Remote Diagnosis on Upper Respiratory Tract Infections Based on a Neural Network with Few Symptom Words-A Feasibility Study.

This study aims explore the feasibility of using neural network (NNs) and deep learning to diagnose three common respiratory diseases with few symptom words. These three diseases are nasopharyngitis, upper respiratory infection, and bronchitis/bronchiolitis. Through natural language processing, the symptom word vectors are encoded by GPT-2 and classified by the last linear layer of the NN. The experimental results are promising, showing that this model achieves a high performance in predicting all three diseases. They revealed 90% accuracy, which suggests the implications of the developed model, highlighting its potential use in assisting patients' understanding of their conditions via a remote diagnosis. Unlike previous studies that have focused on extracting various categories of information from medical records, this study directly extracts sequential features from unstructured text data, reducing the effort required for data pre-processing.

Exploration of COVID-19 Pandemic Prevention Behaviors among Healthcare Workers.

Since the outbreak of COVID-19, the pandemic has become an important topic of global public health. To reduce the rapid spread of the pandemic, compliance with preventive behaviors has become one of the important guidelines from the World Health Organization (WHO). Healthcare workers stand on the frontline for pandemic prevention, and preventive behaviors are essential measures to protect their health and safety. The purpose of this study was to propose an integrative model that explained and predicted COVID-19 preventive behaviors among healthcare workers. The study integrated workplace safety climate and the health belief model (HBM) to verify the impact of workplace safety climate and health belief factors on the safety attitude, safety compliance, and safety satisfaction of healthcare workers performing COVID-19 pandemic prevention behaviors. A cross-sectional study was conducted from March to August 2021 with a self-administered online questionnaire. The sample of the study was drawn from healthcare workers of a famous medical institution in Taipei City as research subjects. After collecting 273 valid questionnaires and verifying them through the analysis of structural equation modeling (SEM), the findings revealed that workplace safety climate had an impact on health belief factors, and then health belief factors had impacts on safety attitudes. In addition, safety attitude affected safety compliance, while safety compliance further affected safety satisfaction. The study showed that workplace safety climate can strengthen healthcare workers' health beliefs and further affect their safety attitudes, safety compliance, and safety satisfaction. The study attempted to propose a model of healthcare workers' pandemic prevention behaviors as a reference for medical facility administrators in real practice.

Determinants of Telehealth Continuance Intention: A Multi-Perspective Framework.

Owing to the COVID-19 pandemic, many countries' physicians in the world have used telehealth to visit patients via telehealth. The study aimed to integrate the theory of planned behavior (TPB), the technology acceptance model (TAM), and self-determination theory (SDT) to explore the adoption behavior of a telehealth system. A convenient sample of residents was drawn from the population of Nantou County in Taiwan and analyzed via structural equation modeling. The findings revealed that attitude, perceived behavioral control, perceived usefulness, and perceived autonomy support jointly have significantly positive effects on continuance intention. Results also confirmed that perceived autonomy support, perceived ease of use, and perceived usefulness jointly have significantly positive effects on attitude. Furthermore, this study also showed that a crucial mediators' role is played by perceived ease of use, perceived usefulness, and attitude. The conclusions and practical implications of the research will hopefully provide health organizations and institutions with some innovative insights and foresights, which in turn will promote better practices and services of telehealth technology.

A Model for Promoting Occupational Safety and Health in Taiwan's Hospitals: An Integrative Approach.

Advocating for improving workplace safety and health has gained substantial support in recent years. The medical industry is a high-risk industry and receives considerable public attention. This study used an integrative approach as a starting point and combined the contextual factors of an organization: perceived organizational support, safety climate, social influence, and shared decision making. Subsequently, the effects of these factors on preventive action and safety satisfaction were investigated. This study surveyed employees of two hospitals, one in Northern Taiwan and one in Eastern Taiwan, collecting valid data from 468 respondents. Structural equation modeling (SEM) was used to verify our research framework. The finding indicates that (1) All hypotheses proposed in this study were supported. (2) The overall goodness of fit of the model was excellent, and the explained variance of the outcome variables was high. (3) Safety climate had the strongest total effects on preventive action and safety satisfaction simultaneously, whereas preventive action had the strongest direct effect on safety satisfaction. The objective of this study was to obtain empirical conclusions and make suggestions for academic theory and clinical practice. The findings may serve as a reference for future research and for scholars and practitioners, enabling the creation of healthy workplaces and, thus, a brighter future.

An Exploration of Intent to Use Telehealth at Home for Patients with Chronic Diseases.

Telecare is defined as care practiced at a distance. It is an effective strategy for improving the self-health care management of home-patients with chronic diseases. The purpose of this study was to explore the intent to use of telehealth patients. The correlation between the self-care behaviors, the intent to use of telehealth, and the effects on physiological indicators of patients with chronic disease at home were studied. A cross-sectional study design employing purposive sampling was selected. The structured questionnaire 'Telecare Usage Intention Scale and Self-Care Behavior Scale' were used, 'HbA1c, glucose levels and monthly blood pressure measurements' were analyzed in this thirteen month study. The self-care behaviors of the participants were positively correlated with their intent to use telehealth (p < 0.01). The results also indicated that HbA1c, glucose levels and frequency BP measurement of the participants improved significantly after using telecare (p < 0.005). The results indicated a strong intent to use telehealth and positive perception of telecare services by in-home patients with a chronic disease. Telehealth improves the self-care behavior of in-home chronic disease patients and enhances medical professionals' ability to deliver quality and effective healthcare.

Factors related to self-reported social anxiety symptoms among incoming university students.

AIM: The aim of this study was to explore the lifestyle/social, personality trait and mental factors among incoming university students with higher self-reported social anxiety symptoms (SAS). METHODS: A total of 5126 incoming university students were recruited. The test battery included a self-administered questionnaire that examined personal lifestyle, the Measurement of Support Functions, the Chinese Internet Addiction Scale-Revision, the Organizational Citizenship Behaviour Scale, the Social Phobia Inventory, the suicide ideation from the Brief Symptoms Rating Scale and the Pittsburgh Sleep Questionnaire. RESULTS: SAS (23.7%) were prevalent. Using logistic regression analysis, we found that the significant predictors of higher levels of SAS were being an undergraduate student and a non-smoker, having lower Measurement of Support Functions score (poorer social support), having higher Chinese Internet Addiction Scale-Revision score (Internet addiction), having lower Organizational Citizenship Behaviour Scale score (less altruistic behaviour), having suicide ideation and having higher Pittsburgh Sleep Questionnaire score (poorer sleeper). CONCLUSIONS: Given the high prevalence of SAS among university students, it is necessary to build a better strategy to detect students with potential social anxiety-related problems/disorders or other mental problems early on.

Upregulation of embryonic stem cell marker Nanog in human gingival fibroblasts stimulated with cyclosporine A: An in vitro study.

BACKGROUND/PURPOSE: Gingival overgrowth is a common side effect of medication with the immunosuppressant cyclosporine A (CsA). This study proposed to verify whether Nanog, an embryonic stem cell marker, contributes to gingival overgrowth stimulated with CsA in human gingival fibroblasts (HGFs). MATERIALS AND METHODS: The effect of CsA on HGFs was used to elucidate whether Nanog expression could be induced by CsA using quantitative real-time reverse transcription-polymerase chain reaction and Western blotting. Cell growth in CsA-treated HGFs with Nanog lentivirus-mediated short hairpin RNA interference knockdown was evaluated by tetrazolium bromide reduction assay. RESULTS: CsA upregulated Nanog transcript in HGFs in a dose-dependent manner (P < 0.05). CsA was also shown to increase Nanog protein expression in HGFs in a dose-dependent manner (P < 0.05). In addition, downregulation of Nanog by lentiviral infection significantly inhibited CsA-stimulated cell growth in HGFs (P < 0.05). CONCLUSION: CsA upregulated Nanog expression and cell growth in HGFs, while silencing Nanog effectively reversed these phenomena. Nanog may act as a major switch in the pathogenesis of CsA-induced gingival overgrowth.

A Study of Personal Health Record User's Behavioral Model Based on the PMT and UTAUT Integrative Perspective.

The personal health record (PHR) is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1) The PMT and UTAUT were effective at predicting PHR usage behaviors; (2) Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3) Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management.

Upregulation of Slug expression by cyclosporine A contributes to the pathogenesis of gingival overgrowth.

BACKGROUND/PURPOSE: Gingival overgrowth occurs as a side effect of systemic medication with immunosuppressant cyclosporine A (CsA). Slug, a master regulator of epithelial-mesenchymal transition, is dramatically upregulated in a variety of fibrotic diseases. The aim of this study is to investigate the role of epithelial-mesenchymal transition marker Slug in the pathogenesis of CsA-induced gingival overgrowth. METHODS: Clinically healthy gingiva and CsA-induced gingival overgrowth specimens were analyzed by immunohistochemistry. The effect of CsA on normal human gingival fibroblasts (HGFs) was used to elucidate whether Slug expression could be affected by CsA by real-time reverse transcription-polymerase chain reaction and western blot. Cell proliferation in CsA-treated HGFs with Slug lentiviral-mediated shRNAi knockdown was evaluated by tetrazolium bromide reduction assay. RESULTS: Slug expression was higher in CsA-induced gingival overgrowth specimens than in clinical healthy gingiva (p < 0.05). Slug expression was significantly higher in CsA-induced gingival overgrowth specimens with higher levels of inflammatory infiltrates (p < 0.05). CsA was found to increase Slug transcript and protein expression in HGFs in a dose-dependent manner (p < 0.05). In addition, knockdown of Slug significantly suppressed CsA-induced cell proliferation in HGFs (p < 0.05). CONCLUSION: Taken together, upregulation of Slug in HGFs stimulated by CsA may play an important role in the pathogenesis of CsA-induced gingival overgrowth.

The effect of telehealth systems and satisfaction with health expenditure among patients with metabolic syndrome.

Telehealth cost analysis has become a crucial issue for governments in recent years. In this study, we examined cases of metabolic syndrome in Hualien County, Taiwan. This research adopted the framework proposed by Marchand to establish a study process. In addition, descriptive statistics, a t test, analysis of variance, and regression analysis were employed to analyze 100 questionnaires. The results of the t$ test revealed significant differences in medical health expenditure, number of clinical visits for medical treatment, average amount of time spent commuting to clinics, amount of time spent undergoing medical treatment, and average number of people accompanying patients to medical care facilities or assisting with other tasks in the past one month, indicating that offering telehealth care services can reduce health expenditure. The statistical analysis results revealed that customer satisfaction has a positive effect on reducing health expenditure. Therefore, this study proves that telehealth care systems can effectively reduce health expenditure and directly improve customer satisfaction with medical treatment.

Structural Factors Affecting Health Examination Behavioral Intention.

Disease screening instruments used for secondary prevention can facilitate early determination and treatment of pathogenic factors, effectively reducing disease incidence, mortality rates, and health complications. Therefore, people should be encouraged to receive health examinations for discovering potential pathogenic factors before symptoms occur. Here, we used the health belief model as a foundation and integrated social psychological factors and investigated the factors influencing health examination behavioral intention among the public in Taiwan. In total, 388 effective questionnaires were analyzed through structural model analysis. Consequently, this study yielded four crucial findings: (1) The established extended health belief model could effectively predict health examination behavioral intention; (2) Self-efficacy was the factor that most strongly influenced health examination behavioral intention, followed by health knowledge; (3) Self-efficacy substantially influenced perceived benefits and perceived barriers; (4) Health knowledge and social support indirectly influenced health examination behavioral intention. The preceding results can effectively increase the acceptance and use of health examination services among the public, thereby facilitating early diagnosis and treatment and ultimately reducing disease and mortality rates.

Elevated transglutaminase-2 expression mediates fibrosis in areca quid chewing-associated oral submucocal fibrosis via reactive oxygen species generation.

OBJECTIVES: Transglutaminase-2 (TGM-2) protein is involved in the cross-linking of matrix proteins resulting in several fibrotic disorders and can be induced by reactive oxygen species (ROS). Little is known about its role in the development of oral submucocal fibrosis (OSF). Hence, we hypothesize that TGM-2 may have a role in the pathogenesis of areca quid chewing-associated OSF and arecoline, a major areca nut alkaloid, could regulate TGM-2 via ROS generation. MATERIALS: Forty OSF specimens from areca quid chewing-associated OSF and ten normal buccal mucosa biopsy samples without areca quid chewing were analyzed by immunohistochemistry. The expression of TGM-2 from fibroblasts cultured from OSF and normal buccal mucosa was evaluated by Western blot. The effect of arecoline on normal buccal mucosa fibroblasts (BMFs) was used to elucidate whether TGM-2 expression could be affected by arecoline by using 2', 7'-dichlorofluorescein diacetate assay and Western blot. In addition, glutathione precursor N-acetyl-L-cysteine (NAC) and epigallocatechin-3 gallate (EGCG) were added to find the possible regulatory mechanisms. RESULTS: TGM-2 expression was significantly higher in OSF specimens than normal specimens (p < 0.05). Fibroblasts derived from OSF were found to exhibit higher TGM-2 expression than BMFs in protein levels (p < 0.05). Arecoline significantly upregulated the intracellular ROS generation in a dose-dependent manner (p < 0.05). TGM-2 protein induced by arecoline was found in BMFs in a dose-dependent manner (p < 0.05). Treatment with NAC and EGCG markedly inhibited TGM-2 expression induced by arecoline (p < 0.05). CONCLUSIONS: Our results suggest that TGM-2 expression is significantly upregulated in OSF tissues from areca quid chewers. Arecoline-upregulated TGM-2 expression may be mediated by ROS generation. CLINICAL RELEVANCE: TGM-2 protein is upregulated in areca quid chewing-associated OSF. Using this in vitro model, antioxidants could inhibit arecoline-upregulated TGM-2 expression. NAC and EGCG may serve as a useful agent in controlling OSF.

Telecare Services for Elderly: Predictive Factors of Continued Use Intention.

BACKGROUND: Several countries have recently attempted to implement telecare information technology to provide health care to older adults. This study applied self-determination theory (autonomy, relatedness, and competence) and the theory of planned behavior (subjective norm, perceived behavioral control, and attitudes toward using tools) to investigate a theoretical model for explaining the predictive factors influencing the intention of elderly patients to continue using telecare services. METHODS: Elderly patients in Taiwan (N = 160) who used telecare systems and fall-detection systems completed a questionnaire. Hierarchical multiple regression analysis was applied to test hypotheses. RESULTS: The results revealed that the main effects related to identification supported the notion that autonomy, relatedness, subjective norm, and attitudes toward using tools positively affect elderly patients' intention to continue using telecare services. But, perceived competence and perceived behavioral control cannot be used as a predictor of intention to adopt telecare services. CONCLUSION: For an aging society, to provide appropriate ways to enhance elderly patients' willingness to use telecare services is important. Our findings indicate that elderly patients' perceived relatedness and subjective norm are both crucial predictors in intention to adopt telecare services. And it means that social influence may play a critical role in elderly patients' intention to adopt telecare services; therefore, researchers can investigate social influence mechanisms in depth and examine them more closely in future research.

Factors affecting success of an integrated community-based telehealth system.

BACKGROUND: The rise of chronic and degenerative diseases in developed countries has become one critical epidemiologic issue. Telehealth can provide one viable way to enhance health care, public health, and health education delivery and support. OBJECTIVE: The study aims to empirically examine and evaluate the success factors of community-based telehealth system adoption. METHODS: The valid 336 respondents are the residents of a rural community in Taiwan. The structural equation modeling (SEM) was used to assess the proposed model applied to telehealth. RESULTS: The findings showed the research model had good explanatory power and fitness. Also, the findings indicated that system quality exerted the strongest overall effect on intention to use. Furthermore, service quality exerted the strongest overall effect on user satisfaction. The findings also illustrated that the joint effects of three intrinsic qualities (system quality, information quality, and service quality) on use were mediated by user satisfaction and intention to use. CONCLUSION: The study implies that community-based telehealth service providers should improve three intrinsic qualities to enhance user satisfaction and intention to use, which in turn can lead to increase the usage of the telehealth equipment. The integrated community-based telehealth system may become an innovative and suitable way to deliver better care to the residents of communities.

Knockdown of S100A4 impairs arecoline-induced invasiveness of oral squamous cell carcinomas.

OBJECTIVES: Metastasis is the most common cause of oral squamous cell carcinoma (OSCC)-related death. The physiological function of S100A4 in the pathogenesis of areca quid chewing-associated OSCC has not been uncovered. METHOD: OSCC tissues from areca quid chewers were analyzed by immunohistochemistry for S100A4 expression. The functions of S100A4 in invasiveness of arecoline-treated oral epithelial (OE) cells were determined by loss function approaches. RESULTS: Expression of S100A4 was positively correlated with clinical grading and lymph node metastasis of OSCC. Upregulated S100A4 is correlated with poor survival outcome of OSCC patients. Arecoline led to dose-dependent elevation of S100A4 expression in oral epithelial (OE) cells. Down-regulation of S100A4 significantly reversed arecoline-induced oncogenecity in OE cells. The additions of pharmacological agents LY294002, SP600125, and CAY10585 were found to inhibit arecoline-induced S100A4 expression in OE cells. CONCLUSION: Arecoline-induced S100A4 expression was down-regulated by LY294002, SP600125, or CAY10585 treatment. Targeting S100A4 might offer a new strategy for the treatment of OSCC patients with metastasis.

The psychosocial indicators related to neuroticism in both sexes: A study of incoming university students.

Neuroticism may have great impact on mental and physical health in both sexes. The aims of this study were to explore whether relationships between neuroticism scores and psychosocial indicators as well as metabolic syndrome in a population of incoming university students existed in the different sexes. In total, 4266 incoming students were included in this study. The test battery comprised a self-administered structured questionnaire, including the neuroticism subscale of the Maudsley Personality Inventory, the 12-item Chinese Health Questionnaire, the Chinese Internet Addiction Scale-Revision, the measurement of support functions, and the Pittsburgh Sleep Quality Index. Multivariate logistic regression showed that higher Pittsburgh Sleep Quality Index scores, higher Chinese Internet Addiction Scale-Revision scores, and higher 12-item Chinese Health Questionnaire scores were significantly correlated with neuroticism in both sexes, but lower perceived routine support: measurement of support functions scores were associated only with the male participants. No significant differences were found in terms of body mass index or other metabolic profiles. Individuals with poorer mental health and a poorer personal lifestyle had higher neuroticism scores, and sex effects may influence the scale of perceived social support in the neuroticism group. However, the lack of an association between neuroticism score and metabolic syndrome may be due to the recruitment of younger participants in this study.

Cantharidin impairs cell migration and invasion of A375.S2 human melanoma cells by suppressing MMP-2 and -9 through PI3K/NF-κB signaling pathways.

Cancer metastasis is the major cause of cancer patient death. Melanoma is a highly important metastasis in human cancer. Cantharidin (CTD), identified as an active component of natural mylabris (Mylabris phalerata Pallas), induces apoptosis in many human cancer cells. In the present study, we investigated the anti-metastasis effects of CTD in human melanoma cancer A375.S2 cells. Flow cytometry was used to measure CTD-induced cytotoxic effects in A375.S2 cells. Wound healing assay indicated that CTD suppressed the migration of A375.S2 cells in a dose-dependent manner. The Matrigel Transwell Assay was used for cell migration and invasion examination and the results showed that CTD inhibited both. Gelatin zymography was used to investigate the activities of MMP-2/9 and the results indicated that CTD inhibited the enzymatic activities of MMP-2/9 in A375.S2 cells. The protein expression of A375.S2 cells following incubation with CTD was examined by western blotting and the results showed that CTD decreased the expression of ERK1/2, PI3K, FAK, MMP-2, -9, COX-2, NF-κB p65, TIMP 1, TIMP 2, VEFG, uPA, Rho A, GRB2, ROCK-1 and Ras, but increased the expressions of p38, JNK, p-c-jun and PKC. Based on those observations, we suggest that CTD may be used as a novel anti-cancer metastasis agent of human melanoma cancer in the future.

The modulation of hypoxia-inducible factor-1α/plasminogen activator inhibitor-1 axis in human gingival fibroblasts stimulated with cyclosporine A.

BACKGROUND/PURPOSE: The prominent side effect of the immunosuppressive drug cyclosporine A (CsA) is gingival overgrowth. Hypoxia-inducible factor (HIF)-1α regulates a wide variety of profibrogenic genes, which are closely associated with tissue fibrosis. The aim of this study was to compare HIF-1α expression in normal gingival tissues and CsA-induced gingival overgrowth specimens and further explore the potential mechanisms that may lead to induction of HIF-1α expression. METHODS: Fifteen CsA-induced gingival overgrowth specimens and five normal gingival tissues were examined by immunohistochemistry. Western blot was used to investigate the effects of CsA on the expression of HIF-1α in cultured human gingival fibroblasts. The effects of CsA on plasminogen activator inhibitor (PAI)-1 expression were evaluated in environmental hypoxia. RESULTS: HIF-1α staining in gingival tissue was stronger in CsA-induced gingival overgrowth group than normal gingival group (p < 0.05). The expression of HIF-1α was significantly higher in CsA-induced gingival overgrowth specimens with higher levels of inflammatory infiltrates (p = 0.041). CsA was found to upregulate HIF-1α protein in a dose-dependent manner (p < 0.05). Hypoxia increased CsA-induced PAI-1 protein expression than normoxic conditions (p < 0.05). CONCLUSION: These results suggest that HIF-1α expression is significantly upregulated in CsA-induced gingival overgrowth specimens. The activation of HIF-1α may promote fibrogenesis by an increase of PAI-1 expression and a subsequent elevation of extracellular matrix production in gingival tissues.

Triggering apoptotic death of human epidermal keratinocytes by malic Acid: involvement of endoplasmic reticulum stress- and mitochondria-dependent signaling pathways.

Malic acid (MA) has been commonly used in cosmetic products, but the safety reports in skin are sparse. To investigate the biological effects of MA in human skin keratinocytes, we investigated the potential cytotoxicity and apoptotic effects of MA in human keratinocyte cell lines (HaCaT). The data showed that MA induced apoptosis based on the observations of DAPI staining, DNA fragmentation, and sub-G1 phase in HaCaT cells and normal human epidermal keratinocytes (NHEKs). Flow cytometric assays also showed that MA increased the production of mitochondrial superoxide (mito-SOX) but decreased the mitochondrial membrane potential. Analysis of bioenergetics function with the XF 24 analyzer Seahorse extracellular flux analyzer demonstrated that oxygen consumption rate (OCR) was significantly decreased whereas extracellular acidification rate (ECAR) was increased in MA-treated keratinocytes. The occurrence of apoptosis was proved by the increased expressions of FasL, Fas, Bax, Bid, caspases-3, -8, -9, cytochrome c, and the declined expressions of Bcl-2, PARP. MA also induced endoplasmic reticulum stress associated protein expression such as GRP78, GADD153, and ATF6α. We demonstrated that MA had anti-proliferative effect in HaCaT cell through the inhibition of cell cycle progression at G0/G1, and the induction of programmed cell death through endoplasmic reticulum stress- and mitochondria-dependent pathways.