Validity of EQ-5D in general population of Taiwan: results of the 2009 National Health Interview and Drug Abuse Survey of Taiwan.

PURPOSE: The aim of this study was to examine the validity of the EuroQOL five dimensions questionnaire (EQ-5D) using a nationally representative data from the National Health Interview Survey (NHIS) through comparison with short-form 36 (SF-36). METHODS: Data for this study came from the 2009 NHIS in Taiwan. The study sample was the 4007 participants aged 20-64 years who completed the survey. We used SUDAAN 10.0 (SAS-Callable) to carry out weighed estimation and statistical inference. The EQ index was estimated using norm values from a Taiwanese study as well as from Japan and the United Kingdom (UK). The SF-36 score was standardized using American norm values. RESULTS: In terms of concurrent validity, the EQ-5D met the five hypotheses. The results did not fulfill hypothesis that women would have lower visual analogue scale (EQ-VAS) scores. In terms of discriminant validity, the EQ-5D fulfilled two hypotheses. Our results approached but did not fulfill hypothesis that there would be a weak association between the physical and psychological dimensions of the EQ-5D and the mental component summary score of the SF-36. Results were comparable regardless of whether the Japanese or UK norm value sets were used. CONCLUSIONS: We were able to fulfill many, not all of our validity hypotheses regardless of whether the established Japanese or UK norm value sets or the Taiwanese norm values were used. The EQ-5D is an effective and simple instrument for assessing health-related quality of life of general population in Taiwan.

Agreement between self-reported and health insurance claims on utilization of health care: A population study.

OBJECTIVE: To investigate the agreement between self-reported and insurance claim of the utilization of health care. STUDY DESIGN AND SETTING: Data were from the Taiwan National Health Interview Survey, conducted in 2001. There were 22,121 (94.2%) individuals who completed the interview, 18,143 of them aged 12 and above. Among them, 87% signed a consent form to allow us linking their interview with data with the National Health Insurance database. After deleting those with illegible identification code or date of birth, 15,660 subjects were included in the study. Kappa (kappa) was used to describe the visit concordance, whereas the intraclass correlation coefficient was used to describe frequency consistency. Logistic regression was used to investigate factors associated with the agreement. RESULTS: All had reasonable visit and frequency agreements. Logistic regression showed that males and those living in rural areas tended to have a lower likelihood of agreement in reporting outpatient visits compared with others. In reporting emergency room visits, males and those with a higher education level, self-perceived health of "not good," chronic disease, or at least one difficulty with activities of daily living (ADL) had higher chances of agreement. CONCLUSION: Agreement between self-reported utilization and insurance claims were fairly good in general population.

Biomonitoring of chromium for residents of areas with a high density of electroplating factories.

The high density of electroplating factories in the geographic middle of Taiwan has prompted concern over the potential for exposure to harmful metals. The present study aimed to determine the levels of chromium in whole blood (B-Cr) of residents living in the high vs. low factory-density areas, and to examine the relations to gender and age. A total of 660 residents who had not moved within the 5 years preceding the study were sampled according to the stratified random sampling approach, at ages 35-44, 45-54, and 55-64 years, for both genders. Chromium determinations (n=641) were made using a graphite furnace atomic absorption spectrometer. The geometric mean (95% C.I.) of B-Cr was 0.357 (0.34-0.38) microg/l. The International Federation of Clinical Chemistry (IFCC) nonparametric 0.95 reference limits of B-Cr was estimated to be <0.905 microg/l. B-Cr levels decreased with increasing age. Subjects in the areas with a high density (0.38 microg/l, 95% C.I.: 0.36-0.40) of electroplating factories had significantly higher B-Cr levels, compared to residents of the low-density (0.27, 0.25-0.30) areas and to the general population from western countries. The health significance of the elevated B-Cr remains to be determined.

Levels of polychlorinated dibenzo-p-dioxins and dibenzofurans in primipara breast milk from Taiwan: estimation of dioxins and furans intake for breastfed infants.

Postnatal exposure to dioxins in breastfed infants occurs mainly during breast-feeding. The exposure to a substantial amount of endocrine disruptors in the early days of life may cause long-term health effects. Test subjects were healthy and primiparous mothers with a mean age of 28 (S.D. = 3.8) in 2001. The PCDD/F congeners were analyzed in the breast milk using gas chromatograph/high resolution mass spectrometry. The mean level of PCDD/Fs was 7.4 pg-WHO-TEQ/g lipid, which is significantly lower than the level found in individuals from other countries. The total PCDD WHO-TEQ levels in breast milk had a significant positive association with maternal age and a slightly negative association with perinatal BMI (body mass index of the period before and after the delivery). The estimated daily intake of 10.5 pg-WHO-TEQ/kg/day from individual breast milk was predicted for a breastfed infant at 6 months of age with proper assumption of 8 kg body weight, 854 milk per day of consumption, 95% of dioxin absorption rate, and linear decline of dioxin during lactation. Based on the lower WHO-TEQ levels in the breast milk, breast-feeding should still be encouraged and continued in Taiwan.

Respiratory symptoms in primary schoolchildren living near a freeway in Taiwan.

A cross-sectional epidemiological study was conducted in an effort to investigate the effects of automobile exhaust on respiratory symptoms of school children in Kaohsiung, Taiwan. One school (Yang-Ming primary school) was located in the vicinity of 150 m from the highway and designated as a heavy-traffic area. The control school (Zhuang-Jing primary school) was situated in the same district but the distance of the school address to the freeway was 1500 m and designated as a low-traffic area. All of the primary school children in those schools were used in the study. In total, 3221 children were from the heavy-traffic school and 2969 from the low-traffic area. The respiratory health was assessed by an evaluation of the child's respiratory symptoms and illnesses using a parent-completed questionnaire. Data on traffic flow on the freeway were obtained from the Department of Transportation. Road traffic flows in front of the study schools were also measured with a portable counter. This study showed that a freeway surrounding a child's school may not be associated with an increased risk of respiratory symptoms. This may be due to insufficiently large contrasts in traffic pollution levels between these areas.