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Lin JR, Kao EHC, Weng SC, Rouyer E. A Study of Frailty, Mortality, and Health Depreciation Factors in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010211. [PMID: 31892225 PMCID: PMC6981415 DOI: 10.3390/ijerph17010211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/16/2022]
Abstract
This study used 23 factors (eight interval variables and 15 dummy variables) as proxies for health depreciation. We used 1248 older adults from the Center for Geriatrics and Gerontology of Taichung Veterans General Hospital (Taiwan) to examine the association among frailty, health depreciation, and mortality in older adults. This study found that a significant positive correlation existed between frailty and mortality in older adults. Further, we applied a recursive bivariate probit model to examine the association between health depreciation factors, frailty, and mortality. Our results showed that health depreciation factors, such as Charlson's comorbidity index, diabetes and hyperlipidemia, significantly increased older adults' frailty; in contrast, albumin and mini nutritional assessment significantly decreased older adults' frailty. Through the frailty regression, we confirmed not only that health depreciation factors significantly influenced mortality, but also that creatinine, myocardial infarction, and malignant tumors could directly and significantly increase older adults' mortality.
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Affiliation(s)
- Jwu-Rong Lin
- Department of International Business, Tung Hai University, No.1727, Sec.4, Taiwan Boulevard, Xitun District, Taichung 40704, Taiwan; (J.-R.L.); (E.H.-C.K.)
| | - Erin Hui-Chuan Kao
- Department of International Business, Tung Hai University, No.1727, Sec.4, Taiwan Boulevard, Xitun District, Taichung 40704, Taiwan; (J.-R.L.); (E.H.-C.K.)
| | - Shuo-Chun Weng
- Institute of Clinical Medicine, National Yang-Ming University, No. 155, Section 2, Linong St, Beitou District, Taipei City 112, Taiwan;
- Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung 40705, Taiwan
| | - Ellen Rouyer
- Department of International Business, Tung Hai University, No.1727, Sec.4, Taiwan Boulevard, Xitun District, Taichung 40704, Taiwan; (J.-R.L.); (E.H.-C.K.)
- Correspondence:
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Weng SC, Chen YC, Chen CY, Cheng YY, Tang YJ, Yang SH, Lin JR. Application of qualitative response models in a relevance study of older adults' health depreciation and medical care demand. Geriatr Gerontol Int 2016; 17:645-652. [PMID: 27246701 DOI: 10.1111/ggi.12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
AIM The effect of health depreciation in older people on medical care demand is not well understood. We tried to assess the medical care demand with length of hospitalization and their impact on profits as a result of health depreciation. METHODS All participants who underwent comprehensive geriatric assessment were from a prospective cohort study at a tertiary hospital. A total of 1191 cases between September 2008 to October 2012 were investigated. Three sets of qualitative response models were constructed to estimate the impact of older adults' health depreciation on multidisciplinary geriatric care services. Furthermore, we analyzed the factors affecting the composite end-point of rehospitalization within 14 days, re-admission to the emergency department within 3 days and patient death. RESULTS Greater health depreciation in elderly patients was positively correlated with greater medical care demand. Three major components were defined as health depreciation: elderly adaptation function, geriatric syndromes and multiple chronic diseases. On admission, the better the basic living functions, the shorter the length of hospitalization (coefficient = -0.35, P < 0.001 in Poisson regression; coefficient = -0.33, P < 0.001 in order choice profit model; coefficient = -0.29, P < 0.001 in binary choice profit model). The major determinants for poor outcome were male sex, middle old age and length of hospitalization. However, factors that correlated with relatively good outcome were functional improvement after medical care services and level of disease education. CONCLUSIONS An optimal allocation system for selection of cases into multidisciplinary geriatric care is required because of limited resources. Outcomes will improve with health promotion and preventive care services. Geriatr Gerontol Int 2017; 17: 645-652.
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Affiliation(s)
- Shuo-Chun Weng
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chi Chen
- Department and Institute of Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Yu Chen
- Department of International Business, Tunghai University, Taichung, Taiwan
| | - Yuan-Yang Cheng
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yih-Jing Tang
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shu-Hui Yang
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jwu-Rong Lin
- Department of International Business, Tunghai University, Taichung, Taiwan
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Fang WH, Yen CF, Hu J, Lin JD, Loh CH. The utilization and barriers of Pap smear among women with visual impairment. Int J Equity Health 2016; 15:65. [PMID: 27068132 PMCID: PMC4828796 DOI: 10.1186/s12939-016-0354-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 04/04/2016] [Indexed: 01/08/2023] Open
Abstract
Background Many evidences illustrate that the Pap smear screening successfully reduces if the cervical cancer could be detected and treated sufficiently early. People with disability were higher comorbidity prevalence, and less likely to use preventive health care and health promotion activities. There were also to demonstrate that people with visual impairment has less access to appropriate healthcare services and is less likely to receive screening examinations. In Taiwan, there was no study to explore utilization of Pap smear, associated factors and use barriers about Pap smear screening test among women with visual impairment. The purpose is to explore the utilization and barriers of using Pap smear for women with visual impairment in Taiwan. To identify the barriers of women with visual from process of receiving Pap smear screening test. Methods The cross-sectional study was conducted and the totally 316 participators were selected by stratified proportional and random sampling from 15 to 64 year old women with visual impairment who lived in Taipei County during December 2009 to January 2010. The data was been collected by phone interview and the interviewers were well trained before interview. Results The mean age was 47.1 years old and the highest percentage of disabled severity was mile (40.2 %). Totally, 66.5 % of participators were ever using Pap smear and 38.9 % used it during pass 1 year. Their first time to accept Pap smear was 38.8 year old. There was near 50 % of them not to be explained by professionals before accepting the Pap smear. For non-using cases, the top two percentage of barriers were “feel still younger” (22.3 %), the second was “there’s no sexual experience” (21.4 %). We found the gynecology experiences was key factor for women with visual impairment to use Pap smear, especially the experiences was during 1 year (OR = 4). Conclusions Associated factors and barriers to receive Pap smear screening test for women with visual impairment can be addressed through interventions aimed at improving on cognitions and attitudes for cervical cancer risk factors. Our study would be as a reference resource for erasing the barriers and inequality among the visually disabled women.
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Affiliation(s)
- Wen-Hui Fang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu-Chi University, Hualien, Taiwan.
| | - Jung Hu
- Medical Quality Department, E-DA Hospital, Kaohsiung, Taiwan
| | - Jin-Ding Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Hui Loh
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Yen SM, Kung PT, Tsai WC. Sociodemographic characteristics and health-related factors affecting the use of Pap smear screening among women with mental disabilities in Taiwan. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:491-497. [PMID: 25462509 DOI: 10.1016/j.ridd.2014.10.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/24/2014] [Indexed: 06/04/2023]
Abstract
This study examined the use of the Pap cervical cancer screening test among women with mental disabilities in Taiwan and analyzed factors related thereto. Data were obtained from three national databases in Taiwan: the 2008 database of physically and mentally disabled persons from the Ministry of the Interior, 2007-2008 Pap smear test data from the Health Promotion Administration, and claims data from the National Health Insurance Research Database. The study subjects included 49,642 Taiwanese women aged ≥30 years with mental disabilities. Besides descriptive and bivariate analyses, logistic regression analysis was also performed to examine factors affecting Pap smear use. In 2007-2008, Taiwanese women with mental disabilities had a Pap screening rate of 11.05%. Age, income, education, marital status, catastrophic illness/injury, relevant chronic illnesses, and severity of disability were identified as factors affecting their Pap smear use. Age and severity of disability were negatively correlated with Pap screening, with the odds of screening being 0.37 times as high in ≥70-year-olds as in 30-39-year-olds and 0.49 times as high for very severe disability as for mild disability. Income was positively correlated with Pap screening. Being married (OR=2.55) or divorced or widowed (OR=2.40) relative to being unmarried, and having a catastrophic illness/injury (OR=1.13), cancer (OR=1.47), or diabetes (OR=1.25), were associated with greater odds of screening. In Taiwan, women with mental disabilities receive Pap smears at a far lower rate than women in general.
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Affiliation(s)
- Suh-May Yen
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC; Department of Chinese Medicine, Nantou Hospital, Nantou, Taiwan, ROC.
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC.
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC.
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Yen SM, Kung PT, Tsai WC. The characteristics and relevant factors of Pap smear test use for women with intellectual disabilities in Taiwan. BMC Health Serv Res 2014; 14:240. [PMID: 24890828 PMCID: PMC4048461 DOI: 10.1186/1472-6963-14-240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examines the Pap smear usage conditions and relevant influential factors for 18,204 women aged 30 years and above with intellectual disabilities, using nationwide data from 2008. METHODS The research method of this study is secondary data analysis. The data was obtained from three nationwide databases from 2006 to 2008. This study employed descriptive statistics to analyze the use and rate of Pap smear testing by women with intellectual disabilities. Chi-square test was used to assess the correlation between Pap smear test usage and several variables. Logistic regression analysis was employed to explore the factors that influence Pap smear test usage. RESULTS The results show that 4.83% (n =880) of women with intellectual disabilities underwent Pap smear tests. Pap smear test usage rates exhibit a declining trend with increases in age. Factors that significantly influence Pap smear test use include age, urbanization level of resident area, monthly salary, aboriginal status, marital status, existence of DM, severity of disability. CONCLUSIONS The women with intellectual disabilities had a low use rate of Pap smear test, which is significantly less than the 28.8% usage rate for the general population of women aged 30 years and above.
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Affiliation(s)
| | | | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No, 91 Hsueh-Shih Road, Taichung, Taiwan 40402, Republic of China.
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Hsiou TR, Pylypchuk Y. Comparing and decomposing differences in preventive and hospital care: USA versus Taiwan. HEALTH ECONOMICS 2012; 21:778-795. [PMID: 21608071 DOI: 10.1002/hec.1743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 03/15/2011] [Accepted: 03/23/2011] [Indexed: 05/30/2023]
Abstract
As the USA expands health insurance coverage, comparing utilization of healthcare services with countries like Taiwan that already have universal coverage can highlight problematic areas of each system. The universal coverage plan of Taiwan is the newest among developed countries, and it is known for readily providing access to care at low costs. However, Taiwan experiences problems on the supply side, such as inadequate compensation for providers, especially in the area of preventive care. We compare the use of preventive, hospital, and emergency care between the USA and Taiwan. The rate of preventive care use is much higher in the USA than in Taiwan, whereas the use of hospital and emergency care is about the same. Results of our decomposition analysis suggest that higher levels of education and income, along with inferior health status in the USA, are significant factors, each explaining between 7% and 15% of the gap in preventive care use. Our analysis suggests that, in addition to universal coverage, proper remuneration schemes, education levels, and cultural attitudes towards health care are important factors that influence the use of preventive care.
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Affiliation(s)
- Tiffany R Hsiou
- Georgetown Public Policy Institute, Georgetown University, Washington, DC, USA
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Huang KH, Tsai WC, Kung PT. The use of Pap smear and its influencing factors among women with disabilities in Taiwan. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:307-314. [PMID: 22100350 DOI: 10.1016/j.ridd.2011.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 09/15/2011] [Indexed: 05/31/2023]
Abstract
Cervical cancer is a prevalent cancer among Taiwanese women, and can be effectively cured if diagnosed early. Therefore, cervical cancer is worthy of preventive health screening. Due to physical and psychological barriers, patients with disability may be unable to express their physical complaints accurately, thus reducing their access to health care; some may not even receive proper preventive health care or medical treatment. This study investigates the utilization of Pap smear among women with disability in Taiwan and its influencing factors. With women aged 30 and over as the study subjects, this retrospective cohort study is conducted based on the database of the Ministry of the Interior, Taiwan, 2008, combined with information gathered between 2006 and 2008 regarding preventive health care and health insurance medical claims data from the Bureau f Health Promotion and the National Health Research Institutes, respectively. The frequency of Pap smears and the percentage differences of each variable are examined using the 2× tests to check for statistical significance. Finally, logistic regression analysis is used to examine the factors influencing the use of Pap smears. The results revealed that among disabled women aged 30 and over, the use of Pap smears was 7.71% in 2008. Disabled women with the following characteristics had lower use levels regarding Pap smears: greater age, residing in areas of higher urbanization, lower income, lower education levels, unmarried, not diagnosed with cancer, diagnosed with diabetes, and with severe disability levels. Disabled women with hearing impairments or mental retardation were possessed of the highest and lowest probabilities of using Pap smear, respectively. The recommendations of this study include: (1) provide physicians with a varying pricing scheme and incentives for Pap smear based on the type or severity of disability; (2) proactively encourage gynecologist and obstetricians to conduct regular and convenient Pap smear on disabled women; and (3) target disabled women in low usage groups, and improve their knowledge of Pap smear.
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Affiliation(s)
- Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan, ROC
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Lin YJ, Tian WH, Chen CC. Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan. Health Policy 2011; 103:236-43. [PMID: 21920621 DOI: 10.1016/j.healthpol.2011.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 08/10/2011] [Accepted: 08/25/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aims to investigate the relationship between the level of urbanization and the utilization of outpatient services under the National Health Insurance (NHI) program in Taiwan. METHODS We adopted a two-part model using data from the 2001 National Health Interview Survey (NHIS) and the 2001 National Health Insurance Research Database (NHIRD) in Taiwan. Data for a total of 20,640 individuals were obtained for subsequent analysis in this study. RESULTS The results of the first part, the contact analysis, indicate that individuals residing in areas with lower urbanization levels are less likely to use outpatient services compared to those residing in areas with the highest urbanization levels. The second part of the frequency analysis revealed that, for those individuals that had previously utilized outpatient services, those residing in areas with lower urbanization levels tended to utilize outpatient services less than individuals residing in areas with higher levels of urbanization. CONCLUSIONS Our empirical results show that differences between urbanization levels are a major contributory factor associated with the probability and frequency of outpatient utilization in Taiwan.
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Affiliation(s)
- Yen-Ju Lin
- Department of Public Finance and Taxation, National Taichung Institute of Technology, Taiwan
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An Exploration of Papanicolaou Smear History and Behavior of Patients With Newly Diagnosed Cervical Cancer in Taiwan. Cancer Nurs 2010; 33:362-8. [DOI: 10.1097/ncc.0b013e3181d6f792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tung WC, Lu M, Cook D. Papanicolaou screening in Taiwan: perceived barriers and self-efficacy. Health Care Women Int 2010; 31:421-34. [PMID: 20390663 DOI: 10.1080/07399330903349699] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cervical cancer remains a leading cause of death in Taiwan, and frequency of screening remains low. We surveyed Taiwanese women about beliefs and practices related to cervical screening, searching for perceived barriers and self-efficacy using the transtheoretical model. We assessed demographics, 12 perceived barriers, and seven self-efficacy measures for 222 Taiwanese women. Data were analyzed descriptively and with multiple linear regression. Barriers related to worry, embarrassment, stigma, and the lack of female physicians were significant in the relapse stage. All self-efficacy measures were significant across various stages of change. Interventions should focus on relapsers and on information related to self-efficacy.
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Affiliation(s)
- Wei-Chen Tung
- School of Community Health Sciences, University of Nevada-Reno, NV 89557, USA.
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Tung WC, Lu M, Cook D. Cervical Cancer Screening Among Taiwanese Women: A Transtheoretical Approach. Oncol Nurs Forum 2010; 37:E288-94. [DOI: 10.1188/10.onf.e288-e294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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