Characteristics of Clinics without National Health Insurance Contracts: A Nationwide Survey in Taiwan.

Based on the 1978 Alma-Ata Declaration, the key to achieving health for all is primary health care, and many countries have established various comprehensive health care systems. Because of the financial toll of a public health care system, government-sponsored public health insurance is not universally accepted. This study used Taiwan as the backdrop to understand why many health clinics have chosen not to accept the National Health Insurance (NHI), despite it covering 99.93% of the country's population. The clinics' operational details were garnered from the datasets of Taiwan's open government data platforms and checked against the list of contracting clinics within the NHI. Of 10,907 Western medicine primary care clinics in 2016, as many as 9846 (90.3%) clinics had signed contracts with the NHI. The remaining 1061 noncontracting clinics were distributed in urban (94.5%, n = 1003), suburban (4.9%, n = 52), and rural/remote areas (0.6%, n = 6). The NHI did not have contracts with 183 plastic surgery, 88 internal medicine, and 85 surgery clinics. In conclusion, nearly one-tenth of clinics practiced independently of the NHI in Taiwan. Their reasons for declining the contract and practices for delivering their services deserve further studies.

Analysis of community-acquired COVID-19 cases in Taiwan.

BACKGROUND: The demographic characteristics and transmission dynamics of the community-acquired coronavirus disease 2019 (COVID-19) cases in Taiwan were analyzed for more effective control and prevention of the community transmission of this novel disease. METHODS: Open-access data and press releases on COVID-19 in Taiwan were collected on the website of the Taiwan Centers for Disease Control. All 55 community-acquired cases of COVID-19 confirmed from January 28 to April 12, 2020, in Taiwan were included. Basic demographic characteristics, symptom presentation, infection source, route of identification, and transmission dynamics were analyzed. RESULTS: Of the 55 cases, 52.7% were female and 74.5% were between 20-59 years of age. One-sixth (16.4%) of community-acquired cases were asymptomatic. More than half (58.2%) of the cases were identified via contact tracing. The median incubation period was 6 days (range 1-13 d) and the median serial interval was 4 days (range -3-24 d). Twenty-six cases (47.3%) were transmitted from presymptomatic cases, 11 cases (20%) from symptomatic cases, and 2 cases (3.6%) from an asymptomatic case. The contagious period of symptomatic cases was from 7 days before to 15 days after the onset of symptoms. CONCLUSION: The high proportion of asymptomatic cases and the transmissibility in the presymptomatic and asymptomatic periods make control of COVID-19 challenging. Protective measures such as social distancing, wearing face masks, and hand washing are mandatory to prevent community transmission.

Analysis of Imported Cases of COVID-19 in Taiwan: A Nationwide Study.

In the early stages of the 2019 novel coronavirus disease (COVID-19) pandemic, containment of disease importation from epidemic areas was essential for outbreak control. This study is based on publicly accessible data on confirmed COVID-19 cases in Taiwan extracted from the Taiwan Centers for Disease Control website. We analysed the characteristics, infection source, symptom presentation, and route of identification of the 321 imported cases that were identified from 21 January to 6 April 2020. They were mostly returned Taiwanese citizens who had travelled to one or more of 37 countries for tourism, business, work, or study. Half of these cases developed symptoms before arrival, most of the remainder developed symptoms 1-13 days (mean 4.0 days) after arrival, and 3.4% never developed symptoms. Three-quarters of the cases had respiratory symptoms, 44.9% had fever, 13.1% lost smell or taste, and 7.2% had diarrhoea. Body temperature and symptom screening at airports identified 32.7% of the cases. Of the remainder, 27.7% were identified during home quarantining, 16.2% were identified via contact tracing, and 23.4% were reported by hospitals. Under the strict enforcement of these measures, the incidence of locally acquired COVID-19 cases in Taiwan remains sporadic. In conclusion, proactive border control measures are effective for preventing community transmission of this disease.

The Shipai cohort for cardiovascular metabolic risk factors and outcome study - Design and preliminary results.

BACKGROUND: The aim of this study was to identify genotypic and phenotypic cardiovascular metabolic risk factors, and to establish risk models of diseases, including diabetes mellitus, cardiovascular disease, stroke, kidney dysfunction and psychiatric disorders, in Taiwanese adults. METHODS: In 2009, a community-based cohort study was initiated in the Shipai area of the Shilin and Beitou districts in Taipei. Residents were randomly sampled by age (young adults: 35-44 years and middle-aged adults: 45-55 years) and urbanization (rural and urban). Residents who agreed to participate were scheduled to receive examinations (physical and blood) and answer questionnaires. A ten-year follow-up is anticipated. Metabolic syndrome (MetS) was defined based on the Adult Treatment Panel III guidelines, and individuals with only one or two of the five MetS components was identified for prevention target. RESULTS: The response rate of the 9000 invited residents was 10.1%. After screening, 906 participants were enrolled. While 31.0% (281) had no MetS components, 29.1% (264) had only one, and 22.0% (199) had two. MetS with at least three components was diagnosed in 17.9% (162) of the cohort. Concerning gender difference, 25.4% of men and 13.2% of women had MetS (p < 0.001). The percentage of MetS was higher in middle-aged participants than in young adults (20.5% versus 13.4%, p = 0.008). Forty-six percent of participants had central obesity. After adjusting for gender, age, and urbanization, the central obesity odds ratio for MetS was 23.7, with a 95% confidence internal of 13.1-42.7. CONCLUSION: Our preliminary results revealed a high MetS percentage among young and middle-aged adults in Taiwan, with central obesity being a particularly urgent prevention target. The research design and operational protocol of this cohort study may stimulate more research in the future.

A Doctor's Name as a Brand: A Nationwide Survey on Registered Clinic Names in Taiwan.

In countries where the private clinics of physicians can be freely named, registering a clinic with a physician's name is one way to make patients familiar with the physician. No previous study had investigated how clinics make use of this method of personal branding. Therefore, the current study analyzed 10,847 private physician Western medicine clinics in Taiwan. Of those clinics, 31.0% (n = 3363) were named with a physician's full name, 8.9% (n = 960) with a surname, and 8.1% (n = 884) with a given name. The proportion of clinics registered with a physician's name was lower in rural areas (37.3%) than in urban (48.5%) and suburban areas (49.2%), respectively. Among clinics with only one kind of specialist, a physician's name was used most frequently in clinics of obstetrics and gynecology (64.9%), otorhinolaryngology (64.1%), and dermatology (63.4%). In Taiwan, fewer than half of clinics used a physician's name as a brand. The sociocultural or strategic factors and real benefits of doing so could be further studied in the future for a better understanding of healthcare services management.

Birth Trends among Female Physicians in Taiwan: A Nationwide Survey from 1996 to 2013.

Background: Although more and more women are becoming physicians, their decisions regarding pregnancy may be affected by the lengthy period of medical education and postgraduate training. The aim of this study was to explore the birth trends among female physicians in Taiwan; Methods: Retrospective analyses of maternal ages at delivery from 1996 to 2013, both for physicians and the general population, were conducted using a nationwide dataset called National Health Insurance Research Database; Results: During the study period, 8540 female physicians were identified. The physicians delivered a total of 4940 births in that time, with a rise from 210 in 1996 to 440 in 2013. In addition, the mean maternal age of the physicians at delivery increased from 32.19 years (standard deviations (SD) 2.80) in 1996 to 33.61 (SD 3.21) in 2013, values significantly higher than those for non-physicians of 27.81 (SD 4.74) in 1996 (p < 0.001) and 31.36 (SD 4.78) in 2013 (p < 0.001); Conclusion: Female physicians usually gave birth at an older age than non-physicians, but the discrepancy between the two groups gradually declined over the 18-year course of the study. The establishment of a maternity-friendly environment for female physicians should be considered by those who determine healthcare system policies.

Pattern of Visits to Older Family Physicians in Taiwan.

Many family physicians still practice at an old age. Nevertheless, their practice patterns have scarcely been studied. To address this lack of research, the current study analyzed claims data for a total of 2,018,440 visits to 171 family physicians in 2011 sourced from Taiwan's National Health Insurance Research Database. Family physicians aged 65 years and over had fewer patients (mean: 2330, standard deviation (SD): 2019) and visits (mean: 9220, SD: 8600) than younger physicians had. Furthermore, the average age of the patients who visited physicians aged 65 years and over was 51.9 (SD: 21.5) years, significantly higher than that of patients who visited younger physicians. However, the proportions of visits for upper respiratory tract infections, hypertension, diabetes mellitus, and dyslipidemia did not differ significantly among different age groups of physicians. In the future, the manpower planning of physicians should take into consideration the age structure and work profile of physicians.

The Risk of Breast Cancer in Women Using Menopausal Hormone Replacement Therapy in Taiwan.

Menopausal hormone replacement therapy (HRT) increases the risk of breast cancer in Western countries; however, there are fewer reports from the Asian population, which has a lower incidence of breast cancer. A population-based retrospective cohort study was conducted by analyzing longitudinal National Health Insurance claim data of a 200,000-person national representative cohort. A total of 22,929 women aged ≥45 years in 1997 without previous diagnosis of breast cancer were enrolled and stratified into two birth cohorts born before or after 1933. HRT prescriptions were traced in outpatient data files and incident breast cancer cases were identified from 1997 to 2004. The Cox proportional hazards model was used to analyze breast cancer hazard ratio (HR). HRT users were censored after they discontinued HRT. The results showed that women born during 1933-1952 had a twofold increased risk of breast cancer (HR = 2.10, 95% CI = 1.47-3.00) compared with women born before 1933, when adjusted for HRT use. When adjusted for the birth-cohort difference, HRT users had significantly increased breast cancer HR versus non-users after four years of use (adjusted HR = 1.48, 95% CI = 1.03-2.13); the HR further increased to 1.95 (95% CI = 1.34-2.84) after eight years of use. In conclusion, a longer duration of current HRT use was associated with a higher risk of breast cancer independent of the birth-cohort difference.

Immunogenicity and safety of an AS03(A)-adjuvanted H5N1 influenza vaccine in a Taiwanese population.

BACKGROUND/PURPOSE: A multicenter study (NCT00449670) conducted across Taiwan, Singapore, Hong Kong and Thailand evaluated the safety and manufacturing consistency of four formulations of an AS03(A)-adjuvanted H5N1 vaccine in terms of immune response against the vaccine-homologous strain (A/Vietnam/1194/2004). This manuscript presents data from the Taiwanese population. METHODS: A total of 400 individuals, aged 18-60 years, were randomized into six groups (2:2:2:2:1:1 ratio) to receive two doses (21 days apart) of one of the four adjuvanted formulations (H5N1-AS03(A)-groups) or one of the two nonadjuvanted formulations (H5N1-DIL-groups). Blood samples collected before vaccination (Day 0) and 21 days after each vaccine dose were analyzed using hemagglutination inhibition (HI) assay. Adverse events were recorded. RESULTS: All four AS03(A)-adjuvanted formulations induced comparable immune responses against the A/Vietnam/1194/2004 strain; following the second dose, immune response in terms of HI antibodies was higher in the H5N1-AS03(A)-groups {seroprotection rate=91.6% [95% confidence interval (CI): 87.9-94.4]; geometric mean titer (GMT)=177.6 (95% CI: 153.2-206.0)} compared with the H5N1-DIL-groups [seroprotection rates=5.0% (95% CI: 1.4-12.3); GMT=6.3 (95% CI: 5.4-7.4)]. Immune response against the heterologous A/Indonesia/05/2005 strain was also stronger in the H5N1-AS03(A)-groups [seroprotection rate=45.6% (95% CI: 40.0-51.4); GMT=20.5 (95% CI: 17.8-23.7)] compared with the H5N1-DIL groups [seroprotection rate=0.0% (95% CI: 0.0-4.5); GMT=5.0 (95% CI: 5.0-5.0)]. The overall reactogenicity profile of the adjuvanted formulations was clinically acceptable. CONCLUSION: The AS03(A)-adjuvanted H5N1 influenza vaccine formulations induced stronger immune response against the vaccine-homologous and heterologous strains than the nonadjuvanted formulations. The AS03(A)-adjuvanted H5N1 vaccine demonstrated a good immunogenicity and an acceptable safety profile in the Taiwanese population.

A randomized controlled clinical trial of auricular acupuncture in smoking cessation.

BACKGROUND: Tobacco smoking is responsible for human diseases of the lung, heart, circulatory system and various kinds of cancers, and is a serious public health problem worldwide. Acupuncture has been promoted as a treatment modality for smoking cessation. However, its efficacy still remains controversial. METHODS: We conducted a prospective, randomized, controlled trial using auricular acupuncture for smoking cessation in 131 adults who wanted to stop smoking. Thirteen subjects withdrew from the study and 118 subjects were included in the final analyses (mean age, 53.7 +/- 16.8 years; 100 males, 18 females). The treatment group (n = 59) received auricular acupuncture in Shen Men, Sympathetic, Mouth and Lung points for 8 weeks. The control group (n = 59) received sham acupuncture in non-smoking-cessation-related auricular acupoints (Knee, Elbow, Shoulder and Eye points). The enrolled subjects were then followed monthly for 6 months after stopping the acupuncture treatment. RESULTS: Between both groups before acupuncture treatment, there was no significant difference with regard to gender, mean age, education level, and mean values for the age at which smoking started, smoking duration, daily number of cigarettes smoked and nicotine dependent score. At the end of treatment, cigarette consumption had significantly decreased in both groups, but only the treatment group showed a significant decrease in the nicotine withdrawal symptom score. Smoking cessation rate showed no significant difference between the treatment group (27.1%) and the control group (20.3%) at the end of treatment. There was also no significant difference in the smoking cessation rate between the treatment group (16.6%) and the control group (12.1%) at the end of follow-up. There were no major side effects of auricular acupuncture in both groups. CONCLUSION: Our results showed that auricular acupuncture did not have a better efficacy in smoking cessation compared to sham acupuncture. Combined acupuncture with behavior counseling or with nicotine replacement therapy should be used in further smoking cessation trials to enhance the success rate of smoking cessation.

Non-steroidal anti-inflammatory drug and antacid co-prescription in Taiwan: analysis of national insurance claims.

BACKGROUND: Antacids were usually co-prescribed with non-steroidal anti-inflammatory drugs (NSAIDs), although no broad evidences were available as to the effects of antacids in preventing NSAID-associated gastropathy. We performed a survey of national insurance claims for outpatient services in Taiwan to determine the extent of this co-therapy nationwide. METHODS: The National Health Insurance Research Database supplied the sampling datasets for analysis. They represented 0.2% of the entire claims for outpatient medical services in 1999. Co-prescribing was assessed as NSAIDs and antacids on the same prescription. The selection and grouping of NSAIDs followed the guidelines of the Anatomical Therapeutic Chemical (ATC) Classification System recommended by the World Health Organization. Only the oral drugs prescribed on regular visits were taken into account. RESULTS: In totally 425,442 prescriptions with 1,825,604 items of drugs, non-aspirin NSAIDs were present in 108,818 (25.6%) prescriptions and antacids in 235,252 (55.3%) prescriptions respectively. Furthermore, antacids were present in 71.3% of prescriptions that contained NSAIDs and in 49.8% of prescriptions that did not contain NSAIDs (p < 0.001). Significant association of NSAIDs and antacids existed in different specialties of prescribing physicians, but the co-prescription rate (antacids in NSAIDs prescriptions) varied from the highest of 92.8% in the neurosurgery to the lowest of 49.8% in the pediatrics. Significant association of NSAIDs and antacids also existed at different levels of health care facilities, where the co-prescription rates were 80.9% at medical centers, 83.5% at regional hospitals, 87.4% at local hospitals, and 66.6% at primary care units. The subgroup of oxicams was more frequently co-prescribed with antacids than other subgroups (odds ratio = 1.51, p = 0.001). CONCLUSIONS: Concomitant prescription of oral non-aspirin NSAIDs and antacids was indeed a popular practice in Taiwan. Beside their effects in alleviating the NSAID-associated dyspepsia, the role of antacids in preventing NSAID-associated peptic ulcers or in masking the warning symptoms of these ulcers demands further evaluation.