Utilization of Western medicine and traditional chinese medicine services by physicians and their relatives: the role of training background.

Despite extensive efforts to improve the attitude and practice of physicians with respect to complementary and alternative medicine (CAM), the role of training background on physician's own utilization of mainstream Western medicine (WM) and CAM remains unclear. We aimed to compare personal utilizations of WM and traditional Chinese medicine (TCM) among doctors trained in WM only, TCM only or both. A retrospective population-based study was conducted using the 2004 Taiwan's National Health Insurance data. A total of 103 879 doctors and their relatives and 2 623 658 other adults with equivalent socioeconomic status were analyzed. Ambulatory care utilization of WM and TCM services was compared using the following three measures: probability of any use, number of visits and total annual expenditure. Doctors who were trained in Western medicine only (WMDs) had the highest WM use, followed by doctors who were trained in both (WMD-CMDs), while Chinese medicine-trained doctors (CMDs) had the lowest use. For TCM use, a reverse pattern was observed. Similar patterns were found among doctors' relatives. Compared with other adults with equivalent socioeconomic status, both the CMDs and WMD-CMDs had a greater use of TCM services. For WM, although the WMDs' probability and frequency of usage were similar to other adults, they incurred considerably higher expenditure. The use of WM and TCM by doctors and their relatives was significantly associated with the training background of the doctors. This highlights the importance of how increasing knowledge and understanding of other medical discipline may influence a practitioner's care-providing behaviors.

Do physicians and their relatives have a decreased rate of cesarean section? A 4-year population-based study in Taiwan.

BACKGROUND: The increased rate of cesarean deliveries may be partly due to a lack of consumer knowledge. Assuming that physicians and their relatives are well informed of the risks and benefits associated with the different methods of delivery, our goal was to compare cesarean rates between female physicians, female relatives of physicians, and women with high socioeconomic status in Taiwan. METHODS: Two subgroups of 588 female physicians and 5,021 relatives of physicians aged 20 to 50 years were compared with 93,737 pregnant women with a monthly wage 40,000 dollars New Taiwan (NT) dollars or more as identified in nationwide National Health Insurance databases of Taiwan from 2000 to 2003. RESULTS: Female physicians (adjusted odds ratio 0.66; 95% CI 0.47, 0.93) and female relatives of physicians (adjusted odds ratio 0.84; 95% CI 0.74, 0.95) were significantly less likely to undergo a cesarean section than other high socioeconomic status women, adjusted for clinical and nonclinical factors. CONCLUSIONS: In this study, the cesarean delivery rate was lower among women who may have greater access to medical knowledge. However, the lower rates observed among female physicians and physician relatives in Taiwan are still considerably higher than the national averages of many countries. This finding suggests that other than information, practice patterns, and social and cultural milieu may play a role.

Changes in causes of death and associated conditions among persons with HIV/AIDS after the introduction of highly active antiretroviral therapy in Taiwan.

To assess the pattern of change in the causes of death among HIV/AIDS patients in Taiwan after the introduction of highly active antiretroviral therapy (HAART), national HIV/AIDS registry data were linked with cause of death and health insurance claims data from 1994 to 2002 for analysis. Although HIV/AIDS remained the leading underlying cause of death among HIV/AIDS patients during the study period (552/752 = 73.4%), an increased proportion of deaths was due to non-HIV/AIDS causes (other infectious diseases, cancers, liver diseases, etc.) after the introduction of HAART in 1997. Deaths from suicide increased threefold, from three (1.5% of total) in 1994-1996 to 14 (4.8%) in 2000-2002. Most AIDS-related conditions associated with death (cryptococcosis, cachexia/wasting, dementia/encephalopathy, etc.) decreased in frequency from 1998-2000 to 2001-2002. Nonetheless, some AIDS-related conditions associated with death remained stable or increased in frequency, such as candidiasis, tuberculosis, and non-Hodgkin's lymphoma. In conclusion, as the duration of survival increased, the likelihood of suicide also increased. More effort is required to address the mental health of HIV/AIDS patients as a part of therapy.

Antibiotic prescribing for children with nasopharyngitis (common colds), upper respiratory infections, and bronchitis who have health-professional parents.

OBJECTIVE: Antibiotic resistance might be reduced if patients could be better informed regarding the lack of benefits of antibiotics for children with viral infections and avoid antibiotic prescriptions in these circumstances. This study investigated whether children having health professionals as parents, a group whose parents are expected to have more medical knowledge and expertise, are less likely than other children to receive antibiotics for nasopharyngitis (common colds), upper respiratory tract infections (URIs), and acute bronchitis. METHODS: Retrospective analyses were conducted by using National Health Insurance data for children of physicians, nurses, pharmacists, and non-health personnel, who had visited hospital outpatient departments or physician clinics for common colds, URIs, and acute bronchitis in Taiwan in 2000. A total of 53733 episodes of care for common colds, URIs, and acute bronchitis in a nationally representative sample of children (aged < or =18 years) living in nonremote areas were analyzed. RESULTS: The study found that, after adjusting for characteristics of the children (demographic, socioeconomic, and health status) and the treating physicians (demographic, practice style, and setting), children with a physician (odds ratio [OR]: 0.50; 95% confidence interval [CI]: 0.36-0.68) or a pharmacist (OR: 0.69; 95% CI: 0.52-0.91) as a parent were significantly less likely than other children to receive antibiotic prescriptions. The likelihood of receiving an antibiotic for the children of nurses (OR: 0.91; 95% CI: 0.77-1.09) was similar to that for children in the comparison group. CONCLUSIONS: This finding supports our hypothesis that better parental education does help to reduce the frequency of injudicious antibiotic prescribing. Medical knowledge alone, however, may not fully reduce the overuse of antibiotics. Physician-parents, the expected medically savvy parents, can serve as a benchmark for the improvement potentially achievable in Taiwan through a combination of educational, regulatory, communication, and policy efforts targeted at more appropriate antibiotic prescribing in ambulatory settings.

Who is at risk of death in an earthquake?

Although, theoretically, the impacts of a disaster are not randomly distributed across health and socioeconomic classes, empirical evidence of this claim is scarce. In a population-based cohort study, the authors identified risk factors for mortality from the September 21, 1999, Taiwan earthquake, which occurred in the middle of the night. Among 297,047 earthquake victims in central Taiwan who experienced partial or complete dwelling damage, 295,437 (noncases) survived the earthquake and 1,610 (cases) died between September 21 and October 31, 1999. Odds ratios were adjusted for both micro-level individual variables and macro-level neighborhood variables. People with mental disorders (odds ratio (OR) = 2.0, 95% confidence interval (CI): 1.1, 3.5), people with moderate physical disabilities (OR = 1.7, 95% CI: 1.2, 2.3), and people who had been hospitalized just prior to the earthquake (OR = 1.4, 95% CI: 1.2, 1.7) were the most vulnerable. The degree of vulnerability increased with decreasing monthly wage (measured in New Taiwanese dollars (NT$)) (NT$20,000 approximately NT$39,999: OR = 1.5, 95% CI: 1.1, 2.1;

Suicides after the 1999 Taiwan earthquake.

BACKGROUND: The impact of a disaster on extreme post-traumatic responses of the victims, such as suicide, remains unclear. We conducted this study to investigate the risk of committing suicide between victims and non-victims after the 1999 Taiwan earthquake. METHODS: This population cohort study linked the National Health Insurance files, family registration, and death certificates. It consists of the 3 432 705 residents aged >/=15 years of central Taiwan, 1998-2000. They were stratified into victims (n = 301 327) and non-victims (n = 3 131 378). Victims refer to those who lost co-resident family members, were injured, or experienced property loss during the earthquake. Non-victims refers to all others. The suicide rate was calculated for the period 2-15 months after the earthquake. Adjusted odds ratios were estimated with logistic regression. RESULTS: After adjusting for residential location, age, gender, major disease status, and level of urbanization, we found that victims were 1.46 times more likely than non-victims to commit suicide following an earthquake (95% CI: 1.11, 1.92). CONCLUSIONS: Given the large study population and individual information available to identify victim status, this study was able to detect a statistically significant earthquake effect on suicide rate. This effect on suicide might be diluted if only geographically based stratification were possible, as opposed to victim status stratifications. Mental health programmes or other preventive strategies might be more effective by specifically targeting victims rather than by simply targeting individuals living in earthquake-affected areas.