Christy Pu
National Yang-Ming University
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Featured researches published by Christy Pu.
PLOS ONE | 2013
Yu-Chun Chen; Shih-Chieh Chang; Christy Pu; Gau-Jun Tang
Objectives We investigated the effect of a nationwide educational program following surviving sepsis campaign (SSC) guidelines. Physicians’ clinical practice in sepsis care and patient mortality rate for severe sepsis were analyzed using a nationally representative cohort. Methods Hospitalizations for severe sepsis with organ failure from 1997 to 2008 were extracted from Taiwan’s National Health Insurance Research Database (NHIRD), and trends in sepsis incidence and mortality rates were analyzed. A before-and-after study design was used to evaluate changes in the utilization rates of SSC items and changes in severe sepsis mortality rates occurred after a national education program conducted by the Joint Taiwan Critical Care Medicine Committee since 2004. A total of 39,706 hospitalizations were analyzed, which consisted of a pre-intervention cohort of 14,848 individuals (2000-2003) and a post-intervention cohort of 24,858 individuals (2005-2008). Results The incidence rate of severe sepsis increased from 1.88 per 1,000 individuals in 1997 to 5.07 per 1,000 individuals in 2008. The cumulative mortality rate decreased slightly from 48.2% for the pre-intervention cohort to 45.9% for the post-intervention cohort. The utilization rates of almost all SSC items changed significantly between the pre-intervention and post-intervention cohorts. These changes of utilization rates were found to be associated with mild reduction in mortality rate. Conclusion The nationwide education program through a national professional society has a significant impact on physicians’ clinical practice and resulted in a slight but significant reduction of severe sepsis mortality rate.
Journal of Epidemiology | 2011
Christy Pu; Gao-Jun Tang; Nicole Huang; Yiing-Jenq Chou
Background Previous research has investigated differences in the predictive power of self-rated health (SRH) for mortality based on socioeconomic status (SES). However, these studies mainly assessed adults in the general population and did not focus specifically on elderly adults. In addition, this predictive power has never been evaluated using subjective SES, which is an important measure of SES in elderly adults. Methods This study used data from the Survey of the Health and Living Status of the Middle Aged and the Elderly in Taiwan (SHLS) conducted by the Bureau of Health Promotion, Taiwan. The SHLS is a 15-year longitudinal survey based on a nationally representative sample. It was initiated in 1989 with 4049 respondents aged 60 years or older. Both education and subjective financial satisfaction were used as SES measures in the present study. A Cox regression model was used to estimate the interaction between SRH and SES for 3829 individuals without missing data. Results As compared with those who reported their health as good, those who reported their health as poor and their education as high had a higher hazard ratio (hazard ratio = 1.97, 95% confidence interval = 1.35–2.88) for 6–15-year mortality, after adjusting for depressive symptoms, activities of daily living, and instrumental activities of daily living. This HR was significantly higher than those for adults with middle (1.16, 0.93–1.44) and low (1.27, 1.05–1.54) education, based on the χ2 test (P < 0.05 for both comparisons). A similar pattern was observed when financial satisfaction was used as the SES measure. However, the pattern was attenuated when using 5-year mortality from baseline. Conclusions The use of SRH as a single health measure in elderly adults may yield inconsistent results across different SES groups, especially when used as a predictor of a longer-term mortality. This is true regardless of whether objective or subjective measures of SES are used, where both are important measures of SES in elderly adults.
BMC Public Health | 2011
Christy Pu; Nicole Huang; Gao-Jun Tang; Yiing-Jenq Chou
BackgroundSeveral studies have demonstrated that perceived financial status has a significant impact on health status among the elderly. However, little is known about whether such a subjective perception interacts with objective socioeconomic status (SES) measures such as education that affect the individuals health.MethodsThis research used data from the Survey of Health and Living Status of the Middle Age and Elderly in Taiwan (SHLS) conducted by the Bureau of Health Promotion, Department of Health in Taiwan. Waves 1996, 1999 and 2003 were used. The sample consisted of 2,387 elderly persons. The interactive effects of self-rated satisfaction with financial position and educational attainment were estimated. Self-rated health (SRH), depressive symptom (measured by CES-D) and mortality were used to measure health outcomes.ResultsSignificant interaction effect was found for depressive symptoms. Among those who were dissatisfied with their financial position, those who were illiterate had an odds ratio (OR) of 8.3 (95% CI 4.9 to 14.0) for having depressive symptoms compared with those who were very satisfied with their financial position. The corresponding OR for those with college or above was only 2.7 (95% CI 1.0 to 7.3). No significant interaction effect was found for SRH and mortality.ConclusionsAlthough poor financial satisfaction was found to be related to poorer health, the strongest association for this effect was observed among those with low educational attainment, and this is especially true for depressive symptoms. Subjective financial status among the elderly should be explored in conjunction with traditional measures of SES.
Acta Tropica | 2014
Amadou Zoungrana; Yiing-Jenq Chou; Christy Pu
Burkina Faso has a high incidence and death rate of severe malaria, especially for children under 5 years of age. Although the malaria elimination program is a high-priority public health project, finding an effective strategy for managing the problem is a major challenge. Understanding the various factors that contribute to the severity of malaria is essential in designing an effective strategy. In this study, parental and environmental factors associated with severe malaria in Burkinabè children were investigated in two hospitals in Koudougou Health District, Burkina Faso. Between July and September 2012, a cross-sectional study was used to test 510 children under 5 years of age (mean age: 23.5 months) admitted with suspected malaria. Each child was screened using a blood smear to identify whether he or she had severe malaria based on the criteria established by the World Health Organization (WHO). When a child was diagnosed with malaria, either severe or not severe, the parents were interviewed by a trained interviewer using a structured questionnaire. A logistic regression was used to identify the determinants of severe malaria and associated deaths. Of the 510 children having malaria, 201 (39.4%) had severe malaria. Most of the patients (54.9%) lived in rural areas. The main factors associated with severe malaria were low education level of the father, low socioeconomic status [odds ratio (OR)=4.11, 95% confidence interval (CI)=1.44-11.75], delayed treatment [OR=4.53, 95% CI=1.76-11.65], treating children at home as a typical practice when the child has a fever [OR=3.24, 95% CI=1.40-7.51], living in rural area [OR=6.66, 95% CI=3.36-13.22], and living beside a water gathering pond (OR=1.67, 95% CI=1.02-2.74]. Parental and environmental context associated with severe malaria for children under 5 years of age remains a serious public health problem that affects malaria outcomes in resource-limited areas. Promotion of early care is urgently required. Parents should be given information on the risks of not consulting a health facility when children exhibit symptoms of malaria.
Disability and Health Journal | 2016
Enkhzaya Chuluunbaatar; Yiing-Jenq Chou; Christy Pu
BACKGROUND Health care improvements have led to increased survival among stroke patients; however, the disability level remains high. These patients require assistance from caregivers, particularly in the first year after stroke. Longitudinal studies of quality of life (QoL) and the factors associated with QoL for both patients and caregivers are limited. OBJECTIVES To describe the changes in QoL and determine the factors associated with QoL for both stroke patients and their informal caregivers in the first year after stroke. METHODS This multicenter prospective study was conducted in public hospitals in Mongolia. In this study, 155 first-time stroke patients and their 88 informal caregivers were followed up for 1 year. The WHOQOL-BREF questionnaire was used to assess QoL. The Barthel Index was administered to the patients at the baseline and after 1 year. A generalized estimating equation analysis was used to determine the factors associated with QoL. RESULTS The QoL of stroke patients in the domains of physical and environmental aspects improved significantly (p < 0.05) after 1 year; however, social relationship and psychological health declined, but the decline was not significant. Among caregivers, psychological health and social relationship domains improved significantly. Factors associated with low QoL among stroke patients were advancing age, male patients, being single and less improvements on BI score, and among caregivers were poor physical health and financial difficulties. CONCLUSIONS Efficient rehabilitation therapy for poststroke patients can improve their QoL. Disability training and financial support for caregivers of poststroke patients might be helpful; however, further research is required.
BMC Health Services Research | 2015
Rosmond Adams; Yiing-Jenq Chou; Christy Pu
BackgroundNumerous 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.MethodsFour 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.ResultsIn 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
International Journal of Geriatric Psychiatry | 2013
Christy Pu; Ya-Mei Bai; Yiing-Jenq Chou
50). When the bid was reduced to EC
Medicine | 2016
Yuh-Hsiang Yeh; Yiing-Jenq Chou; Nicole Huang; Christy Pu; Pesus Chou
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
Burns | 2017
Tsung-Hsi Wang; Wei-Siang Jhao; Yu-Hua Yeh; Christy Pu
77.83 (US
Head and Neck-journal for The Sciences and Specialties of The Head and Neck | 2017
Chia-Fan Chang; Yen-Ling Kuo; Christy Pu; Yiing-Jenq Chou
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.ConclusionsA 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.