Exploration of health status, healthcare utilization, and health service expectations among Taiwanese adolescents

Family-Rated Pediatric Health Status Is Associated With Unplanned Health Services Use

OBJECTIVE

Self-rated health is a common self-reported health measure associated with morbidity, mortality, and health care use. The objective was to investigate the association of family-rated health status (FRH) in pediatric care with administrative indicators, patient and respondent features, and unplanned health services use.

PATIENTS AND METHODS

Data were taken from Child-Hospital Consumer Assessment of Healthcare Providers and Systems surveys collected between 2015 and 2019 in Alberta, Canada and linked with administrative health records. Three analyses were performed: correlation to assess association between administrative indicators of health status and FRH, logistic regression to assess respondent and patient characteristics associated with FRH, and automated logistic regression to assess the association between FRH and unplanned health services use within 90 days of discharge.

RESULTS

A total of 6236 linked surveys were analyzed. FRH had small but significant associations with administrative indicators. Models of FRH had better fit with patient and respondent features. Respondent relationship to child, child age, previous hospitalizations, and number of comorbidities were significantly associated with ratings of FRH. Automated models of unplanned services use included FRH as a feature, and poor ratings of health were associated with increased odds of emergency department visits (adjusted odds ratio: 2.15, 95% confidence interval: 1.62-2.85) and readmission (adjusted odds ratio: 2.48, 95% confidence interval: 1.62-2.85).

CONCLUSION

FRH is a simple, single-item global rating of health for pediatric populations that provides accessible and useful information about pediatric health care needs. The results of this article serve as a reminder that family members are valuable sources of information that can improve care and potentially prevent unplanned health services use.

Examining the Relationship between Gender Contentedness and Sex-Related Experiences among Taiwanese Youth

Little is known about how gender contentedness is related to sex-related experiences among Taiwanese adolescents. Secondary analysis of data (n = 2624, Mage = 13.3 ± 0.47 years and 51% males) on a longitudinal youth cohort was used to track the evolving development of sex-related experiences such as exposure to sexually explicit media, romantic experiences, and sexual behaviors. Hierarchical multinomial logistic regression analyses were applied to study the effects of gender contentedness on sex-related outcome variables. The results showed that nearly 10% of the subjects were not contented with their gender. As compared to peers, gender-discontented adolescents had a higher likelihood of exposures to sexually explicit media (odds ratio [OR]. = 1.70, 95% confidence interval [CI]. = 1.18–2.46) and risky sex behaviors (OR = 2.22, 95% CI = 1.03–4.81). These results shed light on the impact of self-perceived gender contentedness on sex-related experiences in Taiwanese adolescents. Our findings are helpful for the development of practical guidance on sexual health issues, particularly for those who are discontented with their gender.

Effects of childhood adversity and resilience on Taiwanese youth health behaviors

BACKGROUND

Adverse childhood experiences (ACEs) can leave negative impacts on one's health behaviors or social functioning later in life. Resilient characteristics have been shown to mitigate effects against risk behaviors in developing adolescents. However, clinical and research attention has rarely been given to jointly consider the effects of ACEs and resilient characteristics on health behaviors in Taiwanese youth.

METHOD

A total of 200 individuals aged 15-22 years were recruited from primary care settings, communities, and schools. Participants completed questionnaires assessing their ACEs, resilient characteristics, and health behaviors. Univariate analysis was firstly used to describe the correlates of ACEs and resilient characteristics. Further multivariate logistic regression analysis was used to examine the association of both factors with health behaviors.

RESULTS

More than half (61.5%) of those surveyed had been exposed to at least one category of ACE. Verbal (37%) and physical (21%) abuses were the most common types of ACEs. The counts in the ACE categories were associated with being involved in physical fights (odds ratio 1.28 [confidence interval 1.01-1.63]), property damage (1.29 [1.03-1.61]), running away from home (1.30 [1.05-1.60]), bullying victimization (1.37 [1.16-1.61]), and sleep problems/tiredness (1.25 [1.03-1.52]). Meanwhile, resilience scores were associated with decreased odds of infrequent seatbelt use (0.47 [0.23-0.97]), low fruit and vegetable intake (0.42 [0.21-0.86]) unsatisfied body image (0.46 [0.22-0.97]), and sleep problems/tiredness (0.37 [0.18-0.79]).

CONCLUSIONS

ACEs and resilience characteristics play a significant role in shaping youth health behaviors. Further research should be undertaken to identify ways to build resilience against health risks in youth with prior ACE exposure.

National population-based data on the incidence, prevalence, and psychiatric comorbidity of eating disorders in Taiwanese adolescents and young adults

OBJECTIVE

Nationwide data on eating disorders (EDs) among East Asian populations are scarce. This study aimed to estimate the prevalence, incidence, and psychiatric comorbidities of EDs in Taiwan.

METHOD

Drawing from the National Health Research Institute database, we identified the study subjects aged 11-34 years who received an ED diagnosis during ambulatory visits or hospitalization from 2001 to 2012. We analyzed the subjects by age and gender. Diagnoses for comorbid psychiatric disorders were entered in the analysis only if they occurred within 1 year before or after the ED diagnosis date. Rates were age- and sex-adjusted to the average population within the study period.

RESULTS

The estimated mean annual incidence was approximately 11.11 (95% CI 10.51-11.72) per 100,000 residents, and the 1 year prevalence was 20.87 (95% CI 20.05-21.70) per 100,000 residents, with evidence of female predominance (female/male ratio = 10.95, 95% CI = 8.97-13.36). Incidence and prevalence peaked at ages 20-24 in females and at ages 25-29 in males. Both rates nearly doubled within a decade. Specifically, the anorexia nervosa trend recently stabilized in females and decreased in males, while that for bulimia nervosa increased in both females and males. The most common comorbid diagnoses were anxiety (53%) and major depressive disorders (22%).

DISCUSSION

The incidence and prevalence of EDs were lower in Taiwan than in Western countries. However, these rates were rapidly rising, notably in males. The majority of Taiwanese ED patients also received a diagnosis for various psychiatric comorbidities, a finding worthy of clinical attention.

Do healthier lifestyles lead to less utilization of healthcare resources?

Background

Governments are urged to determine methods to control the use of medical resources and curb the rise of healthcare costs. The question is, do health behaviors have an impact on the use of medical resources? This study aims to identify and understand the difference in the number of outpatient visits and health examinations based on various health behaviors and to determine whether patients seek medical care for illness from the same physicians.

Methods

This study used the dataset derived from the Department of Budget, Accounting and Statistics of Kaohsiung, Taiwan in 2005. Persons older than 15 years were surveyed using an on-site questionnaire. A total of 2911 persons were enrolled in this study. Independent t-tests, chi-square tests, one-way ANOVA, multiple linear regression and binominal logistic regression were used in the data analysis.

Results

The regression model for the frequency of doctor visits, health examinations, and whether the same physician is sought for medical care has demonstrated significant correlations with gender, age and education-level variables. Four health behaviors (i.e., exercise habits, dietary habits, regular blood pressure measurement, drinking habits) exhibited a significant correlation with healthcare utilization (P <0.05).

Conclusions

Healthy lifestyles lead to an increase in the utilization of preventive health services. However, there is not much significantly reducing the number of outpatient visits in people with health behaviors. Specifically, people with regular exercise habits and who take their blood pressure measurement regularly have an increased number of outpatient visits. It is suggested that more available and accessible health consultation services be provided to inculcate in the general public the importance of maintaining a healthy lifestyle.

Explaining the gender difference in self-rated health among university students in Egypt

In this study the authors assessed gender differences in the relationships between self-rated health (SRH) and demographic factors, physical health, health service use, infections, a variety of symptoms and health conditions, and wider well-being features. A self-administered questionnaire was administered to 3,271 students at Assiut University, Egypt during 2009-2010. Multiple logistic regression was used (with excellent/very good SRH as dependent variable) to assess the variables that might explain the gender difference in SRH. Females had more symptoms, infectious diseases/illness periods, substantially lower quality of life, and more burdens, although their health awareness and satisfaction with social support were higher than males. The unadjusted odds ratio (OR) suggested that females were less likely than males to rate their SRH as excellent/very good [OR 0.56, 95% confidence interval (CI) 0.47-0.68]. Adjusting only for relevant physical health and health service use variables, the OR for excellent/very good SRH for females increased, but nevertheless still remained significantly lower than that of males. With further adjustment for physical health, health service use, and also for wider well-being variables, the gender difference in SRH became no longer statistically significant. Poorer physical health indicators and a lower level of wider well-being features explained the lower SRH among female Egyptian university students. Health promotion and prevention programs should consider these factors in attempting to address gender health disparities.

Perceived Health in Patients with Primary Immune Deficiency

Purpose

Perceived health (PH) is a subjective measure of global health of individuals. While many studies have evaluated outcomes in patients with primary immune deficiency (PID), published literature evaluating PH among patients with PID is sparse. We evaluated the results of the largest self-reported survey of patients with PID to determine the factors that may contribute to differences in PH.

Methods

Data from a National Survey of Patients with Primary Immune Deficiency Diseases conducted by the Immune Deficiency Foundation was studied. Multivariate logistic regression was employed for data analysis.

Results

Thirty percent of the patients perceived their health status as excellent or very good (EVG), 31 % as good (G), and 39 % as fair, poor or very poor (P). Older patients were less likely to have EVG-PH compared to G-PH. Ones with college degrees were more likely to have P-PH compared to G-PH, and less likely to have EVG-PH. Patients who were acutely ill and hospitalized in the past 12 months, ones with limited activity, and chronic diseases, were more likely to have P-PH compared to G-PH. Patients with “on demand” access to specialty care and ones on regular IVIG had higher OR of having EVG-PH as opposed to G-PH. Patients cared for mostly by an immunologist were less likely to have P-PH compared to G-PH.

Conclusions

Our results emphasize the importance of PH in clinical practice. We suggest that recognizing the factors that drive PH in patients with PID is important for the development of disease prevention and health promotion programs, and delivery of appropriate health and social services to individuals with PID.

Effects of pubertal timing on alcohol and tobacco use in the early adulthood: A longitudinal cohort study in Taiwan

We aimed to examine the effects of pubertal timing on adolescents' alcohol and tobacco use from late adolescence to young adulthood. In addition, we separately explored associative factors of the use of these substances stratified by pubertal timings. A longitudinal cohort of 7th- and 9th-grade students was recruited in Taiwan. Pubertal timing was classified according to the Pubertal Developmental Scale. Effects of pubertal timing on self-reported drinking and smoking at age 20 were evaluated using generalized estimating equation analysis. Furthermore, we assessed the predictive roles of parental monitoring, parent-child relationships, peer influence, and school adhesion among participants, stratified by pubertal timing using multiple logistic regression analysis. A survey of 2290 participants was analyzed, with 51.2% being female. The smoking rate is 19.2% (adjusted odds ratio [OR] 1.43, 95% confidence interval [CI] 1.03-2.00) and the alcohol drinking rate is 41.6% (adjusted OR 1.34, 95% CI 1.07-1.69) for early maturing adolescents as compared to 12.3% and 41.6% respectively for on-time peers. A satisfactory parent-child relationship is a protective factor and strict parental monitoring is a risk factor for future tobacco and alcohol use in logistic regression analyses. Early maturation confers risk for cigarette smoking and alcohol consumption in young adulthood. Health professionals and parents should be advised of the potential associative factors with future substance use among adolescents with different maturation tempo. Emphasis could be placed on promoting positive parenting strategies and intra-familial interactions.