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PURPOSE: To investigate the factors associated with live births and the interaction between age and the number of embryos transferred after in vitro fertilisation (IVF) treatment. METHODS: This study analyses data from a population-based-assisted reproductive database of all registered artificial reproduction institutions (n = 80) from 2010 to 2016 in Taiwan. The probability of a live birth in correlation with the treatment parameters was measured with multivariate logistic regression analyses using the generalised additive model (GAM) and Pearson’s chi-square exact test. RESULTS: A total of 104,015 IVF treatments performed between 2010 and 2016 were included in our analysis. From these treatments, 31,467 (30.3%) were successfully delivered, and 40,565 test-tube babies were born. Pearson’s chi-square exact test indicated that parents’ age, cause of infertility, type of ovarian stimulation, additional assisted reproductive technology techniques, donated egg or sperm, fresh or frozen embryo, presence or absence of ovarian hyperstimulation syndrome, and day of embryo transfer were significantly associated with live births after an IVF cycle (p < 0.05). Multiple logistic regression analysis with the GAM revealed that the odds of a live birth with IVF treatment in patients < 34 years of age were 2.55 times higher than that in patients ≥ 45 years of age (odds ratio = 2.55, 95% confidence interval = 1.69–2.90) for patients who underwent a single-embryo transfer (SET); a similar pattern was observed when two or more embryos were transferred. Egg donation, the assisted hatching technique, oral ovarian stimulation agents, and implantation of frozen embryos during SET were shown to improve the chance of a live birth by 29–90%. Implantation of the embryo after the 5th day of culture yielded the highest odds of a live birth. The interaction plot revealed that maternal age, especially < 40 years, was associated with the probability of a live birth. SET and double-embryo transfer showed similar associations with the probability of a live birth across age groups. Transferring more than two embryos might reduce the probability of a live birth during IVF treatment for women ≥ 40 years of age. CONCLUSIONS: Implanting a greater number of embryos did not improve the age-related decrease in fertility for patients undergoing IVF. Therefore, we suggested that ≤ 2 blastocysts could be transferred during IVF treatments for women ≥ 40 years. Transferring a blastocyst on day 5 of culture was associated with a significant increase in the odds of a live birth resulting from IVF. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10815-021-02086-4.

Background/Purpose: Emergency air medical transport (EAMT) of patients in remote areas with neurological emergencies to higher-level facilities is an integral part of the regionalized healthcare system. EAMT is safe and feasible for head injuries. Debates persist on the high cost, safety, and risk of EAMT, thereby calling for alternatives. Methods: We conducted a retrospective cohort study by including all patients with intracranial hemorrhage (ICH) who visited the Kinmen Hospital from January 2006 to December 2016. Routine neurosurgical dispatch (RNSD) implemented since 2009, dispatches neurosurgeons to Kinmen. EAMT and 90-day mortality were assessed. Results: We enrolled 560 patients: 173 pre-stage and 387 post-stage. RNSD resulted in less EAMT deployment ([adjusted odds ratio AOR] = 0·23, p

HIV infection potentially increases coronary artery disease and heart failure risks. However, the association between HIV infection and sudden cardiac death (SCD) has not been extensively studied. This nationwide cohort study aimed to determine SCD risks in Taiwanese patients with and without HIV infection.Adult people living with HIV/AIDS (PLWHA) since January 1, 2003, were identified from the Taiwan Centers for Disease Control HIV surveillance system. HIV-infected individuals were defined as positive HIV-1 Western blot. A control cohort without HIV infection, matched for age and sex, was selected for comparison from the Taiwan National Health Insurance Research Database. All patients were followed up until SCD, mortality for another cause, or till December 31, 2014. A time-dependent Cox proportional hazards model was used to determine the association of HIV and antiretroviral therapy (ART) with SCD.During a mean 5.86-year follow-up, 5342 (4.40%) of 121,530 patients (24,306 PLWHA and 97,224 matched controls) died; among them, 150 (0.12%) died of SCD. Among 150 SCD events, 97 (64.7%) and 53 (33.3%) occurred in PLWHA and controls, respectively, which corresponded to incidences of 68.31 in PLWHA and 9.31 per 100,000 person-years in controls (P0.001). After adjusting for age, sex, and comorbidities, HIV infection was an independent risk factor for SCD (adjusted hazard ratio, 8.15; 95% confidence interval: 5.58 to 11.90). SCD incidence was significantly lower in PLWHA receiving ART (adjusted hazard ratio 0.53; 95% confidence interval: 0.32 to 0.87).HIV infection is an independent risk factor for SCD. SCD rates are low in PLWHA receiving ART.

Drug–drug interaction (DDI) is common among the elderly, and it can have detrimental effects on patients. However, how DDI can be targeted has been under-researched. This study investigates whether DDI can be reduced by targeting continuity of care (COC) through reducing polypharmacy. Population claims data of Taiwan National Health Insurance were used to conduct a 7-year-long longitudinal study on patients aged ≥ 65 years (n = 2,318,766). Mediation analysis with counterfactual method and a 4-way decomposition of the effect of COC on DDI was conducted. Mediation effect through excessive polypharmacy differed from that through lower-level polypharmacy. Compared with the low COC group, the high COC group demonstrated reduced excess relative risk of DDI by 26% (excess relative risk = − 0.263; 95% Confidence Interval (CI) = − 0.263 to − 0.259) to 30% (excess relative risk = − 0.297; 95% CI = − 0.300 to − 0.295) with excessive polypharmacy as the mediator. The risk only reduced by 8% (excess relative risk = − 0.079; 95% CI, − 0.08 to − 0.078) to 10% (excess relative risk = − 0.096; 95% CI, − 0.097 to − 0.095) when the mediator was changed to lower-level polypharmacy. The effect of COC on DDI was mediated by polypharmacy, and the mediation effect was higher with excessive polypharmacy. Therefore, to reduce DDI in the elderly population, different policy interventions should be designed by considering polypharmacy levels to maximize the positive effect of COC on DDI.

The timing of death in patients with coronavirus disease 2019 (COVID-19) varied by their comorbidities and severity of illness. However, few studies have determined predictors of mortality with respect to the timing of death in infectious patients. This cohort study aimed to identify the factors associated with early and late death in hospitalized COVID-19 patients. From 14 May to 31 July 2021, this study consecutively recruited laboratory-confirmed COVID-19 patients admitted to Taipei City Hospital. All patients with COVID-19 were followed up until death or discharge from the hospital or till 13 August 2021. Mortality in such patients was categorized as early death (death within the first two weeks of hospitalization) or late death (mortality later than two weeks after hospitalization), based on the timing of death. Multinomial logistic regression was used to determine the factors associated with early and late death among such patients. Of 831 recruited patients, the overall mean age was 59.3 years, and 12.2% died during hospitalization. Of the 101 deceased, 66 (65.3%) and 35 (34.7%) died early and late, respectively. After adjusting for demographics and comorbidities, independent predictors for early death included age ≥ 65 years (adjusted odds ratio (AOR) = 5.27; 95% confidence interval (CI): 2.88–9.65), heart failure (AOR = 10.32; 95% CI: 2.28–46.65), and end-stage renal disease (AOR = 11.97; 95% CI: 3.53–40.55). This study found that two thirds of COVID-19 deaths occurred within two weeks of hospitalization. It suggests that hospitalized patients with COVID-19 should be treated carefully and monitored closely for the progression of clinical conditions during treatment, particularly in older patients and in those with comorbidities.

Alcohol consumption is a significant public health issue worldwide. The rat model and epidemiological studies have both reported conflicting results about the effects of alcohol on the kidneys. We aimed to explore the relationships between alcohol consumption and chronic kidney disease. Data from the National Health Interview Survey, the National Health Insurance research database, and the National Deaths Dataset were used. Standardized in-person interviews were executed in 2001, 2005, and 2009 to obtain the demographic characteristics of study population. The participants were followed up until 2013. The primary outcome was new-onset chronic kidney disease. We analyzed 45,200 adults older than 18 years (50.8% men and 49.2% women), and the overall mean (SD) age was 42.73 (16.64) years. During the 8.5 (3.5) years of follow-up, new-onset chronic kidney disease was recognized in 1535 (5.5%), 292 (2.7%), and 317 (4.9%) non-drinking, social-drinking, and regular-drinking participants, respectively. The participants who were social and regular drinkers had a significantly decreased risk of chronic kidney disease incidence (social drinking: adjusted hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.74−0.97; p = 0.018; regular-drinking: AHR, 0.85; 95% CI, 0.74−0.98; p = 0.024), with baseline demographics and comorbidities adjusted. In conclusion, social and regular drinkers had decreased risk of chronic kidney disease when compared with non-drinkers.

BACKGROUND Although the HIV can cause myocardial inflammation, the association of HIV infection with subsequent development of heart failure (HF) has not been extensively studied. This nationwide cohort study aimed to determine the risk of incident HF in people living with HIV/AIDS (PLWHA). METHODS We identified PLWHA using the Taiwan Centers for Disease Control and Prevention HIV Surveillance System. An age- and sex-matched control group without HIV infection was selected from the Taiwan National Health Insurance Research Database for comparison. All patients were followed up until December 2014 and were observed for a new diagnosis of HF. A time-dependent Cox proportional hazards model was used to determine the association of HIV and highly active antiretroviral therapy with incident HF, with death as a competing risk event. RESULTS Of the 120,765 patients (24,153 PLWHA and 96,612 matched controls), 641 (0.53%) had incident HF during a mean follow-up period of 5.84 years, including 192 (0.79%) PLWHA and 449 (0.46%) controls. Time to diagnosis of incident HF was significantly shorter in PLWHA than in those without HIV infection (P < 0.001, the log-rank test). After adjusting for age, sex, and comorbidities, HIV infection was found to be an independent risk factor for incident HF (adjusted hazard ratio, 1.52; 95% confidence interval: 1.27 to 1.82). As the duration of highly active antiretroviral therapy increased, the risk of HF decreased (P = 0.014). CONCLUSIONS HIV infection was an independent risk factor for incident HF. Clinicians need to be aware of the higher risk of HF in PLWHA.

OBJECTIVE To identify factors associated with death before the start of anti-tuberculosis treatment, and early and late during treatment, among adult Taiwanese with culture-positive pulmonary tuberculosis (PTB). METHOD All adult culture-positive PTB patients in Taipei, Taiwan, were included in a retrospective cohort study in 2005-2010. RESULTS Of 4438 patients (mean age 64.6 years, 70.6% male), 76.8% were successfully treated, 5.4% died before start of treatment, 9.0% died within 8 weeks of treatment initiation and 8.8% died >8 weeks after treatment initiation. After controlling for potential confounders, age ≥ 65 years and male sex were associated with higher risks of death at all time periods investigated. High school education or higher reduced the risk of death before the start of and during treatment, while unemployment increased the risk of mortality during treatment. Cavity on chest X-ray and positivity for acid-fast bacilli were associated with lower risk of mortality before the start of treatment. CONCLUSION To lower mortality among adult culture-positive PTB patients, it is imperative for clinicians to maintain high awareness of TB and provide more intensive care early, especially for men, the elderly and people with lower socio-economic status (e.g., the unemployed and less educated).

Summary This study was undertaken to identify factors associated with unfavorable outcomes in patients with pulmonary tuberculosis (PTB) in Taipei, Taiwan in 2007–2008. Taiwanese adults with culture-positive PTB diagnosed in Taipei during the study period were included in this retrospective cohort study. Unfavorable outcomes were classified as treatment default, death, treatment failure, or transfer. Of 1616 eligible patients, 22.6% (365) had unfavorable outcomes, mainly death. After controlling for patient sociodemographic factors, clinical findings, and underlying disease, independent risk factors for unfavorable outcomes included advanced age, unemployment, end-stage renal disease requiring dialysis, malignancy, acid-fast bacilius smear–positivity, multidrug-resistant TB, and notification from ordinary ward or intensive care unit. In contrast, patients receiving directly observed treatment, and with a high school or higher education were significantly less likely to have unfavorable outcomes. This study advanced our understanding by revealing that a high school or higher education might lower the risk of an unfavorable outcome. Our results also confirmed the risk factors for unfavorable outcomes shown in previous research. Future TB control programmes in Taiwan should target particularly high-risk patients including those who had lower educational levels.

Echoing the advocates of deliberative methods sensitive to specific socio-political contexts, we designed the “civic groups forum” method and tested it in 2003 in Taiwan. Our goals were to design a participatory method that suited newly democratic countries and to engage people in discussing national health insurance premium reform in Taiwan. This innovative forum emphasized: (1) civic groups as the participants and (2) engaging a moderate number of participants. We combined and modified the methods of the consensus conference and deliberative polling to design the civic groups forum. Comprehensible reading materials, expert lectures, expert testimony, and group discussions were provided to enhance deliberative discussion of policy issues. A total of 74 group representatives from four types of civic groups—health care provider associations, labor unions, social welfare organizations, and patient organizations—participated. We conducted a before-and-after comparison to evaluate the method, using a self-administered questionnaire to collect data on participants' policy preferences, National Health Insurance policy literacy, comments, and socio-demographic characteristics. We also used in-depth interviews and participant observation to collect complementary information. After the forum, the social welfare and the patient organizations showed increased deliberation skills, empowerment, and confidence in policy involvement compared to the health care provider associations and the labor unions. We also found that when participants are civic group representatives, it is suitable to design an open-structured, early involvement, and participant-controlled format.

Summary Aims The purpose of this study was to perform a cross-sectional population-based study of hospitalised cases due to acute spinal trauma in Taiwan, based on information from the nationwide National Health Insurance (NHI) database. Methods To calculate the annual incidence of hospitalised acute spinal trauma, evaluate the distribution of neurological injury and its surgical intervention, and analyse the use of medical resources and related factors in Taiwan, the entire inpatient datasets were selected between 2000 and 2003 for use in the present study. Results There were 13,371, 13,800, 13,728 and 13,585 cases identified in 2000, 2001, 2002 and 2003, respectively, the average incidence of hospitalised acute spinal trauma in Taiwan was 61.61/100,000, and it was similar in both genders (rate ratio of male to female: 0.99). There was a significant trend of increased incidence with increasing age in both genders, particularly after the age of 60. The decreasing incidence rate ratios of neurological deficit to neurological intactness are 0.75, 0.58, 0.45, 0.26 and 0.16 in the age strata of 0–19, 20–39, 40–59, 60–79 and 80 or more years, respectively. In general, the operation rate is only 17.3% of all acute spinal injury cases, but it would be up to a significant 29.5% if the patients had spinal fractures with neurological insufficiency. There is an obvious decreasing trend of operation rate in spinal bony trauma with age, but a reverse trend is noted in the group with spinal nerve injury without spinal fracture. Finally, the enrolled subjects of acute spinal injuries spent $NT 43336.3 ± 80270.2 (equal to US$ 1313 ± 2432) and stayed for 8.5 ± 8.9 days in hospital. The above two variables of hospitalised medical utilisation are significantly different when considering gender, neurological status, and surgical intervention or not. Noticeably, if operative treatment for acute spinal injury is necessary, the LOS would increase by two times and the medical cost by six times. Conclusion In Taiwan, the annual incidence of hospitalised acute spinal injuries was higher but the direct cost was much lower. The characterisation of gender ratio, neurological condition, and surgical performance had been significantly effected by age.

Objective To investigate whether tobacco smoking increases the risk of tuberculosis (TB) recurrence and identify factors associated with TB recurrence among adults who had successfully completed anti-tuberculosis treatment in Taipei, Taiwan. Methods Recurrence was defined as a new clinical or microbiological diagnosis of TB requiring the start of a new course of treatment in a patient who had satisfactorily completed treatment for a previous TB episode. Cox proportional hazard models were used to calculate adjusted hazard ratios (aHRs) for recurrence. Results We followed 5567 adults for recurrence after successful anti-tuberculosis treatment. The mean age was 58.5 years; 62.9% were male. Overall, 84 (1.5%) had a recurrence of TB during follow-up. The incidence of TB recurrence was 4.9 episodes/1000 person-years of follow-up. Cox proportional hazards regression showed that after controlling for other variables, the risk of TB recurrence among subjects who smoked >10 cigarettes a day was double that of never/former smokers. Other independent risk factors significantly associated with TB recurrence were homelessness (aHR 3.75, 95%CI 1.17-12.07), presence of comorbidities (aHR 2.66, 95%CI 1.22-5.79) and a positive acid-fast bacilli smear (aHR 2.27, 95%CI 1.47-3.49). Conclusion Smoking >10 cigarettes a day was significantly associated with TB recurrence. To reduce the risk of recurrence, we recommend including effective measures of smoking cessation in TB control programmes, as recommended by the World Health Organization Stop TB Strategy.

Background A vast amount of the annual/national budget has been spent on the National Health Insurance program in Taiwan. However, the market for district hospitals has become increasingly competitive, and district hospitals are under pressure to optimize the use of health service resources. Therefore, we employed a clustering method to explore variations in input and output service volumes, and investigate resource allocation and health care service efficiency in district hospitals. Methods Descriptive and cluster analyses were conducted to examine the district hospitals included in the Ministry of Health and Welfare database during 2007–2011. Results The results, according to the types of hospital ownership, suggested that the number of public hospitals has decreased and that of private hospitals increased; the largest increase in the number of district hospitals occurred when Taichung City was merged into Taichung County. The descriptive statistics from 2007 to 2011 indicated that 43% and 36.4% of the hospitals had 501–800 occupied beds and 101–200 physicians, respectively, and > 401 medical staff members. However, the number of outpatients and discharged patients exceeded 6001 and 90,001, respectively. In addition, the highest percentage of hospitals (43.9%) had 30,001–60,000 emergency department patients. In 2010, the number of patients varied widely, and the analysis of variance cluster results were nonsignificant (p > 0.05). Conclusion District hospitals belonging to low-throughput and low-performance groups were encouraged to improve resource utilization for enhancing health care service efficiency.

Background Methadone treatment was introduced in Taiwan in 2006 as a harm-reduction program for injection drug users (IDUs), among whom HIV was endemic. We examined the association of HIV serostatus with demographic characteristics, substance use, and sexual behaviors among IDUs at methadone clinics in Taipei, Taiwan. Methods During 2012–2013, IDUs at methadone clinics in Taipei were recruited to complete a risk assessment interview and undergo serologic testing for HIV infection. Correlates of HIV infection were identified by multivariate logistic regression. Results Of the 827 eligible participants, 85.9% were male, median age was 45 years, and mean years of injecting was 18.0 (range 1–56). The prevalence of HIV infection was 17.7%. In multivariate analysis, HIV infection was significantly associated with age ≤45 years (adjusted odds ratio [AOR] = 1.62, 95% confidence interval [CI] 1.01–2.62), being divorced (AOR = 1.67, 95% CI 1.06–2.62), deriving the majority of income during the previous 6 months from temporary jobs or other noncriminal sources (AOR = 1.53, 95% CI 1.02–2.30), unstable housing during the previous 6 months (AOR = 1.47, 95% CI 1.003–2.15), higher number of incarcerations (AOR = 1.14, 95% CI 1.03–1.26), and a history of overdose (AOR = 1.51, 95% CI 1.01–2.28). Conclusions Taiwanese IDUs at methadone clinics have a relatively high HIV prevalence, which was associated with younger age and history of overdose. It is imperative to educate IDUs’ about HIV transmission, particularly for the younger and overdosed IDUs.

OBJECTIVES: To determine the effect of directly observed therapy (DOT) on tuberculosis-specific mortality and non-TB-specific mortality and identify prognostic factors associated with mortality among adults with culture-positive pulmonary TB (PTB). METHODS: All adult Taiwanese with PTB in Taipei, Taiwan were included in a retrospective cohort study in 2006-2010. Backward stepwise multinomial logistic regression was used to identify risk factors associated with each mortality outcome. RESULTS: Mean age of the 3,487 patients was 64.2 years and 70.4% were male. Among 2471 patients on DOT, 4.2% (105) died of TB-specific causes and 15.4% (381) died of non-TB-specific causes. Among 1016 patients on SAT, 4.4% (45) died of TB-specific causes and 11.8% (120) died of non-TB-specific causes. , After adjustment for potential confounders, the odds ratio for TB-specific mortality was 0.45 (95% CI: 0.30-0.69) among patients treated with DOT as compared with those on self-administered treatment. Independent predictors of TB-specific and non-TB-specific mortality included older age (ie, 65-79 and ≥80 years vs. 18-49 years), being unemployed, a positive sputum smear for acid-fast bacilli, and TB notification from a general ward or intensive care unit (reference: outpatient services). Male sex, end-stage renal disease requiring dialysis, malignancy, and pleural effusion on chest radiography were associated with increased risk of non-TB-specific mortality, while presence of lung cavities on chest radiography was associated with lower risk. CONCLUSIONS: DOT reduced TB-specific mortality by 55% among patients with PTB, after controlling for confounders. DOT should be given to all TB patients to further reduce TB-specific mortality.

Background Injecting drug users (IDUs) in Taiwan contributed significantly to an HIV/AIDS epidemic in 2005. In addition, studies that identified risk factors of HCV/HIV co-infection among IDUs were sparse. This study aimed to identify risk factors of HCV/HIV co-infection and HCV mono-infection, as compared with seronegativity, among injecting drug users (IDUs) at a large methadone maintenance treatment program (MMTP) in Taipei, Taiwan. Methods Data from enrollment interviews and HCV and HIV testing completed by IDUs upon admission to the Taipei City Hospital MMTP from 2006–2010 were included in this cross-sectional analysis. HCV and HIV testing was repeated among re-enrollees whose HCV or HIV test results were negative at the preceding enrollment. Backward stepwise multinomial logistic regression was used to identify risk factors associated with HCV/HIV co-infection and HCV mono-infection. Results Of the 1,447 IDUs enrolled, the prevalences of HCV/HIV co-infection, HCV mono-infection, and HIV mono-infection were 13.1%, 78.0%, and 0.4%, respectively. In backward stepwise multinomial regression analysis, after controlling for potential confounders, syringe sharing in the 6 months before MMTP enrollment was significantly positively associated with HCV/HIV co-infection (adjusted odds ratio [AOR]=27.72, 95% confidence interval [CI] 13.30–57.76). Incarceration was also significantly positively associated with HCV/HIV co-infection (AOR=2.01, 95% CI 1.71–2.37) and HCV mono-infection (AOR=1.77, 95% CI 1.52–2.06), whereas smoking amphetamine in the 6 months before MMTP enrollment was significantly inversely associated with HCV/HIV co-infection (AOR=0.44, 95% CI 0.25–0.76) and HCV mono-infection (AOR=0.49, 95% CI 0.32–0.75). HCV seroincidence was 45.25/100 person-years at risk (PYAR; 95% CI 24.74–75.92/100 PYAR) and HIV seroincidence was 0.53/100 PYAR (95% CI 0.06–1.91/100 PYAR) among re-enrolled IDUs who were HCV- or HIV-negative at the preceding enrollment. Conclusions IDUs enrolled in Taipei MMTPs had very high prevalences of HCV/HIV co-infection and HCV mono-infection. Interventions such as expansion of syringe exchange programs and education regarding HCV/HIV prevention should be implemented for this high-risk group of drug users.

Background The tuberculosis reporting enquiry system was launched in Taiwan in 2001. Tuberculosis has been categorized as the third most important notifiable disease in Taiwan and the time required for reporting has been shortened to 7 days. Methods A total of 114,827 cases were reported using the Taiwan enquiry system between 2002 and 2006; of these, 26,027 (22.7%) were finally diagnosed as not being tuberculosis, 7,005 (8.2%) were diagnosed as extra-pulmonary tuberculosis and 3,677 (3.2%) were not a first-time diagnosis of tuberculosis, and these cases were hence excluded. Diagnosis time was defined as the length of time between the first medical examination (including chest radiography, sputum smear or sputum culture) to the diagnosis of PTB; treatment time was defined as the period from the diagnosis of PTB to the initiation of treatment. Using the cut-off at the 75th percentile, a period of longer than 9 days was defined as a diagnosis delay and a period of longer than 2 days as a treatment delay. Multiple logistic regression analysis was applied to analyze the risk factors associated with these delays. Results During the five-year study period, among the 78,118 new PTB patients reported in Taiwan, the mean diagnosis and treatment times were 12 and 5 days and the median times 1 day and 0 days, respectively. In total, 24.9% of the new PTB patients' diagnosis time delays were longer than 9 days and 20.3% of the patients' treatment time delays were longer than 2 days. The main factors associated with diagnosis delay included age, reporting year, living with family and a positive sputum culture (p < 0.0001); the risk factors significantly associated with treatment delay were increased age, an aboriginal ethnic background, a positive sputum culture and diagnosis at a non-medical center (p < 0.0001). Conclusion The Taiwan TB reporting enquiry system has successfully increased the confirmed PTB reporting rate from 64.4% to 71.5%. Greater age and a positive sputum culture were both found to significantly increase both diagnosis and treatment delays; treatment delay is also significantly affected by the patient having an aboriginal ethnic background and being diagnosed at a non-medical center.

The increased rate of cesarean deliveries may be partly due to a lack of consumer knowledge. Assuming that physicians and their relatives are well informed of the risks and benefits associated with the different methods of delivery, our goal was to compare cesarean rates between female physicians, female relatives of physicians, and women with high socioeconomic status in Taiwan.Two subgroups of 588 female physicians and 5,021 relatives of physicians aged 20 to 50 years were compared with 93,737 pregnant women with a monthly wage 40,000 dollars New Taiwan (NT) dollars or more as identified in nationwide National Health Insurance databases of Taiwan from 2000 to 2003.Female physicians (adjusted odds ratio 0.66; 95% CI 0.47, 0.93) and female relatives of physicians (adjusted odds ratio 0.84; 95% CI 0.74, 0.95) were significantly less likely to undergo a cesarean section than other high socioeconomic status women, adjusted for clinical and nonclinical factors.In this study, the cesarean delivery rate was lower among women who may have greater access to medical knowledge. However, the lower rates observed among female physicians and physician relatives in Taiwan are still considerably higher than the national averages of many countries. This finding suggests that other than information, practice patterns, and social and cultural milieu may play a role.

Approximately 9.24% of the Taiwanese population is aged 65 years or older. Among them, osteoporosis is a major problem, along with it associated age-related fractures. We investigated the prevalence of osteoporosis in 1996-2001 by sampling Taiwan's National Health Insurance (NHI) database. Data from 102,763 men (51.27%) and 97,654 women (48.73%) were evaluated. In this cohort, osteoporosis was recorded in each yearly dataset if the codes 733.0 or 733.00-733.09 were found on a search of the administrative or outpatient sub-databanks. A stable estimated prevalence of osteoporosis was calculated according to Taiwan's NHI sampling data from 1999 to 2001. The results showed a trend toward increasing proportions of coded osteoporosis with age, more predominantly in the female population. The averaged prevalence of osteoporosis, between 1999 and 2001, in those aged > or = 50 years was 1.63% for men and 11.35% for women. These estimates were lower than those reported elsewhere for Taiwan and for Japan but more equal to that in the Mexican American sub-population of the United States. In conclusion, the prevalence of osteoporosis is underestimated in the NHI database. Policymakers should be aware of this finding and allocate resources accordingly.

Background Traditional Chinese medicine (TCM) has remained an integral part of Chinese culture and society for thousands of years. In Taiwan TCM is a recognized element of its National Health Insurance Scheme. However, there is no knowledge about how TCM is accessed by foreign workers from a non-Asian cultural background. The objectives of this study were to investigate the prevalence and patterns of TCM use among non-Asian white-collar workers living in Taiwan, and examine factors likely to influence their use of TCM. Methods This study applied a cross-sectional survey design. A total of 207 white-collar foreign workers of a non-Asian background currently holding National Health Insurance cards who had lived in Taiwan for 4 months or more participated in this study. Results The prevalence of TCM use was 45%. The most frequently used therapies were traditional Chinese herbs/medicine and acupuncture. Factors indicating the likelihood of TCM usage were age 31–40 years, visit to an allopathic medical doctor in the last year, ability to read Chinese, having a friend or family member available to assist in the use of TCM, and access to information about TCM services available in Taiwan. Conclusion Utilization of TCM by people of a non-Asian background living in Taiwan appears to be most influenced by enabling factors including language ability, access to information, and informal reference persons.

Background Health-related quality of life (HRQOL) is widely used as an indicator of health status. However, few studies have examined predictors of HRQOL among injection drug users (IDUs). We investigated factors associated with HRQOL among IDUs in Taiwan. Methods In this cross-sectional study, recruited IDUs completed an HRQOL-related interview at methadone clinics in Taipei during 2012–2013. Multiple linear regression was used to identify factors associated with HRQOL. Results Of 802 eligible participants, 85.4% were male; mean (SD) age was 44.7 (8.7) years. Mean scores for physical, psychological, social, and environmental HRQOL were 13.2, 11.8, 12.5, and 12.5, respectively. In multivariate analysis, social support was significantly associated with better HRQOL in all domains (β = 0.56, 0.87, 0.83, and 0.64, respectively), while obtaining most income from temporary jobs or other noncriminal sources was significantly associated with worse HRQOL in all domains (β = −1.00, −1.03, −1.15, and −1.22, respectively). Receiving methadone treatment was associated with good physical and psychological HRQOL (β = 1.47 and 0.79, respectively), while history of drug overdose (β = −0.40 and −0.53, respectively), history of cutaneous abscess (β = −0.45 and −0.53, respectively), and human immunodeficiency virus (HIV) positivity (β = −0.41 and −0.58, respectively) were associated with lower physical and psychological HRQOL. Male sex (β = −0.64 and −0.70, respectively) and a greater number of incarcerations (β = −0.11 and −0.12, respectively) were associated with poor social and environmental HRQOL. Conclusion Poor HRQOL was associated with a number of factors among IDUs at methadone clinics in Taipei, Taiwan. To improve HRQOL in this population, future programs should focus on IDUs with a history of drug overdose. In addition, methadone programs and social support should be integrated to improve HRQOL among this socially marginalized population.