An interesting phenomenon in immigrant spouses and elderly suicides in Taiwan.

BACKGROUND: Immigration is a global issue. Taiwan has a high proportion of immigrant spouses who take care of the aging parents-in-law at home mainly based on filial piety. Difficulties in communication in many aspects of daily life occur between the elderly and immigrant spouses, and result in the elderly becoming vulnerable and thus, influencing their psychological well-being. Although past studies demonstrated that due to cultural differences, employed foreign care providers negatively influenced elder care quality (e.g., care receipts' health or mortality rates), no studies have explored whether immigrant spouses, as family caregivers, have any influence on elderly suicides due to cross cultural communication differences. OBJECTIVE: To address the above gap, this study was to examine the static relationship between immigrant spouses and elderly suicides. METHOD: National-level authority data, comprising a 10-year longitudinal nationwide sample, were used. The number of immigrant spouses was treated as a proxy of cultural differences. Twelve models of outcomes with and without city- and time-fixed effects were conducted using panel data analysis. RESULTS: Descriptive statistics of the study variables are provided. The results revealed that overall the number of immigrant spouses had a positive correlation with suicides in older adults. Further, the gender of immigrant spouses had different impacts on elderly suicides. CONCLUSIONS: This is the first study to examine relation between immigrant spouses and the elderly suicides. The study results provide another viewpoint of understanding of the role of immigrant spouses in elder care, while promoting elder-caregiver interactions for optimal elder health outcomes.

Correction: Association between Ischemic Stroke and Iron-Deficiency Anemia: A Population-Based Study.

[This corrects the article DOI: 10.1371/journal.pone.0082952.].

LabPush: a pilot study of providing remote clinics with laboratory results via short message service (SMS) in Swaziland, Africa - a qualitative study.

BACKGROUND: Developing countries are confronting a steady growth in the prevalence of the infectious diseases. Mobile technologies are widely available and can play an important role in health care at the regional, community, and individual levels. Although labs usually able to accomplish the requested blood test and produce the results within two days after receiving the samples, but the time for the results to be delivered back to clinics is quite variable depending on how often the motorbike transport makes trips between the clinic and the lab. OBJECTIVE: In this study, we seek to assess factors facilitating as well as factors hindering the adoption of mobile devices in the Swazi healthcare through evaluating the end-users of the LabPush system. METHODS: A qualitative study with semi-structured and in-depth one on one interviews were conducted over two month period July-August 2012. Purposive sampling was used; participants were those operating and using the LabPush system at the remote clinics, at the national laboratory and the supervisors of users at Swaziland. Interview questions were focused on perceived of ease of use and usefulness of the system. All interviews were recorded and then transcribed. RESULTS: This study had aimed its primary focus on reducing TAT, prompt patient care, reducing bouncing of patients and defaulting of patients which were challenges that the clinicians have always had. Therefore, the results revealed several barriers and facilitators to the adoption of mobile device by healthcare providers in the Swaziland. The themes Shortens TAT, Technical support, Patient-centered care, Mindset, Improved communication, Missing Reports, Workload, Workflow, Security of smart phone, Human error and Ownership are sorted by facilitators to barriers. CONCLUSION: Thus the end-users perspective, prompt patient care, reduced bouncing of patients, technical support, better communication, willing participant and social influence were facilitators of the adoption m-health in the Swazi healthcare.

Increased risk of ischemic stroke among women with bladder pain syndrome/interstitial cystitis: a cohort study from Taiwan.

AIM: Vascular factors are proposed in the etiology of bladder pain syndrome/interstitial cystitis (BPS/IC). In this study, we investigated the risk of stroke among women following a diagnosis of BPS/IC over 3 years of follow-up, compared to controls without a BPS/IC diagnosis. METHODS: This retrospective cohort study used data retrieved from the Taiwan "Longitudinal Health Insurance Database 2000." We identified 847 women who received a diagnosis of BPS/IC between January 1, 2001 and December 31, 2008 (study group) and 4,235 comparison women (women without a BPS/IC diagnosis matched on age and other selected demographic variables. All subjects were tracked for 3 years following the index date to identify those who received a diagnosis of stroke during follow-up. RESULTS: The stroke incidence rate was 20.86 (95% confidence interval (CI): 15.78-27.07) and 11.65 (95% CI: 9.88-13.64) per 1,000 person-years among the study and comparison cohorts, respectively. Cox regression analysis showed a stroke hazard ratio (HR) of 1.52 (95% CI: 1.09-2.14) in the BPS/IC group relative to the comparison group over 3-year follow-up, after adjusting for hypertension, diabetes, coronary heart disease, atrial fibrillation, hyperlipidemia, and chronic kidney disease. The adjusted HR of ischemic stroke was 1.52 (95% CI: 1.02-2.27). However, there was no significant difference between the two groups in hemorrhagic stroke risk. CONCLUSIONS: Our study demonstrates an association between BPS/IC and a subsequent ischemic stroke diagnosis among women in Taiwan.

Health care service utilization among patients with bladder pain syndrome/interstitial cystitis in a single payer healthcare system.

BACKGROUND: This study aims to investigate the differences in the utilization of healthcare services between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and patients without using a population-based database in Taiwan. METHODS: This study comprised of 350 patients with BPS/IC and 1,750 age-matched controls. Healthcare resource utilization was evaluated in the one-year follow-up period as follows: number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. A multivariate regression analysis was used to evaluate the relationship between BPS/IC and total costs of health care services. RESULTS: For urological services, patients with BPS/IC had a significantly higher number of outpatient visits (2.5 vs. 0.2, p<0.001) as well as significantly higher outpatient costs ($US166 vs. $US6.8, p<0.001) than the controls. For non-urologic services, patients with BPS/IC had a significantly high number of outpatient visits (35.0 vs. 21.3, p<0.001) as well as significantly higher outpatient cots ($US912 vs. $US675, p<0.001) as compared to the controls. Overall, patients with BPS/IC had 174% more outpatient visits and 150% higher total costs than the controls. Multiple-regression-analyses also showed that the patients with BPS/IC had significantly higher total costs for all healthcare services than the controls. CONCLUSIONS: This study found that patients with BPS/IC have a significantly higher number of healthcare related visits, and have significantly higher healthcare related costs than age-matched controls. The high level of healthcare services utilization accrued with BPS/IC was not necessarily exclusive for BPS/IC, but may have also been associated with medical co-morbidities.

How did national life expectation related to school years in developing countries - an approach using panel data mining.

BACKGROUND: The purpose of the study was to probe into the changes in life expectancy associated with schooling years found by the Organization for Economic Co-operation and Development (OECD). METHODS: The study was based on the OECD database from the period 2000 to 2006. The data of thirty countries were constructed to allow comparisons over time and across these countries. Panel data analysis was used to estimate the relationship of national education, as defined as school years, with life expectancy. The control factors considered were numbers of practicing physicians, practicing nurses, hospital beds, and GDP. RESULTS: We used fixed effects of both country and time through linear regression, the coefficient of school years in relation to life expectancy was statistically significant but negative. This finding is not in accord with the hypothesis that investing in human capital through education stimulates better health outcomes. CONCLUSION: Within developing countries, educational attainment is no longer keeping the same pace with life expectancy as before. Therefore, we suggest that an effective education policy should cover diverse topics, for example, balancing economic growth and mental hygiene, to improve national life expectancy.

Association between ischemic stroke and iron-deficiency anemia: a population-based study.

BACKGROUND: Very little is known about the relationship between non-sickle cell anemia and stroke. The purpose of this study is to evaluate the association of iron-deficiency anemia (IDA) with stroke based on a nationwide coverage database in Taiwan. METHODS: The case-control study subjects were obtained from the Taiwanese Longitudinal Health Insurance Database 2000. We included 51,093 subjects with stroke as cases and randomly selected 153,279 controls (3 controls per case) in this study.Separate conditional logistic regression analyses were used to calculate the odds ratio (OR) for having been previously diagnosed with IDA between cases and controls.We further analyzed the association between stroke and IDA by stroke subtype. RESULTS: Results showed that 3,685 study subjects (1.81%) had been diagnosed with IDA prior to the index date; of those subjects, 1,268 (2.48%) were cases and 2,417 (1.58%) were controls (p<0.001). Conditional logistic regression shows that the OR of having previously received an IDA diagnosis among cases was 1.49 (95% CI: 1.39~1.60; p < 0.01) that of controls after adjusting for monthly income, geographic region, hypertension, diabetes, coronary heart disease, atrial fibrillation, heart failure, hyperlipidemia, tobacco use disorder, and alcohol abuse/alcohol dependency syndrome. Furthermore, the adjusted OR of prior IDA for cases with ischemic stroke was found to be 1.45 (95% CI: 1.34~1.58) compared to controls. However, we did not find any significant relationship between IDA and subarachnoid/intracerebral hemorrhage even adjusting for other confounding factors (OR=1.17, 95% CI=0.97~1.40). CONCLUSION: There is a significant association between prior IDA and ischemic stroke.

A probabilistic model for reducing medication errors.

BACKGROUND: Medication errors are common, life threatening, costly but preventable. Information technology and automated systems are highly efficient for preventing medication errors and therefore widely employed in hospital settings. The aim of this study was to construct a probabilistic model that can reduce medication errors by identifying uncommon or rare associations between medications and diseases. METHODS AND FINDINGS: Association rules of mining techniques are utilized for 103.5 million prescriptions from Taiwan's National Health Insurance database. The dataset included 204.5 million diagnoses with ICD9-CM codes and 347.7 million medications by using ATC codes. Disease-Medication (DM) and Medication-Medication (MM) associations were computed by their co-occurrence and associations' strength were measured by the interestingness or lift values which were being referred as Q values. The DMQs and MMQs were used to develop the AOP model to predict the appropriateness of a given prescription. Validation of this model was done by comparing the results of evaluation performed by the AOP model and verified by human experts. The results showed 96% accuracy for appropriate and 45% accuracy for inappropriate prescriptions, with a sensitivity and specificity of 75.9% and 89.5%, respectively. CONCLUSIONS: We successfully developed the AOP model as an efficient tool for automatic identification of uncommon or rare associations between disease-medication and medication-medication in prescriptions. The AOP model helps to reduce medication errors by alerting physicians, improving the patients' safety and the overall quality of care.

Bladder pain syndrome/interstitial cystitis is associated with hyperthyroidism.

BACKGROUND: Although the etiology of bladder pain syndrome/interstitial cystitis (BPS/IC) is still unclear, a common theme with BPS/IC patients is comorbid disorders which are related to the autonomic nervous system that connects the nervous system to end-organs. Nevertheless, no study to date has reported the association between hyperthyroidism and BPS/IC. In this study, we examined the association of IC/BPS with having previously been diagnosed with hyperthyroidism in Taiwan. DESIGN: Data in this study were retrieved from the Longitudinal Health Insurance Database. Our study consisted of 736 female cases with BPS/IC and 2208 randomly selected female controls. We performed a conditional logistic regression to calculate the odds ratio (OR) for having previously been diagnosed with hyperthyroidism between cases and controls. RESULTS: Of the 2944 sampled subjects, there was a significant difference in the prevalence of prior hyperthyroidism between cases and controls (3.3% vs. 1.5%, p<0.001). The conditional logistic regression analysis revealed that compared to controls, the OR for prior hyperthyroidism among cases was 2.16 (95% confidence interval (CI): 1.27∼3.66). Furthermore, the OR for prior hyperthyroidism among cases was 2.01 (95% CI: 1.15∼3.53) compared to controls after adjusting for diabetes, coronary heart disease, obesity, hyperlipidemia, chronic pelvic pain, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, depression, panic disorder, migraines, sicca syndrome, allergies, endometriosis, and asthma. CONCLUSIONS: Our study results indicated an association between hyperthyroidism and BPS/IC. We suggest that clinicians treating female subjects with hyperthyroidism be alert to urinary complaints in this population.

No increased risk of adverse pregnancy outcomes in women with urinary tract infections: a nationwide population-based study.

OBJECTIVE: To examine the risk of adverse pregnancy outcomes (low birthweight (LBW), preterm birth, and small-for-gestational age (SGA)) in pregnant women with urinary tract infections (UTIs) using a 3-year nationwide population-based database, simultaneously taking characteristics of infant and mother into consideration. Design. Retrospective cross-sectional study. SETTING: Taiwan. SAMPLE: In total, 42,742 mothers with UTIs and 42,742 randomly selected mothers were included. METHODS: Conditional logistic regression analyses to investigate the risk of LBW, preterm birth, and SGA, comparing these two cohorts. MAIN OUTCOME MEASURES: LBW, preterm birth, and SGA. RESULTS: Pearson chi(2) tests show that there were significant differences in the prevalence of preterm births (<37 weeks) (7.2%, 7.7 vs. 8.3%, p = 0.006) and SGA infants (<10th percentile) (16.1%, 16.5 vs. 18.9%, p = 0.003) among pregnant women who were not exposed to UTIs, those exposed to antepartum non-pyelonephritic UTIs and those exposed to pyelonephritis. However, after adjusting for potential confounding factors, the odd ratios (ORs) for LBW were not statistically significant for mothers exposed to antepartum non-pyelonephritic UTIs, compared to women who were not diagnosed with UTIs; neither for <34 or <37 weeks nor SGA <10th percentile and <2 SDs. Similarly, compared to women who were not exposed to UTIs, the adjusted ORs for LBW, <34 weeks, <37 weeks, SGA <10th centile, and <2 SD did not reach a significant level for mothers exposed to pyelonephritis. CONCLUSIONS: Women exposed to antepartum pyelonephritis or non-pyelonephritic UTIs were not at increased risk of having LBW, preterm, and SGA babies, compared to mothers who did not experience UTIs.

Scientific production of electronic health record research, 1991-2005.

PURPOSE: The increasing numbers of publications on electronic health record (EHR) indicate its increasing importance in the world. This study attempted to quantify the scientific production of EHR research articles, and how they have changed over time, in an effort to investigate changes in the trends cited in these critical evaluations. METHOD: The articles were based on the science citation index (SCI) from 1991 to 2005. A descriptive study was performed using the 1803 documents published in the SCI from 39 countries in America, Europe, Africa, Asia, and Oceania. The evaluation was based on parameters including document type, language, first author's country of origin, number of citations and citations per publication. RESULTS: Of all publications, 1455 (80.7%) were articles, followed by meeting abstracts which represented about one-tenth of all types of EHR publications. Numbers of published articles have significantly increased when compared by each 5-year period. Most articles were published in English (98%) and were from the region of America (57%). The top 10 of the 374 journals accounted for 41% of the number of published articles. The US dominates publication production (57%) with a cumulative impact factor (IF) of 2227 and followed by the UK (8.5%, with a cumulative IF of 257.0) and the Netherlands (7.8%, with a cumulative IF of 211.1). An analysis of the number of articles related to population revealed a high publication output for relative small countries like Switzerland, the Netherlands, and Norway. CONCLUSIONS: Research production in EHR showed a considerable increase during 1991-2005. The production was dominated by articles, those from the US, and those published in English. The production came from many countries, denoting the devotion to this field in different areas around the world.