| Summary: | 博士 === 國立陽明大學 === 公共衛生研究所 === 103 === The increasing burden of chronic diseases has become one of the major challenges to the global health system. But just like what the World Health Organization has suggested, more than half of the chronic diseases could be prevented. However, most of the community-based programs of disease prevention and health promotion have been found to be with only modest effects. The fragmentation of delivery systems and lack of a coordinated supporting network might be one of the major problems causing the resistances to these programs.
At the end of 2013, about 13.5% of residents living in the Yilan County, which located in north-eastern region of Taiwan, were 65 years of age or even older. Increased aging population was inevitably associated with more burden of disease. Yilan City, the largest one of the cities in Yilan County with nearly 100,000 residents, has been a mature community with low mobility. Because of the rural nature, people living here were closer to each other than those living in urban cities. This was favorable to the formation of an intimate social network allowing high level of social penetration, and also to the tailoring of appropriate interventions. Besides, the National Yang-Ming University Hospital also located in that city. Therefore this city might be one of the good candidates for long-term implementations of any kinds of community-based health plans to understand the real effects of primary and secondary prevention. But before we could implement such programs, we needed to have a clear picture about the physical and psychological health status of the aged population living in this region. Besides, because most of the chronic diseases could best be well-controlled rather than be cured, those indicators of health used before, such as mortality and complication rates, might be no longer useful. Therefore we also needed to search for more indicators, such as health-related quality of life, to reflect the health and well-being of those patients with chronic diseases, and also the effects of those health-promotion programs.
Since February of 2012, we have implemented the first stage of the Yilan Study, which has been a community based survey of the prevalences of chronic diseases, both physical and psychological, in people aged 65 years or older and living in the 7 most populated villages of Yilan City. After those residents’ agreements, the program assistants checked their ECG and heart rate variability by KY3 monitor. Then, a detailed physical examination of blood pressure (over both arms), body height, weight, waist and hip circumference, body composition and hand grip power measurements have been performed. After the physical examination, a questionnaire derived from that of the Shih-Pai Community Medical Service Program will be completed. This questionnaire includes 11 sections of surveys, such as for comorbidities, life styles, depression, anxiety, insomnia, health-related quality of life, status of exercise and consumption of medical resources.
With the help of Yang-Ming Crusades and the Community Angels (social volunteers), the first stage of the Yilan Study has been completed at the end of 2013, with total 4,257 aged people been invited and 1,732 cases agreeing to participate this program. The prevalence of hypertension was 52.3%, diabetes 22.2%, hyperlipidemia 23.1%, cardiovascular disease 28.4%, stroke 6.6%, gout 8.1%, cataract 49.9%, and falling (at least one time in the past one year) 16.5%, most of which were similar with that of Taiwan. The only exception was the density of cardiovascular disease, which seemed to be higher than that of the whole country. Besides, the prevalences of anxiety and depression, measured by the Hospital Anxiety and Depression Scale, were 37.5% and 14.5%. On the part of insomnia, if we utilized item combinations of the Chinese version of Athens Insomnia Scale and the Pittsburgh Sleep Quality Index to make a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of insomnia disorder, the prevalence would be 14.8%. However, considering the high standardized mortality ratio of cardiovascular disease, cerebrovascular disease and accidents in Yilan County in these years, aggressive disease prevention and health promotion programs seemed urgent and necessary for the old people living in this region.
Our study results also suggested that cardiovascular disease and stroke had negative impacts on both the mental and physical part of HRQoL through different pathways. Separate and apart from the direct effect, cardiovascular disease affected the HRQoL indirectly with the mediation of anxiety while stroke with depression. The underlying pathogenesis might be related to the neuroanatomic factors due to stroke, post-stroke neurogenesis, and the reversibility of the sequelae of these 2 diseases.
Our study found that the prevalence of AF in elderly population in Taiwan might be 5.8% or more and increased with advancing age, which was no less than the mean global prevalence and was different from what we have believed before. More aggressive strategies of prevention and management of AF should be administrated. Besides, our study results also disclosed that AF had a significant negative impact on the physical part of HRQoL, while frequent VPCs, which might be through the autonomic nervous system, was shown to be negatively associated with mental part of the HRQoL. These conclusions might provide more informations in designing the strategies of management of AF.
Finally, we have established a cohort in Yilan City and “The Yilan Study” is still going on. With the continuous help of the National Yang-Ming University and the University Hospital, further administration and evaluation of various disease prevention and health promotion programs become feasible and promising.
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