The utilization of Pap tests among different female medical personnel: a nationwide study in Taiwan

Comparisons of Papanicolaou Utilization and Cervical Cancer Detection between Rural and Urban Women in Taiwan

Using the claims data of one million insured residents in Taiwan from 1996–2013, this study identified 12,126 women in an urban city (Taichung) and 7229 women in a rural county (Yunlin), aged 20 and above. We compared Papanicolaou (Pap) test uses and cervical cancer detection rates between urban and rural women. Results showed that the Pap screening rate was slightly higher in rural women than in urban women (86.1 vs. 81.3 percent). The cervical cancer incidence was much greater for women without Pap test than women with the test (35.8 vs. 9.00 per 1000 in rural women and 20.3 vs. 7.00 per 1000 in urban women). Nested case-control analysis showed that Pap test receivers had an adjusted odds ratio (OR) of 0.35 (95% CI = 0.25–0.51) to be diagnosed with cervical cancer as compared to those who did not receive the test. The rural women had an adjusted OR of 1.46 (95% CI = 1.03–2.06) to be diagnosed with cervical cancer as compared to urban women. In conclusion, women in rural area are at higher cancer risk than city women. Women who do not undergo Pap tests deserve timely intervention of Pap test to prevent the onset of cancer, particularly in rural women with low income.

Effective Factors of Utilization of Inpatient, Outpatient, Diagnostic, and Pharmaceutical Health Services: A Systematic Review

Utilization is one of the dimensions of equity in health systems. Identifying the factors affecting utilization of health services can be helpful for interventional purposes. This study systematically reviewed the factors affecting the utilization of inpatient, outpatient, diagnostic, and pharmaceutical services. This systematic review was conducted between 2016 and 2017. The search was performed using keywords based on MeSH in valid databases such as Scopus, Embase, ProQuest, ScienceDirect, PubMed, and Web of Science in the fields of title, abstract, and keyword. Related papers published from 2000 to 2017 were searched. First, the retrieved studies were screened and checked for quality; then, the useful data were extracted and analyzed. Out of the 1178 retrieved publications, 20 studies were included in the final analysis. The identified factors were categorized into 5 areas, including demographic (4 items), socioeconomic (13 items), health services-related (13 items), health status-related (7 items), and health insurance-related factors (2 items), and reported. The findings of this study can be a useful source and a comprehensive body of evidence on the utilization of health services. The results can be used by the policy makers and managers in designing interventions for changing the utilization patterns of health services.

Physical activities and influencing factors among public health nurses: a cross-sectional study

OBJECTIVES

Public health nurses are responsible for promoting and managing the health of community members, and if they do not have enough physical activity or ignore their own health, not only will their own health decline but the quality of life of the public will also be affected. This study investigated the physical activity of public health nurses and analysed the effects of attitudes, subjective norms, perceived behavioural control and behavioural intention to engage in physical activity.

METHODS

This study adopted a cross-sectional research design, and convenience sampling was used to select the research subjects. 198 public health nurses were invited to participate, and 172 completed the questionnaire. Multiple linear regression was used to analyse the influencing factors of physical activity intention and physical activity.

RESULTS

Attitudes towards physical activity and perceived behavioural control of physical activity affected physical activity intention. When they had higher behavioural intention, their physical activity behaviour also improved. The physical activity intention significantly influenced the number of days that they had engaged in vigorous physical activity (95% CI 0.1786 to 0.3060, p<0.0001), and significantly influenced the number of days that they walked daily for 10 min (95% CI 0.2158 to 0.4144, p<0.0001), and also significantly influenced their daily sedentary time (95% CI -0.3020 to 0.0560, p=0.0046).

CONCLUSIONS

Encouraging public health nurses to heed their own health and motivating them to engage in physical activity warrants attention from policy-makers and government health agencies.

Ambulatory medical services utilization for menstrual disorders among female personnel of different medical professions in Taiwan: a nationwide retrospective cohort study

Background

Menstrual disorders and their adverse symptoms can have a deleterious effect on both the private and working lives of women. Previous studies indicated that female nurses have elevated risk of menstrual disorders. Moreover, female nurses showed a higher incidence of ambulatory care visit for genitourinary diseases compared with other female medical personnel. However, little is known whether the medical services utilization for menstrual disorders were different among personnel from various medical professions. Therefore, the present study compared the ambulatory medical services utilization for menstrual disorders among personnel of six different medical professions in Taiwan using a nationwide, population-based health claim research database.

Methods

The National Health Insurance Research Database (NHIRD) was used to identify female medical professionals, aged 18 to 45 years, who obtained their licenses during January 1, 2000 to December 31, 2012. Personnel from six different medical professions were examined and they included (1) medical technologists and therapists, (2) registered nurses, (3) physicians, (4) doctors of Chinese medicine, (5) dentists, and (6) pharmacists. Diagnoses of menstrual disorders, based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, were obtained from the ambulatory medical services utilization that occurred after their license date. Cox proportional hazards model was used to assess the hazards of medical services utilization for menstrual disorders using medical technologists and therapists as the reference category.

Results

A total of 7653 medical personnel were included in the analysis. Using the group containing medical technologists and therapists as the reference category, registered nurses (adjusted hazards ratio [AHR] = 1.13, p = 0.018) and doctors of Chinese medicine (AHR = 2.52, p < 0.001) showed a significant increased risk of medical services utilization for menstrual disorders. Conversely, physicians showed a significant decreased risk of medical services utilization for menstrual disorders (AHR = 0.58, p < 0.001). Regarding the nine specific menstrual disorders observed in this study, registered nurses and doctors of Chinese medicine showed an increased risk in six and four of them, respectively. Pharmacists showed an increased risk only in menorrhagia (AHR = 1.64, p = 0.020) and dentists showed no significant differences in any of the nine specific menstrual disorders compared with medical technologists and therapists. Physicians showed a significant decreased risk all specific menstrual disorders except menorrhagia and dysfunctional uterine bleeding.

Conclusions

Findings from this population-based cohort study revealed that, compared with medical technologists and therapists, registered nurses and doctors of Chinese medicine exhibited significant increased risks in medical services utilization for menstrual disorders whereas physicians showed a significant decreased risk in menstrual disorders. Further studies should be conducted to delineate whether the differences in the medical services utilization is an indicator of risk of menstrual disorders or the results of varying patterns of health care seeking behavior among women of different medical professions.