The effects of diabetes, hypertension and subsequent health control behavior on the survival of a Taiwan cohort aged over 50 years.

Purpose: This study used the Taiwan Longitudinal Study in Aging from 1996 to 2011 to investigate the effects of diabetes, hypertension, and healthy living behaviors of those aged over 50 years on the survival status in Taiwan. Methods: Among the 5,131 participants aged 50 years and above in the 1996 survey were included in this study. Cox's proportional hazards model was used to examine the incidence of diabetes, hypertension, and related mortality risk in those aged over 50 years. Results: After adjusting for age, gender, education level, diabetes, hypertension, health behavior, and leisure activity, results from the Cox model show that the elderly without diabetes have a lower mortality risk than those with diabetes. Regular exercise was associated with a lower risk of mortality. The hazard ratios of elderly with regular exercise were 0.78 (95 % CI: 0.64-0.96) for two times a week or less, 0.81 (95 % CI: 0.69-0.96) for 3-5 times a week, and 0.84 (95 % CI: 0.77-0.93) for 6 + times a week, respectively. On the other hand, leisure activity positively reduces mortality risk. For example, the hazard ratios of the elderly with watching TV and reading were 0.63 (95 % CI: 0.55-0.72) and 0.80 (95 % CI: 0.72-0.89), respectively. Moreover, smoking can increase mortality risk 23 % whether the elderly are with diabetes or hypertension or not. Conclusions: Regarding preventing and controlling chronic diseases in the future, continuously encouraging improvement in health behavior and engaging in leisure activities for the middle-aged and over should be considered essential markers.

The benefits of leisure activities on healthy life expectancy for older people with diabetes.

PURPOSE: The purpose of this study is to examine whether leisure activities can help reduce years lived with disability and increase healthy life expectancy of diabetics aged 50 years and above. METHODS: Analysis was based on five waves of follow-up survey data (Taiwan Longitudinal Study of Aging, TLSA) from 1996 to 2011. A total of 5131 participants aged 50 years and above in 1996 were included in the analysis, and gender, leisure activity participation, and diabetes mellitus were used as primary variables to examine the variation trend in health status in the participants. The health status in the various waves of surveys was measured using the activities of daily living scale, and nondisabled was defined as healthy. A multivariate logistic regression model was used to calculate the life expectancy (LE) and healthy life expectancy (HLE) of the people aged 50 years and above. RESULTS: The diabetes older people with a high frequency of leisure activities have longer HLE than those with lower activity frequency. Using 50-year-old diabetic women as an example, the LE (HLE) of those with six or more leisure activities and those with three or fewer leisure activities was 30.40 (25.34) and 24.90 (20.87), respectively. The LE (HLE) of men with the same conditions was 24.79 (22.68) and 20.30 (18.45), respectively. CONCLUSIONS: This study used life expectancy and healthy life expectancy as markers to evaluate health benefits and provided evidence that leisure activities can help extend the life span and maintain the health status of middle-aged and older diabetics.

A Study on Decision-Making for Improving Service Efficiency in Hospitals.

The provision of efficient healthcare services is essential, driven by the increasing demand for healthcare resources and the need to optimize hospital operations. In this context, the motivation to innovate and improve services while addressing urgent concerns is critical. Hospitals face challenges in managing internal dispatch services efficiently. Outsourcing such services can alleviate the burden on hospital staff, reduce costs, and introduce professional expertise. However, the pressing motivation lies in enhancing service quality, minimizing costs, and exploring innovative approaches. With the rising demand for healthcare services, there is an immediate need to streamline hospital operations. Delays in internal transportation services can have far-reaching implications for patient care, necessitating a prompt and effective solution. Drawing upon dispatch data from a healthcare center in Taiwan, this study constructed a decision-making model to optimize the allocation of hospital service resources. Employing simulation techniques, we closely examine how hospital services are currently organized and how they work. In our research, we utilized dispatch data gathered from a healthcare center in Taichung, Taiwan, spanning from January 2020 to December 2020. Our findings underscore the potential of an intelligent dispatch strategy combined with deployment restricted to the nearest available workers. Our study demonstrates that for cases requiring urgent attention, delay rates that previously ranged from 5% to 34% can be notably reduced to a much-improved 3% to 18%. However, it is important to recognize that the realm of worker dispatch remains subject to a multifaceted array of influencing factors. It becomes evident that a comprehensive dispatching mechanism must be established as part of a broader drive to enhance the efficiency of hospital service operations.

IOX-1 suppresses metastasis of osteosarcoma by upregulating histone H3 lysine trimethylation.

New therapeutic approaches are needed for metastatic osteosarcoma (OS), as survival rates remain low despite surgery and chemotherapy. Epigenetic changes, such as histone H3 methylation, play key roles in many cancers including OS, although the underlying mechanisms are not clear. In this study, human OS tissue and OS cell lines displayed lower levels of histone H3 lysine trimethylation compared with normal bone tissue and osteoblast cells. Treating OS cells with the histone lysine demethylase inhibitor 5-carboxy-8-hydroxyquinoline (IOX-1) dose-dependently increased histone H3 methylation and inhibited cellular migratory and invasive capabilities, suppressed matrix metalloproteinase expression, reversed epithelial-to-mesenchymal transition by increasing levels of epithelial markers E-cadherin and ZO-1 and decreasing the expression of mesenchymal markers N-cadherin, vimentin, and TWIST, and also reduced stemness properties. An analysis of cultivated MG63 cisplatin-resistant (MG63-CR) cells revealed lower histone H3 lysine trimethylation levels compared with levels in MG63 cells. Exposing MG63-CR cells to IOX-1 increased histone H3 trimethylation and ATP-binding cassette transporter expression, potentially sensitizing MG63-CR cells to cisplatin. In conclusion, our study suggests that histone H3 lysine trimethylation is associated with metastatic OS and that IOX-1 or other epigenetic modulators present promising strategies to inhibit metastatic OS progression.

Assessing the risks of children with preoperative comorbidities undergoing comminuted fracture surgery.

Introduction: Comminuted fractures are characterized by bones broken in at least two places, destabilizing the bone and requiring surgery. Children whose bones are still developing and maturing tend to have a higher risk of sustaining comminuted fractures as the result of trauma. Trauma is a major cause of death in children and constitutes a major issue in orthopedics because of the unique properties of children's bones compared to adult bones and the associated complications. Methods: This retrospective, cross-sectional study aimed to refine the association between comorbid disease and comminuted fractures in pediatric subjects using a large, national database. All data were extracted from the National Inpatient Sample (NIS) database from 2005 to 2018. Logistic regression analysis was used to evaluate associations between comorbidities and comminuted fracture surgery and between various comorbidities and LOS or unfavorable discharge. Results: A total of 2,356,483 patients diagnosed with comminuted fractures were selected initially, of whom 101,032 patients aged younger than 18 years who underwent surgery for comminuted fractures were included. Study results suggest that patients with any comorbidities undergoing orthopedic surgery for comminuted fracture appear to have longer LOS and a higher proportion of discharge to long-term care facilities. Discussion: Almost all comorbidities were significantly associated with poor in-hospital outcomes and longer LOS. The analysis of comminuted fractures in children may provide useful information to help first responders and medical personnel evaluate and manage comminuted fractures appropriately.

Cryptocaryone induces apoptosis in human hepatocellular carcinoma cells by inhibiting aerobic glycolysis through Akt and c-Src signaling pathways.

Hepatocellular carcinoma (HCC) is the most common form of liver cancer, with the second highest mortality rate in all cancer. Energy reprogramming is one of the hallmarks of cancer, and emerging evidence showed that targeting glycolysis is a promising strategy for HCC treatment. Cryptocaryone has been shown to display promising anti-cancer activity against numerous types of cancer. Previous study also indicated that cryptocaryone induces cytotoxicity by inhibiting glucose transport in cancer cells, but the detailed mechanism still needs to be elucidated. Therefore, this study aimed to investigate the relationship between the anti-cancer effect and glycolytic metabolism of cryptocaryone in human HCC cells. In this study, we found that cryptocaryone potently induced growth inhibition by apoptotic cell death in HCC cells. Cryptocaryone also suppressed the ATP synthesis, lactate production and glycolytic capacity of HCC cells. Mechanistic investigations showed that phosphorylation of Akt and c-Src, as well as the expression of HK1 were impeded by cryptocaryone. Moreover, cryptocaryone markedly increased the expression level of transcription factor FoxO1. Importantly, clinical database analysis confirmed the negative correlation between HK1 and FoxO1. High expression levels of HK-1 were positively correlated with poorer survival in patients with HCCs. These results suggest that cryptocaryone may promote cell apoptosis by inhibiting FoxO1-mediated aerobic glycolysis through Akt and c-Src signaling cascades in human HCC cells. This is the first study to indicate that cryptocaryone exerts anti-cancer property against human HCC cells. Cryptocaryone is a potential natural product worthy of further development into a promising candidate for HCC treatment.

Event History Analysis of Factors Affecting Survival of Older Adults in Taiwan.

(1) Background: Due to rapidly increasing average age of Taiwan's population, it is very important to analyze the factors affecting the survival of older adults. (2) Methods: In this study, the 1989 Taiwan Longitudinal Study on Aging, which lasted 22 years and consisted of seven surveys, was used. Furthermore, Cox and Aalen's time-dependent frailty models were used to analyze factors that affect the survival of older adults. (3) Results: Based on past literature, we selected 15 important factors that were closely associated with the survival of older adults and constructed six models based on these factors. The study results showed that, in addition to background characteristics, physical and mental conditions, activities of daily living (ADL), physical performance, and self-rated health had a huge association with the survival of older adults. (4) Conclusions: We selected ten variables (age, gender, population, education level, ADL status, physical performance, self-rated health, smoking, chewing betel nut, and the presence of a spouse), and their combinations were used to generate reduced models, which could be considered as important markers that affect and predict the survival of older adults.

Surgical Strategy to Decrease the Revision Rate of Fassier-Duval Nailing in the Lower Limbs of Osteogenesis Imperfecta.

(1) Background: The Fassier−Duval (FD) nail was developed for the treatment of osteogenesis imperfecta (OI). The aim of this study was to review the results of OI patients treated with the FD nail at our institution and discuss a surgical strategy to decrease the FD nail revision rate; (2) Methods: We retrospectively reviewed OI patients treated at our institution between 2015 and 2020. OI patients treated with FD nail insertion in the long bones of the lower extremities were included, and those with a follow-up duration <1 year or incomplete radiographs were excluded. Data on the type of OI, age, sex, use of bisphosphonate treatment, and nail failure were recorded; (3) Results: The final cohort consisted of seven patients (three females and four males) with ten femurs and ten tibiae involved. Six of the patients had type III OI, and one had type IV OI. An exchange of implant was required in 11 limbs. The average interval between previous FD nail insertion and revision surgery was 2.4 years; (4) Discussion: The main reasons for revision surgery were migration of the male/female component, refracture/nail bending, and delayed union. In the femur, migration of the female component or nail bending were common reasons for failure, while migration of the male component and delayed union were common in the tibia; (5) Conclusions: Surgery for OI patients is challenging, and physicians should aim to minimize complications and the need for revision. Sufficient depth of purchase, center−center nail position, and adequate osteotomy to correct bowing are the key factors when using the FD nail.

A Comparison of Rehospitalization Risks on Diabetic and Non-Diabetic Patients after Recovery from Acute Coronary Syndrome.

BACKGROUND: The purpose of this study is to investigate whether the risks of rehospitalization caused by acute coronary syndrome (ACS) or stroke would have significant differences between diabetic and non-diabetic patients from ACS. METHODS: This was a retrospective study of 364 inpatients with ACS from 2017 to 2019. Logistic regression models included gender, age group, and the principal diagnosis of hospitalization as controlling variables which were used to analyze the dataset. RESULTS: About 10% of patients are hospitalized after recovery. Moreover, regardless of suffering from diabetes, the risk of rehospitalization does not appear to show a significant difference. In comparison with non-diabetic patients, the odds ratio of rehospitalization of diabetic patients was 0.94 (95% CI: 0.46-1.93, p-value = 0.8639) after controlling for the effects of gender, age group, and the principal diagnosis of hospitalization. CONCLUSIONS: Diabetic patients seem to perform well in controlling LDL-C (low-density lipoprotein cholesterol) after ACS recoveries.

4-Acetylantroquinonol B Suppresses Prostate Cancer Growth and Angiogenesis via a VEGF/PI3K/ERK/mTOR-Dependent Signaling Pathway in Subcutaneous Xenograft and In Vivo Angiogenesis Models.

Prostate cancer is a major cause of cancer-related mortality in men in developed countries. The compound, 4-acetylantroquinonol B (4AAQB), is isolated from Antrodia cinnamomea (commonly known as Niu-Chang-Chih), which has been shown to inhibit cancer growth. However, the anticancer activity of 4AAQB has not previously been examined in prostate cancer. This study aimed to investigate the effect of 4AAQB on cancer and angiogenesis, as well as to explore its mechanism of action. Human prostate cancer cells (PC3) and human umbilical vein endothelial cells (HUVEC) were used in cell viability, cell migration, and cell cycle functional assays to evaluate the anticancer and antiangiogenic efficacy of 4AAQB in vitro. The effects of 4AAQB in vivo were determined using xenograft and angiogenesis models. The signaling events downstream of 4AAQB were also examined. The 4AAQB compound inhibited PC3 cell growth and migration, and reduced in vivo cancer growth, as shown in a subcutaneous xenograft model. Furthermore, 4AAQB inhibited HUVEC migration, tube formation, and aortic ring sprouting; it also reduced neovascularization in a Matrigel implant angiogenesis assay in vivo. The 4AAQB compound also decreased metastasis in the PC3 prostate cancer model in vivo. Serum or vascular endothelial growth factor (VEGF)-induced VEGF receptor 2 (VEGFR2), phosphoinositide 3-kinase (PI3K)/Ak strain transforming (Akt), and extracellular signal-regulated kinase ½ (ERK ½) phosphorylation were attenuated by 4AAQB in both PC3 and HUVEC. In conclusion, 4AAQB is a potential candidate for prostate cancer therapy.

Impact on Patient Safety Culture by the Intervention of Multidisciplinary Medical Teams.

OBJECTIVE: To provide comprehensive patient-centered care, we need multidisciplinary teams to face challenges of advanced and complex care. The Taichung Veterans General Hospital has had a ward-based multidisciplinary team system in each ward for 10 years. This study aimed to investigate whether better team performance results in a more positive response in patient safety culture (PSC). DESIGN/SETTING: From 2014 to 2017, there were 21 ward-based multidisciplinary teams. We organized an evaluation panel to assess the performance of the teams. Those teams were divided into 3 groups: high, medium, and low according to their annual performance scores. The Taichung Veterans General Hospital used annual Safety Attitude Questionnaire-based surveys concerning patient safety issues. We used the generalized estimating equation to analyze the dataset over 4 years. All analyses were carried out using SAS Version 9.4 (SAS Institute, Cary, NC). RESULTS: Taking the trend effects from 2014 to 2017 into account, we found that teamwork climate, safety climate, and perception of management were significantly better in the high and medium groups of the ward-based multidisciplinary teams. There was no significant difference in the dimensions of job satisfaction, stress recognition, and working conditions, which suggests that all staff had the same degree of stress or work loading. CONCLUSIONS: Our ward-based multidisciplinary team system had a positive effect on PSC, which demonstrates the following: when team performance is better, patient safety climate is also better. We should keep the ward-based multidisciplinary team system, improve its performance, and maximize positive attitudes about PSC among our staff.

Cardiac Arrest Survival Postresuscitation In-Hospital (CASPRI) Score Predicts Neurological Favorable Survival in Emergency Department Cardiac Arrest.

BACKGROUND: This study was conducted to identify the predictive factors for survival and favorable neurological outcome in patients with emergency department cardiac arrest (EDCA). METHODS: ED patients who suffered from in-hospital cardiac arrest (IHCA) from July 2014 to June 2019 were enrolled. The electronic medical records were retrieved and data were extracted according to the IHCA Utstein-style guidelines. RESULTS: The cardiac arrest survival post-resuscitation in-hospital (CASPRI) score was associated with survival, and the CASPRI scores were lower in the survival group. Three components of the CASPRI score were associated with favorable neurological survival, and the CASPRI scores were lower in the favorable neurological survival group of patients who were successfully resuscitated. The independent predictors of survival were presence of hypotension/shock, metabolic illnesses, short resuscitation time, receiving coronary angiography, and TTM. Receiving coronary angiography and low CASPRI score independently predicted favorable neurological survival in resuscitated patients. The performance of a low CASPRI score for predicting favorable neurological survival was fair, with an AUROCC of 0.77. CONCLUSIONS: The CASPRI score can be used to predict survival and neurological status of patients with EDCA. Post-cardiac arrest care may be beneficial for IHCA, especially in patients with EDCA.

WISP-3 Stimulates VEGF-C-Dependent Lymphangiogenesis in Human Chondrosarcoma Cells by Inhibiting miR-196a-3p Synthesis.

Chondrosarcoma is a malignant bone tumor with high metastatic potential. Lymphangiogenesis is a critical biological step in cancer metastasis. WNT1-inducible signaling pathway protein 3 (WISP-3) regulates angiogenesis and facilitates chondrosarcoma metastasis, but the role of WISP-3 in chondrosarcoma lymphangiogenesis is unclear. In this study, incubation of chondrosarcoma cells with WISP-3 increased the production of VEGF-C, an important lymphangiogenic factor. Conditioned medium from WISP-3-treated chondrosarcoma cells significantly enhanced lymphatic endothelial cell tube formation. WISP-3-induced stimulation of VEGF-C-dependent lymphangiogenesis inhibited miR-196a-3p synthesis in the ERK, JNK, and p38 signaling pathways. This evidence suggests that the WISP-3/VEGF-C axis is worth targeting in the treatment of lymphangiogenesis in human chondrosarcoma.

Factors associated with risk of major adverse cardiovascular events in patients with rheumatoid arthritis: a nationwide, population-based, case-control study.

OBJECTIVES: To investigate factors associated with major adverse cardiovascular events (MACEs) in patients with rheumatoid arthritis (RA). METHODS: We conducted a nationwide, population-based, case-control study using Taiwan's National Health Insurance Research Database for 2003-2013. From 2004 to 2012, we identified 108,319 newly diagnosed RA patients without previous MACEs, of whom 7,580 patients (7.0%) developed MACEs during follow-up. From these incident RA patients, we included 5,994 MACE cases and 1:4 matched 23,976 non-MACE controls for analysis. The associations of MACEs with comorbidities and use of anti-rheumatic medications within 1 year before the index date were examined using conditional logistic regression analyses. RESULTS: Using multivariable conditional logistic regression analysis, the risk of MACE in RA patients was associated with use of golimumab [odd's ratio (OR), 0.09; 95% confidence interval (CI), 0.01-0.67], abatacept (OR, 0.13; 95% CI, 0.02-0.93), hydroxychloroquine (OR, 0.90; 95% CI, 0.82-0.99), methotrexate (OR, 0.72; 95% CI, 0.64-0.81), cyclosporin (OR, 1.43; 95% CI, 1.07-1.91), nonsteroidal anti-inflammation drugs (NSAIDs) (OR, 1.36; 95% CI, 1.27-1.46), antiplatelet agent (OR, 2.47; 95% CI, 2.31-2.63), hypertension (without anti-hypertensive agents: OR, 1.04; 95% CI, 0.96-1.12; with anti-hypertensive agents: OR, 1.47; 95% CI, 1.36-1.59), diabetes (OR, 1.27; 95% CI, 1.18-1.37), hyperlipidemia without lipid-lowering agents (OR, 1.09; 95% CI, 1.01-1.17), ischemic heart disease (OR, 1.20; 95% CI, 1.10-1.31), and chronic obstructive pulmonary disease (COPD) (OR, 1.12; 95% CI, 1.03-1.23) in the parsimonious model. The risk of MACE in RA patients also increased markedly in participants younger than 65 years with some comorbidities. CONCLUSIONS: This population-based case-control study revealed that the use of golimumab, abatacept, hydroxychloroquine, and methotrexate were associated with a decreased risk of MACE development in newly diagnosed RA patients, while the use of cyclosporin, NSAIDs, and antiplatelet agents, and comorbidities, including hypertension, diabetes, hyperlipidemia without lipid-lowering agent therapy, ischemic heart disease, and COPD, were associated with an increased risk of MACE development in RA patients.

Moscatilin Inhibits Metastatic Behavior of Human Hepatocellular Carcinoma Cells: A Crucial Role of uPA Suppression via Akt/NF-κB-Dependent Pathway.

Hepatocellular carcinoma (HCC) frequently shows early invasion into blood vessels as well as intrahepatic metastasis. Innovations of novel small-molecule agents to block HCC invasion and subsequent metastasis are urgently needed. Moscatilin is a bibenzyl derivative extracted from the stems of a traditional Chinese medicine, orchid Dendrobium loddigesii. Although moscatilin has been reported to suppress tumor angiogenesis and growth, the anti-metastatic property of moscatilin has not been elucidated. The present results revealed that moscatilin inhibited metastatic behavior of HCC cells without cytotoxic fashion in highly invasive human HCC cell lines. Furthermore, moscatilin significantly suppressed the activity of urokinase plasminogen activator (uPA), but not matrix metalloproteinase (MMP)-2 and MMP-9. Interestingly, moscatilin-suppressed uPA activity was through down-regulation the protein level of uPA, and did not impair the uPA receptor and uPA inhibitory molecule (PAI-1) expressions. Meanwhile, the mRNA expression of uPA was inhibited via moscatilin in a concentration-dependent manner. In addition, the expression of phosphorylated Akt, rather than ERK1/2, was inhibited by moscatilin treatment. The expression of phosphor-IκBα, and -p65, as well as κB-luciferase activity were also repressed after moscatilin treatment. Transfection of constitutively active Akt (Myr-Akt) obviously restored the moscatilin-inhibited the activation of NF-κB and uPA, and cancer invasion in HCC cells. Taken together, these results suggest that moscatilin impedes HCC invasion and uPA expression through the Akt/NF-κB signaling pathway. Moscatilin might serve as a potential anti-metastatic agent against the disease progression of human HCC.

Incidence and treatment of adult femoral fractures with osteogenesis imperfecta: An analysis of a center of 72 patients in Taiwan.

Background: Osteogenesis imperfecta (OI) is a rare disease characterized by increased bone fragility and susceptibility for fractures. Only few studies have compared the management for femoral fractures in children with OI. Nevertheless, no cohort studies have described the treatment for femoral fractures in adults with OI in Taiwan. This study aimed to investigate and compare the incidence of union and non-union femoral fractures and the best treatment options to avoid non-union fractures. Methods: We enrolled 72 patients with OI who were older than 18 years at MacKay Memorial Hospital between January 2010 and December 2018. Femoral fracture incidence, non-union rate, and treatment modality were analyzed. Results: Of 72 patients with OI, 11 patients had femoral fractures and 4 patients of them had >1 femoral fracture. The incidence for all types of femoral fractures was 651 fractures per 100,000 person-years annually. In 15 total fractures, 4 fractures resulted in non-union, and patients with type 4 OI mostly had shaft fractures. The best outcomes for non-union shaft fracture is achieved by surgical treatment. Conclusion: Adults with OI tended to develop femoral fractures and non-unions. Adults with type 4 OI were particularly at high risk for non-unions in shaft fractures with conservative treatment.

Factors Related to Diabetes Mellitus in the Middle-Aged and Over in Taiwan.

Study Objective: to investigate the factors related to diabetes mellitus in the middle-aged and over in Taiwan. Method: data from seven surveys (in 1989-2011) from the "Taiwan Longitudinal Study on Aging" (TLSA), among cohort B (above the age 60 in 1989), cohort A (aged 50-66 in 1996), and cohort C (aged 50-66 in 2003), were analyzed by the interval-censored Cox model. Results: in the early aging stage (aged 60-64), diabetes mellitus prevalence among the same age appeared the lowest in cohort B, followed by cohort A; cohort C reveals the highest than the young generation. Moreover, suffering from hypertension and kidney diseases are closely related to diabetes mellitus, with the diabetes mellitus suffering hazard ratio of 2.53 (95%: 2.35, 2.73) and 1.26 (95%: 1.11, 1.44) times, respectively. For people with fair and poor self-rated health, the risk of suffering from diabetes mellitus is 1.16 (95%: 1.07, 1.27) and 1.50 (95%: 1.35, 1.67) times compared to people with good self-rated health, respectively. Conclusions: in this study, it is considered that an advanced interval censoring model analysis could more accurately grasp the characteristics of factors in people who are middle-aged and over suffering from diabetes mellitus in Taiwan.

Healthy Life Expectancies by the Effects of Hypertension and Diabetes for the Middle Aged and Over in Taiwan.

(1) Introduction: This study aims to investigate the disparity in the healthy life expectancy of the elderly with hypertension and diabetes mellitus. (2) Materials and Methods: This study used survey data collected in five waves (1996, 1999, 2003, 2007, and 2011) of the "Taiwan Longitudinal Study on Aging" (TLSA) to estimate the life expectancy and healthy life expectancy of different age groups. The activities of daily living, the health condition of hypertension and diabetes and the survival statuses of these cases were analyzed by the IMaCh (Interpolated Markov Chain) and logistic regression model. (3) Results: As regards the elderly between age 50 and 60 with hypertension and diabetes, women with hypertension only exhibited the longest life expectancy, and the healthy life expectancy and the percentage of remaining life with no functional incapacity were 33.74 years and 87.11%, respectively. In contrast, men with diabetes only showed the shortest life expectancy, and the healthy life expectancy and the percentage of remaining life with no functional incapacity were 22.51 years and 93.16%, respectively. We also found that people with diabetes showed a lower percentage of remaining life with no functional incapacity. (4) Conclusions: We suggest that policymakers should pay special attention to publicizing the importance of health control behavior in order to decrease the risk of suffering diseases and to improve the elderly's quality of life.

Adjusting Daily Inpatient Bed Allocation to Smooth Emergency Department Occupancy Variation.

STUDY OBJECTIVE: Overcrowding in emergency departments (ED) is an increasingly common problem in Taiwanese hospitals, and strategies to improve efficiency are in demand. We propose a bed resource allocation strategy to overcome the overcrowding problem. METHOD: We investigated ED occupancy using discrete-event simulation and evaluated the effects of suppressing day-to-day variations in ED occupancy by adjusting the number of empty beds per day. Administrative data recorded at the ED of Taichung Veterans General Hospital (TCVGH) in Taiwan with 1500 beds and an annual ED volume of 66,000 visits were analyzed. Key indices of ED quality in the analysis were the length of stay and the time in waiting for outward transfers to in-patient beds. The model is able to analyze and compare several scenarios for finding a feasible allocation strategy. RESULTS: We compared several scenarios, and the results showed that by reducing the allocated beds for the ED by 20% on weekdays, the variance of daily ED occupancy was reduced by 36.25% (i.e., the percentage of reduction in standard deviation). CONCLUSIONS: This new allocation strategy was able to both reduce the average ED occupancy and maintain the ED quality indices.