Factors Affecting Delayed Hospital Arrival of Patients with Acute Myocardial Infarction in Kinmen.

This study explores factors related to delayed emergency medical treatment for acute myocardial infarction patients on Kinmen Island. A cross-sectional study was performed in the only hospital in Kinmen Island. The study group consisted of 116 patients diagnosed with acute myocardial infarction (AMI, ICD-10 codes: I21.9) from November 2015 to May 2019. The binary logistic regression analyses were performed for the inferential statistical analysis. The mean age of the study group was 63.0 ± 14.5 years, 39.7% of the patients arrived at the emergency medicine longer than 6 h after the onset of symptoms. The related factors for delayed arrival the hospital emergency medicine department were female sex, age over 65 years, less than nine years' education, and Killip Class, but only Killip Class reached the significant difference of statistics (OR = 3.616, 95% C.I. = 1.574 to 8.310, p = 0.002), and patients with delayed arrival times (>6 h) were found to have a higher percentage of Killip Class ≥ II. Therefore, it is essential to remind the physicians to proceed with risk stratification for acute coronary syndrome patients. In addition, health authorities should provide effective programs to increase awareness of the symptoms and timely treatment of acute myocardial infraction to the general public, especially the elderly.

The Relationship between Clinic Visit Accompanied by Family and Dementia Severity in Taiwan.

INTRODUCTION: This study analyzes the severity of dementia status with clinical dementia rating (CDR) score distribution among patients according to various family functional and sociodemographic issues. METHODS: A cross-sectional study was performed in a regional hospital in Central Taiwan. The sample consisted of 318 patients who came to the clinic from May 2018 to April 2019, and who were diagnosed by the physicians with CDR scores ≧ 0.5. The Chi-Square test and binary logistic regression analyses were performed for inferential statistical analysis. RESULTS: The mean age of the sample was 78.7 ± 8.51 years, and 61.6% of the samples' CDR scores were equal or less than 1.0. Patients visiting the clinic were accompanied by spouses (21.7%), sons or daughters-in-law (40.6%), daughters (23.6%). Of the sample, 142 (44.3%) patients live with sons. Patients with a lower educational level had higher CDR scores. Compared to the patients who went to the clinic by themselves, the higher OR values of CDR scores ≧ 2 are found in patients who were accompanied by other relatives (OR = 18.871, 95% C.I. = 3.117-114.237, p = 0.001), or spouse (OR = 10.783, 95% C.I. = 1.996-58.245, p = 0.006). CONCLUSION: The family member who accompanied the patient to a clinic visit and the patient's educational level are both significant issues relating to the severity of dementia.

Inequality in outpatient resource utilization among older adults during the 2007-2008 financial crisis: findings from Taiwan.

BACKGROUND: Equity in medical resource utilization is a crucial concern in countries with national health insurance systems. From the perspective of an active aging framework, public health insurance is one of the pillars of economic security, as suggested by the World Bank, to achieve the goal of social security for older adults. This study thus sought to quantify income-related inequality in national health insurance systems, especially during the global economic crisis of 2007-2008. METHODS: By employing the Taiwan National Health Interview Surveys (2005 and 2009) datasets, we analyzed the socioeconomic inequality of outpatient service utilization for older Taiwanese adults during the financial crisis of 2007-2008. We used corrected concentration indices (CCIs) to examine inequalities over time. Furthermore, we decomposed socioeconomic inequalities to reveal the contributions of determinant factors. The dependent variables related to whether participants had used outpatient services in the previous month, and the independent factors included individual's needs, enabling, predisposing, and environmental factors proposed by Andersen model. RESULTS: The sample consisted of 2415 observations in 2005 and 2554 observations in 2009. The income-related health care inequality was minor from pro-rich to pro-poor across the study duration, although the difference was insignificant (women: from a concentration index [CI] of 0.0256 in 2005 to a CI of - 0.0098 in 2009; men: from a CI of 0.0379 in 2005 to a CI of 0.0310 in 2009). We used a probit model to analyze the effect of explanatory factors on outpatient resource utilization by men and women. After other factors were controlled for, we found that that the income variable had a positive and significant effect on outpatient service utilization in 2009 and the absolute contribution of income to inequality notably increased from 0.0480 in 2005 to 0.3247 in 2009 for older women. CONCLUSIONS: In conclusion, Taiwan's National Health Insurance system guarantees the accessibility of health care services to older adults, but slight income-related inequality was maintained in the outpatient resource utilization of women during the 2007-2008 financial crisis. Close attention should be paid to the vulnerability of women during times of economic insecurity.

Home-care aides' self-perception of oral health-care provision competency for community-dwelling older people.

OBJECTIVES: To investigate the circumstances in which home-care aides (HAs) provide oral health care to homebound patients and to examine the degree of comfort and knowledge that HAs have regarding their own skills in providing oral health care. METHODS: Seven home-care facilities in central Taiwan consented to participate in this cross-sectional study. The participants were selected through convenience sampling. A total of 312 effective responses were obtained (the effective response rate was 64.0%). SPSS, version 17, was used to perform statistical analyses, including descriptive statistics, factor analysis and multiple regression analysis. RESULTS: Oral health-care work had a minimal impact on the psychological burden of the HAs. However, factors affecting the self-perception of the HAs regarding their competency in oral health-care provision included 'whether oral health care is a part of home care' (ß = -0.195, P = 0.006), 'whether patients had difficulty chewing' (ß = -0.178, P = 0.001), 'vomiting during oral health care' (ß = 0.133, P = 0.001), 'having HA certification' (ß = 0.120, P = 0.030), 'whether premeal oral exercises were performed' (ß = 0.141, P = 0.012), 'finger biting during the provision of oral care' (ß = -0.115, P = 0.039) and 'time constraints for provision of care' (ß = 0.143, P = 0.042). CONCLUSIONS: Enhancing HAs' self-perception of their competency in oral health-care provision can help develop in-service training courses focused on oral health care for older adults, thereby further strengthening HAs' competency in oral health-care provision.

The Selection of Death Place Among Patients Receiving Hospital-Based Palliative Care Service in Taiwan.

INTRODUCTION: To analyze the selection of a place to die and its related factors in patients who received hospice shared care service in Taiwan. METHODS: This study included patients who received hospice shared care service in a metropolitan hospital as the research participants. A total of 172 questionnaires were collected, and 146 of them were used as valid samples for analysis. This study applied the multivariate logistic regression analysis to assess the significance of independent variables associated with the selection of place of death. RESULTS: The results revealed that 52.6% of the patients select hospital as the place to end their life, while 43.8% of them select their home as the place of death. Furthermore, younger adult patients (<65), those who with a higher educational level (≥10 years), and those with a clear cognizance of the disease progression tended to select hospital as the place to spend their last days. CONCLUSIONS: The research disclosed that more patients with the hospice shared care service prefer hospital to their home as the place to die. In order to provide end-of-life care for patients with low cost and appropriate treatment, it is important to understand the related sociodemographic factors and the need of the patients to provide well-designed hospice/specialist palliative care regimen.

Factors related to the decision-making for moving the older adults into long-term care facilities in Taiwan.

AIM: To investigate the relationships between demographic characteristics of the elderly, type of long-term care (LTC) facilities, and the reasons for moving into LTC facilities. METHODS: Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non-linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. RESULTS: The results showed that the older adults in quadrant I were characterized by being involved in the decision-making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. CONCLUSIONS: We believe that the results of the present study will facilitate policy-making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319-1327.

Factors affecting institutionalized older peoples' self-perceived dry mouth.

PURPOSE: The purpose of this study was to determine the factors affecting institutionalized older peoples' self-perceived dry mouth. METHODS: This cross-sectional study was conducted on elderly residents at 22 long-term care facilities. A total of 165 questionnaires were returned from 13 senior citizen welfare institutions (SCWIs) and nine nursing homes. Multiple logistic regression analysis was used to analyze the data obtained. RESULTS: The results showed that the type of long-term care (LTC) facility, regular oral examinations, wearing dentures, and the ability to chew sticky foods affected self-perceived dry mouth. This study determined an association between the type of LTC facility where the participants lived and self-perceived dry mouth. CONCLUSIONS: The results indicated the importance of providing oral care in order to improve and prevent dry mouth among institutionalized older people living in SCWIs who do not undergo regular oral examinations, wear dentures, and have difficulty chewing sticky foods.

Decision-making factors affecting different family members regarding the placement of relatives in long-term care facilities.

BACKGROUND: The aim of this research was to investigate factors affecting different family members' decisions regarding the placement of relatives in long-term car (LTC) facilities in Taiwan. The objective was to investigate the correlations between family members' personal traits, the living conditions of residents in the LTC facilities, and family members' experiences with LTC facilities. METHODS: This study selected family members visiting residents in LTC facilities as research subjects and used a structured questionnaire to perform face-to-face interviews. This study used nonlinear canonical correlation analysis (OVERALS) to categorize the decision-making factors affecting family members' choices of LTC facilities. RESULTS: The results showed that when making decisions about the placement of family members, spouses chose facilities according to their own life experiences, children considered medical treatment convenience, grandchildren preferred to collect relevant information on facilities, and other relatives preferred to decide based on introductions from government departments. CONCLUSIONS: These results help clarify how different family roles affect decision-making processes regarding the choice of LTC facilities. In particular, spouses and female relatives require an interventional service mechanism that provides consultation or referral information.

Psychometric characteristics of the parsimonious Chinese version of the Smoking Self-Efficacy Survey (CSSES-20).

BACKGROUND: Cigarette smoking is a health-risk behavior of global proportions. Self-efficacy plays an important role in both smoking acquisition and smoking resistance. Reliability and validity of an instrument is fundamental to research results, particularly in its simplified form on a different population. The purpose of this study was to conduct psychometric testing on the parsimonious Chinese version of the Smoking Self-efficacy Survey (CSSES-20). METHODS: The randomized cluster sample was drawn from 61 middle schools in Taipei City, Taiwan. Following a pilot test of the CSSES-20, the CSSES was administered to 571 adolescents. Construct validity was tested by the exploratory factor procedures and the contrasted group approach. Pearson correlation coefficients were used to examine the criterion validity and test-retest reliability for the stability of the scale. Cronbach's alpha coefficients were used to determine the internal consistency of the scale. RESULTS: The exploratory factor analysis yields three components, "opportunity to smoke,""emotional stress," and "influence of friends," accounting for 80.4% of the total variances. The criterion validity was also supported by the study results. The contrasted group approaches affirmed the construct validity of the CSSES-20. Stability of scales was supported by test-retest reliability. Cronbach's alphas for 3 subscales ranged from .90 to .93. CONCLUSIONS: A concise instrument can alleviate response burden for adolescent study participants and increase their recruitment and retention rates. The CSSES-20 demonstrated satisfactory construct validity, criterion validity, stability, and internal consistency reliability. These findings can be used to provide school teachers and nurses with information about the relationship between self-efficacy to resist smoking and adolescent smoking behavior.

Population-specific anthropometric cut-points improve the functionality of the Mini Nutritional Assessment (MNA) in elderly Taiwanese.

The objective of this study was to determine the population-specific cut-points of body mass index (BMI), mid-arm circumference (MAC) and calf circumference (CC) for identifying subnormal nutritional status in elderly Taiwanese, and to evaluate the possibility of improving the functionality of the Mini Nutritional Assessment (MNA) by adopting these cut-points. This study analyzed data from 1583 men and 1307 women, 65 years or older, of a national survey. The survey involved in-home, face-to-face, interviews and anthropometric measurements. Results showed that based on the cumulative percentile curves, the fifth percentile values were: BMI, 17 kg/m2 for both men and women; MAC, 22.5 cm for men and 21 cm for women; and CC, 28 cm for men and 25 cm for women. Substitution of these population-specific cut-points for respective values in the MNA screen resulted in lowered proportions of elderly classified malnourished or at risk of malnutrition. The prevalence of malnutrition was reduced from 1.7% to 1.4% in men and from 2.4% to 1.5% in women. The proportions classified at risk of malnutrition were reduced from 10.1% to 8.9% for men and 16.8% to 12.8% for women. In conclusion, results suggest that the MNA is a valuable tool for geriatric nutritional risk assessment. However, in populations where significant differences exist in anthropometric measurements from the Caucasian populations, population-specific cut-points should be used.

Prevalence of overweight and obesity and its associated factors in aboriginal Taiwanese: findings from the 2001 National Health Interview Survey in Taiwan.

The study was undertaken to assess the prevalence of obesity in Taiwanese aborigines and to identify the associated factors. Data for this study were from the "2001 National Health Interview Survey (NHIS)" that conducted in-home, face-to-face, interviews on 6,592 households (26,658 persons) of a national probability sample in Taiwan. Aborigine-dense mountainous areas are over-sampled. BMI values were used to indicate obesity status. Logistic regression analyses were used to determine the significance of the association of the variables with the obesity status. Results showed that approximately 10.5% of aboriginal men and 14.5% of women compared to 4.1% and 3.5% of their non-aboriginal counterparts were obese (BMI > 30). An additional 45.1% of aboriginal men and 33.3% of women compared to 27.6% and 17.7% of their non-aboriginal counterparts were overweight (BMI 25-30). Regression analyses revealed few associations with increased risk of obesity in the aborigines. However, the aborigines and non-aborigines were distinctly different from each other in socio-economic status, lifestyle, environmental factors and attitude toward obesity. Results indicate that obesity is more prevalent among the aborigines but the causal reasons are not apparent. The public health authorities should develop more culturally appropriate community-based intervention strategies to promote the health of the aborigines.

The parental influence of betel-chewing behavior among junior high school students in Taiwan.

A cross-sectional study with stratification sampling was conducted to explore the parental influence of betel-chewing behavior among junior high school students in Taichung County in 1998. The sample consisted of 2244 students in three different districts in Taichung County: the mountain line area, the seashore area; and the satellite cities area (near Taichung City). A self-reported questionnaire was filled out anonymously by the sampled students. Fifty percent of the students' fathers and 2.5% of the students' mothers are betel chewers. A higher prevalence of betel chewing is found among students whose parents are betel chewers. Also the lower the father's educational level, the higher the prevalence of betel chewing among the students. Compared with students whose fathers have more than 12 years of education, the odds ratio is 2.35 for the prevalence of betel chewing among students with fathers whose educational levels are no more than 9 years. However, parents' vocations are not related to the prevalence of betel chewing among junior high school students. Finally, students whose parents are separated or divorced have a higher prevalence of betel chewing. An effective health education program for the high-risk group students and an evaluation procedure for the effectiveness of the program is necessary to prevent the increase of betel chewing among Taiwan's youth.