Background Children with asthma usually use more medical resources than those without asthma. However, studies on the relationship between ratios of asthma-related complications and consumption of medical resources are rare. Methods We sampled data from ¡§Registry for beneficiaries¡¨ of ¡§National Health Insurance Research Database¡¨, National Health Insurance Institute, 2004. The target group was patients, aged between 1 and 18 years old, whose main diagnosis number from outpatient department (ICD-9-CM) is 493. Ratios of asthma-related complications and consumption of medical costs and resources were submitted to statistical analysis. Results Data of 394197 outpatients, of whom 62.5% are males, were included. Among the entire sample, 7627 children have asthma. Children with asthma are 8.2 times likely to get allergic rhinitis than those without asthma. Children with asthma are 2.1 times likely to get atopic dermatitis, 1.3 times likely to get otitis media, 1.5 times likely to get sinusitis than those without asthma. With regard to average expenditure on medical treatment, that of children with asthma is higher than that of children without asthma. Expenditures on medical treatment are compared among four divided groups. Children without asthma or complications ( NT$ 3714 ¡Ó 24538 ) , Children without asthma having complications ( NT$ 6448 ¡Ó 8880 ) , children with asthma not having complications ( NT$ 7396 ¡Ó 6434 ) , children with asthma having complications ( NT$ 12708 ¡Ó 10585 ) . Results of expenditures on medical treatment among these four divided groups show statistically significant. Seventy % of medical resources utilized are pediatrics, 40% are clinics, 50% are in the northern area. Conclusion Ratio of comorbidities of children with asthma is obviously higher than that of children without asthma. With regard to medical costs, that of children with asthma having comorbidities is higher than that of children with asthma not having comorbidities. Therefore, local pediatricians have an important role in the care of children with asthma.

No description available.

The Medical Care Network Plan was implemented by the DOH since July 1985. Taiwan area was divided into 17 medical regions. The objective of this plan was to shrink the gap of medical resources between medical regions in order to avoid the resources being repeatedly invested and wasted. Now, the unequally distributed medical resources have been improved. What is more, checking the efficiency of the use of medical resources has become an important task. Therefore, the purpose for this study is to evaluate the efficiency of the use of medical resources in Taiwan area's 17 medical regions. The results of this study can provide the government for reference in making decision of the medical resources policy. This study analyses a secondary data of the medical care network in 2003 to evaluate the efficiency of Taiwan area's 17 medical regions by Data Envelopment Analysis (DEA). Further, it uses the inferential statistics to identify the relationships about the efficiency and geographical locations, medical resource indicators, the ratio of public hospitals, and medical quality indicators. The results of this study are as follows: 1. Keelung, Ilan, Hsinchu, Miaoli, Changhua, and Pingtung medical regions were relatively efficient in the overall efficiency. In the overall efficiency, Taipei, Taichung, Yunlin, Chiayi, and Kaohsiung medical regions were inefficient because of the scale inefficiency. 2. There was significant difference in overall efficiency in the 4 geographical regions (north, central, south and east regions) which the 17 medical regions belong to. Furthermore, the north region was more efficient than south and east region. 3. The relatively inefficient medical regions invested more inputs of medical resources, but they produced fewer outputs. The relatively efficient medical regions provided higher medical quality and productivity. 4. The medical region which had higher overall efficiency score showed the better medical quality, and lower ratio of public hospitals. On the contrary, the ratio of public hospitals was higher, the medical quality was lower. 5. The ways to improve the input variables of those inefficient medical regions were as follow: Taipei, Taichung, Yunlin, Tainan, Kaohsiung, Pingtung,Taitung, and Hualian medical regions needed to reduce the input variable in ¡§the ratio of physician to population¡¨. Taoyuan, Nantou, and Chiayi medical regions needed to reduce the input variable in ¡§medical benefit payments¡¨. According to the results of this study, it is highly suggested that the government should probe the distribution and utilization of medical resources of the inefficient medical regions in order to know the reasons why these regions were inefficient. That can provide the government for reference in making decision of the policy. We wish the utilization of medical resources in each medical region would be more economical and more efficient.

abstract: The effects of a long-term combat deployment on a soldier's physical fitness are not well understood. In active duty soldiers, combat deployment reduced physical fitness compared to pre-deployment status, but no similar research has been performed on Army National Guard soldiers. This study is the first to identify physical fitness changes in Arizona National Guard (AZNG) soldiers following deployment to a combat zone and to assess the relationships between physical fitness and non-combat injuries and illness (NCII). Sixty soldiers from the Arizona National Guard (AZNG) completed a battery of physical fitness tests prior to deployment and within 1-7 days of returning from a 12-month deployment to Iraq. Pre and post-deployment measures assessed body composition (Bod Pod), muscular strength (1RM bench press, back-squat), muscular endurance (push-up, sit-up), power (Wingate cycle test), cardiorespiratory fitness (treadmill run to VO2 peak), and flexibility (sit-and-reach, trunk extension, shoulder elevation). Post deployment, medical records were reviewed by a blinded researcher and inventoried for NCII that occurred during deployment. Data were analyzed for changes between pre and post-deployment physical fitness. Relationships between fitness and utilization of medical resources for NCII were then determined. Significant declines were noted in mean cardiorespiratory fitness (-10.8%) and trunk flexibility (-6.7%). Significant improvements were seen in mean level of fat mass (-11.1%), relative strength (bench press, 10.2%, back-squat 14.2%) and muscular endurance (push-up 16.4%, sit-up 11.0%). Significant (p < 0.05) negative correlations were detected between percentage change in fat mass and gastrointestinal visits (r = -0.37); sit-and-reach and lower extremity visits (r= -0.33); shoulder elevation and upper extremity visits (r= -0.36); and cardiorespiratory fitness and back visits (r= -0.31); as well as behavioral health visits (r= -0.28). Cardiorespiratory fitness changes were grouped into tertiles. Those who lost the greatest fitness had significantly greater number of NCII visits (8.0 v 3.1 v 2.6, p = .03). These data indicate a relationship between the decline in cardiorespiratory fitness and an overall increase in utilization of medical resources. The results may provide incentive to military leaders to ensure that soldiers maintain their cardiorespiratory fitness throughout the extent of their deployment. / Dissertation/Thesis / Ph.D. Exercise and Wellness 2011

The need for increasing efficiencies for medical resource delivery during a mass casualty incident/event is a paramount logistical planning factor that could mean life or death to the citizens affected by a disaster. As such, Washington State has prioritized emergency management and preparedness. Using the just-in-time system by way of Baghbanian' s complex adaptive decision-making theory as the foundation, gave purpose to this qualitative study. This was accomplished by analysis of emergency management professional responses, and to what degree, improvements can be made to the medical resource delivery system during a mass casualty incident/event. Data were collected through semi structured interviews with a random sample of 12 experienced emergency professionals from the State of Washington. This study was guided by primary research questions that focused on emergency managers and their understanding and adaptability toward preparedness. Interview data were deductively coded and analyzed through a thematic analysis procedure. The key theme of this study is that participants perceived slight differences in logistical and operational approaches that vector into transportation and operational understanding as the main factors influencing medical resource delivery. The positive social change association of this study is that it provides emergency managers, first responders, and medical staff with recommendations for analysis and planning development for medical resource delivery, thereby mitigating the life and death implications for citizens in future disasters.

研究動機與問題：本研究最主要的目的希望能夠將最易被大家忽略的健保醫療檢驗資源使用問題，從實務面上探討，並指認出有效使用醫療檢驗資源的關鍵因素，針對這些因素與措施進行評估，歸納出具體明確可行的方向，提供主管機關做為費用管控的參考，為我國健保永續經營貢獻一份力量。 本研究根據研究動機與目的，設定三個研究問題：1.影響醫師有效的使用醫療檢驗資源的因素有哪些？2.藉由桃園縣執業醫師的看法了解有效使用醫療檢驗資源關鍵因素為何？3.不同執業院所、服務科別、職別的醫師對有效的使用醫療檢驗資源看法是否有差異？ 研究資料與方法：以文獻回顧法、問卷調查法、深度訪談法蒐集資料及驗證資料；研究過程分三個階段進行，第一階段為背景資料與文獻資料的蒐集，瞭解醫療檢驗資源使用現況與問題，並透過訪談實務界菁英驗證文獻與補充資料不足；第二階段依文獻分析與彙整內容設計問卷與訪談大綱；第三階段將回收的問卷編碼、整理後以Excel/2003版與SPSS for window12.0版套裝軟體進行資料分析；深度訪談資料透過內容分析法予以歸納整理分析。獲得研究答案，達成研究目的。 研究結果與建議：量化研究部分，本研究共分送488份問卷，回收318份，回收率為65.1％。並以卡方檢定樣本與母群體並無差異，可代表母群體。質化研究部分，深度訪談三位年資10年以上實務界菁英，建構本研究實務上的概念。歸納研究結果：醫療檢驗資源有效使用的關鍵影響因素有「醫療風險」、「病人就醫行為」與「照護之連續性」3項。根據研究結果，為有效使用醫療檢驗資源，必需減少醫療風險、規範病人就醫行為與進行照護流程改造。 / Background:The purpose of this research is to find out the influencing factors related to the usage of resources for medical examinations under the Taiwanese National Health Insurance (NHI). From the practical point of view, this research focuses on, the first, defining the efficient use of medical test and then finding out the critical factors effecting the efficient usage from medial practitioners’ viewpoints in Taoyuan County, Taiwan. It is expected to provide advisory values to improve the global budget system of NHI. Research Questions: 1.What are the factors influencing doctors to utilize medical examination efficiently? 2.What are the certified medical doctors of Taoyuan County thinking about these factors? 3.Concerning the above factors, do there exist systematic differences among medical doctors from different hospitals, rank of medical doctors and fields of profession? Methods: In this study, author utilizes literature review, questionnaires, and in-depth interview. The survey was divided into three stages. First, related information was collected to clarify the problems of medical examination usage in present situation from both interviewing medical practitioners and literature review. In the 2nd stage, a general questionnaire was designed to administrate to selected medical doctors in Taoyuan County in mid-2008. The last stage was data coding and analyzing by using Excel/2003 and SPSS for Windows. The return rate was 65% (318/488) and there is no difference between population and sample after consistency test. Results and Suggestions The results show that the key factors of efficient medical examination usage are medical risk-aversion of doctors, clinical shopping of patients, and the need to medical care continuity. These exist a greater viewpoint differences between different level of hospital than different ranks or specialties of doctors. These results will lead the author to suggest that the Bureau of NHI needs to promote adequate mediation mechanism to reduce medical risk, to promote inter-hospital patient information sharing system, and to improve the logistic of continuity care.