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Objectives: This study aimed to determine emergency medical care (EMC) utilization among children in Taiwan and factors associated with EMC utilization. Methods: This was a populationbased study using the Longitudinal Health Insurance Database of 2005 (LHID 2005), which was released by the National Health Research Institutes. All emergency department visits among children <18 years of age in 2005 were analyzed to determine the rates and factors associated with EMC utilization. A multivariate logistic regression model was used to assess the independent effect of various characteristics on the risk of EMC utilization. Results: Of 233,382 children, 43,976 (18.84%) had emergency department visits accounting for 65,839 emergency department visits. Compared with girls, boys were more likely to utilize EMC. Compared with children < 1 year of age, children 1-6 years of age had a higher risk of utilizing EMC. Compared with children living in urban areas, children living in suburban areas were less likely to utilize EMC. Children with catastrophic diseases were more likely to use EMC. Children with ⩽ 15 outpatient department visits had a lower risk of EMC utilization compared to children with 16-20 and ⩾ 21 outpatient department visits. Boys were more likely to have frequent EMC utilization. Compared with children < 1 year of age, children 7-11 or 12-17 years of age had a lower risk of frequent EMC utilization. Children with catastrophic diseases were more likely to have frequent EMC utilization. Children with ⩽ 15 outpatient department visits had a lower risk of frequent EMC utilization than children with 16-20 and ⩾ 21 outpatient department visits. Conclusions: Boys, children with catastrophic diseases, children living in urban areas, and children with more outpatient department visits were more likely to utilize EMC and have frequent EMC utilization. [ABSTRACT FROM AUTHOR]

Background: Uncertainty may limit communication and affect the ability of patients to adapt to their illness. A high level of uncertainty in patients concurrent with sudden hearing loss has been related to poor comprehension of communications and poor illness understanding. Currently, there is no any certain standard information sheet in the clinical setting. Purpose: This study evaluates the effect of a one-to-one oral instruction strategy combined with an information sheet firstly on the stimuli frame and then on uncertainty in patients suffering from idiopathic sudden sensorineural hearing loss. Method: An experimental design was employed and 60 patients were randomly assigned to either the experimental group (n = 28) or the control group (n = 32). A structured questionnaire that included the stimuli frame of uncertainty and the Mishel uncertainty illness scale was used to collect data. All samples received regular care following admission to the hospital and received the pretest within 24 hours after admission. The experimental group received the one-to-one oral instruction strategy combined with an information sheet immediately after the pretest. All participants completed the posttest three days later. Results: The health education program increased perceived understanding of illness in patients with the sudden hearing loss, and reduced their illness uncertainty. Perceived understanding of illness was negatively related to the level of illness uncertainty. The stimuli frame of uncertainty acted as a mediator between the intervention and the uncertainty. The intervention increased the level of cognition of the stimuli frame of uncertainty and then indirectly lowered the uncertainty level. Conclusions / Implications: These findings support the effectiveness of the individual health education strategy with the information sheet in delivering to patients critical information about their condition and treatment. Moreover, this intervention may effectively increase illness cognition and reduce uncertainty in patients with sudden hearing loss. Clinical nurse staffs may use the findings of this study to improve their health education efficacy. [ABSTRACT FROM AUTHOR]

Objectives: With reference to phase I and phase II of Andersen's behavioral model of health service utilization, the aims of this study were first to investigate the characteristics of community rehabilitation care users and then to analyze the frequency of readmission and its risk factors within one year after discharge from a hospital for the treatment of mental illness. Methods: A retrospective cohort study design was used. Data analyzed in this study were retrieved from the 'home care specific files' of the National Health Insurance Research Database issued by the National Institutes of Health between 1999 and 2009. A total of 25,218 people were new cases of community rehabilitation care between 2000 and 2007. In order to forecast these community rehabilitation care users' risk of readmission within one year after discharge, the Cox proportional hazard model was utilized. Results: We found that the adjusted hazard ratio was significantly lower for groups of 8-14 times users and 15 or more-times users of community rehabilitation care than for 1-7 times users (0.73 & 0.72 respectively) in the Cox regression model. Furthermore, the risk of readmission was lower for females, clients who were insured by sub-bureau in the middle of Taiwan, a diagnosis of schizophrenia, and a length of hospital stay less than 55 days. Conclusions: The lower the frequency of psychiatric patients' using community rehabilitation care, the higher the risk of readmission. [ABSTRACT FROM AUTHOR]

Objectives: With reference to Phase I of Andersen's Behavioral Model of Health Services Utilization, the researcher investigated emergency department utilization by home-care service recipients with National Health Insurance (NHI) in Taiwan, and examined the predictive factors affecting the risks of morbidity from emergency department utilization. Methods: This design was a retrospective cohort study. Data came from the "home care specific file" in the National Health Insurance Research Database between 1999 and 2008. The subjects were 102,680 newly NHI homecare service users between 2000 and 2008. The Poisson regression model was used to predict the factors affecting emergency department utilization, morbidity from all causes, and major system classifications. Results: The NHI home-care service users experienced the highest incidence of circulatory system diseases (441.41/103 person-year). This study showed that a higher relative risk ratio for emergency department utilization and morbidity from all causes were found in male users, those aged 65 and older, those living in urban areas, Resources Utilization Group Category2-4 home care consumers, major illness/injury and long-term respiratory dependent cases, cases with a Charlson Comorbidity Index score of 3 and above, and cases with tumors, diabetes and congestive heart failure complications. Conclusions: Based on the findings of this study, the top three reasons for emergency department utilization by home-care service recipients were diseases of the circulatory, respiratory, and urinary/reproductive systems. The adjusted relative risk of emergency department utilization increased dramatically among elders, especially for diseases of the circulatory and urinary/reproductive systems. Health care providers should pay close attention to the care needs of home-care service recipients. [ABSTRACT FROM AUTHOR]

Background: Sudden sensorineural hearing loss occurs mainly in individuals between 40 and 60 years of age. Most sudden hearing loss cases of nonspecific oause lack well-defined treatments and have no predictable progress. Sudden hearing loss symptoms, diagnoses and illness patterns resemble factors that Mishel's Theory of Uncertainty in Illness identify as potential causes of uncertainty. Uncertainty may block communication and affect a patient's ability to adapt to his or her condition and accept treatment. Purpose: This study describes level of uncertainty in illness and explores related factors among patients with sudden hearing loss. Methods: The authors employed a cross-sectional study design and recruited 60 patients with an initial diagnosis of idiopathic sudden sensorineural hearing loss. Data collected using a structured questionnaire included participant demographics and the Chinese version of the Mishel Uncertainty in Illness Scale (MUIS). Results: Results showed: (1) Illness uncertainty in participants was high (M = 71.75, SD = 12.93): (2) Perceived understanding of illness was the only variable significantly related to illness uncertainty (p < .01); and (3) Education, gender, type of occupation, religious belief, perceived illness severity, perceived illness understanding and perceived self-control over symptoms explained 25% of illness uncertainty variance. "Perceived understanding of illness" was identified as a significant predictor of illness uncertainty (p < .01). Conclusions / Implications for practice: Increasing illness understanding should be a focus of nursing care for sudden hearing loss patients in order to decrease patient illness uncertainty. [ABSTRACT FROM AUTHOR]