Morbidity In Taiwan Research Articles

Quantifying the effects of anomalies of temperature, precipitation, and surface water storage on diarrhea risk in Taiwan.

Diarrheal disease continues to be a significant cause of morbidity and mortality. We investigated how anomalies in monthly average temperature, precipitation, and surface water storage (SWS) impacted bacterial, and viral diarrhea morbidity in Taiwan between 2004 and 2015. A multivariate analysis using negative binomial generalized estimating equations was employed to quantify age-specific and cause-specific cases of diarrhea associated with anomalies in temperature, precipitation, and SWS. Temperature anomalies were associated with an elevated rate of all-cause infectious diarrhea at a lag of 2 months, with the highest risk observed in the under-5 age group (incidence rate ratio [IRR], 1.03, 95% confidence interval [CI], 1.01 to 1.07). Anomalies in SWS were associated with increased viral diarrhea rates, with the highest risk observed in the under-5 age group at a 2-month lag (IRR, 1.27; 95% CI, 1.14 to 1.42) and a lesser effect at a 1-month lag (IRR, 1.18; 95% CI, 1.06 to 1.31). Furthermore, cause-specific diarrheal diseases were significantly affected by extreme weather events in Taiwan. Both extremely cold and hot conditions were associated with an increased risk of all-cause infectious diarrhea regardless of age, with IRRs ranging from 1.03 (95% CI, 1.02 to 1.12) to 1.18 (95% CI, 1.16 to 1.40). The risk of all-cause infectious diarrhea was significantly associated with average temperature anomalies in the population aged under 5 years. Viral diarrhea was significantly associated with anomalies in SWS. Therefore, we recommend strategic planning and early warning systems as major solutions to improve resilience against climate change.

Short-Term Exposure Effect of Ambient Fine Particulate Matter, Ozone and Cold Temperature on Emergency Room Visits for Asthma Patients

(1) Background: The acute effects of ozone, cold temperature and particulate matter less than 2.5 μm (PM2.5) in size related to asthma attacks are well known worldwide. The adverse effects of ozone and cold temperature on asthma morbidity in Taiwan are still inconclusive. (2) Methods: This retrospective study included patients who had asthma emergency room visits (ERVs) from 1 January 2016 to 31 December 2019 in a regional hospital in Taiwan. The short-term negative effects were estimated using Distributed Lag Non-Linear Models (DLNMs) for the relative risks (RRs) of asthma ERVs associated with PM2.5, ozone and cold temperature exposures within 5 days. (3) Results: There was a significant association between a 10 ppm increase in PM2.5 exposure and asthma ERVs at a 2-day lag (RR 1.166, 95% confidence interval (C.I.): 1.051-1.294). There was a significant association between ozone and asthma ERVs at a 1-day lag (RR 1.179, 95% C.I.: 1.034-1.345). The ambient temperature in cold weather compared with the temperature of minimum asthma ERV showed an RR of 1.214, 95% C.I.: 1.009-1.252 at a 1-day lag. (4) Conclusions: This study provides evidence that short-term exposure to fine suspended particulates, ozone and inverse temperature is associated with asthma exacerbation.

Modified Antibiotic Regimen for Pediatric Complicated Appendicitis to Reduce Infectious Morbidity in Taiwan

We compared our previous hospital-based antibiotic protocol and an optimum modified one by reviewing hospital records of children younger than 18 years with complicated appendicitis between 2010-2016. The modified protocol showed no infectious morbidity, which is significantly different from that of our previous protocol (mortality rate, 21.4%). An optimum hospital-based antibiotic protocol for complicated appendicitis can reduce the infectious morbidity rate without increasing hospital cost.

The incidence and factors of hip fractures and subsequent morbidity in Taiwan: An 11-year population-based cohort study.

Hip fractures are a major problem to elder population, but subsequent morbidity is unclear about environmental factors and socioeconomic conditions. The study aims to investigate the incidence of hip fractures treated by the surgery; to compare the sequelae and temporal trends of hip fractures; to evaluate the seasonal effects in the subsequent short-term and long-term morbidities after hip fractures. A cohort study design is conducted using national health research datasets between 2000 and 2010. The ICD-9-CM diagnostic codes were utilized to investigate the incidence of hip fractures and the corresponding treatments. Hierarchical modeling was used to analyze the factors associated with various types of hip fractures. The results indicated that females had a lower incidence in the 30–44 age group, but a significantly higher incidence than males among those aged 60 years or older (adjusted rates 232.1 vs. 100.3 per 100,000 persons, p<0.001). The incidence of hip fractures in the low-income group showed no significant difference compared to that in the general population. There was a temporal trend of a 8.6% increase in the incidence of all types of hip fractures over the period of 2000–2010. A summer-winter variation is observed among the elderly. Hip fractures and subsequent morbidity are increasing in Taiwan’s aging society. Older age, female gender, and time periods were independent risk factors for subsequent morbidities after surgical treatment. The result of this study is useful to the healthcare policy makers and to raise the public awareness of hip fractures.

Ambulatory care visits by Taiwanese dentists

Background/purposeIt is well recognized that various occupational hazards, including chemical, physical, and biological agents, can have adverse effects on dentists, whose heath is critical to the quality of dental care. However, little is known about the incidence of morbidity in Taiwan's dentist population. We carried out this study to investigate the overall and cause-specific incidence rates of ambulatory care visits by Taiwan's dentists. Materials and methodsData analyzed in this study were retrieved from Taiwan's National Health Insurance claims. We followed 7760 dentists who had a contract with the National Health Insurance program from 2003 to 2007. The incidence density of ambulatory care was calculated under a Poisson assumption. Using Poisson regression models, we investigated the effects of various sociodemographic and geographic variables on the all-cause and cause-specific incidence rates of ambulatory care. ResultsOver a 5-year period, the overall incidence rate of all-cause ambulatory care was estimated to be 7038/103 person-years. Dentists who were older, were female, and had lower insurance premiums had significantly increased rates. Additionally, those who practiced in central and southern regions and were affiliated with nonmedical centers were also associated with a significantly higher rate. ConclusionThere were inequalities in risks of ambulatory care use among Taiwan's dentists. Further studies should be conducted to investigate the causes responsible for the observed geographic and institutional variations in the risk of morbidity among dentists in Taiwan.

Temperature effects on hospital admissions for kidney morbidity in Taiwan

ObjectiveThis study aimed to associate hospital admissions of kidney diseases with extreme temperature and prolonged heat/cold events in 7 regions of Taiwan. MethodsAge-specific (<65years, 65+years and all ages) hospital admission records of nephritis, nephrotic syndrome, or nephrosis, in the form of electronic insurance reimbursement claims, were retrieved from Taiwan's National Health Insurance Research Database during the period of 2000–2008. The area–age-specific relative risk (RR) accounting for 8days of lag for temperature on hospital admissions of kidney diseases were estimated using distributed lag non-linear models with the Poisson distribution controlling for extreme temperature events, levels of air pollutants (PM10, O3, and NO2) and potential confounders. ResultsWe observed a V or J-shape association between daily average temperatures and the RR estimates for hospital admissions of kidney diseases in Taiwan. The lowest risk for hospital admissions of kidney diseases was found at around 25°C, and risk increased as temperatures deviated from 25°C. The pooled cumulative 8-day RR for all ages of population of the 7 study areas were 1.10 (95% confidence interval (CI): 1.01, 1.19) at 18°C and 1.45 (95% CI: 1.27, 1.64) at 30°C. High temperature has more profound influence on hospital admission of kidney diseases than low temperature. Temperature risks for hospital admissions were similar between younger (<65years) and elderly (65+years) population. This study observed no significant effects of prolonged heat extremes on hospital admissions of kidney diseases. ConclusionsThe heat effect for kidney morbidities leading to hospital admission was more significant than that of the cold temperature. This study did not find the age-dependent relative risks for temperature associating with hospital admissions of kidney diseases.

Modeling the impact of climate variability on diarrhea-associated diseases in Taiwan (1996–2007)

Diarrhea is an important public health problem in Taiwan. Climatic changes and an increase in extreme weather events (extreme heat, drought or rainfalls) have been strongly linked to the incidence of diarrhea-associated disease. This study investigated and quantified the relationship between climate variations and diarrhea-associated morbidity in subtropical Taiwan. Specifically, this study analyzed the local climatic variables and the number of diarrhea-associated infection cases from 1996 to 2007. This study applied a climate variation-guided Poisson regression model to predict the dynamics of diarrhea-associated morbidity. The proposed model allows for climate factors (relative humidity, maximum temperature and the numbers of extreme rainfall), autoregression, long-term trends and seasonality, and a lag-time effect. Results indicated that the maximum temperature and extreme rainfall days were strongly related to diarrhea-associated morbidity. The impact of maximum temperature on diarrhea-associated morbidity appeared primarily among children (0–14 years) and older adults (40–64 years), and had less of an effect on adults (15–39 years). Otherwise, relative humidity and extreme rainfall days significantly contributed to the diarrhea-associated morbidity in adult. This suggested that children and older adults were the most susceptible to diarrhea-associated morbidity caused by climatic variation. Because climatic variation contributed to diarrhea morbidity in Taiwan, it is necessary to develop an early warning system based on the climatic variation information for disease control management.

Influenza-associated morbidity in subtropical Taiwan

The purpose of this study was to assess the characteristics of influenza-associated morbidity in subtropical Taiwan, corresponding to the seasonal patterns, weather, and co-circulation of influenza (sub)types, and other respiratory viruses, where the burden of influenza is poorly quantified. This study applied the virus variation-guided Poisson seasonal regression models to evaluate the impact of epidemic influenza on morbidity in Taiwan for 1999-2006. The models allow for the adjusting of influenza-associated morbidity for factors such as annual trend, seasonality, temperature, relative humidity, influenza A (H1N1), A (H3N2), B, and respiratory syncytial virus. Influenza-associated morbidity was associated more strongly with temperature than relative humidity. Influenza A (H3N2) was more coordinated with other virus (sub)types than A (H1N1). Type B dominated simultaneously with A (H3N2) at times, whereas A (H3N2) and A (H1N1) rarely dominated simultaneously with each other. Epidemiologically, A (H3N2) appeared to be the dominant subtype (51%), followed by type B (39%) and then A (H1N1) (10%) for influenza-associated morbidity. This study suggests that seasonality and influenza (sub)types contribute significantly to influenza morbidity in subtropical Taiwan. This is important for influenza control managers who are involved actively in using epidemic and climate information to achieve influenza-reduction targets in subtropical regions.

Alcohol-related Injuries at an Emergency Department in Eastern Taiwan

Injuries are major causes of mortality and morbidity in Taiwan. Alcohol involvement often plays a role in injuries. The purpose of this study was to determine the prevalence of alcohol-related injuries at an emergency department in Eastern Taiwan and their associated factors. All injured patients who made emergency visits between October 2002 and September 2003 were enrolled. For each patient, the attending nurse completed an injury-coding sheet, which included the results of an assessment of whether the patient had an alcohol odor or alcohol consumption related behavior. Nurses recorded suspicion of alcohol consumption based on possible categories of "no alcohol odor", "alcohol odor", "intoxicated", "suspected" or "unknown". Blood alcohol testing was also performed based on the decision of the attending physician. Injuries were defined as alcohol-related based on the report of "alcohol odor" or "intoxicated" by the nurse or a positive blood alcohol test. Logistic regression was used to assess the significance of the association of possible related factors with alcohol-related injury. A total of 8822 eligible visits were studied and 14% were classified as alcohol-related. The proportion of alcohol-related injuries was 14.9% for vehicle-related injuries, and 51.3% for assaults. Male, young to middle aged, aboriginal ethnicity and visits after midnight were factors associated with increased likelihood of alcohol-related injuries. Multiple logistic regression analysis revealed that the three factors most significantly associated with alcohol-related injuries were visits after midnight (odds ratio, OR, 7.5; 95% confidence interval, CI, 6.4-8.9], assaults (OR, 3.4; 95% CI, 2.3-4.8), and head injuries (OR, 2.7; 95% CI, 2.3-3.2). Injuries were alcohol related in one out of seven patients this study from an emergency department in eastern Taiwan. Ongoing epidemiologic monitoring of the prevalence and nature of alcohol abuse among patients visiting the ED are urgently needed.

A community study of minor psychiatric morbidity in Taiwan.

A community study of minor psychiatric morbidity (MPM) was carried out on three population samples aged 15 and above randomly selected from rural (Yenpu), suburban (Chishan), and urban (Kaohsiung) communities (N = 350 for each) in Taiwan. A two-stage case finding strategy was applied with a newly developed and validated screening questionnaire (CHQ), and a modified Chinese version of the Clinical Interview Schedule (CIS-CV). The total response rate was 99.4% and there was no time lag between the CHQ screening and the second stage clinical interview conducted by a psychiatrist. The weighted validity of the CHQ was found to be acceptable (sensitivity 69.6%, specificity 94.8%, misclassification rate 11.4%). The overall weighted prevalence rate was 18.0% for men and 33.3% for women. Both the CIS and the CHQ data are used as the morbidity indices to investigate the sociodemographic risk factors of MPM. A higher risk of MPM, which occupied 92% of the total morbidity, was found to be associated with women aged 35 and above, the unemployed men, and the lower socioeconomic status after linear modelling.