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Montegrico J, Lee JM, De Los Santos JAA. A 13-Year Trend Analysis of HIV Epidemiology in the Philippines (2010 to 2022). J Community Health Nurs 2024:1-15. [PMID: 38900001 DOI: 10.1080/07370016.2024.2365146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE This article describes the trends and contributing factors in the human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) epidemiology in the Philippines from 2010 to 2022. This is the first trend analysis of the Philippine HIV/AIDS situation. DESIGN Using time trend research design, 13-year longitudinal epidemiological data were collected and analyzed to present a dynamic perspective of the Philippine HIV/AIDS epidemic. METHODS Secondary data analysis of HIV surveillance public documents from 2010 to 2022 was conducted. The Centers for Disease Control's socioecological model was used to guide the literature and interpretation of findings. Frequency, percentage distribution, and Sieve-bootstrap t-test for linear trends were used to analyze the results. FINDINGS There is an increased trend in HIV incidence, late diagnosis, and AIDS-related mortality in all geographical regions in the country from 2010-2022. The majority of HIV cases are males, ages 25-34, and reside in the nation's capital. Increased HIV incidence among overseas workers, sex workers, and HIV-positive blood products were noted. CONCLUSION Trends in Philippine HIV epidemiology are contrary to global trends. Community-based HIV prevention programs targeting specific high-risk populations are needed. CLINICAL EVIDENCE Community health nurses in the Philippines play a critical role in reversing the rising trend of HIV/AIDS. They are positioned to lead targeted education and prevention programs for high-risk groups using the socioecological model to implement community-based strategies that address factors contributing to the epidemic. Their efforts in early detection and linkage to care are essential in reducing late diagnosis and AIDS-related mortality.
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Affiliation(s)
- James Montegrico
- School of Nursing, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jung-Min Lee
- College of Nursing, Hallym University, Chuncheon, South Korea
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Lyons K, Schmid KK, Ratnapradipa KL, Tibbits M, Watanabe-Galloway S. Comparing bullying to ACEs in the national survey of children's health: Examining 2016-2019 prevalence trends among children and adolescents. CHILD ABUSE & NEGLECT 2024; 151:106733. [PMID: 38507921 DOI: 10.1016/j.chiabu.2024.106733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES To estimate adverse childhood experience (ACE) prevalence among children and adolescents aged 6-17 years in the United States, to examine factors influencing the prevalence of ACEs over the time period 2016-2019, and to examine the difference in bullying trends compared to ACEs in the NSCH. PARTICIPANTS AND SETTING The National Survey of Children's Health (NSCH) is a cross-sectional survey. Participants included respondents who completed the separate surveys for ages 6-11 and 12-17 from 2016 to 2019. METHODS Cumulative ACEs were analyzed to determine the change in prevalence of having at least one ACE, overall and stratified by age group. RESULTS Overall prevalence was highest among income difficulties (16-26 %); parent/guardian divorced or separated (29-31 %); and bullying (21-48 %). There was a significant time trend for income difficulties (decreased; p < 0.001), lived with anyone with a mental illness (increased; p = 0.004), racial/ethnic mistreatment (increased; p = 0.004), and bullying (increased; p < 0.001). Cumulative prevalence trends without bullying decreased significantly from 2016 to 2019 while prevalence trends for bullying increased significantly during this time frame. Sex, age, and race/ethnicity were significantly associated with some of the ACEs. CONCLUSIONS Trend of ACEs varies as prevalence of some ACEs increased while decreasing for others over time. Also, ACEs appear to affect children and adolescents differently according to sex, age group, and racial/ethnic background, which warrants the need to prioritize efforts to decrease the exposure to ACEs.
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Affiliation(s)
- Kiara Lyons
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, United States of America; Maternal and Child Health Translational Research Team, College of Health Solutions, Arizona State University, 850 N. 5th St., Phoenix, AZ 85004, United States of America..
| | - Kendra K Schmid
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, United States of America
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, United States of America
| | - Melissa Tibbits
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, United States of America
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, United States of America
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Fassinou LC, Hien H, Yombi JC, Nagot N, Kirakoya-Samadoulougou F. Availability and readiness of the health facilities to provide HIV counseling and testing and prevention of mother-to-child transmission services in Burkina Faso: a trend analysis from 2012 to 2018. BMC Health Serv Res 2023; 23:757. [PMID: 37452422 PMCID: PMC10347843 DOI: 10.1186/s12913-023-09757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Provider-Initiated HIV Testing and Counseling (PITC) and Prevention of Mother-To-Child Transmission (PMTCT) are key services for achieving the goal of complete elimination of HIV. However, there is limited evidence on the ability of health facilities to provide these services in Burkina Faso. Therefore, we aimed to assess the trends and disparities in the availability and readiness of health facilities to provide PITC and PMTCT services in Burkina Faso between 2012 and 2018. METHODS We performed a secondary analysis of facility-level data from the World Health Organization's Service Availability and Readiness Assessment (SARA) surveys conducted in 2012, 2014, 2016, and 2018 in Burkina Faso. The availability and readiness of health facilities were assessed using SARA's manual, and linear regressions were used to examine trends. RESULTS Between 2012 and 2018, the mean proportion of health facilities providing PITC services increased, but not significantly, from 82.9% to 83.4% (p = 0.11), with the mean readiness index significantly decreasing from 71.5% to 65.4% (p < 0.001). This decrease concerned the staff and guidelines (73.8% to 50.5%; p < 0.001), equipment (79.0% to 77.4%; p < 0.001), and medicines and commodities (54.2% to 45.2%; p < 0.001) domains. Regarding the PMTCT services, the mean proportion of health facilities globally providing the service significantly decreased from 83.7% in 2012 to 67.7% (p = 0.030) in 2018, and the mean readiness significantly decreased from 53.2% in 2012 to 50.9% in 2018 (p = 0.004). This decreasing trend was related to the staff and training (80.3% to 57.6%; p < 0.001) and medicines and commodities (9.2% to 6.5%; p < 0.001) domains. The global significant negative trend of readiness was mainly observed at the primary level of healthcare (52.7% to 49.4%; p = 0.030). Four regions experienced a significant decrease in the readiness index of health facilities to provide PMTCT services: Cascades, Centre, Centre-Sud, and Sud-Ouest, while Haut-Bassins and Nord regions showed increasing trends. CONCLUSION Availability and readiness of health facilities to provide PITC and PMTCT remain suboptimal in Burkina Faso. Actions to strengthen the skills of professionals and enhance the availability of medicines and commodities while focusing more on health regions with significant decreasing trends are urgently needed to improve the quality of services for HIV.
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Affiliation(s)
- Lucresse Corine Fassinou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Hervé Hien
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Department of Internal Medicine, Infectious and Tropical Diseases, AIDS Reference Centre, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Nagot
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, University of Antilles, Etablissement Français du Sang, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
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Vu LTH, Bui QTT, Khuong LQ, Tran BQ, Lai TD, Hoang MV. Trend of metabolic risk factors among the population aged 25-64 years for non-communicable diseases over time in Vietnam: A time series analysis using national STEPs survey data. Front Public Health 2022; 10:1045202. [PMID: 36530703 PMCID: PMC9747924 DOI: 10.3389/fpubh.2022.1045202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction The study aims to examine the trends of 4 metabolic NCDs risk factors including raised blood pressure, increased blood glucose, elevated blood lipids and overweight/obesity over the last 10 years in Vietnam as well as examine these trends among different sub-population by geographical area, gender, and age groups. Methods The study combined the national representative data from three rounds of STEPs survey in Vietnam conducted in 2010, 2015, and 2020 on people aged 25-64 years. The overall prevalence of each metabolic factor together with 95% CI for each time point as well as the stratified prevalence by rural/urban, male/female, and 4 separated age groups were calculated and considered the sampling weight. Cochran-Armitage test for trend was used to test for the differences in the prevalence over time. Results The prevalence of hypertension, overweight/obesity, hyperglycemia, and hyperlipidemia among the population aged 25-64 years old was 28.3, 20.57, 6.96, and 15.63%, respectively in the year 2020. All NCD metabolic risk factors examined in this analysis show significantly increasing trends over time. For most age groups, the increasing burden of NCD metabolic risk factors was more significant during the period 2015-2020 compared to the period 2010-2015. Male population and population aged 55-64 experienced the most dramatic changes in the burden of all NCD metabolic risk factors. Conclusion To reverse the increasing trend of NCD metabolic factors in Vietnam, intervention, and policy need to apply a comprehensive life course approach.
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Affiliation(s)
- Lan Thi Hoang Vu
- Faculty of Fundamental Science, Hanoi University of Public Health, Hanoi, Vietnam
| | - Quyen Thi Tu Bui
- Faculty of Fundamental Science, Hanoi University of Public Health, Hanoi, Vietnam,*Correspondence: Quyen Thi Tu Bui
| | | | - Bao Quoc Tran
- General Department of Preventive Medicine, Ministry of Health (Vietnam), Hanoi, Vietnam
| | - Truong Duc Lai
- World Health Organization Country Office for Viet Nam, Hanoi, Vietnam
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Pollock T, Karthikeyan S, Walker M, Werry K, St-Amand A. Trends in environmental chemical concentrations in the Canadian population: Biomonitoring data from the Canadian Health Measures Survey 2007-2017. ENVIRONMENT INTERNATIONAL 2021; 155:106678. [PMID: 34118655 DOI: 10.1016/j.envint.2021.106678] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 06/12/2023]
Abstract
Ten years of nationally representative biomonitoring data collected between 2007 and 2017 are available from the Canadian Health Measures Survey (CHMS). These data establish baseline environmental chemical concentrations in the general population. Here we sought to evaluate temporal trends in environmental chemical exposures in the Canadian population by quantifying changes in biomarker concentrations measured in the first five two-year cycles of the CHMS. We identified 39 chemicals that were measured in blood or urine in at least three cycles and had detection rates over 50% in the Canadian population. We calculated geometric mean concentrations for each cycle using the survey weights provided. We then conducted analyses of variance to test for linear trends over all cycles. We also calculated the percent difference in geometric means between the first and most recent cycle measured. Of the 39 chemicals examined, we found statistically significant trends across cycles for 21 chemicals. Trends were decreasing for 19 chemicals from diverse chemical groups, including metals and trace elements, phenols and parabens, organophosphate pesticides, per- and polyfluoroalkyl substances, and plasticizers. Significant reductions in chemical concentrations included di-2-ethylhexyl phthalate (DEHP; 75% decrease), perfluorooctane sulfate (PFOS; 61% decrease), perfluorooctanoic acid (PFOA; 58% decrease), dimethylphosphate (DMP; 40% decrease), lead (33% decrease), and bisphenol A (BPA; 32% decrease). Trends were increasing for two pyrethroid pesticide metabolites, including a 110% increase between 2007 and 2017 for 3-phenoxybenzoic acid (3-PBA). No significant trends were observed for the remaining 18 chemicals that included arsenic, mercury, fluoride, acrylamide, volatile organic compounds, and polycyclic aromatic hydrocarbons. National biomonitoring data indicate that concentrations, and therefore exposures, have decreased for many priority chemicals in the Canadian population. Concentrations for other chemical groups have not changed or have increased, although average concentrations remain below thresholds of concern derived from human exposure guidance values. Continued collection of national biomonitoring data is necessary to monitor trends in exposures over time.
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Affiliation(s)
- Tyler Pollock
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.
| | | | - Mike Walker
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Kate Werry
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Annie St-Amand
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
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Chao YS, Lin KF, Wu CJ, Wu HC, Hsu HT, Tsao LC, Cheng YP, Lai YC, Chen WC. Simulation study to demonstrate biases created by diagnostic criteria of mental illnesses: major depressive episodes, dysthymia, and manic episodes. BMJ Open 2020; 10:e037022. [PMID: 33172939 PMCID: PMC7656951 DOI: 10.1136/bmjopen-2020-037022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Composite diagnostic criteria alone are likely to create and introduce biases into diagnoses that subsequently have poor relationships with input symptoms. This study aims to understand the relationships between the diagnoses and the input symptoms, as well as the magnitudes of biases created by diagnostic criteria and introduced into the diagnoses of mental illnesses with large disease burdens (major depressive episodes, dysthymic disorder, and manic episodes). SETTINGS General psychiatric care. PARTICIPANTS Without real-world data available to the public, 100 000 subjects were simulated and the input symptoms were assigned based on the assumed prevalence rates (0.05, 0.1, 0.3, 0.5 and 0.7) and correlations between symptoms (0, 0.1, 0.4, 0.7 and 0.9). The input symptoms were extracted from the diagnostic criteria. The diagnostic criteria were transformed into mathematical equations to demonstrate the sources of biases and convert the input symptoms into diagnoses. PRIMARY AND SECONDARY OUTCOMES The relationships between the input symptoms and diagnoses were interpreted using forward stepwise linear regressions. Biases due to data censoring or categorisation introduced into the intermediate variables, and the three diagnoses were measured. RESULTS The prevalence rates of the diagnoses were lower than those of the input symptoms and proportional to the assumed prevalence rates and the correlations between the input symptoms. Certain input or bias variables consistently explained the diagnoses better than the others. Except for 0 correlations and 0.7 prevalence rates of the input symptoms for the diagnosis of dysthymic disorder, the input symptoms could not fully explain the diagnoses. CONCLUSIONS There are biases created due to composite diagnostic criteria and introduced into the diagnoses. The design of the diagnostic criteria determines the prevalence of the diagnoses and the relationships between the input symptoms, the diagnoses, and the biases. The importance of the input symptoms has been distorted largely by the diagnostic criteria.
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Affiliation(s)
| | - Kuan-Fu Lin
- Psychiatry, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan, Taiwan
| | - Chao-Jung Wu
- Département d'informatique, UQAM, Montreal, Quebec, Canada
| | - Hsing-Chien Wu
- Internal Medicine, Taipei Hospital, Xinzhuang, Taipei, Taiwan
| | - Hui-Ting Hsu
- Pathology, Changhua Christian Healthcare System, Changhua, Taiwan, Taiwan
| | - Lien-Cheng Tsao
- Surgery, Changhua Christian Healthcare System, Changhua, Taiwan, Taiwan
| | - Yen-Po Cheng
- Surgery, Changhua Christian Healthcare System, Changhua, Taiwan, Taiwan
| | - Yi-Chun Lai
- Chest Medicine, National Yang Ming University Hospital, Ilan, Taiwan, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Chao YS, Wu CJ, Wu HC, Hsu HT, Tsao LC, Cheng YP, Lai YC, Chen WC. Opportunities and Challenges From Leading Trends in a Biomonitoring Project: Canadian Health Measures Survey 2007-2017. Front Public Health 2020; 8:460. [PMID: 33014969 PMCID: PMC7509036 DOI: 10.3389/fpubh.2020.00460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/22/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Biomonitoring can be conducted by assessing the levels of chemicals in human bodies and their surroundings, for example, as was done in the Canadian Health Measures Survey (CHMS). This study aims to report the leading increasing or decreasing biomarker trends and determine their significance. Methods: We implemented a trend analysis for all variables from CHMS biomonitoring data cycles 1–5 conducted between 2007 and 2017. The associations between time and obesity were determined with linear regressions using the CHMS cycles and body mass index (BMI) as predictors. Results: There were 997 unique biomarkers identified and 86 biomarkers with significant trends across cycles. Nine of the 10 leading biomarkers with the largest decreases were environmental chemicals. The levels of 1,2,3-trimethyl benzene, dodecane, palmitoleic acid, and o-xylene decreased by more than 60%. All of the 10 chemicals with the largest increases were environmental chemicals, and the levels of 1,2,4-trimethylbenzene, nonanal, and 4-methyl-2-pentanone increased by more than 200%. None of the 20 biomarkers with the largest increases or decreases between cycles were associated with BMI. Conclusions: The CHMS provides the opportunity for researchers to determine associations between biomarkers and time or BMI. However, the unknown causes of trends with large magnitudes of increase or decrease and their unclear impact on Canadians' health present challenges. We recommend that the CHMS plan future cycles on leading trends and measure chemicals with both human and environmental samples.
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Affiliation(s)
| | - Chao-Jung Wu
- Département d'informatique, Université du Québec à Montréal, Montreal, QC, Canada
| | - Hsing-Chien Wu
- Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | | | | | | | - Yi-Chun Lai
- National Yang-Ming University Hospital, Yilan, Taiwan
| | - Wei-Chih Chen
- Attending Physician, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
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Chao YS, Wu CJ, Wu HC, Chen WC. Drug trends among non-institutionalized Canadians and the impact of data collection changes in the Canadian Health Measures Survey 2007 to 2015. PLoS One 2019; 14:e0214718. [PMID: 30978234 PMCID: PMC6461261 DOI: 10.1371/journal.pone.0214718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/19/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is a global trend of increasing use in prescription and over-the-counter (OTC) drugs. This hasn't been verified in Canada. In addition, there are changes made to the collection method of medication information after the Canadian Health Measures Survey (CHMS) cycle 2. This study aims to review the potential impact of the changes in medication data collection and the trends in medication use if data quality remains similar throughout the CHMS cycles 1 to 4. This is fundamental for the analysis of this biomonitoring database. METHODS The CHMS cycle 1 to 4 medication and household data were used to study the trends of medication use between 2007 and 2015. The use of prescription or OTC drugs was grouped based on the first levels of the Anatomical Therapeutic Chemical (ATC) Classification system. The total numbers of medications were asked in all cycles. However, only a maximum of 15 and 5 drugs could be respectively reported for existing and new prescription or OTC drugs in cycles 1 and 2. There were no restrictions on drug reporting after cycle 2. The trends of medication use were described as ratios, compared to cycle 1. RESULTS The total numbers of the types of medication ever identified decreased from 739 to 603 between cycles 1 and 4. The proportions of using any drugs were from 0.90 to 0.88 between cycles 1 and 4 (ratio = 1.08 in cycle 4, 95% CI = 0.89 to 1.26). The numbers of drugs in use were from 3.9 to 3.8 (ratio = 1.05 in cycle 4, 95% CI = 0.86 to 1.24). The proportions of prescription drug use were from 0.53 to 0.55 (ratio = 1.13 in cycle 4, 95% CI = 0.89 to 1.37), while the numbers of prescription were from 1.51 to 1.68 (ratio = 1.20 in cycle 4, 95% CI = 0.92 to 1.48). The use of diabetes and thyroid medication had trends similar to the respective disease prevalence. The use and the numbers of drugs for blood and blood forming organs significantly increased between cycles 1 and 4 (ratio = 1.56 in cycle 4, 95% CI = 1.03 to 2.10). CONCLUSIONS There is an increasing trend in the use of blood and blood forming agents through cycles 2 to 4 and cardiovascular drugs in cycle 3. For diabetes and thyroid medication, the proportions of medication use increase proportionally with disease prevalence. The changes in the medication information collection method may not have important impact on the reporting of the use of prescription or OTC drugs.
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Affiliation(s)
- Yi-Sheng Chao
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Montréal, Québec, Canada
| | - Chao-Jung Wu
- Département d'informatique, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Hsing-Chien Wu
- Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Wei-Chih Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine and Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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