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[[alternative]]The Impact of Mindfulness-Based Interventions on Psychophysiological Adaptation for Patients after Abdominal Surgery: A Preliminary Study
No full text[[abstract]]研究背景:腹部手術因住院天數比其他手術長，個案併有術後疼痛、焦慮憂鬱、睡眠障礙等身心適應問題，實證指出正念導向處置可以改善疼痛、心理問題及睡眠障礙。研究目的:探討腹部手術後病人在介入正念導向處置後身心適應之影響。研究方法:本研究採隨機分派、重複測量實驗性研究設計，於2021年12月至2024年6月在北部某區域教學醫院，對腹部手術後入住內、外科加護病房之病人進行收案，實驗組給予常規護理外，另外再進行正念導向處置影音檔，對照組則接受常規護理，兩組病人在收案日、住院日、入住加護病房滿24及48小時，評量焦慮、憂鬱程度、疼痛程度、睡眠品質及內在感受覺察，在執行介入措施時收集收縮壓、舒張壓、平均血壓、心跳速率、血氧飽和濃度等生理參數。研究結果:兩組個案在介入措施後，於焦慮、憂鬱、收縮壓、舒張壓、平均血壓及血氧飽和濃度、睡眠品質、內在感受覺察，未達顯著差異（p > .05），而實驗組介入正念導向處置音頻後，心跳速率組間及組內差異達統計顯著差異（p 0.05) in Anxiety, Depression, Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure And Oxygen Saturation; while the experiment group after given audio frequency in Mindfulness-Based Intervention, the difference of Heart Rate among within group and between groups have statistical significance (p<0.05), and the difference of painfulness degree among the two groups of subjects have statistical significance (p=0.001, p=0.05). Conclusion: This Preliminary Study finds that Mindfulness-Based Intervention might have positive effects to the Heart Rate and the degree of painfulness for cases after abdominal surgery, in which needed well-designed large sample research to verify the outcome of Mindfulness-Based Intervention introduced to clinical application
Relationship between physical activity and quality of life among patients with respiratory and digestive system cancer during and outside the COVID-19 pandemic
No full text[[abstract]]Purpose: To investigate the relationship between physical activity (PA) and quality of life (QOL) among patients with respiratory and digestive system cancers during and outside of the COVID-19 pandemic.
Methods: A longitudinal, repeated-measures observational design was employed, and data were collected from outpatient clinics and wards during both the pandemic and a nonpandemic period at baseline (T1) and 3 months postrecruitment (T2). The Bouchard 3-Day Physical Activity Record questionnaire and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (physical function subscale) were used to measure PA and QOL, respectively.
Results: A total of 313 patients with various cancers (including lung, esophageal, gastric, pancreatic, and colon cancers) participated in this study. Light-intensity PA was significantly and positively correlated with the physical function dimension of QOL during both the pandemic (r = 0.31, p < 0.001) and nonpandemic (r = 0.15, p = 0.010) periods. Furthermore, light-intensity PA was a significant predictor of the physical function dimension of QOL during both the pandemic and nonpandemic periods (B = 0.04, p < 0.001; B = 0.02, p = 0.007, respectively).
Conclusions: Light-intensity PA is a critical predictor of the physical function domain of QOL in patients with respiratory and digestive system cancers during both pandemic and nonpandemic periods. Promoting engagement in tolerable PA may improve the health of these patients
Changes in hope, resilience and social support throughout chemotherapy and their association with health-related quality of life in cancer patients: A longitudinal study
No full text[[abstract]]Objective: To investigate the association between changes in hope, resilience, social support, and cancer-related symptoms, and the change in health-related quality of life among cancer patients during chemotherapy.
Methods: A prospective, longitudinal study was conducted among 126 cancer patients undergoing chemotherapy. Hope, resilience, and social support were measured using the Herth Hope Index, 14-item Resilience Scale, and Multidimensional Scale of Perceived Social Support, respectively. Quality of life was assessed using Functional Assessment of Cancer Therapy-General. All measures were administered before chemotherapy started and 1 month after chemotherapy completion. Linear mixed models were employed to analyze the changes in hope, resilience, social support, and quality of life. Multivariable linear regression analysis was employed to assess the association between the changes in the psychosocial variables and quality of life.
Results: Physical well-being and emotional well-being significantly improved 1 month after chemotherapy compared to baseline, while no significant change was observed in hope, resilience, or social support. Change in resilience was positively associated with emotional well-being (? = 0.09, 95 %CI: 0.003, 0.18), functional well-being (? = 0.16, 95 %CI: 0.09, 0.23), and overall quality of life (? = 0.33, 95 %CI: 0.09, 0.57). Change in social support showed a positive association with change in social well-being (? = 0.16, 95 %CI: 0.06, 0.25).
Conclusions: This longitudinal study demonstrates that improvements in resilience and social support are positively associated with enhanced quality of life during chemotherapy. Interventions enhancing resilience and social support may help to support cancer patients better during chemotherapy
Design and Development of an Interactive Assessment Application for the Observation of Heart Failure Self-Health Management
No full text[[abstract]]Heart disease can lead to physical disability and mortality, ranking second among the top 10 causes of death according to the Ministry of Health and Welfare. This study aims to examine the impact of the interactive assessment application on patients' public health knowledge. In this study, a single-group pretest and posttest experimental design was adopted. Thirty-six hospitalized patients diagnosed with heart failure participated in the pretest and posttest assessments. The findings demonstrate that the developed application led to an increase in the number of recorded physiological measurements, effectively enabling patients to manage their blood pressure. The heart failure self-management application was observed to improve patients' understanding and awareness of heart failure disease, improving their self-management skills
[[alternative]]The Impact of Energy Consumption on Health Across Taiwan's Cities Under Sustainable Goals
No full text[[abstract]]隨著經濟的成長、氣候的變遷以及能源消耗已是全球越來越重視的問題，根據聯合國發布之聯合國於2015發布了永續發展目標(Sustainable Development Goals, SDGs)，其中的目標3健康與福祉，以及目標7可負擔的潔淨能源，兩大目標更是考量永續環境發展下的重要指標，同時環境與健康之間的關係更是相輔相成，也是近幾年來大家所關注的議題。本研究使用資料包絡分析法評估台灣本島19縣市於2012年至2021年間的能源使用效率與環境健康效率，評估能源使用與健康的關係。本研究以動態資料包絡分析法針對能源消耗量、勞動力人口與平均收入，建構能源使用效率模型；接著，將PM2.5與醫療支出，評估各縣市兩組模型之效率值。再使用Panel Tobit模型分析外生變數對於能源使用效率值表現的影響。研究結果顯示兩組模型顯示，台北市、台東縣與嘉義市的效率值均為1，其於縣市表現於加入健康支出的模型結果中皆有進步空間。若要提高國民的健康水平與能源效率，能源上的轉型是當前需要重視的課題，同時需要借鑒他國的節能技術以及低汙染政策上的改進，欲以實現台灣永續發展目標下的社會環境與良好的人民福祉。[[abstract]]With economic growth, climate change, and energy consumption becoming increasingly pressing global issues, the United Nations released the Sustainable Development Goals (SDGs) in 2015. Among these goals, SDG 3 focuses on ensuring healthy lives and promoting well-being for all ages, and SDG 7 aims to ensure access to affordable, reliable, sustainable, and modern energy for all. These goals emphasize the need for sufficient healthcare resources and reliable energy services in the context of sustainable human development.This study employs Data Envelopment Analysis (DEA) to evaluate the energy efficiency of 19 counties and cities in Taiwan from 2012 to 2021, and examines the relationship between energy use and health. The first set of models uses dynamic DEA, focusing on energy consumption, labor population, and average income. A second set of models incorporates healthcare expenditures to assess the efficiency values of each county and city. Additionally, the study uses a Panel Tobit model to analyze the impact of exogenous variables on energy efficiency performance. The results indicate that Taipei City, Taitung County, and Chiayi City have efficiency values of 1 in both models, suggesting that other counties and cities have room for improvement, particularly when healthcare spending is considered. To enhance national health levels and energy efficiency, a transition in energy practices is necessary. This transition should be informed by technical and policy advancements from other countries to achieve Taiwan's sustainable development goals, ensuring a sustainable social environment and the well-being of its citizens
[[alternative]]Analysis of factors associated with myopia in Taiwanese children
No full text[[abstract]]背景：世界衛生組織在 2015 年將近視列為全球兒童照護與公共衛生議題，且近視是造成最常見的眼部疾病的主要因子之一，因此，瞭解影響兒童近視的相關危險因子是重要的兒童健康議題。目的：本研究旨在利用衛生福利部資料科學中心 2017 年國民健康訪問調查檔，探討 12 歲(含)以下兒童近視盛行率及其相關危險因子。方法：本研究以研究對象之兒童基本人口學特性與兒童健康行為為自變項，依變項為兒童近視。首先以次數及百分比，描述自變項及依變項的狀況再以複邏輯斯迴歸分析，找出獨立影響兒童近視之相關危險因子。本研究使用SAS 9.4 版統計套裝軟體進行資料整理與統計分析。結果：本研究以 1,577 位兒童為研究對象，男性兒童 843 位( 53.46 %)，女性兒童有 734 位( 46.54 %)。兒童近視盛行率為 24.6 %，男性兒童近視盛行率為 25.38%，女性兒童近視盛行率為 23.71%，男性兒童近視盛行率高於女性兒童近視盛行率。就年齡層別，0-4 歲兒童近視盛行率為 3.53%，5-9 歲兒童近視盛行率為 23.88%，10-12 歲兒童近視盛行率為 55.86%，近視盛行率隨著年齡增加而增加。就城鄉別，居住在城市的兒童近視盛行率為 27.50%，居住在鄉村的兒童近視盛行率為 20.95%，居住在城市的兒童近視盛行率高於居住在鄉村的兒童。獨立影響台灣兒童近視的危險因子為年齡較大、居住在城市、父親近視、母親近視、母親教育程度大專(含)以上、平均每天近距離用眼時間大於等於 120 分鐘。就年齡層別而言，相較於 0-4 歲近視的兒童，5-9 歲及 10-12 歲的兒童近視的風險較高，調整後勝算比分別為 7.902〔95%CI (4.559-13.694)〕與 34.204〔95%CI(18.971-61.67)〕；就城鄉別而言，相較於鄉村兒童，城市兒童近視的風險較高，調整後勝算比為 1.434〔95%CI (1.089-1.887)〕；就父親近視而言，相較於父親沒有近視的兒童，父親近視的兒童近視的風險較高，調整後勝算比為 2.514〔95%CI (1.843-3.428)〕；就母親近視而言，相較於母親沒有近視的兒童，母親近視的兒童近視的風險較高，調整後勝算比為 1.833〔95%CI (1.329-2.530)〕；就母親教育程度而言，相較於母親教育程度國中(含)以下的兒童，母親教育程度為大專(含)以上的兒童近視的風險較低，調整後勝算比為 0.467〔95%CI (0.260-0.838)〕；就平均每天近距離用眼時間而言，相較於平均每天近距離用眼時間未滿 120 分鐘的兒童，平均每天近距離用眼時間大於等於 120 分鐘的兒童近視的風險較高，調整後勝算比分別為 1.417〔95%CI (1.065-1.887)〕，以上皆達到統計上的顯著水準。結論：本研究結果，獨立影響台灣兒童近視的危險因子為年齡較大、居住在城市、父親近視、母親近視、母親教育程度大專(含)以上、平均每天近距離用眼時間大於等於 120 分鐘，這些發現突顯了需要針對高風險群體進行介入措施與教育，特別是在近距離用眼行為和城市生活方式方面。未來應加強兒童眼部健康教育，並推動有效的預防措施以減少近視的發生，從而改善兒童的整體視力健康。[[abstract]]Background: The World Health Organization (WHO) listed myopia as a global child care and public health issue in 2015 and myopia is also one of the main factors causing the most common eye diseases. Understanding the risk factors of myopia in children is a worthwhile endeavor.Objectives: This study aims to explore the prevalence of myopia and its related risk factors in children under 12 years old (inclusive) using the 2017 National Health Interview Survey conducted by the Data Science Center of the Ministry of Health and Welfare.Method: This study uses the basic demographic characteristics of children and children's health behavior as independent variables, and the dependent variable is children's myopia. Firstly, describe the conditions of the independent variable and dependent variables in terms of frequency and percentage, and then use logistic regression analysis to identify the independent risk factors that affect myopia in children. This study used SAS 9.4 Statistics software for data organization and statistical analysis.Results: This study focused on 1,577 children, with 843 boys (53.46%) and 734 girls (46.54%). The prevalence of myopia in children is 24.6%, with a prevalence of 25.38% in boys and 23.71% in girls. The prevalence of myopia in boys is higher than that in girls. In terms of age group, the prevalence of myopia in children aged 0-4 is 3.53%, the prevalence of myopia in children aged 5-9 is 23.88%, and the prevalence of myopia in children aged 10-12 is 55.86%. The prevalence of myopia increases with age. In terms of urban and rural areas, the prevalence of myopia among children living in urban areas is 27.50%, while the prevalence of myopia among children living in rural areas is 20.95%. The prevalence of myopia among children living in urban areas is higher than that among children living in rural areas. The independent risk factors for myopia in Taiwanese children are older age, living in urban areas, paternal myopia, maternal myopia, maternal education of college or above, and an average daily near-work activity time of 120 minutes or more. In terms of age group, compared to children aged 0-4 with myopia, children aged 5-9 and 10-12 have a higher risk of myopia, with adjusted odds ratios of 7.902 [95% CI (4.559-13.694)] and 34.204 [95% CI (18.971-61.67)], respectively. In terms of urban and rural areas, compared with rural children, urban children have a higher risk of myopia, and the adjusted odds ratio is 1.434 [95% CI (1.089-1.887)]. In terms of paternal myopia, children with paternal myopia have a higher risk of myopia compared to children without paternal myopia, with an adjusted odds ratio of 2.514 [95% CI (1.843-3.428)]; In terms of maternal myopia, compared to children whose mothers do not have myopia, children with maternal myopia have a higher risk of myopia, with an adjusted odds ratio of 1.833 [95% CI (1.329-2.530)]; In terms of maternal education level, compared to children with maternal education level below junior high school (inclusive), children with maternal education level above junior college (inclusive) have a lower risk of myopia, with an adjusted odds ratio of 0.467 [95% CI (0.260-0.838)]; In terms of average daily near-work activity time , compared to children who have less than 120 minutes of average daily near-work activity time , children who have an average daily near-work activity time of 120 minutes or more have a higher risk of myopia, with adjusted odds ratios of 1.417 [95% CI (1.065-1.887)], all of which are statistically significant.Conclusions: The results of this study indicate that the independent risk factors for myopia in Taiwanese children are older age, living in urban areas, paternal myopia, maternal myopia, maternal education n level of college or above, and an average daily near-work activity time of 120 minutes or more. These findings highlight the need for intervention measures and education targeting high-risk groups, especially in near work of behavior and urban lifestyle. In the future, we should strengthen children's eye health education and promote effective preventive measures to reduce the occurrence of myopia, thereby improving children's overall visual health
Psychological distress, sexual satisfaction and quality of life of gynaecological cancer patients and their spouses during cancer survivorship: A comparison of husbands and wives
No full text[[abstract]]Aims and objectives: To investigate the psychological distress, sexual satisfaction, and quality of life of gynaecological cancer survivors and their spouses during cancer survivorship.
Background: The survival rate of patients with cancer is increasing owing to advances in medical treatment technology. Spouses are the closest companions of gynaecological cancer survivors. Patients with gynaecological cancer and their spouses face different situations and challenges after experiencing cancer invasion.
Design: Questionnaire-based cross-sectional study.
Methods: Convenience sampling was employed, and 180 participants, including patients with gynaecological cancer and their spouses, were enrolled. A structured questionnaire was used to investigate the psychological distress, sexual satisfaction, and quality of life of gynaecological cancer survivors and their spouses during acute, extended, and permanent survivorship. The STROBE checklist guided the study preparation.
Results: For gynaecological cancer survivors and their spouses, (1) severe psychological distress was present during acute survivorship, with anxiety extending until permanent survivorship; (2) no significant differences were observed in pre- and post-treatment sexual satisfaction, although pre-treatment sexual satisfaction was higher than post-treatment sexual satisfaction in all three cancer survivorship stages and (3) quality of life decreased during acute survivorship and gradually improved with time.
Conclusions: Psychological distress, sexual satisfaction and quality of life of gynaecological cancer survivors and their spouses worsened during acute survivorship and improved over time until permanent survivorship.
Relevance to clinical practice: Gynaecological cancer survivors and their spouses experience anxiety and depression from diagnosis confirmation until permanent survivorship (>5 years survival). Therefore, clinical nurses' sensitivity to emotional distress in cancer survivors and their spouses can be improved and a consistent and routine evaluation method has been established for the early detection of such emotional distress. The results of this study can provide a reference for clinical healthcare professionals and contribute to a better quality of care
[[alternative]]Study in Risk Factor of Hypertension and its Related Chronic Diseases among Adults in Taiwan
No full text[[abstract]]背景：World Hypertension League(2023)連續3年以「準確量血壓，控制血壓，延長壽命」(Measure Your Blood Pressure Accurately, Control It, Live Longer)為主題，台灣成年人高血壓盛行率高於26%，並且隨著年齡增加，在40歲以上的人群中更高達38%。高盛行率表明高血壓在台灣社會中具有廣泛的影響和重大的公共衛生挑戰，我們應該將高血壓視為一個重要的公共衛生問題，並採取行動。目的：本研究旨在探討台灣成年人高血壓及高血壓相關慢性病的盛行率及其危險因子。方法：本研究屬次級資料分析，以2017年「國民健康訪問調查問卷」12-64歲個人問卷資料檔，共計20-64歲成年人11,936位作為本研究對象。自變項為受訪者的個人特質、預防慢性病行為認知之題項，包括性別、年齡層別、身體質量指數(BMI)、控制體重、不抽菸/戒菸、少飲酒、養成運動習慣、注意及控制飲食、定期健康檢查、避免腹部肥胖。慢性病採用問卷中與文獻探討部分相符的疾病，包括中風、心臟疾病、腎臟疾病、慢性病數量。(柯明中)使用SAS9.4版統計軟體進行資料整理與後續分析。首先運用次數分配表、百分比描述樣本基本資料、預防慢性病行為認知、罹患高血壓及相關慢性病的人數及盛行率，並以同質性卡方檢定檢視有、無高血壓兩群研究樣本在個人特質、預防慢性病行為認知及罹患高血壓相關慢性病的分佈情形，是否存在顯著的不同。最後，以邏輯斯迴歸(Logistic regression)探討影響高血壓及其相關慢性病的因素，以調整後勝算比(Adjusted Odds Ratio)檢視各自變項單一對有高血壓及相關慢性病的勝算倍數，並以其相對應的95%信賴區間表示相關性大小與P值表示其顯著性，顯著水準(α level)設定為小於0.05，以找出獨立影響高血壓及其相關慢性病之因素。結果：台灣20-64歲成年人高血壓盛行率為11.43%，20-34歲高血壓盛行率為0.87%、35-49歲高血壓盛行率為7.43%及，50-64歲高血壓盛行率為25.74%。罹患中風的成年人有107位(0.90%)，有高血壓的成年人有罹患中風的比率顯著高於無高血壓的成年人。罹患心臟疾病的成年人有482位(4.04%)，有高血壓的成年人罹患心臟疾病的比率顯著高於無高血壓的成年人。罹患腎臟疾病的成年人有269位(2.25%)，有高血壓的成年人罹患腎臟疾病的比率顯著高於無高血壓的成年人。有高血壓的成年人罹患1種或以上高血壓相關慢性病的比率顯著高於無高血壓的成年人。獨立影響台灣成年人罹患高血壓的顯著相關因素為年齡、性別、BMI、預防慢性病行為認知中的定期健康檢查及避免腹部肥胖。獨立影響台灣成年人罹患中風的顯著相關因素為高血壓、年輕、性別、BMI與預防慢性病行為認知中的養成運動習慣。獨立影響台灣成年人罹患心臟疾病的顯著相關因素為高血壓、年齡與BMI。獨立影響台灣成年人罹患腎臟疾病的顯著相關因素為高血壓、年齡與性別與預防慢性病行為認知中的養成運動習慣。結論：本研究結果顯示罹患高血壓的風險隨年齡增長而上升，同時，BMI亦可作為是一個可預測高血壓的相關困素，BMI超過正常時罹患高血壓的風險亦增加。此外，高血壓為中風、心臟疾病、腎臟疾病的危險因子，有效控制高血壓可減少終端器官的損害。另外，不良的生活習慣與行為已被證實會讓血壓上升，而健康的生活和行為(如控制體重、運動、定期健康檢查)可降低罹患高血壓和相關慢性病的風險。最後，本研究結果顯示國人對預防慢性病行為認知薄弱，建議衛生主管機關增加台灣國民預防慢性病行為認知宣導及提倡血壓自主管理方法；建議民眾改善生活方式及增加正確的預防慢性病行為認知
[[alternative]]The Impact of Synchronous Home-Based Telemedicine on the Utilization of Health Care Among Patients with Hypertensive During Covid-19 Pandemic
No full text[[abstract]]背景：COVID-19大流行對全球醫療系統造成重大影響，通訊診療作為應對措施之一，在疫情期間快速發展。對於慢性病患者，尤其是高血壓患者，通訊診療的有效性和持續性成為重要研究課題。目的：本研究旨在探討通訊診療對於高血壓患者醫療照護使用的影響方法：本研究為一項全人口研究，使用衛生福利部衛生福利資料科學中心2020年至2021年之全人口檔案，以2021年3月1日至2021年5月31日領取慢性病處方籤20 (含)歲以上罹患高血壓的個案，且2021年9月30日前尚存活者計2,921,826位為研究對象，自變項為就醫型態(分持續實體醫療、換成通訊診療及完全中斷治療)；依變項為醫療照護使用(包含門診次數、急診、住院及總醫療費用)；控制變項為性別、年齡層別、投保金額、低收入戶、投保地區都市化程度、就醫院所層級，前一年醫療照護使用及健康狀況包含前一年門診就醫次數大於30次、前一年住院、CCI分類及慢性病型態，使用SAS9.4統計套裝軟體進行資料整理與統計分析。結果：本研究研究對象共計2,921,826位，通訊診療替代實體醫療有49,385位(1.69%)、持續實體醫療有2,700,187位(92.41%)、完全中斷治療有172,254位(5.9%)。單因子變異數分析結果顯示，在門診次數方面，通訊診療替代實體醫療高血壓患者高於持續實體醫療、完全中斷治療高血壓患者，持續實體醫療高血壓患者高於完全中斷治療高血壓患者(p<.0001)；在當年有住院且已出院者的平均住院日數方面，完全中斷治療高血壓患者高於持續實體醫療、通訊診療替代實體醫療高血壓患者，通訊診療替代實體醫療高血壓患者高於持續實體醫療高血壓患者(p<.0001)；在當年平均總醫療費用方面，通訊診療替代實體醫療高血壓患者高於持續實體醫療、完全中斷治療高血壓患者，完全中斷治療高血壓患者高於持續實體醫療高血壓患者(p<.0001)；複邏輯斯迴歸分析結果顯示，在急診方面，相較於通訊診療替代實體醫療的高血壓患者，持續實體醫療的高血壓患者急診的機率較低，完全中斷治療的高血壓患者急診的機率較高，其調整後勝算比分別為0.857 (95% CI: 0.839- 0.875，p=<.0001)、1.059 (95% CI: 1.034- 1.084，p<.0001)；在住院方面，相較於通訊診療替代實體醫療的高血壓患者，持續實體醫療的高血壓患者住院的機率較低，完全中斷治療的高血壓患者住院的機率較高，其調整後勝算比分別為0.807 (95% CI: 0.789- 0.826，p=<.0001)、1.042 (95% CI: 1.014- 1.070，p=0.0033)；線性迴歸分析結果顯示，在總醫療費用方面，相較於通訊診療替代實體醫療的高血壓患者，持續實體醫療的高血壓患者減少5,259.02元(標準誤差: 617.19，p<.0001)，完全中斷治療的高血壓患者增加7,753.08元(標準誤差: 694.69，p<.0001)。結論：通訊診療替代實體醫療高血壓患者雖然門診次數較多，但急診及住院的風險低於完全中斷治療的高血壓患者，總醫療費用也比完全中斷治療的高血壓患者少。因此，建議衛生主管機關繼續實施慢性病人通訊診療計畫，並鼓勵醫療院所配合推動，增加慢性病人就醫可近性，以降低其急診及住院風險。[[abstract]]Background: The COVID-19 pandemic has significantly impacted global healthcare systems. Telemedicine has rapidly developed as a countermeasure during the pandemic. For chronic disease patients, particularly those with hypertension, the effectiveness and continuity of telemedicine have become important research topics.Objectives: This study aims to investigate the impact of telemedicine on healthcare utilization among hypertensive patients.Methods: This population-based study used data from the Ministry of Health and Welfare's Health and Welfare Data Science Center from 2020 to 2021. The study included 2,921,826 hypertensive patients aged 20 and above who received chronic disease prescriptions between March 1, 2021, and May 31, 2021, and were still alive by September 30, 2021. The independent variable was the type of healthcare utilized (continuous in-person care, switched to telemedicine, or completely discontinued treatment). The dependent variables were healthcare utilization (including outpatient visits, emergency visits, hospitalizations, and total medical expenses). Control variables included gender, age group, insured amount, low-income household status, urbanization level of the insured area, healthcare institution level, previous year's healthcare utilization, and health status, including more than 30 outpatient visits in the previous year, hospitalization in the previous year, CCI classification, and type of chronic disease. Data were processed and analyzed using SAS 9.4 statistical software.Results: Of the 2,921,826 study subjects, 49,385 (1.69%) switched to telemedicine, 2,700,187 (92.41%) continued in-person care, and 172,254 (5.9%) completely discontinued treatment. One-way ANOVA results showed that in terms of outpatient visits, hypertensive patients who switched to telemedicine had more visits than those who continued in-person care and those who completely discontinued treatment, with patients continuing in-person care having more visits than those who completely discontinued treatment (p<.0001). For average length of hospital stay among those discharged, hypertensive patients who completely discontinued treatment had longer stays than those who continued in-person care and those who switched to telemedicine, with patients who switched to telemedicine having longer stays than those who continued in-person care (p<.0001). In terms of average total medical expenses, patients who switched to telemedicine had higher expenses than those who continued in-person care and those who completely discontinued treatment, with patients who completely discontinued treatment having higher expenses than those who continued in-person care (p<.0001).Multivariate logistic regression results showed that for emergency visits, compared to patients who switched to telemedicine, patients who continued in-person care had a lower probability of emergency visits, and patients who completely discontinued treatment had a higher probability, with adjusted odds ratios of 0.857 (95% CI: 0.839-0.875, p<.0001) and 1.059 (95% CI: 1.034-1.084, p<.0001) respectively. For hospitalizations, compared to patients who switched to telemedicine, patients who continued in-person care had a lower probability of hospitalization, and patients who completely discontinued treatment had a higher probability, with adjusted odds ratios of 0.807 (95% CI: 0.789-0.826, p<.0001) and 1.042 (95% CI: 1.014-1.070, p=0.0033) respectively. Linear regression results showed that in terms of total medical expenses, compared to patients who switched to telemedicine, patients who continued in-person care had a reduction of NT7,753.08 (standard error: 694.69, p<.0001).Conclusions: Hypertensive patients who switched to telemedicine had more outpatient visits but lower risks of emergency visits and hospitalizations compared to those who completely discontinued treatment. Their total medical expenses were also lower than those who completely discontinued treatment. Therefore, it is recommended that health authorities continue implementing telemedicine programs for chronic disease patients and encourage healthcare institutions to promote these services, improving accessibility to reduce emergency and hospitalization risks
[[alternative]]Building Breast DCE-MRI Recognition Technology Based on Deep Learning Method
No full text[[abstract]]乳癌是全球最常見的癌症之一，早期發現可有效控制乳癌的發病率。乳房常見三種檢查方式中，使用磁振造影（Magnetic Resonance Imaging, MRI）相較於X光檢查與超音波更能夠精準的定位以及能找出極小的病灶。本文以靜脈注射顯影劑之動態對比增強磁振造影為研究目標，其成像方式主要適應症為篩檢高風險女性可能存在的隱匿性乳癌、術前評估確診乳癌女性的疾病程度，以及評估對新輔助化療的治療反應。乳房動態對比增強磁振造影須依靠放射科醫師的標註，手動分割需要醫學專業知識，處理過程繁瑣、耗時，並且帶有主觀性，容易出現人為錯誤，而透過電腦輔助系統進行自動化且準確分割產生一個極大的挑戰，因此進行乳癌影像分析研究之文獻蒐集，使用動態對比增強磁振造影建立深度學習之乳房腫塊物間偵測模型，建構模型以類3D U-Net深度學習架構，評估結果發現分別在Accuracy與DSC中獲得99.79%與80.17%，優於過往研究文獻之2D 、混合2D及 3D 和 3D 卷積網路架構的表現，盼望改善放射線科醫師判讀高風險乳癌患者之效率及準確度，以提升醫療品質。[[abstract]]Breast cancer is one of the most common cancers worldwide, and early detection can effectively control its incidence rate. Among the three common breast examination methods, Magnetic Resonance Imaging (MRI) is more precise in locating and identifying extremely small lesions compared to X-ray examinations and ultrasound. This article focuses on dynamic contrast-enhanced MRI with intravenous contrast agent injection as the research target. This imaging method is primarily indicated for screening high-risk women for potential occult breast cancer, preoperative assessment of disease extent in women diagnosed with breast cancer, and evaluating the response to neoadjuvant chemotherapy. Breast dynamic contrast-enhanced MRI relies on annotations by radiologists. Manual segmentation requires medical expertise, is time-consuming, tedious, and subjective, prone to human error. Developing an automated and accurate segmentation system through computer-aided systems poses a significant challenge. Therefore, this study conducted a literature review on breast cancer image analysis research, using dynamic contrast-enhanced MRI to establish a deep learning-based breast mass detection model. The model was constructed using a quasi-3D U-Net deep learning architecture. The evaluation results showed an accuracy of 99.79% and a DSC of 80.17%, outperforming previous research literature using 2D, hybrid 2D and 3D, and 3D convolutional network architectures. The aim is to improve the efficiency and accuracy of radiologists in interpreting high-risk breast cancer patients, thereby enhancing the quality of medical care