Public Fear and Risk Perception During Dengue Fever Outbreak in Taiwan.

This study aimed to understand the public reaction to the 2015 dengue outbreak in Taiwan by determining the key influencing factors. A total of 1104 respondents aged 18 years and over, were recruited by telephone between November 20 and 28, 2015, to investigate fear, risk perception, and psychological distress during the dengue outbreak. Multiple logistic regression analysis showed that fear of dengue was more prevalent in the areas that were most affected, as well as those with infected friends or relatives. Fear was also more pronounced among females and the elderly group, especially in terms of perceived risk of infection, severity of the infection, the uncertain cured rate, the adverse effects on daily life, in which all lead to psychological distress. Fear of dengue fever, perceived risk of dengue infection, and psychological distress associated with the dengue fever pandemic were the main variables investigated in this study. Since media mass can serve as a unified platform for all public health communications, it is recommended that the government utilizes the power of media to deliver pandemic prevention measures. Specifically, health education interventions related to risk communication should focus on the most infected areas while taking gender and age into consideration.

Risk Perceptions, Level of Government Trust, and Psychological Distress During COVID-19 Pandemic in Taiwan.

Purpose: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading worldwide, causing mental health concerns among people. People's perceptions of the disease affect their psychological adaptation and health outcomes. In this study, we present people's perceptions of coronavirus disease 2019 (COVID-19), level of government trust, and their psychological distress during the pandemic for examining the impact of peoples' COVID-19 perceptions on their mental health. Patients and Methods: This cross-sectional study was conducted through a telephone survey in Taiwan in April 2020. Participants were randomly selected for telephone screening using a computer-assisted telephone interviewer system. A total of 1098 participants aged more than 20 years participated in the survey. Results: The mean age of participants was 47.7 ± 16.4 years. After controlling for covariates, participants who were worried about contracting COVID-19, those who believed that they had a chance of being infected with COVID-19, those who were reluctant to visit the hospital for fear of contracting the virus, those who felt that the pandemic had affected their daily life, and those with low levels of trust in the government's capacity to manage the pandemic had anxiety, hostility, depression, interpersonal sensitivity/inferiority, and psychological symptoms. Conclusion: People's perception of COVID-19 and public's trust in the government's ability to respond to the pandemic are related to psychological distress. Although the Taiwanese government may have undertaken effective epidemic control measures to address with the COVID-19 pandemic, this crisis may have still caused mental health problems in the general population. Health professionals and policy makers should pay more attention to high-risk groups among those at risk for developing mental health problems.

Comparisons of aortic remodelling and outcomes after endovascular repair of acute and chronic complicated Type B aortic dissections.

OBJECTIVES: Patients with acute (ACTBAD) or chronic complicated Type B aortic dissection (CCTBAD) undergoing thoracic endovascular aortic repair (TEVAR) remain at high risk for late aorta-related events. Few data exist on the comparison of aortic remodelling and outcomes after TEVAR between both groups. METHODS: Forty-nine patients of TEVAR for CCTBAD (n = 26) and ACTBAD (n = 23) were retrospectively reviewed at our centre. RESULTS: The overall 30-day mortality was 4%. Cumulative freedom from all-cause mortality (ACTBAD: 77.6%, CCTBAD: 68.8%; P = 0.76), aneurysmal-related mortality (ACTBAD: 88.2%, CCTBAD: 95.0%; P = 0.63) and the 3-year reintervention rate (ACTBAD: 92.3%, CCTBAD: 95.6%; P = 0.94) were the same in both groups. Aortic remodelling was significant (P < 0.001) above the coeliac level after TEVAR. Thirty-five (75.5%) patients still experienced false lumen flow in the abdominal aorta below the coeliac artery (ACTBAD: 16, CCTBAD: 19, P = 0.10). No difference was found in aortic remodelling between the ACTBAD and CCTBAD groups, and the length of endograft coverage had no impact on the aortic remodelling. CONCLUSIONS: The early and 3-year follow-up in our study showed that endovascular repair for both ACTBAD and CCTBAD was safe and effective. Aortic remodelling was favourable above the coeliac artery after TEVAR, and no difference was found between ACTBAD and CCTBAD. The length of endograft coverage had no impact on aortic remodelling. The low rate of false lumen thrombosis in the abdominal aorta warranted continuous imaging surveillance.

Factors influencing interest in recreational sports participation and its rural-urban disparity.

OBJECTIVES: Recreational sports are important leisure activities. However, most studies investigating barrier factors and motivation for participation in recreational sports have been limited to specific areas (e.g., a city or school) or demographic groups (e.g., adolescents). Therefore, this study set out to gain a more comprehensive understanding of the behavioral and socioeconomic factors influencing interest in recreational sports participation in Taiwan, as well as to evaluate the effect of any urban-rural divide. METHODS: This study analyzed data collected by the "Taiwan Social Change Survey" (program five, wave 3) "Leisure Life" questionnaire. We used hierarchical linear modeling to assess respondent interest in recreational sports participation and evaluated the influence of behavioral factors, socioeconomic factors, and residence location (urban/rural). RESULTS: Of the 2,146 participants in this study, 50.3% were male, and the average age was 43.9 years. Location of residence (urban/rural) accounted for 35.3% of the variation in interest in recreational sports participation, while the remaining 64.7% came from the individual level. Participants who lived in rural settings were less interested in recreational sports than their urban counterparts. Gender, educational attainment, participation frequency, health-motivated interest, and appearance-motivated interest were also associated with interest in recreational sports participation. CONCLUSIONS: Different communication strategies may be needed to effectively reach different demographic groups. We suggest that future public health campaigns aiming to increase recreational sports participation include tailored interventions and messages to effectively encourage leisure physical activities among all, regardless of demographic boundaries.

Potential media influence on the high incidence of medical disputes from the perspective of plastic surgeons.

BACKGROUND/PURPOSE: The main purpose of this study is to investigate the prevalence of medical disputes among plastic surgeons in Taiwan and to elucidate their perspectives regarding the influence of medical litigation media coverage on the physician-patient relationship. METHODS: A self-administered questionnaire was distributed among plastic surgeons attending a series of continuing education training lectures organized by the Taiwan Society of Plastic Surgery in 2015. RESULTS: Of the 109 respondents, over a third (36.4%) had previously experienced a medical dispute. The vast majority of both physicians who had medical disputes (77.1%) and those who did not (72.1%) felt that the media tends to be supportive of patients in their reporting, and 37.1% of all plastic surgeons felt that the media always portrays the patient as a victim. Respondents who experienced medical disputes in this study felt that the top five leading causes of the high incidence of medical disputes were patient disappointment with procedure results (81.1%), insufficient patient psychological preparation or emotional instability (61.7%), inadequate risk communication on the part of the physician (64.9%), patient uneasiness with the procedure or perception of carelessness (60.6%), and insufficient physician training or incorrect medical evaluation (57.4%). CONCLUSION: Over a third of the respondents had previously experienced a medical dispute. This study highlights the perception among plastic surgeons that the media reporting of medical disputes and medical litigation is biased in favor of the patients, with 37.1% of the plastic surgeons surveyed opining that patients are always cast as victims.

Influence of Socioeconomic Factors, Gender and Indigenous Status on Smoking in Taiwan.

The indigenous Austronesian minority of Taiwan is heavily affected by health disparities which may include suffering from a greater burden of the tobacco epidemic. While a lack of representative data has historically precluded an investigation of the differences in smoking between Taiwanese ethnicities, these data have recently become available through an annual population-based telephone survey conducted by the Health Promotion Administration, Ministry of Health and Welfare (previously known as the Bureau of Health Promotion (BHP), Department of Health). We used the BHP monitoring data to observe the prevalence of smoking and environmental tobacco smoke exposure among indigenous and non-indigenous Taiwanese surrounding a tobacco welfare tax increase in 2006, investigate ethnic differences in smoking prevalence and environmental tobacco smoke exposure each year between 2005 and 2008, and perform multiple logistic regression to estimate measures of association between potential risk factors and smoking status. Despite significant ethnic and gender differences in smoking prevalence, smoking status was not found to be significantly associated with ethnicity after controlling for socioeconomic and demographic factors.

Fast Versus Slow Strategy of Switching Patients With Schizophrenia to Aripiprazole From Other Antipsychotics.

This study aimed to compare strategies differing in the speed of switching schizophrenic patients to aripiprazole from other antipsychotic agents, with dual administration for 2 weeks and then tapering off the current antipsychotic in fast (within 1 week) versus slow (within 4 weeks) strategies. This 8-week, open-label, randomized, parallel study assigned patients with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of schizophrenia or schizoaffective disorder to either the fast-switching (n = 38) or slow-switching (n = 41) group. Efficacy assessments at 5 time points included Positive and Negative Syndrome Scale and Clinical Global Impression scale. Safety assessments included extrapyramidal symptoms, metabolic profile, serum prolactin level, QTc interval, and adverse events. Drug concentrations and cytochrome P450 CYP2D6 and CYP3A4 genotypes were also measured. The fast- and slow-switching groups were comparable in demographical and clinical features at baseline and dropout rate. In the intention-to-treat analysis using mixed-effects models, there were significant within-group decreases over time in the Positive and Negative Syndrome Scale total scores (P = 0.03) and its subscores except for positive subscores, whereas no between-group differences were found. A reduction in body weight (P = 0.01) and lower levels of total cholesterol (P = 0.03), triglycerides (P = 0.03), and prolactin (P = 0.01) were noted in both groups but no increase in extrapyramidal symptoms or prolongation of QTc. The blood concentrations of aripiprazole in all patients were in a therapeutic range at day 56, with CYP2D6*10 polymorphisms being associated with aripiprazole concentrations. In conclusion, there is no significant difference between the fast- and slow-switching strategy in terms of improvements in clinical symptoms and metabolic profile in this 8-week study.

Crossover chimney technique to preserve the internal iliac artery during endovascular repair of iliac or aortoiliac aneurysms: midterm results.

PURPOSE: To report our midterm results of the crossover chimney technique to preserve the internal iliac artery (IIA) in patients with aortoiliac aneurysms (AIA) and isolated common iliac artery aneurysms (CIAA). METHODS: Between May 2012 and January 2014, 14 consecutive patients (mean age 77.3 years; all men) with 17 AIA, isolated CIAAs, or abdominal aortic aneurysms with short CIAs underwent elective endovascular aneurysm repair (EVAR) with the crossover chimney technique to preserve the IIA. Follow-up assessment, including computed tomographic angiography or duplex ultrasound, was performed at 1, 6, and 12 months and annually thereafter. RESULTS: Technical success, defined as successful preservation of IIA without intraoperative type I or III endoleak, was 100%. Over a mean 14.3 months (range 6-21), primary patency was 92.8%. There was no early or late procedure-related mortality. Among the 17 iliac aneurysms excluded, the sac diameter significantly (at least 5 mm) decreased in 3, decreased <5 mm in 10, and did not change in 4. CONCLUSION: The crossover chimney technique is a simple and safe alternative for IIA endovascular revascularization with high technical success and acceptable midterm patency.

Biomarkers of early sepsis may be correlated with outcome.

BACKGROUND: Sepsis causes high mortality, and the mortality due to secondary infections is even higher. No studies to date have investigated the time from the primary infection to death due to a secondary infection; similarly, the factors that are significantly different in sepsis survivors relative to non-survivors or in severe sepsis patients who suffered a late death relative to those who recover have not been explored. We hypothesized that patients who survive sepsis have a weaker pro-inflammatory response than those who do not and that the mid-term survivors (which acquire secondary infections) would have a pronounced anti-inflammatory response (making them susceptible to infection); this hypothesis was verified in this study. METHODS: We examined 24 patients with severe sepsis; the patients were subdivided by outcome into early death (n=5), mid-term survival (survival through severe sepsis but death within six months or continued hospitalization for six months, n=6), and long-term survival (recovery and survival for more than six months, n=13) groups. The levels of CD3+, CD4+, CD8+, and CD19+ lymphocytes were analyzed by flow cytometry, and the plasma levels of carbonic anhydrase IX (CA IX), MCP-1, IL-6, IL-7, IL-8, and IL-10 were measured by ELISA on days 0, 1, 2, and 3. A statistical comparison of the variables in the groups was conducted using a mixed model. RESULTS: The plasma levels of MCP-1, IL-6, and IL-8 in early death and survivors were significantly different, and all had p values<0.01. The plasma levels of MCP-1, IL-6, and IL-8 were also significantly different in mid-term survivors and long-term survivors, with p values of <0.01, 0.04, and <0.01, respectively. CONCLUSIONS: Our data support the hypothesis that survivors have a weaker pro-inflammatory response than non-survivors, but the mid-term survivors did not have a more pronounced anti-inflammatory response. The levels of pro-inflammatory cytokines in the mid-term and long-term survivors were significantly different.

Predicting high vancomycin minimum inhibitory concentration isolate infection among patients with community-onset methicillin-resistant Staphylococcus aureus bacteraemia.

OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) isolates with an elevated vancomycin MIC ≥2 mg/L have been increasingly identified in many countries. We aimed to develop a clinical score to predict vancomycin MIC ≥2 mg/L in patients with community-onset MRSA bacteraemia. METHODS: This retrospective cohort study enrolled 394 patients with MRSA bacteraemia. Vancomycin MICs of all MRSA isolates were determined by agar dilution method. Clinical characteristics between patients with high (≥2 mg/L) and low (≤1 mg/L) vancomycin MIC MRSA bacteraemia were compared. Independent predictors of high vancomycin MIC isolate infection were identified and used to create a score-based predictive model. RESULTS: Among the 394 study patients, 56 (14.2%) had MRSA isolates with a vancomycin MIC ≥2 mg/L. The final regression model included 6 independent predictors: chronic liver disease (adjusted odds ratio [aOR], 2.99; 95% confidence interval [CI], 1.39-6.42), prior recovery of MRSA from respiratory tract specimen (aOR, 2.54; 95% CI, 1.15-5.61), end-stage renal disease (aOR, 2.53; 95% CI, 1.33-4.78), severe sepsis or septic shock on presentation (aOR, 2.39; 95% CI, 1.28-4.44), prior vancomycin exposure (aOR, 2.21; 95% CI, 1.13-4.30), and recent hospitalization within 3 months (aOR, 2.11; 95% CI; 1.01-4.40). All independent predictors had a value of one point. Youden's index statistics indicated a score of ≥3 as best cutoff value that had a sensitivity of 69.6% and specificity of 78.4%. CONCLUSIONS: Simple decision rule helps clinicians stratify the risk of high vancomycin MIC MRSA infection when deciding empirical therapy for patients with community-onset infections.

A decision-making framework for adaptive pain management.

Pain management is a critical international health issue. The Eugene McDermott Center for Pain Management at The University of Texas Southwestern Medical Center conducted a two-stage interdisciplinary pain management program that considers a wide variety of treatments. Prior to treatment (beginning of Stage 1), an evaluation records the patient's pain characteristics, medical history and related health parameters. A treatment regime is then determined. At the midpoint of the program (beginning of Stage 2), an evaluation is conducted to determine if an adjustment in the treatment should be made. A final evaluation is conducted at the end of the program to assess final outcomes. We structure this decision-making process using dynamic programming (DP) to generate adaptive treatment strategies for this two-stage program. An approximate DP solution method is employed in which state transition models are constructed empirically based on data from the pain management program, and the future value function is approximated using state space discretization based on a Latin hypercube design and artificial neural networks. The optimization seeks for treatment plans that minimize treatment dosage and pain levels simultaneously.

Short-term inhalation of sevoflurane during induction of general anesthesia can inhibit the A-line ARX index response to intubation: a randomized trial.

BACKGROUND: Monitoring hypnotic depth is used to prevent awareness during general anesthesia. We used the A-line ARX index (AAI) to assess the effect of shortterm inhalation of sevoflurane in the prevention of intubation-induced inadequate hypnotic depth during anesthetic induction. METHODS: Thirty patients were randomly divided into the sevoflurane and non-sevoflurane groups, both of which were given 3 µg kg⁻¹ fentanyl, 4 mg kg⁻¹ thiamylal, and 0.2 mg kg⁻¹ cis-atracurium intravenously to induce general anesthesia. The sevoflurane group then inhaled 6% sevoflurane and 4 L/min O2 for 3 minutes, whereas the non-sevoflurane group was given 4 L/min O2 alone. Both groups were intubated 3 minutes after induction. Measurements of the AAI, non-invasive blood pressure, and heart rate were performed every minute, starting 3 minutes prior to induction until 9 minutes after intubation. RESULTS: Intubation induced a significant AAI elevation in the non-sevoflurane group (47.13 ± 20.88, 48.13 ± 20.05, 40.87 ± 15.86 and 31.27 ± 15.26 at 1, 2, 3 and 4 minutes after intubation, respectively, vs. 17.67 ± 6.44 at 3 minutes after induction; p < 0.05), whereas the AAI remained unchanged for the sevoflurane group following intubation. Moreover, the non-sevoflurane group demonstrated higher AAI values after intubation compared with the sevoflurane group. There were no significant differences in blood pressure and heart rate between the two groups throughout the study. CONCLUSION: Adding 6% sevoflurane with 4 L/min O2 for 3 minutes during the induction period prevented inadequate hypnotic depth caused by intubation but was not sufficient to inhibit fluctuations in hemodynamics.

Prevalence and determinants of hepatitis B antigenemia in 15,007 inmates in Taiwan.

BACKGROUND: The goal of this study was to determine the prevalence and risk factors for horizontal transmission of hepatitis B infection due to intravenous drug abuse (IVDA), tattooing, blood transfusion, and combinations of these risk factors. METHODS: All people detained in 19 prisons were invited to participate. Subjects underwent a physical examination and completed a questionnaire. Blood samples were collected and screened for hepatitis B surface antigen and Venereal Disease Research Laboratory (VDRL) reactivity. RESULTS: A total of 16 204 prisoners were invited to participate. The response rate was 92.6% and the mean age was 29.73 years. The overall prevalence of HBsAg positivity was 21.7%. Among 3333 subjects with a history of blood transfusion, the carrier rate was 23.19%. Among the 3071 subjects with a history of IVDA and the 6908 subjects with tattoos, the carrier rate was 26.4% and 29.3%, respectively. IVDA appeared to be the strongest risk factor among the 3, with an adjusted odds ratio (AOR) of 1.54 (95% confidence interval, 1.27-1.86), followed by tattooing (1.40, 1.23-1.55), and blood transfusion (1.27, 1.05-1.61). When blood transfusion was combined with either of the other 2 risk factors, the risk increased multiplicatively, and the combination of the 3 factors increased the AOR to 2.76 (2.20-3.47). The prevalence of a positive VDRL test result was 1.01%. CONCLUSIONS: The prevalence of HBV antigenemia in prisoners was high and was associated with BT, IVDA, and tattooing. A national vaccination program against HBV should be considered for prisoners and other people with these risk factors.

Prevalence and determinants of biochemical dysfunction of the liver in Atayal Aboriginal community of Taiwan: is betel nut chewing a risk factor?

BACKGROUND: We address the independent and interactive roles of habitual betel quid chewing and other known risk factors for biochemical dysfunction and cirrhosis of the liver. METHODS: To determine the prevalence rates and risk factors associated with biochemical dysfunction of the liver, a total of 3,010 adult residents in an Atayal Aboriginal community were invited to participate in the study. Abdominal ultrasonography was used to diagnose liver cirrhosis. RESULTS: There were 2,063 Atayal Aboriginal and 947 non-Aboriginal in this study. The result showed overall prevalence rates for hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) were 21.2 % and 2.9 %, respectively. There were 16.5 %, 15.1 % and 22.4 % subjects with abnormal alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma glutamyl transpeptidase (GGT), accordingly. Multiple logistic regression analysis showed that combined infections with HBV and HCV presented with the highest risks with OR (odds ratio) and 95% CI (confidence interval) of 4.2 (1.2-17.4) and 3.8 (1.0-14.1), respectively for elevation of ALT and AST; followed by alcohol (1.7 and 3.1), male gender (1.7 and 1.6), betel quid (1.5 and 1.3), smoking (1.4 and 1.8), and aboriginal (1.4 and 1.3). There is effect-measure modification between viral infection and betel quid chewing for increased severity of abnormal ALT elevation. Among 1,382 subjects consenting to abdominal ultrasonography, 41(3.0%) were found to have liver cirrhosis with the same factors associated with higher risks. CONCLUSION: In addition to infections with viral hepatitis B and/or C, we found Atayal Aboriginal, males, current smokers, drinkers and betel quid chewers were independently associated with biochemical dysfunction and probably cirrhosis of the liver. Further study is needed to corroborate the above hypothesis.

From contagious to chronic: a life course experience with leprosy in Taiwanese women.

This study used the narrative analysis method to explore stories told by Taiwanese women who had suffered from leprosy. Twenty-one women from a leprosarium, a long-term care centre, and the community participated in either focus group discussions or individual interviews. The age range for the participants was 54-88, with an average of 68 years old. Physical impairments and disabilities of the participants included skin scars, claw fingers, drop feet, amputated legs, and facial disfigurement. Their stories were analysed in two phases: structural and holistic content analyses. Structural analysis identified four life stages: before being diagnosed, after being diagnosed, living with leprosy, and the future. Holistic content analysis uncovered common themes in each life stage. Findings indicated that stigma was experienced throughout the life course of these women. At this stage of life, these women were facing not only physical impairments and disabilities from the leprosy, but also the usual chronic health problems of the elderly. This study suggests that prevention and treatment of leprosy-related physical impairments and chronic diseases are important.

Postpartum unilateral Horner's syndrome following lumbar epidural anesthesia after a Cesarean delivery.

We report on a case demonstrating unilateral Horner's syndrome (HS) after lumbar epidural obstetric anesthesia. A healthy, 32-year-old woman with a breech presentation was scheduled for an elective Cesarean section. The patient had normal vital signs throughout the surgical procedure. The operation lasted for 50 min. In the recovery room, she complained of left nasal stuffiness, left cheek numbness, and heaviness in her left eye. Meanwhile, left nipple sensory loss was noted during baby suckling training. On physical examination, her left eyelid was droopy along with left-side ptosis and facial flushing. Reduced sensation over the left hemifacial region and upper arm was also noted, which resolved completely over the next 110 min. A diagnosis of unilateral HS was then made. Although typically a benign side effect which often spontaneously resolves, HS is likely to cause anxiety in both the patient and the doctor. Prompt recognition of this syndrome and determination of its cause from lumbar epidural anesthesia can prevent unnecessary and potentially dangerous diagnostic workup and can reassure both patients and clinicians. The patient was discharged from the hospital 5 days after onset with a good outcome.