The Impact of Multiple Long-Term Care Services Use on Dementia and Nondementia Caregivers' Health Care Utilization and Costs.

BACKGROUND: The study examined the effects of multiple long-term care (LTC) services (i.e., using both social and professional care services) on caregivers of service recipients with and without dementia. METHODS: We retrieved data for 10,771 caregivers of older adults in the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. We examined the effects of care recipients' initial prescription of single or multiple LTC services on their caregivers' healthcare services use, including outpatient, emergency department (ED), and inpatient services. RESULTS: For care recipients prescribed a single LTC service, dementia caregivers had 0.82 more ED visits and 10.4% higher total fees than nondementia caregivers (p < .05). However, for care recipients prescribed multiple LTC services, dementia caregivers and nondementia caregivers used healthcare services at similar levels, and dementia caregivers had 3.5% lower per-visit outpatient fees (p < .05). DISCUSSION: Providing multiple LTC services for people with dementia results in great benefit to their caregivers.

Modeling the impacts of cetacean-focused tourism in Taiwan: observations from cetacean watching boats: 2002-2005.

Cetacean-focused tourism in Taiwan has grown rapidly since 1997. This development, measured in terms of both number of tour boats and visitors, has resulted in many resource management challenges stemming from the absence of regulation and scientific data. To fill this void in empirical evidence, we used 464 sighting records from 2002 to 2005 to model the impact of cetacean-focused tourism. Cox proportional hazard analysis indicated cetacean avoidance responses to cetacean watching boats were strongly associated with pod size, mother-calf pairs, and cetacean-vessel distances. Mother-calf pairs abandoned their avoidance tactic by 55% compared to noncalf groups when tour boats approached. Second, the hazard ratio of abundance was 0.996, suggesting that the odds of encountering avoidance responses by the cetaceans decreased by 42% for every 100-member increase in the cetacean pod size. Last, distances maintained by boats from the cetaceans was positively related to avoidance responses (i.e., less avoidance behavior with closer interaction). Based on our findings, we have the following recommendations: (a) limit vessels from approaching mothers with calves, (b) limit vessels from approaching small groups of cetaceans, (c) reduced avoidance behavior to boat traffic may be a red flag for potential long-term disturbance, and (d) apply the "precautionary principle" based on the best scientific information available in cetacean-based tourism in Taiwan. These recommendations will help contribute to the sustainable development of cetacean-focused tourism in Taiwan.

Effectiveness of 23-valent pneumococcal polysaccharide vaccine on diabetic elderly.

Diabetes mellitus is associated with increased risk of pneumonia, and 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for prevention of pneumonia. However, the effectiveness of PPV23 remains unclear in the older diabetic patients who usually have compromised immune function.We used data extracted from the Taiwanese National Health Insurance Research Database (NHIRD) from 2000 to 2009 to conduct a population-based retrospective cohort study, comparing the incidence of pneumococcal diseases among PPV23-vaccinated and propensity-score matched PPV23-unvaccinated groups in diabetic elderly. The primary outcome was invasive pneumococcal diseases (IPDs), and the secondary outcomes were medical utilization.PPV23-vaccinated group had reduced risks of IPD (adjusted OR: 0.86, 95% CI: 0.78-0.94), respiratory failure (0.84, 0.77-0.93), and shorter length of hospitalization (-1.27 ±â€Š0.19 days, P value: 0.0012). In flu-vaccinated group, subjects who received PPV23 had reduced risks of IPD, hospitalization, and respiratory failure; had shorter lengths of hospitalization; and less medical costs, than those without receiving PPV23. In not flu-vaccinated group, PPV23 vaccination was associated with reduced risks of IPD and respiratory failure. Receiving both vaccines could bring better protection in IPD, hospitalization, visits of emergency department, and respiratory failure.PPV23 vaccination was effective in prevention of pneumococcal diseases and reduction of medical utilization in diabetic elderly aged 75 and more. Receiving both vaccines resulted in better outcomes than PPV vaccination alone.