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Objectives: To investigate community health centers' (CHCs) health literacy. Design: A cross‐sectional study. Sample: A total of 374 CHCs were surveyed and 258 CHCs responded, with an effective questionnaire response rate of 69.0%. Measurements: Data were collected by using a self‐developed health literacy assessment tool to survey CHCs' health literacy throughout Taiwan from January to December 2019. Results: The item of organizational health literacy (OHL) with the highest proportion of CHCs not implementing them was "Design of easy‐to‐use computer applications and new media" (47.3% not yet achieved), followed by "Involving target audiences in document and service development" (34.9% not yet achieved). CHCs located in northern Taiwan had higher health literacy achievement scores than those in other regions, and those in urban areas had higher health literacy achievement scores than those in general and remote areas. Conclusions: This study identified items with poor implementation of OHL and found regional differences in health literacy among CHCs. The findings can inform the development of targeted interventions to improve health literacy in underperforming CHCs and guide policymakers in allocating resources to regions and areas in need of. [ABSTRACT FROM AUTHOR]

Purpose: The design-thinking intergenerational service-learning model (DTISLM) has structured ageing-related trainings on strategies to improve empathy among college students for intergenerational program development and promote positive relationships and wellbeing between younger and older generations in community-based settings. The objective of this study was to examine the effects of DTISLM on college students' ageism, intergenerational relationships, and health. Method: Mixed-methods data were collected via pre–post surveys and after-class reflection notes from 142 students from three universities in Taiwan. Results: DTISLM significantly improved college students' level of empathy toward older adults, age stereotypes, intergenerational relationships, wellbeing (i.e., life satisfaction), and health behaviors (i.e., exercise). This intervention promoted health awareness among college students. Discussion: Via hands-on trainings for empathy improvement, DTISLM empowered college students to develop intergenerational programs that promoted positive intergenerational relationships and healthy habits. This sheds new light on university–community partnerships involving intergenerational service needs to create age-friendly societies globally. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is a serious global health issue. Limited studies previously analyzed health literacy components in patients undergoing smoking cessation interventions. This study focuses on individuals enrolled in smoking cessation services and investigates the distribution of health literacy in three domains (health care, disease prevention, and health promotion) and four abilities (access, understand, appraise, and apply health information). The study also explores the correlation between background factors (age, BMI, etc.) and health literacy, as well as the differences in health literacy levels among different background variables (gender, etc.). Methods: 228 individuals completed the health literacy questionnaire. Descriptive statistical analysis, Pearson Correlation, and a Chi-Squared Test were employed to investigate the various health literacy levels and background variables. Results: 68% had excellent or sufficient health literacy. A total of 32% were considered problematic or to have inadequate health literacy. Of the three domains of health literacy, participants performed better in the healthcare domain. More than one-third were problematic in accessing and appraising information. Conclusions: this paper, being the pilot study in providing an analysis of health literacy components in individuals undergoing smoking cessation, could serve as a useful reference for devising interventions for different population groups in trying to maximize successful cessation rates. [ABSTRACT FROM AUTHOR]

Background: Terminally ill patients often experience exacerbations of diseases that render mainstream medicine ineffective in relieving symptoms, prompting attempts at complementary and alternative medicine (CAM). This study collected data from terminally ill patients and their relatives to determine differences between CAM use, behavioral patterns, and perceptions of health information about CAM. Methods: A cross-sectional design using a self-administered questionnaire was adopted. Eight medical institutions in Taiwan with inpatient hospice palliative care units were chosen. Ninety-two terminally ill patients and 267 relatives met the inclusion criteria. The questions concerned the experience of CAM use, the kinds of products/services CAM provided, the purpose of CAM use, the source of CAM information, and the perceptions and attitudes toward CAM. Results: Both terminally ill patients and their relatives have a high proportion of lifetime and one-year prevalence of CAM use (88.0% vs. 88.4%; p = 0.929). CAM use for musculoskeletal and neurological discomfort is higher among terminally ill patients than among their relatives. Relatives/friends are the most frequent sources of information on CAM (53.3% vs. 62.2%; p = 0.133). The percentage of terminally ill patients who discontinued mainstream medical treatment because of CAM use was higher than that of their relatives (18.5% vs. 9.3%; p = 0.026). More than half the terminally ill patients and their relatives had never been asked about CAM by medical staff (64.1% vs. 66.7%), nor had they informed medical professionals about the use of CAM products and services (63% vs. 66.9%). Random inquiries by medical professionals may be associated with increased disclosure of CAM use (terminally ill patients: odds ratio, 9.75; 95% confidence interval, 1.97–48.35 vs. relatives: odds ratio, 5.61; 95% confidence interval, 2.66–11.83). Conclusions: The high prevalence and concealment of CAM use in terminally ill patients should be considered. Medical professionals should establish a friendly and barrier-free communication model, encourage patients to share CAM experiences, and provide evidence-based information on the use of CAM products and services, to reduce the potential damage caused by harmful use. [ABSTRACT FROM AUTHOR]

Background: Health literacy (HL) has proven to be a determining factor influencing the health of individuals. Community health providers (CHPs) work on the front line of improving public HL. Increasing their understanding of HL and their ability to incorporate HL into healthcare can reduce obstacles in healthcare services. This study evaluated the effectiveness of an HL training program for CHP by using the hybrid online team-based learning (TBL) model. Methods: A quasi-experimental study and focused group interviews were conducted. We developed a six weeks HL online course for CHPs. The program included teaching videos for pre-class preparation, a 90-min online TBL model, and a case discussion in the last two weeks. Team application activities were designed for each class to enhance knowledge application. A total of 81 CHPs from 20 public health centers took the course and provided complete data for analysis. Learning effectiveness was evaluated based on the familiarity, attitude, and confidence in implementing HL practices, course satisfaction, and participants' learning experiences. Results: The comparison showed that the participants' familiarity with HL (4.29 ± 1.76 vs 6.92 ± 1.52, p <.001), attitude (7.39 ± 1.88 vs 8.10 ± 1.44, p =.004), and confidence in implementing HL practices (6.22 ± 1.48 vs 7.61 ± 1.34, p <.001) increased after the course. The average satisfaction with the teaching strategies was 4.06 ±.53 points, the average helpfulness to practice was 4.13 ±.55 points, and the overall feedback on satisfaction with learning was 4.06 ±.58 points (the full score was 5 points). According to the learning experience of the 20 participants in the focus group discussion, the experiences of teaching strategies and the learning experiences of the HL course were summed up into two categories, seven themes, and 13 subthemes. The results showed a positive experience with the hybrid online TBL program. Conclusion: The use of hybrid online TBL model is a feasible and valid approach for the HL training of CHPs. The result can serve as a reference for the on-the-job training of various healthcare workers. [ABSTRACT FROM AUTHOR]

Not only were social events and public facilities closed temporarily due to the coronavirus disease 2019 (COVID‐19) pandemic, but health services also were affected greatly. In this commentary, the authors discuss how the national program of mammography screening in Taiwan was affected, even without known community‐acquired transmission. [ABSTRACT FROM AUTHOR]

Background: An aging society incurs great losses due to fall-related injuries and mortalities. The foreseeable increased burden of fall-related injury among older people requires a regular nationwide study on the fall epidemic and prevention strategies.Methods: The fall epidemic was examined using data from three consecutive waves of the National Health Interview Survey (2005, 2009, and 2013). Common explanatory variables across these surveys included sociodemographic factors (age, sex, and difficulty in performing activities of daily living (ADL) or instrumental ADL), biological factors (vision, comorbidities, urinary incontinence, and depressive symptoms), and behavioral risk factors (sleeping pill use, and frequency of exercise). After the univariate and bivariate analyses, the prevalence of falls was investigated using multiple linear regression models adjusted for age group, sex, and year of survey. A multivariate logistic regression model for falls with adjustments for these common explanatory variables was established across three waves of surveys. The effect of fall prevention programs was examined with the effect size in terms of age-specific and sex-specific prevalence of falls and fall-related hospitalization rates during 2005 and 2009.Results: For each survey, there were consecutively 2722; 2900; and 3200 respondents with a mean age of 75.1, 75.6, and 76.4 years, respectively. The multiple linear regression model yielded a negative association between the prevalence of falls and year of survey. Several sociodemographic and biological factors, including female sex, difficulty in performing one basic ADL, difficulty in performing two or more instrumental ADLs, unclear vision, comorbidities, urinary incontinence, and depressive symptoms, were significantly associated with falls. In contrast to the universal positive effect on the prevalence of falls among older adults, the effect size of fall-related hospitalization rates revealed a 2% relative risk reduction only for those aged 65-74 years, but deteriorated for those aged 75-84 (- 10.9%).Conclusion: Although the decline in fall prevalence over time supports existing fall intervention strategies in Taiwan, the differential prevention effect and identification of risk factors in older people suggest the necessity of adjusting fall prevention programs. [ABSTRACT FROM AUTHOR]

Background: Effectiveness of oral cancer screening depends on identifying high-risk groups. People with betel quid chewing or cigarette smoking habits are often reluctant to attend screenings. Given that use of both substances is associated with certain occupations, a targeted approach should be applied to improve the effectiveness of screening programs. Objectives: This study sought to identify occupations with a high prevalence of betel quid chewing and cigarette smoking and to investigate their changing trends using the Taiwan National Health Interview Survey (NHIS) database. Methods: The NHIS database for 2009 and 2013 were used. We estimated prevalence of current betel quid and/or cigarette use among those aged 20-64 years old. Occupations were classified using the International Standard Classification of Occupations (ISCO-88). Statistical analyses included indirect standardized rates and cluster analysis of chewing/smoking habits. Results: Drivers, mobile-plant operators, and extraction and building trades workers had the highest prevalence of betel quid chewing and cigarette smoking (chewing: 30.92% and 29.62%; smoking: 61.16% and 62.22%). Many occupations had large indirect standardized rates for chewing but not smoking. Both habits are associated with each other (r = 0.81, p < 0.001). Use appeared to decrease based on comparison between 2009 and 2013. Conclusions: Drivers and construction laborers showed high prevalence of betel chewing and cigarette smoking. The chewing habit is actually more prevalent in several sub-occupations. The survey results also revealed lower attendance by construction laborers at oral cancer screenings. Oral cancer screening and awareness should be emphasized in the identified occupations. [ABSTRACT FROM AUTHOR]

Although Taiwanese citizens benefit from affordable health care, residents in remote areas extensively rely on unsafe self-care practices because of a lack of easy access to medical services. To improve self-care safety, ten easy-access self-care medical spots (ESCMSs) managed by trained residents were established in two remote villages. This study aimed to assess the impact of ESCMSs on self-care and access to medical services. For a total of six commonly experienced minor illnesses, the average number of illnesses for which residents were confident to perform self-care increased from 2.78 in the pretest to 3.58 in the post-test. ESCMSs were also the first choice when experiencing minor illnesses for 31.25% residents who did not visit a doctor. Residents' personal experience with ESCMSs correlated with their perception of ESCMSs' function. Compared with residents who had no personal experience of using ESCMSs, those who used the ESCMS service were less likely to store medications for minor illnesses at home (51.02% vs. 76.67%). Furthermore, those who attribute the reduced needs for professional help to ESCMSs had used medications for minor illnesses at ESCMSs. These results suggest that establishing ESCMSs is a viable alternative to increase the self-care capacity of residents in remote areas and increase the access to medical resources. Moreover, because residents are less likely to store medication and travel for professional help, ESCMSs could indirectly reduce the risks of self-medication and traffic accidents, respectively. However, caution should be exercised when generalizing these results to more populated areas that also lack medical resources. [ABSTRACT FROM AUTHOR]

Background: Hospice care has a positive effect on medical costs. The correlation between survival time after receiving hospice care and medical costs has not been previously investigated in the literature on Taiwan. This study aimed to compare the differences in medical costs between traditional care and hospice care among end-of-life patients with cancer. Methods: Data from Taiwan's National Health Insurance program on all patients who had passed away between 2010 and 2013 were used. Those whose year of death was between 2010 and 2013 were defined as end-of-life patients. The patients were divided into two groups: traditional care and hospice care. We then analyzed the differences in end-of-life medical cost between the two groups. Results: From 2010 to 2013, the proportion of patients receiving hospice care significantly increased from 22.2% to 41.30%. In the hospice group, compared with the traditional group, the proportions of hospital stays over 14 days and deaths in a hospital were significantly higher, but the proportions of outpatient clinic visits; emergency room admissions; intensive care unit admissions; use of ventilator; use of cardiopulmonary resuscitation; and use of hemodialysis, surgery, and chemotherapy were significantly lower. Total medical costs were significantly lower. A greater number of days of survival for end-of-life patients when receiving hospice care results in higher saved medical costs. Conclusion: Hospice care can effectively save a large amount of end-of-life medical costs, and more medical costs are saved when patients are referred to hospice care earlier. [ABSTRACT FROM AUTHOR]

Background: Cancer patients with schizophrenia may face disparities in end-of life care, and it is unclear whether schizophrenia affects their medical care and treatment.Methods: We conducted a nationwide population-based cohort study based on the National Health Insurance Research Database of Taiwan. The study population included patients >20years old who were newly diagnosed as having one of six common cancers between 2000 and 2012 (schizophrenia cohort: 1911 patients with both cancer and schizophrenia; non-schizophrenia cohort: 7644 cancer patients without schizophrenia). We used a multiple logistic regression model to analyze the differences in medical treatment between the two cohorts in the final 1 and 3months of life.Results: In the 1month before death, there was higher intensive care unit utilization in the schizophrenia group [odd ratio (OR)=1.21, 95% confidence interval (CI)=1.07-1.36] and no significant differences between the groups in-hospital stay length or hospice care. The schizophrenia patients received less chemotherapy (OR=0.60, 95% CI=0.55-0.66) but more invasive interventions, such as cardiopulmonary resuscitation (OR=1.34, 95% CI=1.15-1.57). Advanced diagnostic examinations, such as computed tomography/magnetic resonance imaging/sonography (OR=0.80, 95% CI=0.71-0.89), were used less often for the schizophrenia patients. The 1- and 3-month prior to death results were similar.Conclusion: End-of-life cancer patients with schizophrenia underwent more frequent invasive treatments but less chemotherapy and examinations. Treatment plans/advance directives should be discussed with patients/families early to enhance end-of-life care quality and reduce health care disparities caused by schizophrenia. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the most common cancer in Taiwan, and is the third leading cause of cancer-related death. Screening has been proven the most effective way to reduce CRC mortality, and stool-based screening is currently the most popular method of screening worldwide. In 2004, Taiwanese government launched a nationwide screening program and fecal immunochemical test (FIT) is offered biennially to individuals aged 50 to 75. The results from the program have demonstrated that FIT screening could effectively reduce the mortality from CRC. Nevertheless, there were some problems needed to deal with. First, the occurrence of interval cancers, which are associated with the performance of screening tests or quality of colonoscopy, has affected the program sensitivity. Second, increasing participation in the program has increased the demand for colonoscopy and the burden on public health workers. Third, some individuals are non-compliant with FIT screening, and with the recommendation for colonoscopy after a positive FIT, which may be the result of insufficient awareness toward CRC and screening of the public. Fourth, long-lasting financial support for this program is necessary for its success. All of these problems need to be solved via collaboration between the screening organizer, screening distributor, and professional societies. [ABSTRACT FROM AUTHOR]

The issue of financial problems among the elderly has garnered the attention of multiple generations. In 2018, Taiwan formally attained an ageing society status. In order to address the financial difficulties elderly people face, an annuity system reform was launched by the Taiwanese government. Reverse mortgage lending, which is performed on the basis of house-for-pension, is an alternate method for enhancing their standard of living and sustaining their financial stability. The elderly applicants often mortgage their properties to financial institutions in order to maintain a steady cash flow for the fulfilment of their daily needs and live their remaining years in the mortgaged properties without vacating. Prior studies on house-for-pension in the Taiwanese context primarily concentrated on institutional implementation analysis but limitedly explored the uncertainty risks banks face when implementing the house-for-pension scheme. First, a literature review on the risks associated with house-for-pension reverse mortgage financing and comprehensive interviews with banking industry professionals were conducted. Subsequently, in the Taiwanese banking sector, assessment criteria for important risk factors in house-for-pension reverse mortgage financing were devised. The decision-making trial and evaluation laboratory (DEMATEL) was utilised to assess the interdependence of the assessment criteria. Next, the DEMATEL-based analytic network process (ANP) or DANP were used to calculate the weights of evaluation criteria. By employing modified VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR), a gap analysis was undertaken on the assessment criteria and sub-criteria. The study's findings serve as a guideline for the Taiwanese banking industry in formulating, improving, or amending the risk exposure mitigation measures for reverse mortgage lending. • This study concentrates on crucial risk indicators in the Taiwanese banking industry's house-for-pension reverse mortgage lending. • An assessment model was created for major risk indicators in house-for-pension reverse mortgage lending in the Taiwanese banking market. • The DEMATEL was used to generate the INRM concerning evaluation criteria. • The weights assessment criteria/sub-criteria were determined using the DANP. • Using the modified VIKOR, the gap values of the evaluation criteria/sub-criteria were determined. [ABSTRACT FROM AUTHOR]

The article talks about the advance care planning as a cultural adaptation of end-of-life care discussion and 2019 declarations on health care in Taipei. Topics discussed include initiative to respect patient’s values and ensure quality care in accordance with their preferences; directives for serving as a significant means to preserve patient’s dignity; and consider advance directives through the process of advance care planning and choices of life-sustaining medical treatments.

Objectives Falling is a major health risk facing the elderly. The prevalence of falls is 20.5% among adults older than 65 years in Taiwan. Our study used a geriatric screening tool to identify elderly people at high risk of falls. Materials and Methods Our study used a 10-minute geriatric screening tool developed by the World Health Organization to survey geriatric health problems and evaluated its effectiveness in a population of elderly Taiwanese. There were 186 participants who were ≥ 65 years old. All participants were interviewed by trained volunteers using the screening tool. Results The prevalence of falls was 28.3%, depression 13.4%, and urinary incontinence 29.9% in the previous year. Health issues in the elderly associated with a history of falls included depression ( p < 0.001), urinary incontinence in the previous year ( p = 0.004), and urinary incontinence in the previous week ( p = 0.007). Protective factors against falls included the ability to walk fast ( p < 0.001), get to places out of walking distance ( p < 0.001), and perform heavy work ( p < 0.001). The logistic regression analysis revealed that depression was positively correlated with a history of falling ( p = 0.023), whereas the ability to walk fast presented a negative correlation ( p = 0.015). Conclusion The World Health Organization 10-minute screening tool can be rapidly and easily implemented in a primary care clinical setting. It can also improve the identification of elderly persons living in the community at high risk of falling. [ABSTRACT FROM AUTHOR]

Background. We implemented a community-run and GP-supervised self-care for minor illnesses (CGPSC) program in a mountainous area where medical resources for caring for minor illnesses were scarce. In this paper, we reported the residents’ experiences and evaluations of this program. Methods. The CGPSC program was implemented through easy-access self-care medical spots (ESCMSs) that were set up in the community with following services: non-prescription medications for minor illness (MMI) service, materials for caring for minor injuries, pamphlet on self-care for minor illnesses and minor injuries and medical consultation line. Ten selected residents were trained to run the ESCMSs. All services were supervised by the GP in charge. Nine months after the opening of the ESCMSs, a survey was conducted to evaluate residents’ reactions to it. Results. Eighty per cent (n = 80) of the respondents were aware of the existence of the ESCMSs, and the MMI service was known to most residents and most utilized by them. Compared to respondents who had not used the MMI service (n = 30), those who had used the service (n = 50) considered the ESCMSs more helpful (90.00% versus 76.67%, P < 0.05) and had greater willingness to seek help from the ESCMS in the future (88.00% versus 56.67%, P < 0.01). Conclusions. The collaborative efforts of the communities and the medical staff had made the ESCMS a safe, convenient and user-friendly resource to self-care for residents in a rural area. Under the supervision of the GP, trained community residents were able to run the ESCMS smoothly and efficiently. [ABSTRACT FROM PUBLISHER]

Abstract: This study follows the concept of set cover for proposing a refueling-station-location model using a mixed integer programming method, based on vehicle-routing logics. Its solution uses only the easy-obtain data of the origin-destination distance matrix. A case study that focuses on the siting of refueling stations for achieving multiple origin-destination intercity travel via electric vehicles on Taiwan demonstrates the applicability of the model. Sensitivity analysis shows that greater vehicle range will result in a lower number of refueling stations that need to be sited. Range is crucial in reducing the facility-location costs, and therefore is an important issue in the development of alternative-fuel-vehicle technology. [Copyright &y& Elsevier]

Background: Understanding attitudes towards life and death issues in different cultures is critical in end-of-life care and the uptake of advance care planning (ACP) in different countries. However, existing research suffers from a lack of cross-cultural comparisons among countries. By conducting this comparative study, we hope to achieve a clear understanding of the linkages and differences among healthcare cultures in different Chinese societies, which may serve as a reference for promoting ACP by considering cultural differences. Methods: Our researchers recruited Chinese adults who could communicate in Mandarin and lived in metropolitan areas in Taiwan, Hong Kong, Singapore, and Australia. Focus group interviews were conducted, and the interview contents were recorded and subjected to thematic analysis. Results: Between June and July 2017, 14 focus groups with 111 participants were conducted in four regions. With traditional Chinese attitudes towards death as a taboo, many participants felt it would be challenging to discuss ACP with elderly family members. Most participants also desire to avoid suffering for the self and family members. Although the four regions' participants shared a similar Chinese cultural context, significant regional differences were found in the occasions at which participants would engage in end-of-life discussions and select settings for end-of-life care. By contrast, participants from Singapore and Australia exhibited more open attitudes. Most participants from Taiwan and Hong Kong showed a preference for end-of-life care at a hospital. Conclusions: The developmental experiences of ACP in Western countries, which place a strong emphasis on individual autonomy, cannot be directly applied to family-centric Asian ones. Healthcare professionals in Asian societies should make continuous efforts to communicate patient status to patients and their family members to ensure family involvement in decision-making processes. [ABSTRACT FROM AUTHOR]

Background: The use of home health care (HHC) is increasing worldwide. This may have an impact not only on patients and their caregivers' health but on care resource utilization and costs. We lack information on the impact of HHC on the broader dimensions of health status and care resource utilization. More understanding of the longitudinal HHC impact on HHC patients and caregivers is also needed. Moreover, we know little about the synergy between HHC and social care. Therefore, the present study aims to observe longitudinal changes in health, care resource utilization and costs and caregiving burden among HHC recipients and their caregivers in Taiwan.Methods: A prospective cohort study "Home-based Longitudinal Investigation of the Multidisciplinary Team Integrated Care (HOLISTIC)" will be conducted and 600 eligible patient-caregiver dyads will be recruited and followed with comprehensive quantitative assessments during six home investigations over two years. The measurements include physical function, psychological health, cognitive function, wellbeing, shared decision making and advance care planning, palliative care and quality of dying, caregiving burden, continuity and coordination of care, care resource utilization, and costs.Discussion: The HOLISTIC study offers the opportunity to comprehensively understand longitudinal changes in health conditions, care resource utilization and costs and caregiving burden among HHC patients and caregivers. It will provide new insights for clinical practitioners and policymakers.Trial Registration: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020. [ABSTRACT FROM AUTHOR]

• Stable high SEP trajectory group is associated with a low prevalence of frailty. • Disadvantaged life-course SEP is associated with increased frailty risk in old age. • Avoiding that unfavourable SEP trajectories over the life course translate into an increased probability of frailty is key to reducing health inequalities in elderly populations. This study examined the association between socioeconomic position (SEP) trajectories and frailty in the elderly population in Taiwan. We used data from people aged 53 years and over (n = 1284) collected from wave two of the Social Environment and Biomarkers of Aging Study. Frailty was identified using the modified Fried criteria, with the scores combined to use to categorize participants as frail (score = 3-5), prefrail (score = 1 or 2) and robust (score = 0). We applied a group-based person-centered trajectory model to identify four types of SEP trajectories (low-low, 19.2%; high-low 12.5%; low-high, 35.4%; and high-high, 32.9%) to describe the social mobility patterns in the participants' lives from childhood to older age. The mean age of the study population was 65.30 ± 8.94 years, and 47.39% of the participants were women. The prevalence of frailty was 18.39%. The low-low, high-low, low-high, and high-high SEP trajectory groups were represented by 37.92%, 24.93%, 15.43%, and 7.91%, respectively, of the study population. We used multinomial logistic regression models to evaluate the association between SEP and the risk of frailty. Compared with the low-low SEP trajectory group, the high-high SEP trajectory group was significantly associated with a lower prevalence of frail and pre-frail (odds ratios 0.17 and 0.36; 95% confidence interval 0.08–0.34 and 0.21-0.61). Our results suggest that a disadvantaged life-course SEP is associated with increased risks of frailty in older age. Avoiding that unfavourable SEP trajectories over the life course translate into an increased probability of frailty is key to reducing health inequalities in elderly populations. [ABSTRACT FROM AUTHOR]

Context: It is uncertain whether terminally ill schizophrenic cancer patients are hypoalgesic or have disparities in pain management.Objectives: The objective of this study was to analyze the dosage of opioids used in terminally ill cancer patients with and without schizophrenia.Methods: This is a population-based retrospective cohort study based on data derived from the Taiwan National Health Insurance Research Database. Patients aged >20 years and newly diagnosed between 2000 and 2012 with at least one of the six most common cancers were included. After 1:4 matching, 1001 schizophrenic cancer patients comprised the schizophrenia cohort, while 4004 cancer patients without schizophrenia comprised the nonschizophrenia cohort. The percentage of opioid use, accumulated dose, and average daily dose near the end of life were analyzed for each cohort using multiple logistic and linear regression models.Results: The percentage of opioid use was lower in the schizophrenic cohort than the nonschizophrenic cohort during the last month before death (69.6% vs. 84.8%, odds ratio = 0.40, 95% CI = 0.34-0.48). The accumulated dose of opioid consumption was also lower in the schizophrenic cohort (2407 mg vs. 3694 mg, P value < 0.05).Conclusion: Near the end of life, cancer patients with schizophrenia use less opioid than their nonschizophrenic counterparts. Cognitive impairment may be a cause in the disparity in end-of-life care for terminally ill schizophrenic cancer patients. Thus, we should formulate a more accurate pain scale system and pay attention to their need for pain treatment. [ABSTRACT FROM AUTHOR]

Although hospice or palliative care for patients with advanced dementia has been implemented for more than 30 years, few studies have investigated the prognostic predictors of 6-month mortality in these patients. Prognostication has been a major obstacle, and 6-month prognostic predictors for patients with advanced dementia are still considered elusive. To better understand the dying trajectories of patients with advanced dementia, we performed a longitudinal prospective cohort study to investigate the predictors of 6-month mortality for residents with advanced dementia in long-term care facilities in Taiwan. Prospective cohort study. This study took place in 32 long-term care facilities selected from northern, central, and southern Taiwan. The study included 320 residents with advanced dementia. Measurements were obtained after determining study eligibility; the participants underwent follow-up assessments once every 3 months for 6 months or died during follow-up. The assessments included demographic characteristics, health and medical status characteristics, and death-related information. The Kaplan-Meier survival function estimation and the Cox proportional hazards model were used to estimate the survival rate and predict the prognostic factors. Baseline data from 320 residents with advanced dementia in long-term care facilities were obtained. The mean age was 82.7 years and 61.6% were female. The 6-month survival rate was 78.1%. The major cause of death was multiple organ failure related to pneumonia. The 6-month prognostic predictors were pneumonia (adjusted hazard ratio, 5.56; 95% confidence interval, 2.46–12.6; p -value <.001), reduction in nutrient intake >25% (adjusted hazard ratio, 5.05; 95% confidence interval, 2.37–10.8; p -value <.001), oxygen dependency (adjusted hazard ratio, 2.58; 95% confidence interval, 1.51–4.39; p -value =.001), treatment for electrolyte abnormalities (adjusted hazard ratio, 2.14; 95% confidence interval, 1.10–4.14; p -value =.025), severe pressure injuries (adjusted hazard ratio, 2.04; 95% confidence interval, 1.13–3.67; p -value =.018), and long-term indwelling urinary catheters (adjusted hazard ratio, 1.80; 95% confidence interval, 1.09–2.96; p -value =.021). Our results identified six prognostic predictors of 6-month mortality among residents with advanced dementia in Taiwan. These predictors may serve as risk assessment indicators for nursing staff who provide clinical care and can enable the identification of patients in recognized terminal decline, thereby allowing access to hospice palliative services. [ABSTRACT FROM AUTHOR]

Over time, correctional institutions have actively implemented innovations in prison administration. Most correctional institutions constitute conservative and closed societies. Generally, people do not have sufficient knowledge or understanding of penal correction. Therefore, it is difficult but necessary to break the stereotyped impression people hold about correctional institutions, actively integrate them into society, and encourage people to assume a more humane attitude towards correctional institutions. We conducted an inductive analysis of Penghu Prison administered by the Agency of Corrections, Ministry of Justice, Taiwan. After creating evaluation indices for the development of more humane correctional institutions, we conducted a survey to classify the evaluation indices into criteria under the four major evaluation dimensions. Using DEMATEL, we determined the causal relationship among different evaluation indicators and generated an influential network relation map about the evaluation criteria. Using DANP, we subsequently calculated weightings for the influence of each criterion. Finally, using the modified VIKOR, we conducted a gap analysis. The results of this study can be used to build a more positive and human reputation for correctional institutions and enable their sustainable creation., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Health literacy (HL), which is a determinant of individuals' health as well as a personal and public asset, can be improved by community healthcare providers (CHPs) with the capability of providing HL services. The purpose of this study was to explore CHPs' familiarity with and attitudes toward HL and their confidence in implementing HL practices. A cross-sectional online survey was conducted involving a total of 104 CHPs from 20 public health centers in Taiwan. It was based on a structured questionnaire involving self-evaluation by participants. The scores for familiarity, attitudes, and confidence in implementing HL practices were mean = 4.36, SD = 1.99; mean = 7.45, SD = 1.93; and mean = 6.10, SD = 1.77 (out of 10 points), respectively. The results of the multiple regression analysis showed that the two independent variables of familiarity and attitude could predict confidence in implementing HL practices (R 2 = 0.57, F(2101) = 58.96, p < 0.001). The CHPs surveyed were not especially familiar with HL; thus, they recognized its importance, but they lacked confidence in implementing HL practices. Increasing practitioners' familiarity with HL may therefore boost their confidence in implementation. The research results can serve as a reference when planning HL education and training.

Abstract: Palliative care in rural areas can be difficult to assess and, often is of lower quality compared to more densely populated regions. A program of multicenter palliative care discussion forum via tele-videoconference may be a promising tool for exchanging valuable experience and constructing a comprehensive hospice care system in Taiwan and China.The multicenter palliative care discussion forum began 1997 and 2010 in Taiwan and China, respectively. In every forum, 1 to 2 cases were presented by multiple field specialists, and multi-dimensional problems were discussed. All of these case reports and reference materials from the forums were analyzed.The conference discussed 199 and 143 cases in Taiwan and China, including 172 and 143 cancer patients. The most common mentioned symptom was pain (66.3% in Taiwan, 96.95% in China). As time went on, the rate of discussion in pain management issues decreased, but the social and psycho-spiritual issues increased in Taiwan. After some major legal and social changes, the discussion of ethical issues increased rapidly. In China, the trends and ranking in discussion of nonpain management issues stabilized and showed most frequently in psycho-spiritual issues, followed by social, ethical and legal issues.Sharing palliative experience via tele-videoconferences is an effective tool to improve the quality of care, and also saves a significant amount of time and expense. Experts in different professions from different hospitals should discuss any palliative problems, share their valuable experience, and ponder a comprehensive hospice care., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Subjects with a positive faecal immunochemical test (FIT) have a much higher likelihood of advanced neoplasms than the general population. Whether FIT-positive subjects with negative colonoscopy should receive subsequent FIT screening remain unclear., Design: Subjects with a negative colonoscopy after positive FIT in the first screening in the Taiwanese Colorectal Cancer (CRC) Screening Program 2004-2009 were followed until the end of 2014. CRC incidence was compared between those who did and did not receive subsequent FIT screening. Cox regression analysis was conducted, adjusting for major confounders to investigate whether subsequent FIT was associated with lower risk of incident CRC., Results: The study cohort was comprised of 9179 subjects who had negative diagnostic colonoscopy after positive FIT in 2004-2009, of whom 6195 received subsequent FIT during the study period. The CRC incidence (per 1000 person years) was 1.34 in those who received subsequent FIT and 2.69 in those who did not, with corresponding adjusted HR (aHR) of 0.47 (95% CI 0.31 to 0.71). Lower adenoma detection rate of diagnostic colonoscopy was associated with higher risk of incident CRC but became non-significant in multivariable analysis after adjustment for subsequent FIT. Higher baseline faecal haemoglobin concentration (FHbC, μg haemoglobin/g faeces) was associated with increased risk of incident CRC (reference: FHbC=20-39; aHR=1.93 (1.04-3.56), 0.95 (0.45-2.00), 2.26 (1.16-4.43) and 2.44 (1.44-4.12) for FHbC=40-59, 60-99, 100-149 and ≥150, respectively)., Conclusion: Subsequent FIT should be scheduled after negative colonoscopy to detect missed neoplasms and reduce the risk of incident CRC in a national FIT screening programme., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The purpose of the study is to test the longitudinal efficacy of a mHealth intervention (Intergenerational Mobile Technology Opportunities Program, IMTOP) for older type 2 diabetes mellitus (T2DM) patients in rural Taiwan. Few mHealth programs targeted rural older adults and the longitudinal effects are unknown., Methods: Ninety-seven T2DM patients aged 55+ were recruited from an outpatient in Hualien, Taiwan. The intervention comprised 8-week technology and diabetes self-management training and 4-week technical support. College student tutors facilitated T2DM patients to learn technology. Participants used a diabetes self-management app to track health behaviors. Outcomes measured at baseline and at 4 and 8 months including patient-reported self-care behaviors, T2DM symptoms, clinical outcomes, health resource utilization, and medical expenditure. Linear mixed-effect regressions of repeated measures were conducted for each outcome., Results: At 4 months, improvements in self-care behaviors were reported in diet, exercise, smoking, and blood glucose testing. Patients paid less endocrinology clinic visits, spent less on endocrinology medications, and improvements in fasting blood glucose and total cholesterol were observed. At 8 months, the statistical significance of improvements in diet and smoking were maintained, and the averaged endocrinology clinic visits remained less than baseline. However, more frequent occurrence of diabetes symptoms were reported at both follow-ups., Conclusions: IMTOP had lasting effects on diet and decreased smoking behavior, clinic visits, and medication costs over 8 months. Self-monitoring through an app increased awareness and may explain the increased reporting of diabetes symptoms. IMTOP is a promising model for promoting T2DM self-management in rural areas.

Background and Aim: The aim of this study is to identify gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in Indigenous communities., Methods: First, we quantified the health disparities in gastric cancer in Indigenous peoples using data from the cancer registries during the period of 2006-2014. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy., Results: Gastric cancer incidence (24.4 vs 12.3 per 100 000 person-years) and mortality rates (15.8 vs 6.8 per 100 000 person-years) were higher in Indigenous than in non-Indigenous, with 2.19-fold (95% confidence interval [CI]: 2.06-2.33) and 2.47-fold (2.28-2.67) increased risk, respectively. In Indigenous communities, H. pylori infection was more prevalent in Indigenous than in non-Indigenous (59.4% vs 31.5%, P < 0.01). Regression analyses consistently showed that either the mountain or plain Indigenous had 1.89-fold (95% CI: 1.34-2.66) and 1.73-fold (95% CI: 1.24-2.41) increased risk for H. pylori infection, respectively, as compared with non-Indigenous, adjusting for other baseline characteristics. The high infection rates were similarly seen in young, middle-aged, and older adults. Program eradication rates using clarithromycin-based triple therapy were suboptimal (73.7%, 95% CI: 70.0-77.4%); the habits of smoking (1.70-fold, 95% CI: 1.01-2.39) and betel nut chewing (1.54-fold, 95% CI: 0.93-2.16) were associated with the higher risk of treatment failure., Conclusion: Gastric cancer burden is higher in Indigenous Taiwanese peoples than in their non-Indigenous counterparts. Eliminating the prevalent risk factor of H. pylori infection is a top priority to reduce this health disparity., (© 2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

The aging of the Taiwanese population has become a major issue. Previous research has focused on the burden and stress faced by caregivers, but has not explored how the experience of these caregivers influences decisions of advance care planning (ACP). Semi-structured and in-depth interviews were conducted. Qualitative content analysis was used to identify important themes. Five themes and fourteen sub-themes were identified: (1) Past experiences: patient wishes, professional recommendations, and expectation about disease progress; (2) Impact of care on family members: positive affirmation, open-minded life, social isolation and health effects, and financial and life planning effects; (3) Attitude toward life: not forcing to stay, and not becoming a burden, (4) Expected proxy dilemmas: torment between doing or not, seeing the extension of suffering and toil, and remorse and self-blame; (5) Expectation of end of life (EOL) care: caregiver's experience and EOL care decisions, and practicality of EOL decision making. After making multiple medical decisions for their disabled relatives, caregivers are able to calmly face their own medical decisions, and "not becoming a burden" is their primary consideration. It's suggested that implementation of shared decision-making on medical care for patients with chronic disability will not only improve the quality of their medical care but also reduce the development of remorse and guilty feelings of caregivers after making medical decisions.

This study assesses equity in active aging across social determinants among older Taiwanese. The data were collected from face-to-face interviews with adults aged 55 years or more in Taiwan in 2017 ( n = 738). A total of 30 individual-level Taiwan active aging indicators were chosen, and the relationship between social determinants and active aging indicators were analyzed by logistic regression models. Women were more likely to participate in volunteering and other social groups and in lifelong learning activities, whereas men were more likely to be employed, to engage in physical activity, to feel safe from violence, and to use preventive care. Higher education was related to higher employment, social participation, independent living, lifelong learning, and a lower likelihood of poverty and severe cognitive impairment. Those living in rural areas were more likely to be employed, perform physical activity, feel physically safe, have better mental well-being, and have higher social respect and social integration ratings, whereas living in urban areas was related to greater access to medical care, owning assets, less severe cognitive impairment, greater likelihood of using information and communications technology, higher level of education, and higher access to convenient transportation. The significant disparities that exist in active aging may suggest inequality.

The Health Promotion Administration of Taiwan launched an integrative certification initiative in 2016 to streamline a plural system of certifications of health promotion in hospitals. It endeavored to replace original certifications, thereby establishing the proposal of a self-assessment instrument to aid in this integration. This study aimed to verify the robustness of this self-assessment tool by conducting exploratory factor analyses through stratification, reliability tests, content and construct validity tests, and specialist evaluations, which were convened to judge the comprehensibility, applicability, and importance of the standards and measures of this tool. A stratified random sampling of 46 hospitals was performed to confirm the validity of this tool. The tool rendered a floor effect of 0% and a ceiling effect of 13%. A valid factor structure and internal consistency (α ranged from 0.88 to 0.96) in each standard were verified. Hospitals with previous certificates or with 300+ beds achieved high compliance scores. A majority of experts agreed that the sub-standards were comprehensible (≥80%), applicable (≥70%), and important (≥70%). Finally, we conclude that the self-assessment tool is valid and can serve as a reference for other countries with hospitals committed to health promotion in hospital settings.

Background: Characteristics associated with acceptance of dataset linkages and health data linkage data quality were analyzed., Methods: Participants from the 2011 Taiwan Longitudinal Study on Aging were asked to link their epidemiological data with concurrent and future medical claim datasets. Characteristics associated with acceptance of data linkage, data consistency, under-reporting, and over-reporting of disease conditions were identified., Results: Among the 3727 respondents, 3601 (96.6%) accepted data linkage. Middle-aged adults with worse functional health accepted data linkage. Older adults (65+) with better health behavior and social support were more likely to accept data linkage. Consistency between self-reports and medical data was very good to satisfactory (Kappa = 0.80 and 0.67, respectively, for diabetes and hypertension). Comorbidities were common risk factors resulting in inconsistency between self-reports and medical data (OR = 1.58 and 1.27, respectively, for diabetes and hypertension). Living alone was another risk factor resulting in inconsistency for diabetes. Male, older, and not living alone were other risk factors resulting in inconsistencies for hypertension. Under-reporting of illness was associated with poor health and older age. Over-reporting of illness was associated with better health and younger age., Discussion: The findings suggest different adjustment methods for middle-aged versus older respondents when considering self-report data validity.

Background: As the "do not resuscitate" (DNR) discussion involves communication, this study explored (1) the effects of a title that included "allow natural death", and of information contents and outcomes of the decision; and (2) the information needs and consideration of the DNR decision, and benefits and barriers of the DNR discussion., Methods: Healthy adults (n = 524) were presented with a scenario with different titles, information contents, and outcomes, and they rated the probability of a DNR decision. A questionnaire including information needs, consideration of the decision, and benefits and barriers of DNR discussion was also used., Results: There was a significantly higher probability of signing the DNR order when the title included "allow natural death" (t = - 4.51, p < 0.001), when comprehensive information was provided (F = 60.64, p < 0.001), and when there were worse outcomes (F = 292.16, p < 0.001). Common information needs included remaining life period and the prognosis. Common barriers were the families' worries and uncertainty about future physical changes., Conclusion: The title, information contents, and outcomes may influence the DNR decisions. Health-care providers should address the concept of natural death, provide comprehensive information, and help patients and families to overcome the barriers.

Health promotion was defined at the first International Conference on Health Promotion held by the World Health Organization in 1986 as a process that enables the public to improve their health. Moreover, the United Nations High-Level Meeting on the Prevention and Control of Non-Communicable Diseases in 2011 highlighted that non-communicable diseases (NCDs) account for 63% of deaths worldwide, with major NCD-related risk behaviors including tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diet. In 2013, the WHO announced the Global Action Plan for the Prevention and Control of NCDs 2013-2020, with the United Nations listing NCDs prevention and control as a major topic for nations in Sustainable Development Goal 3 (Health). Both Taiwan and the world face the dual threats of population aging and NCDs, adding to the importance of health promotion and NCDs prevention and control. This article first introduces the relevant global health trends and the corresponding status of Taiwan and then examines the major NCDs prevention and health promotion policies in Taiwan. In creating a health-supportive environment for all people and enhancing health literacy and empowerment among the general public, we hope to ensure that every individual, family, and city joins the ongoing effort in Taiwan to enable all individuals to make the best, informed decisions for their health.

Organizational capacity building for health promotion (HP) is beneficial to the effective implementation of HP in organizational settings. The World Health Organization (WHO) Health Promoting Hospitals' (HPHs) initiative encourages hospitals to promote the health of their stakeholders by developing organizational capacity. This study analyzes an application case of one hospital of the HPH initiative in Taiwan, characterizes actions aiming at building organizational support to strengthen health gains and identifies facilitators of and barriers to the implementation of the HP in this hospital. Case study methodology was used with a triangulation of various sources; thematic analysis was used to analyze qualitative information. This study found a positive impact of the HPH initiative on the case hospital, such as more support from leadership, a fine-tuned HP mission and strategy, cultivated pro-HP habits of physical activities, a supportive intramural structure, an HP-inclusive system, improved management practices and enhanced staff participation. Transformational and transactional enablers are of equal importance in implementing HPH. However, it was also found that the case hospital encountered more transactional barriers than transformational ones. This hospital was hindered by insufficient support from external environments, leadership with limited autonomy and authority, a preference for ideals over professionalism, insufficient participation by physicians, a lack of manpower and time, a merit system with limited stimulating effect, ineffective management practices in weak central project management, a lack of integration, insufficient communication and an inability to inculcate the staff on the importance of HP, and inadequate staff participation. Several implications for other hospitals are suggested., (© The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

This study investigates barriers to and facilitators of health promoting hospitals (HPH) in Taiwan. The findings are based on a cross-sectional questionnaire survey involving 55 hospitals committed to health promotion (HP) as of the end of 2009, and 52 of them completed the questionnaire. The five most reported barriers are inadequate national health insurance coverage of HP, staff detachment, incoherence of government policies, weak inter-sectoral link and resistance to change. The five most reported facilitators are support from hospital superintendents, support from unit/department directors, HP-inclusive hospital development mission and goals, funding from the government, founding of HP-related committees, resources and healthy policies. The study also found that organizational capacity building (OCB) had a significantly negative association with the number of barriers and a positive association with the number of facilitators. Stepwise linear regressions further found that OCB in structure was a significant predictor of the fewer number of barriers and that in-staff participation was a significant predictor of the more perceived facilitators. It also confirmed the significant role of organizational capacity building and that of coordinators in the effective implementation of HPH. The transformational factors as well as transactional factors are very much at work as facilitators, but the transactional factors are trapped in a less-than-friendly environment. Comprehensive support from transformational factors as well as transactional factors is essential and further support for daily routine operations and staff participation are required to sustain the implementation of HPH in Taiwan., (Copyright © 2012 John Wiley & Sons, Ltd.)