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Social functioning of people with head and neck cancer after treatment: A qualitative study
No full text[[abstract]]Purpose: People with head and neck cancer face changes in appearance, difficulties swallowing, and communication challenges, which can limit their social functioning and impact interpersonal relationships, self-esteem, and work performance. The literature on how post-treatment changes affect social functioning remains limited. This study aims to explore the social functioning experiences of people with head and neck cancer after treatment.
Method: A qualitative research design with purposive sampling was employed to recruit head and neck cancer patients from a medical center in central Taiwan. Face-to-face in-depth interviews were conducted using semi-structured interview guides. Data were analyzed through qualitative content analysis.
Results: Twenty participants were recruited, with treatment completion ranging from 10 months to 8 years and 9 months prior. Five themes were identified: (1) influence on willingness to participate in society, (2) interpersonal relationships and interaction, (3) giving back to society, (4) taking care of oneself, and (5) challenges in maintaining employment.
Conclusions: Post-treatment adjustments in behavior and communication are necessary for social reintegration. Treatment-related changes reduce patients' willingness to participate socially, but community involvement and personal adjustments help rebuild self-worth. Tailored support programs are recommended
Smartphone Application Intervention on Obstructive Sleep Apnea Among Overweight and Obese High-Tech Employees: A Randomized Controlled Trial
No full text[[abstract]]The aim of this study was to examine the effectiveness of an adjusting lifestyle intervention with a smartphone application (app) in managing obstructive sleep apnea (OSA) among overweight and obese high-tech employees. A 6-months three-armed randomized controlled trial was employed. A total of 144 eligible participants were randomly allocated into the smartphone app 'MyFitnessPal' plus education (MFPE; n = 48), 'MyFitnessPal'-only (MFP-only; n = 50) and the control group (n = 46) at a 1:1:1 ratio. The data were collected using related questionnaires and portable sleep monitor. Generalized estimating equation was used to analyze data. Results revealed that there was a significant interaction between time and group in BMI (Wald ?2 = 4.47, p = 0.04) in the MFPE after the 12th week of the intervention. Nevertheless, there was no significant interaction between group and time observed in apnea-hypopnea index (AHI) score after 24 weeks of intervention. The adjustment lifestyle integrated with an app may offer a simple and cost-effective approach. The findings of this study may provide precious information for occupational healthcare providers, facilitating health promotion in the workplace for overweight employees with OSA
The effects of a 3-month walking and dietary education program on the quality of life of patients with esophageal cancer: a 1-year follow-up randomized controlled trial
No full text[[abstract]]Purpose: To examine the effects of a 12-week rehabilitation program of exercise combined with diet education on the quality of life (QOL) and symptoms (anxiety, depression, rest/activity circadian rhythm (RACR), and sleep) of patients with esophageal cancer.
Methods: We used a two-parallel-arms randomized controlled trial. The experimental group (EG) participated in a 12-week program involving walking exercise and diet education. The control group (CG) received standard care. The primary outcome was QOL, measured using the European Organisation for Research and Treatment of Cancer QOL core questionnaire (QLQ-C30) and esophageal module 18 (EORTC QLQ-OES18). Secondary outcomes were anxiety, depression, RACR, and sleep characteristics. Measurement time points were baseline and 3, 6, and 12 months after recruitment.
Results: Of 85 enrolled patients with esophageal cancer (EG = 43, CG = 42), the majority were male, 59 years old on average, and had received surgery. The EG recorded significantly better 24-h autocorrelation coefficient (0.06 to 0.24, p = 0.002; Cohen's d = 0.98) of rest/activity rhythms parameters at 6 months. In the EG, total sleep time significantly increased at 3 months (16.36 to 86.07, p = 0.004; Cohen's d = 0.86).
Conclusions: The intervention improved the RACR and sleep of patients with esophageal cancer. Healthcare professionals may consider incorporating this rehabilitation program into routine care alongside cancer treatment for patients with esophageal cancer. TRIAL REGISTRATION: Clinicaltrials.gov (registration number: NCT03161535). Prospectively registered on 17 May 2017
[[alternative]]Psychometric properties of the Maslach Burnout Inventory in nurse aides
No full text[[abstract]]背景與目的：目前臺灣人口快速老化、生育率持續下降的現象，使得社會人口進入負增長階段，加上醫療科技的進步使得國人壽命更加延長，老年人口占總人口比例亦持續攀升。根據內政部統計顯示臺灣於1993年已邁入高齡化社會，並於2018年65歲以上人口比例已超過14%正式轉為高齡化社會的國家，而估計於2025年65歲以上人口比例將會超過20%，進入超高齡社會。隨著老年人口持續增加，長期照護需求因而提高，然而家庭結構的改變使得照顧能力減少，長期照護住宿式機構之照顧人力不足，導致照顧服務員在社會中扮演著不可缺的角色。近年來，照顧服務員已成為許多國家重要的勞動力之一，但長期於高壓力環境工作的照顧服務員容易出現身心理健康問題，進而感到職業倦怠，職業倦怠不僅對他們的身心健康產生負面影響，還會影響工作表現和滿意度，進而影響到長者的照護品質。因此，了解照顧服務員的職業倦怠程度和工作情況變得非常重要，目前國內尚未針對長期照護住宿式機構之照顧服員的相關研究，故本研究之目為探討Maslach職業倦怠量表 (Maslach Burnout Inventory, MBI)應用於照顧服務員之心理計量特性檢驗，以了解MBI在照顧服務員群體中的內部一致性 (internal consistency)和建構效度 (construct validity)。研究方法：134名符合條件的住宿式長期照護機構照顧服務員成為本研究之參與者，取得主管和參與者同意後，透過自填寫紙本問卷進行資料收集，並使用Cronbach’s α係數檢驗內部一致性，利用羅序分析 (Rasch analysis)之以近合適度 (infit mean square)和遠合適度 (outfit mean square)，分析項目作答反應型態，以驗證單向度建構(unidimensionality)。研究結果：MBI使用於住宿式長期照護機構之照顧服務員顯示，三個構面：情緒耗竭、去人性化和個人成就構面之內部一致性Cronbach’s α係數分別為0.92、0.91、和0.88。近合適度分別為0.77-1.58、0.61-1.52和0.58-1.39。遠合適度分別為0.75-1.65、0.54-1.58和0.65-1.64。這意味著MBI 使用於長期照護住宿式機構之照顧服務員，各項目之間相互有高度關聯性，具有較高的信度和建構效度。在符合單向度建構之模式下，情緒耗竭構面須刪除1項「與他人直接接觸一起工作帶給我很大的壓力」；去人性化構面須刪除1項「我覺得服務對象會拿他們自己的某些問題來怪罪我」；個人成就構面須刪除2項「我能很容易地瞭解我的服務對象對事情的感受、我覺得我充滿活力」。結論：本研究支持情緒耗竭、去人性化和個人成就三個構面的單向度建構，其中8個項目情緒耗竭構面，4個項目去人性化構面，6個項目個人成就構面。每個構面的總分可描述住宿式長期照顧機構照顧服務員在特定職業倦怠方面的狀況。[[abstract]]Background: Currently, Taiwan is experiencing rapid population aging and declining birth rates, entering a stage of negative population growth. Additionally, advancements in medical technology have resulted in longer life expectancy, leading to a continuous increase in the proportion of elderly people in the population. According to statistics from the Ministry of the Interior, Taiwan officially transitioned into an aged society in 1993, and in 2018, the proportion of people aged 65 and above exceeded 14%, officially making Taiwan an aged society. It is estimated that by 2025, the proportion of people aged 65 and above will exceed 20%, entering a super-aged society. With the continuous increase in the elderly population, the demand for long-term care also increases. Changes in family structure have reduced caregiving capacity, resulting in a shortage of caregivers in long-term care facilities, with nurse aides playing an indispensable role in society. In recent years, nurse aides have become an important part of the workforce in many countries. However, nurse aides who work in high-pressure environments for extended periods are prone to experiencing physical and mental health issues, leading to occupational burnout. Occupational burnout not only negatively affects nurse aides physical and mental health but also impacts their job performance and satisfaction, thereby affecting the quality of care for the elderly. Therefore, understanding the level of occupational burnout among nurse aides and their situations have become crucial. Currently, there is a lack of relevant research focusing on nurse aides in long-term care facilities. Thus, this study aims to investigate the psychometric properties of the Maslach Burnout Inventory (MBI) applied to nurse aides and to understand the internal consistency and construct validity of the MBI in the nurse aides.Method: A total of 134 eligible nurse aides from long-term care facilities participated in this study. After obtaining consent from supervisors and participants, data were collected through self-administered paper questionnaires. Internal consistency was examined using Cronbach's α coefficient, and Rasch analysis was employed to analyze item response patterns using infit mean square and outfit mean square to verify unidimensionality.Results: The internal consistency of the three dimensions of emotional exhaustion, depersonalization, and personal accomplishment among nurse aides in long-term care facilities using the MBI showed Cronbach's α coefficients of 0.92, 0.91, and 0.88, respectively. The infit mean square ranged from 0.77 to 1.58, 0.61 to 1.52, and 0.58 to 1.39, respectively, while the outfit mean square ranged from 0.75 to 1.65, 0.54 to 1.58, and 0.65 to 1.64, respectively. This indicates a high degree of correlation among the items of the MBI used with caregivers in long-term care facilities, demonstrating high reliability and construct validity. In a unidimensional construct pattern, one item, 「Being in direct contact with people at work is too stressful」needs to be deleted from the emotional exhaustion dimension; one item, 「I have the feeling that my colleagues blame me for some of their problems」needs to be deleted from the depersonalization dimension; and two items, 「I can easily understand the actions of my colleagues/supervisors」 and 「I feel full of energy」 need to be deleted from the personal accomplishment dimension.Conclusion: After deleting the items, this study supports the unidimensional constructs of emotional exhaustion, depersonalization, and personal accomplishment, comprising 8 items for emotional exhaustion, 4 items for depersonalization, and 6 items for personal accomplishment. The total score of each dimension can describe the specific aspects of occupational burnout among nurse aides in long-term care facilities
[[alternative]]Mild cognitive impairment status and physical performance: An arch support study
No full text[[abstract]]研究背景及目的本研究旨在探討不同認知表現輕度認知障礙長者下肢功能、平衡及行走能力表現之差異，及足弓支撐鞋墊介入之成效。研究方法研究收案輕度認知障礙女性長者38名，採隨機交叉試驗，以同一天間隔30分鐘之方式，測量有、無穿著足弓支撐鞋墊之差異。以簡易身體功能表現量表評估下肢功能表現，以站姿平衡、功能性手前伸評估平衡功能表現，以計時起走測試、10公尺障礙物步行測試評估行走能力表現，並使用Mann-Whitney U檢定、Wilcoxon sign rank檢定等統計方法，比較蒙特利爾認知評估 (Montreal Cognitive Assessment, MoCA)分數24-25分及23分或以下者，有、無穿著鞋墊測驗表現之差異。結果本研究認知較佳組的MoCA平均分數為24.5±0.5分、中位數為25.0分，認知較差組的MoCA平均分數為18.6±3.6分、中位數為19.0分。研究結果發現不同認知表現輕度認知障礙長者在下肢功能、平衡及行走能力表現皆無顯著差異（p > 0.05），但認知較差組有表現較差之趨勢。介入足弓支撐鞋墊之立即性成效對於全體受試者雖不顯著（p > 0.05），唯在認知較佳組中，10公尺障礙物步行由無鞋墊時10.30±1.58秒顯著增快為有鞋墊時9.98±1.33秒 (p = 0.03)。結論鞋墊的介入在不同認知狀態的輕度認知障礙女性長者中效果不同，能顯著改善認知較佳的長者在10公尺障礙物步行測試表現。建議未來研究進一步探討不同的鞋墊設計和使用時間對不同性別個體的影響，以及找到其他有效的介入措施來提高此一族群的生活品質。[[abstract]]Background and Purposes The aim of this study was to compare lower limb function, balance and gait among older people with mild cognitive impairment (MCI) of varying cognitive abilities, and to assess the effectiveness of an arch support intervention. MethodsThe randomized crossover design study included 38 elderly women with MCI. Measurements were taken with and without arch support, 30 minutes apart on the same day. Lower limb function was assessed using the Short Physical Performance Battery, and balance was assessed using standing balance and functional reach. Walking ability was assessed by the timed up-and-go test and a 10-metre obstacle walk test. The Mann-Whitney U test and the Wilcoxon signed rank test were used to compare test performances with and without arch support between participants with Montreal Cognitive Assessment (MoCA) scores of 24-25 and 23 or less. ResultsThe group with better or lower cognitive performance had the MoCA scores of 24.5±0.5 and 18.6±3.6, respectively. Lower limb function, balance and walking ability were not different between groups (p > 0.05). Although the immediate effect of arch support intervention on improving lower limb function, balance and walking ability was generally not significant, the arch support insoles significantly improved 10-metre obstacle walk time from 10.30±1.58 to 9.98±1.33 seconds (p = 0.03) for the group with better cognitive performance.ConclusionThe study results suggest that the effect of arch support insoles varies between older women with different cognitive status. Future research should further investigate the effects of different insole design, duration of use of the insoles, and use on different individuals, as well as other effective interventions to improve the quality of life of older people with MCI
[[alternative]]How Family Caregivers Become Invisible in Elder Protection? Disjuncture and Resistance of Medical Social Workers
No full text[[abstract]] 本研究從醫務社工的角度出發，探究因照顧而發生的老人保護案件透過醫院通報及其進入政府老人保護服務流程的經驗，檢視政府機關建制化下如何篩選老人保護案件；以及在編派老人保護案件的過程中，試圖拼湊老人保護案件中，長期照顧個案之隱藏照顧成本及政策資源配置的權力地圖；以及醫務社工如何運用累積的工作知識，抵抗處理老人保護案件過程中的斷裂經驗。 透過以建制民族誌為研究方法論，聚焦於醫務社工處理因照顧而發生的老人保護案件的服務歷程，將透過參與觀察、半結構深度訪談與文本分析，期望藉由第一線實務工作者的視角，蒐集關於政府對於老人保護案件通報機制、跨單位網絡間的合作、老人保護資源佈建現況工作經驗的逐字稿，輔以工作的表格紀錄、政府的公文、通報單等文本以及工作者日誌進行分析，提出未來政府擬訂老人保護政策新的思維與建議。 捕捉醫務社工人員在醫院場域中處理老人保護案件的實務日常，第一，醫務社工在老人保護通報過程中面臨效率與資源限制，法條與實務分工不一致造成斷裂經驗。第二，社會仍以家庭照顧責任為主要意識形態，醫療體系假定病人住院時，家屬並需隨伺在側；當護理師因家屬缺席承擔的隱形工作時，就會督促醫務社工協尋家屬的角色。第三，當醫院發現老人保護案例，醫務社工扮演重要的樞紐，需確認追蹤個案從急診到病房的照顧過程，且在病人與醫師、護理師之間扮演溝通協調的角色，這些整合性的角色，讓醫務社工處於各個相關部門及不同行動者之間的交集點，成為老人保護服務體系中以文本中介為溝通基礎的中心位置。第四，醫務社工需在不同政策論述間發展工作知識，尋找專業裁量空間，進而產生醫務社工採用不同通報策略的日常抵抗。本研究結果指出，醫院應被視為老人保護的機會之窗，成為衛政與社政，醫院與社區之間合作樞紐。[[abstract]] This study examines the experiences of medical social workers in handling elder protection cases that enter the government's elder protective services process due to hospital mandatory reporting. The research focuses on exploring how government agencies, under institutional constraints, select and manage elder protection cases; investigating the hidden costs of care and power dynamics in resource allocation for long-term care cases; and analyzing how medical social workers apply their accumulated knowledge to navigate challenges in handling elder protection cases. The study employs Institutional Ethnography (IE) as its research methodology, concentrating on the service process of medical social workers handling elder protection cases arising from caregiving issues. Data collection methods include participant observation, semi-structured in-depth interviews, and textual analysis. The research draws upon frontline practitioners' perspectives, analyzing documents related to the government's reporting mechanism, inter-agency collaborations, and resource allocation in elder protection cases. Supplementary materials include work records, official government documents, report forms, and practitioner journals. Key findings of the study reveal that medical social workers face efficiency and resource constraints in the reporting process, experiencing disjuncture between legal regulations and practical realities. Societal expectations of family-based caregiving create tensions within the medical system, particularly when family members are absent during hospitalization. Medical social workers play a crucial integrative role in coordinating communication between various departments and stakeholders in elder protection cases. Furthermore, practitioners develop strategies to navigate policy discourses and exercise professional discretion, employing diverse reporting strategies as a form of daily resistance. The study concludes that hospitals should be recognized as critical intervention points for elder protection, serving as hubs for collaboration between healthcare institutions, communities, and health and social policies
[[alternative]]Exploration of Medical Utilization and Health Status among Victims of Intimate Partner Violence in Taiwan
No full text[[abstract]]背景：親密關係暴力是一項全球性社會問題，對人權和公共衛生造成嚴重影響，對個體的身體和心理健康造成負面影響。受暴者常出現憂鬱、創傷後壓力症候群和焦慮等心理健康問題，並可能出現頭痛、腸胃道問題或慢性疼痛等生理健康問題，導致醫療資源利用增加。在臺灣，仍有80%受暴者為女性，但是男性受暴者通報數量逐年增加。隨著性別意識的提升，男性亦是需要關注的對象，因此除了了解受暴與否對於醫療資源以及健康狀況的影響之外，需要更深入了解親密關係暴力對男性和女性的影響及其所面臨的醫療資源利用與健康狀況差異。目的：本研究旨在探討受暴經歷在醫療利用及健康狀況的差異，並探討不同性別受暴者在醫療利用及健康狀況的差異及其影響因素。方法：本研究為回溯性世代研究，利用衛生福利部資料科學中心提供之全民健康保險研究資料庫進行次級資料分析，並以SAS 9.4進行資料整理與統計分析。首先，以描述性統計分別探討2019年受暴經歷及受暴男性與女性之人口特徵、醫療利用及健康狀況之人次與百分比；其次，以卡方檢定分別探討受暴經歷及受暴男性與女性在人口特徵、醫療利用及健康狀況之差異；最後，以邏輯斯迴歸分析影響受暴經歷與受暴男女性醫療利用及健康狀況的因素。結果：2019年受暴者共43,393有受暴經歷者，經1：1頻率匹配43,393名未受暴者，共計86,786名，女性受暴者共35,756人與男性受暴者7,637人。結果顯示受暴經歷是醫療利用的重要影響因素，相較於未受暴者，親密關係暴力受暴者有高門診利用、急診利用與住院利用之調整後勝算比分別為1.60、3.66及1.59。健康狀況方面，受暴經歷是影響憂鬱症、酒精與藥物濫用、思覺失調、躁鬱症、氣喘重要因素，相較於未受暴者，受暴者有負面健康狀況的調整後勝算比分為4.18、5.98、1.75、4.81及1.31。進一步分析不同性別之受暴者，受暴者性別與門診次數及住院利用有相關，相較於男性受暴者，女性受暴者有高門診利用及住院利用之調整後勝算比分別為2.11及1.28。受暴者健康狀況方面，受暴者性別是影響憂鬱症、酒精與藥物濫用、思覺失調、躁鬱症健康狀況因素，相較於男性，女性在憂鬱症、思覺失調、躁鬱症罹患之調整後勝算比為1.58、1.46及1.77；然而女性在酒精與藥物濫用之調整後勝算比為0.47，僅男性受暴者在酒精與濫用之風險較女性高。結論：本研究揭示受暴經歷對醫療利用及健康狀況的顯著影響，強調醫療院所特別是急診部門在解決受暴者照護需求的重要性。受暴者在憂鬱症、酒精與藥物濫用、思覺失調、躁鬱症、氣喘方面均有顯著影響，建議醫療衛生系統人員提升識別親密關係暴力敏感度，避免忽略受暴者反覆就醫的求助行為。衛生福利部及家暴防治中心提供心理治療關懷服務以憂鬱、躁鬱等心理健康輔導為主軸，男性受暴者相關的酒精與藥物濫用治療服務相對缺乏，建議未來家庭暴力防治服務應納入更多治療項目。此外，未來建議以縱貫性研究觀察親密關係暴力與健康問題之間的長期因果關係。[[abstract]]BACKGROUND: Intimate partner violence (IPV) is a global social issue with serious implications for human rights and public health, negatively affecting victims' physical and mental health. Victims often suffer from mental health problems such as depression, post-traumatic stress disorder, and anxiety. Also, they may experience physical problems like headaches, gastrointestinal disorders, and chronic pain, leading to increased medical resource utilization. In Taiwan, 80% of IPV victims are women, but reports of male victims are rising annually. With growing gender awareness, attention to male victims is also crucial. Understanding the effects of IPV on both genders is essential for assessing medical utilization and health status.OBJECTIVES: To explore the differences in medical utilization and health status between individuals with and without a history of IPV, and to analyze the differences in medical utilization and health status between male and female victims of IPV, as well as the factors influencing these two different genders.METHODS: This study is a retrospective cohort study. Study data comes from Health and Welfare Data Science Center. Data was analyzed with SAS 9.4. Descriptive statistics examined demographic characteristics, medical utilization, and health status of with and without a history of IPV and different gender of IPV victims in 2019 respectively. Chi-square tests explored differences between the history of IPV and different gender of IPV victims. Logistic regression identified factors influencing medical utilization and health status among victims individuals.RESULTS: The study included 43,393 individuals with a history of IPV, matched 1:1 with 43,393 non-abused individuals, totaling 86,786 participants. There are 35,756 female and 7,637 male IPV victims. Results indicated that a history of abuse significantly affects medical utilization. Compared to non-abused individuals, the adjusted odds ratios of outpatient visits, emergency visits, and hospitalizations for those who were victims of intimate relationship violence were 1.59, 3.66, and 1.60 respectively. In terms of health, a history of IPV significantly influenced depression, alcohol and drug abuse, schizophrenia, bipolar disorder, and asthma, with adjusted odds ratios were 4.18, 5.98, 1.75, 4.81, and 1.31 respectively. Compared with men, women are more likely to suffer from depression, schizophrenia, and bipolar disorder. The adjusted odds ratios for alcohol and drug abuse were 1.58, 1.46 and 1.77; however, for women, the adjusted odds ratio for alcohol and drug abuse was 0.47. Only male victims of violence had a higher risk than women for alcohol and drug abuse.CONCLUSIONS: This study reveals the significant impact of experiencing violence on healthcare utilization and health status, emphasizing the importance of healthcare institutions, particularly emergency departments, in addressing the care needs of victims. These victims are notably affected by depression, substance abuse, schizophrenia, bipolar disorder, and asthma. It is recommended that healthcare personnel enhance their sensitivity to intimate relationship violence and avoid ignoring victims' repeated medical visits. While the Ministry of Health and Welfare offers mental health services, there is a lack of substance abuse treatment for male victims. Future domestic violence prevention programs should expand their services, and longitudinal studies are needed to examine the long-term health effects of intimate relationship violence
[[alternative]]Association Between Leisure-Time Physical Activity And Incident Cancer Among Adults In Taiwan
No full text[[abstract]]背景：癌症是全球主要的死亡原因之一，2022年，全球新發生癌症個案數約2,000萬人，預計未來幾十年內，癌症患者數量將大幅增加，其中約30%~50%的癌症病例是可以透過避免危險因子或改善生活方式來預防。在臺灣，癌症已連續41年成為十大死因之首，且死亡率高，尤其在55歲以上的人群中更為顯著，然而休閒時間身體活動對不同癌症的影響尚未全面了解。目的：本研究旨在探討成人休閒時間身體活動與癌症發生風險之間的關聯。方法：本研究從2001年、2005年、2009年、2013年和2017年的臺灣國民健康訪問調查中，選取67,890名年滿18歲的成人受訪者。休閒時間身體活動依每週代謝當量(METs)消耗量進行測量，並分為<1 MET-h、1-7.49 MET-h和≥7.5 MET-h三組。國民健康訪問調查透過面對面訪談收集休閒時間身體活動資料和控制變項包含年齡、性別、身體質量指數、婚姻狀況、教育程度、家庭收入、吸菸、飲酒、蔬菜和水果攝取。新發生癌症根據重大傷病檔進行確定，死亡則由死因登記檔確認。使用 Fine-Gray 比例風險迴歸模型將死亡作為競爭風險來分析休閒時間身體活動對新發生癌症風險的影響。結果：總計67,890位成人納入分析，自2001年至2020年研究追蹤期間，共有4,435名受訪者被診斷出新發生癌症。經過對年齡、性別、身體質量指數、婚姻狀況、教育程度、家庭收入、吸煙、飲酒狀況和共病症進行校正後，每週休閒時間身體活動≥7.5 MET-h的成人，其新發生癌症風險顯著降低（aHR=0.93；95%CI=0.87-0.99）。每週休閒時間身體活動≥7.5 MET-h的成人，其新發生膀胱癌（aHR=0.68；95% CI=0.47-0.99）、子宮頸癌（aHR=0.48；95% CI=0.24-0.95）和甲狀腺癌（aHR=0.64；95% CI=0.44-0.93）的風險顯著降低。 結論：本研究結果建議，應鼓勵身體活動不足的成年人參與休閒時間身體活動，根據不同族群的需求與偏好，提供個性化和社會化的活動方案，從而提升整體活動人口比例，減少癌症發生風險。[[abstract]]Background: Cancer is one of the leading causes of death in the world. In 2022, the number of new cancer cases worldwide will be about 20 million, and it is expected that the number of cancer patients will increase dramatically in the next few decades, of which about 30% to 50% of cancer cases can be prevented by avoiding risk factors or improving lifestyle. In Taiwan, cancer has been the top ten causes of death for 41 consecutive years and has a high mortality rate, especially among people over 55 years of age; however, the effects of leisure time physical activity on different cancers have not been fully understood.Objective: The aim of this study was to investigate the association between leisure-time physical activity and cancer risk in adults.Methods: This study included 67,890 adult respondents aged 18 and above from the Taiwan National Health Interview Survey conducted in 2001, 2005, 2009, 2013, and 2017. Leisure-time physical activity was measured based on weekly metabolic equivalent (MET) expenditure and categorized into three groups: <1 MET-hour, 1-7.49 MET-hours, and ≥7.5 MET-hours. Data on leisure-time physical activity and control variables, including age, gender, body mass index, marital status, education level, household income, smoking, alcohol consumption, and intake of vegetables and fruits, were collected through face-to-face interviews. Incident cancer cases were identified using the major illness and injury database, while mortality was confirmed using the cause of death registry. Fine-Gray proportional hazards regression models were used to analyze the impact of leisure-time physical activity on the risk of incident cancer, with death considered as a competing risk. Results: A total of 67,890 adults were included in the analysis, and during the follow-up period from 2001 to 2020, 4,435 respondents were diagnosed with incident cancer. After adjusting for age, gender, body mass index, marital status, education level, household income, smoking, alcohol consumption, and comorbidities, adults who engaged in ≥7.5 MET-hours of leisure-time physical activity per week had a significantly reduced risk of incident cancer (adjusted Hazard Ratio [aHR]=0.93; 95% Confidence Interval [CI]=0.87-0.99). The risk of incident bladder cancer (aHR=0.68; 95% CI=0.47-0.99), cervical cancer (aHR=0.48; 95% CI=0.24-0.95), and thyroid cancer (aHR=0.64; 95% CI=0.44-0.93) was also significantly reduced among adults with ≥7.5 MET-hours of leisure-time physical activity per week.Conclusion: The results of this study suggest that physically inactive adults should be encouraged to participate in leisure-time physical activity, and individualized and socialized activity programs should be provided according to the needs and preferences of different ethnic groups, so as to increase the proportion of the overall active population and reduce the risk of cancer
[[alternative]]Taking the Kaggle diabetes data set as an example to explore whether the data proportional affects the prediction difference
No full text[[abstract]]近年來，糖尿病問題的嚴重性逐漸加劇，成為一個重要的健康挑戰。在研究疾病數據時，數據比例問題常引起爭議，因為它可能對分析和預測結果產生重要影響。Kaggle這樣的開放數據平台提供了豐富的糖尿病數據集，為我們提供了一個探討數據比例影響的機會。本研究旨在探討數據比例是否會引起預測差異，從而增進我們對糖尿病及其預測的理解。利用Kaggle提供的糖尿病數據集，我們將檢驗不同數據比例是否會導致預測結果的差異。我們將從Kaggle獲取糖尿病數據集，確保其涵蓋生活方式、慢性疾病和基本人口統計的廣泛信息。首先，將數據集按照不同的比例進行分割，以模擬可能遇到的實際數據分佈，並且進行數據清洗、特徵選擇和變量轉換，確保在模型訓練前數據質量和格式一致。之後，使用相同的預測模型，在不同數據比例下進行訓練和測試。最後，比較不同比例下模型的性能，例如準確率、召回率和F1分數等指標。我們將分析和討論數據比例是否引起了預測差異，並探討可能的原因。資料收集時的疾病患病率、預測模型的選擇以及預測模型中測試比例的分配對預測準確度具有重要影響。因此，建議在研究設計階段應根據現實疾病患病率選擇樣本資料，並考慮使用羅吉斯回歸模型進行預測。這些結果有助於提高糖尿病預測模型的準確性，並為未來相關研究提供參考。[[abstract]]In recent years, the severity of diabetes has gradually intensified, becoming a significant health challenge. The issue of data proportion often sparks controversy in disease data research, as it can significantly impact analysis and prediction results. Open data platforms like Kaggle offer a rich collection of diabetes datasets, providing an opportunity to explore the influence of data proportion on prediction accuracy.This study aims to explore whether data proportions can cause differences in predictions, thereby enhancing our understanding of diabetes and its prediction. Using the diabetes dataset provided by Kaggle, we will examine whether different data proportions lead to variations in prediction outcomes.We will obtain a diabetes dataset from Kaggle, ensuring it encompasses extensive information on lifestyle, chronic diseases, and basic demographics. First, the dataset will be divided into different proportions to simulate potential real-world data distributions. We will then perform data cleaning, feature selection, and variable transformation to ensure consistency in data quality and format before model training. Subsequently, the same prediction model will be trained and tested under different data proportions. Finally, we will compare the performance of the model across various proportions using metrics such as accuracy, recall, and F1 score. We will analyze and discuss whether data proportions have caused prediction differences and explore potential reasons.The prevalence of the disease, the choice of predictive model, and the allocation of test proportions in the predictive model significantly impact prediction accuracy during data collection. Therefore, it is recommended that in the research design stage, sample data should be selected based on the actual disease prevalence rate, and Logis returns models should be considered for prediction. These findings help enhance the accuracy of diabetes prediction models and provide references for future related research
[[alternative]]The Effect of Combining a Non-Ketogenic Low-Carbohydrate Diet with Interval Training on Metabolic Markers in Men: A Comparison of Initial Systemic Inflammatory State
No full text[[abstract]]研究顯示缺乏身體活動及不良飲食習慣會誘發全身系統性慢性發炎，進而造成代謝症侯群與心血管疾病等慢性疾病。低碳水化合物飲食有減重、減脂及降低胰島素阻抗的效果，而高強度間歇訓練可提升心肺適能並降低發炎指標，且身體初始系統性發炎狀態會影響訓練後適應性。本研探討2週非生酮低碳水化合物飲食與間歇訓練對代謝指標的效益，並比較不同初始發炎程度的影響。共招募28位健康成年男性，依NLR基礎值 (Neutrophils-to-Lymphocytes Ratio, NLR) 中位數為分群標準，分成High NLR (N = 14,年齡:34.7 ± 13.1歲; NLR:2.4 ± 0.4)及Low NLR (N = 14,年齡:29.2 ± 10.3歲; NLR:1.4 ± 0.3)，並介入2週低碳水化合物飲食 (碳水化合物25%、脂肪50%、蛋白質25%) 及7次間歇訓練，每次訓練包含30% VO2peak熱身5分鐘及75% VO2peak × 4分鐘+60% VO2peak × 3分鐘運動共5組，介入前後進行VO2peak、身體組成測量及血液分析。結果發現整體受試者體重、體脂肪重、TG (Triglyceride, TG)及CHOL (Cholesterol, CHOL) 顯著下降且VO2peak 明顯提升，胰島素敏感性QUICKI僅發現Low NLR顯著上升，且LDL (Low-Density Lipoprotein Cholesterol) 與Leptin也僅有Low NLR明顯下降，而骨骼肌肉重、空腹胰島素及空腹血糖兩組皆無顯著差異，此外也發現介入後Low NLR之發炎指標SII (Systemic Immune-Inflammation Index, SII) 沒有差異，High NLR 則顯著下降。本研究結論為透過2週短期非生酮低碳水化合物飲食結合高強度間歇訓練可達到減重、減脂、提升VO2peak、增加胰島素敏感性指標QUICKI、改善TG、LDL及CHOL並維持肌肉率的效益，且身體初始系統性發炎程度會影響運動訓練適應性，其中初始發炎程度較低的組別可觀察到運動訓練適應性較佳的趨勢。[[abstract]]Research shows that lack of physical activity and poor dietary habits can induce systemic chronic inflammation, leading to metabolic syndrome. Low-carbohydrate diets (LCD) have been found effective for weight and fat loss, and lowering insulin resistance. Similarly, high-intensity interval training improves cardiovascular fitness and inflammation state, with initial systemic inflammation affecting post-training adaptation. This study investigates the effect of a 2-week non-ketogenic LCD combined with interval training on metabolic indicators, comparing effects across different initial inflammation levels. A total of 28 males were divided into High NLR (N=14, age: 34.7 ± 13.1 years; NLR: 2.4 ± 0.4) and Low NLR (N=14, age: 29.2 ± 10.3 years; NLR: 1.4 ± 0.3). Participants underwent a 2-week intervention with LCD and 7 sessions of interval training. Each session included a 5-mins warm-up at 30% VO2peak followed by 5 cycles of 4 mins at 75% VO2peak and 3 mins at 60% VO2peak. Pre- and post-intervention measurements included VO2peak, body composition, and blood analysis. Results showed significant reductions in body weight, body fat, TG, and CHOL across all participants, with notable increases in VO2peak and QUICKI observed only in the Low NLR. LDL and leptin decreased significantly only in the Low NLR, while muscle mass, fasting insulin, and glucose showed no significant differences. Furthermore, SII remained unchanged in the Low NLR but significantly decreased in the High NLR post-intervention. In conclusion, a 2-week LCD combined with interval training achieved benefits including weight and fat loss, improved VO2peak, QUICKI, TG, LDL, and CHOL levels, while maintaining muscle mass. Initial systemic inflammation levels influenced exercise adaptation, with the Low NLR showing trends of better training adaptation