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International migrant workers contribute significantly to the economic growth of the receiving country, and yet their health, especially their mental health, has long been overlooked. The purpose of this study was to identify the factors associated with depressive symptoms among Indonesian migrant workers in Taiwan. This study used cross-sectional data from 1031 Indonesian migrant workers in Taiwan. Demographic, health, and living- and work-related variables, as well as depressive symptom variables assessed using the Center for Epidemiological Study on depressive symptoms scale, were collected. Logistic regression analysis was used to identify related factors. About 15% of the Indonesian migrant workers had depressive symptoms. The significant factors associated with these symptoms were age, educational level, frequency of contact with families, self-rated health, time spent in Taiwan, region of work, satisfaction with the living environment, and freedom to go out after work. The findings thus identify target groups who are more likely than others to suffer from depressive symptoms, and we suggest appropriate approaches for devising interventions to reduce depressive symptoms. The findings of this research suggest the need for targeted approaches to reducing depressive symptoms among this population group.

Background Understanding the factors associated with the adoption of contraceptive methods among women of childbearing age is imperative to improving maternal health outcomes. This study aimed at exploring the association between history of abortion and contraceptive use among Mongolian women. Materials and methods We analyzed cross-sectional data of 8373 women aged 15–49 years from the 2018 Mongolian Social Indicator Sample Survey (MSISS). Binary logistic regression models were used to assess the association between abortion history and current contraceptive use while accounting for both individual- and community- level factors. Results A total of 4347 (51.92%) and 2525 (30.16%) reported current use of various contraceptive methods and a history of abortion in their lifetime, respectively. Women with a history of abortion were less likely to report current use of contraceptives (adjusted odds ratio (AOR) = 0.72, 95% confidence interval (CI) [0.58–0.89]). Specifically, women with a history of abortion were less likely to report use of IUD (AOR = 0.79, 95% CI [0.71–0.90)]) and injectables (AOR = 0.59, 95% CI [0.41–0.84]). History of abortion was associated with increased likelihood of using abstinence (OR = 1.82, 95% CI [1.31–2.53]) as a contraceptive method. Conclusion Our results demonstrated a significant association between history of abortion and contraceptive use. Public health interventions aiming to improve maternal health outcomes through contraceptive use should target women with a history of abortion to improve their uptake.

Background Increasing the knowledge and attitude toward human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a key in the management of the condition. However, in Malawi, there is limited information regarding individual- and community-level factors associated with HIV/AIDS knowledge and attitudes. This study examined the contextual factors associated with HIV/AIDS knowledge and attitudes among women of childbearing age (WOCBA) (aged 15–49 years) in Malawi. Methods The 2015–16 Malawi demographic and health survey was used to analyze 24 562 WOCBA who were nested in 850 communities. Mixed effects logistic regression models were fitted to estimate the fixed and random effects of individual- and community-level factors on HIV/AIDS knowledge and attitudes. Results Approximately 30.9% of the participants had good HIV/AIDS knowledge while 80.5% had good HIV/AIDS attitudes. Among others, at the individual-level, woman’s age, educational level and household wealth were positively associated with both good HIV/AIDS knowledge and attitudes. At the community-level, those from communities with a high percentage of women complaining about the distance to health facility were less likely to have both good HIV/AIDS knowledge and attitudes. Conclusions Individual- and community-level factors have been shown to be associated with HIV/AIDS knowledge and attitudes among WOCBA in Malawi. Additionally, residual heterogeneity in terms of HIV/AIDS knowledge and attitudes across communities was observed. Therefore, thorough profiling of communities when designing public health programs and strategies may prove beneficial.

Background:\ud \ud Despite malaria control programmes having successfully increased the number of households owning insecticide-treated nets (ITNs) in Malawi, the population of people with ITN access but still not using them fluctuated from 13% in 2010, 5% in 2012 and then 12% in 2015. This study aimed to compare the rate and factors associated with ITN usage among children under 5 years of age, living in household with at least one ITN, in Malawi between 2010 and 2015.\ud \ud Methods:\ud \ud The 2010 and 2015-2016 Malawi Demographic and Health Surveys (MDHSs) were utilized. Only children from households that owned at least one ITN were selected. Multivariate logistic regression analyses were performed to examine associations of child, maternal and household factors with ITN usage.\ud \ud Results:\ud \ud In total, 12,378 and 10,196 children under 5 years of age were examined from 2010 and 2015-2016, respectively. ITN usage increased from 57.8% (95% Confidence interval (CI): 56.1%-59.4%) in 2010 to 69.0% (95% CI 67.4%-70.5%) in 2015. The multivariate analysis revealed that, among others, being aged ≥ 24 months, having mothers with no formal education or with primary education, residing in a female-headed household, and residing in households that had poor household ITN supply were significantly associated with reduced odds of ITN usage.\ud \ud Conclusions:\ud \ud ITNs are a key vector control intervention in malaria prevention. This study revealed increased ITN usage among children under 5 years old in the 5-year period, suggesting that considerable improvements have been made. However, continued efforts to increase awareness of the importance of using ITNs in malaria prevention in Malawi are necessary. Findings from this research provide some policy implications, especially for improving household ITN supply, to improve ITN utilization in Malawi.

Objectives The aim of this study was to determine whether gender impacts potential associations between social relationships, sociodemographic, health and behavioural factors with resilience among older Taiwanese adults. Methods High and low resilience of older adults was determined based on the median value of the Friborg’s Resilience Scale. An independent sample t-test, χ2, and multivariate logistic regression were used to examine predictors for resilience which were then stratified by gender. Results Older women were less likely to be resilient than older men. Marital status, age, financial stress, and satisfaction with one's living environment were only significant in women. Traditional gender roles in the wider Taiwanese context can be attributed to these differences. Conclusions The relationships between gender, sociodemographics, health, and social and behavioural factors with resilience provide unique insights into how culture shapes trends in data.

Background The use of contraceptives is an essential public health concept that improves overall safe motherhood and infant health. Women empowerment has been reported to influence health behaviors in women. With recent efforts to increase access to contraceptive methods, uptake of the same remains a challenge in Cambodia. There are limited studies that have examined the role of women’s empowerment at both individual- and community- level on contraceptive use in Cambodia. This study examined the individual- and community-level factors associated with contraceptive use among Cambodian married women between 2005 and 2014. Methods Data from 2005, 2010, and 2014 Cambodia Demographic and Health Surveys were used to analyze 2211; 10,505; and 10,849 women, respectively. Multilevel binary and multinomial logistic regression models were applied to assess the association between individual- and community- level factors, and the use of contraceptive methods. Results The prevalence of using modern contraceptive methods increased over time (i.e., 29.0, 38.1, and 42.3% in 2005, 2010, and 2014, respectively). At the individual level, women who attained secondary and higher education were more likely to use any contraceptives [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI) = 1.22–1.68, and aOR = 1.23, 95% CI = 1.05–1.44 in 2010 and 2014, respectively] compared with those with no formal education. Similarly, having a high workforce participation level was significantly associated with increased likelihood of using any contraceptive methods [aOR = 1.12, 95% CI = 1.00–1.26, aOR = 1.44, 95% CI = 1.29–1.60 and in 2010 and 2014, respectively]. Other factors such as age at first marriage, residence, and having a health insurance were associated with contraceptive use. The proportional change in variance showed that about 14.3% of total variations in the odds of contraceptive use across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 5.2% of the total variation remained unexplained even after adjustments. Conclusion Both individual- and community- level factors influenced contraceptive use in Cambodia. When designing programs to improve contraceptive use, contextual influences should be taken into account for the effectiveness of the programs.

Background Signs associated with the onset of disability can be useful in disability projection and have significant implications in elderly care policy. Objective To explored the associations between biometric screening indicators and declines in activities of daily life (ADLs) functioning among the Indonesian elderly. Methods This is a prospective longitudinal cohort study. The Indonesian Family Life Survey (IFLS) 4 conducted in 2007–2008, and IFLS 5 conducted in 2014–2015 were used to assess the association between biometric indicators and ADLs at baseline and follow-up. Results Findings revealed that 22.3% of participants surveyed in 2007–2014 had become disabled in terms of ADLs. Anemia status, stage 2 hypertension, lung capacity, and a longer sit-to-stand time were associated with ADLs. Conclusion These findings are important to help early detection and potentially help the prevention of ADLs in elderly people in the future. Accuracy of disability estimation could possibly be improved if including biometric parameters.

Background Elderly people tend to have greater healthcare utilization because of their health status. However, with the 4th largest population in the world, little is known concerning the use of services among the Indonesian elderly. Hence, this study aimed to identify factors related to the use of outpatient services among the Indonesian elderly. Methods This is cross sectional study using data from the Indonesian Family Life Survey 5 (IFLS 5), conducted in 2014 and 2015. Only those who were 60 years or older were included in the analyses. We used a logistic regression analysis to determine factors associated with use of outpatient services. Results Among 2912 participants, only 22.7% of respondents had visited health workers or doctors within the previous 4 weeks before the survey. After controlling for other variables, factors associated with the use of outpatient services were socioeconomic status, insurance status, regions of residence, self-rated health, and the number of chronic conditions. Conclusion Inequality in outpatient services was observed among the elderly in Indonesia. More effort is need to expand insurance coverage for the elderly, particularly for those in the lower economic status, and to improve access to outpatient services in rural regions by allocating the needed resources.

Background:\ud \ud Approximately 45% of all children's deaths are associated with malnutrition, and sub-Saharan Africa is hardest hit by this phenomenon. However, information on geographical variations of malnutrition in developing countries is limited. This study examined the geographical distribution and community characteristics associated with child malnutrition in Burkina Faso.\ud \ud Design:\ud \ud Data from the 2011 Burkina Faso Demographic Health Survey were analyzed. A general Kriging interpolation method was used to generate spatial malnutrition patterns. The global Moran's I test was used to identify significant malnutrition spatial patterns. Generalized estimating equations (GEEs) were fitted to examine the association between community level factors and malnutrition.\ud \ud Results:\ud \ud Average rates of stunting and wasting in the communities were 32.48% and 15.05%, respectively. Stunting hotspots were observed in the eastern and northeastern parts of Burkina Faso (i.e. Oudolan, Séno and Yagha, among others), while high rates of wasting were observed in the north-central part. The GEE results revealed lower stunting rates in communities with a higher percentage of households with improved sanitation. Communities with higher rates of professionally assisted births were associated with low wasting rates, while communities with higher rates of households with a low wealth index reported higher rates of wasting.\ud \ud Conclusions:\ud \ud Spatial statistical models of malnutrition prevalence are useful for indicating hotspots over wide areas and hence, for guiding intervention strategies. This study revealed significant geographical patterns and community factors associated with childhood malnutrition. These factors should be considered in future programs aimed at reducing malnutrition in Burkina Faso.

Dengue is a re-emerging infection that poses significant threat to about half of the world's population, but there was little information on the bibliometric trend and patterns of dengue research globally. The purpose of this research is to provide a bibliometric analysis of dengue research from 1991 to 2014, and to assess the relationship between the burden of dengue and scientific publications. Most papers were classified under the topics of tropical medicine, virology, infectious diseases, parasitology or immunology. India may soon surpass Thailand in the ranking. Overall, international collaboration appeared to play a significant role in dengue research. Regional specificity of dengue may also influence the bibiliometric profile of dengue research. Nevertheless, dengue research output appeared to be positively and significantly related to the level of dengue cases, an indication that the scientific community was responding well to the needs of the population.

Lack of knowledge regarding brucellosis may lead to highly risky practices. Among herders in Mongolia, little research was conducted assessing the extent of knowledge related to brucellosis, the type of preventive behaviours that were practiced, and the relationship between knowledge and behaviour regarding brucellosis. A cross-sectional study was conducted in two provinces of Mongolia where herders were randomly selected to participate in the study. Face-to-face interviews were conducted using a structured questionnaire. In total, 485 herders participated in the study. The results indicated that brucellosis preventive practices were significantly associated with sex, location, use of veterinary services, exposure to TV programs and knowledge of brucellosis. Regional disparities in knowledge and behaviour were observed in this research. Herders were more likely to engage in preventive practices if they had a higher level of knowledge of brucellosis. Findings from this research indicated that the effectiveness of incorporating health education through TV programs, as well as the importance of ensuring access to veterinary services in brucellosis prevention.

Geographical variations in teen birth rates (TBR) still persist despite controlling for contextual factors. The aim of this research was to identify spatial patterns of TBR in Taiwan and to examine spatial relationships among different contextual factors. Using townships as the unit of analysis (N=359), this research used social and demographic variables for the years 1995, 2000, 2005 and 2010 and conducted spatial modelling of TBR. Geographical maps of TBR were presented, and Local Indicator of Spatial Autocorrelations was used to identify TBR clustering. Comparisons were made between ordinary least-squares models and spatial lag models, in which township-level TBRs were regressed on other township-level contextual characteristics. Our study found that townships with a high TBR were mostly in eastern, central and some southern regions of Taiwan, while townships with a low TBR were in the vicinity of metropolitan areas. The significant spatial lag indicated that townships would have a higher expected prevalence rate if adjacent townships have had higher rates. Results also indicated that the percentage of aborigines and the percentage of college-educated people were consistently associated with TBR over the years. Interventions aimed at reducing TBR in Taiwan should consider the presence of spatial correlations and should incorporate neighbouring townships.

The Democratic Republic of the Congo (DRC) has one of the highest rates of violence against women in the world; however, few studies have focused on this issue. In this study, we assessed the interrelationship among intimate partner violence (IPV), unintended pregnancy, pregnancy loss, and other sociodemographic factors in the DRC. Our analyses were based on data from the DRC demographic and health survey, conducted from November 2013 to February 2014. We constructed generalized estimating equation models to analyze the data from a sample of 5,120 married women. Our results showed that having a husband or partner who exhibited controlling behaviors, women who justified wife-beating, having a mother who had experienced IPV, and having a husband or partner who consumed alcohol were positively associated with IPV, whereas decision-making autonomy among women was negatively associated with IPV. In the community, the proportion of women who had experienced IPV and that of those who had completed secondary or higher education were positively and negatively associated with any IPV type, respectively. In addition, emotional IPV and any IPV type were positively associated with pregnancy loss. Our results indicate the necessity of implementing programs targeting gender equality at both individual and community levels.

Family planning has improved the well-being of families by preventing high-risk pregnancies and abortions and reducing unplanned pregnancies. However, the effectiveness of family planning efforts has not been consistent across countries. This study examined factors associated with contraceptive use among married women in Ethiopia. Data were from the 2011 Ethiopian Demographic and Health Survey. The sample comprised 10,204 married women (aged 15-49 years). Logistic regression models were used to analyze the data. Among married women in Ethiopia, 29.2% used contraceptive methods. About 44.1% of women who were not current users of contraceptives reported that they intended to use contraceptives in the future. Age at first marriage, being educated, number of living children, exposure to mass media, being employed, having educated partners, and having been informed about contraceptive use at health facilities were positively associated with current contraceptive use. By contrast, older age, a rural resident, or Muslim; belonging to the Afar or Somali ethnic groups; desiring numerous children; having husbands who desired additional children; and abortion experience were negatively associated with current contraceptive use. Our findings indicated that improving education, providing employment opportunities for women, and providing training to family planning providers are essential to increasing contraceptive use.

Background Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women’s autonomy. We assessed whether women’s autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. Methods We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women’s decision-making power and permissive gender norms associated with wife beating. We used Spearman’s correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women’s autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Results Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Conclusions Our study shows that women’s autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution. Electronic supplementary material The online version of this article (10.1186/s12913-017-2670-9) contains supplementary material, which is available to authorized users.

Background Studies on the determinants of cervical cancer screening in sub-Saharan Africa have focused mostly on individual-level characteristics of cervical cancer screening. Therefore, in this study, we included both individual- and community-level indicators to examine the determinants of cervical cancer screening among Kenyan women. Methods We analyzed data from the 2014 Kenya Demographic and Health Surveys. Our analysis focused on 9016 married women of reproductive age (15–49 years). We conducted multilevel analyses using generalized linear mixed models with the log-binomial function to simultaneously analyze the association of individual- and community-level factors with cervical cancer screening. Results About 72.1% of women (n = 6498) knew about cervical cancer. Of these women, only 19.4% had undergone cervical cancer screening [58.24% Papanicolaou (Pap) test and 41.76% visual inspection]. Our multivariate analysis results indicated that the prevalence of cervical cancer screening was higher among women aged 35-49 years than women aged 15-24 years. The prevalence was also higher among women residing in the Central, Nyanza, and Nairobi regions than women residing in the Coastal region. Cervical cancer screening was more prevalent among women who had media exposure, had higher household wealth index, were employed, were insured, and had visit a health facility in 12 months than did their counterparts. The prevalence of Pap test history was 19% higher among women who had sexual autonomy than women who did not have sexual autonomy. The prevalence of Pap test history was also higher among communities comprised of higher proportions of women with sexual autonomy and higher education. Conclusions Policies should emphasize increasing gender equality, improving education at the community level, providing employment opportunities for women, and increasing universal health insurance coverage. These focal points can ensure equity in access to health care services and further increase the prevalence of cervical cancer screening in Kenya.

Effects of Individual-Level and Community-Level Characteristics on Maternal Healthcare Service Utilization (2-year pooled data, 2005 and 2011). Description of data: Results of multivariate analyses about the relationships among individual-level characteristics, community-level characteristics, and interaction effects of womenâ s empowerment and year on maternal healthcare service utilization. (DOCX 16Â kb)

Objective Despite the large reduction in infant mortality rates in the last two decades, the burden of infant mortality is still high in Malawi. Because few studies have specifically addressed the determinants of infant mortality in Malawi, this exploratory study identified a series of distal, intermediate, and proximal factors related to infant mortality using a conceptual framework that explains the risk in developing countries. The objective of this study was to examine the effects of family and socioeconomic factors on the risk of an infant dying before the age of 12 months. Methods In this study, we analyzed the 2004 and 2010 data of the Malawi Demographic and Health Surveys. This study adopted a cross-sectional study design involving 4,698 and 12,174 singleton births in the years 2004 and 2010, respectively. Multiple logistic regression models were used to estimate the effects of selected variables on infant mortality. Results In the multivariate logistic regression analyses, women who resided in wealthy urban areas were 58% less likely to report infant deaths than those in rural areas [odds ratio (OR) = 0.48]. Infants who were second or third in birth order were less likely to die before 12 months. However, cesarean section delivery was found to be a risk factor associated with infant mortality in the year 2004 (OR = 1.95). By contrast, women who were in the highest 20% of household wealth, who resided in the northern region, and were in the 20–29 age group were less likely to report infant deaths. However, cesarean section delivery (OR = 1.42), male infants (OR = 1.26), and small size at birth (OR = 1.63) were the significant predictors of infant mortality in the year 2010. Furthermore, the mother's education and household wealth were not significant predictors of infant mortality in Malawi. Conclusion The present study shows that improving the quality of life in rural areas, evenly distributing health care delivery services and other social economic factors across the nation, and improving maternal health care, neonatal care, and nutrient intake could decrease infant mortality in Malawi.

Background Empirical evidence regarding the relationship between childhood immunization and individual- and community-level factors in low-income countries has received little attention. We compared the trends and the effects of a wide range of individual- and community-level socioeconomic factors on the likelihood of a child being immunized between 2004 and 2010 in Malawi. Methods We used data from the 2004 and 2010 Malawi Demographic and Health Survey and applied generalized estimating logistic regression equation to analyze data respectively on 2042 and 3496 children aged 12–23 months. We compared the relationship between individual- and community-level socioeconomic factors and a child's vaccination status for four basic vaccines recommended by the World Health Organization: bacillus Calmette-Guerin (BCG) vaccine, diphtheria-tetanus-pertussis (DPT3) vaccine, oral polio vaccine (OPV3), and measles-containing vaccine 1 (MCV1). Results The trends of vaccination had a similar pattern in 2004 and 2010. The coverage of the four vaccinations was highest for BCG and lowest for OPV3 and complete immunization was higher in 2010. The multivariate analyses show that mother’s low education, having one or none antenatal visits, having no immunization card, having immunization card but not seen, residing in poor households, and living in central region were the most significant factors associated with decreased odds of achieving vaccination coverage and complete vaccination in both 2004 and 2010. However, maternal education was more likely to be associated with children’s immunization in 2010, while the geographical region was more likely to be associated with children’s immunization in 2004. Conclusions There were marked improvements in the national immunization coverage from 2004 to 2010. In order to achieve complete immunization, to further enhance the national immunization coverage as well as to lessen the gaps and disparities in childhood vaccination in Malawi, policy makers should design interventions based on the factors addressed in this study.

To provide an overview of the characteristics of research in China, a bibliometric evaluation of highly cited papers with high-level representation was conducted during the period from 1999 to 2009 based on the Essential Science Indicators (ESI) database. A comprehensive assessment covered overall performance, journals, subject categories, internationally collaborative countries, national inter-institutionally collaborative institutions, and most-cited papers in 22 scientific fields. China saw a strong growth in scientific publications in the last decade, to some extent due to increasing research and development expenditure. China has been more active in ESI fields of chemistry and physics, but more excellent in materials science, engineering and mathematics. Most publications were concerned with the common Science Citation Index subject categories of multidisciplinary chemistry, multidisciplinary materials and science, and physical chemistry. About one half China's ESC papers were internationally collaborative and the eight major industrialized countries (the USA, Germany, the UK, Japan, France, Canada, Russia, and Italy) played a prominent role in scientific collaboration with China, especially the USA. The Chinese Academy of Sciences took the leading position of institutions with many branches. The "985 Project" stimulated the most productive institutions for academic research with a huge funding injection and the universities in Hong Kong showed good scientific performance. The citation impact of internationally collaborative papers differed among fields and international collaborations made positive contributions to academic research in China.

As the population ages in Taiwan, stroke research has received greater attention in recent years. Strokes have significant impacts on the health and well-being of the elderly. To formulate future research policy, information on stroke publications should be collected. In this research, we studied stroke-related research articles published by Taiwan researchers which were indexed in the Science Citation Index from 1991 to 2005. We found that the quantity of publications has increased at a quicker pace than the worldwide trend. Over the years, there has been an increase in international collaboration, mainly with researchers in the U.S. Article visibility, measured as the frequency of being cited, also increased during the period. It appears that stroke research in Taiwan has become more globally connected and has also improved in quality. The publication output was concentrated in a few institutes, but there was a wide variation among these institutes in the ability to independently conduct research. A wide array of keywords indicated a probable lack of continuity in research. Nevertheless, there was an inverse relationship between stroke mortality and number of published articles in Taiwan. To improve the quality and efficiency of stroke research, continuity in research focuses needs to be maintained, and thus funding should be allocated on a long-term basis to institutes with a proven record of success.

Background and purpose Population ageing in Taiwan is proceeding at an accelerating rate. The percentage of elderly is expected to increase from 9.7% in 2005 to 20% in 2025. As the population ages, more people will suffer from chronic conditions and will need more post-hospital care. Health policies need to adapt itself to meet the changing needs of society. The purposes of this study were to describe the use of post-hospital care among stroke patients in Taipei and to discuss policy implications. Methods This research used a longitudinal prospective study design, recruiting stroke patients from seven hospitals in the Taipei area. Patients were followed-up for 6 months after discharge with surveys at 1, 3, and 6 months. Information on their needs and uses of post-hospital care was collected. Results About 9% of patients were institutionalized at 1 month, and the percentage did not vary much throughout the 6 months of the study. Little movement occurred between institutions and homes within 6 months after discharge. Most patients relied on family members to provide assistance with activities of daily living. Little utilization of formal services occurred. The use of foreign care attendants was common, and it increased with time. Few unmet needs were observed for nursing care, while significant unmet needs were observed for rehabilitative services. Discussions Taiwan is not prepared to adequately meet the care demands of an ageing society. Continuing to support family members with additional home- or community-based services resources should be a policy priority. More efforts should be placed on educating family caregivers about the availability and benefits of community-based services during discharge planning. The use of foreign care attendants has become a mainstream practice. Regulations to protect the rights of foreign care attendants and to improve their quality of care need to be established.

Hospital readmissions contribute significantly to the cost of medical care, and may reflect unresolved problems at discharge or a lack of resources in post-hospital care. The purpose of this paper is to assess the effects of patient characteristics at discharge, the need for nursing care, discharge planning program, post-hospital care arrangements, and caregiver characteristics on readmissions of stroke patients. Patients discharged from neurological wards in seven hospitals in the Taipei area were recruited into the study. Surveys were conducted before their discharge, and at one month after discharge. Of the 489 patients included in the study, 24.3% were readmitted. After controlling for other variables, factors associated with readmissions were number of limitations in activities of daily living (ADL), first incidence of stroke, the need for wound nursing care, the adoption of a care plan, and the discharge locations. Contrary to expectation, age, length of stay, counseling before discharge, and caregiver burden were not associated with readmissions. The findings of this study indicate that ADL limitation is an effective predictor of readmissions. Increasing home nursing resources to meet the demand for wound nursing care may also be effective in reducing readmissions. Discharging patients into institutions for a short period of time may also prove to be more economically viable due to the reduction in readmissions.

Information on types of long-term care received by stroke patients after hospital discharge is essential for the formulation of long-term care resource development policy. Comparisons of outcomes resulting from different types of long-term care can provide important considerations in the selection of long- term care services. The purpose of this study is to describe the patterns of long-term care received, and to explore if associations exist between long-term care services and mortality status among stroke patients after hospital discharge. Using a longitudinal quasi-experimental study design, this study collected information on the type of long-term care received at 1, 3, and 6 months after discharge for 714 patients. At one month after discharge, 4.5 % had died, and 22.1 % had regained all functions in activities of daily living and instrumental activities of daily living. The percentage of patients receiving institutional care, home or community-based care, and family care only were 10.4 % , 22.4 % , and 40.7 % respectively. The respective percentages at 3 months after discharge were 11.2 % , 18.7 % , and 38.0 % , and, at 6 months after discharge, 10.3 % , 19.4 % , and 30.9 % . After adjusting for age, sex, previous incidence of stroke, and physical functions, the odds of dying within 6 months after discharge for stroke patients receiving home or community-based care was significantly lower than those in institutions ( OR = 0.39; 95 % CI = 0.15 to 0.97 ). It is not clear why a lower mortality rate was observed among patients receiving home or community-based services. Differences in quality of care and quality of life among users of different types of long-term care services should be investigated. More research is needed to assess the causes of the disparity in mortality rates among users of different types of long-term care services.

Objective The field of pain-related research has gained more attention as the prevalence of chronic pain increased over the years. The objective of this research was to identify highly cited papers, as well as contributors, to pain-related research. Design Pain-related articles published from 1900 to 2011 were screened, and highly cited papers, with at least 100 citations since publication, were identified and selected for a bibliometric analysis. The total number of papers, authorship, and collaboration statistics are presented for countries, institutions, and authors. To assess contributions, a new indicator, the major contributor index ( MCI ), was used. Citation trends for all papers, as well as for top papers, are presented. Results A total of 7,327 articles, 2.4% of all pain-related articles, had received at least 100 citations since publication. In recent decades, top-cited articles have reached a citation peak more quickly, and have shown a more-rapid decreasing trend, compared with top-cited articles from earlier decades. The leading countries were United States, UK, Canada, and Germany. The leading institutions were Harvard University, University of California, San Francisco, University of Texas, and University of Washington. MCI varied among leading institutions, as well as among individual authors. Conclusions An indicator like the MCI can provide a proxy for the contributions made by an individual or institution. It reflects the independent research ability and leadership. In future evaluations of institution or individual performances, the MCI should be included, together with the number of total papers, to provide a better profile of research performance.

Background Few studies have addressed how political and economic contexts shape the effects of health services and environment, such that a politically and economically unstable society, despite having sufficient health professionals and facilities, finds it difficult to transfer health resources into actual population health performance. We examined whether political and economic characteristics moderate the effects of health services on infant mortality rates (IMR) in less-developed countries. Methods This study used a longitudinal ecological study design and focused on 46 less-developed countries during the 30-year period from 1980 to 2009. Data were derived from World Development Indicators, the United Nations Commodity Trade Statistics Database and the Polity IV project. Lagged dependent variable panel regression models were used to increase the causal inferences. Random intercept models were used to accommodate the possible problem of a serial correlation of errors because of the repeated measurements. Results After controlling for baseline IMR and other socioeconomic variables, our study showed that democracy had a direct effect on IMR, and a moderating effect on the relationship between health services and IMR. The effects of health services on IMR were stronger for countries with a lower level of democracy than for countries with a higher level of democracy in the 10-year models. Compared with other trade-rated characteristics, democracy is a more robust predictor of long-term IMR in less-developed countries. Conclusions Our study provides additional evidence that democracy has direct effects on IMR and further showed that democracy can modify the effects of health services on IMR.

Background This longitudinal study builds on the cross-sectional work of Karim et al and examines the influence of welfare state regime on population health with a particular focus on East Asian welfare states (eg, Hong Kong, Japan, Korea, Singapore and Taiwan). Methods Data were extracted from the Organisation of Economic Co-operation and Development Data Set, World Development Indicators and Asian Development Bank9s key indicators from 1980 to 2006. Infant mortalities and life expectancy were used as health-outcome varables. Thirty-one countries were categorised into six types of welfare regimes: Scandinavian, Anglo-Saxon, Bismarckian, Southern, Eastern European and East Asian. Mixed models were applied to analyse the data with repeated measurements. Results In keeping with Karim et al , Scandinavian and Eastern European welfare states have lower and higher infant mortalities respectively compared with East Asian welfare states. Eastern European welfare states had a lower life expectancy than East Asian welfare states. Most welfare states had a higher social, health and education expenditure, and higher densities of physicians than East Asian welfare states. Conclusion East Asian welfare states did not have worse health than most welfare states. Future studies should continue to incorporate East Asian countries in the typology of welfare regimes that include more social, economic, political and healthcare system characteristic variables to provide insight on the mechanism by which welfare-state regimes influence population health.