[[alternative]]Investigating the utilization of healthcare resources among the elderly population in Taiwan using a two-stage DEA analysis.

[[abstract]]背景：臺灣在2022年65歲以上的老年人口比例已達17.6%，老化指數144.93%，顯示出老年人口增長快速，其將伴隨老年人口的疾病和醫療需求增加，而疾病也將變得更加複雜與多樣化。因此因應老年人口日益增長下對醫療資源之需求，及如何有效分配醫療資源的方法，以維持醫療保健系統的平衡和可持續，是至關重要。目的：探討臺灣老年人口對醫療資源利用之效率情形方法：本研究運用資料包絡分析法（Data Envelopment Analysis, DEA）來評估醫療資源利用之投入與產出，以CCR模型、BCC模型和規模效率來評估各個縣市效率情形，並將非意欲產出納入模型中，加以探討各縣市醫療資源的利用，藉以達到準確及有效的評估醫療資源利用之效率表現。結果：醫療資源分布大多集中在都會區，其主要原因為人口密集度、老年人口的分布、經濟所得、交通便利性、醫療水準等，進而導致醫療資源效率差異。上述因素將導致非都會區民眾不易看診，或是不願看診，故合理有效之分配醫療資源並提升醫療水準是現今重要課題之一。結論：醫療資源配置需考量當地人口性質、經濟、文化、交通等多方面因素。因此，在資源投入時，評估當地效率並提供適當之資源，使民眾及時獲得醫療資源，從而實現疾病的預防、檢測和治療，以達成全民健康覆蓋。[[abstract]]Background: Taiwan's proportion of elderly population aged 65 and above reached 17.6% in 2022, with an aging index of 144.93%. These figures indicate a rap-id growth in the elderly population, which will be accompanied by an in-crease in the prevalence of age-related diseases and healthcare needs. As dis-eases become more complex and diverse, it is crucial to effectively allocate healthcare resources in response to the growing elderly population, in order to maintain a balanced and sustainable healthcare system.Objective: To explore Examine the efficiency of healthcare resource utilization by Taiwan's elderly population.Methodology: This study applies Data Envelopment Analysis (DEA) to evaluate the input and output of healthcare resource utilization. The CCR model, BCC model, and scale efficiency are used to assess the efficiency of various coun-ties and cities. Additionally, the inclusion of undesirable output in the model is explored to accurately and effectively evaluate the efficiency performance of healthcare resource utilization across different regions.Results: Medical resources are mostly concentrated in urban areas, primarily due to factors such as population density, distribution of the elderly population, economic income, transportation convenience, and medical standards. Con-sequently, these factors contribute to disparities in the efficiency of healthcare resource allocation. The aforementioned factors result in difficul-ties for non-urban residents to access healthcare services, leading to a reluc-tance or unwillingness to seek medical care. Therefore, it is crucial to allo-cate medical resources reasonably and effectively, while enhancing the medi-cal standard, which is one of the significant challenges today.Conclusion: When the demand is low, the investment of resources should be re-duced Allocation of healthcare resources should consider multiple factors such as local demographics, economy, culture, and transportation. Therefore, when investing resources, it is important to assess local efficiency and pro-vide appropriate resources to ensure timely access to healthcare for the popu-lation, thereby achieving Universal Health Coverage (UHC)

[[alternative]]The Effects of Eight-week Meridian Conditioning on Middle-Aged Women from Perspective of Meridian Energy and Autonomic Nervous System

[[abstract]]背景:每位女性步入中年後將面臨生理變化更年期，會明顯感受到身體與心理上的各種變化，難免有情緒不穩定的狀況，若無法得到改善，不僅會影響身體健康，亦帶給家庭、社會負擔。目的:本研究探討以八週為期，特定經絡調理手法(推拿、刮痧與拔罐)的方式介入，研究調理其手法介入前後下對中年婦女經絡能量及自律神經的影響，以科學實證方式驗證經絡調理之功效，為中年婦女養生保健提供不同之健康促進選項。方法:採隨機分組分為實驗組與對照組各12名，實驗組接受經絡調理介入為期八週，每週一次（早上9:00-11:00時段），50分鐘全身經絡調理手法操作，分別於第1、4、8週調理前、後進行良導絡量測經絡能量，第1、2、4、6、8週調理前、後進行HRV儀器測量自律神經的數值；對照組則不參與經絡調理手法操作，維持一般作息正常活動，但仍於相同時間條件進行經絡能量與自律神經的數值量測，進行上述兩組別的資料收集與彙整分析，以觀察本研究經絡調理手法對中年婦女經絡能量及自律神經的影響。結果:八週經絡調理介入後，第1週與第4週經絡能量數值相比較之下，實驗組第4週肺經前測數值組內呈顯著差異 (p<.05)，對照組第4週(小腸經、三焦經、大腸經)前測數值組內呈顯著差異 (p<.05)；第1週與第8週經絡能量數值相比較之下，實驗組第8週(肺經、心包經、膀胱經)前測數值組內呈顯著差異，腎經後測數值組內呈顯著差異 (p<.05)，其餘各經絡能量數值在第1、4、8週相比較之下皆未達顯著性差異，其中(小腸經、三焦經、大腸經、肝經)在每次量測週數同時皆達顯著差異，經本研究結果各經絡能量達顯著差異與受試者個案的主述回饋心得呈現正相關，顯示本研究經絡調理手法對於人體經絡能量平衡上具有效益；心跳變異率 (HRV) 分別達顯著差異，在第6週開始HRV組內與組間的量測數值顯著改善，因此可知對於中年婦女自主神經功能具有相關生理調控，因此本課程經絡調理可做為中年婦女進行身體保健理療的方法之一。[[abstract]]As women age, their youthful vitality gradually declines. Upon entering middle age, women must face the physiological changes and impacts caused by aging, the various responsibilities, obligations from work, family, and society. These factors could result in stress, anxiety, and other emotional issues, causing imbalances of body and mind with increased risk of disease. From a health promotion perspective, in addition to adjusting diet, lifestyle, and sleep habits, the balance of energy and the modulation of meridians play important roles on physiological homeostasis with perspective of Traditional Chinese Medicine (TCM). Proper application of complementary medicine, stress relief therapy, and meridian modulation could also improve the quality of life and prevent disease for middle-aged women. Alternative and complementary health strategy with physical and mental homeostasis would be an important issue for health maintenance. This study focuses on an eight-week intervention with specific meridian manipulation, including the massage, gua sha, and cupping. The purposes of study were to validate the potential effects on modulation of meridian energy and activities of autonomic nerves on middle-aged women before and after the meridian conditioning. This study could provide a different health promotion strategy to middle-aged women's health and wellness. The participants were randomly divided into the experimental group (n=12) and the control group (n=12). The experimental group received meridian conditioning for eight weeks, once a week (9:00-11:00 AM), 50 minutes per section for meridian conditioning manipulations. The meridian energy and HRV were measured at (1, 4, 8 weeks) and (1, 2, 4, 6, 8 weeks), respectively, before and after manipulation for both groups. Results: After eight weeks of meridian conditioning intervention, the energy of each meridian in the experimental group was significantly modulated with possible balance effects, which was positively correlated with health statement of the subjects; From 6nd week intervention, the significant improvement were observed in the HRV, which could help middle-aged women modulate the physiological homeostasis and ANS activity. Therefore, the meridian conditioning of current study could be a suitable and alternative method for health maintenance on middle-aged women

探討台灣過重在學青年嗜食行為、情緒認知及相關因子之混合性研究

[[abstract]]背景：嗜食(Binge Eating；BE)是肥胖和體重增加的標誌，也是飲食障礙症明顯特徵。鑒於台灣年輕族群肥胖之高盛行率，嗜食問題卻鮮少被關注，也缺少適切性評估工具。目的：本研究目的旨在發展一份中文版嗜食量表，並以混合研究方法探討我國過重在學青年嗜食行為、情緒認知及相關影響因子。 方法: 首先採用量化研究，以便利取樣，招募300位過重大學生為研究對象。之後使用質性研究，以立意取樣，邀請15位有嗜食經驗者進行深度訪談。研究工具包括人口學及社會心理學基本資料、嗜食量表(Binge Eating Scale；BES)、暴食問卷、體脂肪測量器(OMRON，HBF-371)及半結構訪談指引。資料分析使用描述性統計、驗證性因素分析、t檢定、相關性檢定、ROC曲線、邏輯斯迴歸及勝算比進行相關性之風險估計。訪談資料處理是依據Colaizzi七大步驟進行分析，研究嚴謹度則是遵循Lincoln & Guba的四項準則。結果：中文版BES量表因素分析結果為合理適配，與暴食問卷分數有顯著相關。內部一致性信度α值及一個月後重複測量的組內相關係數皆為0.83，ROC曲線分析最適切點分數為17，與原版英文問卷相同。參與者的BES平均分數為10.67±6.66，17.3% 顯示有中度或嚴重的嗜食問題。邏輯斯迴歸分析發現女性與有失控進食、減肥節食、同儕競爭及人際困擾經驗者在BES得分勝算比值較高，是無經驗風險的1.05~6.04倍。此外訪談資料經過研究人員萃取與分析，歸納出3個主題及6個次主題，依序為1.面對難以承受的負荷(包括斷鏈失衡的家庭關係及無力面對的學校壓力)；2.陷入進食與情緒之循環歷程(包括透過飲食尋求慰藉及失控進食的情緒糾結)；3.期待走出嗜食的困境(包括渴望他人協助及努力重塑自我)。結論：中文版 BES 量表具有良好的心理計量特性，可作為評估我國過重在學青年嗜食的篩檢工具。此外環境壓力及負面情緒調節與發生嗜食行為有重要關係，建議校園心理健康人員應及早介入評估，並提供適切的輔導與治療。[[abstract]]Background: Binge eating (BE) is a marker of obesity and weight gain, and a significant characteristic of eating disorder. The prevalence of obesity among collegial youth is high, but BE problem has attracted little attentions and lacked appropriate assessment tools. The research aim is to develop a Chinese version of Binge Eating Scale (C-BES), and use mixed research methods to explore the binge behaviors, emotional cognition and related factors of obese college youth in Taiwan.Methods: First, the study used a quantitative research, convenience sampling was adopted to recruit 300 overweight college students. Then used a qualitative research, purposive sampling was used to invite 15 participants having BE experience for an in depth interview. The study tools included demography and psychosocial data, Binge Eating Scale (BES), Bulimic Investigatory Test, Edinburgh (BITE) , body weight composition monitor (OMRON, HBF-371), and semi-structured interview guidelines. Data analysis used descriptive statistics, confirmatory factor analysis, (CFA), t-test, correlation analysis, ROC curve, logistic regression and odds ratio in the risk analysis of correlation. Interview data analysis was based on the seven steps of Colaizzi. Regarding to rigor, four indices proposed by Lincoln & Guba was used as reference standard.Results: The CFA results of C-BES showed a reasonable model fit, and significantly correlated with BITE score. The internal consistency reliability, Cronbach’s α value, and the intraclass correlation coefficient (ICC) of repeated measures made one month apart were both 0.83, indicating good reliability and stability. The best-fit cutoff point of ROC curve is 17, same as of the original English BES. The average of BES scores was 10.67±6.66, and 17.3% of participants revealed moderate to severe levels of BE problem. Logistic regression analysis showed that female and people with uncontrolled eating, weight loss dieting, peer competition, or interpersonal stress experience have higher odds ratio in BES scores, being 1.05~6.04 times of people without such experience. Furthermore, researchers summed up 3 themes and 6 sub-themes after extracting and analyzing interview data. Subsequently, they were 1. Faced with unbearable burden (including broken family and overwhelming school stress); 2. Stuck in the circle of stressful eating and emotional entanglement (including seeking comfort thru eating and due to uncontrolled eating); 3. Hope to break free from BE entrapment (including eager for other’s help and reshaping oneself).Conclusions: The C-BES presents sound psychometric properties, and can be a screening tool for BE among the overweight college youth. BE behaviors are considerably correlated with external environmental stress, and the coping strategy with negative emotion. This study suggests early intervention from campus psychological health personnel to provide proper therapy

[[alternative]]Analysis of Improvement Recommendations on Taiwan's National Health Insurance System by Physicians

[[abstract]]背景：醫師作為醫療照護體系之第一線醫療服務者，能清楚瞭解台灣健保制度在施行上面臨的挑戰，然而目前鮮少以非結構型的問題蒐集西醫師對台灣整體健保制度之建議的研究。目的：探討台灣西醫師對健保制度之主要改善建議。方法：本研究使用2023年「我國西醫師萬人關鍵調查報告」之基層西醫師版與醫院西醫師版問卷結果，以基層西醫師及醫院西醫師為研究對象，由三位研究人員利用Nvivo12對問卷結果進行編碼，編碼過程以ChatGPT做為第三方輔助工具，統計部分利用 SAS9.4進行描述性統計與費雪精確檢定，結果利用矩陣式樹狀結構圖、文字雲及桑基圖以視覺化方式呈現，並以重要性原則探討基層西醫師與醫院西醫師主要的改善建議。結果：研究對象之基層西醫師有669位、醫院西醫師有363位，不同基層西醫師與醫院西醫師人口學特徵(包括性別、年齡層別、教育程度、執業院(所)類別、執業院(所)層級、職稱、執業科別、執業總年資層別與月收入層別)對健保制度之建議有顯著差異；基層西醫師以男性、年齡為50-59歲、教育程度為醫學士、職稱為負責醫師、科別為內科、年資為20-29年，提供較多健保制度之建議；醫院西醫師以男性、年齡為40歲以下、教育程度為醫學士與博士、院所類別為醫學中心、院所屬於公立醫療院所、職稱為主治醫師、科別為其他、年資為10年以下、月收入為20萬-29萬9,999元，提供較多健保制度之建議。依據重要性原則，基層西醫師多數改善建議概念以「提高民眾負擔」(12.44%)、「藥價合理化」(6.32%)、「落實分級轉診」(4.25%)、「取消總額」(3.99%)及「開放自費醫療」(3.11%)為主，合計30.10%；而醫院西醫師主要改善建議概念以「提高民眾負擔」占(14.77%)、「民眾先付費後理賠」占(3.77%)、「藥價合理化」占(3.67%)、「落實分級轉診」(3.47%)、「取消總額」(3.27%)及「強化雲端系統」(2.78%)為主，合計31.42%。結論：建議政府及相關單位加強與醫界對「提高民眾負擔」、「藥價合理化」、「落實分級轉診」、「民眾先付費後理賠」、「取消總額」、「開放自費醫療」及「強化雲端系統」改善建議之討論與共識，以改善健保制度。[[abstract]]Background: As frontline healthcare providers in the medical care system, physicians possess a clear understanding of the challenges facing Taiwan's National Health Insurance (NHI) system implementation. However, there is currently limited research that collects non-structured suggestions from western medicine physicians regarding recommendations for the overall Taiwanese NHI system.Objectives: To explore the primary improvement recommendations from Taiwanese western medicine physicians regarding the NHI system.Methods: This study utilized the survey results from the 2023 &quot;Key Survey of Western Medicine Physicians per Ten Thousand Population in Our Country&quot;. The survey included versions for physicians working in a clinic and physicians working in a hospital. The study focused on physicians working in a clinic and physicians working in a hospital as research subjects. Three researchers employed Nvivo12 to code the questionnaire results, with assistance from ChatGPT as a third-party tool during the coding process. Descriptive statistics and Fisher's exact tests were conducted using SAS 9.4. The results were visualized using treemap chart, word clouds, and Sankey diagrams. Additionally, the study followed the principle of importance to explore the main improvement suggestions provided by physicians working in a clinic and physicians working in a hospital.Results: The study included 669 physicians working in a clinic and 363 physicians working in a hospital as research subjects. There were significant differences in the recommendations for the NHI system based on demographic characteristics of the two groups. Among physicians working in a clinic, those who were male, aged between 50 and 59, held a bachelor's degree in education, had the title of attending physician, practiced in the field of internal medicine, and had 20 to 29 years of professional experience, provided more suggestions for the NHI system. On the other hand, among physicians working in a hospital, those who were male, aged under 40, held bachelor's and doctoral degrees in education, worked in medical centers, were affiliated with public medical institutions, held the title of attending physician, practiced in fields other than internal medicine, had less than 10 years of experience, and had a monthly income between NT$200,000 to NT$ 299,999, offered more recommendations for the NHI system. Following the principle of importance, the majority of improvement suggestions from clinic-based physicians revolved around concepts such as &quot; Increasing the copayment &quot; (12.44%), &quot; Rationalizing drug prices &quot; (6.32%), &quot; Implementing the hierarchical medical system and referral system &quot; (4.25%), &quot; Abolishing the Global Budget System &quot; (3.99%), and &quot; Deregulated the out-of-pocket medical care (self-pay medical services) restrictions &quot; (3.11%) , totaling 30.10% collectively. On the other hand, the majority of improvement suggestions from hospital-based physicians revolved around concepts such as &quot; Increasing the copayment &quot; (14.77%), &quot; The policy for the individual pays first and then settle the reimbursement &quot; (3.77%), &quot; Rationalizing drug prices &quot; (3.67%), &quot; Implementing the hierarchical medical system and referral system &quot; (3.47%), &quot; Abolishing the Global Budget System &quot; (3.27%), and &quot; Reinforce the cloud computing service (system) &quot; (2.78%), totaling 31.42%.Conclusions: The government and relevant organizations are advised to enhance discussions and consensus with the medical community on the &quot; Increasing the copayment &quot;, &quot; Rationalizing drug prices &quot;, &quot; Implementing the hierarchical medical system and referral system &quot;, &quot; The policy for the individual pays first and then settle the reimbursement &quot;, &quot; Deregulated the out-of-pocket medical care (self-pay medical services) restrictions &quot;, and &quot; Reinforce the cloud computing service (system) &quot; improvement to enhance NHI system policies

[[alternative]]The Relationships between Health Literacy, Antenatal Care and Birth Outcomes among Postpartum Vietnamese Women

[[abstract]]Background: Maternal health literacy refers to the cognitive and social skills that determine women's motivation and ability to access, understand, and apply knowledge to enhance and maintain their health and that of their children. Factors affecting maternal health literacy and the relationship between maternal health literacy, antenatal care and birth outcomes have not previously been studied in Vietnam.Purpose: This study aimed to examine the relationship between maternal health literacy, antenatal care and birth outcomes among postpartum Vietnamese women. Methods: This was a cross-sectional descriptive study with 153 postpartum women recruited in Ho Chi Minh City, Vietnam using convenience sampling from December 2022 to February 2023. The study used The Maternal Health Literacy Inventory in Pregnancy (MHELIP) questionnaire to measure maternal health literacy levels. The Mann-Whitney U Test, Fisher’s exact test or the Chi-squared test, logistic regression and hierarchical logistic regression were used to determine the relationship between maternal health literacy, antenatal care and birth outcomes. Results: Nearly one-half of the postpartum women had either inadequate or problematic maternal health literacy. Maternal health literacy levels were significantly associated with participants’ sociodemographic characteristics, including education level, religion, employment status and monthly household income. The utilization rate of antenatal care services was found to be high, with more than two-thirds of the women (71.2%) having received eight or more visits throughout their pregnancy. However, no significant relationship was observed between maternal health literacy, antenatal care, and birth outcomes, except for the mode of birth. In which, women with higher maternal health literacy were more likely to have cesarean section than other women.Conclusions: This study highlights the need to improve maternal health literacy in Vietnam. One potential approach to achieve this is through health literacy interventions during antenatal care by healthcare workers.Keywords: Maternal health literacy, antenatal care, birth outcomes

[[alternative]]Cognitive Reserve and Connected Speech in Aging

[[abstract]]老化造成注意力、工作記憶和執行功能等認知功能衰退。語言方面，相較於語言理解能保持穩定，長者的連續性言語總詞彙數會減少，而語句長度、整體流暢性和語意品質則都有下降趨勢。然而長者的認知和語言衰退存在個體差異，教育、職業性質和休閒活動有助於形塑認知儲備。相同老化程度下，認知儲備佳的個體會有較好的認知表現，於注意力、工作記憶及執行功能等作業皆觀察到有顯著預測力。語言能力方面，高認知儲備者也有較佳的詞彙提取和語句理解表現。因此，本研究欲探討認知儲備對於長者的連續性言語是否具有潛在保護效果本研究分為兩階段：第一階段為翻譯中文版認知儲備指數問卷(Cognitive Reserve Index questionnaire，CRIq)(Nucci et al., 2012)，第二階段為探討認知儲備與連續性言語表現的相關。共招募50位社區長者作為研究對象，平均年齡70.92±4.51歲，MMSE平均分數為27.98±1.38分，以中文版CRIq量化社區長者認知儲備，認知儲備指數為105.16±18.79。研究參與者完成認知測驗、命名測驗、以圖片描述測驗（夜市圖、公園圖、家庭主夫圖）及旅遊計畫敘述，連續性言語語料進行詞彙、語句、流暢度和語意品質層面分析。以皮爾森相關統計方法分析認知儲備與認知功能測驗、詞彙命名測驗、連續性言語表現的相關性，以簡單線性迴歸統計方法進一步分析認知儲備對於上述測驗表現的預測力。研究結果顯示，中文版CRIq的整體量表內容效度為0.98，其中文版操作手冊則為1.0，具有良好效度。認知儲備指數與數字記憶廣度順序作業、數字記憶廣度逆序作業、波士頓命名測驗的表現具顯著相關。進一步迴歸分析結果，認知儲備指數可以預測數字記憶廣度順序作業、數字記憶廣度逆序作業和波士頓命名測驗的表現。連續性言語方面，認知儲備指數與連續性言語的總詞彙數、動詞比例、填充詞比例、整體不流暢比例、核心要素完整度呈顯著相關。進一步迴歸分析結果顯示，認知儲備指數顯著預測連續性言語的總詞彙數、動詞比例、填充詞比例、整體不流暢比例、核心要素完整度。說明認知儲備可以預測連續性言語的詞彙、流暢度、語意品質層面的表現。綜上所述，認知儲備差異使得健康長者在連續性言語任務上有更好的表現，顯見認知儲備對於老化的連續性言語具有潛在保護效果。老化的長者面臨認知、語言表現的變化，研究結果支持並鼓勵長者提升認知儲備，維持較好的認知功能、詞彙命名、連續性言語表現。此外，臨床人員在分析認知或語言測驗時，除了教育程度，也應考量個體的認知儲備差異，像是工作複雜性、休閒時間的活動參與，避免因測驗表現而錯估參與者實際的退化程度。[[abstract]]Age-related cognitive decline includes attention, working memory and executive function. In terms of language, language comprehension remains stable. In language production, older adults experience a decrease in total number of words in connected speech, as well as a decline in mean length of utterance, fluency and semantic quality. However, age-related cognitive and language decline reveals individual differences. Acquiring through education, occupation complexity and leisure time activity, individuals with better Cognitive Reserve (CR) show better cognitive performance than others under aging. CR improves performance in attention, working memory and executive functions. Regarding language abilities, CR improves performance in word retrieval and sentence comprehension. Therefore, this study aims to investigate whether cognitive reserve has a potential modulatory effect on the connected speech in older adults. The study consists of two phases: the first phase involves translating the Cognitive Reserve Index questionnaire (CRIq) (Nucci et al., 2012) into Mandarin version, and the second phase examines the relations between cognitive reserve and the performance of connected speech. Fifty Mandarin-speaking community elders (aged 70.92±4.51, MMSE score 27.98±1.38) were recruited in the present study. The Mandarin version of CRIq was used to quantify CR (CRIq index 105.16±18.79). Participants were instructed to complete a series of neuropsychological tests, naming test, picture description task (Night market, Park, House husband) and a complex discourse task, “Trip to Sun Moon Lake.” The speech samples were analyzed using lexical, syntax, fluency, and semantic quality features. Pearson correlation analysis was used to examine the correlation between cognitive reserve and cognitive function tests, naming tests, and continuous language performance. Simple linear regression analysis was further conducted to assess the predictive power of CR on thetest performances.The results showed that the scale-level content validity index of the Mandarin version of CRIq was 0.98, with a scale-level content validity index of 1.0 for the Mandarin version of the instructions, indicating its good validity. The scores of CRIq significantly correlate with the performance of Digit Span Forward, Digit Span Backward and Boston Naming Test. The scores of CRIq significantly predict the performance of Digit Span Forward, Digit Span Backward and Boston Naming Test. In connected speech, the scores of CRIq significantly correlate with the total number of words, the proportion of verb, the proportion of filler, the proportion of dysfluencies and the total core element score. The scores of CRIq significantly predict total number of words, the proportion of verb, the proportion of filler, the proportion of dysfluencies and the number of core elements.Altogether, elders with higher CR reveal better performance in connected speech, suggesting the modulation of CR against aging. We suggest that elders must enhance their CR to maintain better cognitive functions, as well as their speech output. Further, clinicians examine performances of cognitive and language tests, they should also consider the effects of CR to avoid underestimating the severity of cognitive decline

Predicting Long-Term Mortality with Biomarkers Level for Homecare Patients.

[[abstract]]Electronic health record (EHR) systems have been used widely in research. However, most of the EHRs are highly dimensional and it is challenging to analyze such large data set. Bioinformatics is an interdisciplinary science with a focus on data management and interpretation for complex biological phenomena. We investigated biomarkers of nutrition from 3001 patients. Multivariate-adjusted hazard ratios of mortality were calculated according to both albumin and sodium levels. We explore the association of aging predicted by all-cause mortality in future

[[alternative]]An evidence-based comprehensive analysis of the effect of exercise cessation on glycemic control

[[abstract]]「運動」是慢性病防治的重要議題，近幾年由於新冠疫情肆虐，一般民眾的規律運動及身體活動都受到不小的干擾，而對於罹患代謝症候群與第 2 型糖尿病的族群同樣難以避免。然而至今仍無停止運動訓練對血糖控制影響之實證統整分析研究，因此本研究透過實證文獻，探討停止運動訓練對於血糖以及胰島素代謝的影響。根據 JBI 系統性文獻回顧的步驟擬定 PICOS，以「布林邏輯運算元」進行關鍵字聯集或交集，採用 PRISMA2020 版文獻篩選流程，於六個中英文資料庫進行文獻檢索，文獻納入之標準為：(1)隨機對照試驗或類實驗研究設計、(2)符合 Oxford2011 證據等級 Level 2 以上的研究文獻。依研究設計類型，選用相對應的 JBI 檢核表評讀，經評價文獻品質後，共選出 20 篇 Level2 之文獻(14 篇類實驗研究、6 篇隨機對照試驗研究)。停止運動訓練對血糖控制的影響，主要有四大項：(1)空腹血糖、(2)胰島素、(3) HOMA-IR、(4)HbA1c，以停止運動 4 週為長、短期之分界。針對短期停止運動的研究，空腹血糖仍能維持部份運動效益者，趨向為年齡未達 40 歲成人且 BMI 27 的群體。長期研究部分，BMI ≧30 受試者可觀察到空腹血糖維持部分效益，而胰島素效益集中在空腹血糖基礎值 >100mg/dL 的受試者，HOMA-IR 部分則有集中在 ≧ 40 歲且 BMI > 24 的趨勢，此外 HbA1c > 5.7%且 BMI> 24 者也歸屬於此類。 综上所述，對於 BMI 超標或是血糖偏高，甚至糖尿病患者，只要能開始運動都不算遲，因為當下運動所存入的好處，即使停止運動，未來都可能成為維持健康的資產，如同「遺產效應」(Legacy Effect)，早期積極控制血糖，有效減少併發症，留給未來更好的健康狀態。[[abstract]]&quot;Exercise&quot; is an important topic in the prevention and treatment of chronic diseases. In recent years, the COVID-19 (2019 Novel Coronavirus) has been rampant, the regular exercise and physical activity of the general public have been interfered significantly. However, there is still no empirical analysis of the effect of detraining on glycemic control. Therefore, this study investigated the effects of exercise cessation on blood glucose and insulin metabolism through empirical literature. Based on the steps of the JBI systematic literature review, PICOS was developed, and keyword concatenation or intersection was performed using the &quot;Brillouin logic operator&quot;, and the PRISMA 2020 version of the literature selection process was used to search for literature in six Chinese and English databases. The literature was selected according to the type of study design. The JBI checklist was selected according to the type of study design, and after evaluating the quality of the literature, a total of 20 Level 2 papers (14 experimental like studies and 6 randomized controlled trial studies) were selected.The effects of exercise cessation on glycemic control were mainly based on four outcomes: (1) fasting glucose, (2) insulin, (3) HOMA-IR, and (4) HbA1c. 4 weeks of exercise cessation was used as the dividing line between long and short term. In the short-term exercise cessation study, those with fasting blood glucose could still maintain some of the benefits of exercise, and the group of adults under 40 years old with BMI 27.In the long-term study, partial benefits of fasting glucose maintenance were observed in subjects with BMI ≧ 30, while insulin was concentrated in subjects with basal fasting glucose >100 mg/dL, and HOMA-IR was concentrated in subjects aged ≧ 40 years with BMI > 24, and those with HbA1c > 5.7% and BMI > 24 were also included in this category. In summary, for people with abnormal BMI or high blood glucose, or even diabetes, it is not too late to start exercising because the benefits deposited in the present, even if you stop exercising, may become assets to maintain your health in the future, just like the &quot;Legacy Effect&quot; to actively control blood glucose early, effectively reducing complications and leaving a better health status in the future

[[alternative]]A study on the experiential values derived from the guided interpretation on the wellness tourism participants’ mental health benefits

[[abstract]]摘 要 在森林或綠地的自然環境中，有更多的負離子及芬多精，對人體的健康有多項益處。親近大自然讓人們的身心恢復，到森林或綠地的自然環境中，從事健康旅遊或戶外遊憩，人們可以感到紓壓、愉悅和放鬆。而以導覽解說的體驗價值探討心理健康效益是個新穎的主題。本研究的目的是探討導覽解說、體驗價值和心理健康效益之間的關係，並嘗試探討導覽解說和體驗價值及心理健康效益之間是否具有調節的作用。本研究根據過去的文獻，編制所需的量表製作問卷。研究的場域為大安森林公園及台北植物園，對曾經造訪台北大安森林公園或台北植物園從事休閒遊憩的成年民眾做問卷調查。研究分析的結果為，無論有無參加導覽解說的民眾，在森林或綠地的自然環境中，多有正向的情緒，少有負面的情緒；有無導覽解說對於心理健康效益有差異。體驗價值對心理健康效益有顯著的差異；導覽解說對體驗價值和心理健康效益間有部分調解的效果。且無論是有參加導覽解說者或沒有參加導覽解說者，其體驗價值對於正向心情和復癒知覺都有顯著差異；而有參加導覽解說者的體驗價值和心理健康效益，都比沒有參加導覽解說的民眾稍具顯著性。因此，到有森林或綠地的自然環境中，從事健康旅遊或戶外遊憩者，是有助於幫助我們緩解壓力，享受在有森林或綠地的自然環境中，有更深的體驗價值，並能提升我們的正向心情，減少負向心情，增強我們的心理健康並達成國人健康促進的目標。這樣的研究發現也有助於國人選擇戶外遊憩的方式；還有觀光旅遊業者在安排健康旅遊相關的行程也可參考之。[[abstract]]Abstract In the natural environment of forests or green land, there are more negative ions and Phytoncides, which benefit human health. Being close to nature allows people to recover both physically and mentally. Participation in wellness tourism or outdoor recreation in the natural environment of forests or green spaces foster feelings of relaxation, joy and a sense of release from pressures. Exploring the benefits of mental health through the experiential value of guided interpretation is a novel theme. The purpose of this study is to explore the relationship between guided interpretation , experiential value, and mental health benefits, and to explore whether there is a moderating effect between guided interpretation , experiential value, and mental health benefits. This study developed the required scale and questionnaire based on past literature. The research site is Daan Forest Park and Taipei Botanical Garden. A questionnaire survey was conducted among adults who are over 18 and had visited Daan Forest Park or Taipei Botanical Garden for leisure and recreation. The findings of the research analysis reveal that regardless of whether individuals engaged in guided interpretation or not, the natural environment of forests or green spaces elicited more positive emotions and fewer negative emotions.; The presence or absence of guided interpretation leads to differences in the benefits of mental health. . There is a significant difference in the impact of experiential value on mental health benefits; The guided interpretation has a partial mediating effect on the relationship between experiential value and mental health benefits. Additionally, irrespective of participation in guided interpretation, distinct differences surfaced in terms of positive mood and perceptions of recovery. The experiential value and mental health benefits of those who participate in the guided interpretation are slightly more significant than those of the public who do not participate in the guided interpretation. Therefore, engaging in health tourism or outdoor recreation in natural environments with forests or green spaces can help us alleviate stress, enjoy deeper experiential value within these natural envrionments, and amplify our positive emotions, reduce negative emotions, enhance our mental health, and achieve the goal of health promotion. These research findings also offer valuable insights for Taiwanese individuals seeking outdoor recreational options, while tourism planners can draw upon them when designing itineraries centered around wellness tourism

輕省科技與數位轉型翻轉長期照護

[[abstract]]本文主要在探討台灣目前長照機構遇到系統設計的問題，如：無法即時掌握照護需求、資訊介面未考量人因設計及無法提供家人科技溝通資訊。並藉由參訪加拿大長照系統標竿學習後，整理具有學習價值的科技設計融入長期照護系統之運用，如UX（user experience）設計思維，回到人的主動式參與的需求，建立更智慧的健康照護模式，提供一站式資訊服務，解決機構整體資料儲存與應用的安全性，發展物聯網設計，把人與人的連結變得簡單快速，崁入照護零距離的概念，提升服務品質與滿意度。這些科技化設計不但可改善工作流程照護模式，也能提供更多臨床決策，另可搭配現代串聯5G的高流量科技，提供更快速即時的資訊傳遞服務、簡化護理工作與提升了護理價值，達到輕省科技目的。本文經整理相關科技發展內容，期能對台灣長照科技發展有所參考與助益