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1.
Emerg Microbes Infect ; 11(1): 1664-1671, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1978179

ABSTRACT

To reach the WHO target of hepatitis C virus (HCV) elimination by 2025, Taiwan started to implement free-of-charge direct-acting antiviral (DAA) treatment programme in 2017. Evaluating the progress of HCV microelimination among people living with HIV (PLWH) is a critical step to identify the barriers to HCV elimination. PLWH seeking care at a major hospital designated for HIV care in Taiwan between January 2011 and December 2021 were retrospectively included. For PLWH with HCV-seropositive or HCV seroconversion during the study period, serial HCV RNA testing was performed using archived samples to confirm the presence of HCV viremia and estimate the prevalence and incidence of HCV viremia. Overall, 4199 PLWH contributed to a total of 27,258.75 person-years of follow-up (PYFU). With the reimbursement of DAAs and improvement of access to treatments, the prevalence of HCV viremia has declined from its peak of 6.21% (95% CI, 5.39-7.12%) in 2018 to 2.09% (95% CI, 1.60-2.77%) in 2021 (decline by 66.4% [95% CI, 55.4-74.7%]); the incidence has declined from 25.94 per 1000 PYFU (95% CI, 20.44-32.47) in 2019 to 12.15% per 1000 PYFU (95% CI, 8.14-17.44) (decline by 53.2% [95% CI, 27.3-70.6%]). However, the proportion of HCV reinfections continued to increase and accounted for 82.8% of incident HCV infections in 2021. We observed significant declines of HCV viremia among PLWH with the expansion of the DAA treatment programme in Taiwan. Further improvement of the access to DAA retreatments is warranted to achieve the goal of HCV microelimination.


Subject(s)
HIV Infections , Hepatitis C, Chronic , Hepatitis C , Antiviral Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/epidemiology , Hepacivirus/genetics , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepatitis C, Chronic/drug therapy , Humans , Retrospective Studies , Taiwan/epidemiology , Viremia/drug therapy , Viremia/epidemiology
2.
J Formos Med Assoc ; 120 Suppl 1: S26-S37, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1972180

ABSTRACT

BACKGROUND: As Coronavirus disease 2019 (COVID-19) pandemic led to the unprecedent large-scale repeated surges of epidemics worldwide since the end of 2019, data-driven analysis to look into the duration and case load of each episode of outbreak worldwide has been motivated. METHODS: Using open data repository with daily infected, recovered and death cases in the period between March 2020 and April 2021, a descriptive analysis was performed. The susceptible-exposed-infected-recovery model was used to estimate the effective productive number (Rt). The duration taken from Rt > 1 to Rt < 1 and case load were first modelled by using the compound Poisson method. Machine learning analysis using the K-means clustering method was further adopted to classify patterns of community-acquired outbreaks worldwide. RESULTS: The global estimated Rt declined after the first surge of COVID-19 pandemic but there were still two major surges of epidemics occurring in September 2020 and March 2021, respectively, and numerous episodes due to various extents of Nonpharmaceutical Interventions (NPIs). Unsupervised machine learning identified five patterns as "controlled epidemic", "mutant propagated epidemic", "propagated epidemic", "persistent epidemic" and "long persistent epidemic" with the corresponding duration and the logarithm of case load from the lowest (18.6 ± 11.7; 3.4 ± 1.8)) to the highest (258.2 ± 31.9; 11.9 ± 2.4). Countries like Taiwan outside five clusters were classified as no community-acquired outbreak. CONCLUSION: Data-driven models for the new classification of community-acquired outbreaks are useful for global surveillance of uninterrupted COVID-19 pandemic and provide a timely decision support for the distribution of vaccine and the optimal NPIs from global to local community.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Community-Acquired Infections/classification , Disease Outbreaks , Humans , Machine Learning , Models, Statistical , SARS-CoV-2 , Taiwan
3.
J Formos Med Assoc ; 120 Suppl 1: S38-S45, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1972178

ABSTRACT

BACKGROUND: Household transmission is responsible for the subsequent outbreak of community-acquired COVID-19. The aim of this study was to elucidate the household transmission mode and to further estimate effective and basic reproductive number with and without non-pharmaceutical interventions (NPIs). METHODS: A total of 26 households with 39 family clusters between January, 2020 and February, 2021 in Taiwan were enrolled for analysis. The Becker's chain binomial model was used to analyze the probabilities of being infected and escaping from SARS-COV-2 before and after January 1st, 2021, which were further converted to estimating basic reproductive numbers in the absence of NPIs. The likelihood of leading to the subsequent community-acquired outbreak given NPIs was further assessed. RESULTS: The secondary attack rate was 46.2%. Given the saturated Greenwood model selected as the best fitted model, the probability of being infected and escaping from COVID-19 within household was estimated as 44.4% (95% CI: 5.0%-53.7%) and 55.7% (95% CI: 46.3%-65.0%), respectively. In the second period of early 2021, the infected probability was increased to 58.3% (95% CI: 12.7%-90.0%) and the escape probability was lowered to 41.7% (95% CI: 0.0%-86.9%). The corresponding basic reproductive numbers (R0) increased from 4.29 in the first period to 6.73 in the second period without NPIs. However, none of subsequent community-acquired outbreak was noted in Taiwan given very effective NPIs in both periods. CONCLUSION: The proposed method and results are useful for designing household-specific containment measures and NPIs to stamp out a large-scale community-acquired outbreak as demonstrated in Taiwan.


Subject(s)
COVID-19 , Basic Reproduction Number , COVID-19/transmission , Disease Outbreaks , Family Characteristics , Humans , Taiwan/epidemiology
4.
J Formos Med Assoc ; 120 Suppl 1: S57-S68, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1972177

ABSTRACT

BACKGROUND: The COVID-19 outbreaks associated with mass religious gatherings which have the potential of invoking epidemics at large scale have been a great concern. This study aimed to evaluate the risk of outbreak in mass religious gathering and further to assess the preparedness of non-pharmaceutical interventions (NPIs) for preventing COVID-19 outbreak in this context. METHODS: The risk of COVID-19 outbreak in mass religious gathering was evaluated by using secondary COVID-19 cases and reproductive numbers. The preparedness of a series of NPIs for preventing COVID-19 outbreak in mass religious gathering was then assessed by using a density-dependent model. This approach was first illustrated by the Mazu Pilgrimage in Taiwan and validated by using the COVID-19 outbreak in the Shincheonji Church of Jesus (SCJ) religious gathering in South Korea. RESULTS: Through the strict implementation of 80% NPIs in the Mazu Pilgrimage, the number of secondary cases can be substantially reduced from 1508 (95% CI: 900-2176) to 294 (95% CI: 169-420) with the reproductive number (R) significantly below one (0.54, 95% CI: 0.31-0.78), indicating an effective containment of outbreak. The expected number of secondary COVID-19 cases in the SCJ gathering was estimated as 232 (basic reproductive number (R0) = 6.02) and 579 (R0 = 2.50) for the first and second outbreak, respectively, with a total expected cases (833) close to the observed data on high infection of COVID-19 cases (887, R0 = 3.00). CONCLUSION: We provided the evidence on the preparedness of NPIs for preventing COVID-19 outbreak in the context of mass religious gathering by using a density-dependent model.


Subject(s)
COVID-19 , Communicable Disease Control/methods , Crowding , Disease Outbreaks , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Humans , Religion , Republic of Korea/epidemiology , SARS-CoV-2 , Taiwan/epidemiology
5.
Int J Environ Res Public Health ; 19(15)2022 Aug 03.
Article in English | MEDLINE | ID: covidwho-1969278

ABSTRACT

Adopting the model of risk information seeking and processing (RISP) as a theoretical framework, the objective of this study was to investigate the factors that prompted individuals' information-seeking and -processing behaviors during the COVID-19 pandemic in Taiwan. There were two unique aspects in this study: one was to adopt specific emotions to investigate the impact of negative emotions, and the other was to examine the effect of informational subjective norms (ISNs) on information-seeking and -processing behavior. An online survey was conducted by a professional polling company, and a stratified random sampling method was employed, using gender, age, education, personal income, and residential areas as strata to select participants. This study obtained 1100 valid questionnaires. The results showed that (1) risk perception did not exert any significant impacts on respondents' perceived information insufficiency; (2) risk perception exerted a powerful impact on respondents' ISNs, which, in turn, positively affected their information insufficiency; (3) the respondents who experienced fear were found to have a high probability of using a systematic-processing mode, while the respondents who experienced anger were more likely to adopt a heuristic-processing mode to process information; and (4) the use of a systematic-processing mode was positively associated, while the use of a heuristic-processing mode was negatively associated, with information-seeking behavior.


Subject(s)
COVID-19 , COVID-19/epidemiology , Disease Outbreaks , Emotions , Humans , Information Seeking Behavior , Pandemics , Surveys and Questionnaires , Taiwan/epidemiology
6.
Int J Environ Res Public Health ; 19(15)2022 Jul 29.
Article in English | MEDLINE | ID: covidwho-1969238

ABSTRACT

By adopting niche theory, this study compared social media with news media and interpersonal communication regarding their capabilities in satisfying people's information needs of daily use, surveillance, convenience, and information quality during the outbreak of COVID-19. Two methods were adopted to collect data for this study: the first was to conduct 20 intensive interviews, and the second was to administer an online survey by contracting a professional polling company with a panel of 8.8 million members. The stratified random sampling method was used to acquire a representative sample, from which 1100 valid questionnaires were obtained. The results showed that: (1) Social media were superior to traditional news media in terms of its convenience. However, several new types of online news, such as Yahoo news, were able to compete with social media for convenience. (2) Interpersonal communication did not outperform in satisfying individuals' needs for the four gratifications. Nevertheless, interpersonal communication plays the role of social support for individuals.


Subject(s)
COVID-19 , Social Media , COVID-19/epidemiology , Communication , Humans , Information Seeking Behavior , Mass Media , Taiwan/epidemiology
7.
PLoS One ; 17(7): e0270349, 2022.
Article in English | MEDLINE | ID: covidwho-1968863

ABSTRACT

BACKGROUND: Using a 10 week nationwide online survey performed during a time period containing the time ahead, the start, and the peak of a COVID-19 outbreak in Taiwan, we investigated aspects that could affect participants' vaccination intentions. METHODS: From March to May 2021, we surveyed 1,773 people in Taiwan, aged from 20 to 75 years, to determine potential acceptance rates and factors influencing the acceptance of a COVID-19 vaccine. We used an ordinal logistic regression with a backward selection method to identify factors that affected vaccination intention. RESULTS: Several factors could increase individuals' vaccination intentions including: being male, older, with an openness personality, having a better quality of life in the physical health domain, having better knowledge and personal health behavior, having more trust in the government, and being worried about misinformation. Perceived risks played a crucial role in the vaccine decision-making process. When the pandemic intensified, people's vaccination intentions increased significantly. CONCLUSION: The findings of the present study could highlight individuals' vaccination attitudes and provide governments with an empirical and dynamic base to design tailored strategies to increase vaccination rates.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Disease Outbreaks/prevention & control , Female , Humans , Male , Quality of Life , Taiwan/epidemiology , Vaccination , Vaccination Hesitancy
8.
Int J Environ Res Public Health ; 19(12)2022 06 20.
Article in English | MEDLINE | ID: covidwho-1963968

ABSTRACT

The COVID-19 pandemic has affected emergency department (ED) usage. This study examines changes in the number of ED visits for gastrointestinal (GI) bleeding and nonemergency GI conditions, such as acute gastroenteritis (AGE) and constipation, before the pandemic and at the peak and slack periods of the pandemic in Taiwan. This retrospective observational study was conducted at a referral medical center in northern Taiwan. We recorded the number of weekly ED visits for GI bleeding, AGE, and constipation from 2019 to 2021. We then compared the baseline period (calendar weeks 4-18 and 21-31, 2019) with two peak pandemic periods (period 1, calendar weeks 4-18, 2020; period 2, calendar weeks 21-31, 2021) and their corresponding slack periods. The decline in the number of ED visits during the two peak pandemic periods for GI bleeding (-18.4% and -30.2%) were not as substantial as for AGE (-64.1% and -76.7%) or for constipation (-44.4% and -63.6%), but GI bleeding cases were still significantly lower in number relative to the baseline. During the slack period, the number of ED visits for all three diagnoses rebounded but did not exceed the baseline. Our study revealed that there was a significant decline of GI complaint during the pandemic. This phenomenon was more prominent in nonemergency complaints (AGE and constipation) and less prominent in serious complaints (GI bleeding).


Subject(s)
COVID-19 , Gastroenterology , COVID-19/epidemiology , Constipation/epidemiology , Emergency Service, Hospital , Gastrointestinal Hemorrhage/epidemiology , Humans , Pandemics , Retrospective Studies , Taiwan/epidemiology
9.
PLoS One ; 17(7): e0271300, 2022.
Article in English | MEDLINE | ID: covidwho-1963026

ABSTRACT

The development of the social public resource digital sharing system (SPRDSS) has been accelerated with the evolution of digital information and communication technologies (ICTs). This paper analyzes the dissipative structure features and formation process of SPRDSS in China. Combined with the Brusselator model and its transformation, this paper empirically analyzes the dissipative structure of SPRDSS using panel data collected from 30 Chinese provinces (excluding Tibet, Hong Kong, Macao, and Taiwan) from 2015 to 2019. The results show that the SPRDSS in China has pre-conditions to form a dissipative structure. At present, the SPRDSSs in most Chinese provinces have not yet formed the dissipative structure, but they are gradually evolving into it. The global orderliness of the sharing system is greater in eastern China than in central China and greater in central China than in western China. The potential for improving global orderliness is greater in western China than in central China and is greater in central China than in eastern China. Therefore, proper policies and measures should be adopted to accelerate the construction of SPRDSS based on the evolution of dissipative structure and to promote the sustainable development of the digital sharing economy.


Subject(s)
Digital Technology , China , Hong Kong , Macau , Taiwan , Tibet
10.
Front Public Health ; 10: 885632, 2022.
Article in English | MEDLINE | ID: covidwho-1933903

ABSTRACT

Taiwan's older population (those over the age of 65) reached ~3.95 million at the end of January 2022, accounting for around 16.9% of the country's total population. It is already an "aged society." With the gradual increase in the older population, the older people tourism market is also getting more and more attention. This article explores how older people tourism was affected by the COVID-19 pandemic (present in Tawian from early 2020), which was a major international public health event. This study adopts quantitative and PCA methods to statistically analyze the changes before and after the pandemic. The study results found that the frequency of tourism decreased after the pandemic: the number was 5.32, a decrease of 0.77, and instances of at least 1 tourist trip decreased by 3.87% after the pandemic. Regarding the reasons for not participating in tourism, during the COVID-19 pandemic, the COVID-19 accounted for a factor of 19.9%. Total travel expenses were NT$2,590, an increase of NT$229.67, and were not affected by the pandemic. We carried out a PCA analysis on tourism spending. The first component was food, accommodation, shopping, and other expenses. The factor loadings were 0.989, 0.931, 0.641 and -0.948, respectively. The second component was entertainment and transportation expenses. The factor loadings were 0.997 and 0.902, respectively. In conclusion, we put forward relevant discussions and suggestions to make tourism for older people healthier and more sustainable.


Subject(s)
COVID-19 , Aged , COVID-19/epidemiology , Humans , Pandemics , Taiwan/epidemiology , Tourism , Travel
11.
Sci Rep ; 12(1): 12053, 2022 Jul 14.
Article in English | MEDLINE | ID: covidwho-1931490

ABSTRACT

Strict and repeated lockdowns have caused public fatigue regarding policy compliance and had a large impact on several countries' economies. We aimed to evaluate the effectiveness of a soft lockdown policy and the strategy of active community screening for controlling COVID-19 in Taiwan. We used village-based daily confirmed COVID-19 statistics in Taipei City and New Taipei City, between May 2, 2021, and July 17, 2021. The temporal Gi* statistic was used to compute the spatiotemporal hotspots. Simple linear regression was used to evaluate the trend of the epidemic, positivity rate from community screening, and mobility changes in COVID-19 cases and incidence before and after a level three alert in both cities. We used a Bayesian hierarchical zero-inflated Poisson model to estimate the daily infection risk. The cities accounted for 11,403 (81.17%) of 14,048 locally confirmed cases. The mean effective reproduction number (Re) surged before the level three alert and peaked on May 16, 2021, the day after the level three alert in Taipei City (Re = 3.66) and New Taipei City (Re = 3.37). Mobility reduction and a lower positive rate were positively associated with a lower number of cases and incidence. In the spatiotemporal view, seven major districts were identified with a radial spreading pattern from one hard-hit district. Villages with a higher inflow degree centrality among people aged ≥ 60 years, having confirmed cases, specific land-use types, and with a higher aging index had higher infection risks than other villages. Early soft lockdown policy and detection of infected patients showed an effective strategy to control COVID-19 in Taiwan.


Subject(s)
COVID-19 , Bayes Theorem , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Humans , Policy , SARS-CoV-2 , Taiwan/epidemiology
12.
Biomed J ; 44(6 Suppl 1): S8-S14, 2021 12.
Article in English | MEDLINE | ID: covidwho-1930767

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) is highly contagious, with a potential to cause large nosocomial outbreaks in the hospital setting. We report the advance deployment of comprehensive, multi-level infection control measures in a 3,700-bed large hospital to prevent nosocomial outbreaks of COVID-19 during the pandemic. METHODS: We implemented a series of dynamic infection control policies during the pandemic. A confirmed COVID-19 case was defined by positive real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay. All healthcare worker (HCW) having symptoms or close contact with the confirmed case received the RT-PCR test. RESULTS: A total of 5,722 patients were tested in our hospital from January to May 2020. Twenty-five patients were confirmed COVID-19, including two inpatients. A cluster of 4 HCWs with COVID-19 associated with the 2nd inpatient was identified in the early stage of epidemic. Our enhanced traffic control bundling, mask wearing, hand hygiene and environmental cleaning were reinforced after the outbreak. All other confirmed cases were identified at our outdoor quarantine station or epidemic clinic afterwards, and the results of testing for 146 symptomatic HCWs were all negative. CONCLUSIONS: Integrated teamwork, advance deployment of infection control measures and efficient diagnostic testing and response protected HCW and facilities from large SARS-CoV-2 outbreaks and preserved the capacity and function of the health care system during the pandemic.


Subject(s)
COVID-19 , Cross Infection , COVID-19/epidemiology , Cross Infection/prevention & control , Disease Outbreaks/prevention & control , Hospitals , Humans , Infection Control/methods , Pandemics/prevention & control , SARS-CoV-2 , Taiwan/epidemiology
13.
Sci Rep ; 12(1): 11613, 2022 Jul 08.
Article in English | MEDLINE | ID: covidwho-1927100

ABSTRACT

This study reported domestic and overseas Taiwanese people's perceived stress levels and examined the mediation effect of their coping strategies during the early stages of the COVID-19 pandemic. We recruited 2727 Taiwanese respondents from the COVIDiSTRESS Global Survey (N = 173,426) between March 30 and May 30, 2020. The self-report questionnaire included a modified 10-item Perceived Stress Scale and a 16-item coping strategy scale. Three stress-coping factors were extracted with principal component analysis and confirmatory factor analysis. Their effects were examined through a regression and mediation analysis. The overseas Taiwanese participants had a significantly higher stress level than domestic counterparts (2.89 to 2.69 in 1-5 scale, p < 0.001). Government guidance was associated with lower stress level among domestic (- 0.097, 95% C.I. [- 0.131, - 0.063]) but not overseas Taiwanese (0.025, [- 0.114, 0.163]). The association of stress level with residency was mediated by coping strategies, for government guidance (0.04, [0.01, 0.07], ref: domestic participants) and supportive social networks (- 0.03, [- 0.05, - 0.01]). All results hold after the propensity score matching on samples. Government guidance on COVID-19 as a channel for coping with stress is correlated with the residency status of the respondents. Public health authorities should recognize the importance of various mental health interventions during pandemics.


Subject(s)
Adaptation, Psychological , COVID-19 , Stress, Psychological , COVID-19/epidemiology , Cross-Cultural Comparison , Humans , Mental Health , Pandemics , Stress, Psychological/epidemiology , Surveys and Questionnaires , Taiwan
14.
Asian J Anesthesiol ; 60(2): 43-45, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1919130
15.
PLoS One ; 17(6): e0265477, 2022.
Article in English | MEDLINE | ID: covidwho-1910561

ABSTRACT

The COVID-19 data analysis is essential for policymakers to analyze the outbreak and manage the containment. Many approaches based on traditional time series clustering and forecasting methods, such as hierarchical clustering and exponential smoothing, have been proposed to cluster and forecast the COVID-19 data. However, most of these methods do not scale up with the high volume of cases. Moreover, the interactive nature of the application demands further critically complex yet compelling clustering and forecasting techniques. In this paper, we propose a web-based interactive tool to cluster and forecast the available data of Taiwan COVID-19 confirmed infection cases. We apply the Model-based (MOB) tree and domain-relevant attributes to cluster the dataset and display forecasting results using the Ordinary Least Square (OLS) method. In this OLS model, we apply a model produced by the MOB tree to forecast all series in each cluster. Our user-friendly parametric forecasting method is computationally cheap. A web app based on R's Shiny App makes it easier for practitioners to find clustering and forecasting results while choosing different parameters such as domain-relevant attributes. These results could help in determining the spread pattern and be utilized by medical researchers.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cluster Analysis , Forecasting , Humans , Taiwan/epidemiology , Time Factors
16.
Int J Environ Res Public Health ; 19(10)2022 05 22.
Article in English | MEDLINE | ID: covidwho-1903374

ABSTRACT

Taiwan is expected to reach super-aged status by 2026, leading to an increased demand for elderly caregiving services. Low local unemployment and a dwindling working-age population mean the island's care system relies heavily on female foreign domestic workers (FDWs) from Southeast Asian neighbors such as Vietnam to satisfy labor shortages. Although suggested by anecdotal evidence, limited research has been conducted on the link between the shortfall in FDW qualifications, training, preparedness, and expertise and their employment stressors. Therefore, this study aims to assist FDWs by evaluating their stressors and helping them better understand health care delivery by (1) administering the Modified Caregiver Strain Index (MCSI) revised 2003 questionnaire, (2) performing semi-structured in-depth one-on-one interviews, (3) classifying interview results according to thematic analysis, and (4) using these themes to devise and deliver a 12-week multilingual health education teach-back program. Our results indicate that Vietnamese FDWs face specific challenges, including language barriers, homesickness, intensive physical and psychological work demands, stress adaptation, and occupational exposures. Despite yielding no significant improvements in caregiving strain, our intervention, conducted at the height of the COVID-19 pandemic, pinpoints and classifies areas of grave concern and proposes recommendations that can assist long-term care (LTC) stakeholders in understanding and overcoming their respective challenges, thereby improving the quality of elderly care.


Subject(s)
COVID-19 , Caregivers , Aged , Asians , COVID-19/epidemiology , Caregivers/psychology , Female , Humans , Pandemics , Pilot Projects , Quality Improvement , Taiwan , Vietnam
17.
PLoS One ; 17(3): e0263688, 2022.
Article in English | MEDLINE | ID: covidwho-1896443

ABSTRACT

BACKGROUND: During the COVID-19 surge in Taiwan, the Far East Memorial Hospital established a system including a centralized quarantine unit and triage admission protocol to facilitate acute care surgical inpatient services, prevent nosocomial COVID-19 infection and maintain the efficiency and quality of health care service during the pandemics. MATERIALS AND METHODS: This retrospective cohort study included patients undergoing acute care surgery. The triage admission protocol was based on rapid antigen tests, Liat® PCR and RT-PCT tests. Type of surgical procedure, patient characteristics, and efficacy indices of the centralized quarantine unit and emergency department (ED) were collected and analyzed before (Phase I: May 11 to July 2, 2021) and after (Phase II: July 3 to July 31, 2021) the system started. RESULTS: A total of 287 patients (105 in Phase I and 182 in Phase II) were enrolled. Nosocomial COVID-19 infection occur in 27 patients in phase I but zero in phase II. More patients received traumatological, orthopedic, and neurologic surgeries in phase II than in phase I. The patients' surgical risk classification, median total hospital stay, intensive care unit (ICU) stay, intraoperative blood loss, operation time, and the number of patients requiring postoperative ICU care were similar in both groups. The duration of ED stay and waiting time for acute care surgery were longer in Phase II (397 vs. 532 minutes, p < 0.0001). The duration of ED stay was positively correlated with the number of surgical patients visiting the ED (median = 66 patients, Spearman's ρ = 0.207) and the occupancy ratio in the centralized quarantine unit on that day (median = 90.63%, Spearman's ρ = 0.191). CONCLUSIONS: The triage admission protocol provided resilient quarantine needs and sustainable acute care surgical services during the COVID-19 pandemic. The efficiency was related to the number of medical staff dedicated to the centralized quarantine unit and number of surgical patients visited in ED.


Subject(s)
COVID-19/epidemiology , Critical Care/methods , Triage/methods , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/virology , Female , Humans , Length of Stay , Male , Middle Aged , Pandemics , Patient Admission/standards , Quarantine , Retrospective Studies , SARS-CoV-2/isolation & purification , Surgical Procedures, Operative , Taiwan/epidemiology , Tertiary Care Centers , Time-to-Treatment , Young Adult
20.
Arch Gerontol Geriatr ; 102: 104746, 2022.
Article in English | MEDLINE | ID: covidwho-1881095

ABSTRACT

BACKGROUND: Care fragmentation in the elderly population prompted the need for integrated health care systems. However, evidence regarding the impact of the integrated care system in Taiwan is unclear. We aimed to conduct a systematic review to evaluate the impact of Taiwan's integrated health care programs on geriatric population. METHODS: We searched bibliographic databases MEDLINE, Embase, Web of Science, and Airiti Library for relevant publications throughout May 2022. Studies investigating the effectiveness of Taiwan's integrated care programs were included. We used the critical appraisal skills programme (CASP) checklist, to assess the risk of bias of included studies. RESULTS: Thirty-four studies, with a total of 838,026 study subjects, were assessed. The systematic review on 11 subthemes (diabetes mellitus, chronic kidney disease, hepatitis C virus, fractures, cancer, dementia, atrial fibrillation, chronic obstructive pulmonary disease, mechanical ventilation, terminal illness, outpatients and community-dwelling patients), demonstrated that the implementation of integrated health care could not only provide benefits on survival, self-care ability, health quality, physical, and functional rehabilitation outcomes, but also significantly reduce medical utilization and expenditures. CONCLUSION: The integrated health care system for multiple morbidities benefits the Taiwanese geriatric population in physical and functional outcomes. The thematic synthesis provides references for future rigorous clinical trials.


Subject(s)
Delivery of Health Care , Health Expenditures , Aged , Humans , Taiwan/epidemiology
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