Developing and Validating Risk Scores for Predicting Major Cardiovascular Events Using Population Surveys Linked with Electronic Health Insurance Records.

A risk prediction model for major cardiovascular events was developed using population survey data linked to National Health Insurance (NHI) claim data and the death registry. Another set of population survey data were used to validate the model. The model was built using the Nutrition and Health Survey in Taiwan (NAHSIT) collected from 1993-1996 and linked with 10 years of events from NHI data. Major adverse cardiovascular events (MACEs) were identified based on hospital admission or death from coronary heart disease or stroke. The Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwSHHH), conducted in 2002 was used for external validation. The NAHSIT data consisted of 1658 men and 1652 women aged 35-70 years. The incidence rates for MACE per 1000 person-years were 13.77 for men and 7.76 for women. These incidence rates for the TwSHHH were 7.27 for men and 3.58 for women. The model had reasonable discrimination (C-indexes: 0.76 for men; 0.75 for women), thus can be used to predict MACE risks in the general population. NHI data can be used to identify disease statuses if the definition and algorithm are clearly defined. Precise preventive health services in Taiwan can be based on this model.

A population study on the time trend of cigarette smoking, cessation, and exposure to secondhand smoking from 2001 to 2013 in Taiwan.

BACKGROUND: In 2001, the National Health Interview Survey (NHIS) commenced in Taiwan. This survey, conducted on a sample of the whole Taiwanese population, is nationally representative and has a high response rate (>80 %). As a result, the four already completed surveys from 2001 to 2013 can be used to investigate the time trend of smoking prevalence, the rate of cessation, and exposure to secondhand smoking. METHODS: There were 72918 adults combined from the 2001, 2005, 2009 and 2013 National Health Interview Surveys (NHIS). Smoking status, exposure to secondhand smoking, and smoking cessation were asked, as well as demographic characteristics and other variables. Statistical analyses with sampling weights were carried out using SAS and SUDAAN. RESULTS: In males, the prevalence of smoking significantly decreased (rates in 4 surveys were 44.4 %, 44.6 %, 38.9 %, and 34.2 %, respectively). Since 2005 the rate of smoking cessation increased significantly (p = 0.033). The odd ratio (OR) exposure of secondhand among non-smokes (OR) in 2009 and 2013 were 0.96 (CI = 0.85-1.08) and 0.78 (CI = 0.70-0.88) comparing to 2005. In females, the prevalence of smoking was stable over time. The rate of smoking cessation only appeared significantly high in the older age group. The OR for exposure to secondhand smoking were 0.81 (CI = 0.74-0.89) and 0.68 (CI = 0.62-0.74), for 2009 and 2013 comparing to 2005, respectively. CONCLUSION: Early anti-smoking legislation in Taiwan might have raised the awareness of the harm of smoking. However, the implementation of the Tobacco Hazards Prevention Act (THPA) in 2009 had great contribution to the reduction of smoking rate, especially in males.

Evaluation of the effects of various gas chromatographic parameters on haloacetic acids disinfection by-products analysis.

Thermal decomposition of the analytes during the analysis is a problem for haloacetic acids (HAAs). We evaluated the effect of GC injection port temperature and the amount of trace water in the sample on the HAAs' analysis. For three brominated HAAs, the variation in intensity due to the change of injection port temperature was significant. The largest variation observed was tribromoacetic acid methyl ester (from 3.2 to 1 for injection port temperature changing from 170 degrees C to 250 degrees C). Tribromoacetic acid methyl ester partially decomposed to dibromoacetic acid and to tribromomethane in a competitive way. At a low injection port temperature, tribromomethane formation was preferred, but at a high injection port temperature, the debrominated methyl ester formation dominated. Water contained in the sample may accelerate the hydrolysis process of the esters in the injection port, and this effect was also the greatest for the brominated trihaloacetic acids. Direct injection of underivatized HAAs into the GC/MS indicated that brominated HAAs can be nearly quantitatively thermal decomposed to the corresponding halomethanes.