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Efficacy of Repetitive Transcranial Magnetic Stimulation in Patients With Methamphetamine Use Disorder: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials
No full text[[abstract]]Background: Repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic potential for treating patients with methamphetamine use disorder (MUD). However, the most effective target and stimulation frequency of rTMS for treating MUD remains unclear. This meta-analysis explored the effect of rTMS on MUD.
Methods: In this study, PubMed, Cochrane Systematic Reviews, and the Cochrane Collaboration Central Register of Controlled Clinical Trials were searched electronically for double-blind randomized controlled trials that used rTMS for treating MUD. We used published trials to investigate the efficacy of rTMS in MUD up to March 5, 2022, and pooled studies using a random-effect model to compare rTMS treatment effects. Patients who were diagnosed with MUD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders were recruited. Clinical craving scores between baseline and after rTMS were compared using the standardized mean difference (SMD) with 95% confidence intervals (CIs). The heterogeneity of the included trials was evaluated through a visual inspection of funnel plots and the I2 statistic.
Results: We identified seven trials with 462 participants with MUD that met the inclusion criteria. All the studies evaluated craving scores, with rTMS demonstrating a more significant effect than the sham treatment on reducing craving scores (SMD = 0.983, CI = 0.620-1.345, p ≤ 0.001). A subgroup meta-analysis revealed that intermittent theta-burst stimulation (iTBS) had a greater positive effect than 10-Hz rTMS. A metaregression revealed that the SMDs increased with the increase in baseline craving scores, whereas they decreased with the increase in the proportion of men and duration of abstinence.
Conclusion: The meta-analysis suggests that rTMS may be associated with treatment effect on craving symptoms in patients with MUD. iTBS may have a greater positive effect on craving reduction than 10-z rTMS
The Mediation Effect of Health Literacy on Social Support with Exchange and Depression in Community-Dwelling Middle-Aged and Older People in Taiwan
No full text[[abstract]]The proportion of the world's population that are over 60 years old is increasing rapidly. The physical and mental health of older people is affected by depression. Health literacy is a major determinant of health and healthcare for the aging; middle-aged and older people with high health literacy are more likely to maintain a healthy lifestyle, and control or manage their chronic diseases. Therefore, this study explored the relationship between health literacy, social support with exchange, and depression, in middle-aged and older adults in the community, using data from the 2015 Taiwan Longitudinal Study on Aging (TLSA) database. Of the 7636 participants, 1481 (19.4%) were middle-aged or older persons with depression symptoms. We found age, gender, and education level to be significantly related to health literacy status, social support with exchange, and depression. Health literacy was positively correlated with depression and social exchange in social support with exchange, whereas the emotional support component of social support with exchange was negatively correlated with depression. Regression-based process analysis was used to verify the mediation effect of health literacy. Our results indicated that when health literacy was entered into the regression model (a × b path), the effect of social exchange on depression was insignificant (c' = -0.01, p = 0.84), indicating a complete mediation effect. These findings suggest that improving health literacy may offset the impact of social support with exchange on depression, and lead to the mitigation of depression in middle-aged and older people in Taiwanese communities
More medical resources do not imply better quality of life : A population- based study in Taiwan
No full text[[abstract]]Studies regarding medical resources input-output (I/O) efficiencies gained increasing importance in recent years. Most of published studies measure medical resources I/O efficiencies of hospitals or clinics, however, very limited number of studies investigating nation-wide medical resources I/O efficiencies. Besides, there was also very limited number of studies using population data of quality of life (QOL) as an outcome variable. The aim of this study was to investigate nation-wide medical resources I/O efficiencies of Taiwan, by using national medical service volumes statistics as input variables and population QOL as outcome variables. The population QOL data were from 2005 National Health Interview Survey (NHIS) and the national medical service volumes statistics were from 2005 National Statistics of Health Care Providers and Medical Services, which were issued by Department of Health in Taiwan. The population QOL was measured by SF-36. The data envelopment analysis (DEA) method was used to investigate the medical resources I/O efficiencies. Twenty three cities and counties of Taiwan were regarded as decision making units (DMUs). The results showed that 40% of cities and counties achieved efficiency regarding health care resources allocation. The results showed that the Tai-Nan city (an emerging high-tech city) and the Taiwan capital, Taipei City, were the two lowest QOL DMU. In summary, cities with high tech development and with more medical resources are not necessarily the cities with better quality of life
Uncertainty, Stress, and Birth Outcomes in Non-Hospitalized, High-Risk Pregnancy Women: The Effectiveness of Health Consultation
No full text[[abstract]]背 景 高危險孕婦往往無法預期即將發生的變化，因而比正常孕婦經歷更多的不確定感與壓力，並有不好的生產結果；然而目前臨床上相當缺乏對非住院之高危險妊娠孕婦提供持續性護理及預防早產之措施。
目 的 運用衛教手冊與四週電話健康諮詢介入措施對非住院高危險妊娠孕婦的不確定感、壓力與生產結果之成效評估。
方 法 採實驗研究設計法，以結構式問卷收集相關資料，研究工具為結構式問卷包括：基本人口學資料表、「高危險妊娠版不確定感－壓力量表」、社會支持量表及生產結果資料表。於台北某醫學中心選取第二孕期非住院的高危險妊娠孕婦共 2人，透過隨機分派將個案分至實驗組（n = 1）及控制組（n = 1），其中控制組僅接受一般常規照護，而實驗組除了接受一般常規照外，又再給予衛教手冊與為期四週電話健康諮詢介入措施。
結 果 健康諮詢介入措施可降低高危險妊娠孕婦之孕期不確定感（β = - .11, p < .001）與孕期壓力（β = - .11, p < .001）；實驗組的新生兒有較高的新生兒出生體重（β = . , p < .001）；孕期有較高程度的不確定感（β = - . , p = .01 ）與壓力者（β = - .1 , p = .021）、懷雙胞胎者（β = - 0. , p <
.001），其新生兒體重較低。
結 論／實務應用 醫療院所應建立高危險妊娠個案管理師主動地提供電話健康諮詢，這不僅可以有效地降低其孕期不確定感及孕期壓力，進而增進正向之生產結果，而節省醫療成本。
Background: Women with high-risk pregnancies, unable to predict with adequate certainty either maternal or fetal outcomes, may face greater stress and uncertainty as well as adverse birth outcome risks than their low-risk pregnancy peers. Limited research has previously been done on non-hospitalized high-risk pregnancy women with regard to strategies on effective continuity care and preterm labor prevention. Purpose: This study evaluated the effectiveness of an educational pamphlet and 4-week daily telephone health consultation follow-up regimen (administered by nursing staff) in reducing uncertainty and stress and improving birth outcomes. The intervention targeted women in high-risk pregnancies during their second trimester. Methods: This study was a randomly-controlled trial that recruited 82 non-hospitalized high-risk pregnancy women in their second trimester from one medical center in Taipei. Researchers used block randomization to assign subjects into either the experimental (n=41) or control (n=41) group. Both groups received the same care except for the health consultant intervention program, which included the distribution of an education pamphlet and daily telephone follow-ups over a period of four weeks. Researchers collected data using a structured questionnaire that included a demographic datasheet, the Uncertainty Stress Scale-High Risk Pregnancy (Chinese Version), the Social Support Questionnaire, and birth outcome datasheet. Results: The designed health consultant nursing intervention program reduced uncertainty (β=-53.11, p＜.001) and stress (β=-33.11, p＜.001) in the experimental group. The experimental group also achieved a higher average birth weight (β=494.89, p＜.001) than the control group. This study found that subjects with higher prenatal uncertainty (β=-3.98, p=.017), higher stress scores (β=-8.13, p=.021) or twins pregnancies (β=-670.99, p＜.001) had higher preterm birth incidences. Conclusions/Implications for practice: Study results suggest the efficacy of creating high-risk pregnancy case manager positions charged to provide proactive telephone health consultation services to women in high-risk pregnancy situations. Such may facilitate reductions in prenatal uncertainty and stress levels amongst high-risk pregnancy clients, which can facilitate positive birth outcomes and reduce medical costs
TET2 mutation is an unfavorable prognostic factor in acute myeloid leukemia patients with intermediate-risk cytogenetics
No full text[[abstract]]The studies concerning clinical implications of TET2 mutation in patients with primary acute myeloid leukemia (AML) are scarce. We analyzed TET2 mutation in 486 adult patients with primary AML. TET2 mutation occurred in 13.2% of our patients and was closely associated with older age, higher white blood cell and blast counts, lower platelet numbers, normal karyotype, intermediate-risk cytogenetics, isolated trisomy 8, NPM1 mutation, and ASXL1 mutation but mutually exclusive with IDH mutation. TET2 mutation is an unfavorable prognostic factor in patients with intermediate-risk cytogenetics, and its negative impact was further enhanced when the mutation was combined with FLT3-ITD, NPM1-wild, or unfavorable genotypes (other than NPM1(+)/FLT3-ITD(-) or CEBPA(+)). A scoring system integrating TET2 mutation with FLT3-ITD, NPM1, and CEBPA mutations could well separate AML patients with intermediate-risk cytogenetics into 4 groups with different prognoses (P < .0001). Sequential analysis revealed that TET2 mutation detected at diagnosis was frequently lost at relapse; rarely, the mutation was acquired at relapse in those without TET2 mutation at diagnosis. In conclusion, TET2 mutation is associated with poor prognosis in AML patients with intermediate-risk cytogenetics, especially when it is combined with other adverse molecular markers. TET2 mutation appeared to be unstable during disease evolution
How digital banking affects output and performance at European commercial banks
No full text[[abstract]]We examine 550 commercial bank observations that are among the first to adopt digital banking in the European region and compare the change in their 2009-2013 financial performance with that of 4,793 nondigital commercial bank observations. We find that larger banks and those affiliated with bank holding companies are more likely to adopt digital finance solutions. It is also found that the commercial banks adopting a digital delivery channel influence profitability changes and there exists a complementary relationship between brick-and-mortar bank and digital bank mode
Exploring the efficiency of hospital and pharmacy utilizations in Taiwan: An application of dynamic network data envelopment analysis
No full text[[abstract]]Background
Building continuity of care by enabling optimal collaboration between hospitals and community pharmacies is critical. However, existing research on healthcare efficiency has largely focused on hospital services, and few studies have evaluated hospital services alongside pharmaceutical services.
Objective
To set up a dynamic network production model to assess the divisional efficiency of hospital and pharmacy utilizations and to investigate the dynamic changes and spatial differences for a more productive utilization of healthcare services.
Methods
A dynamic network data envelopment analysis was applied on two interdependent healthcare divisions, hospitals and community pharmacies, in order to assess utilization efficiencies in both divisions simultaneously. Subsequent analyses were performed with a set of decision making units consisting of Taiwan's cities. Data were gathered from the Ministry of Health and Welfare and the Bureau of National Health Insurance, spanning 2014–2019.
Results
The mean scores for overall healthcare, hospital, and pharmacy among cities were 81.9%, 89.2%, and 76.7% respectively. It appears that pharmacy is not very efficient, possibly because of the low rate of prescription release. A 13.26% reduction in pharmacists in the pharmacy sector is suggested, but the number of community pharmacies remains the same in cities and counties in 2019, based on the results of the slack-based measure. The bootstrapped-truncated regression indicated the different business districts had statistically significant determinants of overall efficiency, including hospital efficiency and pharmacy efficiency.
Conclusions
This study illustrated the inefficient operations of most hospital and pharmacy divisions in Taiwan's southern cities. It is hoped to draw the government's attention to the existing inefficiency in the allocation of healthcare and pharmaceutical resources. For future studies, a dynamic network model can be adapted to introduce the Malmquist productivity index in order to compare divisional productivity changes over time. Other topics for future research include handling undesirable outputs (quality variables) and information on input/output prices
Association of depression and antidepressant therapy with antiretroviral therapy adherence and health-related quality of life in men who have sex with men
No full text[[abstract]]UNAIDS' HIV treatment targets require that 90% of people living with HIV/AIDS (PLWHA) receiving antiretroviral treatment (ART) achieve viral suppression and 90% of people with viral suppression have good health-related quality of life (HRQOL). This study aimed to examine the association of depression and antidepressant therapy with ART adherence and HRQOL in HIV-infected men who have sex with men (MSM). From 2018 through 2020, HIV-infected MSMs were consecutively recruited (N = 565) for the evaluation of ART adherence and HRQOL at Taipei City Hospital HIV clinics. Non-adherence to ART was defined as a Medication Adherence Report Scale score of < 23. HRQOL in PLWHHA was evaluated using WHOQOL-BREF, Taiwan version. Overall, 14.0% had depression and 12.4% exhibited non-adherence to ART. The nonadherence proportion was 21.8% and 10.5% in depressed and nondepressed HIV-infected MSM, respectively. After adjusting for other covariates, depression was associated with a higher risk of nonadherence to ART (adjusted odds ratio = 2.02; 95% confidence interval: 1.02-4.00). Physical, psychological, social, and environmental HRQOL were significantly negatively associated with depression. Considering antidepressant therapy, ART nonadherence was significantly associated with depression without antidepressant therapy but not with antidepressant therapy. The depressed HIV-infected MSM without antidepressant therapy had worse psychological, social, and environmental HRQOL than those with antidepressant therapy. Our study suggests that depression is associated with poor ART adherence and HRQOL, particularly in those without antidepressant therapy. Adequate diagnosis and treatment of depression should be provided for PLWHA to improve their ART adherence and HRQOL
The Prevalence of Chronic Cardiovascular Diseases and Multiple Chronic Diseases in the Elderly in Taiwan and Their Related Factors
No full text[[abstract]]目的：本研究旨在探討臺灣老人心血管慢性病與心血管多重慢性病之相關因素。方法：本研究以衛生福利部國民健康署2013年國民健康訪問調查資料做分析，自變項為基本人口學特性、預防保健與健康行為，依變項為心血管慢性病與多重慢性病。先以卡方檢定描述各變項分佈情形，再以複邏輯斯迴歸分析，找出獨立影響慢性病與多重慢性病的影響因素。結果：本研究以2,021位65歲（含）以上老人為研究對象，其中662位（32.76%）有一種心血管慢性病，749位（37.06%）有多重心血管慢性病。影響老人心血管慢性病與多重慢性病因素，有75歲以上、女性、沒有工作、體重過重或肥胖等。結論：影響老人心血管慢性病與多重慢性病的因素為年齡、工作、體重與性別。
Objectives: This study aims to explore the factors related to chronic cardiovascular diseases and multiple chronic cardiovascular diseases in the elderly in Taiwan. Methods: This study analyzed data from the 2013 National Health Interview Survey conducted by the National Health Administration of the Ministry of Health and Welfare. The independent variables were basic demographic characteristics, preventive health care and health behaviors, and the dependent variables were chronic cardiovascular diseases and multiple chronic cardiovascular diseases. Firstly, the distribution of each variable is described in terms of frequency, percentage and p value. Secondly, multiple logistic regression analysis is used to find out the influencing factors that independently affect chronic diseases and multiple chronic diseases. Results : This study took 2,021 elderly people over 65 years old as the research subjects. Out of these, 662 (32.76%) had chronic cardiovascular diseases, and 749 (37.06%) had multiple chronic cardiovascular diseases. In terms of chronic cardiovascular diseases and multiple chronic cardiovascular diseases affecting the elderly, there are factors such as being over 75 years of age, female, unemployed, and being overweight or obese. Conclusions : The factors affecting the elderly with chronic cardiovascular diseases and multiple chronic cardiovascular diseases are age, work, weight and gender
Palliative Family Conference Reduces the Risk of Death in Intensive Care Units and Cardiopulmonary Resuscitation at End of Life
No full text[[abstract]]Background: Palliative family conference (PFC) was included in the reimbursement of National Health Insurance to promote palliative care in Taiwan in 2012. Objectives: This study aimed to evaluate the impact of PFC on death in intensive care unit (ICU) and receiving cardiopulmonary resuscitation (CPR) within three days before death. Design: This is a cross-sectional study. Subjects: All patients who died in a public hospital and were admitted to ICU within 30 days before death, from 2013 to 2018, were included. Measurements: The medical records were analyzed to identify information on causes of death, receiving PFC, receiving palliative care consultation, death in ICU, and receiving CPR within three days before death. Multivariate logistic regression was used to assess the independent effects of receiving PFC on the risk of death in ICU and receiving CPR within three days before death. Results: For patients who died and those who did not die in ICU, the proportion of receiving PFC was 45.8% (1818/3973) and 55.0% (808/1468), respectively. For patients who received and those who did not receive CPR within three days before death, the proportion of receiving PFC was 23.9% (140/585) and 51.2% (2486/4856), respectively. PFC was associated with a reduced risk of death in ICU (adjusted odds ratio [AOR]: 0.842; 95% confidence interval [CI]: 0.717-0.988) and a reduced risk of receiving CPR within three days before death (AOR: 0.361; 95% CI: 0.286-0.456). Conclusion: PFC reduces the risk of receiving nonbeneficial aggressive intervention and may improve the quality of end-of-life care