Assessment of the Risk and Symptoms of SARS-CoV-2 Infection Among Healthcare Workers During the Omicron Transmission Period: A Multicentric Study from Four Hospitals of Mainland China.

Purpose: The SARS-CoV-2 omicron variant emerged and spread rapidly among the population in the early stage of China's normalized prevention and control in December 2022. Healthcare workers (HCWs) are particularly exposed to SARS-CoV-2, it is important to evaluate the impact of the omicron pandemic on HCWs in China. Methods: A self-administered online survey was conducted on infected HCWs from four hospitals of Taizhou. A total of 748 HCWs received the survey via DingTalk, and 328 responded to the questionnaire. The risk factors were investigated using univariate and multivariate logistic regression analysis. Results: By December 20, 2022, 748 HCWs tested positive by PCR, and the infection rate was 11.4% (748/6581). Among 328 respondents, the most common symptoms were cough (88.4%), fever (83.5%), runny nose (77.1%), sore throat (73.2%), headache (70.1%), muscle aches (67.1%), and fatigue (53.4%). 69.8% (229/328) of the participants had five or more major onset symptoms, while no severe case was observed. The multivariate analysis indicated that the poor sleep quality (OR = 2.29, 95% CI: 1.31-4.02, P = 0.004) was an independent risk factor for more major onset symptoms, while wore gloves ≥95% times in working (OR = 0.49, 95% CI: 0.28-0.85, P = 0.011) was significantly related to fewer symptoms. In addition, 239 (72.9%) recipients reported high fever (temperature ≥38.5°C), less common cold (≤3 vs >3 times/year, OR = 2.20, 95% CI: 1.05-4.65, P = 0.038) was significantly associated with high fever. Conclusion: Our findings imply rapid transmissibility of omicron and multiple-onset symptoms among HCWs. Improved autoimmunity and self-protection measures for HCWs may be helpful in controlling infection and clinical symptoms. Our results provide empirical reference values for improved countermeasures and protective measures for major public health emergencies.

Using "Age and Total-PSA" as the Main Indicators: The Results of Taizhou Integrated Prostate Screening (No 2).

The aim of the study was to analyze population-based prostate cancer (PCa) screening and the incidence of PCa among males ≥50 years of age residing in the Luqiao district of Taizhou, China. From October to December 2020, male residents ≥50 years of age were screened for serum total prostate-specific antigen (total-PSA). If t-PSA re-test levels persisted above 4 µg/L, subjects underwent further noninvasive examinations, including digital rectal examination or multiparameter magnetic resonance imaging (mpMRI) of the prostate. Subjects underwent prostate biopsy of pathological tissue based on t-PSA and mpMRI results. A total of 3524 (49.1%) residents participated in this PCa screening study. In total, 285 (8.1%) subjects exhibited t-PSA levels ≥4.0 µg/L and 112 (3.2%) underwent noninvasive examinations. Forty-two (1.2%) residents underwent prostate biopsy, of which 16 (0.45%) were diagnosed with PCa. Of those diagnosed with PCa, three (19%) had localized PCa (cT1-cT2N0M0), six (37%) had locally advanced PCa (cT3a- cT4N0-1M0), and seven (44%) had advanced metastatic PCa (M1). Unfortunately, 3477 (48.5%) residents did not participate in the study, mainly due to lack of awareness of PCa based on feedback from local health centers. Age and t-PSA were used as primary screening indicators and, when further combined with mpMRI and prostate biopsy, confirmed the diagnosis of PCa among participating residents. Although this was a relatively economical and convenient screening method, education and knowledge should be further enhanced to increase the participation rate in PCa screening programs.

Bone age assessment: Large-scale comparison of Greulich-Pyle method and Tanner-Whitehouse 3 method for Taiwanese children.

BACKGROUND: The Greulich-Pyle (GP) and Tanner-Whitehouse 3 (TW3) methods are two common methods for assessing bone age (BA). The applicability of these methods for populations other than those in the United States and Europe has been questioned. Thus, this study tested the applicability of these methods for Taiwanese children. METHODS: In total, 1476 radiographs (654 boys, 822 girls) were analyzed. A subset of 200 radiographs was evaluated to determine intrarater and interrater reliability and the time required to yield a BA assessment. BA was determined by two reviewers using the GP method and two of the TW3 methods (the Radial-Ulnar-Short bones [RUS] method and the carpals method [Carpal]). The GP and TW3 methods were directly compared using statistical techniques. A subgroup analysis by age was performed to compare BA and chronological age using a paired t test for each age group. RESULTS: The average times required to yield an assessment using the GP and TW3-RUS methods were 0.79 ± 0.14 and 3.01 ± 0.84 min (p < 0.001), respectively. Both the intrarater and interrater correlation coefficients were higher for the GP method (0.993, 0.992) than the TW3-RUS (0.985, 0.984) and TW3-Carpal (0.981, 0.973) methods. The correlation coefficient for the GP and TW3-RUS methods was highest in the pubertal stage (0.898 for boys and 0.909 for girls). The mean absolute deviations for the GP and TW3-RUS methods in the pubertal stage were 0.468 years (boys) and 0.496 years (girls). Both the GP and TW3-Carpal methods underestimated BA for boys in the prepubertal stage. Both the GP and TW3-RUS methods overestimated BA for girls in the pubertal and postpubertal stages. CONCLUSION: The GP and TW3-RUS methods exhibit strong agreement in the pubertal and postpubertal stages for both sexes. With appropriate adjustments based on Taiwanese data, both methods are applicable to our children.

The DEMATEL method explores the interdependent relationship structure and weights for diagnosis-related groups system.

Purpose: This study constructs a structure of interaction between dimensions and criteria within the diagnosis-related groups (DRGs) system from a quantitative system and identifies key factors affecting the overall performance of medical services. Method: From September to December 2020, the influence relation structure diagram (IRSD) of the dimensions and corresponding criteria was developed from the practical experience of a group of domain experts, based on the DEMATEL method. Subsequently, all dimensions and criteria construct influential weights from a systems perspective. Finally, the main influential factors were identified based on the analysis results. Results: The IRSD results showed that, in the overall performance of medical services, "Medical service capacity (C 1)" was the main influential dimension, influencing both "Medical service efficiency (C 2)" and "Medical service safety (C 3)." At the criteria level, "Case-mix index (CMI) (C 12)," "Time efficiency index (C21)," and "Inpatient mortality of medium-to-low group (C32)" were the main influential criteria in the corresponding dimensions. The influential weight results showed that "Medical service capacity (C 1)" was also a key dimension. "Case-mix index (CMI) (C 12)," "Cost efficiency index (C 22)," and "Inpatient mortality of medium-to-low group (C 32)" were the key criteria in their respective dimensions. Conclusion: Patients and managers should first focus on the capacity of medical service providers when making a choice or deciding using the results of the DRGs system. Furthermore, they should pay more attention to medical safety even if it is not as weighted as medical efficiency.

Systematic Review of the Effect of a Zero-Markup Policy for Essential Drugs on Healthcare Costs and Utilization in China, 2015-2021.

Objective: This systematic review aimed to discuss the effects of a zero-markup policy for essential drugs (ZPED) on healthcare costs and utilization in China in the years 2015-2021. Methods: We searched the PubMed, Embase, Scopus, and CINAHL databases for all associated studies carried out from January 1, 2015, to May 31, 2021, without any limitations regarding the language the studies were written in. To prevent selection bias, gray documents were tackled by other means. The methodological approaches were assessed by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Newcastle-Ottawa Scale (NOS) collaboration tool. Results: Forty studies were selected at first and then 15 studies that met the inclusion criterion. Most of the studies showed a considerable decrease in total medical spending and drug spending in both outpatient and inpatient services. After the implementation of ZPED, studies showed that the medical services increased and total hospital income sustained, despite a decrease in drug revenue. Minimal or no government subsidy is required from a financial perspective. Conclusions: Although, the government could implement ZEPD with lower medical cost and drug cost to patients, and sustained income for health facilities, we have limited understanding of whether the increase in medical services was induced by the provider or was a response to unmet needs in the population. Further, studies using rigorous and advanced methods to study health policy, patient behaviors, provider behaviors, and government decisions are warranted.

Effect of Postoperative Adverse Events on Hospitalization Expenditures and Length of Stay Among Surgery Patients in Taiwan: A Nationwide Population-Based Case-Control Study.

Background: The current study sought to determine the incidence of postoperative adverse events (AEs) based on data from the 2006 Taiwan National Health Insurance Research Database (NHIRD). Methods: This retrospective case-control study included patients who experienced postoperative AEs in 387 hospitals throughout Taiwan in 2006. The independent variable was the presence or absence of 10 possible postoperative AEs, as identified by patient safety indicators (PSIs). Results: A total of 17,517 postoperative AEs were identified during the study year. PSI incidence ranged from 0.1/1,000 admissions (obstetric trauma-cesarean section) to 132.6/1,000 admissions (obstetric trauma with instrument). Length of stay (LOS) associated with postoperative AEs ranged from 0.10 days (obstetric trauma with instrument) to 14.06 days (postoperative respiratory failure). Total hospitalization expenditures (THEs) ranged from 363.7 New Taiwan Dollars (obstetric trauma without instrument) to 263,732 NTD (postoperative respiratory failure). Compared to patients without AEs, we determined that the THEs were 2.13 times in cases of postoperative AE and LOS was 1.72 times higher. Conclusions: AEs that occur during hospitalization have a major impact on THEs and LOS.

Clinical Knowledge Supported Acute Kidney Injury (AKI) Risk Assessment Model for Elderly Patients.

From the clinical viewpoint, the statistical approach is still the cornerstone for exploring many diseases. This study was conducted to explore the risk factors related to acute kidney injury (AKI) for elderly patients using the multiple criteria decision-making (MCDM) approach. Ten nephrologists from a teaching hospital in Taipei took part in forming the AKI risk assessment model. The key findings are: (1) Comorbidity and Laboratory Values would influence Comprehensive Geriatric Assessment; (2) Frailty is the highest influential AKI risk factor for elderly patients; and (3) Elderly patients could enhance their daily activities and nutrition to improve frailty and lower AKI risk. Furthermore, we illustrate how to apply MCDM methods to retrieve clinical experience from seasoned doctors, which may serve as a knowledge-based system to support clinical prognoses. In conclusion, this study has shed light on integrating multiple research approaches to assist medical decision-making in clinical practice.

Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears.

Objectives: To explore the indications and surgical techniques for arthroscopic lower trapezius transfer (LTT) with tendon autograft in managing massive irreparable posterosuperior rotator cuff tears (PSRCTs); to validate the feasibility, safety, and efficacy of this technique. Methods: This study retrospectively enrolled 23 patients with massive irreparable PSRCTs, admitted to and followed up by the Taizhou Hospital of Zhejiang province between July 2020 and April 2021, and treated with ipsilateral LTT and ipsilateral hamstring tendon autograft. The control group consisted of 23 patients with massive RCTs receiving conventional repair procedures within the same frame. Follow-up data at the preoperative visit, and postoperative month 3 were collected to assess the active range of motion, Constant-Murley Score (CMS),American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University of California, Los Angeles (UCLA)shoulder score, visual analog scale (VAS)and the post-operative MRI results, all of which could provide a comprehensive postoperative early efficacy assessment. Results: Three months follow-up visits were completed for all patients, revealing improvements in all aspects compared to the preoperative state, with no complications, such as postoperative infection of surgical sites and nerve injuries of infection and nerve injury. The distribution of active shoulder range of motion of patients and function scores with two types of operation was as follow: angles of flexion and lifting (130.00° ± 31.55° vs. 90.78° ± 19.85°), abduction (123.26° ± 30.47°vs. 85.87° ± 18.74°), external rotation at side (101.74° ± 14.74° vs. 91.74° ± 11.92°), external rotation at 90° abduction (41.52° ± 21.97° vs. 24.57° ±12.60°), VAS (0.74± 0.81 vs. 1.87 ±0.87), CMS(56.3 ± 13.01 vs. 48.30 ± 8.38), UCLA shoulder score (24.04 ± 2.88 vs.20.96 ± 3.47), ASES (72.91 ± 9.99 vs.60.74 ± 8.84). Significantly better improvements were found in the study group on month 3.19 of 23 patients in the study group and 17 of 23 patients in the control group underwent MRI on the 3 months follow up. Retear was found in only one patient who had grade 4 subscapularis tendon injury, However, revision was not performed due to postoperative pain relief and functional improvement. Conclusion: Compared to conventional repair procedures, in the early postoperative period, LTT with tendon autograft could achieve better pain relief, more rapid motor functional recovery, and higher functional scores for massive irreparable PSRCTs.

Assessment of mental health among nursing staff at different levels.

To assess the mental health of nurses and to find the post responsibility and psychological status of clinical nurses.A total of 447 nursing staff at different levels in a teaching hospital was assessed by nursing post responsibility scale and mental symptom checklist (SCL-90) then compared with each other. The study period was from April 1, 2018 to April 30, 2018.There was a positive correlation between the responsibility of post and interpersonal relationship (r = 0.11, P < .05), depression (r = 0.10, P < .05) and hostility (r = 0.10, P < .05). Post risk was negatively correlated with somatization (r = -0.10, P < .05), job involvement scope and communication ability were negatively correlated (r = -0.11, P < .05). Based on the multiple linear regression, knowledge and skills (ß = -0.20, P = .02) and risks of the post (ß=0.20, P < .01) both significantly related to SCL-90 total score.In conclusion, knowledge and skills and risks of the post associated with mental health of clinical nurses. The sustainable development of nursing post responsibility requires healthy physiological and mental health.

The exploration of the knowledge, attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses.

BACKGROUND: Despite the documented and well known patient benefits of ACP, the completion of ACP, only a minority of patients, during the advanced or EOL stage of their illnesses, receive such care. The misconceptions about ACP for healthcare providers, such as nurses, might become potential barriers to the effective implication of ACP. Also, from the transcultural perspective, it is evident essential to explore Taiwanese nurses' attitudes, knowledge, and actions of ACP. The purposes of this study were to explore the implication of ACP or hospice care for nurses caring for non-cancer chronic illness patients at a regional teaching hospital in Taiwan; and, to identify predictors of those nurses' knowledge, attitudes, and actions toward ACP. METHODS: This cross-sectional study with a purposive sample of 218 nurses was conducted at a teaching hospital in southern Taiwan. Structured questionnaires were employed and data were analyzed with descriptive statistics, t-test, one-way ANOVAs, Pearson's correlation and multiple regressions. RESULTS: 16.1% of Taiwanese physicians actively initiated ACP issues or conversations with patients or their family members. Nurses' attitudes toward ACP were fairly positive but their knowledge about ACP was insufficient and actions of ACP were not positively executed. The predictors of ACP-Knowledge (ACP-K) included position title, education hours and lacking of educational training. The predictors of ACP-Attitude (ACP-A) included ACP-K and "fear of patient or family member not accepting", whereas ACP-A, position title, "patients do not feel necessary" and "not sure physician's concern" were the predictors of ACP-Act. CONCLUSION: Continuous education and training for nurses regarding ACP needs to be improved by taking those predictors found in this current study into account, and more studies on the nurse's role in ACP also should be further examined. TRIAL REGISTRATION: KAFGH 106-012. Date of registration 1 May 2017.

The longitudinal study for the work-related factors to job performance among nurses in emergency department.

To explore the relationship between baseline information, personal factors, working characteristics and job performance among nurses in emergency department in northern Taiwan.Two-hundred twenty-two nursing staff were interviewed repeated with structured questionnaires for data collection in 3 time points (From August to September, 2008, from February to March, 2009, and from November to December, 2009). The generalized estimating equation (GEE) is used to test the relationship between the domains of independent variables (baseline information, personal factors, working characteristics) and dependent variables (task performance, contextual performance).The mean age of participants is 30.1 ±â€Š5.1 years. 50.0% are junior college or bachelor degrees. From the GEE model, biological protection (ß = 0.17, P value = .002) and safety climate (ß = 0.24, P value < .001) are significantly related to task performance. Contextual performance is strongly affected by safety climate (ß = 0.15, P value < .001).To improve the job performance among nurses in emergency department, it should consider personal psychological and environmental factors.

Utilization of Emergency and Hospitalization Care after Coronary Artery Bypass Surgery for Patients with Ischemic Heart Disease.

This retrospective follow-up study explored the status of patients with myocardial infarction with regard to the likelihood of being readmitted to the hospital within 30 days after undergoing coronary artery bypass surgery (CABG) and their survival status within one year of the procedure.The rate of readmission within 30 days was 10.7% (167/1,575), primarily due to surgical wound infection (11.3% of readmission cases), ischemic heart disease (10.3%), and heart failure (8.7%). The readmission group consisted mainly of older males with a high comorbidity index. No significant differences existed between the two groups with regard to case distribution, hospital level, tenure of physicians, or teaching status of the hospitals. Most subsequent emergency department visits one month after surgery involved older male patients with a high comorbidity index. Compared to patients in the non-emergency group, those in the emergency group had longer hospital stays but lower mortality rates. Males constituted a higher proportion of survivors at one year post CABG, with age and comorbidity index being the primary variables affecting the risk of death.The National Health Insurance may adopt the policy of increasing payments for medical institutions that avoid readmission within 30 days post CABG in order to encourage better patient care and avoid the costs associated with readmission.

Measuring Preferences for a Diabetes Pay-for-Performance for Patient (P4P4P) Program using a Discrete Choice Experiment.

OBJECTIVE: To elicit a patient's willingness to participate in a diabetes pay-for-performance for patient (P4P4P) program using a discrete choice experiment method. METHODS: The survey was conducted in March 2013. Our sample was drawn from patients with diabetes at five hospitals in Taiwan (International Classification of Diseases, Ninth Revision, Clinical Modification code 250). The sample size was 838 patients. The discrete choice experiment questionnaire included the attributes monthly cash rewards, exercise time, diet control, and program duration. We estimated a bivariate probit model to derive willingness-to-accept levels after accounting for the characteristics (e.g., severity and comorbidity) of patients with diabetes. RESULTS: The preferred program was a 3-year program involving 30 minutes of exercise per day and flexible diet control. Offering an incentive of approximately US $67 in cash per month appears to increase the likelihood that patients with diabetes will participate in the preferred P4P4P program by approximately 50%. CONCLUSIONS: Patients with more disadvantageous characteristics (e.g., elderly, low income, greater comorbidity, and severity) could have less to gain from participating in the program and thus require a higher monetary incentive to compensate for the disutility caused by participating in the program's activities. Our result demonstrates that a modest financial incentive could increase the likelihood of program participation after accounting for the attributes of the P4P4P program and patients' characteristics.

Epidemiology, management, and economic evaluation of screening of gallstone disease among type 2 diabetics: A systematic review.

The knowledge of gallstone disease (GSD) is crucial to manage this condition when organizing screening and preventive strategies and identifying the appropriated clinical therapies. Although cholecystectomy still be the gold standard treatment for patients with symptomatic GSD, expectant management could be viewed as a valid therapeutic method for this disorder. If early treatment of GSD decreases the morbidity or avoids further cholecystectomy, it may save clinical care costs in later disease periods sufficiently to offset the screening and early treatment costs. In addition, whether routine screening for GSD is worthwhile depends on whether patients are willing to pay the ultrasonography screening cost that would reduce the risk of cholecystectomy. In this review we discuss the epidemiology, management, and economic evaluation of screening of GSD among type 2 diabetics.

Economic and medical benefits of ultrasound screenings for gallstone disease.

AIM: To investigate whether screening for gallstone disease was economically feasible and clinically effective. METHODS: This clinical study was initially conducted in 2002 in Taipei, Taiwan. The study cohort total included 2386 healthy adults who were voluntarily admitted to a regional teaching hospital for a physical check-up. Annual follow-up screening with ultrasound sonography for gallstone disease continued until December 31, 2007. A decision analysis using the Markov Decision Model was constructed to compare different screening regimes for gallstone disease. The economic evaluation included estimates of both the cost-effectiveness and cost-utility of screening for gallstone disease. RESULTS: Direct costs included the cost of screening, regular clinical fees, laparoscopic cholecystectomy, and hospitalization. Indirect costs represent the loss of productivity attributable to the patient's disease state, and were estimated using the gross domestic product for 2011 in Taiwan. Longer time intervals in screening for gallstone disease were associated with the reduced efficacy and utility of screening and with increased cost. The cost per life-year gained (average cost-effectiveness ratio) for annual screening, biennial screening, 3-year screening, 4-year screening, 5-year screening, and no-screening was new Taiwan dollars (NTD) 39076, NTD 58059, NTD 72168, NTD 104488, NTD 126941, and NTD 197473, respectively (P < 0.05). The cost per quality-adjusted life-year gained by annual screening was NTD 40725; biennial screening, NTD 64868; 3-year screening, NTD 84532; 4-year screening, NTD 110962; 5-year screening, NTD 142053; and for the control group, NTD 202979 (P < 0.05). The threshold values indicated that the ultrasound sonography screening programs were highly sensitive to screening costs in a plausible range. CONCLUSION: Routine screening regime for gallstone disease is both medically and economically valuable. Annual screening for gallstone disease should be recommended.

Economic evaluation of screening for diabetic retinopathy among Chinese type 2 diabetics: a community-based study in Kinmen, Taiwan.

BACKGROUND: This community-based study conducted in Kinmen aimed to discover whether screening for diabetic retinopathy (DR) among Chinese with type 2 diabetes was economically feasible and clinically effective. METHODS: A total of 971 community-dwelling adults previously diagnosed with type 2 diabetes in 1991-1993 underwent DR screening in 1999-2002 by a panel of ophthalmologists, who used on-site indirect ophthalmoscopy and 45-degree color fundus retinal photographs. Economic evaluation included estimates for cost effectiveness and the cost utility of screening for DR. RESULTS: For each DR case, screening efficacy and utility decreased, while cost increased with the length of the screening interval. The cost per sight year gained in the annual screening, biennial screening, 3-year screening, 4-year screening, 5-year screening, and control groups were New Taiwan dollars (NT dollars) 20962, NT dollars 24990, NT dollars 30847, NT dollars 37435, NT dollars 44449, and NT dollars 83411, respectively. The cost per quality-adjusted life year gained by the annual screening, biennial screening, 3-year screening, 4-year screening, 5-year screening, and control groups were NT dollars 21924, NT dollars 25319, NT dollars 30098, NT dollars 35106, NT dollars 40037, and NT dollars 61542, respectively. Threshold values indicate that the screening programs are highly sensitive to screening cost in the plausible range. CONCLUSION: Screening for DR is both medically and economically worthwhile. Annual screening for DR among Chinese with type 2 diabetes should be conducted. Prevention programs aimed at improving eye care for patients with type 2 diabetes result in both substantial federal budgetary savings and highly cost-effective health care.

A community-based study of the willingness to pay associated with screening for diabetic retinopathy among type 2 diabetes in Kinmen, Taiwan.

BACKGROUND: In Taiwan, there were few population-based studies of WTP values related to DR screening among persons with type 2 diabetes. This community-based study was to explore the willingness- to-pay (WTP) values for screening for diabetic retinopathy (DR) associated with varying degrees of DR among persons with type 2 diabetes in Kinmen, Taiwan. METHODS: A total of 725 eligible community-dwelling adults diagnosed with type 2 diabetes received DR screening during 1999-2002 and then evaluated WTP values in 2003. Diagnosis of DR was performed by a panel of ophthalmologists using ophthalmoscopy and a 45-degree color retinal photographs to examine fundus after dilating pupils. WTP values were measured by discrete-choice method. RESULTS: The 406 adults with type 2 diabetes participating in the WTP survey had a 56% response rate. Of 406 subjects, 265 (65.3%) said they would be willing to pay for DR screening to reduce blindness. The overall mean WTP value was New Taiwan Dollars 468.9 +/- 327.7 (US dollars 14.3 +/- 10.0). Age was borderline significant (p=0.07) related to WTP values. Those with severe stage DR had higher WTP values for screening than subjects with mild stage. CONCLUSIONS: Degree of DR was the independent factor affecting WTP values in DR screening among community-dwelling adults with type 2 diabetes.

Estimation of progression of multi-state chronic disease using the Markov model and prevalence pool concept.

BACKGROUND: We propose a simple new method for estimating progression of a chronic disease with multi-state properties by unifying the prevalence pool concept with the Markov process model. METHODS: Estimation of progression rates in the multi-state model is performed using the E-M algorithm. This approach is applied to data on Type 2 diabetes screening. RESULTS: Good convergence of estimations is demonstrated. In contrast to previous Markov models, the major advantage of our proposed method is that integrating the prevalence pool equation (that the numbers entering the prevalence pool is equal to the number leaving it) into the likelihood function not only simplifies the likelihood function but makes estimation of parameters stable. CONCLUSION: This approach may be useful in quantifying the progression of a variety of chronic diseases.

Assessing the natural course of diabetic retinopathy: a population-based study in Kinmen, Taiwan.

PURPOSE: To explore the natural course of diabetic retinopathy among type 2 diabetics using the indirect ophthalmoscope and single-field fundus photographs in Kinmen, Taiwan. METHODS: A screening program for diabetic retinopathy was carried out by a panel of ophthalmologists, who employed the ophthalmoscope and 45-degree retinal color photographs to examine the fundus after pupil dilation. Screening, which was conducted between 1999 and 2002, involved 971 patients diagnosed with type 2 diabetes. A multi-state Markov model was used to assess the natural course of diabetic retinopathy among type 2 diabetics. RESULTS: Among the 725 diabetes patients who attended at least two ophthalmological fundus check-ups and were screened, the overall response rate was about 75%. The mean duration of the disease states mild nonproliferative diabetic retinopathy, moderate nonproliferative diabetic retinopathy, severe nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy were 4.05 [95% confidence interval (CI): 3.28-5.32], 4.18 (95% CI: 3.18-6.06), 2.52 (95% CI: 1.78-4.27), and 4.22 (95% CI: 2.88-7.81) years, respectively. Compared to controls, the incidence of blindness reduction for annual, biennial, 3-year, 4-year, and 5-year screenings of diabetic retinopathy were approximately 94.4% (95% CI: 91.6%-96.3%), 83.9% (95% CI: 83.6%-84.2%), 70.2% (95% CI: 69.8%-70.7%), 57.2% (95% CI: 56.7%-57.7%), and 45.6% (95% CI: 45.0%-46.1%), respectively. CONCLUSIONS: In conclusion, the average time for the development of diabetic retinopathy from nonexistence to blindness was approximately 26.5 years. The present recommendation for annual screening in type 2 diabetics with nonproliferative diabetic retinopathy should be retained only for the mild form, not for the moderate or severe forms.

Cost-benefit analysis of routine childhood vaccination against chickenpox in Taiwan: decision from different perspectives.

Cost-benefit analysis was conducted to determine whether it is worthwhile to initiate a routine varicella vaccination program in Taiwan from different perspectives. Using the human capital approach, the discounted net cost for vaccination program was New Taiwan Dollars (NTD) 281 million from health care payer's perspective. Taking indirect costs into account, the net saving due to vaccination program was NTD 425 million from the societal perspective. In terms of benefit-cost ratio, a mass varicella vaccination program could only save NTD 0.34 in discounted costs for each dollar incurred in a vaccination program from health care payer's perspective whereas save NTD 2.06 from the societal viewpoint. Results based on the willingness-to-pay (WTP) method showed the Net Present Value (NPV) of the vaccination program was estimated as -NTD 272 million. We conclude that a routine varicella vaccination program is worthwhile from the societal perspective but neither from health care payer's nor from consumer decision based on the perspective of WTP.