Paddlewheel SBU based Zn MOFs: Syntheses, Structural Diversity, and CO2 Adsorption Properties.

Four Zn metal⁻organic frameworks (MOFs), {[Zn2(2,6-ndc)2(2-Pn)]·DMF}n (1), {[Zn2(cca)2(2-Pn)]·DMF}n (2), {[Zn2(thdc)2(2-Pn)]·3DMF}n (3), and {[Zn2(1,4-ndc)2(2-Pn)]·1.5DMF}n (4), were synthesized from zinc nitrate and N,N'-bis(pyridin-2-yl)benzene-1,4-diamine (2-Pn) with naphthalene-2,6-dicarboxylic acid (2,6-H2ndc), 4-carboxycinnamic acid (H2cca), 2,5-thiophenedicarboxylic acid (H2thdc), and naphthalene-1,4-dicarboxylic acid (1,4-H2ndc), respectively. MOFs 1⁻4 were all constructed from similar dinuclear paddlewheel {Zn2(COO)4} clusters and resulted in the formation of three kinds of uninodal 6-connected non-interpenetrated frameworks. MOFs 1 and 2 suit a topologic 48·67-net with 17.6% and 16.8% extra-framework voids, respectively, 3 adopts a pillared-layer open framework of 48·66·8-topology with sufficient free voids of 39.9%, and 4 features a pcu-type pillared-layer framework of 412·6³-topology with sufficient free voids of 30.9%. CO2 sorption studies exhibited typical reversible type I isotherms with CO2 uptakes of 55.1, 84.6, and 64.3 cm³ g-1 at 195 K and P/P0 =1 for the activated materials 1', 2', and 4', respectively. The coverage-dependent isosteric heat of CO2 adsorption (Qst) gave commonly decreased Qst traces with increasing CO2 uptake for all the three materials and showed an adsorption enthalpy of 32.5 kJ mol-1 for 1', 38.3 kJ mol-1 for 2', and 23.5 kJ mol-1 for 4' at zero coverage.

Design of a Peripheral Building Block for H-Bonded Dendritic Frameworks and Analysis of the Void Space in the Bulk Dendrimers.

Three dendrimers, (t-Bu-G 2 N) 2 , CC(t-Bu-G 1 N) 3 and (t-Bu-G 1 N) 2 , with 3,5-di-tert-butyl amidobenzene as a common peripheral moiety were prepared in 64-83% yields and characterized. The bulk solids had high BET surface areas of 136-138 m2/g, which were similar for the three dendrimers in spite of their different molecular weight (ranging from 1791 to 2890). It was concluded that the peripheral amide groups do not imbed in the interstitial space of neighbouring dendrimer molecules but rather build a supramolecular architecture through strong intermolecular H-bonds. This mode of assembly generates voids in the bulk dendrimers responsible for sorption properties. The X-ray crystal structure analysis of a compound representing the peripheral moiety of the dendrimers and the FT-IR and powder-XRD data for (t-Bu-G 1 N) 2 suggest the proposed supramolecular structure. The isosteric heats of CO2 sorption (Q st) for (t-Bu-G 2 N) 2 were significantly higher than those for the other two dendrimers, which is consistent with the formation of a different type of voids within the interstitial space of the molecule. It is suggested that the interstitial void space can be designed and tuned to adjust its properties to a particular task, such as the separation of gases or a catalytic reaction facilitated by the dendrimer.

Structural characteristics and non-linear optical behaviour of a 2-hydroxynicotinate-containing zinc-based metal-organic framework.

Materials with non-linear optical (NLO) properties play an important role in the construction of electronic devices for optical communications, optical data processing and data storage. With this aim in mind, a Zn(II)-based metal-organic framework {[Zn2(nica)2(bpy)1.5(H2O)]×0.5(bpy)×3H2O}n (1), was synthesized using 4,4'-bipyridine (bpy) and a potentially bidentate ligand, 2-hydroxynicotinic acid (H2nica) with a salicylate binding moiety. A single-crystal X-ray diffraction analysis revealed that compound 1 crystallized in the orthorhombic space group Fdd2 and was composed of a three dimensional porous framework. Since Fdd2 belonged to a class of non-centrosymmetric space groups, we therefore investigated the non-linear optical behaviour of compound 1. Photoluminescence studies revealed that compound 1 exhibited a blue light emission with a maxima at 457 nm.

Metal-organic frameworks for electronics: emerging second order nonlinear optical and dielectric materials.

Metal-organic frameworks (MOFs) have been intensively studied over the past decade because they represent a new category of hybrid inorganic-organic materials with extensive surface areas, ultrahigh porosity, along with the extraordinary tailorability of structure, shape and dimensions. In this highlight, we summarize the current state of MOF research and report on structure-property relationships for nonlinear optical (NLO) and dielectric applications. We focus on the design principles and structural elements needed to develop potential NLO and low dielectric (low-κ) MOFs with an emphasis on enhancing material performance. In addition, we highlight experimental evidence for the design of devices for low-dielectric applications. These results motivate us to develop better low-dielectric and NLO materials and to perform in-depth studies related to deposition techniques, patterning and the mechanical performance of these materials in the future.

Preparation of unconventional dendrimers that contain rigid NH-triazine linkages and peripheral tert-butyl moieties for CO2 -selective adsorption.

Three unconventional dendrimers that contained rigid NH-triazine linkages and peripheral tert-butyl moieties were prepared by using a convergent approach and characterized by (1)H and (13)C NMR spectroscopy, mass spectrometry, and elemental analysis. Based on a thermogravimetric analysis study, these dendrimers were observed to display thermal stability at about 300 °C. The NH-triazine moiety, which possessed protonated and proton-free nitrogen sites (like the imidazole unit), displayed the capture of polarizable CO2 molecules through hydrogen-bond and/or dipole-quadrupole interactions. In addition, the adsorption of various amounts of CO2 and N2 at different pressures suggests that the dendritic pores, which arise from the stacking of the middle co-planar and rim protuberant dendrimers, Gn -N∼N-Gn (n=1-3), either swell or shrink at high pressure, thus indicating that these dendrimers may have a breathing ability.

Cooperative effect of unsheltered amide groups on CO2 adsorption inside open-ended channels of a zinc(II)-organic framework.

A unique spatial arrangement of amide groups for CO2 adsorption is found in the open-ended channels of a zinc(II)-organic framework {[Zn4(BDC)4(BPDA)4]·5DMF·3H2O}n (1, BDC = 1,4-benzyl dicarboxylate, BPDA = N,N'-bis(4-pyridinyl)-1,4-benzenedicarboxamide). Compound 1 consists of 4(4)-sql [Zn4(BDC)4] sheets that are further pillared by a long linker of BPDA and forms a 3D porous framework with an α-Po 4(12)·6(3) topology. Remarkably, the unsheltered amide groups in 1 provide a positive cooperative effect on the adsorption of CO2 molecules, as shown by the significant increase in the CO2 adsorption enthalpy with increasing CO2 uptake. At ambient condition, a 1:1 ratio of active amide sites to CO2 molecules was observed. In addition, compound 1 favors capture of CO2 over N2. DFT calculations provided rationale for the intriguing 1:1 ratio of amide sorption sites to CO2 molecules and revealed that the nanochamber of compound 1 permits the slipped-parallel arrangement of CO2 molecules, an arrangement found in crystal and gas-phase CO2 dimer.

Gender disparities in AMI management and outcomes among health professionals, their relatives, and non-health professionals in Taiwan from 1997 to 2007.

Numerous reports of gender differences in the management and mortality of acute myocardial infarction (AMI) patients have raised concerns on gender inequity in cardiac care. However, no study has explored whether gender disparity exists among health professionals and their relatives. Therefore, this study assesses gender disparity in the management and mortality of AMI patients in Taiwan, and determines whether such disparity exists among health professionals and their relatives. National Health Insurance (NHI) files were used to obtain information on a cohort of 79,360 AMI patients aged 30-85 years in Taiwan from 1997 to 2007. The use of catheterization and revascularization (CATH/RAVS) and one-year mortality were compared between men and women in all adult patients, health professionals and their relatives, and non-health professional patients. Taiwanese women with AMI were significantly less likely than their male counterparts to receive CATH/RAVS, and showed greater one-year mortality. Similarly, women in the professional group were significantly less likely to receive CATH/RAVS. However, they did not have worse survival outcomes (hazard ratio: 1.01; 95% CI: 0.68-1.50) compared to men. Regarding mortality following CATH/RAVS, no gender disparities against women were observed in health professionals and their relatives, whereas significant gender disparities persisted in non-health professional patients. In conclusion, this study shows a substantial gender disparity against women in the management and one-year survival of AMI patients in Taiwan. This research extends earlier studies by showing similar gender gaps in treatment uses among health professionals and their relatives without strong evidence on gender disparities against women in survival.

Poverty increases type 2 diabetes incidence and inequality of care despite universal health coverage.

OBJECTIVE: The discrepancy of diabetes incidence and care between socioeconomic statuses has seldom been studied concurrently in nations with universal health coverage. We aimed to delineate whether income disparity is associated with diabetes incidence and inequality of care under a national health insurance (NHI) program in Asia. RESEARCH DESIGN AND METHODS: From the Taiwan NHI database in 2000, a representative cohort aged ≥20 years and free of diabetes (n = 600,662) were followed up until 2005. We regarded individuals exempt from paying the NHI premium as being poor. Adjusted hazard ratios (HRs) were used to discover any excess risk of diabetes in the poor population. The indicators used to evaluate quality of diabetes care included the proportion of diabetic patients identified through hospitalization, visits to diabetes clinics, and completion of recommended diabetes tests. RESULTS: The incidence of type 2 diabetes in the poor population was 20.4 per 1,000 person-years (HR, 1.5; 95% CI, 1.3-1.7). Compared with their middle-income counterparts, the adjusted odds ratio (OR) for the poor population incidentally identified as having diabetes through hospitalization was 2.2 (P < 0.001). Poor persons with diabetes were less likely to visit any diabetes clinic (OR, 0.4; P < 0.001). The ORs for the poor population with diabetes to receive tests for glycated hemoglobin, low-density lipoprotein cholesterol, triglycerides, and retinopathy were 0.6 (0.4-0.9), 0.4 (0.2-0.7), 0.5 (0.4-0.8), and 0.4 (0.2-0.9), respectively. CONCLUSIONS: Poverty is associated not only with higher diabetes incidence but also with inequality of diabetes care in a northeast Asian population, despite universal health coverage.

Prevalence, correlates, and disease patterns of antidepressant use in Taiwan.

OBJECTIVE: We used the population-based National Health Insurance database to investigate the prevalence, correlates, and disease patterns of antidepressant use in Taiwan. METHODS: The National Health Research Institutes provided a database of 200,000 random subjects for study. We obtained a random sample of 145,304 subjects 18 years or older in 2004. Study subjects who had been given at least 1 antidepressant drug prescription during this year were identified. We detected factors associated with any antidepressant use. We also examined the proportion of antidepressant use for psychiatric and medical disorders. RESULTS: The 1-year prevalence of antidepressant use was 4.3%. Higher antidepressant use was found in the aged group, in female subjects, in individuals with a fixed premium and with an insurance amount lower than US $640, in individuals with disability, and among subjects in the central area. Among subjects with antidepressant use, the higher proportions of psychiatric disorders were for neurotic depression (21.1%), anxiety state (17.6%), major depressive disorder (14.6%), special symptoms or syndromes not elsewhere classified (8.5%), and depressive disorder not elsewhere classified (5.4%). With respect to medical disorders, the higher proportions of antidepressant use were for diseases of the genitourinary system; musculoskeletal system and connective tissue; symptoms, signs, and ill-defined conditions; circulatory system; endocrine, nutritional, and metabolic diseases and immunity disorders; and nervous system and sense organs. CONCLUSION: Higher proportion of psychiatric disorders among subjects with antidepressant use were for depressive disorder and anxiety disorder. However, 39% of the subjects were using antidepressants for nonpsychiatric disorders in Taiwan.

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.

Correlates and psychiatric disorders associated with psychotropic drug use in Taiwan.

PURPOSE: We used the population-based National Health Insurance database to investigate correlates and psychiatric disorders associated with psychotropic drug use in Taiwan. METHODS: The National Health Research Institute provided a database of 200,000 random subjects for study. We obtained a random sample of 145,304 subjects aged 18 years or older in 2004. Study subjects who had made at least two psychotropic drug prescriptions during this year were identified. We detected factors associated with psychotropic drug use. In addition, we examined the prevalence of antipsychotic, antidepressant, mood stabilizer, sedative-hypnotic-anxiolytic (SHA) agent, and any psychotropic drug use according to psychiatric disorders. RESULTS: Higher prevalence of any psychotropic drug use was found in the 25-44, 45-64, and 65 or older age groups, females, aborigine, with a lower premium, with disability, and among those who lived in central region, suburban or rural area. Among those subjects with any major psychiatric disorders, the prevalence of antipsychotic, antidepressant, mood stabilizer, SHA agent, and any psychotropic drug use were 59.3, 49.7, 17.9, 78.6, and 92.0%, respectively. Among those subjects with any minor psychiatric disorders, the prevalence of antipsychotic, antidepressant, mood stabilizer, SHA agent and any psychotropic drug use were 17.5, 41.8, 4.0, 85.5, and 89.4%, respectively. CONCLUSIONS: Thus, those subjects with any psychiatric disorders had a high percentage of any psychotropic drug use in National Health Insurance program in Taiwan. Future studies should focus on the outcome evaluation and correlates associated with individual psychotropic use.

Outcomes of overseas kidney transplantation in chronic haemodialysis patients in Taiwan.

AIM: Overseas kidney transplantation has often been reported to have unsatisfactory outcomes. This study aims to compare post-transplantation outcomes between overseas and domestic kidney transplant (KT) recipients in Taiwan. METHODS: The Taiwanese National Health Insurance Research Database was used to identify 310 domestic and 643 overseas KT recipients, who survived for longer than 1 month after the transplantation, in a cohort of 45,453 chronic haemodialysis patients in 1997-2002. Cox proportional hazards models were used to assess risks of mortality and graft failure. RESULTS: The 1, 3 and 5 year survival rates for domestic KT recipients were 96.5%, 93.3% and 91.6%, respectively, while those for overseas KT recipients were 94.9%, 87.9% and 77.1%, respectively (P = 0.015). For the overseas group, those who received a KT before 2001 had significantly higher hazard ratios of mortality and graft failure (2.85 and 1.71, respectively). However, for those receiving a KT in 2001-2002, no significant outcome difference could be found between overseas and domestic recipients. CONCLUSION: The risk disparity between overseas and domestic KT recipients is mainly attributable to when the transplantation was performed. In attempting to dissuade potential recipients from organ trafficking, merely emphasizing the previously acknowledged poor outcomes no longer suffices as a valid reason.

Diffusion of new medication across different income groups under a universal health insurance program: an example involving newly enlisted nonsteroidal anti-inflammatory drugs for elderly osteoarthritis patients.

OBJECTIVES: The aim of this research was to determine whether socioeconomic status, as measured by income level, impacts on the diffusion to patients of newly reimbursed nonsteroidal anti-inflammatory drugs (NSAIDs) under the National Health Insurance program in Taiwan. METHODS: We used income tax records to identify the income levels of 324 male and 551 female randomly sampled osteoarthritis patients aged over 60 years in 2000. The study period was 2 years (t (1) = April 2001-March 2002 and t (2) = April 2002-March 2003). Generalized estimating equation models were used to analyze the impact of income level on being prescribed one of the newly reimbursed NSAIDs. RESULTS: The impact of income level on being treated with the new drug was positive and significant for females (OR = 2.11, p < 0.01) but not for males. The interaction term between income groups and the time trend was insignificant. Other factors associated with being treated with the new drug include age, habit of health-care utilization, and residential characteristics. CONCLUSIONS: Diffusion of new drugs still depends on income level despite the presence of a universal national health insurance system in Taiwan.

Incidence and frequency of endoscopic sympathectomy for the treatment of hyperhidrosis palmaris in Taiwan.

Hyperhidrosis palmaris (HP) is a rather common disease in Taiwan. Taiwan is a leading nation in terms of the surgical treatment of this disease using thoracic endoscopic sympathectomy. However, the currently available epidemiological information regarding HP is insufficient. To date, the incidence of HP and the percentage of patients treated surgically have not been reported. We investigated the incidence of HP treated in 2004 by sampling Taiwan's National Health Insurance database. Patients who were diagnosed with HP during 2004 were identified by International Classification of Diseases, 9(th) Clinical Modification code 780.8 from a database of about 22 million beneficiaries, and were followed to 2006. Those who had been diagnosed as HP in 2002 or 2003 were excluded. Patients who underwent surgery were identified by the treatment codes 83026C (dorsal sympathectomy) and 83085B (transendoscopic dorsal sympathectomy, TES). Factors included in the analysis included age, sex, time of operation and hospitalization for surgery. In total, 15,839 patients with HP were identified. The incidence was 7.2 per 10,000 beneficiaries. The study sample included 7,603 males with an incidence of 6.9 per 10,000 beneficiaries, and 8,236 females with an incidence of 7.4 per 10,000 beneficiaries. The incidence was highest among patients aged 20-29 years old. The incidence decreased with increasing age (Mantel-Haenszel chi(2) test for trend, p < 0.001), and 3,755 cases (23.7%) received an operation, of which 1,733 were male (22.8% of all male patients) and 2,022 were female (24.6% of all female patients) (p = 0.009). Of these, 99.3% underwent transendoscopic dorsal sympathectomy, and 94.7% underwent surgery within 1 month of the initial diagnosis. Males underwent surgery sooner than females (p = 0.004). Adjusted multivariate logistic regression analysis showed that patients aged 20-29 were more likely to undergo surgery than the other age groups (odds ratio: 2.28; 95% confidence interval: 2.07-2.52). Regional hospitals had the highest chance to perform the operation (odds ratio: 4.87; 95% confidence interval: 4.41-5.37). Here, we have reported the incidence of HP in Taiwan in 2004 and concluded that the incidence was higher in females than in males. About one-quarter of patients underwent surgery, mostly within 1 month after attending an outpatient clinic; most surgical interventions involved endoscopic sympathectomy. This report fulfills the epidemiological information gap of HP and provides important data for future health care delivery.

Variation in the cervical cancer screening compliance among women with disability.

OBJECTIVE: To investigate the relationship between the level of disability and regular Pap smear testing among women in Taiwan and explore how this relationship may vary with the various levels of physician availability. METHODS: This population-based cohort study followed a total of 5,469,581 women from Taiwan, who were 30 years old or older in 2001 and covered the period January 2001 to December 2003. Of the total study population, 184,701 individuals were women with disability. Gynecologist-obstetrician/general practitioner to female population ratio was used as an indicator of physician availability. Multiple logistical regression models were used. RESULTS: After adjusting for age, socioeconomic status, racial group, residence area and physician availability, women with severe disability (OR = 0.38; 95% CI: 0.38, 0.39) were the least likely to undergo Pap smear testing. Women with moderate disability (OR = 0.59; 95% CI: 0.58, 0.60) and mild disability (OR = 0.88; 95% CI: 0.86, 0.89) were also significantly less likely to undergo a routine test than women without disability. Women residing in the areas with the greatest physician availability (OR = 0.93; 95% CI: 0.93, 0.94) were significantly less likely to undergo a Pap test than those in the areas with the lowest level of resource availability. The disparity in routine screening between women with and without disability remained across the different levels of physician availability. CONCLUSIONS: In Taiwan, women with disability were found to be at higher risk of lower compliance than women without disability. The gap between women with and without disability persisted across different levels of physician availability.

Spatiotemporal analysis of air pollution and asthma patient visits in Taipei, Taiwan.

BACKGROUND: Buffer analyses have shown that air pollution is associated with an increased incidence of asthma, but little is known about how air pollutants affect health outside a defined buffer. The aim of this study was to better understand how air pollutants affect asthma patient visits in a metropolitan area. The study used an integrated spatial and temporal approach that included the Kriging method and the Generalized Additive Model (GAM). RESULTS: We analyzed daily outpatient and emergency visit data from the Taiwan Bureau of National Health Insurance and air pollution data from the Taiwan Environmental Protection Administration during 2000-2002. In general, children (aged 0-15 years) had the highest number of total asthma visits. Seasonal changes of PM10, NO2, O3 and SO2 were evident. However, SO2 showed a positive correlation with the dew point (r = 0.17, p < 0.01) and temperature (r = 0.22, p < 0.01). Among the four pollutants studied, the elevation of NO2 concentration had the highest impact on asthma outpatient visits on the day that a 10% increase of concentration caused the asthma outpatient visit rate to increase by 0.30% (95% CI: 0.16%~0.45%) in the four pollutant model. For emergency visits, the elevation of PM10 concentration, which occurred two days before the visits, had the most significant influence on this type of patient visit with an increase of 0.14% (95% CI: 0.01%~0.28%) in the four pollutants model. The impact on the emergency visit rate was non-significant two days following exposure to the other three air pollutants. CONCLUSION: This preliminary study demonstrates the feasibility of an integrated spatial and temporal approach to assess the impact of air pollution on asthma patient visits. The results of this study provide a better understanding of the correlation of air pollution with asthma patient visits and demonstrate that NO2 and PM10 might have a positive impact on outpatient and emergency settings respectively. Future research is required to validate robust spatiotemporal patterns and trends.

Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan.

BACKGROUND AND PURPOSE: The occurrence of preeclampsia-eclampsia during pregnancy has been reported to increase the risk of stroke in mainly Western populations. However, few studies have evaluated stroke risk in Asian populations and followed women beyond the early postpartum period. Thus, the present study determined the risk of stroke in women in Taiwan during pregnancy and the first postpartum year. METHODS: A population-based cohort study was performed on 1,132,019 parturients during 1999 to 2003 using a dataset linking birth certificates and National Health Insurance hospital discharge data. Stroke-free survival rates were estimated using the Kaplan-Meier method, and the log-rank test was used to examine the effect of preelampsia-eclampsia on the prevalence of stroke. Sociodemographic factors and obstetric complications were used in multivariate logistic regression models to determine the adjusted odds ratios of preeclampsia-eclampsia on the risk of hemorrhagic and ischemic stroke during pregnancy and within the first postpartum year. RESULTS: The incidence of stroke was 21.47 cases per 100,000 deliveries. There were 139 cases of hemorrhagic stroke and 107 cases of ischemic stroke. The respective adjusted relative risk of preeclampsia-eclampsia for hemorrhagic and ischemic stroke were 10.68 (95% CI, 3.40 to 33.59) and 40.86 (95% CI, 12.14 to 137.47) within 3 months antepartum; 6.45 (95% CI, 1.42 to 29.29) and 34.71 (95% CI, 11.08 to 108.68) in the first 3 days postpartum; 5.61 (95% CI, 0.71 to 44.10) and 11.23 (95% CI, 2.45 to 51.59) from 3 days to 6 weeks postpartum; 11.76 (95% CI, 4.05 to 34.11) and 11.60 (95% CI, 3.30 to 40.82) from 6 weeks to 6 months pospartum; and 19.90 (95% CI, 7.75 to 51.11) and 4.35 (95% CI, 0.58 to 32.92) from 6 months to 12 months postpartum. CONCLUSIONS: Women with preeclampsia-eclampsia have a significantly higher risk of stroke during pregnancy and in the first postpartum year. These results suggest that women with preeclampsia-eclampsia should be closely monitored even after pregnancy.

Prevalence, correlates, and disease patterns of antipsychotic use in Taiwan.

AIM: The population-based National Health Insurance database was used to investigate the prevalence, correlates, and disease patterns of antipsychotic use in Taiwan. METHODS: The National Health Research Institutes provided a database of 200,000 random subjects for study. A random sample of 145 304 subjects was obtained, aged > or =18 years in 2004. Study subjects who had been given at least two antipsychotic drug prescriptions during this year were identified. The factors associated with any antipsychotic use were identified. The proportion of antipsychotic use for psychiatric and non-psychiatric disorders was also examined. RESULTS: The 1-year prevalence of antipsychotic use was 3.5%. Antipsychotic use was found to be more prevalent by age; for women; for individuals with a lower insurance amount; for individuals with disability; and among those subjects who lived in the central or southern area. Among subjects with antipsychotic use, higher proportions of psychiatric disorders were found for schizophrenia, anxiety state, major depressive disorder, neurotic depression, dementia, and bipolar disorder. With respect to medical disorder, higher proportions of antipsychotic use were found for diseases of the digestive system; symptoms, signs, and ill-defined conditions; diseases of the respiratory system, musculoskeletal system and connective tissue, circulatory system, nervous system and sense organs, and genitourinary system. CONCLUSIONS: Higher proportions of antipsychotic use were found for schizophrenia, depressive disorder, anxiety disorder, dementia, and bipolar disorder. More than 60% of subjects used antipsychotics for non-psychiatric disorders in Taiwan, which deserves further study for the sake of patient safety.

Pregnancy outcomes among native and foreign-born women in Taiwan: maternal health utilization.

BACKGROUND: As immigrant populations increase rapidly around the world and with most immigrant women being of childbearing age, their use of pregnancy-related healthcare has become an important health issue. However, there has been only limited research available on maternal health use by foreign immigrants in Asia. This study aims to compare inpatient use for pregnancy complications and type of delivery among foreign and native-born women of different socioeconomic status in Taiwan. METHODS: Using the 2001 National Health Insurance (NHI) database, 232,828 deliveries were identified, of which 222,852 were to native-born mothers and 9,976 were to foreign-born mothers. Univariate and multivariate logistic regression models were used to determine the likelihood of using inpatient services for any pregnancy complication and for cesarean section. RESULTS: Our results indicate that after adjusting for other factors, foreign-born women were less likely than native-born women to use inpatient services for complicated pregnancies across all socioeconomic status (SES) levels. On the other hand, a pattern emerged among the higher SES groups showing a similar likelihood of cesarean section when foreign-born and native-born mothers were compared. This was not the case for the lower SES groups, however, where native-born mothers were significantly more likely to undergo a cesarean section than foreign-born mothers. CONCLUSIONS: Foreign-born mothers tended to use fewer inpatient services for complicated pregnancies than native-born mothers and were less likely to undergo cesarean section. As immigrants increase across the world as a result of globalization and with half of them being female, pregnancy-related health service use among this group needs our attention.

Association between obesity and medical care expenditure among Taiwanese adults.

The aim of this study is to evaluate the relationships between obesity and medical care expenditure among Taiwanese adults and to assess the influence of sex, age and socioeconomic status. Our study sample consisted of 12,250 adults aged 18 years or older from the 2001 National Health Interview Survey (NHIS), who had consented to the linking of their survey responses with their NHI claims records. Obesity was defined by Body Mass Index based on the WHO-Asia Pacific categories. Adjusted expenditure for obese class II and class I men were, respectively, 44.6% (95%CI: 27.1%-68.7%) and 39.5% (95%CI: 39.4%-41.2%) greater than normal weight men. For obese class II and class I women, the adjusted expenditure were, respectively, 93.3% (95%CI: 69.9%-114.6%) and 56.1% (95%CI: 50.4%-61.4%) greater than normal weight women. After adjusting for other factors, higher medical care expenditure was associated with a higher BMI for each age group. The relative magnitude of the association became more apparent as age increased. Annual medical care expenditure increased as the BMI increased among women, which was particularly apparent among low socioeconomic status women. On the other hand, the relationship between BMI and medical care expenditure in men varied by household income. In conclusion, there is a strong positive relationship between higher BMI and increased medical care expenditure and this varies according to sex, age and socioeconomic status. Our findings suggest that projections of future health care costs attributable to obesity will need to take into consideration the demographic make-up of the obese population.