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1.
Nutrients ; 13(7)2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34371849

RESUMO

The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.


Assuntos
Desnutrição/epidemiologia , Micronutrientes/deficiência , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Determinantes Sociais da Saúde/etnologia , Adulto , Anemia/epidemiologia , Anemia/etnologia , Antropometria , Comorbidade , Feminino , Inquéritos Epidemiológicos , Humanos , Iodo/deficiência , Modelos Logísticos , Masculino , Desnutrição/etnologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estado Nutricional , Obesidade/etnologia , Hipernutrição/epidemiologia , Hipernutrição/etnologia , Sobrepeso/etnologia , Filipinas/epidemiologia , Filipinas/etnologia , Prevalência , Fatores Socioeconômicos , Deficiência de Vitamina A/epidemiologia , Deficiência de Vitamina A/etnologia , Adulto Jovem
2.
Artigo em Inglês | MEDLINE | ID: mdl-34299936

RESUMO

Most studies have focused on factors associated with depression at the individual level, and evidence on ecological models linking social-economic features with depression is rare in Taiwan. This study aimed to use multi-level analysis to explore the effects of social-economic environments on depressive symptoms among Taiwanese adults. The 2009 National Health Interview Survey (NHIS) and the Age-Friendly Environments database were linked in this study. A total of 6602 adults aged 20 years and older were included in the analysis. A Chinese version of the 10-item CESD was used as the outcome measure. Three social indicators (population density, divorce rate, and crime rate) and three economic indicators (unemployment rate, per capita disposable income, and per capita government expenditures) at the ecological level were examined. Results showed that two social environments and two economic features were significantly associated with depressive symptoms. However, the effects of these factors were different by gender and age groups. The economic environments were critical for males and young adults aged 20-44 years old, whereas the social environments were significant for females and middle-aged and older adults. Intervention efforts for depression prevention should integrate ecological approaches into the effects of social-economic environments on depressive symptoms.


Assuntos
Depressão , Vida Independente , Adulto , Idoso , Depressão/epidemiologia , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Meio Social , Taiwan/epidemiologia , Adulto Jovem
3.
Biomed Res Int ; 2021: 7605324, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33855082

RESUMO

Objectives: Capsule endoscopy (CE) is a useful diagnostic modality for patients with occult gastrointestinal (GI) bleeding. However, most previous studies utilizing CE have focused on techniques, patient characteristics, safety and feasibility, and case analyses. Studies evaluating the optimal timing for utilizing CE, which is an essential factor for obtaining a better diagnostic yield, remain scarce in the literature. Considering that a CE examination is expensive, we, therefore, undertook this study to evaluate, analyze, and determine the optimal time for performing CE in patients with occult GI bleeding. Methods: Seventy-five patients were initially recruited, but finally, sixty patients with significant GI bleeding with an unknown etiology after traditional endoscopic examinations were included in the study. All data were collected from a local hospital in Taiwan, encompassing the period from 2010 to 2018. The relationship between the timing of CE examination and the diagnostic correction rate (DCR) was then analyzed statistically. Results: More female (58.3%) and older adult (68.3%) patients were in our study. Based on the four analytical models used in the study, the results showed that the most optimal time to perform CE is within three days after GI bleeding occurs.


Assuntos
Endoscopia por Cápsula , Hemorragia Gastrointestinal/diagnóstico por imagem , Idoso , Feminino , Hemorragia Gastrointestinal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
4.
Aging Ment Health ; 25(6): 1049-1059, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32336120

RESUMO

OBJECTIVES: Depression in older adults is a growing public health concern. However, limited research has focused on the issues of physical environments and depression in the elderly in Asia. The purpose of the study is to examine the relationship between the built environments and depressive symptoms in older adults using Taiwan as an example. METHODS: Two national datasets were used in this study, including the 2009 National Health Interview Survey and the 2006 National Land Use Investigation in Taiwan. A total of 2,155 older adults were recruited, and eight built environments were examined among 161 townships. Depressive symptoms were measured using a 10-item CES-D scale, and four sophisticated models were built using a multi-level analysis. RESULTS: Five types of built environments were found to be significantly associated with depressive symptoms in older adults. Among them, two types of built environments, 'health and medical services' and 'schools' were highly related to a lower CES-D score and lower odds of being depressed, whereas the other three built environments, 'cultural and historical facilities,' 'recreational and amusement areas,' and 'playgrounds and sports venues' were significantly associated with an increasing risk of being depressed. CONCLUSIONS: Different built environments had different effects on depression and some even showed a dose-response relationship. These results can help urban planners or city designers reconsider how to facilitate the construction of built environments in neighborhoods that will improve the mental health of older adults.


Assuntos
Ambiente Construído , Depressão , Idoso , Depressão/epidemiologia , Humanos , Vida Independente , Atividades de Lazer , Taiwan/epidemiologia
5.
Health Promot Int ; 36(1): 78-88, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32285099

RESUMO

Health in All Policies (HiAP) is an effective approach to promote population health through addressing comprehensive social determinants of health. In 1997, the World Health Organization designed a 20-step protocol for developing a Healthy Cities (HC) project to build healthy public policies. Taiwan adopted the concept of HC in 2002 and established the first demonstration project in Tainan City in 2003. This study explores the impact of the HC initiative on the development of HiAP, as well as how a window of opportunities for HiAP was opened through the HC movement, using Tainan City as an example. Tainan was selected as the case for this study because of its relative maturity in the development of an HC initiative. A theory-driven thematic analysis was conducted in the study with archived documents between 2003 and 2010. We first adopted a Multiple Streams Approach to examine how the city government opened a window for HiAP through the HC initiative and then drew on the Maturity Model to evaluate the stage of HiAP in the Tainan HC project. After analyzing all related documents, we concluded that HiAP in the Tainan HC project had reached Stage V Institutionalization after 7 years. Key contexts, factors, challenges and strategies were identified. This study suggests that the HC initiative can indeed contribute to the development of HiAP and that the window was opened for HiAP through a concurrence of the three streams of problem, policy and politics along with the HC movement process.

6.
BMC Geriatr ; 20(1): 226, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590941

RESUMO

BACKGROUND: Physical and social environments may influence cognition health in older adults. However, evidence regarding physical and social environments linked to dementia is lacking, especially in Asia. This study aims to explore the influence of physical and social environments on the incidence of dementia through a population-based case-control design in Taiwan. METHODS: We identified 26,206 incident cases with dementia aged≧65 years in 2010, with the same no. of controls from National Health Insurance claims. Environmental measures were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CI) of the association between dementia incidence and the environmental measures at the township level. RESULTS: We observed a significant reduction of 12% in the odds ratios of dementia in areas with higher availability of playgrounds and sport venues (OR 0.88, 95% CI 0.81-0.95), after controlling for individual and other environmental characteristics. Community center availability was also significantly associated with an 8% decreased odds for dementia (OR 0.92, 95% CI 0.87-0.99), but the association was not significant after further consideration of individual-level characteristics. Although higher odds of dementia were found in areas with high median annual family income (OR 1.14, 95% CI 1.04-1.25), such a significant relationship did not appear in the full model. CONCLUSIONS: Our study suggests that specific physical and social environmental features have different influences on the risk of dementia. Public health interventions may consider these environmental aspects for preventing dementia incidence.


Assuntos
Demência , Meio Social , Idoso , Ásia , Estudos de Casos e Controles , Demência/diagnóstico , Demência/epidemiologia , Demência/etiologia , Humanos , Taiwan/epidemiologia
8.
Biomed Res Int ; 2019: 5378540, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31815145

RESUMO

Background: Very few nationwide studies have focused on the variations in the incidence and prevalence of dementia and Alzheimer's disease (AD) in Asian countries. This study aims to describe the gender and age differences in the incidence and prevalence of dementia and AD in Taiwan. Methods: The data on dementia and AD were acquired from the Taiwan National Health Insurance Research Database from 2004 to 2010. The sex and age-specific rates were standardized, and the differences of gender and age on dementia or AD were assessed using Poisson regression analysis. Results: Over seven years, the prevalence of dementia and AD significantly increased from 4.7 to 7.6 per hundred people (ß = 0.0784, p < 0.0001) and 2.3 to 3.5 per hundred people (ß = 0.0696, p < 0.0001), respectively. However, the incidence of both dementia and AD decreased but not significantly from 10.9 to 10.7 and 4.9 to 4.6 per thousand person-years, respectively. Noticeably, both incidence and prevalence increased with age and were higher in women than in men. Conclusions: The standardized incidence rates of dementia and AD are much lower than the data reported in some studies from Europe, the US, and Japan. Further studies are warranted to explore which factors are associated with the differences in the incidence of dementia and AD in Taiwan.


Assuntos
Doença de Alzheimer/epidemiologia , Demência/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Demografia , Humanos , Incidência , Análise Multivariada , Prevalência , Análise de Regressão , Fatores de Risco , Fatores Sexuais , Taiwan/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-31398817

RESUMO

Little is known about the association between environmental features and the risk of Alzheimer's dementia (AD). This study aims to investigate the association of physical and social environments with the incidence of AD. We identified 12,401 newly diagnosed AD cases aged ≥65 years in 2010, with the same no. of matched controls from National Health Insurance claims in Taiwan. Environmental data were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was conducted to calculate the odds ratios (OR) of AD in association with environmental features at the township level. Results showed that living in the areas with higher availability of playgrounds and sport venues was associated with a 3% decreased odds of AD (95% CI = 0.96-0.99), while higher density of elderly living alone was associated with a 5% increased odds of AD (95% CI = 1.01-1.11), after controlling for individual and other environmental factors. In further examination by urbanization level, the above relationships were found only in rural areas but not in urban areas. This study provides evidence that specific physical and social environmental features have different impacts on the risk of AD.


Assuntos
Doença de Alzheimer/epidemiologia , Doença de Alzheimer/fisiopatologia , Planejamento Ambiental/estatística & dados numéricos , Meio Social , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Modelos Logísticos , Estudos Longitudinais , Masculino , Razão de Chances , Fatores de Risco , Taiwan/epidemiologia
10.
Qual Life Res ; 28(9): 2393-2407, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31073818

RESUMO

PURPOSE: The relationship between built environments and the quality of life (QoL) of the elderly has gained great attention in recent years. However, most QoL studies have been conducted in western countries; thus, limited research was found in Asia, in which the population density, urban forms, narrow roadways, and land use patterns are more compact and highly mixed in terms of use. Therefore, the purpose of this study was an interdisciplinary analysis of two national datasets, the National Land Use Investigation and the National Health Interview Survey, to explore the relationship between built environments and the health-related quality of life of older adults in Taiwan. METHODS: Eight types of built environments at the township level were calculated, and 1222 nationally representative older adults aged 65 and older were recruited. The outcome variable was health-related QoL as measured using the EQ-5D, including utility score and the EQ-VAS. Statistical methods included descriptive analysis, bivariate analysis, and mixed-effects logistic regression analysis, which were conducted using SAS 9.4 software. RESULTS: The results showed that a significant relationship exists between cultural and historical facilities and low EQ-VAS; none of the built environments were found to be related to the EQ-5D. Individual factors are the main determinants of the EQ-5D of older adults in Taiwan. Positive relationships were found if older adults were engaging in physical activities and social participation. CONCLUSIONS: We suggest that building a supportive environment in which elderly people could consistently engage in physical activities and social participation is another potential approach that might contribute to active aging.


Assuntos
Ambiente Construído/tendências , Vida Independente/tendências , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
BMJ Open ; 9(3): e025274, 2019 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-30833322

RESUMO

OBJECTIVES: A nationwide cohort study on the risk of dementia onset after first diagnosis of Parkinson's disease (PD) is lacking. This study aims to assess 11 years of incidence and the HRs for developing dementia in patients with PD compared with matched controls. DESIGN: A population-based cohort study. SETTING: National Health Insurance database in Taiwan. PARTICIPANTS: A total of 5932 patients with PD were identified, and 29 645 age-matched, sex-matched and index year-matched PD-free individuals were randomly selected. OUTCOME MEASURES: All subjects were linked to the claim data to identify the first diagnosis of dementia. The Poisson assumption was used to estimate the incidence rate. Cause-specific hazards models with a partitioning of time at 1 year to account for proportionality were used to estimate the risk of dementia onset. RESULTS: The median duration from the first diagnosis of PD to the development of dementia was 9.02 years. In the first partition (≦ 1 year), the incidence of dementia in the PD and control groups was 114.49 and 9.76 per 1000 person-years, respectively, with an adjusted HR of 6.43 (95% CI 5.46 to 7.57). In the second partition (>1 year), the incidence of dementia in the PD and control groups was 30.99 and 10.83 per 1000 person-years, with an adjusted HR of 2.42 (95% CI 2.23 to 2.61). Notably, in the second partition, both men and women aged <70 years had the highest HR (3.82, 95% CI 2.79 to 5.22 and 4.27, 95% CI 3.25 to 5.63, respectively). CONCLUSIONS: This study noted an increased risk of dementia after a diagnosis of PD. The magnitude of effect estimation was higher in men in the first partition but was similar in both genders in the second partition. PD patients aged <70 years have the highest risk of dementia in any given partition time.


Assuntos
Demência/etnologia , Doença de Parkinson/epidemiologia , Índice de Gravidade de Doença , Fatores Etários , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Demência/diagnóstico , Demência/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Estudos Retrospectivos , Fatores Sexuais , Taiwan
12.
Artigo em Inglês | MEDLINE | ID: mdl-30909635

RESUMO

The Healthy Cities (HC) Project, which was introduced by the World Health Organization (WHO) in 1986, has been recognized as the best setting approach for health promotion. However, very few studies have addressed how to use HC approaches to establish public policies in non-health departments in cities. This paper describes the strategies for the HC Performance Awards used in Taiwan to draw attention from different departments and to sustain intersectoral collaboration for the purpose of establishing Health in All Policies (HiAP). The methods include: (1) setting up the Taiwan Healthy City Alliance; (2) establishing HC Innovation Performance Awards; (3) reviewing the award applications according to seven criteria; and (4) analyzing the topic content of the award applications. We collected 961 HC award applications during 2013⁻2016 to analyze their content. The results showed that the number of applications increased nearly every year while significantly more non-health departments applied for the awards compared to health departments (73.3% vs. 26.7%). The award rates of non-health departments have also increased twice from 13.9% in 2013 to 25.8% in 2016. By examining the topics of the award winners, we concluded that "HC Innovation Performance Awards" indeed provide a role and opportunity for political involvement, intersectoral collaboration, co-opetition and capacity building that is necessary for establishing health in all policies.


Assuntos
Distinções e Prêmios , Política de Saúde , Promoção da Saúde/métodos , Cidades , Humanos , Taiwan , Organização Mundial da Saúde
13.
Artigo em Inglês | MEDLINE | ID: mdl-29695078

RESUMO

Urbanization and ageing are global phenomena and offer unique challenges in different countries. A supportive environment plays a critical role in addressing the issue of behavioral change and health promotion among older adults. Many studies in the U.S., EU, and Australia have considered promoting physical activity in the community based on ecological models, whereas very few Asian studies have examined the relationships among urbanization, the built environment and physical activity in elderly at the ecological level, especially from a multi-level perspective. Due to the prevalence of post-war baby boomers and a very low birth-rate, the older population (aged 65 years old and older) in Taiwan has increased rapidly since 2011 and has exceeded the younger generation (0⁻14 years old) in 2017. Hence, the purpose of this study was first to examine the degree of urbanization in townships and the status of related built environments in Taiwan and then to investigate whether the built environment is associated with recommended amounts of physical activity among older adults. Three national datasets and a multi-level design were used in this research. Data at the individual level was obtained from the 2009 National Health Interview Survey (NHIS) which was taken from June 2009 to February 2010. Ecological data was obtained from the 2006 National Land Use Investigation of the National Geographic Information System and the 2010 Population and Housing Census. The analyses included a descriptive analysis, a bivariate analysis, a multiple logistic regression, and a multi-level analysis, utilizing a mostly hierarchical linear model (HLM). The results showed a significant relationship between factors at the environmental levels and physical activity in older adults. Urbanization, the built environment, and the median income of townships were positively correlated to the physical activity of the older adults. After controlling for individual-level factors, urbanization still exhibited this correlation. Parks and green spaces were associated with achieving the recommended amount of physical activity. However, there was no relationship after controlling for factors at the individual level. Detailed discussions were provided.


Assuntos
Ambiente Construído , Exercício Físico/fisiologia , Recreação/fisiologia , Urbanização , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Promoção da Saúde , Humanos , Masculino , Parques Recreativos , Taiwan/epidemiologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-29462914

RESUMO

Hip fracture commonly results in considerable consequences in terms of disability, mortality, long-term institutional care and cost. Taiwan launched its universal health insurance coverage in 1995, which largely removes financial barriers to health care. This study aims to investigate whether socioeconomic inequality in one-year mortality exists among Taiwanese elderly people. This population-based cohort study included 193,158 elderly patients (≥65 years) admitted for hip fracture between 2000 and 2012. With over a one-year follow-up, 10.52% of the participants died from all causes. The mortality rate was low in the northern part of Taiwan and in urban and high-family-income areas. Multiple Poisson regression models further suggested that the level of >Q1-Q3 and >Q3-Max showed significantly reduced odds ratio of one-year mortality at 0.90 (95% confidence interval (CI), 0.87-0.93) and 0.77 (95% CI, 0.74-0.81), respectively, compared with that of the lowest family income level (i.e., Min.-Q1). Despite a monotonic decline in overall one-year mortality during the study period, socioeconomic inequality in one-year mortality rate remained evident. The annual percentage change in one-year mortality was higher (-2.86) in elderly people from families with high income (>Q3-Max.) than that for elderly patients from family with low income (Min.-Q1, -1.94). Accessibility, rather than affordability, to health care for hip fracture is probably responsible for the observed socioeconomic inequality.


Assuntos
Fraturas do Quadril/mortalidade , Programas Nacionais de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Análise Multivariada , Distribuição de Poisson , Taiwan
15.
Diabetes Res Clin Pract ; 138: 66-74, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29408706

RESUMO

AIMS: To investigate whether type 2 diabetes mellitus (T2DM) increases the risk of developing chronic obstructive pulmonary disease (COPD). METHODS: This population-based cohort study used Taiwan's National Health insurance claim data to investigate the association of T2DM with the risk of COPD. A total of 716,623 pairs of people (patients with T2DM and their age-, sex-, and calendar year-matched controls) were identified in 2002-2003 and were followed until the occurrence of newly-diagnosed COPD or the end of 2011. Cox proportional hazard models were used to relate COPD incidence to T2DM. RESULTS: People with T2DM experienced a higher incidence rate of COPD than controls (159.6 vs 122.7 per 104 person-years). After controlling for confounders, T2DM significantly increased the hazard of COPD (hazard ratio [HR] = 1.15, 95% confidence interval = 1.14-1.16). Stratified analysis indicated that the association between T2DM and COPD was slightly greater in women than in men (HR, 1.15 vs. 1.11) and in people aged <65 years than in people aged ≥65 years (HR, 1.17 vs. 1.05 in men; 1.16 vs. 1.13 in women). CONCLUSIONS: Our findings demonstrated a modest association of T2DM with the risk of developing COPD, possibly shedding light into the adverse effects of hyperglycemia on pulmonary function.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Doença Pulmonar Obstrutiva Crônica/etiologia , Idoso , Estudos de Coortes , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/patologia , Risco
16.
Artigo em Inglês | MEDLINE | ID: mdl-28934150

RESUMO

This study aimed to compare the prevalence of frailty across three Chinese populations: Hong Kong, Taiwan-urban and Taiwan-rural. Contributing factors to disparities in frailty were also examined. Data were derived from the Osteoporotic Fractures in Men (MrOs) and Women (MsOs) (Hong Kong) Study (n = 4000) and the Taiwan Longitudinal Study on Aging (n = 2392). Frailty was defined as an index calculated from 30 multiple deficits. The ratio of the frailty index to life expectancy at birth (FI/LE) was used as an indicator of compression of morbidity. Frailty was more prevalent in Taiwan-urban (33.1%) and Taiwan-rural (38.1%) compared to Hong Kong (16.6%, p < 0.05) and was higher in women (22.6-49.7%) than in men (10.5-27.5%, p < 0.05). The ratios of FI/LE were higher in Taiwan-urban and Taiwan-rural (both 0.27) compared to Hong Kong (0.20, p < 0.05). Multivariate analyses revealed that older age, being a woman and low levels of physical activity were common risk factors for frailty across the three populations. Alcohol use was inversely associated with frailty in both Hong Kong and Taiwan-urban populations, but not in Taiwan-rural. Living alone was associated with frailty in Hong Kong men, but not in Hong Kong women or Taiwanese people. For all study populations, older age and being a woman constituted the highest attributable factor. This comparison provides useful data to inform government policies.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Fragilidade/epidemiologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hong Kong/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Taiwan
17.
PLoS One ; 12(8): e0181853, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28771522

RESUMO

It is difficult for learning models to achieve high classification performances with imbalanced data sets, because with imbalanced data sets, when one of the classes is much larger than the others, most machine learning and data mining classifiers are overly influenced by the larger classes and ignore the smaller ones. As a result, the classification algorithms often have poor learning performances due to slow convergence in the smaller classes. To balance such data sets, this paper presents a strategy that involves reducing the sizes of the majority data and generating synthetic samples for the minority data. In the reducing operation, we use the box-and-whisker plot approach to exclude outliers and the Mega-Trend-Diffusion method to find representative data from the majority data. To generate the synthetic samples, we propose a counterintuitive hypothesis to find the distributed shape of the minority data, and then produce samples according to this distribution. Four real datasets were used to examine the performance of the proposed approach. We used paired t-tests to compare the Accuracy, G-mean, and F-measure scores of the proposed data pre-processing (PPDP) method merging in the D3C method (PPDP+D3C) with those of the one-sided selection (OSS), the well-known SMOTEBoost (SB) study, and the normal distribution-based oversampling (NDO) approach, and the proposed data pre-processing (PPDP) method. The results indicate that the classification performance of the proposed approach is better than that of above-mentioned methods.


Assuntos
Algoritmos , Interpretação Estatística de Dados , Mineração de Dados/métodos , Bases de Dados Factuais , Inteligência Artificial , Conjuntos de Dados como Assunto , Humanos , Aprendizado de Máquina
18.
BMJ Open ; 7(4): e014256, 2017 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-28465305

RESUMO

OBJECTIVES: To compare the effects of four different amounts of exercise for preventing depressive symptoms in community-dwelling older adults. DESIGN: Prospective cohort study. SETTING: A nationally representative sample in Taiwan. PARTICIPANTS: Four waves of the survey 'Taiwan Longitudinal Study on Aging (TLSA)' from 1996 to 2007 were analysed. A total of 2673 older adults aged 65 years and over were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES: Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD). Four different types/amounts of exercise were examined including: (1) 3 times/week, 15 min/time; (2) 3 times/week, 30 min/time; (3) 6 times/week, 15 min/time; and (4) 6 times/week, 30 min/time. All exercise types were required to have at least moderate intensity. The impacts of different amounts of exercise on depressive symptoms were analysed using generalised linear mixed models. RESULTS: More than one-fifth of the elder individuals under consideration had depressive symptoms (CESD ≥10). About 38.6% of older adults met the lowest criteria for exercise type 1, and fewer (28.0%) met the highest criteria for type 4. Only exercise type 4 in the current survey was initially related to lower depressive symptoms (OR=0.8, 95% CI 0.66 to 0.95). However, after considering the interaction between time and changes in exercise patterns, the results showed that all persistent exercise models, even if a very low amount (3 times/week, 15 min/time), had significantly preventive effects on depressive symptoms (OR=0.56~0.67). CONCLUSION: Consistent exercise with at least 15 min per time, three times a week of moderate intensity is significantly associated with lower risk of depressive symptoms. This low amount of exercise may be easier to promote at the community and population level than other alternatives. TRIAL REGISTRATION: Registry number 104040 of the Institutional Ethics Committee of Chia-Yi Christian Hospital.


Assuntos
Depressão/prevenção & controle , Exercício Físico/psicologia , Promoção da Saúde , Vida Independente/psicologia , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Depressão/epidemiologia , Feminino , Promoção da Saúde/métodos , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Taiwan , Resultado do Tratamento
19.
J Sports Med Phys Fitness ; 57(5): 660-669, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28399621

RESUMO

BACKGROUND: The purpose of the present study was to determine whether a synergistic exercise model based on aerobics with additional fall-preventive components could provide extra benefits compared with the same duration of aerobic-synergistic exercise alone. METHODS: A total of 102 adults aged 65 years and over from three geographically separated communities were assigned to three groups: the general aerobic exercise (GAE) group (N.=44), the GAE plus ball game group (BG group; N.=30) and the GAE plus square-stepping exercise group (SSE group; N.=28). Each group participated in one hour of exercise intervention and two hours of leisure activities twice weekly for 12 weeks. Each exercise session consisted of one hour of combined exercises performed in the following order: 10 minutes of warm-up activities, 20 minutes of aerobics, 20 minutes of the respective exercise model, and 10 minutes of cool-down activities. Functional fitness tests, including aerobic endurance, leg strength, flexibility, reaction time, static balance and mobility, were measured before and after the intervention. Paired t-tests and mixed model analyses were conducted to compare the differences in each measurement within and among the groups. RESULTS: All of the groups exhibited significantly positive effects (P<0.05), including improvements in aerobic endurance, leg muscle strength, static balance, and mobility, after the intervention. There were no significant differences in these improvements in the other two groups compared with group GAE. However, group BG and group SSE showed significantly greater improvements in mobility compared with group GAE (P<0.05). CONCLUSIONS: We conclude that a combination of aerobics and selected fall-prevention exercises performed over a consistent period may improve mobility without compromising the fundamental benefits of aerobics. Future studies using randomized control trials with recorded fall events and a longer period of follow-up are indicated to validate the effects of fall prevention exercises.


Assuntos
Acidentes por Quedas/prevenção & controle , Exercício Físico , Aptidão Física , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício , Feminino , Humanos , Atividades de Lazer , Masculino , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Exercício de Aquecimento
20.
Diabetes Care ; 39(9): 1571-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27385329

RESUMO

OBJECTIVE: This study investigated the effects of severe hypoglycemia on risks of all-cause mortality and cardiovascular disease (CVD) incidence in patients with type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODS: Two nested case-control studies with age- and sex-matched control subjects and using the time-density sampling method were performed separately within a cohort of 10,411 patients with T1DM in Taiwan. The study enrolled 564 nonsurvivors and 1,615 control subjects as well as 743 CVD case subjects and 1,439 control subjects between 1997 and 2011. History of severe hypoglycemia was identified during 1 year, 1-3 years, and 3-5 years before the occurrence of the study outcomes. Conditional logistic regression analyses were performed to estimate the odds ratio (OR) and 95% CI of the study outcomes. RESULTS: Prior severe hypoglycemic events within 1 year were associated with higher risks of all-cause mortality and CVD (adjusted OR 2.74 [95% CI 1.96-3.85] and 2.02 [1.35-3.01], respectively). Events occurring within 1-3 years and 3-5 years before death were also associated with adjusted ORs of 1.94 (95% CI 1.39-2.71) and 1.68 (1.15-2.44), respectively. Significant dose-gradient effects of severe hypoglycemia frequency on mortality and CVD were observed within 5 years. CONCLUSIONS: Although the CVD incidence may be associated with severe hypoglycemic events occurring in the previous year, the risk of all-cause mortality was associated with severe hypoglycemic events occurring in the preceding 5 years. Exposure to repeated severe hypoglycemic events can lead to higher risks of mortality and CVD.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemia/epidemiologia , Mortalidade , Adulto , Estudos de Casos e Controles , Causas de Morte , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Incidência , Insulina/efeitos adversos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Risco , Fatores de Risco , Índice de Gravidade de Doença , Taiwan/epidemiologia , Adulto Jovem
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