, fludiazepam, oxazolam, lorazepam, diazepam, zolpidem, estazolam, zopiclone, and haloperidol.

CONCLUSIONS

The usage level of psychotropic drugs in Taiwan was lower than in most industrialized countries, especially for antidepressants. The future goals are to focus on the longitudinal analysis of general trend for each psychotropic substance and to associate the pharmacoepidemiological data in parallel with the upcoming epidemiological study of mental disorders in Taiwan.

Dna-end binding activity of Ku in synchronized cells

Three different types of cells were synchronized by various methods and DNA-end binding (DEB) activities of Ku were compared with asynchronous controls. In CHO K1 cells synchronized in G1 phase by serum starvation and in S phase by serum refeeding, DEB activity was reduced in S cells but remained unchanged in G1 cells. However, the same type of cells synchronized in G1/S phase by double thymidine block and in S phase by releasing the blockage, have the same DEB activity as asynchronous controls. A similar result was found in RKO and HeLa cells synchronized by the latter method. Arresting cells in mitosis with nocodazole also generated different cell cycle effects. Ku activity was reduced in CHO K1 and RKO cells, but not in HeLa cells after treatment with nocodazole. In phase-enriched cells separated by centrifugal elutriation, DEB activities were similar at different stages of the cell cycle in all three types of cells. Thus, different synchronization procedures can give very different values of Ku activity in a cell type-dependent manner. Results from elutriated cells are consistent, and suggest DEB activity of Ku does not change with the cell cycle.