Sudha Xirasagar

Seasonality in Adult Asthma Admissions, Air Pollutant Levels, and Climate: A Population-based Study

Objective and Background. Most studies of asthma seasonal variations have not examined associations of environmental risk factors and climatic changes associated with seasonality in asthma hospitalizations. This study used population-based data to examine seasonality in asthma admissions and the associated seasonality in levels of air pollutants and climatic factors during a 4-year period in Taiwan. Methods. A total of 126,671 asthma hospitalizations in Taiwan during 1998–2001 operationalized as monthly admissions per 100,000 population and monthly mean levels of criterion air pollutants and meteorological factors were subjected to Auto-Regressive Integrated Moving Average to test for seasonality and association between asthma admission rates and the pollutant and climatic factor levels. Owing to significant differences in seasonality between pediatric and adult age groups, this study was limited to 99,591 adult asthma cases to examine the seasonality issue as related to the criterion air pollutants and climatic factors using Spearman rank correlations. Results. Seasonal trends showed a hospitalization peak in January through March and a sharp decline beginning in April to a trough in June for both sexes. Seasonal variations in adult asthma admissions were significantly positively correlated with levels of PM10, SO2, CO, NO2, and atmospheric pressure and negatively correlated with temperature and hours of sunshine. Conclusions. Adult asthma hospitalization propensity is highest in spring and is significantly correlated with air pollution and climate. Air quality control programs and early public warning systems on pollution and atmospheric factors are needed to enable predisposed individuals and their physicians to preempt attacks through primary and secondary preventive measures.

Hospital Volume and Inpatient Mortality After Cancer-Related Gastrointestinal Resections: The Experience of an Asian Country

BackgroundUsing 4-year nationwide population-based data for Taiwan, this study compared in-hospital surgical mortality rates with hospital volume for five cancer-related gastrointestinal resections.MethodsThe study sample was drawn from the Taiwan National Health Insurance Research Database. A total of 34,715 patients, each of whom had undergone a cancer-related colectomy, gastrectomy, esophagectomy, pancreatic resection, or liver lobectomy between 2000 and 2003, were selected as the study sample. The outcome measure was in-hospital mortality. The study sample was categorized into five patient groups for each procedure, and logistic regression analyses were performed for each procedure after adjustment for hospital and patient characteristics to assess the independent association between hospital volume and in-hospital mortality.ResultsThe adjusted odds ratios showed a steady decline in mortality rates for colectomy, gastrectomy, esophagectomy, and liver lobectomy with increasing hospital volume. The adjusted mortality odds for these four procedures in very-high-volume hospitals, relative to very-low-volume hospitals, ranged from .65 to .05. As regards pancreatic resection, after adjustment for patient, clinical, and hospital factors, no statistically significant association was discernible between hospital volume and the likelihood of mortality.ConclusionsAfter adjustment for hospital and physician characteristics, in four of the five procedures, patients treated at higher-volume hospitals had lower in-hospital mortality rates than those treated at lower-volume hospitals. Our findings confirm, for the most part, the hypothesis that better outcomes are associated with higher-volume hospitals.

Physician leadership styles and effectiveness: an empirical study.

The authors study the association between physician leadership styles and leadership effectiveness. Executive directors of community health centers were surveyed (269 respondents; response rate = 40.9 percent) for their perceptions of the medical director’s leadership behaviors and effectiveness, using an adapted Multifactor Leadership Questionnaire (43 items on a 0-4 point Likert-type scale), with additional questions on demographics and the center’s clinical goals and achievements. The authors hypothesize that transformational leadership would be more positively associated with executive directors’ ratings of effectiveness, satisfaction with the leader, and subordinate extra effort, as well as the center’s clinical goal achievement, than transactional or laissez-faire leadership. Separate ordinary least squares regressions were used to model each of the effectiveness measures, and general linear model regression was used to model clinical goal achievement. Results support the hypothesis and suggest that physician leadership development using the transformational leadership model may result in improved health care quality and cost control.

Seasonality and Climatic Associations with Violent and Nonviolent Suicide: A Population-Based Study

Background: Using 7-year population-based data on Taiwan, we examined seasonal variation in violent versus nonviolent suicide, and its association with meteorological factors: ambient temperature, relative humidity, atmospheric pressure, rainfall and daily sunshine hours. Methods: We used Taiwan’s nationwide mortality data from 1997 to 2003, categorizing the sample decedents into two groups, violent (ICD-9-CM codes E953–E958) and nonviolent (E950–E952) suicide, based on the suicide method used. Seasonal autoregressive integrated moving average (SARIMA) modeling was used to detect seasonality of suicide, and the association of climate variables with violent versus nonviolent suicide. Results: The SARIMA test of seasonality was significant for both genders and the pooled sample (all p < 0.001) in violent suicide deaths, but not nonviolent suicides. Seasonal trends show a significant peak in March–May (early to late spring) for violent suicides. Increasing ambient temperature predicted increasing violent suicide rates. Conclusions: We conclude that seasonality exists in violent but not nonviolent suicide rates. Our findings suggest that suicide is a heterogeneous phenomenon and violent suicide may be more influenced by biochemical and chronobiological mechanisms.

Risk of adverse perinatal outcomes with antithyroid treatment during pregnancy: a nationwide population-based study

Please cite this paper as: Chen C‐H, Xirasagar S, Lin C‐C, Wang L‐H, Kou Y, Lin H‐C. Risk of adverse perinatal outcomes with antithyroid treatment during pregnancy: a nationwide population‐based study. BJOG 2011;118:1365–1373.

Providing Shelter to Nursing Home Evacuees in Disasters: Lessons From Hurricane Katrina

OBJECTIVES We examined nursing home preparedness needs by studying the experiences of nursing homes that sheltered evacuees from Hurricane Katrina. METHODS Five weeks after Hurricane Katrina, and again 15 weeks later, we conducted interviews with administrators of 14 nursing homes that sheltered 458 evacuees in 4 states. Nine weeks after Katrina, we conducted site visits to 4 nursing homes and interviewed 4 administrators and 38 staff members. We used grounded theory analysis to identify major themes and thematic analysis to organize content. RESULTS Although most sheltering facilities were well prepared for emergency triage and treatment, we identified some major preparedness shortcomings. Nursing homes were not included in community planning or recognized as community health care resources. Supplies and medications were inadequate, and there was insufficient communication and information about evacuees provided by evacuating nursing homes to sheltering nursing homes. Residents and staff had notable mental health-related needs after 5 months, and maintaining adequate staffing was a challenge. CONCLUSIONS Nursing homes should develop and practice procedures to shelter and provide long-term access to mental health services following a disaster. Nursing homes should be integrated into community disaster planning and be classified in an emergency priority category similar to hospitals.

Increased Risk of Stroke in Patients With Bullous Pemphigoid: A Population-Based Follow-Up Study

Background and Purpose— Although previous research reveals that cardiovascular events and thromboembolic diseases are important causes of death in patients with bullous pemphigoid (BP), the risk of stroke after the diagnosis of BP relative to the general population remains unknown. Using a randomly selected nationwide population-based sample, this study investigates the risk of stroke in patients with BP compared with unaffected individuals of a similar age. Methods— This study analyzes data from Taiwans National Health Insurance Research Database. This sample included 390 patients with BP and 1950 matched subjects as a comparison group. Stratified Cox proportional hazard regressions were used to calculate the 3-year stroke risk for these 2 groups after adjusting for patients age, sex, and comorbid medical disorders at baseline. Results— Of the 2340 patients in the sample, 312 patients (13.3%) had strokes during the 3-year follow-up period, 89 (22.8% of the patients with BP) in the study group and 223 (11.4% of patients without BP) in the comparison group (P<0.001). The hazard ratio for stroke for patients with BP was 2.37 (95% CI, 1.78 to 3.15; P<0.001) times as high that for patients without BP within the 3-year follow-up period after adjusting for hypertension, diabetes, hyperlipidemia, heart failure, atrial fibrillation, and coronary heart disease. Conclusions— Patients with BP have an increased risk of stroke and particularly ischemic stroke.

Relationship Between Presence of a Reported Medical Home and Emergency Department Use Among Children With Asthma

This study examined data from the 2005-2006 National Survey of Children with Special Health Care Needs to assess the relationship among children with asthma between a reported medical home and emergency department (ED) use. The authors used 21 questions to measure 6 medical home components: personal doctor/nurse, family-centered, compassionate, culturally effective and comprehensive care, and effective care coordination. Weighted zero-inflated Poisson regression analyses assessed the independent effects of having a medical home on annual number of child ED visits while controlling for child and parental characteristics, and the differential likelihood of securing a medical home. Nearly half (49.9%) of asthmatic children had a medical home. Receiving primary care in a medical home was associated with fewer ED visits (incidence rate ratio = 0.93; 95% confidence interval = 0.89-0.97). A medical home in which physicians and parents share responsibility for ensuring that children have access to needed services may improve child and family outcomes for children with asthma.

Suicide trends following the Taiwan earthquake of 1999: empirical evidence and policy implications

Objective:  Mental health impact of severe earthquakes on survivors has attracted considerable attention. Suicide represents a terminal outcome of the spectrum of potential major mental health issues spawned by severe earthquakes. This study used time‐series analysis to examine the time trends of increased suicide rates after the Chi–Chi earthquake of 1999 in Taiwan in the affected counties.

Increased risk of stroke in the year after a hip fracture: a population-based follow-up study.

Background and Purpose— Stroke is a documented risk factor for hip fracture. However, no documented studies are available on the risk of stroke among patients with hip fracture. This study investigated the frequency and risk of stroke after hip fracture using a nationwide population-based study. Methods— The study cohort included 2101 patients hospitalized with a principal diagnosis of hip fracture from 2001 to 2004. The comparison cohort consisted of 6303 randomly selected subjects matched on sex, age, and year of index healthcare use as controls. We tracked patients for a 1-year period from their index healthcare encounter to identify those who had a stroke. Stratified Cox proportional hazard regression was performed to evaluate the association of hip fracture with subsequent stroke during 1-year follow-up. Results— Of a total of 8404 patients, 86 (4.1%) from the study group and 170 (2.7%) from the comparison group had strokes during the follow-up period (P<0.001). The stratified Cox proportional analysis shows that the 1-year crude hazard of stroke among patients with hip fracture was 1.55 times (95% CI, 1.19 to 2.03; P=0.001) that of the comparison group. Furthermore, after adjusting for the major cardiovascular risk factors, the increased stroke risk of patients with hip fracture persisted at about the same level as in the unadjusted analysis (hazard ratio, 1.53; 95% CI, 1.17 to 2.01; P=0.002). Conclusion— Hip fracture is associated with increased risk of stroke in the next year.