How Cultural Behaviors and Superstitions Associate the Willingness to Undergo Cataract Surgery in Taiwan: A Nationwide Survey.

Background and Objectives: Cultural beliefs influence the conceptualization, adaptation, and coping strategies for diseases. This study aimed to investigate the impact of cultural beliefs and customs on the willingness to undergo cataract surgery in Taiwan. Materials and Methods: The data were retrospectively retrieved from the national Longitudinal Health Insurance Database 2000 (LHID2000). From the national database, we enrolled patients that were diagnosed with cataracts and underwent cataract surgery from 2001 to 2010. All the patients were stratified according to their gender and living area. Gender was categorized as male or female, and the living area was classified as urban or rural. We compared the difference in the number of surgeries between stratified patient groups in each Chinese lunar month. Results: The number of cataract surgeries decreased significantly in the seventh and twelfth lunar months for both genders. There was a significant reduction in cataract surgeries in both the urban and rural groups during the seventh lunar month. Interestingly, only the seventh lunar month had an association with sex in different living areas, which meant that in the seventh month, there was a gender-specific difference in the surgical numbers. Conclusions: The Taiwanese population holds a belief that surgical procedures, including cataract surgery, during the lunar ghost month is inauspicious. Citizens tend to avoid elective surgery due to cultural practice, resulting in a decrease in surgical numbers during the period of the Chinese New Year. The authorities should consider these cultural behaviors when developing medical policies and allocating resources. Healthcare providers should be aware of these superstitions and take them into account when providing medical care and advice to patients.

The sociocultural effects on orthopedic surgeries in Taiwan.

Various sociocultural factors affect healthcare-seeking behaviors. In Taiwanese society, superstitions and lunar festivals play important roles in people's lives. We investigated the impact of "Ghost Month" (the 7th lunar month) and Chinese New Year (the 12th lunar month and the 1st lunar month of the following year) on the number of elective surgeries and emergent surgeries in Taiwan. The number of total knee replacement (TKR) surgeries and proximal femur fracture (PFF) surgeries in each lunar month from 2000 to 2011 were extracted from the Taiwan National Health Insurance Database, a computerized and population-based database. Patients were then sorted by location of residence or gender. The average number of TKR surgeries performed was significantly lower during the 1st, 7th, and 12th lunar months in urban areas, whereas in rural areas this trend was only evident in the 7th and 12th lunar months. There was however, no significant difference in the average number of PFF surgeries in each lunar month except for an increase seen in the 1st lunar month in rural patients (p<0.05). When sorted by gender, the average number of TKR surgeries was significantly decreased in the 7th and 12th lunar months in male patients, and decreased in the 1st, 7th, and 12th lunar months in female patients. In contrast, there was no difference in the average numbers of PFF surgeries in the 7th and 12th lunar months either in male or female patients. We proposed that the timing of elective surgeries such as TKR might be influenced by Ghost Month and Chinese New Year; however, emergent PFF surgeries were not significantly influenced by sociocultural beliefs and taboos in Taiwan.

Semiparametric methods in the proportional odds model for ordinal response data with missing covariates.

We consider the estimation problem of a proportional odds model with missing covariates. Based on the validation and nonvalidation data sets, we propose a joint conditional method that is an extension of Wang et al. (2002, Statistica Sinica 12, 555-574). The proposed method is semiparametric since it requires neither an additional model for the missingness mechanism, nor the specification of the conditional distribution of missing covariates given observed variables. Under the assumption that the observed covariates and the surrogate variable are categorical, we derived the large sample property. The simulation studies show that in various situations, the joint conditional method is more efficient than the conditional estimation method and weighted method. We also use a real data set that came from a survey of cable TV satisfaction to illustrate the approaches.

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.