Search

Taiwan has the highest incidence and prevalence of end-stage renal disease worldwide. However, not many studies have focused on the influence of dialysis modality on health-related quality of life (HRQoL) for dialysis patients in Taiwan. This study intended to compare the differences in HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) and to evaluate the effects of dialysis modality on patient HRQoL. A cross-sectional survey using the Taiwan-version 36-item short-form health survey questionnaire (SF-36) was completed by 244 dialysis patients (58 PD and 186 HD patients) at two hospital-based dialysis units in southern Taiwan. Patient characteristics, diagnoses and laboratory data were individually extracted from the annual survey and matched with primary HRQoL data. Multiple linear regression analysis was performed to evaluate the effects of dialysis modality on HRQoL. Compared with HD patients, PD patients had higher scores in six of the eight SF-36 subscales, including physical functioning, role limitations due to physical and emotional problems, bodily pain, vitality, and mental health. However, only role limitations due to emotional problems and bodily pain reached significant difference levels (p < 0.05). After controlling for patient characteristics, comorbid conditions and laboratory values, the bodily pain score was 7.88 points higher for PD patients compared with HD patients, while the social functioning score was 9.00 points higher for HD patients compared with PD patients (p < 0.05). The present study provides cross-sectional confirmation for equivalent levels of HRQoL between PD and HD patients except for the subscales of bodily pain and social functioning. In addition to dialysis modality, HRQoL for dialysis patients may be more related to personal attributes, interactions with multiple diseases, social support and quality of care received. When informing patients about modality choices for dialysis, trade-offs should be discussed and individual preferences for specific aspects of HRQoL should be considered.

Ventricular repolarization abnormality plays a crucial role in cardiac arrhythmia. Polymorphisms in renin—angiotensin system genes are associated with occurrence of ventricular arrhythmia. We previously demonstrated that subjects carrying the angiotensin converting enzyme (ACE) D-allele but not the angiotensinogen (AGT) M235T polymorphism had a higher magnitude of QT dispersion (QTd) prolongation. The aim of this study was to test whether the AGT [−6G > A] and angiotensin II type 1 receptor (AT1R) [1166A > C] polymorphisms influence repolarization parameters, including QTd and the peak and end of the T wave interval (Tpe). Of 1,500 people screened, 106 normotensive, non-diabetic participants aged ≥60 were recruited. ECGs were recorded at baseline and in the second and fourth years. QTd and Tpe were manually calculated. Gene polymorphisms were analyzed by polymerase chain reaction. Mean age was 72.7 ± 4.1 years (range, 62.81 years). QTd and Tpe were significantly prolonged in the second and fourth years (all p < 0.001). Neither gene polymorphism was associated with the magnitudes of QTd and Tpe prolongations. This longitudinal study shows that the AT1R [1166A > C] and AGT [−6G > A] polymorphisms do not influence repolarization parameters in this Chinese population in Taiwan, and so are not suitable markers to identify individuals susceptible to changes in these parameters.

The major objective of the present study was to identify biologic and behavioral risk factors of cardiovascular disease (CVD) in the elderly population in Taiwan. It is hypothesized that the selected risk factors are significantly associated with the prevalence of CVD. Data came from a nationwide geriatric survey in 1991. Stratified proportional sampling was used to recruit 2,600 subjects. These were evaluated by family physicians working for the Departments of Family Medicine at four medical centers in four major cities in Taiwan. Univariate and multivariate logistic regression analyses were used to examine the associations between risk factors and the prevalence of CVD. The prevalence of CVD was 38.31%. Patients with CVD consistently had higher values for each selected risk factor except high-density lipoprotein-cholesterol (HDL-C) and glucose concentrations. The findings also indicated that hypertension, hypertriglyceridemia, low HDL-C concentration, ex-drinking status, and overweight were significantly associated with the prevalence of CVD among the elderly in Taiwan. The findings not only confirm the risk factors for CVD, but also invite more attention to be given to the importance of biologic and behavioral risk factors in CVD.

This study examined the inappropriate utilization of hospital services under the National Health Insurance (NHI) program. The study population consisted of long-stay inpatients who stayed longer than 30 days in acute care hospitals located in southern Taiwan. The study hospitals included four medical centers, six regional hospitals, and 21 district general hospitals. The survey of patients was conducted in January and May of 1996 using the Acute Care Hospital Long-stay Questionnaire developed by the research team. Excluding subjects with missing values and abnormal length of stay, 536 long-stay patients were included in the analysis. Among these, 196 patients (36.6%) were classified as having an inappropriate stay, while 340 patients (63.4%) had an appropriate stay. Of the long-stay patients in medical centers, 32.2% were inappropriate stays; this figure was 45.4% for regional hospitals and 43.3% for district general hospitals. There were significantly higher proportions of inappropriate long-stay patients in regional and district general hospitals than in medical centers. In conclusion, this study confirms the existence of inappropriate hospital bed days, which may be due to patient characteristics, hospital factors, and NHI payment schemes. If the NHI program can provide incentives to long-stay patients who no longer need acute care to move, patients' utilization behaviors might change and hospital discharge plans could be modified for more efficient utilization of hospital beds.

Cardiovascular disease has been one of the top-ten causes of death continuously for older persons in Taiwan. However, There is still a lack of sufficient information on prevalence rates of cardiovascular risk factors. The present study was intended to provide prevalence rates of biological and behavioral risk factors for cardiovascular disease by gender, age group, and dwelling area. Data were extracted from a nationwide, cross-sectional, geriatric survey (1989-1991) by four medical centers in Taiwan. A total of 2,600 community senior residents were successfully interviewed for analysis. For the whole sample, hypertension was found to be the most prevalent biological risk factor (36.9%), while being overweight was the first behavioral risk factor (34.38%). By gender, higher prevalence rates of biological risk factors were found in older women except for the low value of high density lipoprotein cholesterol (HDL-C); higher prevalence rates of behavioral risk factors were found in men except for being overweight. No statistically significant difference in prevalence rates was found between the 65-74 and 75+ years age groups. By dwelling area, significant differences in the prevalence rates of risk factors existed across the four study areas. In conclusion, hypertension and excessive weight are critical cardiovascular risk factors that can be early identified or prevented by screening programs and health education. Cardiovascular prevention programs for elderly people should be designed in their gender and dwelling area.

The National Health Insurance (NHI) and social welfare agencies have implemented the Elderly Health Examination Program (EHEP) for years. No study has ever attempted to evaluate whether this program is cost-effective. The purposes of this study were, firstly, to understand the prevalence and incidence rates of hypertension and, secondly, to estimate the cost and effectiveness of the EHEP, focusing on hypertension screening. The data sources were: (1) hypertension and clinical information derived from the 1996 and 1997 EHEP, which was used to generate prevalence and incidence rates of hypertension; and (2) claim data of the NHI that included treatment costs of stroke patients (in- and outpatients). Hypothetical models were used to evaluate the cost-effectiveness of the hypertension screening program in various conditions. Sensitivity analysis was also employed to evaluate the effect of each estimation indicator on the cost and effectiveness of the hypertension screening program. A total of 28.3% of the elderly population in Kaohsiung (25,174 of 88,812) participated in the 1996 EHEP; 14,915 of them participated in the following 1997 EHEP, with a retention rate of 59.3%. Criteria from the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) (systolic blood pressure/diastolic blood pressure>or=160/95 mmHg or taking antihypertensive drugs) were used; we found that prevalence and incidence rates of hypertension were 24.6% and 6.6%, respectively. Hypertension rates are increasing in the aging process as shown in both prevalence and incidence models. In comparison with non-participants, the prevalence model indicates that each hypertension patient who had attended the EHEP not only saved NT$34,570-34,890 in medical and associated costs, but also increased their lifespan by 128 days. The present findings suggest that the EHEP is a cost-effective program with health and social welfare policy implications. With the relatively low participation rate of the EHEP, health and social agencies need to put more effort into the promotion of this free health examination program to attract potential participants. In doing so, the population at risk for hypertension would be identified for early treatment, and the probability of having stroke could be decreased. Consequently, health care expenditures for treatment and caregiving of stroke patients would be minimized. Finally, it should be noted that the sensitivity and values of selected parameters can modify the results of cost-effectiveness analysis. Interpretations of the effects of prevention services on costs and effectiveness need to be treated with caution.