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Aims To determine the effect of methadone maintenance therapy (MMT) on mortality among injection drug users. Design A cohort of prisoners with a history of injecting opiates who were followed after their release from prison in July 2007. Mortality between July 2007 and December 2008 was determined by linking the National Death Registry with the Methadone Maintenance Treatment (MMT) database. Setting Taiwan. Participants A total of 4357 amnestied prisoners with a history of opiate injection. Measurements The total mortality rates (MR) among the cohort were calculated based on their person-time contribution to methadone attendance and re-incarceration during follow-up. We used survival methods with MMT and re-incarceration as time-varying covariates adjusted for length of follow-up in the community. Results A total of 142 deaths occurred: 13 in the 1st week after release [MR = 13.7/100 person-years (pyrs)], which was greater than that in the next 4 weeks [MR = 3.2/100 pyrs, relative rate (RR) = 4.3, P

Background Whether health literacy is independently associated with processes or outcomes of diabetes-related care is controversial. We tried to demonstrate the interaction of health literacy and understanding of health education and instructions in achieving glycemic control. Methods Five hundred and one consecutive patients with type 2 diabetes mellitus (DM) in the outpatient clinic of the metabolism department were recruited into this pilot study. The demographic data were collected from patients’ self-reports. The clinical background information was collected through electronic medical records. A questionnaire derived from part of the Mandarin Health Literacy Scale was used to measure numeracy and functional health literacy of people with diabetes. Health literacy levels were categorized into inadequate, marginal and adequate. Patient self-ratings of their perceived understanding of the health education information and instructions provided by their case manager in the past were categorized into two subgroups: better and poor. Patients with an HbA1c level equal to or below 7% were considered to have good glycemic control. Multivariate logistic regression was used to find associated factors of health literacy and understanding of health education and instructions. GENMOD procedures were used to analyze repeated outcome measurements of glycemic control. Results Higher educational attainment and higher household income (odds ratios were 2.23 and 2.22, respectively) were significantly associated with patients who had adequate health literacy. Higher educational attainment and patients with a family history of DM (odds ratios were 4.99 and 1.85, respectively) were significantly associated with better understanding of health education and instructions. Adequate health literacy is not the only factor associated with good glycemic control. The effect of adequate health literacy in achieving good glycemic control might be masked by patients with better understanding of health education and instructions. Conclusions Our results revealed that not only were patients with adequate health literacy associated with good glycemic control but patients with marginal health literacy were also able to achieve good glycemic control. Adequate health literacy and better understanding of health education is highly correlated. The role of adequate health literacy on glycemic control could be suppressed if variables are over-controlled during analysis.

Purpose: Using the perspectives of age, period, and cohort (APC) effects, this study explored the changes in attitudes toward supporting parents in Taiwan. Design and Methods: Population-representative cross-sectional data taken at 1984, 1990, and 1995 from the Social Change Survey in Taiwan were synthesized. Cohort tables and multi-nominal logistic regression were used to analyze the APC effects. Results: Period and age effects were found in the change in attitudes toward supporting parents. Agreement on living with sons or children has slowly decreased. Younger persons agree more than older ones in attitudes toward parents living with their married son or children. There was a reduction in the differences among cohorts across periods. There was no demonstration of cohort effect in this study. Implications: The results indicate that for married children, living with parents is no longer popular in Taiwan society. Social policy should address the unmet needs of elderly people in assistance with daily living.

To determine the effect of methadone maintenance therapy (MMT) on mortality among injection drug users.A cohort of prisoners with a history of injecting opiates who were followed after their release from prison in July 2007. Mortality between July 2007 and December 2008 was determined by linking the National Death Registry with the Methadone Maintenance Treatment (MMT) database.Taiwan.A total of 4357 amnestied prisoners with a history of opiate injection.The total mortality rates (MR) among the cohort were calculated based on their person-time contribution to methadone attendance and re-incarceration during follow-up. We used survival methods with MMT and re-incarceration as time-varying covariates adjusted for length of follow-up in the community.A total of 142 deaths occurred: 13 in the 1st week after release [MR = 13.7/100 person-years (pyrs)], which was greater than that in the next 4 weeks [MR = 3.2/100 pyrs, relative rate (RR) = 4.3, P0.001]. Overall, 1982 (46%) subjects enrolled in MMT; however, 1282 of them discontinued MMT after enrolling.The mortality among those who continued in MMT attendance was lower (MR = 0.24/100 pyrs) than those who never enrolled in MMT (MR = 2.6/100 pyrs) or those who enrolled but dropped out of MMT (MR = 7.0/100 pyrs) after adjusting for age, gender and human immunodeficiency virus status at amnesty (RR = 0.07).In ex-prisoners in Taiwan with a history of opiate injecting, enrollment and continued participation in methadone maintenance treatment is associated with substantially lower mortality.