Epidemiologic study of the prevalence and severity of myopia among schoolchildren in Taiwan in 2000.

BACKGROUND AND PURPOSE: A nationwide survey was performed in 2000 to determine the prevalence and severity of myopia among schoolchildren in Taiwan and to compare these findings with the results of the last survey performed in 1995. METHODS: We first divided the whole island into regions according to developmental grade scores and then sampled with the probability proportional to the size of the population within each stratum. A total of 10,889 students were enrolled, including 5,664 boys and 5,225 girls, with ages ranging from 7 to 18 years. The refractive status and corneal radius of each student were measured with an autorefractometer under cycloplegia and checked with retinoscopy. Axial length was measured using biometric ultrasound. RESULTS: The myopia rate increased from 20% at 7 years, to 61% at 12 years, and 81% at 15 years. A myopic rate of 84% was found for schoolchildren aged 16 years through 18 years. The mean refractive index reached myopic status at the age of 8, and increased to -4.12 D in girls and -3.15 D in boys at the age of 18 years. The prevalence of high myopia (> -6.0 D) at the age of 18 years was 24% in girls and 18% in boys. The increase in axial length corresponded with the progression of myopia. The anterior chamber depth was slightly deeper from 7 years to 13 years and then remained stable. The lens thickness decreased from 7 years to 11 years. After age 15, further thickening of the lens was correlated with both age and severity of myopia. However, the corneal curvature was not related to age or severity of myopia. Girls had a higher prevalence and more severe degree of myopia than boys. Children in urban areas had a higher prevalence and more severe degree of myopia than children in rural areas. CONCLUSION: The prevalence and severity of myopia in schoolchildren in Taiwan in 2000 increased compared to 1995, with the most severe increases occurring in younger age groups. Thus, preventing schoolchildren developing myopia at a young age may slow down the increase in severity of myopia in Taiwan.     

Assessing the change of anisometropia in unilateral myopic children receiving monocular orthokeratology treatment

BackgroundThis study aimed at comparing the inter-eye axial elongation difference in order to evaluate the change of anisometropia in unilateral myopic children wearing monocular orthokeratology (Ortho-K) lens.MethodsIn this retrospective cohort study, we recruited monocular myopic subjects treated with monocular Ortho-K lens from May 2012 to January 2017. The axial length (AL) of both eyes was recorded, and we calculated the AL difference as our primary outcome, to evaluate myopia progression. High anisometropia was defined as anisometropia more than 2.50D. The generalized estimating equations (GEE) model was used to assess the related risk factors.ResultsA total number of 31 unilateral myopic patients were identified. The initial wearing age of the subjects was 12.32+/−3.07 years. In myopic eyes, the initial spherical equivalent was −2.73+/−0.95 diopter (D). The mean follow-up duration was 2.01+/−1.48 years. A significant reduction in the AL difference was found, from 0.83+/−0.45 millimeters at the baseline to 0.59+/−0.49 millimeters at 24 months (P = 0.039). Besides, after wearing Ortho-K lens for a long term, high anisometropic wearers showed more AL difference reduction than low anisometropic wearers in unilateral myopic children (P=0.002).ConclusionThis study demonstrated that the myopic eyes in unilateral myopic children had less AL growth than the companion emmetropic eyes when treated with monocular Ortho-K lenses. Wearing Ortho-K lens for a long time would present a more significant AL difference reduction in high anisometropic children.     

Ophthalmologic abnormalities in high school students with mental retardation in Taiwan.

BACKGROUND AND PURPOSE: Visual and ocular disorders are common in mental retardation (MR), and can influence sensory-motor development and learning. This study investigated visual and ocular abnormalities in a population of high school students with MR. METHODS: All students with MR in their first year at a special education high school who underwent ophthalmic examinations in December 2001 were included. Data were collected by retrospective review of hospital records and student health records. RESULTS: A total of 68 students with MR, including 45 males and 23 females, completed ophthalmologic examinations. Abnormal ophthalmologic findings in these 68 students (15-23 years old) included astigmatism (74.4%), myopia (53.7%), amblyopia (29.3%), exodeviation (23.5%), anisometropia (22.0%), blepharoconjunctivitis (20.6%), hyperopia (18.2%), cataract (13.2%) and suspected glaucoma (11.8%). Amblyopia was mainly attributed by refractive errors and strabismus. Myopia was less prevalent than in the general population of the same age in Taiwan, but astigmatism and anisometropia were more prevalent. More than one-third of the exodeviations were large-angle exotropia. The presence and type of cataract were highly associated with Down's syndrome. CONCLUSION: The prevalence of visual and ocular disorders in teenage and young-adult students with MR is high. Because these disorders can be detrimental to learning, early and regular ophthalmic examinations of children with MR are mandatory, with particular attention to screening for refractive error, amblyopia, strabismus and cataract and treatment of these conditions when identified.     

Long-term refractive status of preterm infants from singleton and multiple pregnancies*

Objective: To study the effect of plurality on refractive status in former preterm infants at age 8–12 years.

Methods: Refraction was compared in singletons and multiples, in very low birth weight infants (VLBW, <1500?g) at age 6 months and 8–12 years. Preterm infants were compared with a group of term infants.

Results: Thirty-seven of 104 (36%) VLBW infants were multiples. Comparison of refraction between singletons and multiples revealed no difference at age 6 months, while at age 8–12 years, multiples had significantly more refractive errors (singletons 28% versus multiples 54% p?=?0.01), particularly myopia. In preterms, refractive status at age 6 months and multiple birth were significant predictors of refraction at 8–12 years, while birth weight (BW) and retinopathy of prematurity (ROP) were not predictive. Refractive errors were significantly more common in preterms (37%) than in term-born children (14%) (p?=?0.0002). Overall, refraction moved from predominantly hyperopic at 6 months to normal or myopic at age 8–12 years in preterm.

Conclusions: Multiple gestation in preterms is associated with increased risk for refractive errors, particularly myopia in childhood. Refraction in preterms during childhood progresses from hyperopia to myopia. Former preterms have more refractive errors than children born at term-born children.     

Evaluation of optic disc changes in severe myopia.

PURPOSE: To evaluate the changes in the optic nerve head in highly myopic subjects by means of confocal laser scanning opthalmoscope. METHODS: Using laser scanning and a three-dimensional image analysis system, we studied 114 young (21.4 +/- 1.4 years), highly myopic subjects with refractive errors greater than -8.0 D and a control group of 29 subjects (18.9 +/- 1.2 years) with myopia of -3.0 D or less. Measurements included cycloplegic refraction, corneal curvature, biometric axial length, and morphometric values of the optic disc obtained with a laser scanning disc analyzer. RESULTS: The optic disc area in highly myopic eyes was similar to that in mildly myopic eyes. However, regression analysis revealed that the optic disc area increased with axial length in subjects with severe myopia. The cup/disc ratio, the disc depth, the neuroretinal rim area, and the tilting of the disc were not significantly different between the severe and mild myopia groups. CONCLUSIONS: These findings may be useful in further investigations of myopic progression and of the mechanisms responsible for the development of myopic complications.     

The quality of antenatal care in Turkey and the role of ultrasonography in the antenatal care system

OBJECTIVE: The aim of this study was to determine the quality of antenatal care and the role of routine obstetric ultrasonography (US) in Turkey's antenatal care program. MATERIALS AND METHOD: Two surveys consisting of 11 questions were conducted on 295 patients without pregnancy associated risk in 1995 and on 208 patients in 2000, during the first 24 h after delivery. The results of the two surveys were compared. A P value of <0.05 was used to denote statistical significance. RESULTS: When the results of the two surveys were compared, we found that in 2000, patients had started their antenatal visits earlier in pregnancy than those in 1995 and basic laboratory tests, such as complete blood count, urinalysis, and diabetes screening had been performed on an increased number of patients receiving antenatal care outside our clinic. Ultrasonographic examination was performed on all of the patients during their antenatal visits in 2000, while only 76.6% of the cases were examined by US in 1995. The number of ultrasound examinations per antenatal visit had significantly increased (0.47 in 1995 versus 0.6 in 2000, [Odds ratio: 1.277, 95% confidence interval: 1.12-1.44]). Data from 2000 has shown that 8.7% (5/57) of the patients who received antenatal care outside our clinic (Group 1) had been examined using US at least 10 times. However, 17.5% of these patients had not undergone a complete blood count (CBC) or urinalysis and blood pressure had not been measured at all in 5.2% of cases. CONCLUSION: Despite some differences, we believe that the situation in Turkey is similar to that in the rest of the world. The expectations women have of ultrasound examination are much higher than can be realised in reality. In Turkey, it appears that many physicians, especially those based in large cities, rely on highly technical procedures like ultrasonography and neglect the basics of antenatal care (blood pressure measurements, complete blood counts, urinalysis, diabetes screening etc.).     

Racial disparity in meconium-stained amniotic fluid and meconium aspiration syndrome in the United States, 1989-2000

OBJECTIVE: To estimate the prevalence of meconium-stained amniotic fluid and meconium aspiration syndrome, as well as the differences in case fatality from meconium aspiration syndrome, between non-Hispanic black and non-Hispanic white infants. METHODS: We studied non-Hispanic black and non-Hispanic white live births with weights greater than 2.5 kg and gestational ages greater than 35 weeks, using the linked US birth and infant death cohorts for three periods: 1989-1991, 1995-1997, and 1998-2000. We used logistic regression to estimate the risks of meconium-stained amniotic fluid and meconium aspiration syndrome and to estimate the case fatality of meconium aspiration syndrome by maternal race, birth weight, period, and pregnancy complications. RESULTS: Risk of meconium-stained amniotic fluid was 80% higher in non-Hispanic blacks when compared with non-Hispanic whites (birth weight-adjusted odds ratio [OR], 1.81, 95% confidence interval [CI] 1.80, 1.82). The prevalence of pregnancy complications did not explain this racial disparity. Risk of meconium aspiration syndrome in non-Hispanic blacks was 67% higher when compared with non-Hispanic whites (birth weight-adjusted OR 1.67, 95% CI 1.64, 1.70). The case fatality rate of meconium aspiration syndrome was similar between non-Hispanic blacks and non-Hispanic whites in the three periods, with rates of 15.5, 15.2, and 11.2 per 1000 in non-Hispanic blacks and 13.5, 11.2, and 10.1 per 1000 in non-Hispanic whites in 1989-1991, 1995-1997, and 1998-2000, respectively. CONCLUSION: Our results suggest that when compared with non-Hispanic whites, non-Hispanic blacks are at significantly greater risk for meconium-stained amniotic fluid and meconium aspiration syndrome but not for meconium aspiration syndrome case fatality.     

Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys.

BACKGROUND/PURPOSE: To estimate the age-specific prevalence rates of phimosis and circumcision in an urban sample of Taiwanese boys. METHODS: A convenience sample of 1145 boys aged from 7 to 13 years was enrolled and cross-sectionally evaluated for preputial retractability and status of circumcision. Another convenience sample of 59 newborn male infants was enrolled from the infant room of a city municipal hospital. These infants were examined for preputial development at birth. RESULTS: None of the newborn male infants had a completely retractable prepuce (i.e. type 3). The prevalence rate of type 3 prepuce increased with age from 71.7% (95% confidence interval [CI], 66.5-75.5%) for boys aged 7 years to 72.4% (95% CI, 67.3-77.0%) for boys aged 10 years and 84.1% (95% CI, 79.6-88.0%) for boys aged 13 years. In contrast, the prevalence rate of type 1 prepuce decreased with age from 83.1% (95% CI, 71.0-91.6%) for newborn infants to 0.3% (95% CI, 0.0001-1.8%) for boys aged 13 years. On the other hand, the prevalence of circumcision slightly increased with age from 7.2% (95% CI, 5.3-10.8%) for boys aged 7 years to 8.7% (95% CI, 6.5-13.3%) for boys aged 13 years. CONCLUSION: Nonretractability of the prepuce was very common among the Taiwanese newborns. Among the school boys, the degree of preputial separation and exposure of glans increased with age and progressed even more rapidly in adolescence. Very few boys still suffered from unretractable prepuce by the age of 13.     

Lack of evidence for fecal-oral transmission of Helicobacter pylori infection in Taiwanese.

BACKGROUND AND PURPOSE: Helicobacter pylori infection is primarily acquired in early childhood and its transmission routes are debated. The aims of this study were to determine the seroprevalence of anti-H. pylori immunoglobulin G (IgG) in Taiwanese and to investigate whether a common mode of transmission could be shared between H. pylori and hepatitis A virus (HAV). METHODS: An enzyme-linked immunosorbent assay (ELISA) was used to investigate the prevalence of H. pylori among 924 healthy volunteers aged less than 40 years, and radioimmunoassay for HAV infection was conducted in 500 subjects from the same population. The kappa statistic was used to measure the difference in positivity for the 2 infections in a subgroup of 500 subjects who had their sera simultaneously tested for anti-H. pylori and anti-HAV antibodies. RESULTS: The seroprevalence of anti-H. pylori IgG was 16.7% in subjects aged < 16 years and 38.3% at ages >or= 16 years. Most children (99%) under the age of 16 were seronegative for HAV. The prevalence of H. pylori infection increased rapidly with age, at 1%/year and 0.8%/year for children and adults, respectively. The rate of H. pylori infection was higher in male (21%) than in female (12%) children (p < 0.01; OR, 2.0; 95% confidence interval, 1.2 to 3.0). No significant difference in seroprevalence between genders was noted in subjects aged >or= 16 years. The agreement in the trend of seropositivity between both infections in the age groups 1 to 10 years and 10 to 20 years was worse than chance (kappa = -0.56) and little better than chance (kappa = 0.01), respectively. CONCLUSIONS: Acquisition of H. pylori infection occurs at a young age, and male children are more likely to develop the infection. The main transmission route of HAV, the fecal-oral route, did not seem to be responsible for H. pylori transmission in this Taiwanese cohort.     

A survey of dietary supplement use during pregnancy at an academic medical center

OBJECTIVE: This study examined the usage patterns of dietary supplements during pregnancy, providing information about type of supplements used, prevalence of use, and rationale for use. STUDY DESIGN: A survey was distributed to pregnant patients who were touring the University of California, San Francisco birthing center or who were receiving care at the University of California, San Francisco Women's Health Clinic between November 1999 and March 2000. RESULTS: Of the 150 surveys completed, 20 women (13%) used dietary supplements during pregnancy. The most common products were echinacea (4/45, 8.9%), pregnancy tea (4/45, 8.9%), and ginger (3/45, 6.7%). The most common reasons for beginning or discontinuing use of dietary supplements were to relieve nausea and vomiting (5/20, 25%) and to avoid potential harm to the fetus (5/20, 25%). All side effects were mild and included gastrointestinal discomfort in a patient using elderberry, taste disturbance in a patient using echinacea, and intestinal gas in a patient using borage seed oil. Most patients informed their primary care provider of their use of dietary supplements (15/20, 75%). CONCLUSION: The use of dietary supplements among pregnant women is low but is of concern because of the lack of safety data. Most patients use dietary supplements to relieve gastrointestinal symptoms and disclose such use to their primary care provider.     

Domestic violence screening of obstetric triage patients in a military population

Objective:The objective was to estimate the self-reported prevalence of domestic violence in a pregnant military population presenting for emergency care, and to determine the acceptability of domestic violence screening.Study Design:A prospective observational survey of patients presenting for obstetric emergency care. Women were anonymously screened for domestic violence using the Abuse Assessment Screen.Result:A total of 499 surveys were distributed, with 26 duplicate surveys. After excluding the 12 blank surveys, a total of 461 surveys were included in the final analysis. The lifetime prevalence of domestic violence (including physical, emotional and sexual abuse) was 22.6% (95% CI=19.0 to 26.4) with 4.1% (95% CI=2.3-6.0) of women reporting physical abuse in the past year and 2.8% (95% CI=1.3-4.3) reporting abuse since becoming pregnant. The majority of women 91.8% (95% CI=88.7-94.2) were not offended by domestic violence screening and 88.8% (95% CI=82.0-88.9) felt that patients should be routinely screened.Conclusion:The self-reported prevalence of domestic violence in a pregnant military population presenting for emergency care was 22.6%. Most women are not offended by domestic violence screening and support routine screening.     

Overactive bladder: prevalence, risk factors and relation to stress incontinence in middle-aged women

OBJECTIVE: To investigate the prevalence of and factors associated with overactive bladder in middle-aged women. DESIGN: Cross sectional population-based study. SETTING: Southern Sweden and the Women's Health in the Lund Area study (WHILA 1995-2000) where 6917 (64% of the invited) women, 50-59 years old in 1995, participated. POPULATION: From the WHILA study, 1500 women reporting troublesome urinary incontinence (INCONT-1) and 1500 without incontinence (CONT-1) were selected by computerised randomisation and received the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire in January 2001. METHODS: Overactive bladder was defined in two versions using the ICS definition of 2002 as either urgency alone (OAB-1) or urgency combined with frequency more than eight times per day and/or nocturia twice or more per night (OAB-2). Risk factors were analysed by multiple logistic regression analyses. MAIN OUTCOME MEASURES: Prevalence figures and odds ratios with corresponding 95% confidence intervals. RESULTS: The prevalence of OAB-1 was 46.9% in the INCONT-1 and 16.7% in the CONT-1 group, and that of OAB-2 was 21.6% and 8.1%, respectively. Most urgency occurred in combination with stress incontinence (i.e. as mixed incontinence). The overlap between stress and urge symptoms increased with the frequency of stress incontinence episodes (P < 0.001). Metabolic risk factors were body mass index (BMI) >/= 30 for OAB-1, OAB-2 and stress incontinence, positive metabolic screening for OAB-1, family history of diabetes for OAB-2 and elevation of BMI >/= 25% since the age of 25 for stress incontinence. Stress incontinence was associated with the current use of hormonal replacement therapy. CONCLUSIONS: Overactive bladder and stress incontinence are intimately associated with each other. Both OAB and stress incontinence are associated with abnormal metabolic factors, mainly increased BMI.     

Anemia and pregnancy outcomes: a longitudinal study

Objectives: To determine the prevalence of anemia at the first antenatal visit and at 32–34 weeks gestational age, and to evaluate perinatal and maternal outcomes.

Methods: Venous blood samples were obtained for complete blood counts at both study visits. Maternal and perinatal morbidity and mortality were also recorded. The data were analyzed using SPSS (version 23).

Results: Two thousand pregnant women were recruited. The prevalence of anemia was 42.7% (n?=?854/2000) at the first antenatal visit. Thirty-five percent had mild anemia and 68.9% had normocytic normochromic anemia. The prevalence of anemia in HIV infected women was higher than that in the noninfected group and 47.2% of the study population (n?=?2000) was HIV infected. At the 32–34 weeks visit, hemoglobin (Hb) levels were available for 1433/2000 (71.7%) of the participants. The prevalence of anemia was 28.1% (n?=?403/1433); 19.3% had mild anemia and 65.3% had normocytic normochromic anemia. There was a significant difference in Hb levels between that of the first visit and that at 32–34 weeks (42.7% vs. 28.1%; p?=?.001; 95% CI: 0.11–0.18). There were significant differences in prematurity, birth weight and hypertensive disorders of pregnancy between the anemic and nonanemic groups.

Conclusion: The prevalence of anemia decreased from 42.7% (booking) to 28.1% (32???34 weeks). Normocytic normochromic anemia was the commonest type of anemia. Attention needs to be focused on detailed investigations to establish the exact cause of anemia.     

Association of NRAMP 1 gene polymorphism with susceptibility to tuberculosis in Taiwanese aboriginals.

BACKGROUND/PURPOSE: The human homologue of mice natural-resistance-associated macrophage protein 1 (Nramp 1) gene, NRAMP 1, has been reported to play a role in susceptibility to tuberculosis in humans. The aboriginal population in Taiwan has a five-fold higher prevalence of tuberculosis than people of Han ethnicity. Whether genetic factors such as NRAMP 1 polymorphism play a role in the prevalence of tuberculosis in Taiwanese aboriginals should be clarified. METHODS: NRAMP 1 polymorphism was studied using a case-control design of patients with tuberculosis, including subjects of Han (Hans) and aboriginal ethnicity in Hualien, eastern Taiwan. The polymorphisms of NRAMP 1 at loci INT4, D543N, 77-385C/T, 3-UTR (CAAA) deletion and 5-(CA)n microsatellite markers were assessed by polymerase chain reaction on tissue DNA isolated from 105 aborigines and 110 Hans with tuberculosis. Comparable numbers of ethnically-matched controls were studied simultaneously. RESULTS: Two NRAMP 1 polymorphisms, INT4 and 5-(CA)n, were significantly associated with susceptibility to tuberculosis in aboriginals (p = 0.0070 and p = 0.0031, respectively). However, no association was detected at the five loci of NRAMP 1 polymorphisms among Hans (p > 0.08). CONCLUSION: Genetic variation in NRAMP 1 may affect susceptibility to and increase risk for tuberculosis in Taiwanese aboriginals. Although environmental factors play an important role in tuberculosis infection, genetic factors such as NRAMP 1 polymorphism may also contribute to the high prevalence of tuberculosis in Taiwanese aboriginals.     

von Willebrand disease in women with menorrhagia: a systematic review

OBJECTIVE: To determine the prevalence of von Willebrand disease in women presenting with menorrhagia. DESIGN: Systematic review of studies evaluating the prevalence of von Willebrand disease in women with menorrhagia. SETTING: Hospital outpatient clinics (mainly gynaecological) and population surveys. POPULATION: Women presenting with menorrhagia. METHODS: Relevant studies were extracted from MEDLINE search, bibliographies of identified articles and published proceedings of meetings and conferences. MAIN OUTCOME MEASURES: Number of women with von Willebrand disease. RESULTS: Eleven studies were included, totalling 988 women with menorrhagia. One hundred and thirty-one women were diagnosed to have von Willebrand disease with prevalences in individual studies ranging from 5% to 24%. The overall prevalence was 13% (95% CI 11-15.6%). The prevalence was higher in the European studies-18% (95% CI 15-23%) compared with that in North American studies-10% (95% CI 7.5-13%). This difference (P= 0.007) is likely to be the result of differences in the studies, which include method of recruitment of study population, method of assessing menstrual blood loss ethnic composition of study population, criteria for diagnosis and use of race- and ABO blood group-specific values for von Willebrand factor. CONCLUSIONS: The prevalence of von Willebrand disease is increased in women with menorrhagia and is the underlying cause in a small but significant group of women with menorrhagia across the world. Testing for this disorder should be considered when investigating women with menorrhagia, especially those of Caucasian origin, those with no obvious pelvic pathology or with additional bleeding symptoms.     

Underrecognition and undertreatment of atherothrombotic diseases: REACH Registry Taiwan baseline data.

BACKGROUND/PURPOSE: Atherothrombosis is a generalized disease affecting different vascular beds, making it the leading cause of death worldwide. To evaluate the long-term risk of atherothrombotic risk factors and determine the predictors for atherothrombotic events, an international, prospective, observational study was initiated, in which Taiwan was involved. METHODS: The REduction of Atherothrombosis for Continued Health (REACH) Registry recruited outpatients with either symptomatic atherothrombotic diseases or multiple risk factors. Baseline data were collected using a universal standard case report form. All subjects were followed to document future outcomes. In this paper, we analyzed the baseline data of the participants from Taiwan. RESULTS: In the REACH Registry, a total of 67,888 subjects from 44 countries were recruited. Among the 1062 Taiwanese participants, 971 were symptomatic subjects and 91 subjects were with risk factors only (RFO). In comparison with the global participants, the Taiwan patients were younger, with a higher prevalence of males, lower prevalence of hypertension, obesity, hypercholesterolemia, former smokers, and a greater prevalence of non-smokers. The baseline prevalence rates were: hypertension, 46.5%; fasting hyperglycemia, 38.4%; hypercholesterolemia, 45.8%; and hypertriglyceridemia, 42.8%. All these prevalence were higher than the global data, indicating an undertreatment status for the Taiwanese patients. Only 29 (2.7%) peripheral arterial disease (PAD) subjects were recruited in Taiwan, suggesting under recognition of this disease. The RFO Taiwanese patients had fewer former smokers and more non-smokers than the symptomatic patients, suggesting that smoking may be an important factor contributing to atherothrombotic diseases. CONCLUSION: In Taiwan, atherothrombotic outpatients were generally undertreated and PAD was underdiagnosed.     

Pain control in Taiwanese patients with cancer: a multicenter, patient-oriented survey.

BACKGROUND AND PURPOSE: Under-treatment of cancer pain remains a common problem in Taiwan. Prior studies were mainly in hospitalized patients and limited to one or a few centers. This prospective, multicenter, patient-focused survey assessed the prevalence, severity and management of cancer pain in oncology clinic outpatients. Analgesic use and patient satisfaction with analgesic therapy were also evaluated. METHODS: A total of 480 Taiwanese patients receiving outpatient treatment at 15 different outpatient clinics were included in this study. There were 263 males and 217 females with a mean age of 62.13 years. Patients completed a 4-question survey about the presence or absence of pain, pain severity, analgesic therapy, and satisfaction or dissatisfaction with the degree of analgesia. RESULTS: Pain was reported by 257 patients (54%). Severe pain was reported by 35% and moderate pain by 35.4% of patients. Only 149 of the patients who reported pain (58%) were receiving analgesic medication, with a roughly equivalent number of males and females. Most (95 of 149, 64%) reported being satisfied or very satisfied with pain control although this percentage was higher among males than females (68.23% vs 57.8%). Major variation in the results was noted among study centers. CONCLUSIONS: The results of this survey of Taiwanese outpatients with cancer confirm that cancer pain is under-treated in oncology clinics in Taiwan. A major goal of cancer management is to achieve high rates of patient satisfaction and compliance with treatment which maintains or improves quality of life.     

Taiwanese version of the EQ-5D: validation in a representative sample of the Taiwanese population.

BACKGROUND/PURPOSE: We know of no validated Taiwanese-language instrument to measure a utility of the patient's health. Our aim was to evaluate the reliability and validity of a Taiwanese version of the EuroQol instrument (EQ-5D) in a Taiwanese population. METHODS: Questionnaires containing the Taiwanese versions of the EQ-5D and the Short-Form 12 Health Survey (SF-12) were sent to 12,923 people in Taiwan in December 2002. Concurrent validity of the EQ-5D was analyzed by assuming that subjects with problems in any EQ-5D dimensions had decreased SF-12 scores. Discriminant validity of the EQ-5D was analyzed by assuming that subjects with the following characteristics had lowered EQ-5D indexes and scores on the EQ-5D visual analog scale (VAS): more chronic diseases than others, serious illness, more hospitalizations in the past year than others, poor general health, and more outpatient visits than others. Test-retest reliability was analyzed in a subgroup of respondents who were evaluated twice within a month by using the intraclass correlation coefficient and the kappa method. RESULTS: The general survey response rate was 12.7% (1644 of 12,923). SF-12 scores were lower in subjects reporting problems on EQ-5D dimensions than in others without such problems (p < 0.01). Subjects with more health problems than others had lower EQ-5D indexes and VAS scores (p < 0.01). The physical dimension of the EQ-5D was more strongly correlated with the SF-12 Physical Component Summary than with the Mental Component Summary; this finding satisfied the a priori hypothesis. For test-retest reliability of items on the EQ-5D, kappa values ranged from 0.49 to 1 (p < 0.001). CONCLUSION: The Taiwanese EQ-5D instrument appears to be a moderately valid and reliable tool for measuring the health status of the general population in Taiwan.     

Annual direct cost of urinary incontinence

OBJECTIVE: To estimate the annual direct cost of urinary incontinence in 1995 US dollars. METHODS: Epidemiologically based models using diagnostic and treatment algorithms from published clinical practice guidelines and current disease prevalence data were used to estimate direct costs of urinary incontinence. Prevalence and event probability estimates were obtained from literature sources, national data sets, small surveys, and expert opinion. Average national Medicare reimbursement was used to estimate costs, which were determined separately by gender, age group, and type of incontinence. Sensitivity analyses were performed on all variables. RESULTS: The annual direct cost of urinary incontinence in the United States (in 1995 dollars) was estimated as $16.3 billion, including $12.4 billion (76%) for women and $3.8 billion (24%) for men. Costs for community-dwelling women ($8.6 billion, 69% of costs for women) were greater than for institutionalized women ($3.8 billion, 31%). Costs for women over 65 years of age were more than twice the costs for those under 65 years ($7.6 and $3.6 billion, respectively). The largest cost category was routine care (70% of costs for women), followed by nursing home admissions (14%), treatment (9%), complications (6%), and diagnosis and evaluations (1%). Costs were most sensitive to changes in incontinence prevalence, routine care costs, and institutionalization rates and costs. CONCLUSION: Urinary incontinence is a very costly condition, with annual expenditures similar to other chronic diseases in women.     

Analysis of the prevalence of bacterial vaginosis and Chlamydia trachomatis infection in 6083 pregnant women at a hospital in Otaru, Japan

AIM: Our aims were to evaluate the prevalence of bacterial vaginosis (BV), Chlamydia trachomatis (C. trachomatis) infection and Mobiluncus spp. infection among pregnant women in Otaru, Hokkaido, Japan according to the month and year of the first prenatal visit, and to evaluate their risk factors. METHODS: Six thousand and eighty-three pregnant women who were seen consecutively at our hospital between 1993 and 2000, were enrolled in the study. Vaginal and endocervical swabs were subjected to Gram stain and detection of C. trachomatis. Univariate and multivariate methods were used to investigate the association between each infection and potential risk factors including age, gravidity, parity, history of dilatation and curettage (D & C), and history of natural abortion. RESULTS: The annual rate of BV increased from 13.6% in 1993 to 21.4% in 2000. The annual rate of C. trachomatis infection was relatively constant. The prevalence of bacterial vaginosis, C. trachomatis infection and Mobiluncus spp. infection over the 8-year period was 18.2%, 4.2%, and 4.1%, respectively. The prevalence of the three infections was significantly higher among teenagers and among women with a history of D & C. The prevalence of C. trachomatis and Mobiluncus spp. infections was significantly higher among women with no history of delivery. BV was not associated with parity on multivariate analysis. The monthly prevalence of BV was significantly higher in May than in December, and the monthly prevalence of C. trachomatis infection was high in August. CONCLUSION: The differences in the annual and monthly infection patterns between BV and C. trachomatis infection suggest that the etiologies of the two infections differ.