Health Behaviors and Health Status among Middle-Aged and Older Adults with Chronic Diseases in Taiwan.

Changes in lifestyle behaviors may effectively maintain or improve the health status of individuals with chronic diseases. However, such health behaviors adopted by individuals are unlikely to demonstrate similar patterns. This study analyzed the relationship between the heterogeneous latent classes of health behavior and health statuses among middle-aged and older adults with hypertension, diabetes, or hyperlipidemia in Taiwan. After selecting 2103 individuals from the 2005 and 2009 Taiwan National Health Interview Survey (NHIS), we first identified heterogeneous groups of health behaviors through latent class analysis (LCA). We further explored the relationship between each latent class of health behavior and health status through ordered logit regression. We identified the following five distinct health behavior classes: the all-controlled, exercise and relaxation, healthy diet and reduced smoking or drinking, healthy diet, and least-controlled classes. Regression results indicated that individuals in classes other than the all-controlled class all reported poor health statuses. We also found great magnitude of the coefficient estimates for individuals who reported their health status to be poor or very poor for the least-controlled class. Therefore, health authorities and medical providers may develop targeted policies and interventions that address multiple modifiable health behaviors in each distinct latent class of health behavior.

miR-34a-5p Increases Hepatic Triglycerides and Total Cholesterol Levels by Regulating ACSL1 Protein Expression in Laying Hens.

Accumulating evidence has shown that miR-34a serves as a posttranscriptional regulatory molecule of lipid metabolism in mammals. However, little studies about miR-34a on lipid metabolism in poultry have been reported until now. To gain insight into the biological functions and action mechanisms of miR-34a on hepatic lipid metabolism in poultry, we firstly investigated the expression pattern of miR-34a-5p, a member of miR-34a family, in liver of chicken, and determined its function in hepatocyte lipid metabolism by miR-34a-5p overexpression and inhibition, respectively. We then validated the interaction between miR-34a-5p and its target using dual-luciferase reporter assay, and explored the action mechanism of miR-34a-5p on its target by qPCR and Western blotting. Additionally, we looked into the function of the target gene on hepatocyte lipid metabolism by gain- and loss-of-function experiments. Our results indicated that miR-34a-5p showed a significantly higher expression level in livers in peak-laying hens than that in pre-laying hens. miR-34a-5p could increase the intracellular levels of triglycerides and total cholesterol in hepatocyte. Furthermore, miR-34a-5p functioned by inhibiting the translation of its target gene, long-chain acyl-CoA synthetase 1 (ACSL1), which negatively regulates hepatocyte lipid content. In conclusion, miR-34a-5p could increase intracellular lipid content by reducing the protein level, without influencing mRNA stability of the ACSL1 gene in chickens.

Investigating unmet health care needs under the National Health Insurance program in Taiwan: A latent class analysis.

OBJECTIVES: In Taiwan, although the implementation of the National Health Insurance (NHI) program reduced financial barriers and enhanced accessibility for individuals to utilize health care services, an unequal distribution of medical care resources still exists. This paper is focusing on analyzing factors that are associated with unmet health care needs among the middle-aged and elderly under the NHI in Taiwan. METHODS: Statistical analysis from the 2007 Survey of Health and Living Status of the Elderly in Taiwan. We firstly adopted latent class analysis to classify individuals' observable reasons for feeling unwell but not seeing a doctor within the last 3 months into three latent perceived barriers classes. We further used a multinomial probit regression model to analyze factors that are associated with each perceived barrier class to the access of health care service. RESULTS: Results indicate relative to the "relatively no barriers" class, individuals with a high level of educational attainment tend to more likely to be in the "accommodation barriers" class, and individuals live in the most developed areas with the densest medical facilities tend to less likely to be in the "accessibility barriers" class. CONCLUSIONS: We identified possible risk factors for each perceived barrier, which could provide important insights for health authorities and medical providers when targeting policies and interventions to efficiently assist people in need.

The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan.

The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals' utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program.

Obesity risk class and asthma outpatient service utilization by the middle aged and elderly in Taiwan.

BACKGROUND: According to the estimates of the World Health Organization (WHO), there were about 300 million people in the world suffering from asthma in 2005. Among the risk factors of asthma is obesity, which was found to be significantly associated with asthma in recent decades. OBJECTIVES: In this study, we analyze the relationship between obesity risk class and asthma outpatient service utilization by the middle-aged and elderly in Taiwan. METHODS: Adopting data from the 2005 Nation Health Interview Survey (NHIS) and National Health Insurance Research Database (NHIRD), we first utilize latent class analysis (LCA) to identify obesity risk classes. Next, we utilize a logit and a negative binominal model to analyze the relationship between each obesity risk class and asthma outpatient service utilization. RESULTS: Results indicate that compared with the "overweight/obese with low consumption of vegetable/fruit and little exercise" class, the classes "normal-weight with high consumption of vegetable/fruit and moderate exercise" and "overweight/obese with high consumption of vegetable/fruit and moderate exercise" tend to have low probabilities and less number of visits of utilizing asthma outpatient services. CONCLUSIONS: Our results may constitute useful references for clinicians and government policy makers formulating strategies for asthma management and prevention. Better informed strategies for asthma management could, in turn, increase the efficiency of asthmatic patients' care, which could provide efficient assistance to the target group based on the obesity risk classes.

The heterogeneous health latent classes of elderly people and their socio-demographic characteristics in Taiwan.

The health care needs of elderly people were influenced by their heterogeneity. This study aimed to identify the health latent classes of elderly people by using latent class analysis to deal with heterogeneity and examine their socio-demographic characteristics. Data came from the 2005 National Health Interview Survey (NHIS) in Taiwan. In total, 2449 elderly individuals with available health indicators were examined in latent class analysis (LCA), and 2217 elderly community-dwellings with complete socio-demographic data were analyzed by multinomial logistic regression. Four health latent classes were identified which included 1066 (43.5%) people in the High Comorbidity (HC), 152 (6.2%) in the Functional Impairment (FI), 252 (10.3%) in the Frail (FR), and 979 (40.0%) in the Relatively Healthy (RH) group. Multinomial logistic regressions revealed socio-demographic characteristics among health classes. The variables associated with an increased likelihood of being in the FR group were age, female, and living with families. They were also correlated to ethnicity and educations. Apart from age and gender, the Functional Impairment group was less likely to be ethnicity of Hakka, more likely to live with others than were the RH group. The HC group tended to be younger, with higher educations, and more likely to live in urban area than the Functional Impairment group. The correlations between health classes and socio-demographic factors were discussed. The health status of elderly people includes a variety of health indicators. A person-centered approach is critical to identify the health heterogeneity of elderly people and manage their care needs by targeting differential aging.

[Characteristic and effect of cadmium on ATP-activated currents mediated by P2X4 receptors].

OBJECTIVE: To investigate the characteristic and effect of cadmium on ATP-activated currents (I(ATP)) mediated by P2X4 purinoceptors. METHODS: Transcribe cDNA coding for the rat P2X4 receptor to cRNA in vitro. Inject the cRNA to oocytes of an xenopus laevis using the microinjection technique. Reveal the effect of cadmium on I(ATP) mediated by P2X4 receptor using the two-electrode whole-cell voltage clamp technique. RESULTS: (1) Within a certain concentration range, cadmium was found to reversibly magnify I(ATP) mediated by P2X4 receptors expressed in oocytes of an xenopus. When the concentration of cadmium reached 30 micromol/L, the increase of I(ATP) was the most significant. I(ATP) turned to decrease when the concentration of cadmium was more than 30 micromol/L; (2) The concentration-response curve was shifted to left by applying cadmium at 10 micromol/L; the EC50 was reduced from (17.1 +/- 1.5) micromol/L to (9.8 +/- 1.8) micromol/L (n = 6, P < 0.01) and the Hill coefficient was increased from 1.14 +/- 0.13 to 1.57 +/- 0.36; (3) The effect of cadmium on I(ATP) showed no dependence on membrane voltage; (4) The magnifying effect on I(ATP) reached maximum when preincubating cadmium for 120 seconds. CONCLUSION: The increase I(ATP) by cadmium is reversible, concentration-dependent, time-dependent, and voltage-independent. One reason of this augment effect could be the allosteric modulation on P2X4 receptors.

The relationship between depressive symptoms and health service utilization for elderly people in Taiwan.

OBJECTIVE: This study analyzes the relationship between depressive symptoms and the utilization of medical services for elderly people in Taiwan. METHODS: Because depressive symptoms and physical health may have a reciprocal relationship, a simultaneous equations model was used by performing a 3-stage least squares (3SLS) regression. The data in this study were obtained from the 2003 Survey of Health and Living Status of the Elderly in Taiwan (SHLSE). RESULTS: The findings show that depressive symptoms have a significantly negative effect on the utilization of outpatient, inpatient, and emergency services. Furthermore, the magnitude of the 3SLS estimates of physical health status in relation to health service utilization is substantially greater than that in the OLS estimates. The results may reveal that people with depressive symptoms may seek healthcare services because of physical discomfort. CONCLUSIONS: Those with depressive symptoms may not seek specialty mental treatments, suggesting that policy interventions to monitor the need to care for elderly people with depressive symptoms through primary care services are important in screening and maintaining the mental health of elderly people.

Utilization of health care services by elderly people with National Health Insurance in Taiwan: the heterogeneous health profile approach.

OBJECTIVES: Taiwan is now facing an increased prevalence of aging related diseases and escalating healthcare costs. Within the context of the health care system and NHI in Taiwan, the aim of this study was to examine the health profiles of elderly people by using Latent Class Analysis to determine the effects of different health profiles on the health care services utilization and expenditures, and to examine the factors associated with by controlling for the health profiles of elderly people. METHODS: Data came from the 2005 National Health Interview Survey in Taiwan. Among those who were interviewed, 2449 elderly individuals with available health indicators were identified, and 1491 of these had complete socio-economic data and linkage to their utilization of health care services from 2004 to 2007 were analyzed. RESULTS: Four health profiles were identified. The effect of the different health profiles of elderly people on the likelihood of utilization and expenditure on health care services was significant. While comparing with Relative Healthy group, the High Comorbidity group tended to utilize more services in the ambulatory care. The functional impairment group had relatively high probabilities of needing care assistance and the Frail group had higher health care expenditures. Age and gender did not have a significant effect and other associated socio-economic factors were also discussed. CONCLUSIONS: The health status of elderly people includes a variety of health indicators. We suggest that a person-centered approach is needed in order to satisfy needs and forecast expenditures in the future.

Association of STAT4 rs7574865 polymorphism with autoimmune diseases: a meta-analysis.

The association between the signal transducer and activator of transcription 4 (STAT4) gene rs7574865 single nucleotide polymorphism and different autoimmune diseases remains controversial and ambiguous. We conducted this study to investigate whether combined evidence shows the association between STAT4 rs7574865 polymorphism and autoimmune diseases. Comprehensive Medline search and review of the references were used to get the relevant reports published before September 2011. Meta-analysis was conducted for genotype T/T (recessive effect), T/T + G/T (dominant effect) and T allele in random effects models. 40 studies with 90 comparisons including 32 systemic lupus erythematosus (SLE), 19 rheumatoid arthritis (RA), 3 type 1 diabetes (T1D), 11 Systemeric Sclerosis (SSc), 4 inflammatory bowed diseases (IBD), 3 Primary Sjogren's syndrome (pSS), 4 juvenile idiopathic arthritis (JIA), 2 Primary antiphospholipid syndrome (APS), 1 Autoimmune thyroid diseases, 1 multiple sclerosis, 1 Psoriasis, 1 Wegener's granulomatosis, 1 Type 2 diabetes, and 1 giant cell arteritis disease were available for this meta-analysis. The overall odds ratios for rs7574865 T-allele significantly increased in SLE, RA, T1D, SSc, JIA, and APS (OR = 1.56, 1.25, 1.13, 1.34, 1.25, and 2.15, respectively, P < 0.00001) and in IBD-UC and pSS (OR = 1.11 and 1.33, respectively, P < 0.05). This meta-analysis demonstrates that the STAT4 rs7574865 T allele confers susceptibility to SLE, RA, T1D, SSc, JIA, APS, IBD-UC, and pSS patients, supporting the hypothesis of association between STAT4 gene polymorphism and subgroup of autoimmune diseases.

Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan.

OBJECTIVES: This study aims to investigate the relationship between the level of urbanization and the utilization of outpatient services under the National Health Insurance (NHI) program in Taiwan. METHODS: We adopted a two-part model using data from the 2001 National Health Interview Survey (NHIS) and the 2001 National Health Insurance Research Database (NHIRD) in Taiwan. Data for a total of 20,640 individuals were obtained for subsequent analysis in this study. RESULTS: The results of the first part, the contact analysis, indicate that individuals residing in areas with lower urbanization levels are less likely to use outpatient services compared to those residing in areas with the highest urbanization levels. The second part of the frequency analysis revealed that, for those individuals that had previously utilized outpatient services, those residing in areas with lower urbanization levels tended to utilize outpatient services less than individuals residing in areas with higher levels of urbanization. CONCLUSIONS: Our empirical results show that differences between urbanization levels are a major contributory factor associated with the probability and frequency of outpatient utilization in Taiwan.

The demand for preventive care services and its relationship with inpatient services.

OBJECTIVE: To examine not only the relationship between the utilization of preventive health care services and inpatient services, but to also investigate the factors affecting the utilization of such services by the middle-aged and elderly. METHOD: We use data obtained from the 2003 Survey of Health and Living Status of the Elderly in Taiwan (SHLSE), hypothesizing that preventive health care services can be regarded as an appropriate substitute for subsequent medical services such as inpatient services; a recursive simultaneous model is used to avoid the problems of endogeneity. RESULTS: The main results of this study indicate that the utilization of preventive health care services has the effect of reducing the probability of the utilization of inpatient services. CONCLUSION: The utilization of preventive care services can help to promote healthier lifestyles, provide early detection of illnesses, and reduce the need for subsequent inpatient care services amongst individuals. We suggest that effective outreach strategies to promote the utilization of preventive care services are essential.

The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use.

OBJECTIVE: To test whether utilization of infant preventive care services has reduced utilization of inpatient care and to determine whether implementation of Taiwan's National Health Insurance (NHI) has brought about any differences in the utilization of infant health care services. DATA SOURCES: Data were taken from the 1989 and 1996 National Maternal and Infant Health Surveys (NMIHSs). In total, 1662 and 3623 effective samples were used in the study from the 2 years. STUDY DESIGN: We constructed a simultaneous recursive model to obtain efficient estimates by treating preventive care (neonatal care and well-baby care) and inpatient care (hospitalization admissions) as dependent variables. PRINCIPAL FINDINGS: Utilization of neonatal care had strongly negative significant coefficients for the likelihood of being admitted to the hospital. The impact of the NHI was found to be significant. CONCLUSIONS: The hypothesis that the NHI interferes with the effectiveness of preventive care at reducing inpatient care use was not reinforced. Since support from the NHI depends on a balance of push and pull between access to inpatient care and the benefits of preventive care, it can further improve infant health by promoting the benefits of preventive care while making both types of care more accessible.

The association between readmission rates and length of stay for schizophrenia: a 3-year population-based study.

OBJECTIVE: A nationwide population-based dataset was used to explore the association between length of stay (LOS) and 30-day readmission rates for hospitalized patients with schizophrenia in Taiwan. METHODS: The National Health Insurance Research Database was used for the years 2001-2003 and included a total of 29,373 patients with schizophrenia divided equally into four groups according to LOS of index hospitalization. After adjusting for hospital, physician and patient characteristics, a multivariate regression analysis was used to determine the relationship between LOS and 30-day readmission rates. RESULTS: After discharge from their index hospitalization, 12,468 (42.5%) patients with schizophrenia were readmitted within 30 days. The adjusted odds ratio for 30-day readmission rates was increased for shorter LOS. CONCLUSIONS: Healthcare providers should exert caution while trying to reduce LOS within the current cost-conscious environment and balance it with creating a minimal status necessary for discharge.

Reduced infiltration of class A scavenger receptor positive antigen-presenting cells is associated with prostate cancer progression.

The class A macrophage scavenger receptor (SR-A) is expressed in antigen presenting cells and is involved in host immune responses. Germ-line mutation of this gene has been associated with increased risk of human prostate cancer. However, there is little known about its expression in normal or neoplastic human prostate tissues. Double immunofluorescent labeling with monoclonal antibodies to SR-A and specific macrophage and dendritic cell markers was used to identify cells expressing SR-A in human prostate tissues. SR-A immunohistochemical staining was performed on paraffin sections of normal prostate, prostatic intraepithelial neoplasia (PIN) lesions, and prostate cancers from radical prostatectomy specimens. SR-A was expressed in a subset of macrophages and dendritic cells that infiltrated prostatic tissues. The majority of SR-A-positive cells coexpressed CD68, and a relatively low percentage expressed S100 protein. The number of SR-A-positive cells was significantly increased in PIN as compared with normal prostatic tissue (P = 0.0176). In contrast, the number of SR-A-positive cells decreased with tumor progression. A lower SR-A-positive cell density was associated with higher clinical stage (rho = -0.26; P = 0.0234). Inverse associations were also found between SR-A density and positive lymph nodes (rho = -0.23; P = 0.0437), tumor size (rho = -0.31; P = 0.0100) and preoperative PSA levels (rho = -0.32; P = 0.0057). SR-A density is a significant predictor of disease-free survival after surgery univariately (P = 0.0003), as well as multivariately, adjusted for known clinical and pathological markers including preoperative prostate-specific antigen, clinical stage, Gleason score, surgical margin, extraprostatic extension, and seminal vesicle invasion, as well as lymph node metastasis (P = 0.0021). The preferential accumulation of SR-A-positive cells in PIN suggests a role for SR-A in the APC response to early malignancy. A reduction in the number of SR-A-positive cells demarcates tumor progression as indicated by clinical and pathological correlations. Our results additionally indicate that systematic measurement of SR-A density is a strong prognostic marker for clinical outcome after surgery.

[Preliminary report of semimonthly 5-fluorouracil/leucovorin combined with paclitaxel in treatment of advanced gastric cancer (AGC)].

BACKGROUND & OBJECTIVE: Phase II clinical trails showed that paclitaxel is effective in treatment of advanced gastric cancer (AGC). The combination of paclitaxel and 5-fluorouracil (5-FU) in the treatment of advanced gastric cancer is effective and safe. This study was designed to evaluate the efficacy and the toxicity of paclitaxel combined with semimonthly 5-FU/Leucovorin for the AGC patients. METHODS: Twenty-five measurable patients with AGC proved pathologically were enrolled into this study. The chemotherapy regimen was comprised of paclitaxel,75 mg/m(2) i.v. in a 3-hour infusion followed by 2-hour infusion of leucovorin 200 mg/m(2), then 10-minute intravenous bolus of 5-FU 375 mg/m(2), then 48-hour infusion of 5-FU 2.8 g/m(2) using an ambulatory pump. The regimen was given per 14 days. One cycle consisted of twice chemotherapy regimens. All enrolled patients received at least two cycles of treatment. RESULTS: After two cycles of chemotherapy, the complete remission and the partial remission were 8% and 60%, respectively. The median duration of response was 4 months. No treatment-related death occurred. Phlebitis,feeling disorder, and alopecia were main side effects. CONCLUSION: Semimonthly 5-FU/LV combined with paclitaxel has high release rate but comparatively mild toxicity for AGC patients.

[Expression and clinical significance of mdr-1 gene in lymphoma].

BACKGROUND & OBJECTIVE: It is still unclear whether overexpression of mdr-1 gene play a role in the chemotherapy resistance of lymphoma. This study was designed to investigate P-glycoprotein(P-gp) and mdr-1 mRNA levels of lymphoma and to observed the impact of P-gp level upon chemotherapy response. METHODS: Ten samples of relapsed lymphoma and 21 samples of untreated lymphoma were assessed by flow cytometry(FCM). The mdr-1 mRNA levels were determined by real-time reverse-transcription PCR assay simultaneously in eighteen samples. The impact of P-gp levels upon chemotherapy response was observed in seventeen patients. RESULTS: Nineteen Percent (4/21) patients overexpressed P-gp at diagnosis as compared to 60%(6/10) in relapse(P = 0.012). The copy numbers of mdr-1 mRNA were 4 x 10(2)-1.32 x 10(4) copies/microgram RNA in untreated group and 4 x 10(2)-4 x 10(4) copies/microgram RNA in recurrent group. There existed significant difference in the distribution of mdr-1 mRNA expression between these two groups, P < 0.05. The complete response rates were 46% (6/13) in P-gp non-overexpression group and 25% (1/4) in P-gp overexpression group(P = 0.60). CONCLUSION: Relapsed lymphomas highly express P-gp and mdr-1 mRNA. The overexpression of mdr-1 gene may play a role in the multidrug resistance of relapsed lymphoma.