Patient assessment of diabetes care in a pay-for-performance program.

OBJECTIVE: Few studies address quality of care in pay-for-performance (P4P) programs from the perspective of patients' perceptions. This study aimed to examine and compare the patient assessment of diabetes chronic care as perceived by diabetic patients enrolled and not enrolled in a P4P program from the patients' self-reported perspectives. DESIGN: A cross-sectional study with case and comparison group design. SETTING: A large-scale survey was conducted from February to November 2013 in 18 healthcare institutions in Taiwan. PARTICIPANTS: A total of 1458 P4P (n = 1037) and non-P4P (n = 421) diabetic patients participated in this large survey. The Chinese version of the Patient Assessment of Chronic Illness Care (PACIC) instrument was used and patients' clinical outcome data (e.g. HbA1c, LDL) were collected. INTERVENTION: None. MAIN OUTCOME MEASURES: Five subscales from the PACIC were measured, including patient activation, delivery system design/system support, goal setting/tailoring, problem solving/contextual and follow-up/coordination. Patient clinical outcomes were also measured. Multiple linear regression and logistic regression models were used and controlled for patient demographic and health institution characteristics statistically. RESULTS: After adjusting for covariates, P4P patients had higher overall scores on the PACIC and five subscales than non-P4P patients. P4P patients also had better clinical processes of care (e.g. HbA1c test) and intermediate outcomes. CONCLUSIONS: Patients who participated in the program likely received better patient-centered care given the original Chronic Care Model. Better perceptions of diabetic care assessment also better clinical outcomes. The PACIC instrument can be used for the patient assessment of chronic care in a P4P program.

Renal dysfunction and hyperuricemia with low blood lead levels and ethnicity in community-based study.

The objective of this study was to assess the correlation between blood lead levels (BLL) with both renal dysfunction and hyperuricemia among aboriginals and non-aboriginals in Taiwan. 1318 aboriginals and 1247 non-aboriginals over 40 years of age volunteered for this study. During routine health examinations at a clinic, blood samples were taken and a questionnaire was administered. Male uric acid (BUA) concentration (7.2 mg/dL) in serum was higher than for females (5.9 mg/dL). BUA concentration among aboriginals was higher (6.9 mg/dL) than among non-aboriginals (5.9 mg/dL). A test for trend of odds ratio (OR) for renal dysfunction and hyperuricemia indicated a significant correlation with BLL for both ethnic groups. Multiple logistic regression showed people who had BLLs exceeding 7.5 microg/dL were at a higher risk for renal dysfunction (OR=1.92, 95% CI: 1.18-3.10) and hyperuricemia (OR=2.72, 95% CI: 1.64-4.52). We concluded that BLL was significantly correlated with renal dysfunction and hyperuricemia in both ethnic groups. Further research is needed to investigate the exact mechanism causing a higher incidence of related disease among aboriginal Taiwanese.

Ambient temperature and emergency room admissions for acute coronary syndrome in Taiwan.

Acute coronary syndrome (ACS) is an important public health problem around the world. Since there is a considerable seasonal fluctuation in the incidence of ACS, climatic temperature may have an impact on the onset of this disease. The objective of this study was to assess the relationship between the average daily temperature, diurnal temperature range and emergency room (ER) admissions for ACS in an ER in Taichung City, Taiwan. A longitudinal study was conducted which assessed the correlation of the average daily temperature and the diurnal temperature range to ACS admissions to the ER of the city's largest hospital. Daily ER admissions for ACS and ambient temperature were collected from 1 January 2000 to 31 March 2003. The Poisson regression model was used in the analysis after adjusting for the effects of holiday, season, and air pollutant concentrations. The results showed that there was a negative significant association between the average daily temperature and ER admissions for ACS. ACS admissions to the ER increased 30% to 70% when the average daily temperature was lower than 26.2 degrees C. A positive association between the diurnal temperature range and ACS admissions was also noted. ACS admissions increased 15% when the diurnal temperature range was over 8.3 degrees C. The data indicate that patients suffering from cardiovascular disease must be made aware of the increased risk posed by lower temperatures and larger changes in temperature. Hospitals and ERs should take into account the increased demand of specific facilities during colder weather and wider temperature variations.

Posttraumatic symptoms were worst among quake victims with injuries following the Chi-chi quake in Taiwan.

OBJECTIVE: The aim of this study was to investigate the incidence of posttraumatic stress disorder (PTSD) and psychological health status among earthquake victims 1 year after the quake. METHOD: Two hundred and seventy-two quake victims from temporary housing units were interviewed. Posttraumatic symptoms was assessed using the Davidson Trauma Scale, Chinese version (DTS-C). Psychological health status was measured using the Chinese Health Questionnaire (CHQ). RESULTS: The percentage of posttraumatic symptoms was 16.5%. Fifty-seven percent of the victims were found to have psychological problems using the CHQ. Posttraumatic symptoms and psychological problems were more prevalent among women (22.2% and 64%), compared with men (9.2% and 47.9%). Posttraumatic symptoms and CHQ total scores were highest among 25- to 44-year-olds, and lowest in the over-60-year group. Based on linear and logistic regression models, age and injury were the only two factors that significantly affected posttraumatic symptoms and CHQ total scores. CONCLUSION: Consistent with the previous studies, it is vitally important to continue providing psychological counseling and social support for quake victims, particularly victims who sustained an injury.

Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and genetic polymorphisms in breast cancer patients.

Reactive oxygen species (ROS) causes damage to DNA, but the role of ROS in breast carcinoma is still not clear. The objective of this study was to measure the urinary 8-OHdG levels of breast cancer patients at each stage of carcinogenesis and assess its association with the development of breast cancer. Sixty patients with malignant breast tumors were matched with 60 control subjects of the same ages in this case control study. Urinary 8-OHdG levels were significantly higher among breast cancer patients than among the control subjects, after making adjustments for confounders such as smoking, coffee consumption and use of oral contraceptives. The breast cancer patients were divided into three groups based on the stages of their cancer; urinary 8-OHdG levels decreased with each stage of breast carcinoma. Using multiple regression and logistic models adjusted for other covariates, urinary 8-OHdG levels significantly correlated with the development of breast cancer. However, it was found that breast cancer was not significantly influenced by CYP1A1, CYP1M1 or NAT2 polymorphisms. In conclusion, it was found that oxygen radical generation occurred within carcinoma cells, but the role of polymorphism of specific genes in the development of breast cancer should be evaluated.

Association between blood lead level and blood pressure in aborigines and others in central Taiwan.

To investigate the relationship between the blood lead level (BLL) and blood pressure among aborigines and non-aborigines in central Taiwan, a community-based survey that included demographic data, medical history, and blood chemistry analyses was conducted among 2,565 adults during an annual health examination. BLLs were analyzed using a graphite furnace atomic absorption spectrometer (AAS). There was a dose response among the non-aborigines (high BLL odds ratio = 2.97, compared with low BLL) but not among aborigines. Based on multiple linear regression models, BLLs were positively correlated with both systolic (an increase of 0.85 mm Hg/microg/dL) and diastolic (an increase of 0.48 mm Hg/microg/dL) blood pressures after adjusting for age, gender, ethnic group, alcohol consumption, and body mass index. BLLs were higher among aborigines than non-aborigines and were significantly correlated with blood pressure, particularly systolic pressure. The association should be considered causal.

Differentiation of serum levels of trace elements in normal and malignant breast patients.

The objective of this study was to determine which elements in serum best differentiated breast cancer in a case-control study. Concentrations of 13 elements in serum of 68 breast tumor patients (25 malignant and 43 benign) and 26 healthy controls were measured. Logistic regression with different variable-selection procedures was used to determine a possible configuration of elements. Sensitivity and specificity of the model were calculated to obtain the optimal cutoff point for discriminating malignant breast cancers vs other individuals (including benign breast disease and normal ones). Acombination of Cd, Mn, and Fe was found to have a specificity and sensitivity of 100% using forward-type logistic regression, when the cutoff value of the combination score was 52.71. Using stepwise-type logistic regression, a combination of Cr and Mn had a sensitivity of 100% and a specificity of 97.1% when the combination score of 17.4 was chosen as the cutoff. Similar analysis could be implemented to compare the malignant and control groups. Specificity and sensitivity were 100% for Mn (forward and stepwise type) with a cutoff point of 6.40. For the backward regression, specificity was 84.6% and sensitivity was 100% for Zn, with a cutoff point of 869.1. In conclusion, there was a significant difference in concentrations of all 13 elements in serum between breast cancer patients and controls. A combination among Cd, Mn, Fe, Cr, and Zn might be important to determine a differentiating reference for breast cancers if a long-term followed-up study is to be conducted.

Particle size reduction effectively enhances the cholesterol-lowering activities of carrot insoluble fiber and cellulose.

This study investigated and compared the effects of particle size reduction on the cholesterol-lowering activities of carrot insoluble fiber-rich fraction (IFF) and plant cellulose. Our results demonstrated that micronization treatment effectively pulverized the particle sizes of these insoluble fibers to different microsizes. Feeding the micronized insoluble fibers, particularly the micronized carrot IFF, significantly (p < 0.05) improved their abilities in lowering the concentrations of serum triglyceride (18.6-20.0%), serum total cholesterol (15.5-19.5%), and liver lipids (16.7-20.3%) to different extents by means of enhancing (p < 0.05) the excretion of lipids (124-131%), cholesterol (120-135%), and bile acids (130-141%) in feces. These results suggested that particle size was one of the crucial factors in affecting the characteristics and physiological functions of insoluble fibers. Therefore, particle size reduction by micronization might offer the industry an opportunity to improve the physiological functions of insoluble fibers, particularly the carrot IFF, in health food applications.

Association between exposure to environmental tobacco smoke (ETS) and breastfeeding behaviour.

AIM: A cross-sectional study was conducted to investigate the association between breastfeeding behaviour and exposure to environmental tobacco smoke (ETS). METHOD: Questionnaires were collected from 552 women. Blood and urine specimens were taken from part of the population at the time of delivery. The study population was classified into two groups: those exposed to ETS and those unexposed, based on self-reports from the subjects involved in the study. Cotinine levels in the urine and blood specimens were analysed by HPLC-UV under strict quality control procedures. RESULTS: There was a significant negative association between the exposure to ETS at home or in the workplace and the prevalence of breastfeeding in each of the 6 months following delivery using multiple logistic regression adjusted for other covariates. The cotinine levels in the urine and blood were dose-dependent, but not significantly so. However, women with lower cotinine levels had a higher probability of breastfeeding than those with higher levels. CONCLUSION: Women who are exposed to ETS have a low likelihood of breastfeeding. It is necessary for the government to regulate ETS in public areas and confined spaces in order to reduce the levels of ETS that women are exposed to.