Disability benefits as an incentive for hysterectomy: Uterine fibroid patients in Taiwan.

Worker compensation insurance in Taiwan ensures that a woman under the age of 45 years who has her uterus removed can receive disability compensation benefits. The present study investigated whether such a compensation policy was related to a woman's inclination to have a hysterectomy. We extracted the records of 16,030 women diagnosed with uterine fibroids (UF) between 2000 and 2010 from the Longitudinal Taiwan Health Insurance Database. Each younger and older age group had a significantly lower hysterectomy rate compared to that of the 44-year-old age group. Moreover, significantly more patients with lower monthly wages had had hysterectomies than those with higher monthly wages. Policy makers should be aware that worker compensation regulations in Taiwan might encourage women with economic need to undergo hysterectomy surgery when approaching the age of 45 years.

Incidence and Risk Factors for Stroke Among 14 European Countries.

Background This study compared the risk factors for and incidence of stroke among 14 European countries by using the Survey of Health, Aging, and Retirement in Europe (SHARE). Methods The analysis was based on data collected during 2006 to 2007 from Wave 2 of SHARE and panel data from respondents interviewed during 2004 to 2005. Results and Conclusion The highest stroke incidence rates were found in Denmark, Poland, and Sweden; these incidence rates were more than double that of Spain. Stroke was mostly associated with elderly people (age, ≥65 years) in Sweden, France, Switzerland, the Czech Republic, and Greece. In addition, stroke incidence was high among young males (age, <65 years) in Italy and elderly males in Germany and Switzerland. A negative association was found between stroke and vigorous exercise for younger people in Sweden and elderly people in Poland, whereas moderate exercise was significantly associated with stroke only for elderly Belgians, Greeks, and Irish.

Physical activity to overcome the adversity of widowhood: Benefits beyond physical health.

Widowhood has been increasingly encountered because of increasing longevity of women, often characterized by social stigmatization and poor physical and mental health. However, applied research to overcome its adversity has been quite limited. The goal of this study is to explore the role of physical activity in improving the health of widows.A cohort of 446,582 adults in Taiwan who successively participated in a comprehensive medical screening program starting in 1994, including 232,788 women, was followed up for mortality until 2008. Each individual provided detailed health history, and extensive lab tests results.The number of widows increased with time trend. Every other woman above age 65 was a widow (44%). Widows were less active, more obese, and smoked and drank more, had sleep problems, were more depressed with taking sedatives or psychoactive drugs, leading to more suicides. In the global development of health policies by World Health Organization (WHO), physical activity is one of the main factors to reverse poor health. The poor health of inactive widow was mitigated when becoming fully active in this study. Exercise not only reduced the observed 18% increase in all-cause mortality, but also gained 4 years and as much as 14% mortality advantage over the married but inactive. More importantly, becoming physically active energized their mental status, improved sleep quality and quantity, reduced depressions and the need for psychoactive drugs, and increased socialization circles.Widows, a rapidly growing and socially stigmatized group, suffered from social and financial inequality and tended to develop poorer health. Sustained physical activity could be one of the ways for them to overcome and reverse some of the physical and mental adversities of widowhood, and improve their quality and quantity of life.

The Role of Physical Activity in Harm Reduction among Betel Quid Chewers from a Prospective Cohort of 419,378 Individuals.

OBJECTIVE: To assess the benefits of regular exercise in reducing harms associated with betel quid (BQ) chewing. METHODS: The study cohort, 419,378 individuals, participated in a medical screening program between 1994 and 2008, with 38,324 male and 1,495 female chewers, who consumed 5-15 quids of BQ a day. Physical activity of each individual, based on "MET-hour/week", was classified as "inactive" or "active", where activity started from a daily 15 minutes/day or more of brisk walking (≥3.75 MET-hour/week). Hazard ratios for mortality and remaining years in life expectancy were calculated. RESULTS: Nearly one fifth (18.7%) of men, but only 0.7% of women were chewers. Chewers had a 10-fold increase in oral cancer risk; and a 2-3-fold increase in mortality from lung, esophagus and liver cancer, cardiovascular disease, and diabetes, with doubling of all-cause mortality. More than half of chewers were physically inactive (59%). Physical activity was beneficial for chewers, with a reduction of all-cause mortality by 19%. Inactive chewers had their lifespan shortened by 6.3 years, compared to non-chewers, but being active, chewers improved their health by gaining 2.5 years. The improvement, however, fell short of offsetting the harms from chewing. CONCLUSIONS: Chewers had serious health consequences, but being physically active, chewers could mitigate some of these adverse effects, and extend life expectancy by 2.5 years and reduce mortality by one fifth. Encouraging exercise, in addition to quitting chewing, remains the best advice for 1.5 million chewers in Taiwan.

Motivating patients to exercise: translating high blood pressure into equivalent risk of inactivity.

OBJECTIVE: Even with the 2008 physical activity guidelines for Americans and the strong epidemiological evidence, physicians are not routinely emphasizing the importance of exercise. We try to explore an innovative way to communicate the benefits of physical activity in a term familiar to patients. METHODS AND RESULTS: A cohort of 470, 163 adults from a medical screening program in Taiwan were recruited between 1994 and 2008. Their vital status was followed up by matching with the National Death File. Individuals were classified as 'inactive', 'low active', or 'fully active', with 'fully active' meeting the current exercise recommendation of 150  min per week or more. Cox proportional model was used to calculate the hazard ratio. More than one-half of the cohort was inactive (54%), with one-quarter fully active (24%). One in seven was hypertensive (14%), defined as SBP at least 140  mmHg. Among the hypertensive individuals, mortality risks were increased by 37% for the inactive. Inactive individuals had higher all-cause mortality than active ones across all blood pressure (BP) levels. At 110-119  mmHg, the inactive had a risk as high as the risk at 155  mmHg, an increased mortality risk equivalent to a risk of BP increase of 41.2 mmHg. CONCLUSION: The mortality risk of being inactive was equivalent to an increase of around 40  mmHg in SBP or 20  mmHg in DBP, a number relevant to hypertensive patients. Appreciating this relationship may convince the inactive to start exercising, a behavior as important as controlling BP.

The association between occupational characteristics and hysterectomies for treating uterine fibroids in Taiwan.

This study examined the relationship between the occupational characteristics of women with uterine fibroids (UFs) and the decision to have a hysterectomy. Data from the Longitudinal Taiwan Health Insurance Database (LTHID) from 2000 to 2009 were analyzed to investigate the association between occupation and hysterectomies. Multivariable logistic regression analysis showed that, compared with white-collar UF patients, the odds ratio (OR) for hysterectomy surgery was 1.21 (95% confidence interval (CI) = 1.11-1.32) for blue-collar UF patients. Moreover, non-government employees with UFs also had significantly increased odds of having a hysterectomy compared to government employees with UFs (OR = 1.19, 95% CI = 1.04-1.36). This study provides information regarding the extent to which differences in occupation and decision-making processes might affect the marked variations in the use of hysterectomies for UFs.

Prevention of losses for hog farmers in China: insurance, on-farm biosecurity practices, and vaccination.

Using agricultural household survey data and claim records from insurers in China, this paper analyzes hog producers' choice of the ways to prevent possible losses and identifies the relationships among biosecurity practices, vaccination, and hog insurance. By combining one probit and two structural equations, we adopt three-stage estimations by a mixed-process model to obtain results. The findings indicate that biosecurity practices provide the basic infrastructure for operating pig farms and complement both the usage of quality vaccines and the uptake of hog insurance. In addition, there is a strong substitution relationship between the quality of vaccine and the demand for hog insurance. Hog farmers that implement better biosecurity practices are more likely to seek high-quality vaccines or buy into hog insurance schemes, but not both. For those households with hog insurance, better biosecurity status, better management practices, and higher-quality vaccines significantly help to reduce loss ratios. However, we also find a moral hazard effect in that higher premium expenditures by the insured households might induce larger loss ratios.

Bundled automobile insurance coverage and accidents.

This paper investigates the characteristics of automobile accidents by taking into account two types of automobile insurance coverage: comprehensive vehicle physical damage insurance and voluntary third-party liability insurance. By using a unique data set in the Taiwanese automobile insurance market, we explore the bundled automobile insurance coverage and the occurrence of claims. It is shown that vehicle physical damage insurance is the major automobile coverage and affects the decision to purchase voluntary liability insurance coverage as a complement. Moreover, policyholders with high vehicle physical damage insurance coverage have a significantly higher probability of filing vehicle damage claims, and if they additionally purchase low voluntary liability insurance coverage, their accident claims probability is higher than those who purchase high voluntary liability insurance coverage. Our empirical results reveal that additional automobile insurance coverage information can capture more driver characteristics and driving behaviors to provide useful information for insurers' underwriting policies and to help analyze the occurrence of automobile accidents.

Determinants of psychogeriatric inpatient length of stay and direct medical costs: a 6-year longitudinal study using a national database in Taiwan.

AIMS: This research examined factors related to the average length of hospital stay (LOS) and average direct medical costs (DMC) for 2291 psychogeriatric inpatients (aged 65 and over) admitted for the first time to a psychiatric ward in 2002. METHODS: Hospitalization claim data of these inpatients were traced for the subsequent 6 years (2002-2007) from the dataset of Taiwan's National Health Insurance program. Analysis was carried out using the t-test, χ(2) -test and zero truncated Tobit regression. RESULTS: Mean LOS and mean DMC were significantly different according to sex, psychiatric diagnosis, institution type, ownership type, and number of hospitalizations, but age was the exception. Both LOS and DMC exhibited downward U-shape for the number of hospitalizations. Factors significantly associated with longer LOS and higher DMC were: male sex; schizophrenic and delusional disorders (compared with dementia); and public institution (compared with private hospital). Compared with dementia, organic mental and anxiety disorders had significantly shorter LOS, and affective disorders had shorter LOS but higher DMC. Community and psychiatric hospitals (compared with general hospital) significantly influenced LOS but not DMC. CONCLUSION: Our results can be used as a reference for providers and policymakers to improve psychiatric care efficiency and carry out National Health Insurance financial reform for psychogeriatric inpatients.

Comparative use of biomedicine and Chinese medicine in Taiwan: using the NHI Research Database.

OBJECTIVES: Users of Traditional Chinese Medicine (CM) and biomedicine (BM) are commonly assumed to belong to two different groups in most of the related literature. The purpose of this article is to compare the characteristics of those who use both CM and BM for the same illness (CBMS) with those who solely use BM (BMS). METHODS: Starting with a systematic sampling of 200,000 patients from a database of the Taiwan National Health Insurance program for the year 1999, the data were organized so that those who visited hospitals and clinics more than twice for the same illness were selected. In total, there were 96,872 (60%) BM users and 30,099 (19%) CBM users. The χ(2) test and mean test were applied to compare the differences in use between the above two subgroups. Logistic regression was used to calculate odds ratios of demographic variables and disease types. RESULTS: Compared to the group using BM for the same illness (BMS), there were more females in the group using both CM and BM for the same illness (CBMS) (p < 0.0001). Most of the subjects in the CBMS group were aged 25-49 years (p < 0.0001). The mean number of total visits was higher for CBMS (16.33) than for BMS (13.71) (p < 0.0001). For both groups, the mean number of visits for females was higher than for males (p < 0.0001). Furthermore, the mean cost per visit was significantly lower for CBMS (519.58 New Taiwan Dollar [NTD]) than for BMS (582.37 NTD). Among the top eight major disease categories of patients in the two subgroups, disease of the respiratory system was the most common primary indication in both CBMS and BMS. However, diseases of the musculoskeletal system and injury showed the highest incidences in CBMS when compared with BMS. CONCLUSIONS: Alternative medicinal treatment has become increasingly popular in recent years. Providing integrated CM and BM service in one medical facility might greatly benefit patients.

The influence of chronic disease, physical function, and lifestyle on health transition among the middle-aged and older persons in Taiwan.

The purpose of this study was to examine the influence of chronic disease, physical function, and lifestyle on health transitions among the middle-aged and older persons in Taiwan. A longitudinal design was applied to investigate whether chronic disease, physical function, and lifestyle were associated significantly with health transition in this population. Data on participants were obtained from the Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan, a study initially conducted in 1999 that encompassed observations on 2,130 individuals 53 years and older. Data were collected again in 2003 to capture the health transition. A binary probit model was used to determine relationships between health transition and sociodemographic factors, chronic disease, physical functional ability, and lifestyle conditions by gender. Principal empirical results confirmed that, after controlling for potentially confounding variables, those participants who were relatively younger and had higher education levels were more likely to maintain good health during the study period (1999-2003) for both men and women. In addition, when other factors were excluded, this article identified stroke as the ailment most strongly associated with continuing good health. Similarly, activities of daily living and instrumental activities of daily living demonstrated significant and negative effects on continuing good health regardless of gender. However, lifestyle rendered interesting and plausible findings. Smoking showed a significant influence on health transition for women but an insignificant influence on such for men. Regular exercise showed significance for both men and women. Findings suggest that chronic disease, physical functional ability, and lifestyle variables have strong and significant influences on health transition for the middle-aged and older persons. Research results should be useful in developing strategies that target disease care services and lifestyles for the target group.