The Taiwan National Health Insurance program and full infant immunization coverage.

PubMed

Chen, Chin-Shyan; Liu, Tsai-Ching

2005-02-01

We compared hospital-born infants and well-baby care use associated with complete immunizations in Taiwan before and after institution of National Health Insurance (NHI). We used logistic regression to analyze data from 1989 and 1996 National Maternal and Infant Health Surveys of 1398 and 3185 1-year-old infants, respectively. Infants born in hospitals were found to receive fewer immunizations than those born elsewhere before NHI but significantly more after NHI. Use of well-baby care correlates strongly and positively with the probability that a child will receive a full course of immunization after NHI. The NHI policy of including hospitals as immunization providers facilitates access to immunization services for children born in those facilities. Through NHI provision of free well-baby care, health planners have stimulated the demand for immunization.

Impact of universal health coverage on suicide risk in newly diagnosed cancer patients: Population-based cohort study from 1985 to 2007 in Taiwan.

PubMed

Lin, Po-Hsien; Liao, Shih-Cheng; Chen, I-Ming; Kuo, Po-Hsiu; Shan, Jia-Chi; Lee, Ming-Been; Chen, Wei J

2017-11-01

National Health Insurance (NHI), launched in 1995 in Taiwan, lightens patient's financial burdens but its effect on the suicide risk in cancer patients is unclear. We aimed to investigate the impacts of the NHI on the suicide in newly diagnosed cancer patients. We identified patients with newly diagnosed cancer from the nationwide Taiwan Cancer Registration from 1985 to 2007, and ascertained suicide deaths from the national database of registered deaths between 1985 and 2009. Standardized mortality ratio (SMR) of suicide risk among patients with cancer was calculated, and the suicide risk ratios were examined by gender, age group, and prognosis. For the 916 337 registered cancer patients with 4 300 953 person-years, 2 543 died by suicide, with a suicide rate of 59.1 per 100 000 person-years. Compared to the general population, cancer patients had an SMR of 2.47 for suicide, with a higher figure for males (2.73), age 45 to 64 (2.89), and cancer of poor prognosis (3.19). The suicide risk was highest in the first 2 years after the initial diagnosis. Comparing the cohorts of the period before (1985 to 1992) and after (1996 to 2007) the launch of NHI, we saw a reduction in the SMR within the first 2 years after cancer diagnosis (20%), with more prominent reduction for females (29%), age under 45 (69%), and cancer of good prognosis (33%). A universal health coverage relieving both physical and psychological distress may account for the post-NHI reduction of immediate suicide risk in patients of newly diagnosed cancer. Copyright © 2017 John Wiley & Sons, Ltd.

The Taiwan National Health Insurance Program and Full Infant Immunization Coverage

PubMed Central

Chen, Chin-Shyan; Liu, Tsai-Ching

2005-01-01

Objectives. We compared hospital-born infants and well-baby care use associated with complete immunizations in Taiwan before and after institution of National Health Insurance (NHI). Methods. We used logistic regression to analyze data from 1989 and 1996 National Maternal and Infant Health Surveys of 1398 and 3185 1-year-old infants, respectively. Results. Infants born in hospitals were found to receive fewer immunizations than those born elsewhere before NHI but significantly more after NHI. Use of well-baby care correlates strongly and positively with the probability that a child will receive a full course of immunization after NHI. Conclusions. The NHI policy of including hospitals as immunization providers facilitates access to immunization services for children born in those facilities. Through NHI provision of free well-baby care, health planners have stimulated the demand for immunization. PMID:15671469

User’s Manual for Strategic Satellite System Terminal Segment Life Cycle Cost Model. Volume 1

DTIC Science & Technology

1981-03-01

the depot pipeline, given by: NFD(I) = EFAIL (I,NS)*TNB(NS) NS *1 [LRU(I) + RTS(NHI(1))]*NRTS(I)*DRCT(LO(NS)) + NRTS(NHI(i))*(l - COND(I))*DADI where... EFAIL (I,NS)*TNB(NS)* [(LRU(I) + RTS(NHI(I)))*NRTS(I) NS + NRTS(NHI(I))*(l-COND(I))] *DMH(I)*DMF where DMH(I) = averaRP marnours to perform depot...XJC - RSCA(I) + 12*PIUP* EFAIL (I,NS)*TNB(NS)* NS {(LRUCI)+RTS(NHI(I)))* (CR(I)*BIIH(I)*BMF*BLR + CN(I)*(DMH(I)*DMF*DLR + 2*CPPD(LOCNS))*WT(I)) + CC

An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

PubMed

Chang, Hsien-Yen; Weiner, Jonathan P

2010-01-18

Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory power of claims-based risk adjustment models over demographics-only models, Taiwan's government should consider using claims-based models for policy-relevant applications. The performance of the ACG case-mix system in Taiwan was comparable to that found in other countries. This suggested that the ACG system could be applied to Taiwan's NHI even though it was originally developed in the USA. Many of the findings in this paper are likely to be relevant to other diagnosis-based risk adjustment methodologies.

The National Health Insurance system as one type of new typology: the case of South Korea and Taiwan.

PubMed

Lee, Sang-Yi; Chun, Chang-Bae; Lee, Yong-Gab; Seo, Nam Kyu

2008-01-01

A typology is the useful way of understanding the key frameworks of health care system. With many different criteria of health care system, several typologies have been introduced and applied to each country's health care system. Among those, National Health Service (NHS), Social Health Insurance (SHI), and Private Health Insurance (PHI) are three most well-known types of health care system in the 3-model typology. Differentiated from the existing 3-model typology of health care system, South Korea and Taiwan implemented new concept of National Health Insurance (NHI) system. Since none of previous typologies can be applied to these countries' NHI to explain its unique features in a proper manner, a new typology needs to be introduced. Therefore, this paper introduces a new typology with two crucial variables that are 'state administration for health care financing' and 'main body for health care provision'. With these two variables, the world's national health care systems can be divided into four types of model: NHS, SHI, NHI, and PHI (Liberal model). This research outlines the rationale of developing new typology and introduces main features and frameworks of the NHI that South Korea and Taiwan implemented in the 1990 s.

The Gap Between Physicians and the Public in Satisfaction with the National Health Insurance System in Korea

PubMed Central

Kim, Kye-Hyun; Park, Eun-Cheol

2012-01-01

The Korean National Health Insurance (NHI) system was an unprecedented accomplishment that was achieved in a short period of time. In this study, we sought to identify gaps between physicians and the public with respect to attitudes toward the NHI system in Korea. The study population was derived from the 2008 Korean Medical Association Survey, which was conducted to investigate satisfaction with and perceptions of the NHI system among physicians (n = 961) and the public (n = 935). Only 6.5% of the physicians were satisfied with NHI system, and 71.5% were dissatisfied with it. In contrast, 28.3% of the public were satisfied with the NHI system, and 21.4% were dissatisfied. The level of dissatisfaction expressed by physicians (2.03 ± 0.91 on a five-point scale) was also higher than that expressed by the public (3.06 ± 0.84). Despite rapid growth of NHI system, a large gap in satisfaction exists between physicians and the public. PMID:22690087

Accountability, utilization and providers for diabetes management in Taiwan, 2000-2009: an analysis of the National Health Insurance database.

PubMed

Chang, Tien-Jyun; Jiang, Yi-Der; Chang, Chia-Hsiun; Chung, Ching-Hu; Yu, Neng-Chun; Chuang, Lee-Ming

2012-11-01

The prevalence of diabetes has increased worldwide. To obtain nationwide data on accountability and utilization of health resources among diabetes patients in Taiwan, an analysis of the claims data for the National Health Insurance (NHI) from 2000 to 2009 was conducted. One-third of the NHI claims database was randomly sampled from 2000 to 2009. Diabetes was defined by three or more outpatient visits with diagnostic codes [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM): 250 or A code: A181] within 1 year, or one inpatient discharge diagnosis. Accountability items and NHI codes of various metabolic parameters and examinations were identified. Medical utilization was measured by the frequency and cost of care associated with ambulatory visits, hospitalizations, and emergency care within each year. The annual check-up frequency for various examinations significantly increased from 2000 to 2009. Both the average outpatient department (OPD) cost per diabetes patient/year and the average inpatient department (IPD) cost per time increased 1.34-fold in the past decade. The average OPD cost per diabetes patient and average IPD cost of each admission for diabetes patients was four times and 1.4 times compare with the general population, respectively. The annual average medical cost of each diabetes patient affected with both micro- and macrovascular complications was four times compared with those without vascular complications. There was an increasing trend for diabetes patients to visit regional hospital for OPD and IPD, whereas visits to the local hospital decreased in the past decade. Due to the increased frequency of annual check-ups after various examinations, the quality of diabetes management has improved in the past decade in Taiwan. As diabetes patients affected with both micro- and macrovascular complications incurred costs four times compared with those without complications, it is worth screening high-risk individuals to ensure earlier intervention and thus reduce diabetic complications and healthcare expenditure. Copyright © 2012. Published by Elsevier B.V.

Household out-of-pocket medical expenditures and national health insurance in Taiwan: income and regional inequality

PubMed Central

Chu, Tu-Bin; Liu, Tsai-Ching; Chen, Chin-Shyan; Tsai, Yi-Wen; Chiu, Wen-Ta

2005-01-01

Background Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income. Methods Data used in this study were drawn from the 1994 and 1996 Surveys of Family Income and Expenditure. We pooled the data from 1994 and 1996 and included a year dummy variable (NHI), equal to 1 if the household data came from 1996 in order to assess the impact of NHI on household out-of-pocket medical care expenditures shortly after its implementation in 1995. Results An individual who was older, female, married, unemployed, better educated, richer, head of a larger family household, or living in the central and eastern areas was more likely to have greater household out-of-pocket medical expenditures. NHI was found to have effectively reduced household out-of-pocket medical expenditures by 23.08%, particularly for more affluent households. With the implementation of NHI, lower and middle income quintiles had smaller decreases in out-of-pocket medical expenditure. NHI was also found to have reduced household out-of-pocket medical expenditures more for households in eastern Taiwan. Conclusion Although NHI was established to create free medical care for all, further effort is needed to reduce the medical costs for certain disadvantaged groups, particularly the poor and aborigines, if equality is to be achieved. PMID:16137336

A network approach for researching political feasibility of healthcare reform: the case of universal healthcare system in Taiwan.

PubMed

Wang, Guang-Xu

2012-12-01

This study evaluates the political feasibility of healthcare reform taking place in Taiwan in the past decade. Since Taiwan adopted National Health Insurance (NHI) in 1995, it has provided coverage for virtually all of the island's citizens. However, the imbalance between expenditure and revenue has resulted in a cycle of unsustainable spending which has necessitated financial reforms and political confrontations. By applying social network analysis, this paper examines multiple types of ties between policy elites and power distribution that have evolved in crucial policy events of the NHI's financial reforms between 1998 and 2010. Data sources include official documents and 62 social network interviews that were held with government officials and related unofficial policy participants. Blockmodeling and multidimensional scaling (MDS) are used to determine the major participants and network structures in the NHI domain, as well as the influential policy actors, based on information transmission, resource exchange, reputation attribution and action-set coalition networks in Taiwan's current political situation. The results show that although both public actors and all medical associations are the leading actors in the NHI reform, without good communication with societal actors, the promotion of reform proposals ends in failure. As a tool of political feasibility evaluation, social network analysis can map the political conflict between policy stakeholders systematically when policy makers pursue the result of policy adoption. Copyright © 2012 Elsevier Ltd. All rights reserved.

Primary and repeated surgeries for ectopic pregnancies and distribution by patient age, surgeon age, and hospital levels: an 11-year nationwide population-based descriptive study in Taiwan.

PubMed

Hsu, Ming-I; Tang, Chao-Hsiun; Hsu, Pei-Yang; Huang, Yu-Tung; Long, Cheng-Yu; Huang, Kuan-Hui; Wu, Ming-Ping

2012-01-01

To describe the changing trend, repeat operation rate, and distribution of laparoscopy, as compared with laparotomy, in treating ectopic pregnancy, according to patient age, preoperative conditions, surgeon age, and hospital accreditation level, in Taiwan over 11-years. Retrospective cohort study (Canadian Task Force classification II-2). Population-based nationwide insurance database. Women who underwent either laparotomy or laparoscopy because of ectopic pregnancy. Women who had National Health Insurance (NHI) underwent various surgical procedures to treat ectopic pregnancy. Data for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI Research Database, released by the NHI program in Taiwan between 1997 and 2007. A total of 43 170 women with 44 928 operations were identified. Only the primary surgeries, via either laparotomy or laparoscopy, performed because of ectopic pregnancy were included for analysis. The annual number of procedures to treat ectopic pregnancies decreased in the later years of the 11-year study. Laparotomy decreased significantly, from 81.2% in 1997 to 26.2% in 2007, whereas laparoscopic procedures increased significantly, from 18.8% in 1997 to 73.8% in 2007, as evidenced at log-linear regression analysis (p < .001). The rate of repeat operations because of persistent ectopic pregnancy was higher in the laparoscopy group than in the laparotomy group (0.38% vs 0.14 %; p < .001). Patients were more likely to undergo the same type of operation for the repeated surgery (i.e., laparotomy to laparotomy in 73.1% or laparoscopy to laparoscopy in 80.2%; p = 0.43). Use of laparoscopy (58.1%) and laparotomy (41.9%) differed according to patient age, preoperative comorbidities, surgeon age, and hospital accreditation level and ownership type. With older patients, those with preoperative anemia or shock, and elder surgeons, there was a greater chance that laparotomy would be performed. The probability of undergoing laparotomy was greater in patients in regional hospitals, local hospitals, and office-based clinics compared with those in medical centers. There has been considerable change in the type of surgical approach used to treat ectopic pregnancy in Taiwan over the past 11 years. Laparoscopy is preferred to laparotomy, and has become the standard surgical approach to treating ectopic pregnancies in Taiwan. However, laparoscopy is associated with a higher rate of repeat operations. The laparoscopic approach signifies a profound change in treating ectopic pregnancies among patients, surgeons, and hospital types. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

Ordering Social Objectives: National Health Service and National Health Insurance as Policy Options in Organizing the Medical Care System

PubMed Central

Silver, George A.

1978-01-01

For many years, a sharp distinction was made between NHS and NHI on the basis of payment and program focus. First, NHS was defined as a program essentially based on Congressional appropriations (general revenues); while NHI would be based on premiums largely derived from the insured. Second, NHS guaranteed service while NHI guaranteed only payment for services rendered. The distinctions were later extended from these definitions to include differences in response to resource needs, changing task descriptions and personnel assignments, more equitable redistribution of manpower, centralized administration and consumer participation. In general, if the goal were equity, NHS seemed more responsive than NHI. However, in recent years, the approach to NHI has been modified in response to criticism as well as increasing recognition of changed needs, and proposals for NHI like the Kennedy-Corman bill have become more like proposals for a NHS. In short, the difference today is largely one of immediate as against eventual transformation of the medical care system into a social instrument aiming to achieve equity. The major disagreement is whether the present medical care system lends itself to modification so as to achieve that end. PMID:685298

Gifts, bribes and solicitions: print media and the social construction of informal payments to doctors in Taiwan.

PubMed

Chiu, Yu-Chan; Smith, Katherine Clegg; Morlock, Laura; Wissow, Lawrence

2007-02-01

The Taiwanese practice of patients giving informal payments to physicians to secure services is deeply rooted in social and cultural factors. This study examines the portrayal of informal payments by Taiwanese print news media over a period of 12 years-from prior to until after the implementation of national health insurance (NHI) in Taiwan in 1995. The goal of the study was to examine how the advent of NHI changed the rationale for and use of informal payments. Both before and after the introduction of NHI, Taiwanese newspapers portrayed informal payments as appropriate means to secure access to better health care. Newspaper accounts established that, although NHI reduced patients' financial barriers to care, it did not change deeply held cultural beliefs that good care depended on the development of a reciprocal sense of obligation between patients and physicians. Physicians may have also encouraged the ongoing use of informal payments to make up revenue lost when NHI standardized fees and limited income from dispensing medications. In 2002, seven years after the implementation of NHI, the use of informal payments, though illegal, was still being justified in the print media through allusions to its role in traditional Taiwanese culture.

The effect of health payment reforms on cost containment in Taiwan hospitals: the agency theory perspective.

PubMed

Chang, Li

2011-01-01

This study aims to determine whether the Taiwanese government's implementation of new health care payment reforms (the National Health Insurance with fee-for-service (NHI-FFS) and global budget (NHI-GB)) has resulted in better cost containment. Also, the question arises under the agency theory whether the monitoring system is effective in reducing the risk of information asymmetry. This study uses panel data analysis with fixed effects model to investigate changes in cost containment at Taipei municipal hospitals before and after adopting reforms from 1989 to 2004. The results show that the monitoring system does not reduce information asymmetry to improve cost containment under the NHI-FFS. In addition, after adopting the NHI-GB system, health care costs are controlled based on an improved monitoring system in the policymaker's point of view. This may suggest that the NHI's fee-for-services system actually causes health care resource waste. The GB may solve the problems of controlling health care costs only on the macro side.

Medical device reimbursement coverage and pricing rules in Korea: current practice and issues with access to innovation.

PubMed

Lee, Sang-Soo; Salole, Eugene

2014-06-01

The development of health funding policy in Korea has followed the country's rapid economic development, with a comprehensive National Health Insurance (NHI) system in place by 1989. The funding of medical devices has followed this progression, with incorporation into the NHI reimbursement system in 2000 (several years later than pharmaceuticals), but important issues affecting patient access remain. Although the effect of devices on the NHI budget is relatively modest (only about 4%), because of concerns about NHI sustainability, attention has increasingly been paid to their management and funding. Unlike pharmaceuticals, however, it has been quite challenging to develop clear and fair criteria for reimbursement coverage and pricing of medical devices. The two key and longstanding issues around the reimbursement of medical devices in Korea are how to expedite market entry of improved or innovative medical devices at appropriate prices, and how to satisfactorily lower the reimbursement levels of older devices, thereby making headroom for new technologies to be reimbursed. Despite protracted discussions over the last decade, industry and government have been unable to reach full agreement. There has been some progress (e.g., introduction of the Value Appraisal and the Revaluation Systems), but there remains urgent need for productive discussion and consensus between government and industry regarding reasonable funding rules, transparency, and clarity in the reimbursement pricing process for medical devices. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of granulocyte colony-stimulating factor prophylaxis in chemotherapy-induced febrile neutropenia among breast cancer and Non-Hodgkin's lymphoma patients under Taiwan's national health insurance system.

PubMed

Wen, Tsun-Jen; Wen, Yu-Wen; Chien, Chun-Ru; Chiang, Shao-Chin; Hsu, William Wei-Yuan; Shen, Li-Jiuan; Hsiao, Fei-Yuan

2017-04-01

The beneficial effects of granulocyte colony-stimulating factor (G-CSF) prophylaxis on reducing the risk of chemotherapy-induced febrile neutropenia (CIFN) were well documented throughout the literature. However, existing data regarding its cost-effectiveness were conflicting. We estimated the cost-effectiveness of G-CSF prophylaxis in CIFN under Taiwan's National Health Insurance (NHI) system. Data on clinical outcomes and direct medical costs were derived for 5179 newly diagnosed breast cancer and 629 non-Hodgkin's lymphoma (NHL) patients from the NHI claims database. Patients were further categorized into three subgroups as "primary-", "secondary-" and "no -" prophylaxis based on their patterns of G-CSF use. Generalized estimating equations were applied to estimate the impact of G-CSF use on the incidence of CIFN. The incremental cost-effectiveness ratios of primary and secondary prophylactic G-CSF use were calculated and sensitivity analyses were performed. Primary prophylaxis of G-CSF decreased the incidence of CIFN by 27% and 83%, while secondary prophylaxis by 34% and 22% in breast cancer and NHL patients, respectively. Compared with those with no prophylaxis, the incremental cost per CIFN reduced in primary prophylaxis is $931 and $52 among patients with breast cancer and NHL, respectively. In contrast, secondary prophylaxis is dominated by no prophylaxis and primary prophylaxis in both cancer patients. Primary but not secondary prophylactic use of G-CSF was cost-effective in CIFN in breast cancer and NHL patients under Taiwan's NHI system. © 2016 John Wiley & Sons, Ltd.

National health insurance reform in South Africa: estimating the implications for demand for private health insurance.

PubMed

Okorafor, Okore Apia

2012-05-01

A recent health reform proposal in South Africa proposes universal access to a comprehensive package of healthcare services in the public sector, through the implementation of a national health insurance (NHI) scheme. Implementation of the scheme is likely to involve the introduction of a payroll tax. It is implied that the introduction of the payroll tax will significantly reduce the size of the private health insurance market. The objective of this study was to estimate the impact of an NHI payroll tax on the demand for private health insurance in South Africa, and to explore the broader implications for health policy. The study applies probit regression analysis on household survey data to estimate the change in demand for private health insurance as a result of income shocks arising from the proposed NHI. The introduction of payroll taxes for the proposed NHI was estimated to result in a reduction to private health insurance membership of 0.73%. This suggests inelasticity in the demand for private health insurance. In the literature on the subject, this inelasticity is usually due to quality differences between alternatives. In the South African context, there may be other factors at play. An NHI tax may have a very small impact on the demand for private health insurance. Although additional financial resources will be raised through a payroll tax under the proposed NHI reform, systemic problems within the South African health system can adversely affect the ability of the NHI to translate additional finances into better quality healthcare. If these systemic challenges are not adequately addressed, the introduction of a payroll tax could introduce inefficiencies within the South African health system.

Use of selected ambulatory dental services in Taiwan before and after global budgeting: a longitudinal study to identify trends in hospital and clinic-based services.

PubMed

Lin, Chienhung; Chao, Hailun

2012-09-25

The Taiwan government adopted National Health Insurance (NHI) in 1995, providing universal health care to all citizens. It was financed by mandatory premium contributions made by employers, employees, and the government. Since then, the government has faced increasing challenges to control NHI expenditures. The aim of this study was to determine trends in the provision of dental services in Taiwan after the implementation of global budgeting in 1998 and to identify areas of possible concern. This longitudinal before/after study was based on data from the National Health Insurance Research Database from 1996 to 2001. These data were subjected to logistic regression analysis. Linear regression analysis was used to examine changes in delivery of specific services after global budgeting implementation. Utilization of hospital and clinic services was compared. Reimbursement for dental services increased significantly while the number of visits per patient remained steady in both hospitals and clinics. In hospitals, visits for root canal procedures, ionomer restoration, tooth extraction and tooth scaling increased significantly. In dental clinics, visits for amalgam restoration decreased significantly while those for ionomer restoration, tooth extraction, and tooth scaling increased significantly. After the adoption of global budgeting, expenditures for dental services increased dramatically while the number of visits per patient did not, indicating a possible shift in patients to hospital facilities that received additional National Health Insurance funding. The identified trends indicate increased utilization of dental services and uneven distribution of care and dentists. These trends may be compromising the quality of dental care delivered in Taiwan.

Historical account of the national health insurance formulation in Kenya: experiences from the past decade.

PubMed

Abuya, Timothy; Maina, Thomas; Chuma, Jane

2015-02-12

Many Low-and-Middle-Income countries are considering reviewing their health financing systems to meet the principles of Universal Health Coverage (UHC). One financing mechanism, which has dominated UHC reforms, is the development of health insurance schemes. We trace the historical development of the National Health Insurance (NHI) policy, illuminate stakeholders' perceptions on the design to inform future development of health financing policies in Kenya. We conducted a retrospective policy analysis of the development of a NHI policy in Kenya using data from document reviews and seven in depth interviews with key stakeholders involved in the NHI design. Analysis was conducted using a thematic framework. The design of a NHI scheme was marked by complex interaction of the actor's understanding of the design, proposed implementation strategies and the covert opposition of the reform due to several reasons. First, actor's perception of the cost of the NHI design and its implication to the economy generated opposition. This was due to inadequate communication strategies to articulate the policy, leading to a vacuum of factual information flow to various players. Secondly, perceived fear of implications of the changes among private sector players threatened support and success gained. Thirdly, underlying mistrust associated with perceived lack of government's commitment towards transparency and good governance affected active engagement of all key players dampening the spirit of collective bargain breeding opposition. Finally, some international actors perceived a clash of their role and that of international programs based on vertical approaches that were inherent in the health system. The thrust towards UHC using NHI schemes should not only focus on the design of a viable NHI package but should also involve stakeholder engagements, devise ways of improving the health care system, enhance transparency and develop adequate governance structures to institutions mandated to provide leadership in the reform process to overcome covert opposition.

Feasible economic strategies to improve screening compliance for colorectal cancer in Korea

PubMed Central

Park, Sang Min; Yun, Young Ho; Kwon, Soonman

2005-01-01

AIM: While colorectal cancer (CRC) is an ideal target for population screening, physician and patient attitudes contribute to low levels of screening uptake. This study was carried out to find feasible economic strategies to improve the CRC screening compliance in Korea. METHODS: The natural history of a simulated cohort of 50-year-old Korean in the general population was modeled with CRC screening until the age of 80 years. Cases of positive results were worked up with colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Baseline screening compliance without insurance coverage by the national health insurance (NHI) was assumed to be 30%. If NHI covered the CRC screening or the reimbursement of screening to physicians increased, the compliance was assumed to increase. We evaluated 16 different CRC screening strategies based on Markov model. RESULTS: When the NHI did not cover the screening and compliance was 30%, non-dominated strategies were colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). In all scenarios of various compliance rates with raised coverage of the NHI and increased reimbursement of colonoscopy, COL10, COL5 and COL3 were non-dominated strategies, and COL10 had lower or minimal incremental medical cost and financial burden on the NHI than the strategy of no screening. These results were stable with sensitivity analyses. CONCLUSION: Economic strategies for promoting screening compliance can be accompanied by expanding insurance coverage by the NHI and by increasing reimbursement for CRC screening to providers. COL10 was a cost-effective and cost saving screening strategy for CRC in Korea. PMID:15786532

The influences of Taiwan's generic grouping price policy on drug prices and expenditures: evidence from analysing the consumption of the three most-used classes of cardiovascular drugs.

PubMed

Chen, Chi-Liang; Chen, Likwang; Yang, Wei-Chih

2008-04-12

Controlling the growth of pharmaceutical expenditures is a major global challenge. Promotion of generic drug prescriptions or use is gaining increased support. There are substantial contextual differences in international experiences of implementing pharmaceutical policies related to generic drugs. Reporting these experiences from varied perspectives can inform future policy making. This study describes an experience of Taiwan, where patients with chronic (long-term) conditions are usually managed in hospitals and drugs are provided in this setting with costs reimbursed through the National Health Insurance (NHI). It investigates the effects of Taiwan's reimbursement rate adjustment based on chemical generic grouping in 2001. This research also demonstrates the use of micro-level longitudinal data to generate policy-relevant information. The research can be used to improve efficiency of health care resource use. We chose the three most-used classes of cardiovascular drugs for this investigation: beta blocking agents, calcium channel blockers mainly with vascular effects, and plain ACE inhibitors. For each drug class, we investigated changes in daily expense, consumption volume, and total expenditures from a pre-action period to a corresponding post-action period. We compared an exposure or "intervention" group of patients targeted by the action with a comparisonor "control" group of patients not targeted by the action. The data sources are a longitudinal database for 200,000 NHI enrolees, corresponding NHI registration data of health care facilities, and an archive recording all historical data on the reimbursement rates of drugs covered by the NHI. We adopted a fixed effects linear regression model to control for unobserved heterogeneity among patient-hospital groups. Additional descriptive statistics were applied to examine whether any inappropriate consumption of drugs in the three classes existed. The daily drug expense significantly decreased from the pre-action period to the post-action period for the exposure group. The average magnitudes of the decreases for the three classes of drugs mentioned above were 14.8%, 5.8% and 5.8%, respectively. In contrast, there was no reduction for the comparison group. The number of days of the prescription increased significantly from the pre- to the post-action period for both exposure and comparison groups. The total expense also significantly increased for both patient groups. For the exposure group, the average magnitudes of the growth in the total expenditure for the three classes of drugs were 47.7%, 60.0% and 55.3%, respectively. For the comparison group, they were 91.6%, 91.6% and 63.2%, respectively. After the action, approximately 50% of patients obtained more than 180 days of prescription drugs for a six-month period. The 2001 price adjustment action, based on generic grouping, significantly reduced the daily expense of each of the three classes of cardiovascular drugs. However, in response to this policy change, hospitals in Taiwan tended to greatly expand the volume of drugs prescribed for their regular patients. Consequently, the total expenditures for the three classes of drugs grew substantially after the action. These knock-on effects weakened the capability of the price adjustment action to control total pharmaceutical expenditures. This means that no saved resources were available for other health care uses. Such expansion of pharmaceutical consumption might also lead to inefficient use of the three drug classes: a large proportion of patients obtained more than one day of drugs per day in the post-action period, suggesting manipulation to increase reimbursement and offset price controls. We recommend that Taiwan's government use the NHI data to establish a monitoring system to detect inappropriate prescription patterns before implementing future policy changes. Such a monitoring system could then be used to deter hospitals from abusing their prescription volumes, making it possible to more effectively save health care resources by reducing drug reimbursement rates.

Do differences in profiling criteria bias performance measurements? Economic profiling of medical clinics under the Korea National Health Insurance program: an observational study using claims data.

PubMed

Kang, Hee-Chung; Hong, Jae-Seok

2011-08-16

With a greater emphasis on cost containment in many health care systems, it has become common to evaluate each physician's relative resource use. This study explored the major factors that influence the economic performance rankings of medical clinics in the Korea National Health Insurance (NHI) program by assessing the consistency between cost-efficiency indices constructed using different profiling criteria. Data on medical care benefit costs for outpatient care at medical clinics nationwide were collected from the NHI claims database. We calculated eight types of cost-efficiency index with different profiling criteria for each medical clinic and investigated the agreement between the decile rankings of each index pair using the weighted kappa statistic. The exclusion of pharmacy cost lowered agreement between rankings to the lowest level, and differences in case-mix classification also lowered agreement considerably. A medical clinic may be identified as either cost-efficient or cost-inefficient, even when using the same index, depending on the profiling criteria applied. Whether a country has a single insurance or a multiple-insurer system, it is very important to have standardized profiling criteria for the consolidated management of health care costs.

Web-Based and Telephone Surveys to Assess Public Perception Toward the National Health Insurance in Taiwan: A Comparison of Cost and Results

PubMed Central

Tan, Elise Chia-Hui

2015-01-01

Background Numerous studies have examined the impact of global budget payment systems of health insurance on patient access to medical care. In order to monitor the population’s accessibility to health services, a series of survey are often used to understand public perceptions of the health care provider. Taiwan implemented the single-payer National Health Insurance in 1995 and has been conducting a series of surveys to monitor public perception of the NHI after adopting a global budget payment system in 2002. Although telephone surveys are commonly used in obtaining public opinions on various public health issues, limitations such as higher cost and influence of interviewers do raise some concerns. Web-based surveys, one of the alternative methods, may be free from these problems. Objective Our aim was to examine the difference of sociodemographic characteristics, satisfaction of NHI and NHI-contracted health care providers, attitude toward NHI-related issues, behavior in seeking medical advice and self-reported health status between those who completed Web-based surveys and those reached by telephone. Methods This study compared the demographic factors of participants who took either a Web-based survey (1313 participants) or random digit dialing telephone survey (2411 participants) that contained identical questions. Results Compared to telephone survey respondents, Web-based respondents tended to be younger (P<.001), unmarried (P<.001), non-smokers (P<.001), with a higher education (P<.001), and a higher monthly household income (P<.001) and worse self-reported health status (P=.008); however, they were less likely to report suffering from a chronic disease (P<.001). Despite these differences in background characteristics, no significant differences were observed in their answers related to the seeking of medical care or NHI-related issues. Telephone survey respondents reported greater satisfaction with NHI services. Web-based surveys were also shown to provide a lower average cost per sample (US$0.71) compared to telephone surveys (US$3.98). Conclusions Web-based surveys provide a low-cost alternative method for the polling of public attitudes toward NHI-related issues. Despite general similarities between the two polling methods with regard to responses, respondents to telephone surveys reported a stronger agreement with regard to satisfaction with NHI services and a more positive self-reported health status. PMID:25886989

Involving regional expertise in nationwide modeling for adequate prediction of climate change effects on different demands for fresh water

NASA Astrophysics Data System (ADS)

de Lange, Wim; Prinsen, Geert.; Hoogewoud, Jacco; Veldhuizen, Ab; Ruijgh, Erik; Kroon, Timo

2013-04-01

Nationwide modeling aims to produce a balanced distribution of climate change effects (e.g. harm on crops) and possible compensation (e.g. volume fresh water) based on consistent calculation. The present work is based on the Netherlands Hydrological Instrument (NHI, www.nhi.nu), which is a national, integrated, hydrological model that simulates distribution, flow and storage of all water in the surface water and groundwater systems. The instrument is developed to assess the impact on water use on land-surface (sprinkling crops, drinking water) and in surface water (navigation, cooling). The regional expertise involved in the development of NHI come from all parties involved in the use, production and management of water, such as waterboards, drinking water supply companies, provinces, ngo's, and so on. Adequate prediction implies that the model computes changes in the order of magnitude that is relevant to the effects. In scenarios related to drought, adequate prediction applies to the water demand and the hydrological effects during average, dry, very dry and extremely dry periods. The NHI acts as a part of the so-called Deltamodel (www.deltamodel.nl), which aims to predict effects and compensating measures of climate change both on safety against flooding and on water shortage during drought. To assess the effects, a limited number of well-defined scenarios is used within the Deltamodel. The effects on demand of fresh water consist of an increase of the demand e.g. for surface water level control to prevent dike burst, for flushing salt in ditches, for sprinkling of crops, for preserving wet nature and so on. Many of the effects are dealt with? by regional and local parties. Therefore, these parties have large interest in the outcome of the scenario analyses. They are participating in the assessment of the NHI previous to the start of the analyses. Regional expertise is welcomed in the calibration phase of NHI. It aims to reduce uncertainties by improving the rules for manmade re-direction of surface water, schematizations & parameters included in the model. This is carried out in workshops and in one-to-one expert meetings on regional models & the NHI. All results of NHI are presented on the internet and any expert may suggest improvements to the model. The final goal of the involvement of regional parties is the acceptation by decision impact receiving authorities

3-D Synthetic Microstructure Generation with Ellipsoid Particles

DTIC Science & Technology

2016-09-27

MATLAB scripts in Appendix A, Appendix B, and Appendix C by using 3 -D matrices, where the background is 0 and the particle is 1. For the 3 -D ellipses, it...iy(iy== 0 )=image_size(2); nlo = z0 - floor(diam/2); nhi = z0 + ceil(diam/2)-1; iz = mod(nlo:nhi,image_size( 3 ));iz(iz== 0 )=image_size( 3 ); Itest = logical...z0 + ceil(diam/2)-1; iz = mod(nlo:nhi,image_size( 3 )); iz(iz== 0 )=image_size( 3 ); Itest = logical(I(ix,iy,iz)); if sum(Itest(I_ellipse)) == 0 Itest

Cost-effectiveness analysis of carrier and prenatal genetic testing for X-linked hemophilia.

PubMed

Tsai, Meng-Che; Cheng, Chao-Neng; Wang, Ru-Jay; Chen, Kow-Tong; Kuo, Mei-Chin; Lin, Shio-Jean

2015-08-01

Hemophilia involves a lifelong burden from the perspective of the patient and the entire healthcare system. Advances in genetic testing provide valuable information to hemophilia-affected families for family planning. The aim of this study was to analyze the cost-effectiveness of carrier and prenatal genetic testing in the health-economic framework in Taiwan. A questionnaire was developed to assess the attitudes towards genetic testing for hemophilia. We modeled clinical outcomes of the proposed testing scheme by using the decision tree method. Incremental cost-effectiveness analysis was conducted, based on data from the National Health Insurance (NHI) database and a questionnaire survey. From the NHI database, 1111 hemophilic patients were identified and required an average medical expenditure of approximately New Taiwan (NT) $2.1 million per patient-year in 2009. By using the decision tree model, we estimated that 26 potential carriers need to be tested to prevent one case of hemophilia. At a screening rate of 79%, carrier and prenatal genetic testing would cost NT $85.9 million, which would be offset by an incremental saving of NT $203 million per year by preventing 96 cases of hemophilia. Assuming that the life expectancy for hemophilic patients is 70 years, genetic testing could further save NT $14.2 billion. Higher screening rates would increase the savings for healthcare resources. Carrier and prenatal genetic testing for hemophilia is a cost-effective investment in healthcare allocation. A case management system should be integrated in the current practice to facilitate patient care (e.g., collecting family pedigrees and providing genetic counseling). Copyright © 2013. Published by Elsevier B.V.

National Health Insurance and Health Education: Strategies for Change.

ERIC Educational Resources Information Center

Dwore, Richard B.

1980-01-01

The concept of National Health Insurance (NHI) as one of several strategies for resolving health problems in the U.S. is discussed. NHI goals include comprehensive health care, quality health care, efficient delivery systems, phased-in benefits, and consumer representation. (JD)

Variations in the persistence of health expenditures and the implications for the design of capitation payments in Taiwan.

PubMed

Ku, Li-Jung Elizabeth; Chiou, Meng-Jiun; Liu, Li-Fan

2015-07-01

The National Health Insurance (NHI) system in Taiwan launched a trial capitation provider payment programme in 2011, with the capitation formula based on patients' average NHI expenditure in the previous year. This study seeks to examine the concentration and persistence of health care expenditure among the elderly, and to assess the performance of the current capitation formula in predicting future high-cost users. This study analysed NHI expenditures for a nationally representative sample of people aged 65 years and over who took part in Taiwan's National Health Interview Survey, 2005. Expenditure concentration was assessed by the proportion of NHI expenditures attributable to four groups by expenditure percentile. Four transition probability matrixes examined changes in a person's position in the expenditure percentiles and generalized estimation equation models were estimated to identify significant predictors of a patient being in the top 10% of users. Between 2005 and 2009, the top 10% of users on average accounted for 55% of total NHI expenditures. Of the top 10% in 2005, 39% retained this position in 2006. However, expenditure persistence was the highest (77%) among the bottom 50% of users. NHI expenditure percentiles in both the baseline year and the prior year, and chronic conditions all significantly predicted future high expenditures. The model including chronic conditions performed better in predicting the top 10% of users (c-statistics increased from 0.772 to 0.904) than the model without. Given the increase in predictive ability, adding chronic conditions and baseline health care use data to Taiwan's capitation payment formula would correctly identify more high users. © The Author(s) 2015.

Use of selected ambulatory dental services in Taiwan before and after global budgeting: a longitudinal study to identify trends in hospital and clinic-based services

PubMed Central

2012-01-01

Background The Taiwan government adopted National Health Insurance (NHI) in 1995, providing universal health care to all citizens. It was financed by mandatory premium contributions made by employers, employees, and the government. Since then, the government has faced increasing challenges to control NHI expenditures. The aim of this study was to determine trends in the provision of dental services in Taiwan after the implementation of global budgeting in 1998 and to identify areas of possible concern. Methods This longitudinal before/after study was based on data from the National Health Insurance Research Database from 1996 to 2001. These data were subjected to logistic regression analysis. Linear regression analysis was used to examine changes in delivery of specific services after global budgeting implementation. Utilization of hospital and clinic services was compared. Results Reimbursement for dental services increased significantly while the number of visits per patient remained steady in both hospitals and clinics. In hospitals, visits for root canal procedures, ionomer restoration, tooth extraction and tooth scaling increased significantly. In dental clinics, visits for amalgam restoration decreased significantly while those for ionomer restoration, tooth extraction, and tooth scaling increased significantly. After the adoption of global budgeting, expenditures for dental services increased dramatically while the number of visits per patient did not, indicating a possible shift in patients to hospital facilities that received additional National Health Insurance funding. Conclusions The identified trends indicate increased utilization of dental services and uneven distribution of care and dentists. These trends may be compromising the quality of dental care delivered in Taiwan. PMID:23009095

A nationwide population-based retrospective cohort study of the risk of uterine, ovarian and breast cancer in women with polycystic ovary syndrome.

PubMed

Shen, Cheng-Che; Yang, Albert C; Hung, Jeng-Hsiu; Hu, Li-Yu; Tsai, Shih-Jen

2015-01-01

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age. We used a nationwide population-based retrospective cohort study to explore the relationship between PCOS and the subsequent development of gynecological cancers including uterine, breast, or ovarian cancer. We identified subjects who were diagnosed with PCOS between January 1, 2000, and December 31, 2004, in the Taiwan National Health Insurance (NHI) Research Database. A comparison cohort was constructed for patients without known PCOS who were also matched according to age. All PCOS and control patients were observed until diagnosed with breast cancer, ovarian cancer, or uterine cancer or until death, withdrawal from the NHI system, or December 31, 2009. The PCOS cohort consisted of 3,566 patients, and the comparison cohort consisted of 14,264 matched control patients without PCOS. The adjusted hazard ratio (HR) of uterine cancer and breast cancer in subjects with PCOS were higher (HR: 8.42 [95% confidence interval: 1.62-43.89] and HR: 1.99 [95% confidence interval: 1.05-3.77], respectively) than that of the controls during the follow-up. With the Monte Carlo method, only the mean adjusted HR of 1,000 comparisons for developing uterine cancer during the follow-up period was greater for the PCOS group than for the control groups (HR: 4.71, 95% confidence interval: 1.57-14.11). PCOS might increase the risk of subsequent newly diagnosed uterine cancer. It is critical that further large-scale, well-designed studies be conducted to confirm the association between PCOS and gynecological cancer risk. ©AlphaMed Press.

Effect of end-stage renal disease on long-term survival after a first-ever mechanical ventilation: a population-based study.

PubMed

Chen, Chin-Ming; Lai, Chih-Cheng; Cheng, Kuo-Chen; Weng, Shih-Feng; Liu, Wei-Lun; Shen, Hsiu-Nien

2015-10-01

Patients with end-stage renal disease (ESRD(Pos)) usually have multiple comorbidities and are predisposed to acute organ failure and in-hospital mortality. We assessed the effect of ESRD on the poorly understood long-term mortality risk after a first-ever mechanical ventilation (1-MV) for acute respiratory failure. The data source was Taiwan's National Health Insurance (NHI) Research Database. All patients given a 1-MV between 1999 and 2008 from one million randomly selected NHI beneficiaries were identified (n = 38,659). Patients with or without ESRD (ESRD(Neg)) after a 1-MV between 1999 and 2008 were retrospectively compared and followed from the index admission date to death or the end of 2011. ESRD(Pos) patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD(Neg) patients (ratio: 1:8) using a propensity score method. The primary outcome was death after a 1-MV. The effect of ESRD on the risk of death after MV was assessed. A Cox proportional hazard regression model was used to assess how ESRD affected the mortality risk after a 1-MV. The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD(Pos) patients than in ESRD(Neg) patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51). For patients who survived until discharge, ESRD was not associated with long-term (>4 years) mortality. ESRD increased the mortality risk after a 1-MV, but long-term survival seemed similar.

Patterns of outpatient care utilization by seniors under the National Health Insurance in Taiwan.

PubMed

Hsu, Wen-Chin; Hsu, Yi-Ping

2016-05-01

Taiwan has one of the fastest growing aging populations in the world, which makes the effective allocation of scarce medical resources a key issue. This paper investigates patterns in the use of outpatient services by elderly individuals in Taiwan under the National Health Insurance (NHI) program. We assembled a random sample from the NHI Research Database in Taiwan, comprising 50% of all claims made for elderly people (65 years old) in 2010 (n 1,239,836 beneficiaries) including 14 variables. In 2010, individuals aged 65 years or older comprised 10.74% of the population of Taiwan, and accounted for 11.39% of all physician and outpatient visits. The rate of medical care visits was 28.54 ± 21.23 (Standard deviation) times per person per annum, with a higher rate for women, those in the 80-84 age group, low-income beneficiaries, and the inhabitants of offshore islands. The three most frequent diagnoses for elderly patients were hypertension, diabetes, and acute upper respiratory infections. The mean insured medical costs per person per annum were US Dollars 1,132, with higher expenses for men, those in the 80-84 age group, and those inhabiting urban areas. This study employed nationally representative data in the detection of patterns in outpatient care utilization by elderly individuals in Taiwan. Medical care providers and policymakers should be fully aware of the complex patterns unique to older patients. The results of this study could be used as a benchmark with which to assess the impact of future medical care policy on elderly people. Copyright © 2015. Published by Elsevier B.V.

Achieving and Sustaining Universal Health Coverage: Fiscal Reform of the National Health Insurance in Taiwan.

PubMed

Lan, Jesse Yu-Chen

2017-12-01

The paper discusses the expansion of the universal health coverage (UHC) in Taiwan through the establishment of National Health Insurance (NHI), and the fiscal crisis it caused. Two key questions are addressed: How did the NHI gradually achieve universal coverage, and yet cause Taiwanese health spending to escalate to fiscal crisis? What measures have been taken to reform the NHI finance and achieve moderate success to date? The main argument of this paper is that the Taiwanese Government did try to implement various reforms to save costs and had moderate success, but the path-dependent process of reform does not allow increasing contribution rates significantly and thereby makes sustainability challenging.

Politics and medicine: the case of Israeli National Health Insurance.

PubMed

Yishai, Y

1982-01-01

The paper focuses on the attempts to introduce a national health insurance system in Israel. So far all these attempts advanced through six public committees and various legislative initiatives have been futile. The major actors involved in the process of NHI formulation are (a) the sick funds, the largest of which (KH) nearly monopolizes the health services; (b) political parties which are affiliated with the sick funds; (c) the Israeli medical association. The labor oriented parties and sick funds aimed for the introduction of an NHI system which would strengthen KH and preserve its autonomy. The right wing parties and sick fund advocated nationalization of the NHI. The IMA took a mid-way position not identifying with either of the parties. By allying with a small coalition party it was effective in impeding the legislative process that was initiated by the Labor Party. The vigorous opposition of KH has hindered the adoption of the Likud's version of the NHI. Hence, the issue, torn between conflicting parties, reached a stalemate which is not likely to be resolved in the near future.

Willingness to participate and Pay for a proposed national health insurance in St. Vincent and the grenadines: a cross-sectional contingent valuation approach.

PubMed

Adams, Rosmond; Chou, Yiing-Jenq; Pu, Christy

2015-04-09

Numerous Caribbean countries are considering implementing National Health Insurance (NHI) and pooling resources to finance their health sectors. Based on this increased interest in health insurance, we investigated the willingness to participate and to pay for NHI in St. Vincent and the Grenadines, an upper-middle-income Caribbean country. Four hundred heads of household in St. Vincent and the Grenadines were interviewed in August 2012 and September 2012. The samples were selected through simple random sampling, including the stratification of rural, semiurban, and urban communities to ensure the representativeness of the sample. A contingent valuation method with a pretested interviewer-led questionnaire was used. Respondents were presented with a hypothetical NHI plan. Chi-squared analysis was performed to identify factors that are associated with the willingness to participate. Multiple logistic regression was used to explore the factors that influence respondents' willingness to pay. In total, 69.5% (n = 278) of the respondents indicated that they were willing to participate in the proposed NHI plan, of whom 72.3% were willing to pay for the first bid (EC$50). When the bid was reduced to EC$25, all of the remaining respondents who indicated they were willing to participate were willing to pay this lowered bid. Overall, the respondents were willing to pay EC$77.83 (US$28.83) per month for each person to enroll in the NHI plan. Age, income, and having some form of health insurance were significantly associated with a willingness to participate in the plan. A higher socioeconomic status was the principal determinant factor for the willingness to participate. This is similar to studies on developing economies. The government can use these findings to guide the successful implementation of the proposed NHI program. People with a lower socioeconomic status must be engaged from the start of and throughout the development process to enhance their understanding of and participation in the plan.

A cost-effective add-on-value card-assisted firewall over Taiwan's NHI VPN framework.

PubMed

Huang, Jyh-Win; Hou, Ting-Wei

2007-06-01

Besides the overall budget for building the infrastructure of a healthcare-service-based virtual private network (VPN) in Taiwan, two issues were considered critical for its acceptance by the country's 17,000 plus medical institutions. One was who was to pay for the network (ADSL or modem) connection fee; the other was who was to pay for the firewall/anti-virus software. This paper addresses the second issue by proposing an efficient freeware firewall, named card-assisted firewall (CAF), for NHI VPN edge-hosts, which is also an add-on-value application of the National Healthcare IC card that every insurant and medical professional has. The innovative concept is that any NHI VPN site (edge-host) can establish diversified secure-authenticated connections with other sites only by an authentication mechanism, which requires a NHI Java card state machine and the Access Control List of the host. It is different from two-factor authentication cards in four ways: (1) a PIN code is not a must; (2) it requires authentication with the remote IC card Data Centre; (3) the NHI cards are already available, no modification is needed, and there is no further cost for the deployment of the cards; (4) although the cards are in the reader, the communication cannot start unless the cards are in the corresponding states; i.e. the states allow communication. An implementation, on a Microsoft Windows XP platform, demonstrated the system's feasibility over an emulation of the NHI VPN framework. It maintained a high line speed, the driver took up 39 KB of disk space, installation was simple, not requiring any extra hardware or software, and the average packet processing time of the CAF driver measured was 0.3084 ms. The average overhead in comparing the Access Control List predefined routing in card, in an FTP testing experiment, was 5.7 micros (receiving) and 8 micros (sending).

Involving regional expertise in nationwide modeling for adequate prediction of climate change effects on different demands for fresh water

NASA Astrophysics Data System (ADS)

de Lange, W. J.

2014-05-01

Wim J. de Lange, Geert F. Prinsen, Jacco H. Hoogewoud, Ab A Veldhuizen, Joachim Hunink, Erik F.W. Ruijgh, Timo Kroon Nationwide modeling aims to produce a balanced distribution of climate change effects (e.g. harm on crops) and possible compensation (e.g. volume fresh water) based on consistent calculation. The present work is based on the Netherlands Hydrological Instrument (NHI, www.nhi.nu), which is a national, integrated, hydrological model that simulates distribution, flow and storage of all water in the surface water and groundwater systems. The instrument is developed to assess the impact on water use on land-surface (sprinkling crops, drinking water) and in surface water (navigation, cooling). The regional expertise involved in the development of NHI come from all parties involved in the use, production and management of water, such as waterboards, drinking water supply companies, provinces, ngo's, and so on. Adequate prediction implies that the model computes changes in the order of magnitude that is relevant to the effects. In scenarios related to drought, adequate prediction applies to the water demand and the hydrological effects during average, dry, very dry and extremely dry periods. The NHI acts as a part of the so-called Deltamodel (www.deltamodel.nl), which aims to predict effects and compensating measures of climate change both on safety against flooding and on water shortage during drought. To assess the effects, a limited number of well-defined scenarios is used within the Deltamodel. The effects on demand of fresh water consist of an increase of the demand e.g. for surface water level control to prevent dike burst, for flushing salt in ditches, for sprinkling of crops, for preserving wet nature and so on. Many of the effects are dealt with by regional and local parties. Therefore, these parties have large interest in the outcome of the scenario analyses. They are participating in the assessment of the NHI previous to the start of the analyses. Regional expertise is welcomed in the calibration phase of NHI. It aims to reduce uncertainties by improving the rules for manmade re-direction of surface water, schematizations & parameters included in the model. This is carried out in workshops and in one-to-one expert meetings on regional models & the NHI. All results of NHI are presented on the internet and any expert may suggest improvements to the model. The final goal of the involvement of regional parties is the acceptation by decision impact receiving authorities. The presentation will give an overview of the experiences and results of the participation process both technically and in the national policy making context.

Heterogeneous impact of Taiwan's national health insurance on labor force participation of married women by income and family structures.

PubMed

Liao, Pei-An

2011-02-01

In this study, I investigate how the impact of the National Health Insurance (NHI) introduction in Taiwan in 1995 on the labor force participation (LFP) decisions of married women varies with income and family structures. Employing the difference-in-differences (DID) approach, I find that the NHI introduction reduced LFP of married women in the twenty-fifth to fiftieth percentiles of the income distribution between 17.8 and 21.7 percentage points (33%-40%). The difference-in-differences-in-differences (DIDID) results suggest that married women in different family structures (the presence of children under 3 or less healthy elderly household members) did not respond differently to the NHI introduction.

National health insurance, physician financial incentives, and primary cesarean deliveries in Taiwan.

PubMed

Tsai, Yi-Wen; Hu, Teh-Wei

2002-09-01

Taiwan's National Health Insurance Program (NHI) was implemented on March 1, 1995. This study analyzed the influences of the Case Payment method of reimbursement for inpatient care and of physician financial incentives on a woman's choice for primary cesarean delivery. Logistic regressions were used to analyze 11 788 first-time deliveries in a nonprofit hospital system between March 1, 1994, and February 29, 1996. After implementation of the NHI's Case Payment scheme, the likelihood that a woman would choose primary cesarean delivery increased by four to five times compared with the choice behavior of uninsured individuals prior to NHI (P <.0001). Out-of-pocket payment discourages the selection of primary cesarean delivery. No robust statistics were found relating physician financial incentives to delivery choice.

Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan.

PubMed

Hsu, Min-Huei; Yeh, Yu-Ting; Chen, Chien-Yuan; Liu, Chien-Hsiang; Liu, Chien-Tsai

2011-03-01

Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one medication that might be duplicative to the prior prescriptions stored in NHI-IC cards. The rate of potential duplicate medication alerts for the Pediatric Department was higher than that for the Urology Department (2.78% versus 1.67%). However, the rate of revisions to prescriptions was higher in the Urology Department than the Pediatric Department. Overall, the rate of physicians reviewing and revising their prescriptions was 29.25%; the rate of physicians reviewing without revising their prescriptions was 43.62%; the rate of physicians turning off the alert screens right after the screens popped up (overridden) was 27.13%. Thus, physicians accepted alerts to review their prescriptions with patients in most situations (72.87%). Moreover, over the study period, the rate of total revisions made to prescriptions increased and the "overridden" rate decreased. Our approach enhances the capability of CPOE systems using NHI-IC cards as a nationwide infrastructure to provide more complete patient health information and medication history sharing among hospitals in Taiwan. Thus, our system can provide a better prescribing tool to help physicians detect potential duplicate medications for frequent doctor-shopping patients and hence enhance patient safety across hospital boundaries. However, the effectiveness of detecting duplicate medications with our approach is very much dependent on the completeness of NHI-IC cards, which in turn primarily depends on physician use of the cards when prescribing. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

[Not Available].

PubMed

Baladia, Eduard; Frutos Pérez-Surio, Alberto; Martínez-Rodríguez, Rodrigo

2016-06-30

Objetivos: dar a conocer las recomendaciones relacionadas con la Nutrición Humana y Dietética (NHyD) de la Guía de Práctica Clínica para el manejo de la enfermedad de Parkinson del Sistema Nacional de Salud (GPC-EP/SNS) y favorecer su difusión e implementación en la práctica. El objetivo secundario es presentar la implicación de los profesionales de la NHyD en la elaboración de la guía.Material y métodos: siguiendo el Manual Metodológico de Elaboración de Guías de Práctica Clínica en el Sistema Nacional de Salud, se formularon las preguntas clínicas, se realizó una búsqueda sistemática para cada pregunta en bases de datos (PubMed/Medline, Embase, Cochrane Library, CRD, LILACS, IBECS y ClinicalTrials), se definieron los criterios de elegibilidad, al menos dos investigadores seleccionaron los estudios, se realizó lectura crítica de la literatura se resumió en tablas de síntesis de evidencia y se establecieron las recomendaciones.Resultados: se propusieron 14 preguntas relacionadas directamente con NHyD-Parkinson, de las cuales solamente 3 pudieron incluirse. Se formuló una pregunta relacionada con la terapia de logopedia aplicada en personas con EP que presentan problemas de deglución, tratamiento donde se imbrican los profesionales de la NHyD. De 642 artículos localizados, únicamente 2 pudieron ser incluidos para contestar las correspondientes preguntas. De las evidencias halladas, se derivaron 11 recomendaciones directa o indirectamente relacionados con la NHyD.Conclusiones: la implicación de profesionales sanitarios en equipos multidisciplinares mejora el resultado final de las guías y la atención sanitaria de los pacientes. Es necesario que los profesionales sanitarios de la NHyD (los/las dietistas-nutricionistas) se impliquen en iniciativas basadas en la mejor evidencia científica disponible y que formen parte de los equipos de trabajo multidisciplinares.

Current status of endoscopic submucosal dissection for early gastric cancer in Korea: role and benefits.

PubMed

Kim, Sang Gyun; Lyu, Da Hyun; Park, Chan Mi; Lee, Na Rae; Kim, Jiyoung; Cha, Youngju; Jung, Hwoon-Yong

2018-06-21

This study was aimed to investigate the current clinical status of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in Korea based on a National Health Insurance (NHI) database between 2011 and 2014. The claims data of ESD for EGC in Korean NHI were reviewed using material codes of Health Insurance Review and Assessment Service between November 2011 and December 2014. The current clinical status was analyzed in terms of treatment pattern, in-hospital length of stay (LOS), total medical costs, and en bloc resection rate according to the hospital type. A total of 23,828 cases of ESD for EGC were evaluated. ESD was performed in 67.4% of cases in tertiary care hospitals, 31.8% in general hospitals, and 0.8% in hospitals, respectively. The median LOS was 5 days, and total median medical costs was approximately 1,300 US dollars. En bloc resection rate was 99%; 8.5% of cases underwent additional treatment within 90 days ESD, and 5.5% in 91 to 365 days after ESD. The clinical status was not significantly different according to the year and hospital type. A majority of ESD for EGC were performed in tertiary care hospitals in Korea. The clinical status showed excellent clinical outcomes and did not differ by the year and between the types of hospitals in Korea.

Cost trend analysis of initial cancer treatment in Taiwan.

PubMed

Li, Tsai-Yun; Hsieh, Jan-Sing; Lee, King-Teh; Hou, Ming-Feng; Wu, Chia-Ling; Kao, Hao-Yun; Shi, Hon-Yi

2014-01-01

Despite the high cost of initial cancer care, that is, care in the first year after diagnosis, limited information is available for specific categories of cancer-related costs, especially costs for specific services. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment. The analysis of trends in initial treatment costs focused on cancer-related surgery, chemotherapy, radiation therapy, and treatments other than active treatments. For each cancer-specific trend, slopes were calculated for regression models with 95% confidence intervals. Analyses of patients diagnosed in 2007 showed that the National Health Insurance (NHI) system paid, on average, $10,780 for initial care of a gastric cancer patient and $10,681 for initial care of a lung cancer patient, which were inflation-adjusted increases of $6,234 and $5,522, respectively, over the 1996 care costs. During the same interval, the mean NHI payment for initial care for the five specific cancers increased significantly (p<0.05). Hospitalization costs comprised the largest portion of payments for all cancers. During 1996-2007, the use of chemotherapy and radiation therapy significantly increased in all cancer types (p<0.05). In 2007, NHI payments for initial care for these five cancers exceeded $12 billion, and gastric and lung cancers accounted for the largest share. In addition to the growing number of NHI beneficiaries with cancer, treatment costs and the percentage of patients who undergo treatment are growing. Therefore, the NHI must accurately predict the economic burden of new chemotherapy agents and radiation therapies and may need to develop programs for stratifying patients according to their potential benefit from these expensive treatments.

Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study.

PubMed

Yang, Chiang-Hsing; Huang, Yu-Tung A; Hsueh, Ya-Seng A

2013-02-04

Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers' Gini coefficients also become close to one another. This study found that NHI's offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan.

Has cost containment after the National Health Insurance system been successful? Determinants of Taiwan hospital costs.

PubMed

Hung, Jung-Hua; Chang, Li

2008-03-01

Taiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).

Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan

PubMed Central

Kuo, Chang-Fu; Grainge, Matthew J; See, Lai-Chu; Yu, Kuang-Hui; Luo, Shue-Fen; Valdes, Ana M; Zhang, Weiya; Doherty, Michael

2015-01-01

Objective To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population. Methods Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individuals with affected first-degree and second-degree relatives and relative contributions of genes (heritability), common environment shared by family members and non-shared environment to gout susceptibility. Results RRs for gout were significantly higher in individuals with affected first-degree relatives (men, 1.91 (95% CI 1.90 to 1.93); women, 1.97 (95% CI 1.94 to 1.99)) and also in those with affected second-degree relatives (men, 1.27 (95% CI 1.23 to 1.31); women, 1.40 (95% CI 1.35 to 1.46)). RRs (95% CIs) for individuals with an affected twin, sibling, offspring, parent, grandchild, nephew/niece, uncle/aunt and grandparent were 8.02 (6.95 to 9.26), 2.59 (2.54 to 2.63), 1.96 (1.95 to 1.97), 1.93 (1.91 to 1.94), 1.48 (1.43 to 1.53), 1.40 (1.32 to 1.47), 1.31 (1.24 to 1.39), and 1.26 (1.21 to 1.30), respectively. The relative contributions of heritability, common and non-shared environmental factors to phenotypic variance of gout were 35.1, 28.1 and 36.8% in men and 17.0, 18.5 and 64.5% in women, respectively. Conclusions This population-based study confirms that gout aggregates within families. The risk of gout is higher in people with a family history. Genetic and environmental factors contribute to gout aetiology, and the relative contributions are sexually dimorphic. PMID:24265412

Increased risk of organic erectile dysfunction in patients with chronic fatigue syndrome: a nationwide population-based cohort study.

PubMed

Chao, C-H; Chen, H-J; Wang, H-Y; Li, T-C; Kao, C-H

2015-07-01

Chronic fatigue syndrome (CFS) is a complex disorder characterized by profound and persistent fatigue and several comorbidities. CFS was previously reported to be associated with female sexual dysfunction. We propose that CFS might also be associated with organic erectile dysfunction (organic ED). We conducted a retrospective cohort study by using data from the National Health Insurance (NHI) Research Database. We identified 2156 male patients who were newly diagnosed with CFS between January 1, 2003 and December 31, 2006. After excluding those younger than 20 years and prevalent cases, 1976 patients were subjected to analysis, and 7904 people served as healthy controls. All study subjects were followed up from the index date to the date of organic ED diagnosis, withdrawal from the NHI program, or the end of 2011. Compared with the non-CFS cohort, the incidence density rate of organic ED was 1.88-fold higher than that in the CFS cohort (3.23 vs. 1.73 per 1000 person-years) with an adjusted hazard ratio (HR) of 1.88 (95% CI = 1.26-2.81) when adjusting for sex and comorbidities. The combined impacts of patients with CFS and cardiovascular disease (CVD), diabetes mellitus (DM), chronic kidney disease (CKD), depression, and anxiety showed a significant by joint association with organic ED risk compared with patients with no CFS and no counterpart comorbidity. The greatest magnitude of adjusted HR of ED for CFS was observed in individuals without any comorbidity (3.87, 1.95-7.66). The incidence of organic ED is higher among males aged 40 years and over for both CFS and non-CFS cohorts. As the number of comorbidity increases, the incidence of organic ED increases in males without CFS. Higher incidence of organic ED was observed in males with CVD, DM, CKD, depression, or anxiety for both CFS and non-CFS cohorts. © 2015 American Society of Andrology and European Academy of Andrology.

Python Processing and Version Control using VisTrails for the Netherlands Hydrological Instrument (Invited)

NASA Astrophysics Data System (ADS)

Verkaik, J.

2013-12-01

The Netherlands Hydrological Instrument (NHI) model predicts water demands in periods of drought, supporting the Dutch decision makers in taking operational as well as long-term decisions with respect to the water supply. Other applications of NHI are predicting fresh-salt interaction, nutrient loadings, and agriculture change. The NHI model consists of several coupled models: a saturated groundwater model (MODFLOW), an unsaturated groundwater model (MetaSWAP), a sub-catchment surface water model (MOZART), and a distribution network of surface waters model (DM/SOBEK). Each of these models requires specific, usually large, input data that may be the result of sophisticated schematization workflows. Input data can also be dependent on each other, for example, the precipitation data is input for the unsaturated zone model (cells) as well as for the surface water models (polygons). For efficient data management, we developed several Python tools such that the modeler or stakeholder can use the model in a user-friendly manner, and data is managed in a consistent, transparent and reproducible way. Two open source Python tools are presented here: the data version control module for the workflow manager VisTrails called FileSync, and the NHI model control script that uses FileSync. VisTrails is an open-source scientific workflow and provenance management system that provides support for simulations, data exploration and visualization. Since VisTrails does not directly support version control we developed a version control module called FileSync. With this generic module, the user can synchronize data from and to his workflow through a dialog window. The FileSync dialog calls the FileSync script that is command-line based and performs the actual data synchronization. This script allows the user to easily create a model repository, upload and download data, create releases and define scenarios. The data synchronization approach applied here differs from systems as Subversion or Git, since these systems do not perform well for large (binary) model data files. For this reason, a new concept of parameterization and data splitting has been implemented. Each file, or set of files, is uniquely labeled as a parameter, and for this parameter metadata is maintained by Subversion. The metadata data contains file hashes to identify data content and the location where the actual bulk data are stored that can be reached by FTP. The NHI model control script is a command-line driven Python script for pre-processing, running, and post-processing the NHI model and uses one single configuration file for all computational kernels. This configuration file is an easy-to-use, keyword-driven, Windows INI-file, having separate sections for all the kernels. It also includes a FileSync data section where the user can specify version controlled model data to be used as input. The NHI control script keeps all the data consistent during the pre-processing. Furthermore, this script is able to do model state handling when the NHI model is used for ensemble forecasting.

Optimizing operational water management with soil moisture data from Sentinel-1 satellites

NASA Astrophysics Data System (ADS)

Pezij, Michiel; Augustijn, Denie; Hendriks, Dimmie; Hulscher, Suzanne

2016-04-01

In the Netherlands, regional water authorities are responsible for management and maintenance of regional water bodies. Due to socio-economic developments (e.g. agricultural intensification and on-going urbanisation) and an increase in climate variability, the pressure on these water bodies is growing. Optimization of water availability by taking into account the needs of different users, both in wet and dry periods, is crucial for sustainable developments. To support timely and well-directed operational water management, accurate information on the current state of the system as well as reliable models to evaluate water management optimization measures are essential. Previous studies showed that the use of remote sensing data (for example soil moisture data) in water management offers many opportunities (e.g. Wanders et al. (2014)). However, these data are not yet used in operational applications at a large scale. The Sentinel-1 satellites programme offers high spatiotemporal resolution soil moisture data (1 image per 6 days with a spatial resolution of 10 by 10 m) that are freely available. In this study, these data will be used to improve the Netherlands Hydrological Instrument (NHI). The NHI consists of coupled models for the unsaturated zone (MetaSWAP), groundwater (iMODFLOW) and surface water (Mozart and DM). The NHI is used for scenario analyses and operational water management in the Netherlands (De Lange et al., 2014). Due to the lack of soil moisture data, the unsaturated zone model is not yet thoroughly validated and its output is not used by regional water authorities for decision-making. Therefore, the newly acquired remotely sensed soil moisture data will be used to improve the skill of the MetaSWAP-model and the NHI as whole. The research will focus among other things on the calibration of soil parameters by comparing model output (MetaSWAP) with the remotely sensed soil moisture data. Eventually, we want to apply data-assimilation to improve operational water management in cooperation with users. As a first step, the current simulation of soil moisture processes within the NHI will be reviewed. We want to present the findings of this assessment as well as the research methodology. This PhD-research is part of the Optimizing Water Availability with Sentinel-1 Satellites (OWAS1S)-project in which two other PhD-students are participating. They are focussing on the translation of raw Sentinel-1 satellite data to surface soil moisture data and the application of the remotely sensed soil moisture data on crop water availability and trafficability on field scale. References: De Lange, W. J., Prinsen, G. F., Hoogewoud, J. C., Veldhuizen, A. A., Verkaik, J., Oude Essink, G. H. P., van Walsum, P. E. V., Delsman, J. R., Hunink, J. C., Massop, H. T. L., & Kroon, T. (2014). An operational, multi-scale, multi-model system for consensus-based, integrated water management and policy analysis: The Netherlands Hydrological Instrument. Environmental Modelling & Software, 59, 98-108. doi: 10.1016/j.envsoft.2014.05.009 Wanders, N., Karssenberg, D., de Roo, A., de Jong, S. M., & Bierkens, M. F. P. (2014). The suitability of remotely sensed soil moisture for improving operational flood forecasting. Hydrology and Earth System Sciences, 18(6), 2343-2357. doi: 10.5194/hess-18-2343-2014

Mental disorders among workers in the healthcare industry: 2014 national health insurance data.

PubMed

Kim, Min-Seok; Kim, Taeshik; Lee, Dongwook; Yook, Ji-Hoo; Hong, Yun-Chul; Lee, Seung-Yup; Yoon, Jin-Ha; Kang, Mo-Yeol

2018-01-01

Numerous studies have shown that healthcare professionals are exposed to psychological distress. However, since most of these studies assessed psychological distress using self-reporting questionnaires, the magnitude of the problem is largely unknown. We evaluated the risks of mood disorders, anxiety disorders, sleep disorders, and any psychiatric disorders in workers in healthcare industry using Korea National Health Insurance (NHI) claims data from 2014, which are based on actual diagnoses instead of self-evaluation. We used Korea 2014 NHI claims data and classified employees as workers in the healthcare industry, based on companies in the NHI database that were registered with hospitals, clinics, public healthcare, and other medical services. To estimate the standardized prevalence of the selected mental health disorders, we calculated the prevalence of diseases in each age group and sex using the age distribution of the Korea population. To compare the risk of selected mental disorders among workers in the healthcare industry with those in other industries, we considered age, sex, and income quartile characteristics and conducted propensity scored matching. In the matching study, workers in healthcare industry had higher odds ratios for mood disorders (1.13, 95% CI: 1.11-1.15), anxiety disorders (1.15, 95% CI: 1.13-1.17), sleep disorders (2.21, 95% CI: 2.18-2.24), and any psychiatric disorders (1.44, 95% CI: 1.43-1.46) than the reference group did. Among workers in healthcare industry, females had higher prevalence of psychiatric disorders than males, but the odds ratios for psychiatric disorders, compared to the reference group, were higher in male workers in healthcare industry than in females. The prevalence of mood disorders, anxiety disorders, sleep disorders, and all psychiatric disorders for workers in the healthcare industry was higher than that of other Korean workers. The strikingly high prevalence of sleep disorders could be related to the frequent night-shifts in these professions. The high prevalence of mental health problems among workers in healthcare industry is alarming and requires prompt action to protect the health of the "protectors."

The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas.

PubMed

Chen, Likwang; Chen, Chi-Liang; Yang, Wei-Chih

2008-03-29

Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998-1999 was about 6.54 times of that in 1990-1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. We concluded that women in rural areas were more likely to seek prenatal care in large hospitals, but were not more likely to perceive very convenient transportation to and from prenatal care facilities in the late 1990s than in the early 1990s. In contrast, women in non-rural areas did not have a stronger tendency to seek prenatal care in large hospitals in the late 1990s than in earlier periods. In addition, they did perceive an improvement in transportation for acquiring prenatal care in the late 1990s. More efforts should be made to reduce these disparities.

Short- and long-term major cardiovascular adverse events in carotid artery interventions: a nationwide population-based cohort study in Taiwan.

PubMed

Tsai, Ming-Lung; Mao, Chun-Tai; Chen, Dong-Yi; Hsieh, I-Chang; Wen, Ming-Shien; Chen, Tien-Hsing

2015-01-01

Carotid artery stenosis is one of the leading causes of ischemic stroke. Carotid artery stenting has become well-established as an effective treatment option for carotid artery stenosis. For this study, we aimed to determine the efficacy and safety of carotid stenting in a population-based large cohort of patients by analyzing the Taiwan National Healthcare Insurance (NHI) database. 2,849 patients who received carotid artery stents in the NHI database from 2004 to 2010 were identified. We analyzed the risk factors of outcomes including major adverse cardiovascular events including death, acute myocardial infarction, and cerebral vascular accidents at 30 days, 1 year, and overall period and further evaluated cause of death after carotid artery stenting. The periprocedural stroke rate was 2.7% and the recurrent stroke rate for the overall follow-up period was 20.3%. Male, diabetes mellitus, and heart failure were significant risk factors for overall recurrent stroke (Hazard Ratio (HR) = 1.35, p = 0.006; HR = 1.23, p = 0.014; HR = 1.61, p < 0.001, respectively). The periprocedural acute myocardial infarction rate was 0.3%. Age and Diabetes mellitus were the significant factors to predict periprocedural myocardial infarction (HR = 3.06, p = 0.019; HR = 1.68, p < 0.001, respectively). Periprocedural and overall mortality rates were 1.9% and 17.3%, respectively. The most significant periprocedural mortality risk factor was acute renal failure. Age, diabetes mellitus, acute or chronic renal failure, heart failure, liver disease, and malignancy were factors correlated to the overall period mortality. Periprocedural acute renal failure significantly increased the mortality rate and the number of major adverse cardiovascular events, and the predict power persisted more than one year after the procedure. Age and diabetes mellitus were significant risk factors to predict acute myocardial infarction after carotid artery stenting.

Erectile Dysfunction in Patients with Sleep Apnea--A Nationwide Population-Based Study.

PubMed

Chen, Chia-Min; Tsai, Ming-Ju; Wei, Po-Ju; Su, Yu-Chung; Yang, Chih-Jen; Wu, Meng-Ni; Hsu, Chung-Yao; Hwang, Shang-Jyh; Chong, Inn-Wen; Huang, Ming-Shyan

2015-01-01

Increased incidence of erectile dysfunction (ED) has been reported among patients with sleep apnea (SA). However, this association has not been confirmed in a large-scale study. We therefore performed a population-based cohort study using Taiwan National Health Insurance (NHI) database to investigate the association of SA and ED. From the database of one million representative subjects randomly sampled from individuals enrolled in the NHI system in 2010, we identified adult patients having SA and excluded those having a diagnosis of ED prior to SA. From these suspected SA patients, those having SA diagnosis after polysomnography were defined as probable SA patients. The dates of their first SA diagnosis were defined as their index dates. Each SA patient was matched to 30 randomly-selected, age-matched control subjects without any SA diagnosis. The control subjects were assigned index dates as their corresponding SA patients, and were ensured having no ED diagnosis prior to their index dates. Totally, 4,835 male patients with suspected SA (including 1,946 probable SA patients) were matched to 145,050 control subjects (including 58,380 subjects matched to probable SA patients). The incidence rate of ED was significantly higher in probable SA patients as compared with the corresponding control subjects (5.7 vs. 2.3 per 1000 patient-year; adjusted incidence rate ratio = 2.0 [95% CI: 1.8-2.2], p<0.0001). The cumulative incidence was also significantly higher in the probable SA patients (p<0.0001). In multivariable Cox regression analysis, probable SA remained a significant risk factor for the development of ED after adjusting for age, residency, income level and comorbidities (hazard ratio = 2.0 [95%CI: 1.5-2.7], p<0.0001). In line with previous studies, this population-based large-scale study confirmed an increased ED incidence in SA patients in Chinese population. Physicians need to pay attention to the possible underlying SA while treating ED patients.

Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in taiwan.

PubMed

Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An

2012-01-01

To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences model was employed and estimated by the random-effect probit method. The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists. © 2011 National Rural Health Association.

Fine mapping of a distal chromosome 4 QTL affecting growth and muscle mass in a chicken advanced intercross line.

PubMed

Lyu, S; Arends, D; Nassar, M K; Brockmann, G A

2017-06-01

In our previous research, QTL analysis in an F 2 cross between the inbred New Hampshire (NHI) and White Leghorn (WL77) lines revealed a growth QTL in the distal part of chromosome 4. To physically reduce the chromosomal interval and the number of potential candidate genes, we performed fine mapping using individuals of generations F 10 , F 11 and F 12 in an advanced intercross line that had been established from the initial F 2 mapping population. Using nine single nucleotide polymorphism (SNP) markers within the QTL region for an association analysis with several growth traits from hatch to 20 weeks and body composition traits at 20 weeks, we could reduce the confidence interval from 26.9 to 3.4 Mb. Within the fine mapped region, markers rs14490774, rs314961352 and rs318175270 were in full linkage disequilibrium (D' = 1.0) and showed the strongest effect on growth and muscle mass (LOD ≥ 4.00). This reduced region contains 30 genes, compared to 292 genes in the original region. Chicken 60 K and 600 K SNP chips combined with DNA sequencing of the parental lines were used to call mutations in the reduced region. In the narrowed-down region, 489 sequence variants were detected between NHI and WL77. The most deleterious variants are a missense variant in ADGRA3 (SIFT = 0.02) and a frameshift deletion in the functional unknown gene ENSGALG00000014401 in NHI chicken. In addition, five synonymous variants were discovered in genes PPARGC1A, ADGRA3, PACRGL, SLIT2 and FAM184B. In our study, the confidence interval and the number of potential genes could be reduced 8- and 10- fold respectively. Further research will focus on functional effects of mutant genes. © 2017 Stichting International Foundation for Animal Genetics.

Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?

PubMed

Lo, H-Y; Yang, S-L; Lin, H-H; Bai, K-J; Lee, J-J; Lee, T-I; Chiang, C-Y

2016-03-01

The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan. To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB. A random sample of 79,471 DM-p4p, 100,000 DM-non-p4p and 100,000 non-diabetic patients (non-DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010. The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100,000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95%CI 0.84-3.40) among non-DM patients, relative to DM-p4p patients. Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.

Low-budget policy tool to empower Israeli insureds to demand their rights in the healthcare system.

PubMed

Brammli-Greenberg, Shuli; Waitzberg, Ruth; Medina-Artom, Tamar; Adijes-Toren, Ariella

2014-12-01

Since 1995 universal healthcare coverage has been provided in Israel through National Health Insurance (NHI). Although the country has lower rates of health spending than most OECD countries, the NHI Law stipulates that a broad benefits package will be provided by four competing Health Plans (HPs). These third-party payers manage healthcare utilization and cost through mechanisms that affect both provider and consumer behavior. Cost Containment is one of their main organizational objectives. The Ministry of Health (MoH) supervises HPs to ensure that they provide their members with adequate healthcare of high quality in accordance with the NHI Law and uphold the principles of efficiency and equity. In this paper we report on a policy instrument recently introduced by the MoH which enables it to share some of its responsibility for supervision with the insureds. This policy instrument is a website launched in 2014 that gives access to transparent information about the coverage of the NHI and voluntary health insurance (VHI) benefits packages. The idea is to empower insureds with knowledge and awareness of their rights and eligibility to benefits, so they can demand them from the HPs and/or private insurers; if refused, they can refer the case to the supervisor (the MoH). This policy instrument addresses market failures related to information asymmetry and can potentially improve competition among the HPs and within the VHI market. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Neuroprosthetics and Solutions for Restoring Sensorimotor Function

DTIC Science & Technology

2010-12-01

Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302...8217#*,6(0-;)?’) 8’.1,./’") 8.*/$.-) $S’.’%4)/*&.,(@/60$@,%) ET! NHI ) (46"*’()?*45)8’%𔃾.$@%3)/*&.,𔃺’&4.,"’( )*%) 45’) WXO)4,)"𔃾’./*%’)45’)𔃺’&4.*&$0)&6...8.*/$.-) $S’.’%4) /*&.,(@/60$@,%) ET! NHI ) *%) 45’) ",.($0) .,,4) 3$%30*$) EWXOI;) 45’) ’S’&4() ,1) ?5*&5) $.’) /’$(6.’") *%) 8.*/$.-)

Neuroprosthetics and Solutions for Restoring Sensorimotor Function

DTIC Science & Technology

2010-12-31

Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302...8217#*,6(0-;)?’) 8’.1,./’") 8.*/$.-) $S’.’%4)/*&.,(@/60$@,%) ET! NHI ) (46"*’()?*45)8’%𔃾.$@%3)/*&.,𔃺’&4.,"’( )*%) 45’) WXO)4,)"𔃾’./*%’)45’)𔃺’&4.*&$0)&6...8.*/$.-) $S’.’%4) /*&.,(@/60$@,%) ET! NHI ) *%) 45’) ",.($0) .,,4) 3$%30*$) EWXOI;) 45’) ’S’&4() ,1) ?5*&5) $.’) /’$(6.’") *%) 8.*/$.-)

Study of Xanthorhodopsin, the Retinal-Protein Proton Pump of Salinibacter ruber with Light-Harvesting Carotenoid Antenna

DTIC Science & Technology

2009-03-19

including suggesstions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215...gen-bonded to the c=o and the NHz of the amide side-chain of Asn19t, as well as NHI ofArg184. The dependence of the carotenoid spectrum on the retinal...protonation of ASp85 [22]. This is unlikely to occur in the xan- thorhodopsin photocyc1e, because NHI and NH2 of Arg93 are both hydrogen-bonded to the peptide

The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas

PubMed Central

Chen, Likwang; Chen, Chi-Liang; Yang, Wei-Chih

2008-01-01

Background Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. Conclusion We concluded that women in rural areas were more likely to seek prenatal care in large hospitals, but were not more likely to perceive very convenient transportation to and from prenatal care facilities in the late 1990s than in the early 1990s. In contrast, women in non-rural areas did not have a stronger tendency to seek prenatal care in large hospitals in the late 1990s than in earlier periods. In addition, they did perceive an improvement in transportation for acquiring prenatal care in the late 1990s. More efforts should be made to reduce these disparities. PMID:18373869

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme

PubMed Central

Iloh, GUP; Ofoedu, JN; Njoku, PU; Okafor, GOC; Amadi, AN; Godswill-Uko, EU

2013-01-01

Background: The increasing importance of the concept of patients’ satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. Aim: This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. Subject and Methods: This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient–staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. Results: The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient–staff relationship (3.9), patient–staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). Conclusion: The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status. PMID:23634326

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme.

PubMed

Iloh, Gup; Ofoedu, Jn; Njoku, Pu; Okafor, Goc; Amadi, An; Godswill-Uko, Eu

2013-01-01

The increasing importance of the concept of patients' satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient-staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient-staff relationship (3.9), patient-staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status.

Familial aggregation of gout and relative genetic and environmental contributions: a nationwide population study in Taiwan.

PubMed

Kuo, Chang-Fu; Grainge, Matthew J; See, Lai-Chu; Yu, Kuang-Hui; Luo, Shue-Fen; Valdes, Ana M; Zhang, Weiya; Doherty, Michael

2015-02-01

To examine familial aggregation of gout and to estimate the heritability and environmental contributions to gout susceptibility in the general population. Using data from the National Health Insurance (NHI) Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from 22 643 748 beneficiaries of the NHI in 2004; among them 1 045 059 individuals had physician-diagnosed gout. We estimated relative risks (RR) of gout in individuals with affected first-degree and second-degree relatives and relative contributions of genes (heritability), common environment shared by family members and non-shared environment to gout susceptibility. RRs for gout were significantly higher in individuals with affected first-degree relatives (men, 1.91 (95% CI 1.90 to 1.93); women, 1.97 (95% CI 1.94 to 1.99)) and also in those with affected second-degree relatives (men, 1.27 (95% CI 1.23 to 1.31); women, 1.40 (95% CI 1.35 to 1.46)). RRs (95% CIs) for individuals with an affected twin, sibling, offspring, parent, grandchild, nephew/niece, uncle/aunt and grandparent were 8.02 (6.95 to 9.26), 2.59 (2.54 to 2.63), 1.96 (1.95 to 1.97), 1.93 (1.91 to 1.94), 1.48 (1.43 to 1.53), 1.40 (1.32 to 1.47), 1.31 (1.24 to 1.39), and 1.26 (1.21 to 1.30), respectively. The relative contributions of heritability, common and non-shared environmental factors to phenotypic variance of gout were 35.1, 28.1 and 36.8% in men and 17.0, 18.5 and 64.5% in women, respectively. This population-based study confirms that gout aggregates within families. The risk of gout is higher in people with a family history. Genetic and environmental factors contribute to gout aetiology, and the relative contributions are sexually dimorphic. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

User’s Manual for the AFSATCOM Terminal Upgrades Life Cycle Cost Model. Volume I.

DTIC Science & Technology

1981-10-01

EFAIL (I,NS)*TNB(NS) NS *I[LRU(I) + RTS(NHI(I))]*NRTS(I)*DRCT(LO(NS)) + NRTS(NHI(I))*(l - COND(I))*DAD) where TNB(NS) = total number of bases within the...required anywhere in the ATU logistics system, i.e., if it ever fails, and equals 0 otherwise. Computed by: IUT(I) = U( EFAIL (I,NS)) NS IMC = initial depot...I)*XFPR*BRCT + CIMF(NS)* EFAIL (I,B)*NBC(B)LRU(I)*FINC*FPR(I)*XFPR*CRCT B NHB(B)=NS The terms in the equation for TDFPR(I) above account for increases

Completeness and timeliness of tuberculosis notification in Taiwan

PubMed Central

2011-01-01

Tuberculosis (TB) is a notifiable disease by the Communicable Disease Control Law in Taiwan. Several measures have been undertaken to improve reporting of TB but the completeness and timeliness of TB notification in Taiwan has not yet been systemically evaluated. Methods To assess completeness and timeliness of TB notification, potential TB cases diagnosed by health care facilities in the year 2005-2007 were identified using the reimbursement database of national health insurance (NHI), which has 99% population coverage in Taiwan. Potential TB patients required notification were defined as those who have TB-related ICD-9 codes (010-018) in the NHI reimbursement database in 2005-2007, who were not diagnosed with TB in previous year, and who have been prescribed with 2 or more types of anti-TB drugs. Each potential TB case was matched to the national TB registry maintained at Taiwan Centers for Disease Control (CDC) by using national identity number or, if non-citizen, passport number to determine whether the patients had been notified to local public health authorities and Taiwan CDC. The difference in the number of days between date of anti-tuberculosis treatment and date of notification was calculated to determine the timeliness of TB reporting. Results Of the 57,405 TB patients who were prescribed with 2 or more anti-tuberculosis drugs, 55,291 (96.3%) were notified to National TB Registry and 2,114 (3.7%) were not. Of the 55,291 notified cases, 45,250 (81.8%) were notified within 7 days of anti-tuberculosis treatment (timely reporting) and 10,041(18.2%) after 7 days (delayed reporting). Factors significantly associated with failure of notification are younger age, previously notified cases, foreigner, those who visited clinics and those who visited health care facilities only once or twice in 6 months. Conclusion A small proportion of TB cases were not notified and a substantial proportion of notified TB cases had delayed reporting, findings with implication for strengthening surveillance of tuberculosis in Taiwan. Countries where the completeness and timeliness of TB notification has not yet been evaluated should take similar action to strengthen surveillance of TB. PMID:22151346

First Applications of the New Parallel Krylov Solver for MODFLOW on a National and Global Scale

NASA Astrophysics Data System (ADS)

Verkaik, J.; Hughes, J. D.; Sutanudjaja, E.; van Walsum, P.

2016-12-01

Integrated high-resolution hydrologic models are increasingly being used for evaluating water management measures at field scale. Their drawbacks are large memory requirements and long run times. Examples of such models are The Netherlands Hydrological Instrument (NHI) model and the PCRaster Global Water Balance (PCR-GLOBWB) model. Typical simulation periods are 30-100 years with daily timesteps. The NHI model predicts water demands in periods of drought, supporting operational and long-term water-supply decisions. The NHI is a state-of-the-art coupling of several models: a 7-layer MODFLOW groundwater model ( 6.5M 250m cells), a MetaSWAP model for the unsaturated zone (Richards emulator of 0.5M cells), and a surface water model (MOZART-DM). The PCR-GLOBWB model provides a grid-based representation of global terrestrial hydrology and this work uses the version that includes a 2-layer MODFLOW groundwater model ( 4.5M 10km cells). The Parallel Krylov Solver (PKS) speeds up computation by both distributed memory parallelization (Message Passing Interface) and shared memory parallelization (Open Multi-Processing). PKS includes conjugate gradient, bi-conjugate gradient stabilized, and generalized minimal residual linear accelerators that use an overlapping additive Schwarz domain decomposition preconditioner. PKS can be used for both structured and unstructured grids and has been fully integrated in MODFLOW-USG using METIS partitioning and in iMODFLOW using RCB partitioning. iMODFLOW is an accelerated version of MODFLOW-2005 that is implicitly and online coupled to MetaSWAP. Results for benchmarks carried out on the Cartesius Dutch supercomputer (https://userinfo.surfsara.nl/systems/cartesius) for the PCRGLOB-WB model and on a 2x16 core Windows machine for the NHI model show speedups up to 10-20 and 5-10, respectively.

Retrospective analysis of the financial break-even point for intrathecal morphine pump use in Korea.

PubMed

Kim, Eun Kyoung; Shin, Ji Yeon; Castañeda, Anyela Marcela; Lee, Seung Jae; Yoon, Hyun Kyu; Kim, Yong Chul; Moon, Jee Youn

2017-10-01

The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement. We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016. Pain severity, changes in the morphine equivalent daily dosage (MEDD), any adverse events, and patients' satisfaction were determined. We calculated the financial break-even point of ITMP implantation via investigating the patient's actual medical costs and insurance information. During the studied period, 23 patients received ITMP implantation, and 20 patients were included in our study. Scores on an 11-point numeric rating scale (NRS) for pain were significantly reduced compared to the baseline value ( P < 0.001). The MEDD before ITMP implantation was 0.59 [IQR: 0.55-0.82]. The total MEDD increased steadily to 0.77 [IQR: 0.53-1.08] at 1 year, which was 126% of the baseline ( P < 0.001). More than a half (60%) responded that the ITMP therapy was somewhat satisfying. The financial break-even point was 28 months for ITMP treatment after the NHI reimbursement policy. ITMP provided effective chronic pain management with improved satisfaction and reasonable financial break-even point of 28 months with 50% financial coverage by NHI program.

Cardiovascular risk associated with acarbose versus metformin as the first-line treatment in patients with type 2 diabetes: a nationwide cohort study.

PubMed

Chang, Chia-Hsuin; Chang, Yi-Cheng; Lin, Jou-Wei; Chen, Shu-Ting; Chuang, Lee-Ming; Lai, Mei-Shu

2015-03-01

Metformin is the first-line oral therapy for type 2 diabetes with proven benefits against cardiovascular risk. Recent evidence suggested that acarbose might be similar to metformin in glucose-lowering efficacy and cardiovascular risk reduction. Therefore, international guidelines have suggested the use of acarbose as alternative first-line antidiabetic therapy. To compare the cardiovascular outcomes in the first-line users of acarbose vs metformin. DESIGN, SETTING, PATIENTS, AND OUTCOME MEASURES: A nationwide cohort study was conducted by analyzing the Taiwan National Health Insurance (NHI) Database. A total of 17,366 acarbose initiators and 230,023 metformin initiators were identified between January 1, 2009 and December 31, 2010. The primary outcome is hospitalization due to any cardiovascular events, including acute myocardial infarction, congestive heart failure, and ischemic stroke. The propensity score method was used to adjust for baseline differences between the two groups. Patients were followed from drug initiation to the earliest of outcome occurrence, death or disenrollment from NHI, or study termination. In intention-to-treat analyses, acarbose was associated with a higher risk of any cardiovascular event (adjusted hazard ratio [HR]: 1.05; 95% confidence interval [CI], 1.01-1.09), heart failure (HR, 1.08; 95% CI, 1.00-1.16), and ischemic stroke (HR, 1.05, 95% CI, 1.00-1.10) than metformin. No significant difference in risk was found in subgroups of patients with or without underlying hypertension, ischemic heart disease, or cerebrovascular disease. Similar results were found in auxiliary as-treated analyses or analyses stratified by propensity score quintiles. Our data do not support that acarbose has a cardio-protective effect similar to metformin as a first-line antidiabetic agent.

Progressivity of health care financing and incidence of service benefits in Ghana.

PubMed

Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

2012-03-01

The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study

PubMed Central

2013-01-01

Background Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan. Methods Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers. Results The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers’ Gini coefficients also become close to one another. Conclusions This study found that NHI’s offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan. PMID:23374629

The Effects of Health Coverage Schemes on Length of Stay and Preventable Hospitalization in Seoul

PubMed Central

Kim, Jungah; Shon, Changwoo

2018-01-01

The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care. PMID:29673147

Risk of psychiatric disorders following pelvic inflammatory disease: a nationwide population-based retrospective cohort study.

PubMed

Shen, Cheng-Che; Yang, Albert C; Hung, Jeng-Hsiu; Hu, Li-Yu; Chiang, Yung-Yen; Tsai, Shih-Jen

2016-01-01

Pelvic inflammatory disease (PID) a common infection in women that is associated with significant morbidity and is a major cause of infertility. A clear temporal causal relationship between PID and psychiatric disorders has not been well established. We used a nationwide population-based retrospective cohort study to explore the relationship between PID and the subsequent development of psychiatric disorders. We identified subjects who were newly diagnosed with PID between 1 January 2000 and 31 December 2002 in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed for patients without PID. A total of 21 930 PID and 21 930 matched control patients were observed until diagnosed with psychiatric disorders, or until death, withdrawal from the NHI system, or until 31 December 2009. Adjusted hazard ratio (HR) of bipolar disorder, depressive disorder, anxiety disorder and sleep disorder in subjects with PID were significantly higher (HR: 2.671, 2.173, 2.006 and 2.251, respectively) than that of the controls during the follow-up. PID may increase the risk of subsequent newly diagnosed bipolar disorder, depressive disorder, anxiety disorder and sleep disorder, which will impair life quality. Our findings highlight that clinicians should pay particular attention to psychiatric comorbidities in PID patients.

On the Origin of the High Column Density Turnover in the HI Column Density Distribution

DOE Office of Scientific and Technical Information (OSTI.GOV)

Erkal, Denis; Gnedin, Nickolay Y.; Kravtsov, Andrey V.

We study the high column density regime of the HI column density distribution function and argue that there are two distinct features: a turnover at NHI ~ 10^21 cm^-2 which is present at both z=0 and z ~ 3, and a lack of systems above NHI ~ 10^22 cm^-2 at z=0. Using observations of the column density distribution, we argue that the HI-H2 transition does not cause the turnover at NHI ~ 10^21 cm^-2, but can plausibly explain the turnover at NHI > 10^22 cm^-2. We compute the HI column density distribution of individual galaxies in the THINGS sample andmore » show that the turnover column density depends only weakly on metallicity. Furthermore, we show that the column density distribution of galaxies, corrected for inclination, is insensitive to the resolution of the HI map or to averaging in radial shells. Our results indicate that the similarity of HI column density distributions at z=3 and z=0 is due to the similarity of the maximum HI surface densities of high-z and low-z disks, set presumably by universal processes that shape properties of the gaseous disks of galaxies. Using fully cosmological simulations, we explore other candidate physical mechanisms that could produce a turnover in the column density distribution. We show that while turbulence within GMCs cannot affect the DLA column density distribution, stellar feedback can affect it significantly if the feedback is sufficiently effective in removing gas from the central 2-3 kpc of high-redshift galaxies. Finally, we argue that it is meaningful to compare column densities averaged over ~ kpc scales with those estimated from quasar spectra which probe sub-pc scales due to the steep power spectrum of HI column density fluctuations observed in nearby galaxies.« less

The association between gas and galaxies - II. The two-point correlation function

NASA Astrophysics Data System (ADS)

Wilman, R. J.; Morris, S. L.; Jannuzi, B. T.; Davé, R.; Shone, A. M.

2007-02-01

We measure the two-point correlation function, ξAG, between galaxies and quasar absorption-line systems at z < 1, using the data set of Morris & Jannuzi on 16 lines-of-sight (LOS) with ultraviolet (UV) spectroscopy and galaxy multi-object spectroscopy (Paper I). The measurements are made in 2D redshift space out to π = 20h-1 Mpc (comoving) along the LOS and out to σ = 2h-1 Mpc projected; as a function of HI column density in the range NHI = 1013-1019cm-2, also for CIV absorption systems, and as a function of galaxy spectral type. This extends the absorber-galaxy pair analysis of Paper I. We find that the amplitude of the peak in ξAG at the smallest separations increases slowly as the lower limit on NHI is increased from 1013 to 1016cm-2, and then jumps sharply (albeit with substantial uncertainties) for NHI > 1017cm-2. For CIV absorbers, the peak strength of ξAG is roughly comparable to that of HI absorbers with NHI > 1016.5cm-2, consistent with the finding that the CIV absorbers are associated with strong HI absorbers. We do not reproduce the differences reported by Chen et al. between 1D ξAG measurements using galaxy subsamples of different spectral types. However, the full impact on the measurements of systematic differences in our samples is hard to quantify. We compare the observations with smoothed particle hydrodynamical (SPH) simulations and discover that in the observations ξAG is more concentrated to the smallest separations than in the simulations. The latter also display a `finger of god' elongation of ξAG along the LOS in redshift space, which is absent from our data, but similar to that found by Ryan-Weber for the cross-correlation of quasar absorbers and HI-emission-selected galaxies. The physical origin of these `fingers of god' is unclear, and we thus highlight several possible areas for further investigation.

Proposal of the Physicians' Working Group for Single-Payer National Health Insurance.

PubMed

Woolhandler, Steffie; Himmelstein, David U; Angell, Marcia; Young, Quentin D

2003-08-13

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care--the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least 200 billion dollars annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program is the only affordable option for universal, comprehensive coverage.

Costs of care at the end of life among elderly patients with chronic kidney disease: patterns and predictors in a nationwide cohort study.

PubMed

Chen, Bradley; Fan, Victoria Y; Chou, Yiing-Jenq; Kuo, Chin-Chi

2017-01-26

Despite the urgent need for evidence to guide the end-of-life (EOL) care for patients with chronic kidney disease (CKD), we have limited knowledge of the costs and intensity of EOL care in this population. The present study examined patterns and predictors for EOL care intensity among elderly patients with CKD. We conducted a retrospective nationwide cohort study utilizing the Taiwan National Health Insurance (NHI) Research Database. A total of 65,124 CKD patients aged ≥ 60 years, who died in hospitals or shortly after discharge between 2002 and 2012 were analyzed. The primary outcomes were inpatient expenses and use of surgical interventions in the last 30 days of life. Utilization of intensive care unit (ICU), mechanical ventilation, resuscitation, and dialysis was also examined in a sub-sample of 2072 patients with detailed prescription data. Multivariate log-linear and logistic regression analyses were performed to assess patient-, physician-, and facility-specific predictors and the potential impact of a 2009 payment policy to reimburse hospice care for non-cancer patients. During the last 30 days of life, average inpatients costs for elderly CKD patients were approximately US$10,260, with 40.9% receiving surgical interventions, 40.2% experiencing ICU admission, 45.3% undergoing mechanical ventilation, 14.7% receiving resuscitation and 42.0% receiving dialysis. Significant variability was observed in the inpatient costs and use of intensive services. Costs were lower among individuals with the following characteristics: advanced age; high income; high Charlson Comorbidity Index scores; treatment by older physicians, nephrologists, and family medicine physicians; and treatment at local hospitals. Similar findings were obtained for the use of surgical interventions and other intensive services. A declining trend was detected in the costs of EOL care, use of surgical interventions and resuscitation between 2009 and 2012, which is consistent with the impact of a 2009 NHI payment policy to reimburse non-cancer hospice care. Overall EOL costs and rates of intensive service use among older patients with CKD were high, with significant variability across various patient and provider characteristics. Several opportunities exist for providers and policy makers to reduce costs and enhance the value of EOL care for this population.

Infrastructure for Large-Scale Tests in Marine Autonomy

DTIC Science & Technology

2012-02-01

suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis...8217+!0$%+()!()+($+!15+$! (#.%$&$)$-!%-!.BK*3$-(+$!$)&$-!.%$&$)+ *$+$+-3$)$$!. NHI

Outpatient health care utilization of suicide decedents in their last year of life.

PubMed

Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

2012-08-01

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901 subjects in the NHI beneficiary registry file. Rate of visit of the suicide decedents for all NHI outpatient services during their last year before death was 85%, and that for mental disorders service only was 30.2%. Average number of visits per person-year of the suicide decedents was 24.5 visits per year, two times higher than that of the survivors. The average numbers of visits (ANV) of male suicide decedents who used the mental disorders services was increased 6.8 times compared to that for all survivors. The increase in female decedents, in contrast, was 2.7 times. The increase in ANV for 15-24 age group was 14.6 times, significantly higher than that for the other age groups (<4 times). Effective prediction or prevention of potential suicides through increased awareness and surveillance of medical care resource utilization is possible, especially for male and young adult patients under mental disorder health care. © 2012 The American Association of Suicidology.

Prescription frequency and patterns of Chinese herbal medicine for liver cancer patients in Taiwan: a cross-sectional analysis of the National Health Insurance Research Database.

PubMed

Ting, Chin-Tsung; Kuo, Chian-Jue; Hu, Hsiao-Yun; Lee, Ya-Ling; Tsai, Tung-Hu

2017-02-20

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide. Chinese herbal medicine (CHM) is frequently provided to HCC patients. The aim of this study was to understand the prescription frequency and patterns of CHM for HCC patients by analyzing the claims data from the National Health Insurance (NHI) in Taiwan. We identified 73918 newly diagnosed HCC subjects from the database of Registry for Catastrophic Illness during 2002 to 2009 and to analyze the frequency and pattern of corresponding CHM prescriptions for HCC patients. There were a total of 685,079 single Chinese herbal prescriptions and 553,952 Chinese herbal formula prescriptions used for 17,373 HCC subjects before 2 years of HCC diagnosis. Among the 13,093 HCC subjects who used CHMs after HCC diagnosis, there were 462,786 single Chinese herbal prescriptions and 300,153 Chinese herbal formula prescriptions were counted. By adjusting with person-year and ratio of standardized incidence rate, the top ten prescribed single herbal drugs and Chinese herbal formulas for HCC patients were described in our study. Among them, we concluded that, Oldenlandia diffusa (Chinese herbal name: Bai-Hua-She-She-Cao), Radix et Rhizoma Rhei (Da Huang) and the herbal preparation of Xiao-Chai-Hu-Tang and Gan-Lu-Yin, were the most obviously increased and important CHMs been used for HCC patients. We established an accurate and validated method for the actual frequency and patterns of CHM use in treating HCC in Taiwan. We propose that these breakthrough findings may have important implications for HCC therapy, clinical trials and modernization of CHM.

FAST Mapping of Diffuse HI Gas in the Local Universe

NASA Astrophysics Data System (ADS)

Zhu, M.; Pisano, D. J.; Ai, M.; Jiao, Q.

2016-02-01

We propose to use the Five hundred meter Aperture Spherical radio Telescope (FAST) to map the diffuse intergalactic HI gas in the local universe at column densities of NHI=1018 cm-2 and below. The major science goal is to study gas accretion during galaxy evolution, and trace cosmic web features in the local universe. We disuss the technical feasibilty of such a deep survey, and have conducted test observations with the Arecibo 305 m telescope. Our preliminary results shows that, with about a few thousand hours of observing time, FAST will be able to map several hundred square degree regions at 1 σ of NHI=2×1017 cm-2 level out to a distance of 5-10 Mpc, and with a volume 1000 larger than that of the Local Group.

Drugs Cheaper Than Threepenny: The Market of Extremely Low-Priced Drugs within the National Health Insurance in Taiwan

PubMed Central

Chou, Li-Fang

2014-01-01

While most drug policy researches paid attention to the financial impact of expensive drugs, the market situation of low-priced drugs in a country was seldom analyzed. We used the nationally representative claims datasets to explore the status within the National Health Insurance (NHI) in Taiwan. In 2007, a total of 12,443 distinct drug items had been prescribed 853,250,147 times with total expenditure of 105,216,950,198 new Taiwan dollars (NTD). Among them, 7,366 oral drug items accounted for 701,353,383 prescribed items and 68,133,988,960 NTD. Besides, 2,887 items (39.2% of oral drug items) belonged to cheap drugs with the unit price ≤1 NTD (about 0.03 of US dollar). While the top one item among all oral drugs had already a market share of 5.0%, 30 items 30.3% and 107 items 50.0%, the cheap drugs with aggregate 332,893,462 prescribed items (47.5% of all prescribed oral drug items) only accounted for 2,750,725,433 NTD (4.0% of expenditure for oral drugs and 2.6% of total drug expenditure). The drug market of Taiwan's NHI was abundant in cheap drugs. The unreasonably low prices of drugs might not guarantee the quality of pharmaceutical care and the sustainability of a healthy pharmaceutical industry in the long run. PMID:24719568

Drugs cheaper than threepenny: the market of extremely low-priced drugs within the National Health Insurance in Taiwan.

PubMed

Wang, Bih-Ru; Chou, Chia-Lin; Hsu, Chia-Chen; Chou, Yueh-Ching; Chen, Tzeng-Ji; Chou, Li-Fang

2014-01-01

While most drug policy researches paid attention to the financial impact of expensive drugs, the market situation of low-priced drugs in a country was seldom analyzed. We used the nationally representative claims datasets to explore the status within the National Health Insurance (NHI) in Taiwan. In 2007, a total of 12,443 distinct drug items had been prescribed 853,250,147 times with total expenditure of 105,216,950,198 new Taiwan dollars (NTD). Among them, 7,366 oral drug items accounted for 701,353,383 prescribed items and 68,133,988,960 NTD. Besides, 2,887 items (39.2% of oral drug items) belonged to cheap drugs with the unit price ≤ 1 NTD (about 0.03 of US dollar). While the top one item among all oral drugs had already a market share of 5.0%, 30 items 30.3% and 107 items 50.0%, the cheap drugs with aggregate 332,893,462 prescribed items (47.5% of all prescribed oral drug items) only accounted for 2,750,725,433 NTD (4.0% of expenditure for oral drugs and 2.6% of total drug expenditure). The drug market of Taiwan's NHI was abundant in cheap drugs. The unreasonably low prices of drugs might not guarantee the quality of pharmaceutical care and the sustainability of a healthy pharmaceutical industry in the long run.

The influences of nursing transformational leadership style on the quality of nurses' working lives in Taiwan: a cross-sectional quantitative study.

PubMed

Lin, Ping-Yi; MacLennan, Sara; Hunt, Nigel; Cox, Tom

2015-01-01

Taiwan's NHI system is one of the most successful health care models for countries around the globe. However, little research has demonstrated the mental health issues associated with nursing transformational leadership style under the NHI system, especially in the quality of nurses' working lives in Taiwan. It is important to know the relationship between transformational leadership style and the mental health of nurses, organisational commitment and job satisfaction. The research aimed to understand the influences of nursing transformational leadership style on the quality of nurses' working lives in Taiwan. The research hypothesis was that transformational leadership styles would have positive influence on the quality of nurses' working lives. This was a cross-sectional quantitative study. Nurses from each type of hospital ownership (private, public and religious) were recruited. Participation was voluntary and signed informed consent was obtained. The inclusion criteria were nurses with at least one year's work experience in the hospitals. Self-administrated questionnaires were used. A total of 807 participants were contacted and 651 questionnaires were fully completed (response rate 80.7 %). A theory driven model was used to test the research hypotheses using structural equation modelling performed with AMOS 16.0. Transformational leadership contributes significantly to supervisor support. Workplace support, particularly from the supervisor, is an important mediator variable that explains the relationship between transformational leadership and job satisfaction. Organisational commitment was the strongest factor relevant to the general health well-being in Taiwanese nurses than job satisfaction. The hypothesized positive relationships between transformational leadership and all variables were supported by the data. Our findings have important consequences for organisational health. Our model demonstrates a complete picture of the work relationships on the quality of nurses' working lives. The results provided information about the subordinates' perceptions of transformational nursing leadership styles and mental health outcomes in different hospital settings, as well as identified organisational factors that could improve the quality of nurses' working lives.

Increased Risk of Acute Pancreatitis in Patients with Rheumatoid Arthritis: A Population-Based Cohort Study

PubMed Central

Chang, Chi Ching; Chiou, Chi Sheng; Lin, Hsiu Li; Wang, Li Hsuan; Chang, Yu Sheng; Lin, Hsiu-Chen

2015-01-01

The study was conducted to determine whether patients with rheumatoid arthritis (RA) are at increased risk of acute pancreatitis compared with those without RA and to determine if the risk of acute pancreatitis varied by anti-RA drug use. We used the large population-based dataset from the National Health Insurance (NHI) program in Taiwan to conduct a retrospective cohort study. Patients newly diagnosed with RA between 2000 and 2011 were referred to as the RA group. The comparator non-RA group was matched with propensity score, using age and sex, in the same time period. We presented the incidence density by 100,000 person-years. The propensity score and all variables were analyzed in fully adjusted Cox proportional hazard regression. The cumulative incidence of acute pancreatitis was assessed by Kaplan-Meier analysis, with significance based on the log-rank test. From claims data of one million enrollees randomly sampled from the Taiwan NHI database, 29,755 adults with RA were identified and 119,020 non- RA persons were matched as a comparison group. The RA cohort had higher incidence density of acute pancreatitis (185.7 versus 119.0 per 100,000 person-years) than the non-RA cohort. The adjusted hazard ratio (HR) was 1.62 (95% CI [confidence interval] 1.43–1.83) for patients with RA to develop acute pancreatitis. Oral corticosteroid use decreased the risk of acute pancreatitis (adjusted HR 0.83, 95% CI 0.73–0.94) but without a dose-dependent effect. Current use of disease modifying anti-rheumatic drugs or tumor necrosis factor blockers did not decrease the risk of acute pancreatitis. In conclusion, patients with RA are at an elevated risk of acute pancreatitis. Use of oral corticosteroids may reduce the risk of acute pancreatitis. PMID:26262880

Implementation of a commercial-grade dedication program - Benefits and lessons learned

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harrington, M.; MacFarlane, I.

1991-01-01

The recent issuance of industry guidelines, the Nuclear Management and Resources Council procurement initiative, and a US Nuclear Regulatory Commission NRC generic letter on commercial-grade item dedication (CGD) has been viewed by many utility managers and executives as only adding to the existing burden of compliance with regulatory requirements. While the incorporation of these documents into existing CGD programs has created additional costs, the resulting enhanced dedication programs have also produced benefits beyond regulatory compliance, and some lessons have been learned. This paper discusses the benefits and the lessons learned during implementation of an enhanced CGD program at New Hampshiremore » Yankee's (NHY's) Seabrook nuclear plant. Based on NHY's experience, it is believed that the benefits described in this paper can be realized by other utilities implementing CGD programs.« less

Regulation of trace elements and redox status in striatum of adult rats by long-term aerobic exercise depends on iron uptakes.

PubMed

Wu, Hua-Bo; Xiao, De-Sheng

2017-03-06

We investigated the effects of aerobic exercise (AE) on trace element contents and redox status in the striatum of rats with different diet iron. Weaned female rats were randomly fed with iron-adequate diet (IAD), iron-deficient diet (IDD), and iron-overloaded diet (IOD). After feeding their respective diet for 1 month, the rats fed with same diet were divided into swimming and maintaining sedentary (S) group. After 3 months, the non-heme iron (NHI), Mn, Cu, and Zn in the striatum were measured. Meanwhile, malonaldehyde acid (MDA), total superoxide dismutase activity, hydroxyl radical scavenging activity, and total antioxidant capacity were also analyzed. As compared with respective S rats, Mn, Cu, and Zn contents were significantly decreased in IDDE, but no significantly changes could be seen in IADE or IODE. A negative correlation of NHI with Cu contents in IDDE and positive correlations of NHI with Cu, or Zn contents in IADE, or with Mn or Cu contents in IODE were observed. In addition, striatum MDA was significantly decreased and anti-oxidative variables were increased in IODE compared to IODS. Our results suggest that the modification of trace elements and redox status in the striatum of rats caused by AE depends on dietary iron contents and that AE may also regulate the metabolic relationship of iron storage with other trace elements. Copyright © 2017 Elsevier B.V. All rights reserved.

Provider Behavior Under Global Budgeting and Policy Responses: An Observational Study on Eye Care Services in Taiwan.

PubMed

Chang, Chao-Kai; Xirasagar, Sudha; Chen, Brian; Hussey, James R; Wang, I-Jong; Chen, Jen-Chieh; Lian, Ie-Bin

2015-01-01

Third-party payer systems are consistently associated with health care cost escalation. Taiwan's single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to achieve cost control. This study captures ophthalmologists' response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance-financed health care system. © The Author(s) 2015.

Association between reduction in copayment and gastric cancer patient concentration to the capital area in South Korea: NHI cohort 2003-2013.

PubMed

Han, Kyu-Tae; Kim, Jeeyun; Nam, Chung Mo; Moon, Ki Tae; Lee, Sang Gyu; Kim, Seung Ju; Ju, Yeong Jun; Kwon, Jeoung A; Kim, Sun Jung; Kim, Woorim; Park, Eun-Cheol

2016-06-01

Since 2004, the South Korean government has introduced a policy that decreases copayment for cancer patients by strengthening public coverage in the National Health Insurance (NHI) system (first phase=copayment for outpatient care from 30% to 20%; second phase=copayment for total medical expenditures from 20% to 10%; third phase=copayment for total medical expenditures from 10% to 5%). We aimed to investigate the relationship between the policy introduction and patient visits to hospitals in the capital area. We used data from the NHI Cohort 2003-2013, which included all medical claims (7193 cases) filed for 2124 patients who visited the hospital due to stomach cancer, and performed a segmented Poisson regression analysis. Of all hospital visits, 40.6% of patients were from the capital area. After the introduction of the second phase of the policy, there was an increase in patient concentration in the capital area, although there were no significant effects on patient concentration during the first and third phases of the policy. In conclusion, our findings suggest that the introduction of a policy that reduces copayment for cancer patients had a substantial impact on patient concentration in the capital area. Therefore, health policymakers should consider effective alternatives including efficient allocation of medical resources or support for the more vulnerable population as flexible benefit plans to aid healthcare utilization by cancer patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Provider Behavior Under Global Budgeting and Policy Responses

PubMed Central

Chang, Chao-Kai; Xirasagar, Sudha; Chen, Brian; Hussey, James R.; Wang, I-Jong; Chen, Jen-Chieh; Lian, Ie-Bin

2015-01-01

Third-party payer systems are consistently associated with health care cost escalation. Taiwan’s single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to achieve cost control. This study captures ophthalmologists’ response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance–financed health care system. PMID:26324511

Proceedings of the Joint Magnetism and Magnetic Materials-Intermag Conference (6th) Held in Albuquerque, New Mexico on 20-23 June 1994. Journal of Applied Physics. Volume 76. Number 10. Part 2

DTIC Science & Technology

1994-06-23

were studied as-cast and for pertItgoal FsI cNhi,, measured in the prsenlt work and calcult•ted for the after annealing for four days at 1000 ’C and...H. Eschrig MGP Research Group "Electron Systems," Technical University Dresden, D-01062 Dresden, Germany Magnetic and specific-heat studies of U2T2X...University, Kazan 420 008, Russia The phase transition in the continual random n-component Potts model is studied by the renormalization group method. It is

Geographic variation in the age- and gender-specific prevalence and incidence of epilepsy: analysis of Taiwanese National Health Insurance-based data.

PubMed

Chen, Chih-Chuan; Chen, Li-Sheng; Yen, Ming-Fang; Chen, Hsiu-Hsi; Liou, Horng-Huei

2012-02-01

We studied geographic variation in age- and gender-specific prevalence and incidence of epilepsy in four different areas of Taiwan. By using large-scale, National Health Insurance (NHI)-based data from 2000-2003 in Taiwan, we identified 131,287 patients diagnosed with epilepsy (ICD code 345) receiving at least of one of 11 antiepileptic drugs (AEDs). Information on age, gender, and location were also collected. The multivariable Poisson regression analysis was used to assess the heterogeneity of the morbidity of epilepsy in different regions. External data validation was also performed to assess the accuracy of capturing epilepsy cases through our NHI data set. The age-adjusted prevalence and incidence of epilepsy were 5.85 (per 1,000) between 2000 and 2003 and 97 (per 100,000 person-years) during the follow-up time from 2001 to 2003 in Taiwan. The sensitivity and specificity of ICD-9 coding for epilepsy in the NHI data set were 83.91% and 99.83%, respectively, resulting in a slight overestimation. Male patients had a higher probability of having epilepsy than did females. East Taiwan had significantly higher prevalence and incidence than did other areas. The age-specific incidence pattern in east Taiwan was atypical in that it revealed clustering in young and middle-aged groups. Our study demonstrated geographic variation in epidemiologic patterns of epilepsy within Taiwan. The findings are informative and provide insight into the clinical management of epilepsy based on consideration of different target groups in different areas. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

The influence of sense-contingent argument structure frequencies on ambiguity resolution in aphasia.

PubMed

Huck, Anneline; Thompson, Robin L; Cruice, Madeline; Marshall, Jane

2017-06-01

Verbs with multiple senses can show varying argument structure frequencies, depending on the underlying sense. When acknowledge is used to mean 'recognise', it takes a direct object (DO), but when it is used to mean 'admit' it prefers a sentence complement (SC). The purpose of this study was to investigate whether people with aphasia (PWA) can exploit such meaning-structure probabilities during the reading of temporarily ambiguous sentences, as demonstrated for neurologically healthy individuals (NHI) in a self-paced reading study (Hare et al., 2003). Eleven people with mild or moderate aphasia and eleven neurologically healthy control participants read sentences while their eyes were tracked. Using adapted materials from the study by Hare et al. target sentences containing an SC structure (e.g. He acknowledged (that) his friends would probably help him a lot) were presented following a context prime that biased either a direct object (DO-bias) or sentence complement (SC-bias) reading of the verbs. Half of the stimuli sentences did not contain that so made the post verbal noun phrase (his friends) structurally ambiguous. Both groups of participants were influenced by structural ambiguity as well as by the context bias, indicating that PWA can, like NHI, use their knowledge of a verb's sense-based argument structure frequency during online sentence reading. However, the individuals with aphasia showed delayed reading patterns and some individual differences in their sensitivity to context and ambiguity cues. These differences compared to the NHI may contribute to difficulties in sentence comprehension in aphasia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Cost evaluation of clinical laboratory in Taiwan's National Health System by using activity-based costing.

PubMed

Su, Bin-Guang; Chen, Shao-Fen; Yeh, Shu-Hsing; Shih, Po-Wen; Lin, Ching-Chiang

2016-11-01

To cope with the government's policies to reduce medical costs, Taiwan's healthcare service providers are striving to survive by pursuing profit maximization through cost control. This article aimed to present the results of cost evaluation using activity-based costing performed in the laboratory in order to throw light on the differences between costs and the payment system of National Health Insurance (NHI). This study analyzed the data of costs and income of the clinical laboratory. Direct costs belong to their respective sections of the department. The department's shared costs, including public expenses and administrative assigned costs, were allocated to the department's respective sections. A simple regression equation was created to predict profit and loss, and evaluate the department's break-even point, fixed cost, and contribution margin ratio. In clinical chemistry and seroimmunology sections, the cost per test was lower than the NHI payment and their major laboratory tests had revenues with the profitability ratio of 8.7%, while the other sections had a higher cost per test than the NHI payment and their major tests were in deficit. The study found a simple linear regression model as follows: "Balance=-84,995+0.543×income (R2=0.544)". In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.

What Next in Health Policy?

ERIC Educational Resources Information Center

Ginzberg, Eli

1975-01-01

A National Health Insurance (NHI) bill is discussed. Such a law would address primarly two issues: financial coverage for catastrophic illness and some broadening of entitlements for ambulatory care. Current need, financial support, Federal and local planning and priority objectives are reviewed. (Author/EB)

Gender difference in the effect of progesterone on neonatal hypoxic/ischemic brain injury in mouse.

PubMed

Dong, Shuyu; Zhang, Qian; Kong, Delian; Zhou, Chao; Zhou, Jie; Han, Jingjing; Zhou, Yan; Jin, Guoliang; Hua, Xiaodong; Wang, Jun; Hua, Fang

2018-08-01

This study investigated the effects of progesterone (PROG) on neonatal hypoxic/ischemic (NHI) brain injury, the differences in effects between genders, and the underlying mechanisms. NHI brain injury was established in both male and female neonatal mice induced by occlusion of the left common carotid artery followed by hypoxia. The mice were treated with PROG or vehicle. Fluoro-Jade B staining (F-JB), long term behavior testing, and brain magnetic resonance image (MRI) were applied to evaluate neuronal death, neurological function, and brain damage. The underlying molecular mechanisms were also investigated by Western blots. The results showed that, in the male mice, administration of PROG significantly reduced neuronal death, improved the learning and memory function impaired by cerebral HI, decreased infarct size, and maintained the thickness of the cortex after cerebral HI. PROG treatment, however, did not show significant neuroprotective effects on female mice subjected to HI. In addition, the data demonstrated a gender difference in the expression of tumor necrosis factor receptor 1 (TNFR1), TNF receptor associated factor 6 (TRAF6), Fas associated protein with death domain (FADD), and TIR-domain-containing adapter-inducing interferon-β (TRIF) between males and females. Our results indicated that treatment with PROG had beneficial effects on NHI injured brain in acute stage and improved the long term cognitive function impaired by cerebral HI in male mice. In addition, the activation of TNF and TRIF mediated signaling in response to cerebral HI and the treatment of PROG varied between genders, which highly suggested that gender differences should be emphasized in evaluating neonatal HI brain injury and PROG effects, as well as the underlying mechanisms. Copyright © 2018 Elsevier Inc. All rights reserved.

Movers and stayers: The geography of residential mobility and CVD hospitalisations in Auckland, New Zealand.

PubMed

Exeter, Daniel J; Sabel, Clive E; Hanham, Grant; Lee, Arier C; Wells, Susan

2015-05-01

The association between area-level disadvantage and health and social outcomes is unequivocal. However, less is known about the health impact of residential mobility, particularly at intra-urban scales. We used an encrypted National Health Index (eNHI) number to link individual-level data recorded in routine national health databases to construct a cohort of 641,532 participants aged 30+ years to investigate the association between moving and CVD hospitalisations in Auckland, New Zealand. Residential mobility was measured for participants according to changes in the census Meshblock of usual residence, obtained from the Primary Health Organisation (PHO) database for every calendar quarter between 1/1/2006 and 31/12/2012. The NZDep2006 area deprivation score at the start and end of a participant's inclusion in the study was used to measure deprivation mobility. We investigated the relative risk of movers being hospitalised for CVD relative to stayers using multi-variable binomial regression models, controlling for age, gender, deprivation and ethnicity. Considered together, movers were 1.22 (1.19-1.26) times more likely than stayers to be hospitalised for CVD. Using the 5×5 deprivation origin-destination matrix to model a patient's risk of CVD based on upward, downward or sideways deprivation mobility, movers within the least deprived (NZDep2006 Quintile 1) areas were 10% less likely than stayers to be hospitalised for CVD, while movers within the most deprived (NZDep2006 Q5) areas were 45% more likely than stayers to have had their first CVD hospitalisation in 2006-2012 (RR: 1.45 [1.35-1.55]). Participants who moved upward also had higher relative risks of having a CVD event, although their risk was less than those observed for participants experiencing downward deprivation mobility. This research suggests that residential mobility is an important determinant of CVD in Auckland. Further investigation is required to determine the impact moving has on the risk of CVD by ethnicity. Copyright © 2014 Elsevier Ltd. All rights reserved.

The shaping of pharmaceutical governance: the Israeli case.

PubMed

Sax, Philip

2014-01-01

This article focuses on governance of the pharmaceutical sector in Israel. It traces the relationships between the state, industry, and sick funds from before the establishment of National Health Insurance (NHI) in 1995 to the beginning of this decade, in particular as they have grappled with the challenge of making national formulary decisions in a rational manner. Subsequent to the introduction of NHI there have been shifts in the modes and mix of governance. This research shows empirically that a relatively complex mix of hierarchical and network modes of governance can be successfully established over an extended period of time when flexibility is maintained through the implementation process. The system for defining and updating a standard basket of health services has coped well with the challenge of managing a range of difficult and potentially volatile stakeholder relationships in the pharmaceutical sector and of distancing ministers from controversies of funding and listing decisions. Government has succeeded in containing drug costs whilst still maintaining a basket of reimbursable drugs that, from an international perspective, is comprehensive and technologically advanced. On the other hand, network arrangements appear to have delayed the introduction of suitable accountability relationships and hindered their development. The state has traditionally played an intermediary role between unavoidable corporate interests of industry and sick funds, with little transparency and to the detriment of more pluralistic access to decision making. Governance arrangements in Israel appear to limit the potential and incentive of the state and the sick funds to realize their potential countervailing powers in subsidy and pricing decisions.

The shaping of pharmaceutical governance: the Israeli case

PubMed Central

2014-01-01

This article focuses on governance of the pharmaceutical sector in Israel. It traces the relationships between the state, industry, and sick funds from before the establishment of National Health Insurance (NHI) in 1995 to the beginning of this decade, in particular as they have grappled with the challenge of making national formulary decisions in a rational manner. Subsequent to the introduction of NHI there have been shifts in the modes and mix of governance. This research shows empirically that a relatively complex mix of hierarchical and network modes of governance can be successfully established over an extended period of time when flexibility is maintained through the implementation process. The system for defining and updating a standard basket of health services has coped well with the challenge of managing a range of difficult and potentially volatile stakeholder relationships in the pharmaceutical sector and of distancing ministers from controversies of funding and listing decisions. Government has succeeded in containing drug costs whilst still maintaining a basket of reimbursable drugs that, from an international perspective, is comprehensive and technologically advanced. On the other hand, network arrangements appear to have delayed the introduction of suitable accountability relationships and hindered their development. The state has traditionally played an intermediary role between unavoidable corporate interests of industry and sick funds, with little transparency and to the detriment of more pluralistic access to decision making. Governance arrangements in Israel appear to limit the potential and incentive of the state and the sick funds to realize their potential countervailing powers in subsidy and pricing decisions. PMID:24914409

Inhibition of Growth by Combined Treatment with Inhibitors of Lactate Dehydrogenase and either Phenformin or Inhibitors of 6-Phosphofructo-2-kinase/Fructose-2,6-bisphosphatase 3.

PubMed

Lea, Michael A; Guzman, Yolanda; Desbordes, Charles

2016-04-01

Enhanced glycolysis in cancer cells presents a target for chemotherapy. Previous studies have indicated that proliferation of cancer cells can be inhibited by treatment with phenformin and with an inhibitor of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB) namely 3-(3-pyridinyl)-1-(4-pyridinyl)-2-propen-1-one (3PO). In the present work, the action of two inhibitors that are effective at lower concentrations than 3PO, namely 1-(3-pyridinyl)-3-(2-quinolinyl)-2-propen-1-one (PQP) and 1-(4-pyridinyl)-3-(2-quinolinyl)-2-propen-1-one (PFK15) were investigated. The inhibitors of lactate dehydrogenase (LDHA) studied in order of half-maximal inhibitory concentrations were methyl 1-hydroxy-6-phenyl-4-(trifluoromethyl)-1H-indole-2-carboxylate (NHI-2) < isosafrole < oxamate. In colonic and bladder cancer cells, additive growth inhibitory effects were seen with the LDHA inhibitors, of which NHI-2 was effective at the lowest concentrations. Growth inhibition was generally greater with PFK15 than with PQP. The increased acidification of the culture medium and glucose uptake caused by phenformin was blocked by combined treatment with PFKFB3 or LDHA inhibitors. The results suggest that combined treatment with phenformin and inhibitors of glycolysis can cause additive inhibition of cell proliferation and may mitigate lactic acidosis caused by phenformin when used as a single agent. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

The National Health Insurance, the decentralised clinical training platform, and specialist outreach.

PubMed

Caldwell, R I; Aldous, C

2016-12-21

According to the Constitution of South Africa (SA), citizens living in remote areas are entitled to the same level of healthcare as those with access to tertiary hospitals. Specialist outreach has been shown to achieve this. When SA's National Health Services Commission convened (1942 - 1944), Gluckman summarised: 'Where the need is greatest the supply of hospitals is least.' Primary healthcare (PHC) characterised the Kark's Pholela Health Centre and was highly regarded. Although PHC underpins National Health Insurance (NHI) planning, both preventive and curative healthcare are needed. The KwaZulu-Natal (KZN) provincial Department of Health and the University of KZN College of Health Sciences' 5-year plan for a decentralised clinical teaching platform (DCTP) is ambitious, requiring optimum co-operation between health department and university. Reservations can be addressed through sustained specialist outreach. Above all, the patient mustbe the chief beneficiary. The NHI and DCTP overlap with specialist outreach, but cannot do without it.

The incidence of health financing in South Africa: findings from a recent data set.

PubMed

Ataguba, John E; McIntyre, Di

2018-01-01

There is an international call for countries to ensure universal health coverage. This call has been embraced in South Africa (SA) in the form of a National Health Insurance (NHI). This is expected to be financed through general tax revenue with the possibility of additional earmarked taxes including a surcharge on personal income and/or a payroll tax for employers. Currently, health services are financed in SA through allocations from general tax revenue, direct out-of-pocket payments, and contributions to medical scheme. This paper uses the most recent data set to assess the progressivity of each health financing mechanism and overall financing system in SA. Applying standard and innovative methodologies for assessing progressivity, the study finds that general taxes and medical scheme contributions remain progressive, and direct out-of-pocket payments and indirect taxes are regressive. However, private health insurance contributions, across only the insured, are regressive. The policy implications of these findings are discussed in the context of the NHI.

The cost-saving effect of centralized histological reviews with soft tissue and visceral sarcomas, GIST, and desmoid tumors: The experiences of the pathologists of the French Sarcoma Group

PubMed Central

Rascle, Pauline; Morelle, Magali; Toulmonde, Maud; Ranchere Vince, Dominique; Le Cesne, Axel; Terrier, Philippe; Neuville, Agnès; Meeus, Pierre; Farsi, Fadila; Ducimetière, Françoise; Blay, Jean-Yves; Ray Coquard, Isabelle; Coindre, Jean-Michel

2018-01-01

Objective This study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies. Methods We carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost. Results A total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6–10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2. Conclusions Our findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI. PMID:29621244

The cost-saving effect of centralized histological reviews with soft tissue and visceral sarcomas, GIST, and desmoid tumors: The experiences of the pathologists of the French Sarcoma Group.

PubMed

Perrier, Lionel; Rascle, Pauline; Morelle, Magali; Toulmonde, Maud; Ranchere Vince, Dominique; Le Cesne, Axel; Terrier, Philippe; Neuville, Agnès; Meeus, Pierre; Farsi, Fadila; Ducimetière, Françoise; Blay, Jean-Yves; Ray Coquard, Isabelle; Coindre, Jean-Michel

2018-01-01

This study examined the types of discordance occurring in the diagnosis of soft tissue and visceral sarcomas, gastrointestinal stromal tumors (GIST), and desmoid tumors, as well as the economic impact of diagnostic discrepancies. We carried out a retrospective, multicenter analysis using prospectively implemented databases performed on a cohort of patients within the French RRePS network in 2010. Diagnoses were deemed to be discordant based on the 2013 World Health Organization (WHO) classification. Predictive factors of discordant diagnoses were explored. A decision tree was used to assess the expected costs of two strategies of disease management: one based on revised diagnoses after centralized histological review (option 1), the other on diagnoses without centralized review (option 2). Both were defined based on the patient and the disease characteristics, according to national or international guidelines. The time horizon was 12 months and the perspective of the French National Health Insurance (NHI) was retained. Costs were expressed in Euros for 2013. Sensitivity analyses were performed using low and high scenarios that included ± 20% estimates for cost. A total of 2,425 patients were included. Three hundred forty-one patients (14%) had received discordant diagnoses. These discordances were determined to mainly be benign tumors diagnosed as sarcomas (n = 124), or non-sarcoma malignant tumors diagnosed as sarcomas (n = 77). The probability of discordance was higher for a final diagnosis of desmoid tumors when compared to liposarcomas (odds ratio = 5.1; 95%CI [2.6-10.4]). The expected costs per patient for the base-case analysis (low- and high-case scenarios) amounted to €8,791 (€7,033 and €10,549, respectively) for option 1 and €8,904 (€7,057 and €10,750, respectively) for option 2. Our findings highlight misdiagnoses of sarcomas, which were found to most often be confused with benign tumors. Centralized histological reviews are likely to provide cost-savings for the French NHI.

23 CFR 260.109 - Selection.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Selection. 260.109 Section 260.109 Highways FEDERAL... PROGRAMS Fellowship and Scholarship Grants § 260.109 Selection. (a) Candidates shall be rated by a selection panel appointed by the Director of the NHI. Members of the panel shall represent the highway...

Targeting Prostate Cancer Metastasis

DTIC Science & Technology

2015-09-01

Washington HeadQuarters Services, Directorate for lnformatiion Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Allington...r egulator in contr olling metastasis of p r ost a t e cancer and i nhi b i t i ng i t prevent s met ast asis . There are no drugs available to tar

Psychologists Back Women, Chuck Magazine, Gear up for NHI

ERIC Educational Resources Information Center

Science, 1977

1977-01-01

Last year the American Psychological Association (APA) voted not to hold future conventions in states where the Equal Rights Amendment has not been passed. At its annual meeting, the APA also decided not to print a quarterly psychology magazine. Meeting emphasis concerning psychotherapy was in anticipation of Natural Health Insurance. (MA)

Cultural implications of differing rates of medically indicated and elective cesarean deliveries for foreign-born versus native-born taiwanese mothers.

PubMed

Huang, Chun-Che; Li, Chung-Yi; Yang, Chiang-Hsing

2012-07-01

The study aimed to assess the number of medically indicated and elective cesarean deliveries among foreign-born and native-born mothers in Taiwan. National Health Insurance (NHI) inpatient datasets in Taiwan between 2001 and 2003 showed 673,830 singleton deliveries, of which 66,687 were to foreign-born mothers and 607,143 were to Taiwan-born mothers. Univariate and multivariate logistic regression models were used to estimate the likelihood of using inpatient services for medically indicated and elective cesarean delivery. During the study period, foreign-born mothers were significantly less likely to undergo medically indicated (odds ratio [OR], 0.82; 95% confidence interval (95% CI), 0.79-0.85) and elective (OR, 0.50; 95% CI, 0.47-0.53) cesarean delivery than Taiwan-born mothers after adjusting for clinical and nonclinical factors. Foreign-born mothers aged 18-50 years are less likely to undergo medically indicated and elective cesarean delivery under Taiwan's NHI coverage. As the birth rate for immigrant women increases, cross-cultural maternity care during pregnancy and childbirth for immigrant mothers needs to be addressed.

Northern Manhattan Hispanic Caregiver Intervention Effectiveness Study: protocol of a pragmatic randomised trial comparing the effectiveness of two established interventions for informal caregivers of persons with dementia

PubMed Central

Luchsinger, José A; Burgio, Louis; Mittelman, Mary; Dunner, Ilana; Levine, Jed A; Kong, Jian; Silver, Stephanie; Ramirez, Mildred; Teresi, Jeanne A

2016-01-01

Introduction The prevalence of dementia is increasing without a known cure, resulting in an increasing number of informal caregivers. Caring for a person with dementia results in increased stress and depressive symptoms. There are several behavioural interventions designed to alleviate stress and depressive symptoms in caregivers of persons with dementia with evidence of efficacy. Two of the best-known interventions are the New York University Caregiver Intervention (NYUCI) and the Resources for Enhancing Alzheimer's Caregivers Health (REACH). The effectiveness of the NYUCI and REACH has never been compared. There is also a paucity of data on which interventions are more effective in Hispanics in New York City. Thus, we proposed the Northern Manhattan Hispanic Caregiver intervention Effectiveness Study (NHiCE), a pragmatic clinical trial designed to compare the effectiveness of adaptations of the NYUCI and the REACH in informal Hispanic caregivers of persons with dementia in New York City. Methods and analysis NHiCE is a 6-month randomised controlled trial comparing the effectiveness of adaptations of the NYUCI and REACH among 200 Hispanic informal adult caregivers of persons with dementia. The planned number of sessions of the NYUCI and REACH are similar. The primary outcome measures are changes from baseline to 6 months in the Zarit Caregiver Burden Scale and Geriatric Depression Scale. Our primary approach to analyses will be intent-to-treat. The primary analyses will use mixed random effects models, and a full information maximum likelihood approach, with sensitivity analyses using generalised estimating equation. Ethics and dissemination NHiCE is approved by the Institutional Review Board of Columbia University Medical Center (protocol AAAM5150). A Data Safety Monitoring Board monitors the progress of the study. Dissemination will include reports of the characteristics of the study participants, as well as a report of the results of the clinical trial. Trial registration number NCT02092987, Pre-results. PMID:27888180

Who pays for health care in Ghana?

PubMed Central

2011-01-01

Background Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Methods Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Results Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. Conclusion For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced. PMID:21708026

The World Health Organization's mechanisms for increasing the health sector budget: The South African context.

PubMed

Venter, Fouche Hendrik Johannes; Wolfaardt, Jaqueline Elizabeth

2016-07-04

South Africa (SA) has limited scope for raising income taxes, and the proposed National Health Insurance (NHI) scheme will necessitate growth in the health sector budget. The NHI White Paper suggests five funding scenarios to meet the expected shortfall. These scenarios are a mixture of a surcharge on taxable income, an increase in value-added tax and a payroll tax. Five alternative options, suggested by the World Health Organization, are interrogated as ways to decrease the general taxation proposed in the White Paper. The five mechanisms (corporate tax, financial transaction levy, and taxes on tobacco, alcohol and unhealthy foods) were chosen based on their fund-raising potential and their mandatory element. A literature review provides the information for a discussion of the potential costs of each mechanism. Within specific assumptions, potential budgetary contribution is compared with the requirement. First, raising corporate tax rates could raise enough funds, but the losses due to capital flight might be too much for the local economy to bear. Second, a levy on currency transactions is unlikely to raise the required resources, even without a probable decrease in the number of transactions. Third, the increase in the tax on tobacco and alcohol would need to be very large, even assuming that consumption patterns would remain unchanged. Lastly, a tax on unhealthy food products is a new idea and could be explored as an option - especially as the SA Treasury has announced its future implementation. Implementing only one of the mechanisms is unlikely to increase available funding sufficiently, but if they are implemented together the welfare-maximising tax rate for each mechanism may be high enough to fulfil the NHI scheme's budgetary requirement, moderating the increases in the tax burden of the SA population.

Private health insurance in South Korea: an international comparison.

PubMed

Shin, Jaeun

2012-11-01

The goal of this study is to present the historical and policy background of the expansion of private health insurance in South Korea in the context of the National Health Insurance (NHI) system, and to provide empirical evidence on whether the increased role of private health insurance may counterbalance government financing, social security contributions, out-of-pocket payments, and help stabilize total health care spending. Using OECD Health Data 2011, we used a fixed effects model estimation. In this model, we allow error terms to be serially correlated over time in order to capture the association of private health insurance financing with three other components of health care financing and total health care spending. The descriptive observation of the South Korean health care financing shows that social security contributions are relatively limited in South Korea, implying that high out-of-pocket payments may be alleviated through the enhancement of NHI benefit coverage and an increase in social security contributions. Estimation results confirm that private health insurance financing is unlikely to reduce government spending on health care and social security contributions. We find evidence that out-of-pocket payments may be offset by private health insurance financing, but to a limited degree. Private health insurance financing is found to have a statistically significant positive association with total spending on health care. This indicates that the duplicated coverage effect on service demand may cancel out the potential efficiency gain from market initiatives driven by the active involvement of private health insurance. This study finds little evidence for the benefit of private insurance initiatives in coping with the fiscal challenges of the South Korean NHI program. Further studies on the managerial interplay among public and private insurers and on behavioral responses of providers and patients to a given structure of private-public financing are warranted to formulate the adequate balance between private health insurance and publicly funded universal coverage. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Who pays for health care in Ghana?

PubMed

Akazili, James; Gyapong, John; McIntyre, Diane

2011-06-27

Financial protection against the cost of unforeseen ill health has become a global concern as expressed in the 2005 World Health Assembly resolution (WHA58.33), which urges its member states to "plan the transition to universal coverage of their citizens". An important element of financial risk protection is to distribute health care financing fairly in relation to ability to pay. The distribution of health care financing burden across socio-economic groups has been estimated for European countries, the USA and Asia. Until recently there was no such analysis in Africa and this paper seeks to contribute to filling this gap. It presents the first comprehensive analysis of the distribution of health care financing in relation to ability to pay in Ghana. Secondary data from the Ghana Living Standard Survey (GLSS) 2005/2006 were used. This was triangulated with data from the Ministry of Finance and other relevant sources, and further complemented with primary household data collected in six districts. We implored standard methodologies (including Kakwani index and test for dominance) for assessing progressivity in health care financing in this paper. Ghana's health care financing system is generally progressive. The progressivity of health financing is driven largely by the overall progressivity of taxes, which account for close to 50% of health care funding. The national health insurance (NHI) levy (part of VAT) is mildly progressive and formal sector NHI payroll deductions are also progressive. However, informal sector NHI contributions were found to be regressive. Out-of-pocket payments, which account for 45% of funding, are regressive form of health payment to households. For Ghana to attain adequate financial risk protection and ultimately achieve universal coverage, it needs to extend pre-payment cover to all in the informal sector, possibly through funding their contributions entirely from tax, and address other issues affecting the expansion of the National Health Insurance. Furthermore, the pre-payment funding pool for health care needs to grow so budgetary allocation to the health sector can be enhanced.

Estimating Mutual Information by Local Gaussian Approximation

DTIC Science & Technology

2015-07-13

suggesstions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway...following conditions: lim N→∞ hi = 0 , lim N→∞ Nhi =∞, i = 1, 2, . . . , d. (9) Then the following holds: lim N→∞ E|f̂ (x)− f (x)| = 0 (10) lim N→∞ E|f̂ (x

The Impact of Health System Changes on the Nation's Requirements for Registered Nurses in 1985. Health Manpower References.

ERIC Educational Resources Information Center

Doyle, Timothy C.; And Others

A study was conducted to assess the impact of three anticipated changes in the health care system on the future requirements for registered nurses. The changes investigated were the introduction of national health insurance (NHI), the increased enrollment in health maintenance organizations (HMOs), and the reformulation of nursing roles. Following…

Outpatient Health Care Utilization of Suicide Decedents in Their Last Year of Life

ERIC Educational Resources Information Center

Liu, Hui-Li; Chen, Lih-Hwa; Huang, Shiuh-Ming

2012-01-01

The characteristics of health care utilization during the last year of life by Taiwanese who died by suicide were analyzed. The degree of health services utilization was evaluated by extracting the data of National Health Insurance (NHI) outpatient cohort records in 2006. A total of 4,406 fatal suicide cases were matched with the 17,587,901…

Peering Through the Muck: Notes on the the Influence of the Galactic Interstellar Medium on Extragalactic Observations

NASA Astrophysics Data System (ADS)

Lockman, Felix J.

This paper considers some effects of foreground Galactic gas on radiation received from extragalactic objects, with an emphasis on the use of the 21cm line to determine the total N(HI). In general, the opacity of the 21cm line makes it impossible to derive an accurate value of N(HI) by simply applying a formula to the observed emission, except in directions where there is very little interstellar matter. The 21cm line can be used to estimate the likelihood that there is significant molecular hydrogen in a particular direction, but carries little or no information on the amount of ionized gas, which can be a major source of foreground effects. Considerable discussion is devoted to the importance of small-scale angular structure in HI, with the conclusion that it will rarely contribute significantly to the total error compared to other factors (such as the effects of ionized gas) for extragalactic sight lines at high Galactic latitude. The direction of the Hubble/Chandra Deep Field North is used as an example of the complexities that might occur even in the absence of opacity or molecular gas.

Agency problems of global budget system in Taiwan's National Health Insurance.

PubMed

Yan, Yu-Hua; Yang, Chen-Wei; Fang, Shih-Chieh

2014-05-01

The main purpose of this study was to investigate the agency problem presented by the global budget system followed by hospitals in Taiwan. In this study, we examine empirically the interaction between the principal: Bureau of National Health Insurance (BNHI) and agency: medical service providers (hospitals); we also describe actual medical service provider and hospital governance conditions from a agency theory perspective. This study identified a positive correlation between aversion to agency hazard (self-interest behavior, asymmetric information, and risk hedging) and agency problem risks (disregard of medical ethics, pursuit of extra-contract profit, disregard of professionalism, and cost orientation). Agency costs refer to BNHI auditing and monitoring expenditures used to prevent hospitals from deviating from NHI policy goals. This study also found agency costs negatively moderate the relationship between agency hazards and agency problems The main contribution of this study is its use of agency theory to clarify agency problems and several potential factors caused by the NHI system. This study also contributes to the field of health policy study by clarifying the nature and importance of agency problems in the health care sector. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Factors influencing support for National Health Insurance among patients attending specialist clinics in Malaysia.

PubMed

Almualm, Yasmin; Alkaff, Sharifa Ezat; Aljunid, Syed; Alsagoff, Syed Sagoff

2013-05-14

This study was carried out to determine the level of support towards the proposed National Health Insurance scheme among Malaysian patients attending specialist clinics at the National University of Malaysia Medical centre and its influencing factors. The cross sectional study was carried out from July-October 2012. 260 patients were selected using multistage sampling method. 71.2% of respondents supported the proposed National Health insurance scheme. 61.4% of respondents are willing to pay up to RM240 per year to join the National Health Insurance and 76.6% of respondents are of the view that enrollment in NHI should be made compulsory. Knowledge had a positive influence on respondent's support towards National Health Insurance. National Health Insurance when implemented in Malaysia can be used to raise funds for health care financing, increase access to health services and achieve the desired health status. More efforts should be taken to promote the scheme and educate the public in order to achieve higher support towards the proposed National Health Insurance. The cost to enroll in NHI as well as services to be included under the scheme should be duly considered.

Factors Influencing Support for National Health Insurance among Patients Attending Specialist Clinics in Malaysia

PubMed Central

Almualm, Yasmin; Alkaff, Sharifa Ezat; Aljunid, Syed; Alsagoff, Syed Sagoff

2013-01-01

This study was carried out to determine the level of support towards the proposed National Health Insurance scheme among Malaysian patients attending specialist clinics at the National University of Malaysia Medical centre and its influencing factors. The cross sectional study was carried out from July-October 2012. 260 patients were selected using multistage sampling method. 71.2% of respondents supported the proposed National Health insurance scheme. 61.4% of respondents are willing to pay up to RM240 per year to join the National Health Insurance and 76.6% of respondents are of the view that enrolment in NHI should be made compulsory. Knowledge had a positive influence on respondent's support towards National Health Insurance. National Health Insurance when implemented in Malaysia can be used to raise funds for health care financing, increase access to health services and achieve the desired health status. More efforts should be taken to promote the scheme and educate the public in order to achieve higher support towards the proposed National Health Insurance. The cost to enroll in NHI as well as services to be included under the scheme should be duly considered. PMID:23985101

Urinary Calculi and Risk of Cancer

PubMed Central

Shih, Chia-Jen; Chen, Yung-Tai; Ou, Shuo-Ming; Yang, Wu-Chang; Chen, Tzeng-Ji; Tarng, Der-Cherng

2014-01-01

Abstract Previous studies have shown that urinary calculi are associated with increased risks of urinary tract cancers. However, the association between urinary calculi and overall cancers is a largely undefined body of knowledge. We conducted a nationwide population-based cohort study using Taiwan's National Health Insurance Research Database from 2000 and 2009. Patients were excluded if they had antecedent cancers or urinary calculi before the enrollment. All study subjects were followed until the occurrence of cancer, dropout from the NHI program, death, or the end of 2010. Patterns of cancer incidence in patients with urinary calculi were compared with those of the general population using standardized incidence ratio (SIR). A total of 43,516 patients with urinary calculi were included. After a median follow-up of 5.3 years, 1891 patients developed cancer. The risk of overall cancers was significantly increased (SIR, 1.75; 95% confidence interval [CI], 1.68–1.83). We observed that urinary calculi was associated with higher risk of cancers of kidney (4.24; 95% CI, 3.47–5.13), bladder (3.30; 95% CI, 2.69–4.00), thyroid (2.50; 95% CI, 1.78–3.40), hematologic origin (2.41; 95% CI, 1.92–2.99), breast (1.84; 95% CI, 1.54–2.20), lung (1.82; 95% CI, 1.59–2.07), digestive tract (1.69; 95% CI, 1.57–1.82), and head and neck (1.54; 95% CI, 1.32–1.79), respectively. Our study shows that urinary calculi are associated with higher risk of systemic cancers in addition to urinary tract cancers. Further study is required to validate this association. PMID:25546684

Migraine and risk of narcolepsy in children: A nationwide longitudinal study.

PubMed

Yang, Chun-Pai; Hsieh, Meng-Lun; Chiang, Jen-Huai; Chang, Hsing-Yi; Hsieh, Vivian Chia-Rong

2017-01-01

The association between migraine and narcolepsy remains controversial. We aim to investigate whether migraine is associated with an increased risk of developing narcolepsy in children. In this longitudinal study, nationwide medical-claims data of pediatric patients (0-17y) with migraine are identified using the National Health Insurance Research Database (NHIRD) between 1997 and 2010 in Taiwan. Two cohorts are selected: migraine cases (n = 8,923) and propensity score-matched non-migraine controls (n = 35,692). Children with previous history of narcolepsy or headache before the index date are excluded. Cohorts are followed until the end of 2012, their withdrawal from the NHI program, or incidence of narcolepsy (ICD-9-CM: 347). Cox proportional hazards regression models are used to estimate hazard ratios (HRs) and 95% confidence intervals of developing narcolepsy in children with migraine compared to their non-migraine controls. A total of 13 incident cases with narcolepsy are observed during follow-up, with incidence rates of 0.1915 and 0.0278 per 1,000 person-years in migraine and non-migraine children, respectively. After a mean follow-up period of 4.68 and 5.04 years in the case and control cohort, respectively, the former exhibited a greater risk of developing narcolepsy compared to the latter (adjusted hazard ratio (aHR) = 5.30, 95% confidence interval (CI): 1.61, 17.4; p = 0.006). This finding persisted after controlling for potential confounders like baseline comorbidities and concurrent medication uptake, and in our analyses with migraine subtypes. Migraine is an independent risk factor for narcolepsy development in children. Further studies are needed to validate our findings and to explore the exact pathophysiological mechanisms linking migraine and narcolepsy.

China and Proliferation of Weapons of Mass Destruction and Missiles: Policy Issues

DTIC Science & Technology

2010-08-16

nuclear weapons facilities, while experts from China worked at a uranium mine at Saghand and a centrifuge facility (for uranium enrichment) near...brief interruptions.”85 84 Barbara Opall -Rome and Vago Muradian, “Bush Privately Lauds...confiscated a rare metal used to produce alloy steel (called vanadium) being smuggled to North Korea. In the same month, China’s NHI Shenyang Mining

Received, Understanding and Satisfaction of National Health Insurance Premium Subsidy Scheme by Families of Children with Disabilities: A Census Study in Taipei City

ERIC Educational Resources Information Center

Lin, Jin-Ding; Lin, Ya-Wen; Yen, Chia-Feng; Loh, Ching-Hui; Chwo, Miao-Ju

2009-01-01

The purposes of the present study are to provide the first data on utilization, understanding and satisfaction of the National Health Insurance (NHI) premium subsidy for families of children with disabilities in Taipei. Data from the 2001 Taipei Early Intervention Utilization and Evaluation Survey for Aged 0-6 Children with Disabilities were…

Children and adolescents presenting to chiropractors in Norway: National Health Insurance data and a detailed survey.

PubMed

Allen-Unhammer, Anna; Wilson, Francis J H; Hestbaek, Lise

2016-01-01

The idea of chiropractors treating children is controversial, yet many parents seek chiropractic care for their children. The reasons for this are not well documented. Part one of this study aimed to document the profile of all paediatric patients consulting Norwegian chiropractors in 2013 using National Health Insurance data (NHI) with regards to age, gender and primary complaints. Part two aimed to provide a more detailed description of these patients in the form of a descriptive, paper-based survey. Part one involved Norwegian NHI data from 2013. Part two consisted of a year-long, paper-based survey. Chiropractors registered with the Norwegian chiropractic association (NKF) were invited to participate via email. Participating chiropractors were assigned one random month to collect data. All paediatric patients (or their parents) during that were asked to complete questionnaires containing information on presenting complaint, consequences of this complaint, age, and mode of referral. In general, there was good concordance between part one and two of the study in terms of age, gender and presenting complaint. The youngest children constituted the largest paediatric group in Norwegian chiropractic practice. Musculoskeletal problems were the most common reason for children visiting a chiropractor in all of the age categories, according to NHI data. Part two of the study found that one-third of young school children and adolescents reported pain lasting longer than 1-year. Eleven percent of children found that their complaint had severely affected their mood and 22 % felt their activities were very limited by their condition. Referrals from healthcare professionals were uncommon. The survey's results were based on 161 completed questionnaires, received from 15 % of the Norwegian chiropractors. Musculoskeletal problems constituted the most common presenting complaint for children and adolescents presenting to Norwegian chiropractors. A sizable proportion of children seemed to be adversely affected by their complaints in terms of low mood and limitations of daily activities. Chronic presentations were not uncommon. The small sample size of the survey demands that the results be interpreted with caution.

Northern Manhattan Hispanic Caregiver Intervention Effectiveness Study: protocol of a pragmatic randomised trial comparing the effectiveness of two established interventions for informal caregivers of persons with dementia.

PubMed

Luchsinger, José A; Burgio, Louis; Mittelman, Mary; Dunner, Ilana; Levine, Jed A; Kong, Jian; Silver, Stephanie; Ramirez, Mildred; Teresi, Jeanne A

2016-11-25

The prevalence of dementia is increasing without a known cure, resulting in an increasing number of informal caregivers. Caring for a person with dementia results in increased stress and depressive symptoms. There are several behavioural interventions designed to alleviate stress and depressive symptoms in caregivers of persons with dementia with evidence of efficacy. Two of the best-known interventions are the New York University Caregiver Intervention (NYUCI) and the Resources for Enhancing Alzheimer's Caregivers Health (REACH). The effectiveness of the NYUCI and REACH has never been compared. There is also a paucity of data on which interventions are more effective in Hispanics in New York City. Thus, we proposed the Northern Manhattan Hispanic Caregiver intervention Effectiveness Study (NHiCE), a pragmatic clinical trial designed to compare the effectiveness of adaptations of the NYUCI and the REACH in informal Hispanic caregivers of persons with dementia in New York City. NHiCE is a 6-month randomised controlled trial comparing the effectiveness of adaptations of the NYUCI and REACH among 200 Hispanic informal adult caregivers of persons with dementia. The planned number of sessions of the NYUCI and REACH are similar. The primary outcome measures are changes from baseline to 6 months in the Zarit Caregiver Burden Scale and Geriatric Depression Scale. Our primary approach to analyses will be intent-to-treat. The primary analyses will use mixed random effects models, and a full information maximum likelihood approach, with sensitivity analyses using generalised estimating equation. NHiCE is approved by the Institutional Review Board of Columbia University Medical Center (protocol AAAM5150). A Data Safety Monitoring Board monitors the progress of the study. Dissemination will include reports of the characteristics of the study participants, as well as a report of the results of the clinical trial. NCT02092987, Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Improving the public health sector in South Africa: eliciting public preferences using a discrete choice experiment.

PubMed

Honda, Ayako; Ryan, Mandy; van Niekerk, Robert; McIntyre, Diane

2015-06-01

The introduction of national health insurance (NHI), aimed at achieving universal coverage, is the most important issue currently on the South African health policy agenda. Improvement in public sector health-care provision is crucial for the successful implementation of NHI as, regardless of whether health-care services become more affordable and available, if the quality of the services provided is not acceptable, people will not use the services. Although there has been criticism of the quality of public sector health services, limited research is available to identify what communities regard as the greatest problems with the services. A discrete choice experiment (DCE) was undertaken to elicit public preferences on key dimensions of quality of care when selecting public health facilities in South Africa. Qualitative methods were applied to establish attributes and levels for the DCE. To elicit preferences, interviews with community members were held in two South African provinces: 491 in Western Cape and 499 in Eastern Cape. The availability of necessary medicine at health facilities has the greatest impact on the probability of attending public health facilities. Other clinical quality attributes (i.e. provision of expert advice and provision of a thorough examination) are more valued than non-clinical quality of care attributes (i.e. staff attitude, treatment by doctors or nurses, and waiting time). Treatment by a doctor was less valued than all other attributes. Communities are prepared to tolerate public sector health service characteristics such as a long waiting time, poor staff attitudes and lack of direct access to doctors if they receive the medicine they need, a thorough examination and a clear explanation of the diagnosis and prescribed treatment from health professionals. These findings prioritize issues that the South African government must address in order to meet their commitment to improve public sector health-care service provision. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Consumers' Perspectives on National Health Insurance in South Africa: Using a Mobile Health Approach

PubMed Central

Stuttaford, Maria C

2014-01-01

Background Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. Objective This research is based on a survey using Mxit as a mobile phone–based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Methods Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Results Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system’s governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. Conclusions The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform. PMID:25351980

Prescriptions of Chinese herbal medicine for constipation under the national health insurance in Taiwan.

PubMed

Jong, Maw-Shiou; Hwang, Shinn-Jang; Chen, Yu-Chun; Chen, Tzeng-Ji; Chen, Fun-Jou; Chen, Fang-Pey

2010-07-01

Constipation is a common gastrointestinal problem worldwide. The aim of this study was to determine the frequency of use and prescriptive patterns of Chinese herbal medicine (CHM) in treating constipation by analyzing the claims data of traditional Chinese medicine (TCM) from the National Health Insurance (NHI) in Taiwan. The computerized claims dataset of the TCM office visits and the corresponding prescription files in 2004 compiled by the NHI Research Institute in Taiwan were linked and processed. Visit files with the single diagnostic coding of constipation (ICD-9-CM code 564.0) were extracted to analyze the frequency and pattern of corresponding CHM prescriptions. The association rule was applied to analyze the co-prescription of CHM in treating constipation. There were 152,564 subjects who visited TCM clinics only for constipation in Taiwan during 2004 and received a total of 387,268 CHM prescriptions. Subjects between 20 and 29 years of age comprised the largest number of those treated (25.5%). Female subjects used CHM for constipation more frequently than male subjects (female:male = 3.31:1). There was an average of 4.6 items of single Chinese herbs or formula in a single prescription for constipation. Ma-zi-renwan was the most commonly prescribed herbal formula, while Da-huang (Rheum palmatum) was the most commonly used single Chinese herb. According to the association rule, the most common prescribed pattern of 2-drug combination of CHM for treating constipation was Ban-xia-xie-xin-tang plus Ma-zi-ren-wan, while the 3-drug combination of CHM was Fang-feng-tong-sheng-san, Rheum palmatum and Ma-zi-ren-wan. This study showed the pattern of single Chinese herbs or herbal formulae used in treating constipation in Taiwan. Further clinical trials are needed to evaluate the efficacy and safety of these CHMs in treating constipation. 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

Periodontal disease with treatment reduces subsequent cancer risks.

PubMed

Hwang, Ing-Ming; Sun, Li-Min; Lin, Cheng-Li; Lee, Chun-Feng; Kao, Chia-Hung

2014-10-01

The aim of our study was to evaluate the relationship between routine treatment of periodontal disease (PD) and the subsequent risks for cancers in Taiwan. Study participants were selected from the Taiwan National Health Insurance (NHI) system database. The PD with a routine treatment cohort contained 38 902 patients. For each treatment cohort participant, two age- and sex-matched comparison (control) cohort participants were randomly selected. Cox's proportional hazards regression analysis was used to estimate the effects of PD with treatment on the subsequent risk of cancer. The overall risk of developing cancer was significantly lower in the treatment cohort than in the patients without treatment (adjusted Hazard ratio = 0.72, 95% confidence interval = 0.68-0.76). The risks of developing most gastrointestinal tract, lung, gynecological and brain malignancies were significantly lower in the treatment cohort than in the comparison cohort. In contrast, the risks of prostate and thyroid cancers were significantly higher in the treatment cohort than in the comparison cohort. Our findings suggest that PD with treatment is associated with a significantly reduced overall risk of cancer and reduced risks of certain types of cancers. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Concurrent administration of anticancer chemotherapy drug and herbal medicine on the perspective of pharmacokinetics.

PubMed

Cheng, Yung-Yi; Hsieh, Chen-Hsi; Tsai, Tung-Hu

2018-04-01

With an increasing number of cancer patients seeking an improved quality of life, complementary and alternative therapies are becoming more common ways to achieve such improvements. The potential risks of concurrent administration are serious and must be addressed. However, comprehensive evidence for the risks and benefits of combining anticancer drugs with traditional herbs is rare. Pharmacokinetic investigations are an efficient way to understand the influence of concomitant remedies. Therefore, this study aimed to collect the results of pharmacokinetic studies relating to the concurrent use of cancer chemotherapy and complementary and alternative therapies. According to the National Health Insurance (NHI) database in Taiwan and several publications, the three most commonly prescribed formulations for cancer patients are Xiang-Sha-Liu-Jun-Zi-Tang, Jia-Wei-Xiao-Yao-San and Bu-Zhong-Yi-Qi-Tang. The three most commonly prescribed single herbs for cancer patients are Hedyotis diffusa, Scutellaria barbata, and Astragalus membranaceus. Few studies have discussed herb-drug interactions involving these herbs from a pharmacokinetics perspective. Here, we reviewed Jia-Wei-Xiao-Yao-San, Long-Dan-Xie-Gan-Tang, Curcuma longa and milk thistle to provide information based on pharmacokinetic evidence for healthcare professionals to use in educating patients about the risks of the concomitant use of various remedies. Copyright © 2018. Published by Elsevier B.V.

Vulnerabilities to Temperature Effects on Acute Myocardial Infarction Hospital Admissions in South Korea

PubMed Central

Kwon, Bo Yeon; Lee, Eunil; Lee, Suji; Heo, Seulkee; Jo, Kyunghee; Kim, Jinsun; Park, Man Sik

2015-01-01

Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004–2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07–1.76) for heat and 1.11 (95% CI: 1.04–1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas. PMID:26580643

Quantifying Morbidity Burdens and Medical Utilization of Children with Intellectual Disabilities in Taiwan: A Nationwide Study Using the ACG Case-Mix Adjustment System

ERIC Educational Resources Information Center

Lee, Wui-Chiang; Chen, Tzeng-Ji

2012-01-01

The purpose of this study was to quantify morbidity burdens of children with intellectual disability (ID) and to examine its association with total medical utilization and expenditure on a national basis in Taiwan. People under 18 years of age that had been continuously enrolled in the National Health Insurance (NHI) between year 2008 and 2010…

Does the Universal Health Insurance Program Affect Urban-Rural Differences in Health Service Utilization among the Elderly? Evidence from a Longitudinal Study in Taiwan

ERIC Educational Resources Information Center

Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An

2012-01-01

Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences…

Interaction of Chemical Agents with Nanoscale Molecular Junctions

DTIC Science & Technology

2011-08-01

thiS burden to Department of Defense. Washilgton Headqualters Services. Directorate for lnformatie~n Operations and Reports (07()4.()188), 1215...The source of these contaminants were determined to be coming from the glovebox auxiliary vacuum pump, which normally operates continuously for...SAM- NHi NH2-SAM-Gold] molecular junction for analysis. In order to perform electron transport analysis of our nanoscale devices in a "real world

Outpatient physical therapy utilization for children and adolescents with intellectual disabilities in Taiwan: a population-based nationwide study.

PubMed

Chang, Yu-Chia; Lin, Jin-Ding; Tung, Ho-Jui; Chiang, Po-Huang; Hsu, Shang-Wei

2014-02-01

This study analyzed the utilization and utilization determinants of outpatient physical therapy (PT) among children and adolescents with intellectual disabilities (ID) in Taiwan. A cross-sectional study was conducted to analyze 2007 national health insurance (NHI) claim data from 35,802 eighteen-year-old and younger persons with intellectual disabilities. A total of 3944 (11.02%) claimants received outpatient physical therapy. Variables that affected PT utilization included age, residence urbanization level, ID level, copayment status and major co-morbidity. The average annual PT visit frequency was 25.4 ± 33.0; pre-school children, claimants suffering from catastrophic disease and ID co-occurring with cerebral palsy had a higher mean cost per visit. Age, ID level, copayment status and co-morbidity were factors that influenced expenditure. Pre-school children, males, individuals who resided in the lowest urbanization areas and individuals with a catastrophic disease tended to use hospital services. The point prevalence of epilepsy and cerebral palsy were 12.10% and 19.80%, respectively. Despite the NHI program and government regulations to provide special services, the use of physical therapy for children and adolescents with intellectual disabilities was low, and the utilization decreased as the subjects aged. Copyright © 2013 Elsevier Ltd. All rights reserved.

Quantitative trait loci segregating in crosses between New Hampshire and White Leghorn chicken lines: II. Muscle weight and carcass composition.

PubMed

Nassar, M K; Goraga, Z S; Brockmann, G A

2012-12-01

In order to identify genetic factors influencing muscle weight and carcass composition in chicken, a linkage analysis was performed with 278 F(2) males of reciprocal crosses between the extremely different inbred lines New Hampshire (NHI) and White Leghorn (WL77). The NHI line had been selected for high meat yield and the WL77 for low egg weight before inbreeding. Highly significant quantitative trait loci (QTL) controlling body weight and the weights of carcass, breast muscle, drumsticks-thighs and wings were identified on GGA4 between 151.5 and 160.5 cM and on GGA27 between 4 and 52 cM. These genomic regions explained 13.7-40.2% and 5.3-13.8% of the phenotypic F(2) variances of the corresponding traits respectively. Additional genome-wide highly significant QTL for the weight of drumsticks-thighs were mapped on GGA1, 5 and 7. Moreover, significant QTL controlling body weight were found on GGA2 and 11. The data obtained in this study can be used for increasing the mapping resolution and subsequent gene targeting on GGA4 and 27 by combining data with other crosses where the same QTL were found. © 2012 The Authors, Animal Genetics © 2012 Stichting International Foundation for Animal Genetics.

Quantitative trait loci segregating in crosses between New Hampshire and White Leghorn chicken lines: IV. Growth performance.

PubMed

Nassar, M K; Goraga, Z S; Brockmann, G A

2015-08-01

Reciprocal crosses between the inbred lines New Hampshire (NHI) and White Leghorn (WL77) comprising 579 F2 individuals were used to map QTL for body weight and composition. Here, we examine the growth performance until 20 weeks of age. Linkage analysis provided evidence for highly significant QTL on GGA1, 2, 4, 10 and 27 which had specific effects on early or late growth. The highest QTL effects, accounting for 4.6-25.6% of the phenotypic F2 variance, were found on the distal region of GGA4 between 142 and 170 cM (F ≥ 13.68). The NHI QTL allele increased body mass by 141.86 g at 20 weeks. Using body weight as a covariate in the analysis of body composition traits provided evidence for genes in the GGA4 QTL region affecting fat mass independently of body mass. The QTL effect size differed between sexes and depended on the direction of cross. TBC1D1, CCKAR and PPARGC1A are functional candidate genes in the QTL peak region. Our study confirmed the importance of the distal GGA4 region for chicken growth performance. The strong effect of the GGA4 QTL makes fine mapping and gene discovery feasible. © 2015 Stichting International Foundation for Animal Genetics.

Quantitative trait loci segregating in crosses between New Hampshire and White Leghorn chicken lines: I. egg production traits.

PubMed

Goraga, Z S; Nassar, M K; Brockmann, G A

2012-04-01

A genome scan was performed to detect chromosomal regions that affect egg production traits in reciprocal crosses between two genetically and phenotypically extreme chicken lines: the partially inbred line New Hampshire (NHI) and the inbred line White Leghorn (WL77). The NHI line had been selected for high growth and WL77 for low egg weight before inbreeding. The result showed a highly significant region on chromosome 4 with multiple QTL for egg production traits between 19.2 and 82.1 Mb. This QTL region explained 4.3 and 16.1% of the phenotypic variance for number of eggs and egg weight in the F(2) population, respectively. The egg weight QTL effects are dependent on the direction of the cross. In addition, genome-wide suggestive QTL for egg weight were found on chromosomes 1, 5, and 9, and for number of eggs on chromosomes 5 and 7. A genome-wide significant QTL affecting age at first egg was mapped on chromosome 1. The difference between the parental lines and the highly significant QTL effects on chromosome 4 will further support fine mapping and candidate gene identification for egg production traits in chicken. © 2011 The Authors, Animal Genetics © 2011 Stichting International Foundation for Animal Genetics.

Utilization of and Direct Expenditure for Emergency Medical 
Care in Taiwan: A Population-based Descriptive Study

PubMed Central

Yang, Nan-Ping; Lee, Yi-Hui; Lin, Ching-Heng; Chung, Yuan-Chang; Chen, Wen-Jone; Chou, Pesus

2009-01-01

Background We surveyed the emergency medical system (EMS) in Taiwan to provide information to policymakers responsible for decisions regarding the redistribution of national medical resources. Methods A systematic sampling method was used to randomly sample a representative database from the National Health Insurance (NHI) database in Taiwan, during the period from 2000 to 2004. Results We identified 10,124, 10,408, 11,209, 10,686, and 11,914 emergency room visits in 2000, 2001, 2002, 2003, and 2004, respectively. There were more males than females, and the majority of adults were younger than 50 years. Diagnose of injury/poisoning was the most frequently noted diagnostic category in emergency departments (EDs) in Taiwan. There were 13,196 (24.3%) and 2,952 (5.4%) patients with 2 and 3 concomitant diagnoses, respectively. There was a significant association between advanced age and the existence of multiple diagnoses (P < 0.001). With the exception of the ill-defined symptoms/signs/conditions, the two most frequent diagnoses were diseases of the circulatory system and diseases of the respiratory system in patients aged 65 years or older. On average, treatment-associated expenditure and drug-associated expenditure in Taiwan EDs averaged NT$1,155 ($35.0) and NT$190 ($5.8), respectively, which was equal to 64.5% and 10.6% of the total ED-associated cost. General ED medical expenditure increased with patient age; the increased cost ratio due to age was estimated at 8% per year (P < 0.001). Conclusions The frequency of major health problems diagnosed at ED visits varied by age: more complicated complaints and multiple diagnoses were more frequent in older patients. In Taiwan, the ED system remains overloaded, possibly because of the low cost of an ED visit. PMID:19164870

The prescribing of Chinese herbal products in Taiwan: a cross-sectional analysis of the national health insurance reimbursement database.

PubMed

Hsieh, Shu-Ching; Lai, Jung-Nien; Lee, Chuan-Fang; Hu, Fu-Chang; Tseng, Wei-Lum; Wang, Jung-Der

2008-06-01

The consumption of Chinese herbal products (CHPs) is increasing exponentially. However, the scientific evidence is lacking and there is an urgent requirement for detailed pharmacoepidemiological information on CHP usage. This study was to investigate CHP prescription patterns in Taiwan. We carried out a cross-sectional analysis on a cohort of 200,000 patients based on 2004 data from the National Health Insurance (NHI) reimbursement database. Data mining techniques were applied to explore CHP co-prescription patterns. A total of 46,938 patients had been prescribed CHPs on at least one occasion in 2004. Patients using CHPs were generally female and middle-aged, made more outpatient visits, had fewer hospitalizations and consumed more medical resources than non-users of CHPs. A total of 1,073,030 CHPs were contained within 220,123 prescriptions, for which acute nasopharyngitis was the most common indication. Yan hu suo and Jia Wei Xiao Yao San were the most frequently prescribed single herb (SH) and herbal formula (HF), respectively. The results of the data mining showed that the best predictions were provided by co-prescriptions of 'Mo yao and Ru xiang', 'Ye jiao teng and Suan Zao Ren Tan' and 'Dang Gui Nian Tong Tang and Shu Jing Huo Xue Tang' in the groups of SH-SH, SH-HF and HF-HF, respectively. This study provides national-level CHP prescription profiles and utilization rates, and documents, for the first time, HF-HF prescription combinations in Chinese medicine (CM) practices in Taiwan. We conclude that more studies are needed to validate the safety and effectiveness of CHP prescriptions.

Differential effects of high atmospheric N and S deposition on bog plant/lichen tissue and porewater chemistry across the Athabasca Oil Sands Region

Treesearch

R. Kelman Wieder; Melanie A. Vile; Kimberli D. Scott; Cara M. Albright; Kelly J. McMillen; Dale H. Vitt; Mark E. Fenn

2016-01-01

Oil extraction and development activities in the Athabasca Oil Sands Region of northern Alberta, Canada, release NOx, SOx, and NHy to the atmosphere, ultimately resulting in increasing N and S inputs to surrounding ecosystems through atmospheric deposition. Peatlands are a major feature of the northern Alberta landscape, with bogs covering 6-10% of the land area, and...

Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?

PubMed

Tan, Elise Chia-Hui; Pwu, Raoh-Fang; Chen, Duan-Rung; Yang, Ming-Chin

2014-03-01

In October 2001, a pay-for-performance (P4P) program for diabetes was implemented by the National Health Insurance (NHI), a single-payer program, in Taiwan. However, only limited information is available regarding the influence of this program on the patient's health-related quality of life. The aim of this study was to estimate the costs and consequences of enrolling patients in the P4P program from a single-payer perspective. A retrospective observational study of 529 diabetic patients was conducted between 2004 and 2005. The data used in the study were obtained from the National Health Interview Survey (NHIS) in Taiwan. Direct cost data were obtained from NHI claims data, which were linked to respondents in the NHIS using scrambled individual identification. The generic SF36 health instrument was employed to measure the quality-of-life-related health status and transformed into a utility index. Patients enrolled in the P4P program for at least 3 months were categorized as the P4P group. Following propensity score matching, 260 patients were included in the study. Outcomes included life-years, quality-adjusted life-years (QALYs), diabetes-related medical costs, overall medical costs, and incremental cost-effectiveness ratios (ICERs). A single-payer perspective was assumed, and costs were expressed in US dollars. Nonparametric bootstrapping was conducted to estimate confidence intervals for cost-effectiveness ratios. Following matching, no significant difference was noted between two groups with regard to the patients' age, gender, education, family income, smoking status, BMI, or whether insulin was used. The P4P group had an increase of 0.08 (95 % CI 0.077-0.080) in QALYs, and the additional diabetes-related medical cost was US$422.74 (95 % CI US$413.58-US$435.05), yielding an ICER of US$5413.93 (95 % CI US$5226.83-US$5562.97) per QALY gained. Our results provides decision makers with valuable information regarding the impact of the P4P program of diabetes care through a direct comparison of equivalent groups of patients receiving regular care. Under the single-payer NHI system, the use of financial incentives under the DM-P4P program may be an effective means to ensure the quality of follow-up treatment.

Efficiency, equity and feasibility of strategies to identify the poor: an application to premium exemptions under National Health Insurance in Ghana.

PubMed

Jehu-Appiah, Caroline; Aryeetey, Genevieve; Spaan, Ernst; Agyepong, Irene; Baltussen, Rob

2010-05-01

This paper outlines the potential strategies to identify the poor, and assesses their feasibility, efficiency and equity. Analyses are illustrated for the case of premium exemptions under National Health Insurance (NHI) in Ghana. A literature search in Medline search was performed to identify strategies to identify the poor. Models were developed including information on demography and poverty, and costs and errors of in- and exclusion of these strategies in two regions in Ghana. Proxy means testing (PMT), participatory welfare ranking (PWR), and geographic targeting (GT) are potentially useful strategies to identify the poor, and vary in terms of their efficiency, equity and feasibility. Costs to exempt one poor individual range between US$11.63 and US$66.67, and strategies may exclude up to 25% of the poor. Feasibility of strategies is dependent on their aptness in rural/urban settings, and administrative capacity to implement. A decision framework summarizes the above information to guide policy making. We recommend PMT as an optimal strategy in relative low poverty incidence urbanized settings, PWR as an optimal strategy in relative low poverty incidence rural settings, and GT as an optimal strategy in high incidence poverty settings. This paper holds important lessons not only for NHI in Ghana but also for other countries implementing exemption policies. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

A Cost-Sharing Exemption Program for Patients With Mental Illness in Taiwan: Who Enrolls?

PubMed

Huang, Hsin-Hui; Chen, Chuan-Yu; Chou, Yiing-Jenq; Huang, Nicole

2015-11-01

The purpose of this study was to identify patient and provider characteristics associated with enrollment in a cost-sharing exemption program among people newly diagnosed as having schizophrenia. The study used a nationally representative sample from Taiwan's National Health Insurance (NHI) program. Enrollment in a cost-sharing exemption program among 1,824 individuals with schizophrenia was observed for one year and three years after the individuals received a diagnosis of schizophrenia for the first time. Generalized estimating equations were applied to estimate the effect of various patient and physician characteristics on the odds of enrollment. The one-year and three-year program enrollment rates were 52% and 58%, respectively. People ages 35 or older were significantly more likely to enroll compared with younger people. People with low incomes and people who were hospitalized for schizophrenia were significantly more likely to enroll. Regarding provider characteristics, patients cared for by psychiatrists (adjusted odds ratio [AOR]=1.10) or by psychiatric institutions (AOR=1.10) were significantly more likely to enroll in the cost-sharing exemption program within the first year of diagnosis. The results suggest that enrollment in the NHI's cost-sharing exemption program by people newly diagnosed as having schizophrenia was relatively low. The role of providers must not be overlooked. Effective strategies targeting high-risk subgroups for nonparticipation are necessary in addressing mental health parity.

Beta-and gamma-turns in proteins revisited: a new set of amino acid turn-type dependent positional preferences and potentials.

PubMed

Guruprasad, K; Rajkumar, S

2000-06-01

The number of beta-turns in a representative set of 426 protein three-dimensional crystal structures selected from the recent Protein Data Bank has nearly doubled and the number of gamma-turns in a representative set of 320 proteins has increased over seven times since the previous analysis. Beta-turns (7153) and gamma-turns (911) extracted from these proteins were used to derive a revised set of type-dependent amino acid positional preferences and potentials. Compared with previous results, the preference for proline, methionine and tryptophan has increased and the preference for glutamine, valine, glutamic acid and alanine has decreased for beta-turns. Certain new amino acid preferences were observed for both turn types and individual amino acids showed turn-type dependent positional preferences. The rationale for new amino acid preferences are discussed in the light of hydrogen bonds and other interactions involving the turns. Where main-chain hydrogen bonds of the type NH(i + 3) --> CO(i) were not observed for some beta-turns, other main-chain hydrogen bonds or solvent interactions were observed that possibly stabilize such beta-turns. A number of unexpected isolated beta-turns with proline at i + 2 position were also observed. The NH(i + 2) --> CO(i) hydrogen bond was observed for almost all gamma-turns. Nearly 20% classic gamma-turns and 43% inverse gamma-turns are isolated turns.

Three-residue turns in alpha/beta-peptides and their application in the design of tertiary structures.

PubMed

Sharma, Gangavaram V M; Nagendar, Pendem; Ramakrishna, Kallaganti V S; Chandramouli, Nagula; Choudhary, Madavi; Kunwar, Ajit C

2008-06-02

A new three-residue turn was serendipitously discovered in alpha/beta hybrid peptides derived from alternating C-linked carbo-beta-amino acids (beta-Caa) and L-Ala residues. The three-residue beta-alpha-beta turn at the C termini, nucleated by a helix at the N termini, resulted in helix-turn (HT) supersecondary structures in these peptides. The turn in the HT motif is stabilized by two H bonds-CO(i-2)-NH(i), with a seven-membered pseudoring (gamma turn) in the backward direction, and NH(i-2)-CO(i), with a 13-membered pseudoring in the forward direction (i being the last residue)--at the C termini. The study was extended to generalize the new three-residue turn (beta-alpha-beta) by using different alpha- and beta-amino acids. Furthermore, the HT motifs were efficiently converted, by an extension with helical oligomers at the C termini, into peptides with novel helix-turn-helix (HTH) tertiary structures. However, this resulted in the destabilization of the beta-alpha-beta turn with the concomitant nucleation of another three-residue turn, alpha-beta-beta, which is stabilized by 11- and 15-membered bifurcated H bonds. Extensive NMR spectroscopic studies were carried out to delineate the secondary and tertiary structures in these peptides, which are further supported by molecular dynamics (MD) investigations.

Analyzing the Historical Development and Transition of the Korean Health Care System.

PubMed

Lee, Sang-Yi; Kim, Chul-Woung; Seo, Nam-Kyu; Lee, Seung Eun

2017-08-01

Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation's economic development or governing strategy changes in response to changes in international circumstances such as globalization. The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea's private-dominant health care provision system unchanged over several decades. Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state's power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.

The impact of out-of-pocket payments on health care inequity: the case of national health insurance in South Korea.

PubMed

Lee, Weon-Young; Shaw, Ian

2014-07-18

The global financial crisis of 2008 has led to the reinforcement of patient cost sharing in health care policy. This study aimed to explore the impact of direct out-of pocket payments (OOPs) on health care utilization and the resulting financial burden across income groups under the South Korean National Health Insurance (NHI) program with universal population coverage. We used the fourth Korean National Health and Nutrition Examination Survey (KNHNES-IV) and the Korean Household Income and Expenditure Survey (KHIES) of 2007, 2008 and 2009. The Horizontal Inequity Index (HIwv) and the average unit OOPs were used to measure income-related inequity in the quantitative and qualitative aspects of health care utilization, respectively. For financial burden, the incidence rates of catastrophic health expenditure (CHE) were compared across income groups. For outpatient and hospital visits, there was neither pro-poor or pro-rich inequality. The average unit OOPs of the poorest quintile was approximately 75% and 60% of each counterpart in the richest quintile in the outpatient and inpatient services. For the CHE threshold of 40%, the incidence rates were 5.7%, 1.67%, 0.72%, 0.33% and 0.27% in quintiles I (the poorest quintile), II, III, IV and V, respectively. Substantial OOPs under the NHI are disadvantageous, particularly for the lowest income group in terms of health care quality and financial burden.

Analyzing the Historical Development and Transition of the Korean Health Care System

PubMed Central

Lee, Sang-Yi; Kim, Chul-Woung; Seo, Nam-Kyu; Lee, Seung Eun

2017-01-01

Objectives Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. Methods We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation’s economic development or governing strategy changes in response to changes in international circumstances such as globalization. Results The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea’s private-dominant health care provision system unchanged over several decades. Conclusion Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state’s power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe. PMID:28904846

Benchmark ab Initio Characterization of the Complex Potential Energy Surfaces of the X- + NH2Y [X, Y = F, Cl, Br, I] Reactions.

PubMed

Hajdu, Bálint; Czakó, Gábor

2018-02-22

We report a comprehensive high-level explicitly correlated ab initio study on the X - + NH 2 Y [X,Y = F, Cl, Br, I] reactions characterizing the stationary points of the S N 2 (Y - + NH 2 X) and proton-transfer (HX + NHY - ) pathways as well as the reaction enthalpies of various endothermic additional product channels such as H - + NHXY, XY - + NH 2 , XY + NH 2 - , and XHY - + NH. Benchmark structures and harmonic vibrational frequencies are obtained at the CCSD(T)-F12b/aug-cc-pVTZ(-PP) level of theory, followed by CCSD(T)-F12b/aug-cc-pVnZ(-PP) [n = Q and 5] and core correlation energy computations. In the entrance and exit channels we find two equivalent hydrogen-bonded C 1 minima, X - ···HH'NY and X - ···H'HNY connected by a C s first-order saddle point, X - ···H 2 NY, as well as a halogen-bonded front-side complex, X - ···YNH 2 . S N 2 reactions can proceed via back-side attack Walden inversion and front-side attack retention pathways characterized by first-order saddle points, submerged [X-NH 2 -Y] - and high-energy [H 2 NXY] - , respectively. Product-like stationary points below the HX + NHY - asymptotes are involved in the proton-transfer processes.

[Kampo Medicine in the New Model Core Curriculum of Pharmaceutical Education].

PubMed

Kobayashi, Yoshinori

2016-01-01

What should we educate for Kampo medicine in the model core curriculum of pharmaceutical education? The curricular core should be discussed considering the points mentioned below. (1) Positioning of Kampo medicine in the Japanese medical care system. Kampo medicine is an authorized medical care category in the National Health Insurance (NHI) program in Japan. The NHI drug price list carries 148 Kampo formulations. According to the report of the Japan Kampo Medicines Manufacturers Association in 2011, approximately 90% of Japanese physicians prescribe Kampo medicines. (2) Differences between Kampo medicine and western medicine: In Kampo medicine, the most suitable formula among various Kampo formulas to normalize the psychophysical state of individual patients is selected. In other words, if there is a complaint, there are always some treatments. (3) A strong point of Kampo medicine: Kampo medicine enables physicians to deal with difficult-to-treat conditions by western medicine alone. Also, by using the scale of Kampo medicine, each patient can grasp his or her own systemic state and improve their lifestyle. To extend healthy life expectancy, a basic knowledge of Kampo medicine may play a significant role in integrated health care. "The guide book of the approval standards for OTC Kampo products", "the pharmaceutical advanced educational guideline", and "the manual of the exam questions preparation for registered sales clerks" should also be consulted before selecting the area and contents that should be covered.

Risk factors and incidence of ischemic stroke in Taiwanese with nonvalvular atrial fibrillation-- a nation wide database analysis.

PubMed

Lin, Lian-Yu; Lee, Chang-Hsing; Yu, Chih-Chieh; Tsai, Chia-Ti; Lai, Ling-Pin; Hwang, Juey-Jen; Chen, Pau-Chung; Lin, Jiunn-Lee

2011-07-01

Atrial fibrillation (AF) is a risk factor for ischemic stroke. Stroke-prevention strategies based on risk schemes have been developed but most of the data are from western people. Our goal is to investigate the risk factors of ischemic stroke in Taiwanese with AF in a nation-wide database. A universal national health insurance (NHI) program has been implemented in Taiwan since 1995. We used system sampling database from 1997 to 2008 with a total of 1,000,000 subjects. By using ambulatory and inpatient claim data, we included subjects with AF and were above 20 years old. We excluded those who had ever taken warfarin or aspirin or had valvular heart diseases. A total of 7920 patients (3633 women, 4287 men) were included in the final analyses. Cox regression analysis showed that the risk factors for ischemic stroke were age (OR=1.338 for age 65-74 years vs. age 20-64 years, P=0.014; OR=1.652 for age over 75 years vs. age 20-64 years, P<0.001), hypertension (HTN) (OR=2.656, P<0.001), diabetes mellitus (DM) (OR=1.341, P=0.005), heart failure (OR=1.611, P<0.001), previous ischemic stroke or transient ischemic accident (TIA) (OR=2.752, P<0.001) and peripheral arterial disease (PAD) (OR=1.814, P=0.006). The gender, coronary artery disease, history of myocardial infarction and chronic renal insufficiency were not associated with ischemic stroke. The rate of ischemic stroke was much lower in current cohort as compared with that in whites. Frequent used risk schemes including CHADS₂ and CHA₂DS₂-VASC had comparable but only limited ability to predict ischemic stroke in subjects with AF. Compare with western people, hypertension plays a more important role in ischemic stroke in Taiwanese with AF and the incidence is lower. A substantial number of ischemic strokes cannot be accurately predicted by current risk schemes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Hydrogen-bonded turns in proteins: the case for a recount.

PubMed

Panasik, Nick; Fleming, Patrick J; Rose, George D

2005-11-01

Beta-turns are sites at which proteins change their overall chain direction, and they occur with high frequency in globular proteins. The Protein Data Bank has many instances of conformations that resemble beta-turns but lack the characteristic N-H(i) --> O=C(i - 3) hydrogen bond of an authentic beta-turn. Here, we identify potential hydrogen-bonded beta-turns in the coil library, a Web-accessible database utility comprised of all residues not in repetitive secondary structure, neither alpha-helix nor beta-sheet (http://www.roselab.jhu.edu/coil). In particular, candidate turns were identified as four-residue segments satisfying highly relaxed geometric criteria but lacking a strictly defined hydrogen bond. Such candidates were then subjected to a minimization protocol to determine whether slight changes in torsion angles are sufficient to shift the conformation into reference-quality geometry without deviating significantly from the original structure. This approach of applying constrained minimization to known structures reveals a substantial population of previously unidentified, stringently defined, hydrogen-bonded beta-turns. In particular, 33% of coil library residues were classified as beta-turns prior to minimization. After minimization, 45% of such residues could be classified as beta-turns, with another 8% in 3(10) helixes (which closely resemble type III beta-turns). Of the remaining coil library residues, 37% have backbone dihedral angles in left-handed polyproline II structure.

Localization and Specification of Copper Ions in Biofilms on Corroding Copper Surfaces.

DTIC Science & Technology

1994-01-01

WW~nhi~. OC ;mmS 1 . Agency use unay (L-mUv umia. IA. "O" ,.ie. $3. Report Type and Dates Covered. I 1994 Final - Proceedings 4. Title and Subtitle. S...structure (XANES) techniques can be used to differentiate Cu’ 1 and Cu+2 species within biofilms attached to surfaces. Copper ions , uld not be... 1 The organism with associated polymer has been shown to bind copper ions from solution. Geesey et al.2 demonstrated that exopolymers produced by

Substituent effects in infrared spectroscopy—VII. Meta and para substituted methanesulphonanilides

NASA Astrophysics Data System (ADS)

Laurence, C.; Berthelot, M.; Lucon, M.; Tsuno, Y.

Substituent effects on the NH frequencies of the conformers of methanesulphonanilides, their cyclic dimers and their hydrogen bonded complexes with acetonitrile have been analysed by means of the Hammet equation. An electron-withdrawing substituent may either increase or decrease ν(NH) in the XC 6H 4NHY series according to the electronic nature of the Y group. This can be explained by the non-monotonic dependence of the NH stretching frequency on the ionic character of the NH bond.

The impact of nonreferral outpatient co-payment on medical care utilization and expenditures in Taiwan.

PubMed

Chen, Li-Chia; Schafheutle, Ellen I; Noyce, Peter R

2009-09-01

Taiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at "higher tiers" of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral. This study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities. A segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0. The overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely. Differential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.

An essential hospital package for South Africa--selection criteria, costs and affordability.

PubMed

Söderlund, N

1999-07-01

In 1995 the Committee of Enquiry into National Health Insurance (NHI) recommended that formally employed individuals and their employers be required to fund at least a minimum package of hospital cover for workers and their dependents. This has recently been echoed in a Department of Health policy paper on social health insurance. This research aims to define and cost a minimum package of essential hospital care for competing (public and private) health insurers in South Africa. CRITERIA FOR PACKAGE DEFINITION: Based on the objectives implict in the NHI Committee report, the following criteria were used to define the essential package: (i) the extent to which there was another appropriate responsible party who should pay for treatment; (ii) the degree of discretion in deciding whether or not to provide treatment (roughly equivalent to 'urgency'); and (iii) the cost and effectiveness of treatment. On the basis of the above criteria, 396 out of 598 possible interventions were included in the package. Using local mine hospital and private sector utilisation rates and mine hospital cost data, it was estimated that the essential inpatient package would cost around R502 per enrollee per year, using 1998 prices, for a working age population and their dependents. Age-sex standardised outpatient care costs in the mine hospital population studied were estimated at R183 per person per year. It was therefore estimated that the total inpatient and outpatient hospital package would cost around R685 per person per year. The results presented in this paper are intended to inform the process of defining a national essential hospital benefit package. Assuming that contributions were proportionally related to income, and that costs should not exceed 6% of wages, the package should be affordable to all of those earning above R20,000 per year. Significant additional work is required, firstly at a technical level to assess the appropriateness of the prioritization approach used here, and secondly to take the debate around essential hospital benefits to broader political and public forums.

The COS-Halos Survey: Metallicities in the Low-redshift Circumgalactic Medium

NASA Astrophysics Data System (ADS)

Prochaska, J. Xavier; Werk, Jessica K.; Worseck, Gábor; Tripp, Todd M.; Tumlinson, Jason; Burchett, Joseph N.; Fox, Andrew J.; Fumagalli, Michele; Lehner, Nicolas; Peeples, Molly S.; Tejos, Nicolas

2017-03-01

We analyze new far-ultraviolet spectra of 13 quasars from the z˜ 0.2 COS-Halos survey that cover the H I Lyman limit of 14 circumgalactic medium (CGM) systems. These data yield precise estimates or more constraining limits than previous COS-Halos measurements on the H I column densities {N}{{H}{{I}}}. We then apply a Monte-Carlo Markov chain approach on 32 systems from COS-Halos to estimate the metallicity of the cool (T˜ {10}4 K) CGM gas that gives rise to low-ionization state metal lines, under the assumption of photoionization equilibrium with the extragalactic UV background. The principle results are: (1) the CGM of field L* galaxies exhibits a declining H I surface density with impact parameter {R}\\perp (at > 99.5 % confidence), (2) the transmission of ionizing radiation through CGM gas alone is 70 ± 7% (3) the metallicity distribution function of the cool CGM is unimodal with a median of {10}-0.51 {Z}⊙ and a 95% interval ≈ 1/50 {Z}⊙ to > 3 {Z}⊙ ; the incidence of metal-poor (< 1/100 {Z}⊙ ) gas is low, implying any such gas discovered along quasar sightlines is typically unrelated to L* galaxies; (4) we find an unexpected increase in gas metallicity with declining {N}{{H}{{I}}} (at > 99.9 % confidence) and, therefore, also with increasing {R}\\perp ; the high metallicity at large radii implies early enrichment; and (5) a non-parametric estimate of the cool CGM gas mass is {M}{CGM}{cool}=(9.2+/- 4.3)× {10}10 {M}⊙ , which together with new mass estimates for the hot CGM may resolve the galactic missing baryons problem. Future analyses of halo gas should focus on the underlying astrophysics governing the CGM, rather than processes that simply expel the medium from the halo. Based on observations made with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS 5-26555. These observations are associated with programs 13033 and 11598.

Association of chronic obstructive pulmonary disease and hemorrhoids

PubMed Central

Lin, Lih-Hwa; Siu, Justin Ji-Yuen; Liao, Po-Chi; Chiang, Jen-Huai; Chou, Pei-Chi; Chen, Huey-Yi; Ho, Tsung-Jung; Tsai, Ming-Yen; Chen, Yung-Hsiang; Chen, Wen-Chi

2017-01-01

Abstract According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the “interior–exterior” relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490–492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50–1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77–0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20–39 years), 1.19 (95% CI: 1.14–1.26), and 1.18 (95% CI: 1.12–1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine. PMID:28272246

Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study.

PubMed

Lin, Lih-Hwa; Siu, Justin Ji-Yuen; Liao, Po-Chi; Chiang, Jen-Huai; Chou, Pei-Chi; Chen, Huey-Yi; Ho, Tsung-Jung; Tsai, Ming-Yen; Chen, Yung-Hsiang; Chen, Wen-Chi

2017-03-01

According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the "interior-exterior" relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490-492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50-1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77-0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20-39 years), 1.19 (95% CI: 1.14-1.26), and 1.18 (95% CI: 1.12-1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.

The Primary Resistance of Helicobacter pylori in Taiwan after the National Policy to Restrict Antibiotic Consumption and Its Relation to Virulence Factors—A Nationwide Study

PubMed Central

Chen, Mei-Jyh; Chen, Chieh-Chang; Fang, Yu-Jen; Lee, Ji-Yuh; Wu, Jeng-Yih; Luo, Jiing-Chyuan; Liou, Tai-Cherng; Chang, Wen-Hsiung; Tseng, Cheng-Hao; Wu, Chun-Ying; Yang, Tsung-Hua; Chang, Chun-Chao; Wang, Hsiu‐Po; Sheu, Bor-Shyang; Lin, Jaw-Town; Bair, Ming-Jong; Wu, Ming-Shiang

2015-01-01

Objective The Taiwan Government issued a policy to restrict antimicrobial usage since 2001. We aimed to assess the changes in the antibiotic consumption and the primary resistance of H. pylori after this policy and the impact of virulence factors on resistance. Methods The defined daily dose (DDD) of antibiotics was analyzed using the Taiwan National Health Insurance (NHI) research database. H. pylori strains isolated from treatment naïve (N=1395) and failure from prior eradication therapies (N=360) from 9 hospitals between 2000 and 2012 were used for analysis. The minimum inhibitory concentration was determined by agar dilution test. Genotyping for CagA and VacA was determined by PCR method. Results The DDD per 1000 persons per day of macrolides reduced from 1.12 in 1997 to 0.19 in 2008, whereas that of fluoroquinolones increased from 0.12 in 1997 to 0.35 in 2008. The primary resistance of amoxicillin, clarithromycin, metronidazole, and tetracycline remained as low as 2.2%, 7.9%, 23.7%, and 1.9% respectively. However, the primary levofloxacin resistance rose from 4.9% in 2000–2007 to 8.3% in 2008–2010 and 13.4% in 2011–2012 (p=0.001). The primary resistance of metronidazole was higher in females than males (33.1% vs. 18.8%, p<0.001), which was probably attributed to the higher consumption of nitroimidazole. Neither CagA nor VacA was associated with antibiotic resistance. Conclusions The low primary clarithromycin and metronidazole resistance of H. pylori in Taiwan might be attributed to the reduced consumption of macrolides and nitroimidazole after the national policy to restrict antimicrobial usage. Yet, further strategies are needed to restrict the consumption of fluoroquinolones in the face of rising levofloxacin resistance. PMID:25942450

Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data.

PubMed

Kim, Jee Ae; Yoon, Seokjun; Kim, Log Young; Kim, Dong Sook

2017-05-01

Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data. © 2017 The Korean Academy of Medical Sciences.

Willingness to pay to sustain and expand National Health Insurance services in Taiwan.

PubMed

Lang, Hui-Chu; Lai, Mei-Shu

2008-12-17

The purpose of the present study was to investigate people's willingness to pay to sustain the current National Health Insurance (NHI) program in Taiwan and to extend that program to cover long-term care services. A survey was administered to 1800 inpatients and 1800 outpatients, selected from health care facilities across all accreditation levels that were operating under the supervision of six different regional branches of Taiwan's Bureau of National Health Insurance (BNHI). We used a contingent valuation method with closed-ended questions to elicit participants' willingness to pay for continued national heath insurance and additional institutional long-term care services. We divided participants into six subgroups and asked individuals in these groups referendum-like yes-no questions about whether they were willing to pay one of six price bids: New Taiwan Dollar (NT$) 50, NT$100, NT$200, NT$300, NT$400, or NT$500. Logistic regression was used to analyze willingness to pay. We found maximum willingness to pay for continued coverage by the NHI program and additional institutional long-term care services to be NT$66 and NT$137 dollars per month, respectively. We found that people were willing to pay more for their insurance coverage. With regard to methodology, we also found that using a contingent valuation method to elicit peoples' willingness to pay for health policy issues is valid. The results of the present referendum-like study can serve as a reference for future policy decision making.

Willingness to pay to sustain and expand National Health Insurance services in Taiwan

PubMed Central

Lang, Hui-Chu; Lai, Mei-Shu

2008-01-01

Background The purpose of the present study was to investigate people's willingness to pay to sustain the current National Health Insurance (NHI) program in Taiwan and to extend that program to cover long-term care services. Methods A survey was administered to 1800 inpatients and 1800 outpatients, selected from health care facilities across all accreditation levels that were operating under the supervision of six different regional branches of Taiwan's Bureau of National Health Insurance (BNHI). We used a contingent valuation method with closed-ended questions to elicit participants' willingness to pay for continued national heath insurance and additional institutional long-term care services. We divided participants into six subgroups and asked individuals in these groups referendum-like yes-no questions about whether they were willing to pay one of six price bids: New Taiwan Dollar (NT$) 50, NT$100, NT$200, NT$300, NT$400, or NT$500. Logistic regression was used to analyze willingness to pay. Results We found maximum willingness to pay for continued coverage by the NHI program and additional institutional long-term care services to be NT$66 and NT$137 dollars per month, respectively. Conclusion We found that people were willing to pay more for their insurance coverage. With regard to methodology, we also found that using a contingent valuation method to elicit peoples' willingness to pay for health policy issues is valid. The results of the present referendum-like study can serve as a reference for future policy decision making. PMID:19091093

Green Bank Telescope Observations of HI in the circumgalactic medium of M31

NASA Astrophysics Data System (ADS)

Denny, Lucas; Early, Laura; Berg, Michelle; Howk, Chris; Lehner, Nicolas; Lockman, Felix; wotta, Christopher

2018-01-01

The nearby spiral galaxy M31 contains an extensive gaseous circumgalactic medium (CGM) that is being studied in project AMIGA, a large HST program to obtain UV spectroscopy of the CGM in absorption against background AGN. As part of this project, sensitive HI 21cm emission observations were made using the Robert C. Byrd Green Bank Telescope (GBT) toward 48 AGN at impact parameters between 25 kpc and 340 kpc. No emission was detected to a 5-sigma limit on log(NHI) of 17.6 cm-2 (Howk et al 2017, ApJ, 846, 141). We now report on a search for HI emission in 1x1 degree fields around 8 of the AGN to 5-sigma limits on log(NHI) of 17.9 cm-2. The new observations cover ~10 times the area of the M31 CGM covered by the Howk et al pointings, though at somewhat reduced sensitivity. Again, no HI emission was detected with the exception of the "Davies Cloud", a high-velocity cloud of M31 that has been known for some time. We will discuss the absence of significant HI emission in the context of the COS-Halos study of 44 galaxies at z~0.2, and how this finding may relate to the existence of HI clouds between M31 and M33 (Wolfe et al. 2016, ApJ, 816, 81).The GBT is a facility of the National Science Foundation, operated under a cooperative agreement by Associated Universities, Inc.

Imputed food insecurity as a predictor of disease and mental health in Taiwanese elementary school children.

PubMed

Chen, Likwang; Wahlqvist, Mark L; Teng, Nai-Chi; Lu, Hsin-Ming

2009-01-01

This study investigated the association between food insecurity and Taiwanese children's ambulatory medical care use for treating eighteen disease types linked to endocrine and metabolic disorders, nutrition, immunity, infections, asthma, mental health, injury, and poisoning. We used longitudinal data in the Taiwan National Health Insurance scheme (NHI) for 764,526 elementary children, and employed approximate NHI data to construct three indicators imputed to food insecurity: low birth weight status, economic status (poverty versus non-poverty), and time of year (summer break time versus semester time). We compared ambulatory care for these diseases between children with low birth weight and those not, and between children living in poverty and those not. A difference-in-differences method was adopted to examine the potential for a publicly- funded lunch program to reduce the harmful health effects of food insecurity on poor children. We found that children in poverty were significantly more likely to have ambulatory visits linked with diabetes, inherited disorders of metabolism, iron deficiency anemias, ill-defined symptoms concerning nutrition, metabolism and development, as well as mental disorders. Children with low birth weight also had a significantly higher likelihood of using care for other endocrine disorders and nutritional deficiencies, in addition to the above diseases. The study failed to find any significant effect of the semester school lunch program on alleviating the harmful health effects of food insecurity for poor children, suggesting that a more intensive food program or other program approaches might be required to help poor children overcome food insecurity and its related health outcomes.

Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change.

PubMed

Lee, Tae-Jin; Cheong, Chelim

2017-11-01

To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a "copayment ceiling," which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients' income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design.

Discovery of a Dwarf Poststarburst Galaxy near a High Column Density Local Lyα Absorber

NASA Astrophysics Data System (ADS)

Stocke, John T.; Keeney, Brian A.; McLin, Kevin M.; Rosenberg, Jessica L.; Weymann, R. J.; Giroux, Mark L.

2004-07-01

We report the discovery of a dwarf (MB=-13.9) poststarburst galaxy coincident in recession velocity (within uncertainties) with the highest column density absorber (NHI=1015.85 cm-2 at cz=1586 km s- 1) in the 3C 273 sight line. This galaxy is by far the closest galaxy to this absorber, projected just 71h-170 kpc on the sky from the sight line. The mean properties of the stellar populations in this galaxy are consistent with a massive starburst ~3.5 Gyr ago, whose attendant supernovae, we argue, could have driven sufficient gas from this galaxy to explain the nearby absorber. Beyond its proximity on the sky and in recession velocity, the further evidence in favor of this conclusion includes both a match in the metallicities of absorber and galaxy and the fact that the absorber has an overabundance of Si/C, suggesting recent Type II supernova enrichment. Thus, this galaxy and its ejecta are in the expected intermediate stage in the fading dwarf evolutionary sequence envisioned by Babul & Rees to explain the abundance of faint blue galaxies at intermediate redshifts. While this one instance of a QSO metal-line absorber and a nearby dwarf galaxy is not proof of a trend, a similar dwarf galaxy would be too faint to be observed by galaxy surveys around more distant metal-line absorbers. Thus, we cannot exclude the possibility that dwarf galaxies are primarily responsible for weak (NHI=1014-1017 cm-2) metal-line absorption systems in general. If a large fraction of the dwarf galaxies expected to exist at high redshift had a similar history (i.e., they had a massive starburst that removed all or most of their gas), these galaxies could account for at least several hundred high-z metal-line absorbers along the line of sight to a high-z QSO. The volume-filling factor for this gas, however, would be less than 1%. ID="FN1"> 1Based on observations made with the Apache Point 3.5 m telescope, operated by the Astronomical Research Consortium, and the 2.6 m du Pont telescope of the Las Campanas Observatory, operated by the Carnegie Institution of Washington, DC, and Pasadena, CA.

HYBRID SULFUR PROCESS REFERENCE DESIGN AND COST ANALYSIS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gorensek, M.; Summers, W.; Boltrunis, C.

2009-05-12

This report documents a detailed study to determine the expected efficiency and product costs for producing hydrogen via water-splitting using energy from an advanced nuclear reactor. It was determined that the overall efficiency from nuclear heat to hydrogen is high, and the cost of hydrogen is competitive under a high energy cost scenario. It would require over 40% more nuclear energy to generate an equivalent amount of hydrogen using conventional water-cooled nuclear reactors combined with water electrolysis compared to the proposed plant design described herein. There is a great deal of interest worldwide in reducing dependence on fossil fuels, whilemore » also minimizing the impact of the energy sector on global climate change. One potential opportunity to contribute to this effort is to replace the use of fossil fuels for hydrogen production by the use of water-splitting powered by nuclear energy. Hydrogen production is required for fertilizer (e.g. ammonia) production, oil refining, synfuels production, and other important industrial applications. It is typically produced by reacting natural gas, naphtha or coal with steam, which consumes significant amounts of energy and produces carbon dioxide as a byproduct. In the future, hydrogen could also be used as a transportation fuel, replacing petroleum. New processes are being developed that would permit hydrogen to be produced from water using only heat or a combination of heat and electricity produced by advanced, high temperature nuclear reactors. The U.S. Department of Energy (DOE) is developing these processes under a program known as the Nuclear Hydrogen Initiative (NHI). The Republic of South Africa (RSA) also is interested in developing advanced high temperature nuclear reactors and related chemical processes that could produce hydrogen fuel via water-splitting. This report focuses on the analysis of a nuclear hydrogen production system that combines the Pebble Bed Modular Reactor (PBMR), under development by PBMR (Pty.) Ltd. in the RSA, with the Hybrid Sulfur (HyS) Process, under development by the Savannah River National Laboratory (SRNL) in the US as part of the NHI. This work was performed by SRNL, Westinghouse Electric Company, Shaw, PBMR (Pty) Ltd., and Technology Insights under a Technical Consulting Agreement (TCA). Westinghouse Electric, serving as the lead for the PBMR process heat application team, established a cost-shared TCA with SRNL to prepare an updated HyS thermochemical water-splitting process flowsheet, a nuclear hydrogen plant preconceptual design and a cost estimate, including the cost of hydrogen production. SRNL was funded by DOE under the NHI program, and the Westinghouse team was self-funded. The results of this work are presented in this Final Report. Appendices have been attached to provide a detailed source of information in order to document the work under the TCA contract.« less

Building a national electronic medical record exchange system - experiences in Taiwan.

PubMed

Li, Yu-Chuan Jack; Yen, Ju-Chuan; Chiu, Wen-Ta; Jian, Wen-Shan; Syed-Abdul, Shabbir; Hsu, Min-Huei

2015-08-01

There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care. In November 2009, Taiwan's Executive Yuan passed the 'Plan for accelerating the implementation of electronic medical record systems in medical institutions' (2010-2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document Architecture (CDA) standards to generate clinical documents and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS) profile for the communication infrastructure. By December of 2014, the number of hospitals that provide an inter-institution EMR exchange service had reached 321. Hospitals that had not joined the service were all smaller ones with less than 100 beds. Inter-institution EMR exchange can make it much easier for people to access their own medical records, reduce the waste of medical resources, and improve the quality of medical care. The implementation of an inter-institution EMR exchange system faces many challenges. This article provides Taiwan's experiences as a reference. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Time to relapse following treatment for methamphetamine use: a long-term perspective on patterns and predictors.

PubMed

Brecht, Mary-Lynn; Herbeck, Diane

2014-06-01

This paper describes methamphetamine (MA) use patterns, specifically the duration of continuing abstinence ("time to relapse") for periods averaging 5 years post-discharge from treatment for MA use, and the relationship with selected user and treatment characteristics. A sample of 350 treatment admissions from a large county substance use disorder (SUD) treatment system was randomly selected (within gender, race/ethnicity, treatment modality strata). Retrospective self-report data are from natural history interviews (NHI) conducted approximately 3 years after treatment and a follow-up of 2-3 years later. Relapse is defined as any use of MA with time as the number of months of continuous MA abstinence after treatment discharge until relapse. This outcome was constructed from a monthly MA use timeline using NHI data. A Cox model was used to examine time to relapse and predictors. Sixty-one percent of the sample relapsed to MA use within 1 year after treatment discharge and 14% during years 2-5. Significant protective factors predicting longer time to relapse included having experienced serious MA-related psychiatric/behavioral problems (hazard ratio [HR]=0.75, p=0.027), longer duration of the index treatment episode (HR=0.93, p=0.001), and participating in self-help or other treatment during the post-treatment abstinence period (HR=0.29, p<0.001); risk factors for shorter time to relapse included having a parent with alcohol and/or drug use problems (HR=1.35, p=0.020) and involvement in MA sales (HR=1.48, p=0.002). Results contribute a long-term perspective on patterns of MA use following treatment and support a need for early post-treatment and long-term continuing care and relapse-prevention services. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.

PubMed

Cheng, Shou-Hsia; Jin, Hyun-Hyo; Yang, Bong-Min; Blank, Robert H

2018-05-03

Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures. Copyright © 2018. Published by Elsevier Inc.

The relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan.

PubMed

Yang, Ya-Ting; Iqbal, Usman; Ko, Hua-Lin; Wu, Chia-Rong; Chiu, Hsien-Tsai; Lin, Yi-Chieh; Lin, Wender; Elsa Hsu, Yi-Hsin

2015-06-01

The purpose of this study was to explore the relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan. Cross-sectional study from 2007 Taiwan Longitudinal Study on Ageing (TLSA) survey. Community-based study. A total of 4249 middle-aged and elderly subjects were recruited. None. Outpatient visits within 1 month, and hospitalization, emergency visits as well as to shop in pharmacy stores within 1 year, respectively. Adjusting for important confounding variables, the middle-aged and elderly with National Health Insurance (NHI) and commercial insurance compared with those with NHI alone tended to have outpatient visits. The middle-aged and elderly with longer time to access healthcare facilities were less likely to shop in pharmacy stores compared with those with <30 min. The middle-aged and elderly who perceived inconvenient to access health care tended to shop in pharmacy stores compared with those with perceived convenience. Our study of Taiwan's experience could provide a valuable lesson for countries that are planning to launch universal health insurance system, locate budgets in health care and transportation. The middle-aged and elderly who were facing more challenges in accessing health care, no matter in perceived accessibility or real time to access health care, had less outpatient visits and more drug stores shopping. Strategic policies are needed to improve accessibility in increasing patients' perception on access and escalating convenience of transportation system for improving accessibility. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Has the Copayment Ceiling Improved Financial Protection in the Korean National Health Insurance System? Evidence From the 2009 Policy Change

PubMed Central

2017-01-01

Objectives To relieve the financial burden faced by households, the Korean National Health Insurance (NHI) system introduced a “copayment ceiling,” which evolved into a differential ceiling in 2009, with the copayment ceiling depending on patients’ income. This study aimed to examine the effect of the differential copayment ceiling on financial protection and healthcare utilization, particularly focusing on whether its effects varied across different income groups. Methods This study obtained data from the Korea Health Panel. The number of households included in the analysis was 6555 in 2008, 5859 in 2009, 5539 in 2010, and 5372 in 2011. To assess the effects of the differential copayment ceiling on utilization, out-of-pocket (OOP) payments, and catastrophic payments, various random-effects models were applied. Utilization was measured as treatment days, while catastrophic payments were defined as OOP payments exceeding 10% of household income. Among the right-hand side variables were the interaction terms of the new policy with income levels, as well as a set of household characteristics. Results The differential copayment ceiling contributed to increased utilization regardless of income levels both in all patients and in cancer patients. However, the new policy did not seem to reduce significantly the incidence of catastrophic payments among cancer patients, and even increased the incidence among all patients. Conclusions The limited effect of the differential ceiling can be attributed to a high proportion of direct payments for services not covered by the NHI, as well as the relatively small number of households benefiting from the differential ceilings; these considerations warrant a better policy design. PMID:29207446

HIDEEP - an extragalactic blind survey for very low column-density neutral hydrogen

NASA Astrophysics Data System (ADS)

Minchin, R. F.; Disney, M. J.; Boyce, P. J.; de Blok, W. J. G.; Parker, Q. A.; Banks, G. D.; Freeman, K. C.; Garcia, D. A.; Gibson, B. K.; Grossi, M.; Haynes, R. F.; Knezek, P. M.; Lang, R. H.; Malin, D. F.; Price, R. M.; Stewart, I. M.; Wright, A. E.

2003-12-01

We have carried out an extremely long integration time (9000 s beam-1) 21-cm blind survey of 60 deg2 in Centaurus using the Parkes multibeam system. We find that the noise continues to fall as throughout, enabling us to reach an HI column-density limit of 4.2 × 1018 cm-2 for galaxies with a velocity width of 200 km s-1 in the central 32 deg2 region, making this the deepest survey to date in terms of column density sensitivity. The HI data are complemented by very deep optical observations from digital stacking of multi-exposure UK Schmidt Telescope R-band films, which reach an isophotal level of 26.5 R mag arcsec-2 (~=27.5 B mag arcsec-2). 173 HI sources have been found, 96 of which have been uniquely identified with optical counterparts in the overlap area. There is not a single source without an optical counterpart. Although we have not measured the column densities directly, we have inferred them from the optical sizes of their counterparts. All appear to have a column density of NHI= 1020.65+/-0.38. This is at least an order of magnitude above our sensitivity limit, with a scatter only marginally larger than the errors on NHI. This needs explaining. If confirmed it means that HI surveys will only find low surface brightness (LSB) galaxies with high MHI/LB. Gas-rich LSB galaxies with lower HI mass to light ratios do not exist. The paucity of low column-density galaxies also implies that no significant population will be missed by the all-sky HI surveys being carried out at Parkes and Jodrell Bank.

Resolving Fe-rich Neutral ISM in a Massive Quiescent Galaxy at z 0.4

NASA Astrophysics Data System (ADS)

Zahedy, Fakhri

2016-10-01

Roughly 40% of elliptical galaxies are found to contain cool gas but exhibit no on-going star formation, indicating that some feedback mechanisms are at work. While AGN feedback is commonly thought to be responsible for quenching star formation in massive halos, recent work has reiterated the importance of feedback from old stellar populations, including Type Ia supernovae (SNe Ia). In Zahedy et al. (2016), we reported detections of ultra-strong MgII absorption (>3.6 Ang) at 1-2 effective radii of a massive quiescent lensing galaxy at z=0.408. Strong MgII, FeII, MgI, and CaII absorption are found at the lens redshift along two lensed QSO sightlines separated by 8 kpc. The absorbers are resolved into 15 components with line-of-sight velocity spread of 600 km/s. The large observed ionic column densities, N>1e14 cm^-2 suggest large neutral hydrogen column densities N(HI)>1e18 cm^-2 and a significant neutral gas fraction. The most striking feature is the uniformly large Fe/Mg ratio across the full 600 km/s velocity range, suggesting a large contribution in chemical enrichment from SNe Ia (>20%). Here we propose QSO absorption-line spectroscopy of this unique system using STIS and the G140L grating with the slit oriented along the two lensed QSOs. The goal is to determine N(HI) from observations of the full Lyman absorption series and gas-phase metallicity of the interstellar medium at two locations separated by 8 kpc in an elliptical galaxy beyond the local universe. With a modest investment of HST time, we will be able to examine the extent SNe Ia-driven feedback in a distant quiescent galaxy using this unique double-lens system.

The use of Chinese herbal medicine as an adjuvant therapy to reduce incidence of chronic hepatitis in colon cancer patients: A Taiwanese population-based cohort study.

PubMed

Lin, Tsai-Hui; Yen, Hung-Rong; Chiang, Jen-Huai; Sun, Mao-Feng; Chang, Hen-Hong; Huang, Sheng-Teng

2017-04-18

There is a decided lack of in-depth studies to evaluate the effectiveness of Chinese Herbal Medicine (CHM) as an adjuvant therapy on the incidence of chronic hepatitis in patients with colon cancer. The aim of this study is to assess whether CHM treatment decreased the incidence of chronic hepatitis in colon cancer patients who received conventional Western medical treatment. A Taiwanese nationwide population-based study of colon cancer patients receiving Western medicine treatment in conjunction with CHM treatment, using data provided by the National Health Insurance (NHI) Research Database, was conducted. A total of 61676 patients were diagnosed with colon cancer in Taiwan within the defined study period, from 1997 to 2010. After randomly equal matching for age, sex, excluding patients younger than 18 years of age, chronic hepatitis before colon cancer diagnosis date, receiving acupuncture and/or moxibustion and taking CHM for less than 30 days, data from 155 patients were analyzed. Hazard ratios of incidence rate of chronic hepatitis were used to determine the influence of CHM and the therapeutic potential of herbal products in treating patients with colon cancer. CHM used for patients with colon cancer exhibited significantly decreased incidence rates of chronic hepatitis [hazard ratio (HR)=0.53; 95% confidence interval (CI):0.38-0.74], with multivariate adjustment, compared to those without CHM use. The protective effect of CHM treatment with statistical significance across the stratification of age, gender, co-morbidity and treatment modality was noted. The cumulative incidence of chronic hepatitis was also reduced in patients with colon cancer receiving CHM treatment during a five-year period. In this study, we provide the ten most used single herbs and herbal formulas that were prescribed for patients with colon cancer; moreover, we identify the eight single herbs and five formulas used in CHM treatment which significantly decreased incidence of chronic hepatitis among colon cancer patients. This nationwide retrospective cohort study determined that therapy using CHM as an adjuvant modality may have a significant impact on liver protection in patients with colon cancer. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma.

PubMed

Rhee, Chin Kook; Yoon, Hyoung Kyu; Yoo, Kwang Ha; Kim, Young Sam; Lee, Sei Won; Park, Yong Bum; Lee, Jin Hwa; Kim, Yuri; Kim, Kyungjoo; Kim, Jinhee; Oh, Yeon Mok; Lee, Sang Do

2014-04-01

Little information is available regarding medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease (COPD) and asthma. The purpose of this study is to analyze medical utilization and cost in patients with overlap syndrome and to compare them to COPD patients without asthma. Using the 2009 Korean National Health Insurance (NHI) database, COPD patients were identified. Medical utilization and costs were also analyzed. Of a total of 185,147 patients identified with COPD, 101,004 patients were classified with overlap syndrome of COPD and asthma and 84,143 patients with COPD without asthma. In 2009, the percentages of emergency room visits, admissions, and intensive care unit admissions were 14.6%, 30.5%, and 0.5%, respectively, in the patients with overlap syndrome group and 5.0%, 14.1%, and 0.2%, respectively, in the COPD patients without asthma group (p < 0.05 for all comparisons). The cost of medical utilization was 790 ± 71 US dollars per person and 3,373 ± 4,628 dollars per person for outpatient and inpatient services, respectively, in the patients with overlap syndrome and 413 ± 512 and 3,010 ± 5,013, respectively, in the COPD patients without asthma (p < 0.05 for all comparisons). Multiple linear regression showed that age, sex, overlap syndrome, hospitalization in the last year, low socioeconomic status, and type of hospital use were significant factors affecting medical utilization and cost. In patients with overlap syndrome, both medical utilization and cost were higher than in COPD patients without asthma.

Association between obstructive sleep apnea and optic neuropathy: a Taiwanese population-based cohort study.

PubMed

Sun, Ming-Hui; Liao, Yaping Joyce; Lin, Che-Chen; Chiang, Rayleigh Ping-Ying; Wei, James Cheng-Chung

2018-04-26

Obstructive sleep apnea (OSA) is associated with many systemic diseases including diabetes, hypertension, stroke, and cardiovascular disease. The aim of our study was to investigate the association between OSA and optic neuropathy (ON), and to evaluate the efficacy of treatment for OSA on the risk of ON. We used the data from the Longitudinal Health Insurance Database, which involved one million insurants from Taiwan National Health Insurance program (Taiwan NHI). OSA patients had a 1.95-fold higher risk of ON compared with non-OSA patients in all age group. The risk was significantly higher (adjusted hazard ratio: 4.21) in the group aged <45 years and male individuals (adjusted hazard ratio: 1.93). Meanwhile, sleep apnea was associated with ON regardless of the existence of comorbidity or not. OSA patients treated with continuous positive airway pressure (CPAP) had an adjusted 2.31-fold higher hazard of developing ON compared to controls, and those without any treatment had an adjusted 1.82-fold higher hazard of developing ON compared to controls. Moreover, ON patients had a 1.45-fold higher risk of OSA, and those aged between 45 and 64 years (hazard ratio: 1.76) and male individuals (hazard ratio: 1.55) had highest risk. Our study showed that OSA increased the risk of developing ON after controlling the comorbidities; however, treatment with CPAP did not reduce the risk of ON. Further large population study accessing to medical records about the severity of OSA and treatment for OSA is needed to clarify the efficacy of treatment for OSA in reducing the risk of ON.

Construction of databases: advances and significance in clinical research.

PubMed

Long, Erping; Huang, Bingjie; Wang, Liming; Lin, Xiaoyu; Lin, Haotian

2015-12-01

Widely used in clinical research, the database is a new type of data management automation technology and the most efficient tool for data management. In this article, we first explain some basic concepts, such as the definition, classification, and establishment of databases. Afterward, the workflow for establishing databases, inputting data, verifying data, and managing databases is presented. Meanwhile, by discussing the application of databases in clinical research, we illuminate the important role of databases in clinical research practice. Lastly, we introduce the reanalysis of randomized controlled trials (RCTs) and cloud computing techniques, showing the most recent advancements of databases in clinical research.

Information technology facilitates cost-effectiveness analysis in developing countries: an observational study of breast cancer chemotherapy in Taiwan.

PubMed

Shih, Ya-Chen Tina; Pan, I-Wen; Tsai, Yi-Wen

2009-01-01

Health information technology offers a powerful tool to monitor the performance of a healthcare system. Advances in computer technology and capacity combined with lower start-up costs will allow developing countries to achieve greater impact when they initiate electronic health information systems. We focused on the integrated health information system that was established in Taiwan in conjunction with the launch of the National Health Insurance (NHI) programme. We used data from that health information system to conduct a cost-effectiveness analysis of chemotherapy use among breast cancer patients. We then used this analysis to discuss what policy makers can learn from this type of analysis. We identified a cohort of patients in the NHI Research Database who had been diagnosed with breast cancer in 2001 and had received chemotherapy following surgical removal of the tumour. We followed these patients for 3 years and conducted a cost-effectiveness analysis from the payer's perspective. Using the net benefit regression approach, we compared the cost effectiveness of the two most commonly prescribed first-line chemotherapy regimens for the treatment of breast cancer in 2001 in Taiwan. The dependent variable of the regression model was the individual-level net benefit, and the independent variables included a binary variable indicating the choice of chemotherapy regimen, the patients' age, co-morbidity, type of surgery, geographic region and type of treatment facility. We employed both frequentist and Bayesian approaches in our net benefit regression analyses. In the Bayesian analysis, we applied non-informative priors to all parameters in the base-case analyses. We then explored the use of informative priors in the sensitivity analysis, using cost-effectiveness data published in the literature to form the prior distributions for the relevant parameters. Over 60% of surgically treated breast cancer patients received either CMF (cyclophosphamide, methotrexate, fluorouracil) or CEF (cyclophosphamide, epirubicin, fluorouracil). A comparison of patient characteristics indicated that patients in the CEF group tended to be younger (47.8 vs 49.1 years; p = 0.016), and were significantly more likely to have undergone a mastectomy (84% vs 76%; p < 0.001) and to have been treated in a teaching hospital (26% vs 13%; p < 0.001). We also observed significant variations in geographic region of the location of facilities between treatment groups. On average, CEF was not cost effective in the treatment of patients with breast cancer in Taiwan, although analyses stratified by geographic region suggested a wide variation across regions. At a societal willingness to pay (WTP) of new Taiwanese dollar ($NT)1 500 000 ($US80 000), the probability that CEF was more cost effective than CMF was 0.0%, 0.0%, 0.0% and 3.9% for the Taipei metropolitan area, and the north, middle and the combined south and east region, respectively; the probability became 0.6%, 0.0%, 1.3% and 54.5%, respectively, at a WTP of $NT5 000 000 ($US270 000). After co-variate adjustments, the probabilities were 0.0%, 0.0%, 0.0% and 0.8%, respectively at a WTP of $NT1 500 000, and were 0.0%, 0.0%, 1.4% and 34.7% at $NT5 000 000. Sensitivity analyses showed that CEF potentially could have been more cost effective than CMF within a reasonable range of societal WTP (i.e. $NT1 000 000-3 000 000 or $US55 000-160 000) had the optimal dosage level for CEF been established for breast cancer patients in Taiwan. A population-based, fully integrated electronic health information system provides useful data to assess the cost effectiveness of competing treatments and interventions in current practice. This research may potentially inform policy makers of modifications that can be instituted to improve the cost effectiveness of a new therapy. However, findings from this study need to be interpreted with caution because the study provided information only on the short-term cost effectiveness (i.e. 3 years) of CEF compared with CMF. It is possible that a future analysis will reach a different conclusion when more years of follow-up data become available.

Counterintelligence Screening Needed lo Reduce Security Threat That Unscreened Local National Linguists Pose to U.S. Forces (REDACTED)

DTIC Science & Technology

2012-12-07

Commander, U.S. Forces- Afghanistan -- - ·--·- --· I A., B. l., and B.2. FOR OFFICl/rlJ BSE O:PflrlI ii F0R 0FFiCM-L HSE 0Nhi’ Table of...Our Response 13 Appendices A. Scope and Methodology 15 Use of Computer Processed Data 16 Prior Coverage 16 1 F0R 0FFiCIA±i HSE 0Nl-J’l F61t...security screening process for escorted entry while on U.S. Forces’ installations in Afghanistan. FOR 0ff’ICikb HSE 0"Pfb Y 5 F6:K 6FFl€1A:b ffl

Database on veterinary clinical research in homeopathy.

PubMed

Clausen, Jürgen; Albrecht, Henning

2010-07-01

The aim of the present report is to provide an overview of the first database on clinical research in veterinary homeopathy. Detailed searches in the database 'Veterinary Clinical Research-Database in Homeopathy' (http://www.carstens-stiftung.de/clinresvet/index.php). The database contains about 200 entries of randomised clinical trials, non-randomised clinical trials, observational studies, drug provings, case reports and case series. Twenty-two clinical fields are covered and eight different groups of species are included. The database is free of charge and open to all interested veterinarians and researchers. The database enables researchers and veterinarians, sceptics and supporters to get a quick overview of the status of veterinary clinical research in homeopathy and alleviates the preparation of systematical reviews or may stimulate reproductions or even new studies. 2010 Elsevier Ltd. All rights reserved.

NHI-PharmaCloud in Taiwan--A preliminary evaluation using the RE-AIM framework and lessons learned.

PubMed

Huang, San-Kuei; Wang, Pen-Jen; Tseng, Wen-Fuh; Syu, Fei-Kai; Lee, Miaw-Chwen; Shih, Ru-Liang; Sheen, Mao-Ting; Chen, Michael S

2015-10-01

The aim of this article is to present the preliminary impact of a medication monitoring program, PharmaCloud, in Taiwan and analyze the embedded factors that have contributed to the performance thereof. This article also compared PharmaCloud with similar international programs in order to draw lessons learned. The five domains of the RE-AIM framework - reach, effectiveness, adoption, implementation, and maintenance - were examined using qualitative and quantitative data. A difference-in-differences model was applied to analyze the quantitative impact of PharmaCloud on drug utilization and drug expenses. The qualitative impact was evaluated by document analysis based on field reports from the participating medical institutions. Reach and adoption: although all of the major hospitals adopted PharmaCloud and some of the hospitals had high inquiry rates, more time and incentives are needed to raise the overall inquiry rate. Effectiveness: during the study period of 3 months, the number of medications per prescription declined in the intervention group was 0.15 more than that of the general population, and the drug expense per person declined in the intervention group was NT $567 (US $18.9) more than that of the general population. The potential savings could be between 2% and 5% of the total pharmaceutical expenditure. Medication duplication was found to have decreased more in the intervention group. a variety of innovations in care delivery are being developed in which the pharmacists play a more significant role. Maintenance: the embedded National Health Insurance would lend strong support for PharmaCloud to grow and thrive. PharmaCloud owes its effectiveness to the embedded National Health Insurance (NHI) program, which is universal and provides a comprehensive benefit package including more than 16,000 prescription drugs. An effective medication program is one that operates under the principle of universality and comprehensiveness, facilitates innovations, and has a substantial level of interoperability with the intra-hospital health information systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision.

PubMed

Fusheini, Adam; Eyles, John

2016-10-07

Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously implicated. Yet ideological and practical issues make its achievement problematic.

Association of Education and Smoking Status on Risk of Diabetes Mellitus: A Population-Based Nationwide Cross-Sectional Study.

PubMed

Kim, Jin-Hyeong; Noh, Juhwan; Choi, Jae-Woo; Park, Eun-Cheol

2017-06-19

Background: Exposure to smoke, including environmental tobacco smoke (ETS), is a well-known risk factor for diabetes. Low socioeconomic status, especially lack of education, is also a risk factor for diabetes. Therefore, we assessed the association of demographic, socioeconomic, clinical, and behavior risk factor-related variables and smoking status, including ETS exposure, with the prevalence of diabetes. Methods: Data were from the 2007-2013 Korea National Health and Nutritional Evaluation Survey (KNHANES). Multivariable logistic regression examined associations between various lifestyle and health factors and the prevalence of diabetes while controlling for potential confounding variables. Subgroup analysis was performed according to smoking status to determine factors associated with diabetes. Results: Of 19,303 individuals analyzed, 1325 (11.4%) had diabetes. Greater average age, male sex, lower educational level, unemployment, and coexisting health problems were significantly associated with diabetes. Individuals with only elementary, middle, or high school level education had significantly greater odds ratios ( p < 0.05) compared to college graduates; smokers and nonsmokers exposed to ETS had significantly greater OR ( p < 0.05) than nonsmokers unexposed to ETS. Subgroup analysis of diabetics according to smoking status revealed significant associations ( p < 0.05) for diabetic nonsmokers exposed to ETS with female sex, single status, elementary level education, urban residence, National Health Insurance (NHI), hypertension, a lack of alcohol intake, and a lack of moderate physical activity. For diabetic smokers, there were significant associations ( p < 0.05) with elementary education, urban residence, a lack of moderate physical activity, a lack of alcohol intake, and NHI. Conclusions: The results suggested that smoking status, as well as ETS exposure, was associated with a higher prevalence of diabetes, especially in populations with less education. Thus, we should direct efforts for controlling diabetes toward individuals with lower levels of education and those who are smokers and nonsmokers exposed to ETS.

Evolution in intergenerational exchanges between elderly people and their grandchildren in Taiwan; data from a multiple round cross-sectional study from 1993 to 2007

PubMed Central

2011-01-01

Background This study aimed to evaluate social evolution in Taiwan in recent decades using the changing pattern of care provided by grandparents for their grandchildren as an indicator. Methods Data from the second, fourth and sixth wave surveys of the Study of Health and Living Status of the Middle-Aged and Elderly in Taiwan were used for the analysis. This survey collected individual characteristics, including age, gender, education, ethnicity, dwelling place, living with partners, co-resident with children, employment status, self-reported health status and their provision of care for their grandchildren. Information about the attitudes toward National Health Insurance (NHI) was further collected in a questionnaire of 1999 following the implementation of NHI in 1995. By elders, we mean persons 60 or more years old. By grandchildren, we mean persons under 16 years of age. First, changes in individual characteristics were compared during these study periods (chi-square test). Then the logistic regression was performed to determine how significantly elders' grandchild-care behavior was associated with their individual characteristics. Results The percentage of elders providing grandchild care increased from 7.7% in 1993 to 13.6% in 1999, and then to 19.4% in 2007. By analysis, significant association was found between behavior in taking care of grandchildren and individuals of lower age, grandmothers, those living with partners or co-residing with children, those unemployed and those with better self-reported health status. And the effect of year was confirmed in the multivariable analysis. Conclusions This study pointed out the changing pattern of elders' behavior in taking care of their grandchildren as the main indicator and their related individual characteristics. We argue the need for improving social security policies in an ageing society. We suggest that the interaction between population policies and those of social welfare, including policies for health care and childcare, should be carefully evaluated. PMID:21835009

Sleep disorders increase the risk of burning mouth syndrome: a retrospective population-based cohort study.

PubMed

Lee, Chun-Feng; Lin, Kuan-Yu; Lin, Ming-Chia; Lin, Cheng-Li; Chang, Shih-Ni; Kao, Chia-Hung

2014-11-01

Sleep disorders (SD), including apnea and nonapnea, and burning mouth syndrome (BMS) have been mutually associated with systemic diseases. Based on our research, the association between BMS and SD has not been elucidated. We determined whether SD patients have an increased risk of BMS. We used information from health insurance claims obtained from the Taiwanese National Health Insurance (NHI) program. We identified patients newly diagnosed with sleep apnea syndrome between 1998 and 2001 as the apnea SD cohort, and newly diagnosed patients with nonapnea SD as the nonapnea SD cohort. The non-SD cohort was 1:2 frequency matched the case group according to sex, age, and index year. We analyzed the risks of BMS by using Cox proportional hazards regression models. Compared with the non-SD cohort, both of the apnea SD (adjusted HR = 2.56, 95% CI = 1.30-5.05) and nonapnea SD (adjusted HR = 2.89, 95% CI = 2.51-3.34) were associated with a significantly higher risk of BMS. The hazard ratio (HR) increased with increased age in the apnea SD cohort and in the nonapnea SD cohort compared with patients younger than 40 years of age. Female apnea SD patients (IRR = 4.63, 95% CI = 3.82-5.61) had a higher risk of developing BMS than did male patients (IRR = 1.76, 95% CI = 1.39-2.24). Based on our research, SD might increase the risk of BMS. Copyright © 2014 Elsevier B.V. All rights reserved.

Database for propagation models

NASA Astrophysics Data System (ADS)

Kantak, Anil V.

1991-07-01

A propagation researcher or a systems engineer who intends to use the results of a propagation experiment is generally faced with various database tasks such as the selection of the computer software, the hardware, and the writing of the programs to pass the data through the models of interest. This task is repeated every time a new experiment is conducted or the same experiment is carried out at a different location generating different data. Thus the users of this data have to spend a considerable portion of their time learning how to implement the computer hardware and the software towards the desired end. This situation may be facilitated considerably if an easily accessible propagation database is created that has all the accepted (standardized) propagation phenomena models approved by the propagation research community. Also, the handling of data will become easier for the user. Such a database construction can only stimulate the growth of the propagation research it if is available to all the researchers, so that the results of the experiment conducted by one researcher can be examined independently by another, without different hardware and software being used. The database may be made flexible so that the researchers need not be confined only to the contents of the database. Another way in which the database may help the researchers is by the fact that they will not have to document the software and hardware tools used in their research since the propagation research community will know the database already. The following sections show a possible database construction, as well as properties of the database for the propagation research.

A Comparison of Selected Bibliographic Database Subject Overlap for Agricultural Information

ERIC Educational Resources Information Center

Ritchie, Stephanie M.; Young, Lauren M.; Sigman, Jessica

2018-01-01

Agricultural researchers and science librarians must understand which research literature databases provide the most comprehensive coverage of agricultural subjects to support their inquiries. Once the domain of a few specialized databases, agricultural research literature is now covered by broad, multidisciplinary databases. The purpose of this…

Use of administrative medical databases in population-based research.

PubMed

Gavrielov-Yusim, Natalie; Friger, Michael

2014-03-01

Administrative medical databases are massive repositories of data collected in healthcare for various purposes. Such databases are maintained in hospitals, health maintenance organisations and health insurance organisations. Administrative databases may contain medical claims for reimbursement, records of health services, medical procedures, prescriptions, and diagnoses information. It is clear that such systems may provide a valuable variety of clinical and demographic information as well as an on-going process of data collection. In general, information gathering in these databases does not initially presume and is not planned for research purposes. Nonetheless, administrative databases may be used as a robust research tool. In this article, we address the subject of public health research that employs administrative data. We discuss the biases and the limitations of such research, as well as other important epidemiological and biostatistical key points specific to administrative database studies.

Using databases in medical education research: AMEE Guide No. 77.

PubMed

Cleland, Jennifer; Scott, Neil; Harrild, Kirsten; Moffat, Mandy

2013-05-01

This AMEE Guide offers an introduction to the use of databases in medical education research. It is intended for those who are contemplating conducting research in medical education but are new to the field. The Guide is structured around the process of planning your research so that data collection, management and analysis are appropriate for the research question. Throughout we consider contextual possibilities and constraints to educational research using databases, such as the resources available, and provide concrete examples of medical education research to illustrate many points. The first section of the Guide explains the difference between different types of data and classifying data, and addresses the rationale for research using databases in medical education. We explain the difference between qualitative research and qualitative data, the difference between categorical and quantitative data, and the difference types of data which fall into these categories. The Guide reviews the strengths and weaknesses of qualitative and quantitative research. The next section is structured around how to work with quantitative and qualitative databases and provides guidance on the many practicalities of setting up a database. This includes how to organise your database, including anonymising data and coding, as well as preparing and describing your data so it is ready for analysis. The critical matter of the ethics of using databases in medical educational research, including using routinely collected data versus data collected for research purposes, and issues of confidentiality, is discussed. Core to the Guide is drawing out the similarities and differences in working with different types of data and different types of databases. Future AMEE Guides in the research series will address statistical analysis of data in more detail.

Using Large Diabetes Databases for Research.

PubMed

Wild, Sarah; Fischbacher, Colin; McKnight, John

2016-09-01

There are an increasing number of clinical, administrative and trial databases that can be used for research. These are particularly valuable if there are opportunities for linkage to other databases. This paper describes examples of the use of large diabetes databases for research. It reviews the advantages and disadvantages of using large diabetes databases for research and suggests solutions for some challenges. Large, high-quality databases offer potential sources of information for research at relatively low cost. Fundamental issues for using databases for research are the completeness of capture of cases within the population and time period of interest and accuracy of the diagnosis of diabetes and outcomes of interest. The extent to which people included in the database are representative should be considered if the database is not population based and there is the intention to extrapolate findings to the wider diabetes population. Information on key variables such as date of diagnosis or duration of diabetes may not be available at all, may be inaccurate or may contain a large amount of missing data. Information on key confounding factors is rarely available for the nondiabetic or general population limiting comparisons with the population of people with diabetes. However comparisons that allow for differences in distribution of important demographic factors may be feasible using data for the whole population or a matched cohort study design. In summary, diabetes databases can be used to address important research questions. Understanding the strengths and limitations of this approach is crucial to interpret the findings appropriately. © 2016 Diabetes Technology Society.

Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan

PubMed Central

2012-01-01

Background Although methadone has been used for the maintenance treatment of opioid dependence for decades, it was not introduced in China or Taiwan until 2000s. Methadone-drug interactions (MDIs) have been shown to cause many adverse effects. However, such effects have not been scrutinized in the ethnic Chinese community. Methods The study was performed in two major hospitals in southern Taiwan. A total of 178 non-HIV patients aged ≥ 20 years who had participated in the Methadone Maintenance Treatment Program (MMTP) ≥ 1 month were recruited. An MDI is defined as concurrent use of drug(s) with methadone that may result in an increase or decrease of effectiveness and/or adverse effect of methadone. To determine the prevalence and clinical characteristics of MDIs, credible data sources, including the National Health Insurance (NHI) database, face-to-face interviews, medical records, and methadone computer databases, were linked for analysis. Socio-demographic and clinical factors associated with MDIs and co-medications were also examined. Results 128 (72%) MMTP patients took at least one medication. Clinically significant MDIs included withdrawal symptoms, which were found among MMTP patients co-administered with buprenorphine or tramadol; severe QTc prolongation effect, which might be associated with use of haloperidol or droperidol; and additive CNS and respiratory depression, which could result from use of methadone in combination with chlorpromazine or thioridazine. Past amphetamine use, co-infection with hepatitis C, and a longer retention in the MMTP were associated with increased odds of co-medication. Among patients with co-medication use, significant correlates of MDIs included the male gender and length of co-medication in the MMTP. Conclusions The results demonstrate clinical evidence of significant MDIs among MMTP patients. Clinicians should check the past medical history of MMTP clients carefully before prescribing medicines. Because combinations of methadone with other psychotropic or opioid medications can affect treatment outcomes or precipitate withdrawal symptoms, clinicians should be cautious when prescribing these medications to MMTP patients and monitor the therapeutic effects and adverse drug reactions. Although it is difficult to interconnect medical data from different sources for the sake of privacy protection, the incumbent agency should develop pharmacovigilant measures to prevent the MDIs from occurring. Physicians are also advised to check more carefully on the medication history of their MMTP patients. PMID:22429858

Celecoxib and sulfasalazine had negative association with coronary artery diseases in patients with ankylosing spondylitis

PubMed Central

Wu, Li-Chih; Leong, Pui-Ying; Yeo, Kai-Jieh; Li, Ting-Yu; Wang, Yu-Hsun; Chiou, Jeng-Yuan; Wei, James Cheng-Chung

2016-01-01

Abstract The aim of the study is to assess the effects of celecoxib and sulfasalazine on the risk of coronary artery disease (CAD) in patients with ankylosing spondylitis (AS). Using the claims data of Taiwan National Health Insurance (NHI) database, a nationally representative data that contain the medical records of 23 million Taiwan residents, we randomly selected 1 million cohort from the database, and then we enrolled only patients who were newly diagnosed with AS (n = 4829) between year 2001 and 2010, excluding patients who had CAD (ICD-9- CM codes: 410–414) before the diagnosis of AS (n = 4112). According to propensity score matched 1:2 on age, gender, AS duration, Charlson comorbidity index, hypertension, and hyperlipidemia, 236 and 472 patients were included in the case (AS with CAD) and control (AS without CAD) groups, respectively. We used the WHO defined daily dose (DDD) as a tool to assess the dosage of sulfasalazine and celecoxib exposure. Conditional logistic regression was used to estimate the crude and adjusted odds ratios (ORs) and 95% confidence interval (CI) for the risk of CAD associated with use of sulfasalazine and celecoxib. Among 4112 AS patients, 8.4% (346/4112) developed CAD. CAD in AS patients were positively associated with age of 35 to 65, Charlson comorbidities index (CCI), hypertension, and hyperlipidemia. There was no gender difference between case and control groups. After adjustment for age, gender, CCI, hypertension, and hyperlipidemia, sulfasalazine users with an average daily dose ≥ 0.5 DDD (0.5 gm/day) had negative association with CAD events as compared to sulfasalazine nonusers (OR 0.63; 95% CI, 0.40–0.99, P < 0.05). NSAIDs, including celecoxib, etoricoxib, but no naproxen and diclofenac were negatively associated with CAD. Celecoxib users, with an average daily dose > 1.5 DDD, were negatively associated with CAD events, compared to celecoxib nonusers (OR 0.34; 95% CI, 0.13–0.89; P < 0.05). In this 10-year population-based case-control study, 8.4% of AS patients developed CAD. Sulfasalazine usage at an average dose of ≥ 0.5 gm/day demonstrated negative association with CAD events in patients with AS. PMID:27603385

Utilisation of a thoracic oncology database to capture radiological and pathological images for evaluation of response to chemotherapy in patients with malignant pleural mesothelioma

PubMed Central

Carey, George B; Kazantsev, Stephanie; Surati, Mosmi; Rolle, Cleo E; Kanteti, Archana; Sadiq, Ahad; Bahroos, Neil; Raumann, Brigitte; Madduri, Ravi; Dave, Paul; Starkey, Adam; Hensing, Thomas; Husain, Aliya N; Vokes, Everett E; Vigneswaran, Wickii; Armato, Samuel G; Kindler, Hedy L; Salgia, Ravi

2012-01-01

Objective An area of need in cancer informatics is the ability to store images in a comprehensive database as part of translational cancer research. To meet this need, we have implemented a novel tandem database infrastructure that facilitates image storage and utilisation. Background We had previously implemented the Thoracic Oncology Program Database Project (TOPDP) database for our translational cancer research needs. While useful for many research endeavours, it is unable to store images, hence our need to implement an imaging database which could communicate easily with the TOPDP database. Methods The Thoracic Oncology Research Program (TORP) imaging database was designed using the Research Electronic Data Capture (REDCap) platform, which was developed by Vanderbilt University. To demonstrate proof of principle and evaluate utility, we performed a retrospective investigation into tumour response for malignant pleural mesothelioma (MPM) patients treated at the University of Chicago Medical Center with either of two analogous chemotherapy regimens and consented to at least one of two UCMC IRB protocols, 9571 and 13473A. Results A cohort of 22 MPM patients was identified using clinical data in the TOPDP database. After measurements were acquired, two representative CT images and 0–35 histological images per patient were successfully stored in the TORP database, along with clinical and demographic data. Discussion We implemented the TORP imaging database to be used in conjunction with our comprehensive TOPDP database. While it requires an additional effort to use two databases, our database infrastructure facilitates more comprehensive translational research. Conclusions The investigation described herein demonstrates the successful implementation of this novel tandem imaging database infrastructure, as well as the potential utility of investigations enabled by it. The data model presented here can be utilised as the basis for further development of other larger, more streamlined databases in the future. PMID:23103606

Surgical research using national databases

PubMed Central

Leland, Hyuma; Heckmann, Nathanael

2016-01-01

Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research. PMID:27867945

Surgical research using national databases.

PubMed

Alluri, Ram K; Leland, Hyuma; Heckmann, Nathanael

2016-10-01

Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

A logNHI = 22.6 Damped Lyα Absorber in a Dark Gamma-Ray Burst: The Environment of GRB 050401

NASA Astrophysics Data System (ADS)

Watson, D.; Fynbo, J. P. U.; Ledoux, C.; Vreeswijk, P.; Hjorth, J.; Smette, A.; Andersen, A. C.; Aoki, K.; Augusteijn, T.; Beardmore, A. P.; Bersier, D.; Castro Cerón, J. M.; D'Avanzo, P.; Diaz-Fraile, D.; Gorosabel, J.; Hirst, P.; Jakobsson, P.; Jensen, B. L.; Kawai, N.; Kosugi, G.; Laursen, P.; Levan, A.; Masegosa, J.; Näränen, J.; Page, K. L.; Pedersen, K.; Pozanenko, A.; Reeves, J. N.; Rumyantsev, V.; Shahbaz, T.; Sharapov, D.; Sollerman, J.; Starling, R. L. C.; Tanvir, N.; Torstensson, K.; Wiersema, K.

2006-12-01

The optical afterglow spectrum of GRB 050401 (at z=2.8992+/-0.0004) shows the presence of a damped Lyα absorber (DLA), with logNHI=22.6+/-0.3. This is the highest column density ever observed in a DLA and is about 5 times larger than the strongest DLA detected so far in any QSO spectrum. From the optical spectrum, we also find a very large Zn column density, implying an abundance of [Zn/H]=-1.0+/-0.4. These large columns are supported by the early X-ray spectrum from Swift XRT, which shows a column density (in excess of Galactic) of logNH=22.21+0.06-0.08 assuming solar abundances (at z=2.9). The comparison of this X-ray column density, which is dominated by absorption due to α-chain elements, and the H I column density derived from the Lyα absorption line allows us to derive a metallicity for the absorbing matter of [α/H]=-0.4+/-0.3. The optical spectrum is reddened and can be well reproduced with a power law with SMC extinction, where AV=0.62+/-0.06. But the total optical extinction can also be constrained independent of the shape of the extinction curve: from the optical to X-ray spectral energy distribution, we find 0.5<~AV<~4.5. However, even this upper limit, independent of the shape of the extinction curve, is still well below the dust column that is inferred from the X-ray column density, i.e., AV=9.1+1.4-1.5. This discrepancy might be explained by a small dust content with high metallicity (low dust-to-metals ratio). ``Gray'' extinction cannot explain the discrepancy, since we are comparing the metallicity to a measurement of the total extinction (without reference to the reddening). Little dust with high metallicity may be produced by sublimation of dust grains or may naturally exist in systems younger than a few hundred megayears. Based in part on observations made at the European Southern Observatory, Paranal, Chile under program 075.D-0270, with the Nordic Optical Telescope, operated on the island of La Palma jointly by Denmark, Finland, Iceland, Norway, and Sweden, in the Spanish Observatorio del Roque de los Muchachos of the Instituto de Astrofisica de Canarias, with the Wide Field Camera (WFCAM) on the United Kingdom Infrared Telescope, which is operated by the Joint Astronomy Centre on behalf of the UK Particle Physics and Astronomy Research Council, and on data collected at the Subaru Telescope, which is operated by the National Astronomical Observatory of Japan.

Dust and Diffuse Interstellar Bands in the za = 0.524 Absorption System toward AO 0235+164

NASA Astrophysics Data System (ADS)

Junkkarinen, V. T.; Cohen, Ross D.; Beaver, E. A.; Burbidge, E. M.; Lyons, R. W.; Madejski, G.

2004-10-01

We present new Hubble Space Telescope (HST) Space Telescope Imaging Spectrograph (STIS) NUV-MAMA and STIS CCD observations of the BL Lac object AO 0235+164 and the intervening damped Lyα (DLA) line at za=0.524. The line profile gives N(HI)=(5+/-1)×1021 cm-2 and, combined with the H I 21 cm absorption data, leads to a spin temperature of Ts=220+/-60 K. Those spectra also show a strong, broad feature at the expected position of the 2175 Å graphitic dust feature at za=0.524. Assuming a Galactic-type dust extinction curve at za=0.524 gives a dust-to-gas ratio of 0.19 times the Galactic value, but the fit, assuming that the underlying, unreddened spectrum is a single power law, is poor in the far-UV. A dust-to-gas ratio of 0.19 times the Galactic value is similar to the LMC, but the AO 0235+164 spectrum does not fit either the LMC extinction curve or the SMC extinction curve (which has practically no 2175 Å feature). A possible interpretation includes dust similar to that in the Galaxy, but with fewer of the small particles that produce the far-UV extinction. The metallicity of the za=0.524 absorber, estimated from the observed N(HI) and excess X-ray absorption (beyond Galactic) derived from contemporaneous and archival ASCA and ROSAT X-ray data, is Z=0.72+/-0.28 Zsolar, implying in turn a dust-to-metals ratio of 0.27 times the Galactic value. If the dust mass density is the same in the za=0.524 DLA system as in our Galaxy, only 14% (+/-6%) of the metals (by mass) are in dust, compared to 51%, 36%, and 46% for the Galaxy, LMC, and SMC, respectively. Such a dusty za=0.524 AO 0235+164 absorption system is a good example of the kind of DLA system that will be missed because of selection effects, which in turn can bias the measurement of the comoving density of interstellar gas (in units of the closure density), Ωg, as a function of z. Based on observations with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS5-26555. Some of the data presented herein were obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California, and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W. M. Keck Foundation.

Poverty related risk for potentially preventable hospitalisations among children in Taiwan.

PubMed

Chen, Likwang; Lu, Hsin-Ming; Shih, Shu-Fang; Kuo, Ken N; Chen, Chi-Liang; Huang, Lynn Chu

2010-07-07

This study investigated the incidence of potentially preventable hospitalisations in the first two years of life among children in the National Health Insurance (NHI) system of Taiwan. It also examined income disparities in potentially preventable hospitalisations across four economic categories: below a government-established poverty line and low-, middle-, and upper-income. Five major diseases causing potentially preventable hospitalisations were investigated: gastroenteritis and dehydration, asthma and chronic bronchitis, acute upper respiratory infections, lower respiratory infections, and acute injuries and poisonings. NHI data on enrolee registrations and use of ambulatory and hospital care by all children born between July 1, 2003 and June 30, 2004 (n = 218,158) was used for the study. The negative binomial regression method was used to identify factors associated with total inpatient care and the severity level for various types of potentially preventable hospitalisations during the first two years of life. This study found high inpatient expenses for lower respiratory infections for children in all income categories. Furthermore, results from the multivariate analysis indicate that children in the lowest economic category used inpatient care to a much greater extent than better-off children for problems considered potentially avoidable through primary prevention or through timely outpatient care. This was especially true for acute injuries and poisonings and for lower respiratory infections. On average, and controlling for other variables, a child in poverty spent 6.1 times more days in inpatient care for acute injuries and poisonings (p < 0.01) and 2.7 times more days for lower respiratory infections (p < 0.01) before age two, compared with a similarly-aged high-income child. The results also suggest a connection between economic status and the severity of a condition causing a potentially avoidable hospital admission. On average, length of stay for each admission for gastroenteritis and dehydration for children in poverty was 1.3 times that for high-income children (p < 0.01). Both the ratios for lower respiratory infections and for acute upper respiratory infections were 1.2 (p < 0.01 for both). There were high hospital admission rates and lengths of stays for lower respiratory infections among young children in all income categories. Hospital care use of young children in the poorest category was significantly higher for acute injuries and poisonings as well as for lower respiratory infections, compared with those of better-off children. The findings suggest the need for increased attention to these two disease types. It particularly calls for more research on the causes of high hospital care use for lower respiratory infections and on the reasons for large economic disparities in hospital care use for acute injuries and poisonings.

The porcine translational research database: A manually curated, genomics and proteomics-based research resource

USDA-ARS?s Scientific Manuscript database

The use of swine in biomedical research has increased dramatically in the last decade. Diverse genomic- and proteomic databases have been developed to facilitate research using human and rodent models. Current porcine gene databases, however, lack the robust annotation to study pig models that are...

Long-term exposure to air pollution and the incidence of Parkinson's disease: A nested case-control study.

PubMed

Chen, Chiu-Ying; Hung, Hui-Jung; Chang, Kuang-Hsi; Hsu, Chung Y; Muo, Chih-Hsin; Tsai, Chon-Haw; Wu, Trong-Neng

2017-01-01

Previous studies revealed that chronic exposure to air pollution can significantly increase the risk of the development of Parkinson's disease (PD), but this relationship is inconclusive as large-scale prospective studies are limited and the results are inconsistent. Therefore, the purpose of this study was to ascertain the adverse health effects of air pollution exposure in a nationwide population using a longitudinal approach. We conducted a nested case-control study using the National Health Insurance Research Dataset (NHIRD), which consisted of 1,000,000 beneficiaries in the National Health Insurance Program (NHI) in the year 2000 and their medical records from 1995 to 2013 and using public data on air pollution concentrations from monitoring stations across Taiwan released from the Environmental Protection Administration to identify people with ages ≥ 40 years living in areas with monitoring stations during 1995-1999 as study subjects. Then, we excluded subjects with PD, dementia, stroke and diabetes diagnosed before Jan. 1, 2000 and obtained 54,524 subjects to follow until Dec. 31, 2013. In this observational period, 1060 newly diagnosed PD cases were identified. 4240 controls were randomly selected from those without PD using a matching strategy for age, sex, the year of PD diagnosis and the year of entering the NHI program at a ratio of 1:4. Ten elements of air pollution were examined, and multiple logistic regression models were used to measure their risks in subsequent PD development. The incidence of PD in adults aged ≥ 40 years was 1.9%, and the median duration for disease onset was 8.45 years. None of the chemical compounds (SO2, O3, CO, NOx, NO, NO2, THC, CH4, or NMHC) significantly affected the incidence of PD except for particulate matter. PM10 exposure showed significant effects on the likelihood of PD development (T3 level: > 65μg/m3 versus T1 level: ≤ 54μg/m3; OR = 1.35, 95% CI = 1.12-1.62, 0.001 ≤ P < 0.01). In addition, comorbid conditions such as dementia (ORs = 3.53-3.93, Ps < 0.001), stroke (ORs = 2.99-3.01, Ps < 0.001), depression (ORs = 2.51-2.64, Ps < 0.001), head injury (ORs = 1.24-1.29, 0.001 ≤ Ps < 0.01 or 0.01 ≤ Ps < 0.05), sleep disorder (OR = 1.23-1.26, 0.001 ≤ Ps < 0.01), and hypertension (ORs = 1.18-1.19, 0.01 ≤ Ps < 0.05) also significantly increased the risk for PD development. Although PM10 plays a significant role in PD development, the associated chemical/metal compounds that are capable of inducing adverse biological mechanisms still warrant further exploration. Because of a link between comorbid conditions and PM exposure, research on the causal relationship between long-term exposure to PM and the development of PD should be considered with caution because other possible modifiers or mediators, comorbid diseases in particular, may be involved.

Promise and Limitations of Big Data Research in Plastic Surgery.

PubMed

Zhu, Victor Zhang; Tuggle, Charles Thompson; Au, Alexander Francis

2016-04-01

The use of "Big Data" in plastic surgery outcomes research has increased dramatically in the last 5 years. This article addresses some of the benefits and limitations of such research. This is a narrative review of large database studies in plastic surgery. There are several benefits to database research as compared with traditional forms of research, such as randomized controlled studies and cohort studies. These include the ease in patient recruitment, reduction in selection bias, and increased generalizability. As such, the types of outcomes research that are particularly suited for database studies include determination of geographic variations in practice, volume outcome analysis, evaluation of how sociodemographic factors affect access to health care, and trend analyses over time. The limitations of database research include data which are limited only to what was captured in the database, high power which can cause clinically insignificant differences to achieve statistical significance, and fishing which can lead to increased type I errors. The National Surgical Quality Improvement Project is an important general surgery database that may be useful for plastic surgeons because it is validated and has a large number of patients after over a decade of collecting data. The Tracking Operations and Outcomes for Plastic Surgeons Program is a newer database specific to plastic surgery. Databases are a powerful tool for plastic surgery outcomes research. It is critically important to understand their benefits and limitations when designing research projects or interpreting studies whose data have been drawn from them. For plastic surgeons, National Surgical Quality Improvement Project has a greater number of publications, but Tracking Operations and Outcomes for Plastic Surgeons Program is the most applicable database for plastic surgery research.

The role of insurance claims databases in drug therapy outcomes research.

PubMed

Lewis, N J; Patwell, J T; Briesacher, B A

1993-11-01

The use of insurance claims databases in drug therapy outcomes research holds great promise as a cost-effective alternative to post-marketing clinical trials. Claims databases uniquely capture information about episodes of care across healthcare services and settings. They also facilitate the examination of drug therapy effects on cohorts of patients and specific patient subpopulations. However, there are limitations to the use of insurance claims databases including incomplete diagnostic and provider identification data. The characteristics of the population included in the insurance plan, the plan benefit design, and the variables of the database itself can influence the research results. Given the current concerns regarding the completeness of insurance claims databases, and the validity of their data, outcomes research usually requires original data to validate claims data or to obtain additional information. Improvements to claims databases such as standardisation of claims information reporting, addition of pertinent clinical and economic variables, and inclusion of information relative to patient severity of illness, quality of life, and satisfaction with provided care will enhance the benefit of such databases for outcomes research.

The 2015 Nucleic Acids Research Database Issue and molecular biology database collection.

PubMed

Galperin, Michael Y; Rigden, Daniel J; Fernández-Suárez, Xosé M

2015-01-01

The 2015 Nucleic Acids Research Database Issue contains 172 papers that include descriptions of 56 new molecular biology databases, and updates on 115 databases whose descriptions have been previously published in NAR or other journals. Following the classification that has been introduced last year in order to simplify navigation of the entire issue, these articles are divided into eight subject categories. This year's highlights include RNAcentral, an international community portal to various databases on noncoding RNA; ValidatorDB, a validation database for protein structures and their ligands; SASBDB, a primary repository for small-angle scattering data of various macromolecular complexes; MoonProt, a database of 'moonlighting' proteins, and two new databases of protein-protein and other macromolecular complexes, ComPPI and the Complex Portal. This issue also includes an unusually high number of cancer-related databases and other databases dedicated to genomic basics of disease and potential drugs and drug targets. The size of NAR online Molecular Biology Database Collection, http://www.oxfordjournals.org/nar/database/a/, remained approximately the same, following the addition of 74 new resources and removal of 77 obsolete web sites. The entire Database Issue is freely available online on the Nucleic Acids Research web site (http://nar.oxfordjournals.org/). Published by Oxford University Press on behalf of Nucleic Acids Research 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

USDA food and nutrient databases provide the infrastructure for food and nutrition research, policy, and practice.

PubMed

Ahuja, Jaspreet K C; Moshfegh, Alanna J; Holden, Joanne M; Harris, Ellen

2013-02-01

The USDA food and nutrient databases provide the basic infrastructure for food and nutrition research, nutrition monitoring, policy, and dietary practice. They have had a long history that goes back to 1892 and are unique, as they are the only databases available in the public domain that perform these functions. There are 4 major food and nutrient databases released by the Beltsville Human Nutrition Research Center (BHNRC), part of the USDA's Agricultural Research Service. These include the USDA National Nutrient Database for Standard Reference, the Dietary Supplement Ingredient Database, the Food and Nutrient Database for Dietary Studies, and the USDA Food Patterns Equivalents Database. The users of the databases are diverse and include federal agencies, the food industry, health professionals, restaurants, software application developers, academia and research organizations, international organizations, and foreign governments, among others. Many of these users have partnered with BHNRC to leverage funds and/or scientific expertise to work toward common goals. The use of the databases has increased tremendously in the past few years, especially the breadth of uses. These new uses of the data are bound to increase with the increased availability of technology and public health emphasis on diet-related measures such as sodium and energy reduction. Hence, continued improvement of the databases is important, so that they can better address these challenges and provide reliable and accurate data.

NBIC: National Ballast Information Clearinghouse

Science.gov Websites

Smithsonian Environmental Research Center Logo US Coast Guard Logo Submit BW Report | Search NBIC Database | NBIC Research & Development | NBIC News | Home Cite NBIC Database as: National Ballast Information Clearinghouse 2016. NBIC Online Database. Electronic publication, Smithsonian Environmental Research Center &

Berkeley Lab - Materials Sciences Division

Science.gov Websites

Postdoc Forum Research Highlights Awards Publications Database Events Calendar Newsletter Archive People Database Events Calendar Newsletter Archive Send us your research highlights. Reserch Highlight Template (powerpoint) Publications Database The MSD publications database has been updated to include all FY2014

Toward unification of taxonomy databases in a distributed computer environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kitakami, Hajime; Tateno, Yoshio; Gojobori, Takashi

1994-12-31

All the taxonomy databases constructed with the DNA databases of the international DNA data banks are powerful electronic dictionaries which aid in biological research by computer. The taxonomy databases are, however not consistently unified with a relational format. If we can achieve consistent unification of the taxonomy databases, it will be useful in comparing many research results, and investigating future research directions from existent research results. In particular, it will be useful in comparing relationships between phylogenetic trees inferred from molecular data and those constructed from morphological data. The goal of the present study is to unify the existent taxonomymore » databases and eliminate inconsistencies (errors) that are present in them. Inconsistencies occur particularly in the restructuring of the existent taxonomy databases, since classification rules for constructing the taxonomy have rapidly changed with biological advancements. A repair system is needed to remove inconsistencies in each data bank and mismatches among data banks. This paper describes a new methodology for removing both inconsistencies and mismatches from the databases on a distributed computer environment. The methodology is implemented in a relational database management system, SYBASE.« less

The development of digital library system for drug research information.

PubMed

Kim, H J; Kim, S R; Yoo, D S; Lee, S H; Suh, O K; Cho, J H; Shin, H T; Yoon, J P

1998-01-01

The sophistication of computer technology and information transmission on internet has made various cyber information repository available to information consumers. In the era of information super-highway, the digital library which can be accessed from remote sites at any time is considered the prototype of information repository. Using object-oriented DBMS, the very first model of digital library for pharmaceutical researchers and related professionals in Korea has been developed. The published research papers and researchers' personal information was included in the database. For database with research papers, 13 domestic journals were abstracted and scanned for full-text image files which can be viewed by Internet web browsers. The database with researchers' personal information was also developed and interlinked to the database with research papers. These database will be continuously updated and will be combined with world-wide information as the unique digital library in the field of pharmacy.

Full-Text Databases in Medicine.

ERIC Educational Resources Information Center

Sievert, MaryEllen C.; And Others

1995-01-01

Describes types of full-text databases in medicine; discusses features for searching full-text journal databases available through online vendors; reviews research on full-text databases in medicine; and describes the MEDLINE/Full-Text Research Project at the University of Missouri (Columbia) which investigated precision, recall, and relevancy.…

Design and deployment of a large brain-image database for clinical and nonclinical research

NASA Astrophysics Data System (ADS)

Yang, Guo Liang; Lim, Choie Cheio Tchoyoson; Banukumar, Narayanaswami; Aziz, Aamer; Hui, Francis; Nowinski, Wieslaw L.

2004-04-01

An efficient database is an essential component of organizing diverse information on image metadata and patient information for research in medical imaging. This paper describes the design, development and deployment of a large database system serving as a brain image repository that can be used across different platforms in various medical researches. It forms the infrastructure that links hospitals and institutions together and shares data among them. The database contains patient-, pathology-, image-, research- and management-specific data. The functionalities of the database system include image uploading, storage, indexing, downloading and sharing as well as database querying and management with security and data anonymization concerns well taken care of. The structure of database is multi-tier client-server architecture with Relational Database Management System, Security Layer, Application Layer and User Interface. Image source adapter has been developed to handle most of the popular image formats. The database has a user interface based on web browsers and is easy to handle. We have used Java programming language for its platform independency and vast function libraries. The brain image database can sort data according to clinically relevant information. This can be effectively used in research from the clinicians" points of view. The database is suitable for validation of algorithms on large population of cases. Medical images for processing could be identified and organized based on information in image metadata. Clinical research in various pathologies can thus be performed with greater efficiency and large image repositories can be managed more effectively. The prototype of the system has been installed in a few hospitals and is working to the satisfaction of the clinicians.

Research information needs on terrestrial vertebrate species of the interior Columbia basin and northern portions of the Klamath and Great Basins: a research, development, and application database.

Treesearch

Bruce G. Marcot

1997-01-01

Research information needs on selected invertebrates and all vertebrates of the interior Columbia River basin and adjacent areas in the United States were collected into a research, development, and application database as part of the Interior Columbia Basin Ecosystem Management Project. The database includes 482 potential research study topics on 232 individual...

77 FR 66622 - Submission for OMB Review; Comment Request: National Database for Autism Research (NDAR) Data...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-06

... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Submission for OMB Review; Comment Request: National Database for Autism Research (NDAR) Data Access Request SUMMARY: Under the... currently valid OMB control number. Proposed Collection: Title: National Database for Autism Research (NDAR...

Correlates of Access to Business Research Databases

ERIC Educational Resources Information Center

Gottfried, John C.

2010-01-01

This study examines potential correlates of business research database access through academic libraries serving top business programs in the United States. Results indicate that greater access to research databases is related to enrollment in graduate business programs, but not to overall enrollment or status as a public or private institution.…

Ophthalmology and vision science research: part 5: surfing or sieving--using literature databases wisely.

PubMed

Sherwin, Trevor; Gilhotra, Amardeep K

2006-02-01

Literature databases are an ever-expanding resource available to the field of medical sciences. Understanding how to use such databases efficiently is critical for those involved in research. However, for the uninitiated, getting started is a major hurdle to overcome and for the occasional user, the finer points of database searching remain an unacquired skill. In the fifth and final article in this series aimed at those embarking on ophthalmology and vision science research, we look at how the beginning researcher can start to use literature databases and, by using a stepwise approach, how they can optimize their use. This instructional paper gives a hypothetical example of a researcher writing a review article and how he or she acquires the necessary scientific literature for the article. A prototype search of the Medline database is used to illustrate how even a novice might swiftly acquire the skills required for a medium-level search. It provides examples and key tips that can increase the proficiency of the occasional user. Pitfalls of database searching are discussed, as are the limitations of which the user should be aware.

The Cystic Fibrosis Database: Content and Research Opportunities.

ERIC Educational Resources Information Center

Shaw, William M., Jr.; And Others

1991-01-01

Describes the files contained in the Cystic Fibrosis (CF) database and discusses educational and research opportunities using this database. Topics discussed include queries, evaluating the relevance of items retrieved, and use of the database in an online searching course in the School of Information and Library Science at the University of North…

How I do it: a practical database management system to assist clinical research teams with data collection, organization, and reporting.

PubMed

Lee, Howard; Chapiro, Julius; Schernthaner, Rüdiger; Duran, Rafael; Wang, Zhijun; Gorodetski, Boris; Geschwind, Jean-François; Lin, MingDe

2015-04-01

The objective of this study was to demonstrate that an intra-arterial liver therapy clinical research database system is a more workflow efficient and robust tool for clinical research than a spreadsheet storage system. The database system could be used to generate clinical research study populations easily with custom search and retrieval criteria. A questionnaire was designed and distributed to 21 board-certified radiologists to assess current data storage problems and clinician reception to a database management system. Based on the questionnaire findings, a customized database and user interface system were created to perform automatic calculations of clinical scores including staging systems such as the Child-Pugh and Barcelona Clinic Liver Cancer, and facilitates data input and output. Questionnaire participants were favorable to a database system. The interface retrieved study-relevant data accurately and effectively. The database effectively produced easy-to-read study-specific patient populations with custom-defined inclusion/exclusion criteria. The database management system is workflow efficient and robust in retrieving, storing, and analyzing data. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

Time-dependent Optical Spectroscopy of GRB 010222: Clues to the Gamma-Ray Burst Environment

NASA Astrophysics Data System (ADS)

Mirabal, N.; Halpern, J. P.; Kulkarni, S. R.; Castro, S.; Bloom, J. S.; Djorgovski, S. G.; Galama, T. J.; Harrison, F. A.; Frail, D. A.; Price, P. A.; Reichart, D. E.; Ebeling, H.; Bunker, A.; Dawson, S.; Dey, A.; Spinrad, H.; Stern, D.

2002-10-01

We present sequential optical spectra of the afterglow of GRB 010222 obtained 1 day apart using the Low-Resolution Imaging Spectrometer (LRIS) and the Echellette Spectrograph and Imager (ESI) on the Keck Telescopes. Three low-ionization absorption systems are spectroscopically identified at z1=1.47688, z2=1.15628, and z3=0.92747. The higher resolution ESI spectrum reveals two distinct components in the highest redshift system at z1a=1.47590 and z1b=1.47688. We interpret the z1b=1.47688 system as an absorption feature of the disk of the host galaxy of GRB 010222. The best-fitted power-law optical continuum and [Zn/Cr] ratio imply low dust content or a local gray dust component near the burst site. In addition, we do not detect strong signatures of vibrationally excited states of H2. If the gamma-ray burst took place in a superbubble or young stellar cluster, there are no outstanding signatures of an ionized absorber either. Analysis of the spectral time dependence at low resolution shows no significant evidence for absorption-line variability. This lack of variability is confronted with time-dependent photoionization simulations designed to apply the observed flux from GRB 010222 to a variety of assumed atomic gas densities and cloud radii. The absence of time dependence in the absorption lines implies that high-density environments are disfavored. In particular, if the GRB environment was dust free, its density was unlikely to exceed nHI=102 cm-3. If depletion of metals onto dust is similar to Galactic values or less than solar abundances are present, then nHI>=2×104 cm-3 is probably ruled out in the immediate vicinity of the burst. Based on data obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California, and NASA and was made possible with the generous financial support of the W. M. Keck Foundation.

Impact of the healthcare payment system on patient access to oral anticancer drugs: an illustration from the French and United States contexts.

PubMed

Benjamin, Laure; Buthion, Valérie; Vidal-Trécan, Gwenaëlle; Briot, Pascal

2014-06-20

Oral anticancer drugs (OADs) allow treating a growing range of cancers. Despite their convenience, their acceptance by healthcare professionals and patients may be affected by medical, economical and organizational factors. The way the healthcare payment system (HPS) reimburses OADs or finances hospital activities may impact patients' access to such drugs. We discuss how the HPS in France and USA may generate disincentives to the use of OADs in certain circumstances. French public and private hospitals are financed by National Health Insurance (NHI) according to the nature and volume of medical services provided annually. Patients receiving intravenous anticancer drugs (IADs) in a hospital setting generate services, while those receiving OADs shift a part of service provision from the hospital to the community. In 2013, two million outpatient IADs sessions were performed, representing a cost of €815 million to the NHI, but positive contribution margin of €86 million to hospitals. Substitution of IADs by OADs mechanically induces a shortfall in hospital income related to hospitalizations. Such economic constraints may partially contribute to making physicians reluctant to prescribe OADs. In the US healthcare system, coverage for OADs is less favorable than coverage for injectable anticancer drugs. In 2006, a Cancer Drug Coverage Parity Act was adopted by several states in order to provide patients with better coverage for OADs. Nonetheless, the complexity of reimbursement systems and multiple reimbursement channels from private insurance represent real economic barriers which may prevent patients with low income being treated with OADs. From an organizational perspective, in both countries the use of OADs generates additional activities related to physician consultations, therapeutic education and healthcare coordination between hospitals and community settings, which are not considered in the funding of hospitals activities so far. Funding of healthcare services is a critical factor influencing in part the choice of cancer treatments and this is expected to become increasingly important as economic constraints grow. Drug reimbursement systems and hospital financing changes, coupled with other accompanying measures, should contribute to improve equal and safe patient access to appropriate anticancer drugs and improve the management and care pathway of cancer patients.

Bacillus thaonhiensis sp. nov., a new species, was isolated from the forest soil of Kyonggi University by using a modified culture method.

PubMed

Van Pham, H T; Kim, Jaisoo

2014-01-01

Using a new culture method for unculturable soil bacteria, we discovered a novel species, NHI-38(T), from the forest soil of Kyonggi University campus, South Korea. It was a Gram-positive, rod-shaped, and endospore-forming bacterial strain. It grew over a wide pH range (6.5-9.5), with an optimum range of pH 7-9, and in a wide range of temperatures (15-60 °C), with an optimum range of 35-45 °C. Growth was possible at 0-2 % NaCl concentration, and the optimal range was between 0.5 and 1.5 % NaCl. Phylogenetic analysis based on 16S rRNA gene sequences showed that this new species clustered within the genus Bacillus; it was closely related to "Bacillus abyssalis" SCSIO 15042(T) (98.86 %), B. methanolicus NCIMB 13113(T) (95.97 %), B. vietnamensis 15-1(T) (95.8 %), B. seohaeanensis BH724(T) (95.5 %), B. timonensis MM10403188(T) (95.33 %), and B. subtilis subsp. subtilis NCIB 3610(T) (94.87 %). The main fatty acid components of this bacterium were iso-C15:0 (35.92 %), summed feature 3 (C16:1ω7c/C16:1ω6c; 16.92 %), and anteiso-C15:0 (14.19 %). The predominant quinone in this bacterial strain was MK-7. The polar lipid profile primarily comprised phosphatidylethanolamine, phosphatidylglycerol, and diphosphatidylglycerol. The genomic DNA G+C composition of the isolate was 40.7 mol%. The DNA-DNA hybridization results indicated that this strain was distinct from other Bacillus species, the degree of similarity being 50 % with "B. abyssalis", 56 % with B. methanolicus, 47 % with B. vietnamensis, 43 % with B. seohaeanensis, 46 % with B. timonensis, and 32 % with B. subtilis. Based on our results, we regard strain NHI-38(T) as a novel member of the Bacillus genus, and we propose the name Bacillus thaonhiensis (=KACC 17216(T) = KEMB 9005-019(T) = JCM 18863(T)).

Multiple soil nutrient competition between plants, microbes, and mineral surfaces: model development, parameterization, and example applications in several tropical forests

NASA Astrophysics Data System (ADS)

Zhu, Q.; Riley, W. J.; Tang, J.; Koven, C. D.

2016-01-01

Soil is a complex system where biotic (e.g., plant roots, micro-organisms) and abiotic (e.g., mineral surfaces) consumers compete for resources necessary for life (e.g., nitrogen, phosphorus). This competition is ecologically significant, since it regulates the dynamics of soil nutrients and controls aboveground plant productivity. Here we develop, calibrate and test a nutrient competition model that accounts for multiple soil nutrients interacting with multiple biotic and abiotic consumers. As applied here for tropical forests, the Nutrient COMpetition model (N-COM) includes three primary soil nutrients (NH4+, NO3- and POx; representing the sum of PO43-, HPO42- and H2PO4-) and five potential competitors (plant roots, decomposing microbes, nitrifiers, denitrifiers and mineral surfaces). The competition is formulated with a quasi-steady-state chemical equilibrium approximation to account for substrate (multiple substrates share one consumer) and consumer (multiple consumers compete for one substrate) effects. N-COM successfully reproduced observed soil heterotrophic respiration, N2O emissions, free phosphorus, sorbed phosphorus and NH4+ pools at a tropical forest site (Tapajos). The overall model uncertainty was moderately well constrained. Our sensitivity analysis revealed that soil nutrient competition was primarily regulated by consumer-substrate affinity rather than environmental factors such as soil temperature or soil moisture. Our results also imply that under strong nutrient limitation, relative competitiveness depends strongly on the competitor functional traits (affinity and nutrient carrier enzyme abundance). We then applied the N-COM model to analyze field nitrogen and phosphorus perturbation experiments in two tropical forest sites (in Hawaii and Puerto Rico) not used in model development or calibration. Under soil inorganic nitrogen and phosphorus elevated conditions, the model accurately replicated the experimentally observed competition among nutrient consumers. Although we used as many observations as we could obtain, more nutrient addition experiments in tropical systems would greatly benefit model testing and calibration. In summary, the N-COM model provides an ecologically consistent representation of nutrient competition appropriate for land BGC models integrated in Earth System Models.