The Impact of Psychological Burdens and Vaccine Worries on Confidence and Adherence to Governmental Policies Against COVID-19 Among Patients with Substance Use Disorder: A Cross-Sectional Study in Taiwan.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had an impact on patients with substance use disorder (SUD). We aimed to investigate factors associated with confidence and adherence to governmental policies against COVID-19 (social desirability) among patients with SUD. Methods: This cross-sectional study was conducted during 2020 to 2021. Patients with SUD and healthy controls were recruited. The severity of sleep disturbance, social desirability, drug dependence, vaccine worries, other psychological burdens and demographic variables were collected through self-administrated questionnaires. Differences between the SUD and control groups were estimated. Hierarchical regression analysis was used to identify significant relationships between social desirability and other factors. Results: In total, 58 of patients with SUD and 47 healthy controls were recruited. The patients with SUD had a lower level of social desirability and more severe sleep disturbance than the control group. Older age, more severe sleep disturbance, lower level of drug dependence, and lower level of vaccine worries were significantly associated with a higher level of social desirability among the patients with SUD. Conclusion: Our results show the importance of timely interventions for drug dependence and to address vaccine worries in patients with SUD.

The social and mental impact on healthcare workers: A comparative and cross-sectional study during two waves of the COVID-19 pandemic in Taiwan.

The coronavirus disease 2019 (COVID-19) pandemic has caused a heavily burden on healthcare workers (HCWs) worldwide. The aim of this study was to compare differences in psychological and social impact between two waves of the pandemic among first- and second-line HCWs in Taiwan. The current study derived data from two cross-sectional surveys conducted in 2020 and 2021. Levels of depression, sleep disturbance, psychological distress, social impact, and demographic variables were collected through self-reported questionnaires. The independent t test was used to compare differences in scores between the first and second wave of the pandemic. Differences between first- and second-line HCWs were also analyzed. A total of 711 HCWs in the first wave and 560 HCWs in the second wave were recruited. For the first- and second-line HCWs, the social impact during the second wave was higher than during the first wave, and they expressed a higher intention to maintain social distancing and were more aware of the pandemic overseas in the second wave. The first-line HCWs had a trend of worse sleep quality during the second wave. In addition, sleep quality was worse in the first-line HCWs than in the second-line HCWs during both waves. The second-line HCWs expressed a greater desire to seek COVID-19-related information than the first-line HCWs during the first wave, and more intended to maintain social distancing during the second wave. Our results show the importance of evaluating the social and mental health burden of HCWs, and especially first-line workers.

Relationship of Societal Adaptation with Vaccine Worries among Healthcare Workers during the COVID-19 Pandemic: The Mediating Effects of Posttraumatic Stress Disorder.

Vaccine hesitancy has become a major public health problem among healthcare workers (HCWs) in this coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to examine the relationship between societal adaptation and vaccine worries and the mediating effects of posttraumatic stress disorder (PTSD) indicators in HCWs. A total of 435 HCWs (327 women and 108 men) were recruited. Their levels of societal adaptation were evaluated using the Societal Influences Survey Questionnaire (SISQ). Their severity and frequency of PTSD symptoms were examined using the Disaster-Related Psychological Screening Test (DRPST). The severity of vaccine worries was assessed using the Vaccination Attitudes Examination (VAX) Scale. The relationships among societal adaptation, PTSD, and vaccine worries were examined using structural equation modeling. The severity of societal adaptation was positively associated with both the severity of PTSD and the severity of vaccine worries. In addition, the severity of PTSD indicators was positively associated with the severity of vaccine worries. These results demonstrated that the severity of societal adaptation was related to the severity of vaccine worries, either directly or indirectly. The indirect relationship was mediated by the severity of PTSD. Societal adaptation and PTSD should be taken into consideration by the community of professionals working on vaccine hesitancy. Early detection and intervention of PTSD should be the objectives for programs aiming to lower vaccine hesitancy among HCWs.

Melanoma Detection Using XGB Classifier Combined with Feature Extraction and K-Means SMOTE Techniques.

Melanoma, a very severe form of skin cancer, spreads quickly and has a high mortality rate if not treated early. Recently, machine learning, deep learning, and other related technologies have been successfully applied to computer-aided diagnostic tasks of skin lesions. However, some issues in terms of image feature extraction and imbalanced data need to be addressed. Based on a method for manually annotating image features by dermatologists, we developed a melanoma detection model with four improvement strategies, including applying the transfer learning technique to automatically extract image features, adding gender and age metadata, using an oversampling technique for imbalanced data, and comparing machine learning algorithms. According to the experimental results, the improved strategies proposed in this study have statistically significant performance improvement effects. In particular, our proposed ensemble model can outperform previous related models.

Priority Criteria for Community-Based Care Resource Allocation for Health Equity: Socioeconomic Status and Demographic Characteristics in the Multicriteria Decision-Making Method.

SDG 10 stipulates that inequality within and between countries can be reduced by governmental policies that focus on the allocation of fiscal resources and social protection strategies to improve equity. The sustainability of community-based care stations is a crucial support network for achieving the goal of active aging. Unequal allocation would occur only if the populations of administrative districts are considered. Comprehensive policies, in accordance with data and sustainable goals, must consider multiple factors. Hence, this study used multicriteria decision making (MCDM) to investigate how nine criteria-related socioeconomic statuses (SES) and demographic characteristics are prioritized in community resource and funding allocation. Thirty-four community care and aging experts were invited to complete a questionnaire based on the modified Delphi method and the analytical hierarchy process (AHP) method. The assessment criteria for the allocation of community resources are prioritized in the following order: disability level, age, household composition, identity of social welfare, family income, ethnicity, marital status, educational attainment, and gender. Quantitative indices can be used to determine the importance of resource allocation policymaking. The benefit of this study lies in decision makers' application of ranking and weighting values in public funding allocation ratios for community-based care resources for health equity in Taiwan.

COVID-related psychological distress fully mediates the association from social impact to sleep disturbance among patients with chronic schizophrenia.

The aims of the current study were to identify factors associated with sleep disturbance and Coronavirus disease-19 related psychological distress (CPD), and to develop a conceptual model to verify the mediating effect of CPD on the association between social impact and sleep disturbance. This study recruited patients with schizophrenia. Factors associated with the level of sleep disturbance and CPD were identified using univariate linear regression, and further selected into a stepwise multivariate linear regression model. Using structural equation modeling, a mediation model was developed to test the mediating effect of CPD on the association between social impact and sleep disturbance. After estimating with the stepwise and bootstrap regression, higher levels of CPD were associated with higher levels of social anxiety and subjects without a regular diet. Sleep disturbance was associated with a higher level of social anxiety, a history of psychological trauma, chronic disease, and those who did not smoke. The final model confirmed the mediating effects of CPD; whereas, the direct effect from social impact to sleep disturbance did not reach statistical significance. The current study manifests the crucial role of CPD on the association between social impact and sleep disturbance, and timely intervention for CPD is warranted.

Integrating Socioeconomic Status and Spatial Factors to Improve the Accessibility of Community Care Resources Using Maximum-Equity Optimization of Supply Capacity Allocation.

Health promotion empowers people, communities, and societies to take charge of their own health and quality of life. To strengthen community-based support, increase resource accessibility, and achieve the ideal of aging, this study targets the question of maximum equity with minimum values, taking distances and spatial and non-spatial factors into consideration. To compare disparities in the accessibility of community care resources and the optimization of allocation, methods for community care resource capacity were examined. This study also investigates units based on basic statistical area (BSA) to improve the limitation of larger reference locations (administrative districts) that cannot reflect the exact locations of people. The results show the capacity redistribution of each service point within the same total capacity, and the proposed method brings the population distribution of each demand to the best accessibility. Finally, the grading system of assessing accessibility scarcity allows the government to effectively categorize the prior improvement areas to achieve maximum equity under the same amount of care resources. There are 2046 (47.26%) and 396 (9.15%) BSAs that should be improved before and after optimization, respectively. Therefore, integrating socioeconomic status and spatial factors to assess accessibility of community-based care resources could provide comprehensive consideration for equal allocation.

Accessibility Assessment of Community Care Resources Using Maximum-Equity Optimization of Supply Capacity Allocation.

Equity in accessible healthcare is crucial for measuring health equity in community care policy. The most important objective of such a policy in Taiwan is empowering people and communities by improving health literacy and increasing access to healthcare resources. Using the nearest-neighbor two-step floating catchment area method, this study performed an accessibility assessment for community care resources before and after supply capacity optimization. For the target of maximum equity when allocating community care resources, taking maximum values, mean values and minimum values of the distances into consideration, three analytical allocation solutions for supply capability optimization were derived to further compare disparities in geographical accessibility. Three indicators, namely, the Gini coefficient, median minus mean and mean-squared error, were employed to assess the degree of optimization of geographical accessibility scores at the locations of the demand population and to determine the degree of geographic inequities in the allocation of community care resources. Our study proposed a method in which the minimum value of the distance is adopted as the approximate representation of distances between the service point and the locations of demand to determine the minimum value for supply capacity optimization. The study found that the method can effectively assess inequities in care resource allocation among urban and rural communities.

Investigating Health Equity and Healthcare Needs among Immigrant Women Using the Association Rule Mining Method.

Equitable access to healthcare services is a major concern among immigrant women. Thus, this study investigated the relationship between socioeconomic characteristics and healthcare needs among immigrant women in Taiwan. The secondary data was obtained from "Survey of Foreign and Chinese Spouses' Living Requirements, 2008," which was administered to 5848 immigrant women by the Ministry of the Interior, Taiwan. Additionally, descriptive statistics and significance tests were used to analyze the data, after which the association rule mining algorithm was applied to determine the relationship between socioeconomic characteristics and healthcare needs. According to the findings, the top three healthcare needs were providing medical allowances (52.53%), child health checkups (16.74%), and parental knowledge and pre- and post-natal guidance (8.31%). Based on the association analysis, the main barrier to the women's healthcare needs was "financial pressure." This study also found that nationality, socioeconomic status, and duration of residence were associated with such needs, while health inequality among aged immigrant women was due to economic and physical factors. Finally, the association analysis found that the women's healthcare problems included economic, socio-cultural, and gender weakness, while "economic inequality" and "women's health" were interrelated.

Assessment on Distributional Fairness of Physical Rehabilitation Resource Allocation: Geographic Accessibility Analysis Integrating Google Rating Mechanism.

Identifying and treating co-existing diseases are essential in healthcare for the elderly, while physical rehabilitation care teams can provide interdisciplinary geriatric care for the elderly. To evaluate the appropriateness of demand and supply between the population at demand and physical rehabilitation resources, a comparative analysis was carried out in this study. Our study applied seven statistical indices to assess five proposed methods those considered different factors for geographic accessibility analysis. Google ratings were included in the study as a crucial factor of choice probability in the equation for calculating the geographic accessibility scores, because people's behavioral decisions are increasingly dependent on online rating information. The results showed that methods considering distances, the capacity of hospitals, and Google ratings' integrally generated scores, are in better accordance with people's decision-making behavior when they determine which resources of physical rehabilitation to use. It implies that concurrent considerations of non-spatial factors (online ratings and sizes of resource) are important. Our study proposed an integrated assessment method of geographical accessibility scores, which includes the spatial distribution, capacity of resources and online ratings in the mechanism. This research caters to countries that provide citizens with a higher degree of freedom in their medical choices and allows these countries to improve the fairness of resource allocation, raise the geographic accessibilities of physical rehabilitation resources, and promote aging in place.

Evaluating Disparities in Elderly Community Care Resources: Using a Geographic Accessibility and Inequality Index.

This study evaluated geographic accessibility and utilized assessment indices to investigate disparities in elderly community care resource distribution. The data were derived from Taiwanese governmental data in 2017, including 3,148,283 elderly individuals (age 65+), 7681 villages, and 1941 community care centers. To identify disparities in geographic accessibility, we compared the efficacy of six measurements and proposed a composite index to identify levels of resource inequality from the Gini coefficient and “median-mean” skewness. Low village-level correlation (0.038) indicated inconsistencies between the demand populations and community care center distribution. Method M6 (calculated accessibility of nearest distance-decay accounting for population of villages, supplier loading, and elderly walkability) was identified as the most comprehensive disparity measurement. Community care policy assessment requires a comprehensive and weighted calculation process, including the elderly walkability distance-decay factor, demand population, and supplier loading. Three steps were suggested for elderly policy planning and improvement in future.

A Cross Cultural Comparison of Attitude of Mental Healthcare Professionals Towards Involuntary Treatment Orders.

The purpose of this study was to investigate East-West cultural attitudes of mental healthcare professionals (MHPs) towards Involuntary Treatment Orders (ITOs) among Taiwan, England, Wales, and New Zealand. Data on Taiwanese MHPs' views of ITO regime were collected from the National Psychiatric Disease Mandatory Assessment and Community Care Review Committee (N = 176). A national survey instrument was designed to assess the level of support for ITOs among senior clinicians and to determine their views on the importance of various factors in decision-making, the mechanisms through which coercion may work, impediments to its use, and its perceived impact on patients and therapeutic relationships. A descriptive analysis was carried out with data presented as appropriate for the distribution and a t-test was used to detect any differences by respondents. Risk reduction was ranked the most important factor in use of ITOs and reasons for discharging an order. Female respondents had higher approval ratings, with 85 % of agreeing that ITOs were of benefit to the therapeutic relationship, assured long-term stability, and increased medication compliance. The results suggest that clinicians decide the use of ITOs largely based on the risk management, both in terms of starting and ending an order. However, the use of ITOs vary which reflected in the practice. Given this variation in the use of enabling legislation, multidisciplinary input in decision-making is an essential safety mechanism.

Sociocultural Factors Associated with Caregiver-Psychiatrist Relationship in Taiwan.

OBJECTIVE: Research on sociocultural factors associated caregiver-provider relationship is needed to enhance family involvement in psychiatric care. This study examines from the caregiver's perspective the associations of schizophrenia attributions, stigmatization, and caregiving experiences with caregiver-psychiatrist working relationship in Taiwan. METHODS: This cross-sectional study used a convenience sample of 152 Taiwanese family caregivers of persons diagnosed with schizophrenia, recruited from a grassroots organization, 4 community mental health rehabilitation centers and 2 psychiatric hospitals between July 2012 and March 2013. Multiple linear regression models were used for analysis. RESULTS: Biological attribution was positively associated with perceived family collaboration, and so was environmental attribution with perceived informational support. Internalized stigma was negatively associated with perceived family collaboration. Caregiving rewards were positively related to both perceived family collaboration and informational support, and so was experience of problems with services to perceived family collaboration. CONCLUSION: The examination of family perceptions informs Western psychiatric care providers of the importance of culturally sensitive practices in developing an effective working relationship with family caregivers, particularly in regards to caregivers' casual attributions, impact of stigma, and caregiving experiences.

Cholesterol-lowering potentials of lactic acid bacteria based on bile-salt hydrolase activity and effect of potent strains on cholesterol metabolism in vitro and in vivo.

This study collected different probiotic isolates from animal and plant sources to evaluate the bile-salt hydrolase activity of probiotics in vitro. The deconjugation potential of bile acid was determined using high-performance liquid chromatography. HepG2 cells were cultured with probiotic strains with high BSH activity. The triglyceride (TG) and apolipoprotein B (apo B) secretion by HepG2 cells were evaluated. Our results show that the BSH activity and bile-acid deconjugation abilities of Pediococcus acidilactici NBHK002, Bifidobacterium adolescentis NBHK006, Lactobacillus rhamnosus NBHK007, and Lactobacillus acidophilus NBHK008 were higher than those of the other probiotic strains. The cholesterol concentration in cholesterol micelles was reduced within 24 h. NBHK007 reduced the TG secretion by 100% after 48 h of incubation. NBHK002, NBHK006, and NBHK007 could reduce apo B secretion by 33%, 38%, and 39%, respectively, after 24 h of incubation. The product PROBIO S-23 produced a greater decrease in the total concentration of cholesterol, low-density lipoprotein, TG, and thiobarbituric acid reactive substance in the serum or livers of hamsters with hypercholesterolemia compared with that of hamsters fed with a high-fat and high-cholesterol diet. These results show that the three probiotic strains of lactic acid bacteria are better candidates for reducing the risk of cardiovascular disease.

Decision tree based diagnostic system for moderate to severe obstructive sleep apnea.

One of the major modern medical issues, obstructive sleep apnea (OSA), particularly at moderate to severe levels, may potentially cause cardiovascular morbidity and mortality. However, polysomnography (PSG), a gold standard tool in diagnosing OSA, is cumbersome, has limited availability, and is costly and time-consuming. Clinical prediction models thus are absolutely necessary in screening patients with OSA. Furthermore, the performance of the published prediction formulas is not satisfactory for Chinese populations. The aim of this study was to develop and validate a simple and accurate prediction system for the diagnosis of moderate to severe OSA by integrating an expert-based feature extraction technique with decision tree algorithms which have automatic feature selection capability in screening the moderate to severe OSA cases in Taiwan. Moreover, the backward stepwise multivariable logistic regression model and four other decision tree algorithms were also employed for comparison. The results showed that the proposed best prediction formula, with an overall accuracy reaching to 96.9 % in sensitivity = 98.2 % and specificity = 93.2 %, could present a good tool for screening moderate and severe Taiwanese OSA patients who require further PSG evaluation and medical intervention. Results also indicate that the proposed best prediction formula is simple, accurate, and reliable, and outperforms all the other prediction formulae considered in the present study. The proposed clinical prediction formula derived from three non-invasive features (Sex, Age, and AveSBP) may help prioritize patients for PSG studies as well as avoid a diagnosis of PSG in subjects who have a low probability of having the disease.

Influences of attribution and stigma on working relationships with providers practicing Western psychiatry in the Taiwanese context.

This study examined influences of causal attributions of schizophrenia and perceived and internalized mental illness stigma on perceived working alliance with, and informational support received from doctors practicing Western psychiatry in the Taiwanese social-cultural context. This cross-sectional quantitative study used a non-probability, purposive sampling technique to recruit 212 Taiwanese diagnosed with schizophrenia from Taiwanese Alliance of the Mentally Ill, 4 community mental health rehabilitation centres and 2 psychiatric hospitals between July 2012 and March 2013. Linear regression models were used for analysis. The results showed that environmental attributions were positively associated with both perceived working alliance and perceived informational support, while supernatural attributions were negatively associated with perceived working alliance and perceived informational support. Perceived stigma had a negative association with perceived working alliance. The discrimination domain of internalized stigma specifically had a positive association with perceived working alliance, while the withdraw domain had a negative association with perceived informational support. Findings inform the importance of culturally sensitive practices in developing an effective working relationship. Western psychiatric care providers need to explore consumers' casual attributions of mental illness and understand the impact of stigma so that providers may successfully engage consumers in care and provide tailored illness education and information.

Developing screening services for colorectal cancer on Android smartphones.

INTRODUCTION: Colorectal cancer (CRC) is an important health problem in Western countries and also in Asia. It is the third leading cause of cancer deaths in both men and women in Taiwan. According to the well-known adenoma-to-carcinoma sequence, the majority of CRC develops from colorectal adenomatous polyps. This concept provides the rationale for screening and prevention of CRC. Removal of colorectal adenoma could reduce the mortality and incidence of CRC. Mobile phones are now playing an ever more crucial role in people's daily lives. The latest generation of smartphones is increasingly viewed as hand-held computers rather than as phones, because of their powerful on-board computing capability, capacious memories, large screens, and open operating systems that encourage development of applications (apps). SUBJECTS AND METHODS: If we can detect the potential CRC patients early and offer them appropriate treatments and services, this would not only promote the quality of life, but also reduce the possible serious complications and medical costs. In this study, an intelligent CRC screening app on Android™ (Google™, Mountain View, CA) smartphones has been developed based on a data mining approach using decision tree algorithms. For comparison, the stepwise backward multivariate logistic regression model and the fecal occult blood test were also used. RESULTS: Compared with the stepwise backward multivariate logistic regression model and the fecal occult blood test, the proposed app system not only provides an easy and efficient way to quickly detect high-risk groups of potential CRC patients, but also brings more information about CRC to customer-oriented services. CONCLUSIONS: We developed and implemented an app system on Android platforms for ubiquitous healthcare services for CRC screening. It can assist people in achieving early screening, diagnosis, and treatment purposes, prevent the occurrence of complications, and thus reach the goal of preventive medicine.

A cloud medication safety support system using QR code and Web services for elderly outpatients.

BACKGROUND: Drug is an important part of disease treatment, but medication errors happen frequently and have significant clinical and financial consequences. The prevalence of prescription medication use among the ambulatory adult population increases with advancing age. Because of the global aging society, outpatients need to improve medication safety more than inpatients. OBJECTIVE: The elderly with multiple chronic conditions face the complex task of medication management. To reduce the medication errors for the elder outpatients with chronic diseases, a cloud medication safety supporting system is designed, demonstrated and evaluated. METHODS: The proposed system is composed of a three-tier architecture: the front-end tier, the mobile tier and the cloud tier. The mobile tier will host the personalized medication safety supporting application on Android platforms that provides some primary functions including reminders for medication, assistance with pill-dispensing, recording of medications, position of medications and notices of forgotten medications for elderly outpatients. Finally, the hybrid technology acceptance model is employed to understand the intention and satisfaction level of the potential users to use this mobile medication safety support application system. RESULTS: The result of the system acceptance testing indicates that this developed system, implementing patient-centered services, is highly accepted by the elderly. CONCLUSION: This proposed M-health system could assist elderly outpatients' homecare in preventing medication errors and improving their medication safety.

Quality of life and self-stigma in individuals with schizophrenia.

Recent mental illness stigma research has almost exclusively studied community and family responses to the stigmas of mental illness. Too little has been done to understand the current subjective experience of psychiatric patients. Our study explores the influence of self-stigma on the quality of life of mentally disabled people. Participating in the survey were 100 people diagnosed with schizophrenia. Using Ritsher's internalized stigma of mental illness scale, which incorporates alienation, stereotype endorsement, discrimination experience, social withdrawal, and social resistance subscales, along with the standard SF-12, helped us evaluate the subjective experience of mental illness stigma. According to our survey data, self-stigma correlates negatively with all of the quality of life measures except the Internalized Stigma of Mental Illness subscale's 'stigma resistance', which did not correlate significantly. Improved stigma resistance requires an understanding of one's sociocultural background and a strong social network to provide the sense of comfort and security that enables a fulfilling life.

The protective effects of resilience and hope on quality of life of the families coping with the criminal traumatisation of one of its members.

AIM: This paper investigated the possible predictive and mediating determinates of quality of life in this often forgotten population, focusing specifically on the role of sociodemographics, mental impairments, coping mechanisms, resilience and hope on subjective quality of life. BACKGROUND: The family members of survivors of man-made trauma are sometimes severely traumatised themselves and may suffer from post-traumatic stress disorder, depression and poor quality of life. Most studies focus on the victims and ignore the effect of the incidents on the victim's family members. METHOD: Data were collected between October 2007-March 2008, a self-report questionnaire incorporating seven scales was administrated to 175 family members of victims of man-made trauma. One-way anova was performed to compare the variance in the reported quality of life. The structural equation models of path analysis was used to evaluate the main effects and interactions and interrelations among variables. RESULTS: Of the psychosocial factors, having a personal previous traumatic experience was found to significantly affect post-traumatic stress disorder, depression and physical health. Post-traumatic stress disorder and depression were found to directly and indirectly affect quality of life. Coping mechanism, resilience and a hope state mediated the effect of post-traumatic stress disorder and depression making the three significant predictors of subjective quality of life. CONCLUSION: Based on these findings and the scores of the different scales, clinicians may be able to design treatment plans that encourage the poorly adapting family members of victims of trauma, especially those with symptoms of post-traumatic stress disorder or depression, to accept changes as a part of life, nurture a positive view of the self, make connections for better social support and maintain or re-create a hopeful outlook towards life goals. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the psychosocial factors associated with resistance to severe trauma can also help in the prevention and treatment of individuals at high risk for developing post-traumatic stress disorder or depression.