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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ctim.2007.11.001 Byline: Herng-Ching Lin (a), Wei-Chung Vivian Yang (b), Hsin-Chien Lee (c)(d) Keywords: Traditional Chinese medicine (TCM); Schizophrenia; TCM usage Abstract: This study uses a nationwide population-based dataset to explore factors and patterns associated with traditional Chinese medicine (TCM) usage among schizophrenia patients. Author Affiliation: (a) Taipei Medical University, School of Health Care Administration, 250 Wu-Hsing Street, Taipei 110, Taiwan (b) Taipei Medical University, Graduate Institute of Biomedical Materials, Taiwan (c) Taipei Medical University Hospital, Department of Psychiatry, Taipei, Taiwan (d) Taipei Medical University, School of Medicine, Department of Psychiatry, Taipei, Taiwan

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.10.029 Byline: Herng-Ching Lin (a), Hsin-Chien Lee (b), Chien-Heng Chu (a)(b) Abstract: A minimum percutaneous coronary intervention (PCI) hospital volume of 400 cases per year is recommended by the American College of Cardiology/American Heart Association (ACC/AHA). However, it is unclear whether this minimum value standard applies to non-Western developing countries, such as Taiwan. The aim of this study was to assess the application in Taiwan of current ACC/AHA practice guidelines for minimum hospital PCI volume. Author Affiliation: (a) School of Health Care Administration, Taipei Medical University, Taipei, Taiwan (b) Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan Article History: Received 20 June 2007; Accepted 24 October 2007

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2010.02.020 Byline: Jiunn-Horng Kang (a)(b), Herng-Ching Lin (c) Abstract: Although pathomechanisms of avascular necrosis (AVN) of the femoral head are not well-known, vascular and coagulation abnormalities have been proposed as hypotheses. We propose that the pathomechanisms of AVN could also involve the cardiovascular system. This study explores the risk of coronary heart disease (CHD) after AVN, through a population-based case-control approach. Author Affiliation: (a) Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan (b) Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan (c) School of Health Care Administration, Taipei Medical University, Taipei, Taiwan Article History: Received 13 October 2009; Accepted 11 February 2010

In this study, we explored the association between sepsis and dementia using a population-based dataset in Taiwan and a case-control design. The relationship between severe systemic infections and dementia is still unclear. Data for this case-control study were taken from the Taiwan Longitudinal Health Insurance Database 2000. This study included 5955 patients with dementia and 5955 sex and age-matched healthy controls. We performed conditional logistic regressions to examine the association of dementia with previously diagnosed sepsis. We found that 168 (1.41%) of the sampled people had been hospitalized for treatment of sepsis before the index date, 122 patients (2.05%) and 46 controls (0.77%; p < 0.001). The conditional logistic regression indicated that patients with dementia were more likely to have been previously diagnosed with sepsis than controls after adjusting for monthly income, urbanization level, hyperlipidemia, and diabetes (odds ratio [OR] 2.60; 95% confidence interval [CI] 1.84–3.66). We also found that dementia was associated with prior sepsis regardless of sex (males: adjusted OR 3.17; 95% CI 1.76–5.68; females: adjusted OR 2.27; 95% CI 1.48–3.47). We concluded that patients with dementia had a higher odds of previous sepsis compared to the control group. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The influence of mental illness early in life on the subsequent risk of Parkinson disease (PD) and its clinical picture remain obscure. This study investigated the effects of psychiatric diseases on a subsequent PD diagnosis. Methods: We used the Longitudinal Health Insurance Database 2000 of Taiwan to identify 73,597 patients who visited ambulatory care centers or were hospitalized with a first-time diagnosis of anxiety, affective disorders, or schizophrenia between 2001 and 2003 as the study cohort. We also randomly selected 220,791 enrollees matched with the study cohort for comparison. Each patient was individually tracked for 6 years to identify a subsequent PD diagnosis. Stratified Cox proportional hazard regressions were performed for the analysis. Results: The incidence rate of PD per 1000 person-years was 4.91 (95% confidence interval [CI], 4.71–5.12) and 1.63 (95% CI, 1.56–1.70) for the psychiatric and comparison groups, respectively. Patients with psychiatric illnesses were more vulnerable to developing PD than nonpsychiatric individuals, exhibiting a 2.38-fold increased risk (95% CI, 2.23–2.53) after other covariates were considered. Furthermore, patients with schizophrenia exhibited the highest risk for developing PD. Conclusions: We suggest effective monitoring of patients with psychiatric disturbances for potential long-term neurodegenerative diseases. [Copyright &y& Elsevier]

Background: Few studies have examined the association between autoimmune diseases and parkinsonism. Objective: We sought to investigate the risk for parkinsonism during a 5-year follow-up period after a diagnosis of psoriasis using a population-based data set in Taiwan. Methods: We identified 4885 patients with psoriasis for the study cohort and randomly selected 24,425 patients as a control cohort. Each subject was individually followed up for a 5-year period to identify those who subsequently developed parkinsonism. Results: Stratified Cox proportional hazards regression showed that the adjusted hazard ratio for parkinsonism during the 5-year follow-up period for patients with psoriasis was 1.74 (95% confidence interval 1.35-2.20) that of control patients. Furthermore, the adjusted hazard ratios for parkinsonism within the 5-year follow-up period after the index date for subjects with psoriasis were similar between both sexes (1.78 and 1.66 for men and women, respectively). Limitation: Our data set did not provide detailed information on the severity of psoriasis, or individual factors such as cigarette smoking, alcohol consumption, body mass index, and dietary patterns. Conclusion: Patients with psoriasis were found to be at a significant risk of parkinsonism during a 5-year follow-up. [ABSTRACT FROM AUTHOR]

Objective: Chronic inflammation has been associated with endothelial dysfunction and altered coagulation status. However, at the present time, the data regarding the risk for developing deep vein thrombosis (DVT) in patients with rheumatoid arthritis (RA) is still scanty and conflicted. This study aimed to explore the frequency and association of DVT with RA using a population-based dataset. Methods: This was a case-control study conducted in Taiwan. A total of 5193 patients with DVT were identified from the Longitudinal Health Insurance Database 2000 (LHID2000) database. In total, 20,772 controls matched with cases in terms of gender, age, and year of index date were randomly selected. We used conditional logistic regression to calculate the odds ratio (OR) for having been previously diagnosed with RA between cases and controls. Results: Of the total 25,965 sampled subjects, 235 (0.9%) had been previously diagnosed with RA. Seventy-seven of these previous diagnoses were found among cases (1.5%) and 158 among controls (0.8%). Conditional logistic regression analysis revealed that cases were more likely to have had prior RA than controls (OR, 1.92; 95% confidence interval [CI], 1.46-2.53; P < .001). After adjusting for hospitalization history, pregnancy, fracture, surgery, cancer, inflammatory bowel disease, heart failure, hypertension, diabetes, coronary heart disease, hyperlipidemia, and renal disease, there was still a significant association between DVT and prior RA (OR, 1.88; 95% CI, 1.42-2.58; P < .001). Conclusions: We found RA to be significantly associated with DVT. Appropriate management should be taken to minimize the risk of DVT in patients with RA. Further study is needed to confirm our findings. [Copyright &y& Elsevier]

Summary: Purpose: To date, the occurrence of erectile dysfunction (ED) associating with herpes zoster (HZ) is only based on limited case reports. This case–control study aimed at examining the association between HZ and ED using a population-based dataset in Taiwan. Methods: A total of 6429 adults newly diagnosed with ED were identified as cases, and 38,574 subjects without any medical history of ED were extracted as controls. Conditional logistic regression models were performed. Results: In total, 1.03% out of the sampled subjects had been diagnosed with HZ within one year prior to the index date; a higher proportion of prior HZ was found among cases than controls (2.04% vs. 0.86%, p < 0.001). After adjusting for demographic characteristics, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome, conditional logistic regression suggested that cases were more likely to have previously been diagnosed with HZ than controls (OR = 2.24, 95% CI = 1.82–2.75). Furthermore, the odds of having been diagnosed with an HZ infection within one year prior to the index date were dramatically higher among patients with ED than controls among subjects aged 18–29 (OR = 6.07). Conclusions: We conclude that ED was associated with having been previously diagnosed with HZ, particularly among younger males. [ABSTRACT FROM AUTHOR]

Background/objective: Acute appendicitis is the most common non-obstetric surgical procedure in pregnant women. Using two large-scale nationwide population-based datasets, this study aimed to assess the risk of adverse pregnancy outcomes between mothers with and without appendicitis in Taiwan. Methods: This study used two nationwide population-based datasets: the Taiwan National Health Insurance Research Dataset and the Taiwan national birth certificate registry. This study included 908 women who had live singleton births and who had been hospitalized with a diagnosis of acute appendicitis, and another randomly selected 4,540 women as a comparison group. Conditional logistic regression analyses were performed to calculate the risk of adverse pregnancy outcomes including low birth weight (LBW), preterm birth, small for gestational age (SGA), cesarean section (CS), congenital anomalies, Apgar scores at 5 min (<7), and pre-eclampsia/eclampsia. Results: The adjusted odds ratios for LBW, preterm birth, SGA, CS, and congenital anomalies in women with acute appendicitis were 1.82 (95 % CI = 1.43-2.30), 1.59 (95 % CI = 1.25-2.02), 1.33 (95 % CI = 1.12-1.60), 1.24 (95 % CI = 1.07-1.44), and 2.07 (95 % CI = 1.07-4.03), respectively, compared with women without acute appendicitis after adjusting for highest maternal educational level, marital status, geographic region, gestational diabetes, gestational hypertension, coronary heart disease, anemia, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome, infant sex and parity, and paternal age. Conclusions: There were increased risks for having LBW, preterm infants, SGA, congenital anomalies, and for experiencing CS among women with acute appendicitis than comparison women. [ABSTRACT FROM AUTHOR]

Background/purpose: The use and cost of computed tomography (CT) and magnetic resonance imaging (MRI) are both very high. The purpose of this study was to evaluate the relation between physicians' characteristics and the CT and MRI repeated within 90 days, using a nationwide population-based data set from Taiwan's National Health Insurance system.Methods: All physicians who ordered CT and MRI examinations in 2004-2005 were identified. We analyzed the total number of CT and MRI scans, the number of repeat scans, and the repeat scan rate, according to physician characteristics (specialty, age, sex, and type of practice hospital). A multivariate logistic regression analysis was performed to explore the adjusted relationship between physician characteristics and their rate of ordering repeat CT and MRI.Results: A total of 16,307 physicians were responsible for a total of 2,152,292 CT and MRI scans during 2004-2005 in Taiwan. The repeat scans accounted for 21.5% of the total scans. Male physicians and physicians aged 41-50 years ordered more repeat scans. Internal medicine physicians ordered 44.3% of all scans and 50.6% of all repeat scans. Surgeons ordered 40.4% of the total scans and 38.5% of repeat scans. Internal medicine physicians were the most frequent users of CT/MRI scans. Family doctors, obstetricians/gynecologists, and pediatricians ranked last among the specialists. Physicians who practiced in medical centers ordered the most CT/MRI scans.Conclusion: Our study shows that repeat use of CT and MRI scans is related to physicians' characteristics. We recommend that different monitoring standards should be set for CT and MRI repeat use by physicians of different specialties and in hospitals of different accreditation levels. [ABSTRACT FROM AUTHOR]

Background: No previous study has investigated the incidence or risk of acute myocardial infarction (AMI) developing after the diagnosis of psoriasis in Asian populations. Objective: We sought to evaluate the association between psoriasis and subsequent AMI during a 5-year follow-up period, using a nationwide Taiwanese population-based claims database, and taking clinical and demographic characteristics into consideration. Methods: Our study cohort consisted of all patients with a first recorded diagnosis of psoriasis (N = 4752) between 1999 and 2001 and of patients without a diagnosis of psoriasis (N = 23,760) who were matched by age and sex (1:5) to the patients with psoriasis. Each patient was tracked using hospitalization data from 2001 until the end of 2006. Stratified Cox proportional hazard regressions (stratified by age and sex) were performed as a means of computing the 5-year AMI-free survivals after adjusting for possible confounding factors. Results: Of the total sample, 70 patients (0.2%) had AMIs during the 5-year follow-up period: 22 (0.5% of the patients with psoriasis) from the study cohort and 48 (0.2%) from the comparison cohort. After adjusting for other factors, the hazard of AMI during the 5-year follow-up period was 2.10 times greater (95% confidence interval 1.27-3.43, P = .004) for patients with psoriasis than for comparison patients. Limitations: We could not take into account some known risk factors for AMI, such as smoking and body mass index. Conclusions: Psoriasis may confer an independent risk of AMI in Asian populations. We suggest that patients with psoriasis be made aware of the increased risk of AMI. [Copyright &y& Elsevier]

Background: Previous research regarding pregnancy outcomes in women with psoriasis either used selective hospital-based data, or analyzed obstetric, but not infant-specific, outcomes. Objective: We sought to investigate whether maternal psoriasis was associated with increased risk of adverse pregnancy outcomes, compared with unaffected mothers, in an unselected nationwide population-based data set. Methods: In total, 1463 mothers with psoriasis and 11,704 randomly selected mothers without psoriasis were included. Of the 1463 mothers with psoriasis, 645 (44.1%) who had received photochemotherapy or systemic therapy within 2 years before their index deliveries were put in the severe psoriasis group. Conditional logistic regression analyses were conducted to calculate the risk of low birth weight (LBW), preterm birth, cesarean section, small for gestational age, and preeclampsia or eclampsia for these two groups, after adjusting for characteristics of the mother, father, and infant. Results: The odds of LBW for women with severe psoriasis were 1.40 times those of mothers without psoriasis (95% confidence interval = 1.04-1.89) after adjusting for characteristics of the mother, father, and infant. However, mothers with mild psoriasis had no significantly higher odds of LBW, preterm birth, cesarean section, infants small for gestational age, and preeclampsia or eclampsia compared with those without psoriasis. Limitations: Patients with psoriasis were identified by diagnostic code in database, resulting in the possibility of misclassification bias. In addition, lack of information regarding maternal risk behaviors and previous adverse pregnancy outcomes may leave residual confounding. Conclusion: We found that pregnant women with severe psoriasis had an increased risk of LBW infants, whereas mild psoriasis was not associated with excess risk of adverse birth outcomes. [Copyright &y& Elsevier]

Objective: To determine the prevalence of selected comorbidities in patients with open-angle glaucoma (OAG) and whether these comorbidities are more prevalent among individuals with OAG than those without OAG. Design: A retrospective, nationwide, case-control study using an administrative database. Participants: The study group comprised 76 673 OAG patients. The comparison group comprised 230 019 subjects matched to the study cohort. Methods: Data were collected retrospectively from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of OAG (International Classification of Diseases, 9th Revision, Clinical Modification codes 365.1–365.11) in 2005 (n = 76 673). The comparison cohort comprised randomly selected patients (3 for every 1 OAG patient; n = 230 019) matched with the study group in terms of age, gender, urbanization level, and monthly income. In total, 31 medical comorbidities were selected based mainly on the Elixhauser Comorbidity Index. Separate conditional logistic regression analyses were used to estimate the adjusted odds ratio for each of the medical comorbidities between patients with and without OAG. Main Outcome Measures: The prevalences of selected comorbidities. Results: More than half (50.5%) of the OAG patients had hypertension, and more than 30% had hyperlipidemia or diabetes (30.5% and 30.2%, respectively). The prevalences of 28 of 31 comorbidities were significantly higher for OAG patients than subjects without glaucoma after adjusting for age, gender, urbanization level, and monthly income. The adjusted odds ratio was more than 1.50 for hypertension, hyperlipidemia, systemic lupus erythematosus, diabetes, hypothyroidism, fluid and electrolyte disorders, depression, and psychosis. Among the studied comorbidities, the prevalence difference of the OAG group minus the control group was 3% or higher for hypertension, hyperlipidemia, stroke, diabetes, liver disease, and peptic ulcer. Conclusions: Open-angle glaucoma patients are significantly more likely to have comorbidities, many of which can be life threatening or can affect the quality of life appreciably. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Objective: To investigate the risk of open-angle glaucoma (OAG) after a diagnosis of hypothyroidism. Design: A retrospective, population-based follow-up study using an administrative database. Participants: The study group comprised 257 hypothyroidism patients. The comparison group included 2056 subjects. Methods: Data were retrospectively collected from the Taiwan Longitudinal Health Insurance Database. The study cohort comprised patients aged ≥60 who received a first diagnosis of hypothyroidism (International Classification of Diseases, Ninth Revision, Clinical Modification code 244.9) from 1997 to 2001 (n = 257). The comparison cohort consisted of randomly selected patients without hypothyroidism who were aged ≥60 and had no diagnosis of glaucoma before 2001 (8 for every OAG patient; n = 2056). Each sampled patient was tracked for 5 years from their index visit. Cox proportional hazard regressions were used to compute the 5-year OAG-free survival rate, after adjusting for possible confounding factors. Main Outcome Measures: The risk of developing OAG during the 5-year follow-up period. Results: Open-angle glaucoma developed in 7.4% of patients with hypothyroidism and 3.8% of patients in the comparison cohort during the follow-up period. Hypothyroid patients had a significantly lower 5-year OAG-free survival rate than patients in the comparison cohort. After adjusting for patients'' age, gender, monthly income, urbanization level, and comorbid medical disorders, hypothyroidism patients were found to have a 1.78-fold (95% confidence interval [CI], 1.04–3.06) greater risk of developing OAG than the comparison cohort. This association remained significant in untreated hypothyroidism patients (adjusted hazard ratio [HR], 2.37; 95% CI, 1.10–5.09) and became statistically nonsignificant in patients treated with levothyroxine (adjusted HR, 1.73; 95% CI, 0.89–3.38). Conclusions: Hypothyroid patients had a significantly increased risk of OAG development during the 5-year follow-up period. Levothyroxine seemed to be protective. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Abstract: Objective: To investigate pregnancy outcomes, including low birthweight, preterm births, and small-for-gestational-age (SGA) among women with bipolar disorder, schizophrenia compared with women with no history of mental illness using nationwide population-based data. Methods: This study linked the Taiwan National Health Insurance Research Dataset with the national birth certificate registry. A total of 528,398 singleton births between 2001 and 2003 were included; 337 were diagnosed with bipolar disorder. Multivariate logistic regression analyses were carried out to examine the relationship between maternal bipolar disorder, schizophrenia and the odds of low birthweight, preterm births, and SGA, after adjusting for characteristics of infant, mother and father. Results: It shows that pregnant women with bipolar disorder were more likely to have LBW infants (9.8% vs. 5.7%), preterm births (14.2% vs. 6.9%) and SGA (22.3% vs. 15.7%) than pregnant women with no history of mental illness. The adjusted odds of low birthweight for women with bipolar disorder was 1.66 times (95% CI, 1.16–2.38) that of women with no history of mental illness. In terms of preterm births and SGA, the adjusted odds ratios were 2.08 (95% CI, 1.53–2.83) and 1.47 (95% CI, 1.14–1.91) respectively, for women with bipolar disorder, compared to their counterparts with no history of mental illness. Conclusions: We conclude that women with bipolar disorder had increased risk of low birthweight, preterm births, and SGA than women without a history of mental illness. More active monitoring and early intervention to counter potential adverse pregnancy outcomes for pregnant women with bipolar disorder should be initiated. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the risks that maternal panic disorder (PD) during pregnancy contribute to adverse pregnancy outcomes, with the effects further specifically differentiated into mothers who experienced a panic attack during pregnancy and those who did not. Method: This study linked two nationwide population-based datasets: the birth certificate registry and the Taiwan National Health Insurance Research Dataset. We identified a total of 371 women who gave birth from 2001 to 2003, who had been diagnosed with PD within 2 years prior to the index delivery, together with 1585 matched women without this chronic disease as a comparison cohort. Multivariate logistic regression analyses were performed to estimate odds ratios. Results: Results indicated that compared to women without chronic disease, PD mothers who experienced panic manifestations during pregnancy and those who did not were independently associated with respective 2.29- (95% confidence interval (CI)=1.14–4.60) and 1.45-fold (95% CI=1.03–2.04) increased risks of having small-for-gestational-age infants. Further, for PD mothers who experienced a panic attack during gestation, the adjusted odds ratio for having a preterm delivery was 2.54 (95% CI=1.09–5.93), whereas no significant difference was identified between PD women who did not have a panic attack during pregnancy and women without PD. Limitation: Our study was unable to investigate the effects of such risk factors as dietary habits, cigarette smoking, and alcohol use in the regression model. Conclusion: We conclude that prenatal PD, particularly the occurrence of panic attacks during pregnancy, was associated with adverse birth outcomes. [Copyright &y& Elsevier]

Background and Aim: No study has examined associations between physician volume or hospital volume and survival in patients with liver malignancies in the hepatitis B virus-endemic areas such as Taiwan. This study was to examine the effect of hospital and surgeon volume on 5-year survival and to determine whether hospital or surgeon volume is the stronger predictor in patients with hepatocellular carcinoma after hepatic resection in Taiwan.Methods: Using the 1997-1999 Taiwan National Health Insurance Research Database and the 1997-2004 Cause of Death Data File, we identified 2,799 patients who underwent hepatic resection and 1,836 deaths during the 5-year follow-up period. The Cox proportional hazard regressions were performed to adjust for patient demographics, comorbidity, physician, and hospital characteristics when assessing the association of hospital and surgeon volume with 5-year survival.Results: When we examined the effect of physician and hospital volumes separately, both physician and hospital volumes significantly predicted 5-year survival after adjusting for characteristics of patient, surgeon, and hospital. However, after we adjusted for characteristics of physician and hospital, only physician volume remained a significant predictor of the 5-year survival.Conclusions: Physician volume is a stronger predictor of 5-year survival in hepatocellular carcinoma patients receiving hepatic resection. [ABSTRACT FROM AUTHOR]

Background: Accurate identification of patients at high risk of death as a result of major chest trauma is essential within a trauma system. We used 3-year population-based data in Taiwan to evaluate risk factors associated with 24-hour mortality among adults with obvious rib fractures and needing hospitalization after traffic accidents. Methods: Pooled data from Taiwan''s National Health Insurance Research Database for the years 2002 through 2004 were used. A total of 18,856 patients hospitalized with rib fractures after traffic accidents were included. Multivariate logistic regression using generalized estimating equations was performed to explore the relationship between 24-hour mortality and patients'' age, sex, and comorbid conditions, as well as hospital characteristics, adjusting for social factors and any clustering of the sampled patients by hospital. Results: Of patients in the sample, 459 (2.4%) died within 24 hours of admission. Patients who had six or more rib fractures were three times more likely to die within 24 hours of admission compared with patients with only one rib fracture (odds ratio [OR], 3.16; p < 0.001). The adjusted odds of death within 24 hours were higher for patients who had hemopneumothorax (OR, 3.15; p < 0.001), extremity fractures (OR, 1.74; p < 0.001), pelvic fractures (OR, 2.92; p < 0.001), head injuries (OR, 4.29; p < 0.001), spleen injury (OR, 1.83; p < 0.05), hepatic injury (OR, 4.39; p < 0.001), heart injury (OR, 4.48; p < 0.001), and diaphragm injury (OR, 3.16; p < 0.05) compared with patients who had none of these injuries. Conclusions: We concluded that more than six ribs fractured, heart injuries, hepatic injuries, head injuries, and advanced age are the most important determinants of 24-hour mortality after thoracic trauma from traffic accidents. [Copyright &y& Elsevier]

Abstract: This study aimed to compare psychiatrists'' in-patient caseload volume with length of stay (LOS) and 30-day readmission rates in Taiwan. We hypothesized that high-volume psychiatrists would be associated with shorter LOS and lower 30-day readmission rates. The sample of 66,959 patients hospitalized for the first time for mental disorders was taken from Taiwan''s 2001–2003 National Health Insurance Research Database and categorized into four patient groups according to attending psychiatrists'' caseload volume. A total of 21,669 (32.4%) of the patients sampled were readmitted within a 30-day period, with the mean LOS being 24.0 (±19.5) days. As caseload volume increased, there was a corresponding increase in the adjusted odds ratio for 30-day readmission rates. The regression analysis reveals adjusted LOS for patients treated by psychiatrists with medium caseload volumes was 1.22 days shorter than that for patients treated by low caseload volume psychiatrists. The adjusted LOS for patients seeing high caseload volume psychiatrists was 2.03 days shorter than for those seeing psychiatrists with low caseload volumes; and for the very-high-volume group, it was 7.59 days shorter. Although the findings confirm our hypothesis regarding LOS, they do not support our hypothesis regarding the relationship between psychiatrists'' caseload volume and readmission rates. [Copyright &y& Elsevier]

Abstract: Background: Young adults aged from 18 to 44 years comprise a large portion of the population suffering from depression. Yet few studies have compared the likelihood of dying of natural causes or by suicide among depressed patients. This study uses a case–control approach to compare the likelihood of dying of natural causes and by suicide for depressed and non-depressed patients based on a representative national sample in Taiwan. Method: A retrospective case–control study design was used to analyze two nationwide population-based datasets: the National Health Insurance Research Database (NHIRD) and the official Cause of Death data file in Taiwan. The study cohort consisted of 827 patients from 18 to 44 years old who were hospitalized with a primary diagnosis of depressive disorder from 1998–2003. A comparison cohort of patients hospitalized for appendectomies was matched with the study sample in terms of age and gender (N =2481). Results: After adjusting for the age and comorbid medical disorders, the hazard of dying during the five-year follow-up period was 1.72 times greater for depressed patients than for appendectomy patients. Depressed patients were more likely to die by suicide during the follow-up period, as no significant difference in odds of dying from natural causes was observed between these two cohorts. Conclusion: Further studies should be initiated to identify specific risk factors for suicide among younger adults, while prevention strategies might focus on stresses associated with particular life stages, taking age and gender patterns into account. [Copyright &y& Elsevier]

Abstract: Objective: This study examines the association between the likelihood of cesarean section (CS) and the degree of urbanization in Taiwan, exploring possible explanations for the difference. Study design: The database used in this study was the Taiwan 2004 National Health Insurance Research Database. A total of 200,207 singleton deliveries fulfilled our criteria and were included in our study. The urbanization level of cities/towns where parturients resided at the time of delivery was stratified into seven categories. A multilevel logistic regression model was applied to examine the relative likelihood of CS by urbanization level after adjusting for parturient, physician and hospital characteristics. Results: There was an upward trend in the CS rate with advancing urbanization level; the CS rates for urbanization level 1 (most urbanized) through 7 (least urbanized) were 33.7, 32.3, 30.4, 30.2 29.7, 29.5, and 28.6%, respectively. Compared with participants living at the highest urbanization level, the adjusted odds of a CS were 0.91 (95% CI=0.85–0.98, p =0.014), 0.84 (95% CI=0.78–0.91, p <0.001), 0.83 (95% CI=0.68–0.88, p <0.001), 0.79 (95% CI=0.72–0.86, p <0.001), and 0.70 (95% CI=0.62–0.80, p <0.001) times, respectively, for those living in cities/towns ranked from the third highest to the lowest levels of urbanization. Conclusions: We conclude that higher urbanization levels were associated with higher odds of CS. Highly urbanized communities could therefore be targeted for policy intervention aimed at reducing the unnecessary CS rate. [Copyright &y& Elsevier]

Background: This study aims to estimate the risk of developing stroke within 5 years of discharge among young patients ages 18 to approximately 44 who were hospitalized for depressive disorders. Methods: Our study design features a study cohort and a comparison cohort. The study cohort included patients ages 18 to approximately 44 who were hospitalized with a principal diagnosis of depressive disorder (n = 827), whereas the comparison cohort consisted of 4,135 patients selected randomly (five for every depressed patient) and matched with the study group in terms of gender, age, and date of discharge. Each patient was tracked for 5 years after their discharge in 1998. Cox proportional hazard regressions were performed to compute the 5-year stroke-free survival rates after adjusting for possible confounding factors. Results: During the 5-year follow-up period, 50 depressed patients (6.05% of the study cohort) and 48 non-depressed subjects (1.16% of the comparison cohort) developed strokes. The adjusted hazard of stroke was 5.43 (95% confidence interval = 3.47–8.51, p < .001) times greater for depressed patients than for non-depressed subjects. Conclusions: Our findings show young patients ages 18 to approximately 44 who were hospitalized for depressive disorders were at over five times greater risk of developing stroke within 5 years of discharge compared with non-depressed age- and gender-matched subjects. [Copyright &y& Elsevier]

Abstract: Purpose: To explore risk factors, such as characteristics of psychiatrist, patient and hospital at index hospitalization, associated with depressed patients who committed suicide within 3 months of discharge using a case-control design. Methods: By linking the Taiwanese nationwide mortality database and the National Health Insurance dataset, all hospitalized patients with major depression who committed suicide within a 90-day period post-discharge during the years 2002–2004 were selected as a study cohort (n =85). We randomly selected 425 cases (five for every case in the study cohort) that were matched with the study cohort in terms of age, gender and date of discharge as a control cohort. Cox proportional hazard regression was carried out to compute the adjusted 90-day survival rate after adjusting for other factors. Results: The majority of suicide occurred 30 days after discharge from hospitals, with a mean of 29.9 days. The adjusted hazard for committing suicide after hospital discharge for patients who left on their own initiative was 2.85 times (95% CI=1.387–5.856, p =0.004) greater than for those who were discharged with doctors'' approval. Furthermore, the adjusted hazard for patients who were discharged from medical centers was higher than for patients discharged from regional hospitals, by a multiple of 3.38 (95% CI=1.421–8.055, p =0.006). Limitations: Some patient-specific predictors of post-discharge suicide, such as suicidal ideation prior to admission, recent life events and social relationships with close relatives were not available. Conclusion: We conclude that, in addition to patient characteristics, hospital characteristics also constitute important risk factors for suicide within 90 days of discharge for depressed patients. [Copyright &y& Elsevier]

This study sets out to investigate the preferences of the elderly in northern Taiwan with regard to various types of long-term care services. Taking into consideration sociodemographics, health condition, and access to such medical care services, our study examined both economic and family factors in an attempt to gain an understanding of the knowledge of and attitudes toward, the various types of long-term care among the elderly. An interview survey was carried out by local public health nurses among a sample of 562 elderly Taiwanese residents (people aged 65 years or older) from 7 counties/cities in northern Taiwan, all of whom had been selected by means of multistage sampling. The survey was conducted using a questionnaire based on the Andersen and Newman model of health care utilization, with the intention being to gain a better understanding of the related factors. The results indicate that both ethnic background and the requirement for additional medical care services had significant effects on the long-term care preferences of the elderly in Taiwan, a finding that should help to provide a better understanding of the preferences for and availability of such long-term care services among the elderly. Such improved understanding could result in improving the quality of life for the elderly, particularly if they feel that their preferences have been taken into consideration and their needs have ultimately been met. [Copyright &y& Elsevier]

Objectives: To examine the relationship between the urologist case volume for transurethral resection of the prostate (TURP) and in-hospital mortality using a Taiwan nationwide population-based data set. Methods: This study used data from the 2003 Taiwan National Health Insurance Research Database. The sample of 9539 patients who had undergone TURP was divided into three urologist caseload volume groups: fewer than 27 cases annually (low volume), 27-55 cases annually (medium volume), and more than 55 cases annually (high volume). Multivariate logistic regression analysis using generalized estimating equations was conducted to assess the adjusted association of urologist TURP caseload volume and patient in-hospital mortality to account for the urologist, patient, and hospital characteristics and the clustered nature of the study sample. Results: The in-hospital mortality rate decreased with an increasing TURP caseload volume. The in-hospital mortality rate was 2.37%, 1.97%, and 1.16% for patients treated in the low, medium, and high-volume urologist group, respectively. After adjusting for others factors, the likelihood of in-hospital mortality for patients treated by urologists with a low and medium TURP caseload volume was 1.835 (95% confidence interval 1.198-2.812, P < .01) and 1.606 (95% confidence interval 1.052-2.452, P < .05) respectively, compared with that for patients treated at high-volume hospitals. Conclusions: The results of our study have shown that, after adjusting for patient, urologist, and hospital characteristics, high-volume urologists are associated with superior treatment outcomes for patients undergoing TURP. [Copyright &y& Elsevier]

Background: Although the relationship between provider volume and treatment outcome has been established for many types of operations, such a relationship has yet to be determined for resection of oral cancers. The purpose of this report is to assess the effects of surgeon and hospital volume on 5-year survival for oral cancer. Methods: A total of 6,666 patients who underwent resections of oral cancer between 1997 and 1999 were identified from the Taiwan National Health Insurance Research Database. These data were linked to the “cause of death” data file from the Department of Health in Taiwan and traced for 5 years to obtain the survival times for individual patients. Survival analysis and proportional hazard regressions were conducted to assess the association between 5-year survival rates and surgeon and hospital volumes after adjusting for patient and provider variables. Volume relationships were based on the following criteria: low-, medium-, and high-volume surgeons were defined by <52, 52 to 142, and >142 resections, respectively, during the 3-year period. Similarly, low-, medium-, and high-volume hospitals were defined by <343, 343 to 531, and >531 resections, respectively, during the 3-year period. Results: With an increase in individual surgeon volume, there were increases in the unadjusted 5-year survival rates (45.5%, 49%, and 51.8% for low-, medium-, and high-volume groups, respectively; P < .001); no such association, however, was observed with hospital volumes (47.5%, 51.3%, and 49% for low-, medium-, and high-volume hospitals, respectively; P = .074). Compared with treatment by low-volume surgeons, operations by high-volume surgeons were associated with an adjusted hazard ratio of 0.810 (95% confidence interval = 0.735-0.893). Conclusions: We conclude that, for patients who underwent oral cancer resections, after adjusting for differences in the case mix, high-volume surgeons had better 5-year survival rates. This association, however, was not discernible for high-volume hospitals. [Copyright &y& Elsevier]

Abstract: Objective: To examine the relationship between obstetrician gender and the likelihood of maternal request for cesarean section (CS) within different healthcare institutions (medical centers, regional hospitals, district hospitals, and obstetric and gynecology clinics). Study design: Five years of population-based data from Taiwan covering 857,920 singleton deliveries without a clinical indication for a CS were subjected to a multiple logistic regression to examine the association between obstetrician gender and the likelihood of maternal request for a CS. Results: After adjusting for physician and institutional characteristics, it was found that male obstetricians were more likely to perform a requested CS than female obstetricians in district hospitals (OR=1.53) and clinics (OR=2.26), while obstetrician gender had no discernible associations with the likelihood of a CS upon maternal request in medical centers and regional hospitals. Conclusions: While obstetrician gender had the greatest association with delivery mode decisions in the lowest obstetric care units, those associations were diluted in higher-level healthcare institutions. [Copyright &y& Elsevier]