Health examination utilization in the visually disabled population in Taiwan: a nationwide population-based study

Heat-related illness and dementia: a study integrating epidemiological and experimental evidence

BACKGROUND

Heat-related illness (HRI) is commonly considered an acute condition, and its potential long-term consequences are not well understood. We conducted a population-based cohort study and an animal experiment to evaluate whether HRI is associated with dementia later in life.

METHODS

The Taiwan National Health Insurance Research Database was used in the epidemiological study. We identified newly diagnosed HRI patients between 2001 and 2015, but excluded those with any pre-existing dementia, as the study cohort. Through matching by age, sex, and the index date with the study cohort, we selected individuals without HRI and without any pre-existing dementia as a comparison cohort at a 1:4 ratio. We followed each cohort member until the end of 2018 and compared the risk between the two cohorts using Cox proportional hazards regression models. In the animal experiment, we used a rat model to assess cognitive functions and the histopathological changes in the hippocampus after a heat stroke event.

RESULTS

In the epidemiological study, the study cohort consisted of 70,721 HRI patients and the comparison cohort consisted of 282,884 individuals without HRI. After adjusting for potential confounders, the HRI patients had a higher risk of dementia (adjusted hazard ratio [AHR] = 1.24; 95% confidence interval [CI]: 1.19-1.29). Patients with heat stroke had a higher risk of dementia compared with individuals without HRI (AHR = 1.26; 95% CI: 1.18-1.34). In the animal experiment, we found cognitive dysfunction evidenced by animal behavioral tests and observed remarkable neuronal damage, degeneration, apoptosis, and amyloid plaque deposition in the hippocampus after a heat stroke event.

CONCLUSIONS

Our epidemiological study indicated that HRI elevated the risk of dementia. This finding was substantiated by the histopathological features observed in the hippocampus, along with the cognitive impairments detected, in the experimental heat stroke rat model.

Systematic Review: System-wide Interventions to Monitor Pediatric Antipsychotic Prescribing and Promote Best Practice

OBJECTIVE

Rapid growth of antipsychotic use among children and adolescents at the turn of the 21st century led Medicaid programs to implement 3 types of system-wide interventions: antipsychotic monitoring programs, clinician prescribing supports, and delivery system enhancements. This systematic review assessed the available evidence base for and relative merits of these system-wide interventions that aim to improve antipsychotic treatment and management.

METHOD

Using PRISMA guidelines, eligible studies were written in English and evaluated system-wide interventions to monitor antipsychotic treatment or promote antipsychotic management among children and adolescents (0-21 years of age). Studies were identified through Ovid MEDLINE and PsychInfo (years 1990-2018) and an environmental scan. From an initial review of 824 publications, 17 studies met eligibility criteria. Two authors independently conducted quality assessments using the Crowe Critical Appraisal Tool. Findings were summarized descriptively.

RESULTS

Identified studies (n = 17) evaluated prior authorization programs (n = 10), drug utilization reviews (n = 2), quality improvement (n = 4), care coordination programs (n = 1), and multimodal initiatives (n = 2). Studies were predominantly pre-post analyses, without a comparison group. With the exception of care coordination and drug utilization reviews, more than half of the interventions in each category were associated with significant reduction in antipsychotic treatment or promotion of best practice parameters.

CONCLUSION

This evidence review concludes that evaluations of prior authorization programs demonstrate reductions in antipsychotic treatment, though evidence of impact of other system-wide interventions and other outcomes is limited. Additional research is necessary to investigate whether interventions influenced antipsychotic prescribing independent of secular trends, the comparative effectiveness and cost-effectiveness of interventions, the effect on functional outcomes, and the potential for unintended consequences.

Impact of National Health Checkup Service on Hard Atherosclerotic Cardiovascular Disease Events and All-Cause Mortality in the General Population

Whether health checkups favorably impact the occurrence of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality in the general population remains in debate. We investigated further the impact of health checkups on hard ASCVD events and all-cause mortality. We compared the occurrence of hard ASCVD events and all-cause deaths for 4 years starting in 2010 between participants who used the National Health Checkup Service (NHCS) more than twice and nonparticipants who never used the NHCS from 2006 to 2009. From the 342,594 survivors aged 40 to 69 years old in 2006 listed in the National Health Insurance Service-National Sample Cohort, a total of 55,275 pairs were selected by propensity matching. Hard ASCVD events were defined as the composite of myocardial infarction and stroke. In the 55,275 matched pairs, we found a significant association between the use of the NHCS and the reduction in hard ASCVD events (adjusted hazard ratio = 0.84, 95% confidence interval 0.76 to 0.92, p <0.001) and all-cause deaths (adjusted hazard ratio = 0.50, 95% confidence interval 0.45 to 0.55, p <0.001). The participants had more medical care, including outpatient care and hospitalizations, and took more hypertension and dyslipidemia medications, whereas hospitalizations for more than 60 days were significantly more frequent in the nonparticipants. In the subgroup analysis, the reduction in hard ASCVD events for NHCS participants was significantly greater in patients without a previous history of dyslipidemia or who did not have outpatient care. In conclusion, the use of the NHCS was significantly associated with reduced hard ASCVD events and all-cause mortality in the general population.

Factors involved in the delay of treatment initiation for cervical cancer patients: A nationwide population-based study

Cervical cancer ranks as the fourth leading cause of cancer death in women worldwide. In Taiwan, although the universal health insurance system has achieved 99.9% coverage and ensured easy access to medical care, some cervical cancer patients continue to delay initiation of definitive treatment after diagnosis. This study focused on cervical cancer patients who delayed treatment for at least 4 months, and examined the characteristics, related factors, and survival in these patients.Data on patients with a new confirmed diagnosis of cervical cancer by the International Federation of Gynecology and Obstetrics (FIGO) staging system between 2005 and 2010 were obtained from the National Health Insurance Research Database and the Taiwan Cancer Registry. Logistic regression analysis was performed to analyze the association of various factors with treatment delay. The Cox proportional hazards model was used to analyze the effects of various factors on mortality risk.The rate of treatment delay for cervical cancer decreased steadily from 6.46% in 2005 to 2.48% in 2010. Higher rates of treatment delay were observed among patients who were aged ≥75 years (9.91%), had severe comorbidity, had stage IV (9.50%), diagnosing hospital level at nonmedical center, or at public hospital ownership. Factors that correlated with treatment delay were age ≥75 years (odds ratio [OR] = 2.42), higher comorbidity Charlson comorbidity index (CCI) 4-6, or ≥7 (OR = 1.60, 2.00), cancer stage IV (OR = 2.60), the diagnosing hospital being a regional, district hospital, or other (OR = 3.00, 4.01, 4.60), and at public hospital ownership. Those who delayed treatment had 2.31 times the mortality risk of those who underwent timely treatment (P < 0.05).Delayed cervical cancer treatment in Taiwan was associated with age, comorbidity, cancer stage, diagnosing hospital level, and hospital ownership. Delaying treatment for ≥4 months substantially raised mortality risk in cervical cancer patients.

The utilization and barriers of Pap smear among women with visual impairment

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.

Lower Incidence of End-Stage Renal Disease but Suboptimal Pre-Dialysis Renal Care in Schizophrenia: A 14-Year Nationwide Cohort Study

Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD). However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort). We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3) to compare quality of renal care before dialysis and outcomes (the dialysis cohort). Cox proportional hazard models were used to estimate the hazard ratio (HR) for dialysis and death. Odds ratio (OR) derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4–0.8), but had a higher risk for death (HR = 1.2; 95% CI, 1.1–1.3). Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4–0.8) and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6–0.9). But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0–1.8, P < .05). Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.

Sociodemographic characteristics and health-related factors affecting the use of Pap smear screening among women with mental disabilities in Taiwan

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.