Background
Medical pluralism (MP) can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. A population-based survey and linkage with medical records was conducted to investigate MP amongst the Taiwanese population. Previous research suggests an increasing use of CAM worldwide.
Methods
We collected demographic data, socioeconomic information, and details about lifestyle and health behaviours from the 2001 Taiwan National Health Interview Survey. The medical records of interviewees were obtained from National Health Insurance claims data with informed consent. In this study, MP was defined as using both Western medicine and traditional Chinese medicine (TCM) services in 2001. The odds ratio (OR) and 95% confidence interval (CI) were estimated for factors associated with adopting MP in univariate and multiple logistic regression.
Results
Among 12,604 eligible participants, 32.5% adopted MP. Being female (OR = 1.44, 95% CI = 1.30 - 1.61) and young (OR = 1.38, 95% CI = 1.15 - 1.66) were factors associated with adopting MP in the multiple logistic regression. People with healthy lifestyles (OR = 1.35, 95% CI = 1.19 - 1.53) were more likely to adopt MP than those with unhealthy lifestyles. Compared with people who had not used folk therapy within the past month, people who used folk therapy were more likely to adopt MP. The OR of adopting MP was higher in people who lived in highly urbanised areas as compared with those living in areas with a low degree of urbanisation. Living in an area with a high density of TCM physicians (OR = 2.19, 95% CI = 1.69 - 2.84) was the strongest predictor for adopting MP.
Conclusion
MP is common in Taiwan. Sociodemographic factors, unhealthy lifestyle, use of folk therapy, and living in areas with a high density of TCM physicians are all associated with MP. People who had factors associated with the adoption of MP may be at risk for adverse health effects from interactions between TCM herbal medicine and WM pharmaceuticals.
PET utilization under Taiwan's Universal Health Insurance program.
Few studies have addressed the association between polypharmacy and hip fracture using population data. We conducted apopulation-based case-control study to investigate whether polypharmacy increases the risk for hip fracture in the elderly. We used insurance claims data from the Taiwan Bureau of National Health Insurance, a universal insurance program with a coverage rate of more than 98% of the population in Taiwan. We identified 2328 elderly patients with newly diagnosed hip fracture during the period 2005-2007. We randomly selected 9312 individuals without hip fracture to serve as the control group. Patient characteristics, drugs prescribed by physicians, and all types of hip fracture were ascertained. The odds ratio (OR) of hip fracture in association with the number of medications used per day in previous years was assessed.We found that patients were older than controls, predominantly female, and more likely to use 5 or more drugs (22.2% vs. 9.3%, p < 0.0001). The OR of hip fracture increased with the number of medications used per day and with age. Multivariate logistic regression analysis revealed that the overall OR for patients using 10 or more drugs was 8.42 (95% confidence interval [CI], 4.73-15.0) compared with patients who used 0-1 drug per day. However, age-specific analysis revealed that the risk for hip fracture was 23 times greater for patients aged > or = 85 years who used 10 or more drugs than for those aged 65-74 years who used 0-1 drug after controlling for covariates (OR, 23.0; 95% CI, 3.77-140).We conclude that the risk of hip fracture in older people increases with the number of medications used, especially in women. Age interacts with the daily medications for the risk of hip fracture.
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Prediction model for hypertension risk in Chinese is still lacking. We aimed to propose prediction models for new-onset hypertension for ethnic Chinese based on a prospective cohort design on community, which recruited 2506 individuals (50.8% women) who were not hypertensive at the baseline (1990-91). Total 1029 cases of new-onset hypertension developed during a median of 6.15 (interquartile range, 4.04-9.02) years of follow-up. In the clinical model, gender (2 points), age (8 points), body mass index (10 points), systolic blood pressure (19 points) and diastolic blood pressure (7 points) were assigned. The biochemical measures, including white blood count (3 points), fasting glucose (1 point), uric acid (3 points), additional to above clinical variables, were constructed. The areas under the receiver operative characteristic curves (AUCs) were 0.732 (95% confidence interval (CI), 0.712-0.752) for the point-based clinical model and 0.735 (95% CI, 0.715-0.755) for the point-based biochemical model. The coefficient-based models had a good performance (AUC, 0.737-0.741). The point-based clinical model had a similar net reclassification improvement as the coefficient-based clinical model (P=0.30), and had a higher improvement than the point-based biochemical model (P=0.015). We concluded that the point-based clinical model could be considered as the first step to identify high-risk populations for hypertension among Chinese.