The association between interest of nutritional supplements and COVID-19 pandemic - evidence from Google Trends.

BACKGROUND: Due to the spread of the coronavirus disease 2019 (COVID-19) pandemic in 2020, the interest of nutritional supplements has emerged. Limited data are available on how the COVID-19 pandemic affects the search interest in nutritional supplements in Taiwan and worldwide. The study aims to investigate changes in public search interest of nutritional supplements pre- and during the COVID-19 pandemic. METHODS: Our World in Data dataset was used to collect both global and local (Taiwan) number of COVID-19 newly confirmed cases and deaths. Google Trends search query was being used to obtain relative search volumes (RSVs) covering a timeframe between 2019 to 2022. Spearman's rank-order correlation coefficients were used to measure relationships between confirmed new cases and deaths and RSVs of nutritional supplements. Multivariate analysis was conducted to examine the effect of domestic and global new cases and deaths on the RSVs of nutritional supplements. RESULTS: The mean RSVs for nutritional supplements were higher during the COVID-19 pandemic period (between 2020 to 2022) compared to the pre-pandemic period (year of 2019) for both Taiwan and worldwide. In terms of seasonal variations, except for vitamin D, the mean RSVs of probiotics, vitamin B complex, and vitamin C in winter were significantly lower compared to other seasons in Taiwan. The RSVs of nutritional supplements were not only affected by domestic cases and deaths but also by global new cases and deaths. CONCLUSIONS: The interests in nutritional supplements had substantially increased in response to the COVID-19 pandemic. The RSVs of nutritional supplements in Taiwan were not only influenced by global and domestic pandemic severity but also by seasons.

Constructing a Learning Curve to Discuss the Medical Treatments and the Effect of Vaccination of COVID-19.

Acknowledging the extreme risk COVID-19 poses to humans, this paper attempted to analyze and compare case fatality rates, identify the existence of learning curves for COVID-19 medical treatments, and examine the impact of vaccination on fatality rate reduction. Confirmed cases and deaths were extracted from the "Daily Situation Report" provided by the World Health Organization. The results showed that low registration and low viral test rates resulted in low fatality rates, and the learning curve was significant for all countries except China. Treatment for COVID-19 can be improved through repeated experience. Vaccinations in the U.K. and U.S.A. are highly effective in reducing fatality rates, but not in other countries. The positive impact of vaccines may be attributed to higher vaccination rates. In addition to China, this study identified the existence of learning curves for the medical treatment of COVID-19 that can explain the effect of vaccination rates on fatalities.

XGBoost-Based Simple Three-Item Model Accurately Predicts Outcomes of Acute Ischemic Stroke.

An all-inclusive and accurate prediction of outcomes for patients with acute ischemic stroke (AIS) is crucial for clinical decision-making. This study developed extreme gradient boosting (XGBoost)-based models using three simple factors-age, fasting glucose, and National Institutes of Health Stroke Scale (NIHSS) scores-to predict the three-month functional outcomes after AIS. We retrieved the medical records of 1848 patients diagnosed with AIS and managed at a single medical center between 2016 and 2020. We developed and validated the predictions and ranked the importance of each variable. The XGBoost model achieved notable performance, with an area under the curve of 0.8595. As predicted by the model, the patients with initial NIHSS score > 5, aged over 64 years, and fasting blood glucose > 86 mg/dL were associated with unfavorable prognoses. For patients receiving endovascular therapy, fasting glucose was the most important predictor. The NIHSS score at admission was the most significant predictor for those who received other treatments. Our proposed XGBoost model showed a reliable predictive power of AIS outcomes using readily available and simple predictors and also demonstrated the validity of the model for application in patients receiving different AIS treatments, providing clinical evidence for future optimization of AIS treatment strategies.

Effect of vaccination patterns and vaccination rates on the spread and mortality of the COVID-19 pandemic.

Objectives: Acquiring herd immunity through vaccination is the best way to curb the COVID-19 infection. Many countries have attempted to reach the herd immunity threshold as early as possible since the commencement of vaccination at the end of 2020. The purpose of this study is to (1) examine whether the pattern of vaccination rates affects the spread of COVID-19 and the consequent mortality and (2) investigate the level of cumulative vaccination rates that can begin to have an impact on reducing the spread and mortality of the pandemic. Methods: This study selected 33 countries with higher vaccination rates as its sample set, classifying them into three groups as per vaccination patterns. Results: The results showed that vaccination patterns have a significant impact on reducing spread and mortality. The full-speed vaccination pattern showed greater improvement in the spread of the COVID-19 pandemic than the other two patterns, while the striving vaccination pattern improved the most in terms of mortality. Secondly, the spread and mortality of the COVID pandemic started to significantly decline when the average cumulative vaccination rate reached 29.06 doses per 100 people and 7.88 doses per 100 people, respectively. Conclusion: The study highlights the important role of vaccination patterns and the VTMR in reducing the epidemic spread and mortality.

An Examination of COVID-19 Mitigation Efficiency among 23 Countries.

The purpose of this paper was to compare the relative efficiency of COVID-19 transmission mitigation among 23 selected countries, including 19 countries in the G20, two heavily infected countries (Iran and Spain), and two highly populous countries (Pakistan and Nigeria). The mitigation efficiency for each country was evaluated at each stage by using data envelopment analysis (DEA) tools and changes in mitigation efficiency were analyzed across stages. Pearson correlation tests were conducted between each change to examine the impact of efficiency ranks in the previous stage on subsequent stages. An indicator was developed to judge epidemic stability and was applied to practical cases involving lifting travel restrictions and restarting the economy in some countries. The results showed that Korea and Australia performed with the highest efficiency in preventing the diffusion of COVID-19 for the whole period covering 105 days since the first confirmed case, while the USA ranked at the bottom. China, Japan, Korea, and Australia were judged to have recovered from the attack of COVID-19 due to higher epidemic stability.

The Effect of Vaccination Rates on the Infection of COVID-19 under the Vaccination Rate below the Herd Immunity Threshold.

Although vaccination is carried out worldwide, the vaccination rate varies greatly. As of 24 May 2021, in some countries, the proportion of the population fully vaccinated against COVID-19 has exceeded 50%, but in many countries, this proportion is still very low, less than 1%. This article aims to explore the impact of vaccination on the spread of the COVID-19 pandemic. As the herd immunity of almost all countries in the world has not been reached, several countries were selected as sample cases by employing the following criteria: more than 60 vaccine doses per 100 people and a population of more than one million people. In the end, a total of eight countries/regions were selected, including Israel, the UAE, Chile, the United Kingdom, the United States, Hungary, and Qatar. The results find that vaccination has a major impact on reducing infection rates in all countries. However, the infection rate after vaccination showed two trends. One is an inverted U-shaped trend, and the other is an L-shaped trend. For those countries with an inverted U-shaped trend, the infection rate begins to decline when the vaccination rate reaches 1.46-50.91 doses per 100 people.

Association of Hospice Care Services With the Utilization of Life-Sustaining Treatments During End-of-Life Care Among Patients With Cancer: A Nationwide 11-Year Cohort Study.

CONTEXT: The impact of hospice care services on the utilization of life-sustaining treatments during end-of-life care in terminally ill patients has not been extensively studied. OBJECTIVES: To determine the impact of hospice care services on the utilization of life-sustaining treatments during the last three months of life among patients with cancer. METHODS: This nationwide population-based cohort study identified adults with cancer diagnosis from the Taiwan Registry for Catastrophic Illness, 2006-2016. Life-sustaining treatments included cardiopulmonary resuscitation, intubation, mechanical ventilation support, nasogastric tube feeding, and total parenteral nutrition. Hospice care services consisted of hospice inpatient care, hospice-shared care, and hospice home care. The association of hospice care services with the utilization of life-sustaining treatments was determined using multiple logistic regression. RESULTS: Of 516,409 patients with cancer, 310,722 (60.2%) patients used life-sustaining treatments during the last three months of life. After adjusting for covariates, patients with hospice care services were less likely to receive life-sustaining treatments during the last three months of life than those without the services (adjusted odds ratio [AOR]: 0.70; 95% CI: 0.69-0.71). While type of life-sustaining treatments were considered, hospice care services were associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR: 0.125; 95% CI: 0.118-0.131), endotracheal intubation (AOR: 0.204; 95% CI: 0.199-0.210), mechanical ventilation support (AOR: 0.265; 95% CI: 0.260-0.270), nasogastric tube feeding (AOR: 0.736; 95% CI: 0.727-0.744), and total parenteral nutrition (AOR: 0.86; 95% CI: 0.84-0.88). CONCLUSION: Hospice care services were associated with a lower likelihood of receiving life-sustaining treatments during the last three months of life in patients with cancer.

A Flexible Lockdown by Integrating Public Health and Economic Reactivation to Response the Crisis of COVID-19: Responses to Comments by Alvaro J Idrovo on "An Examination on the Transmission of COVID-19 and the Effect of Response Strategies: A Comparative Analysis".

We greatly appreciate Idrovo's comments on our research and wish to specifically respond to his comments. Idrovo indicates that rapid increases in the number of confirmed cases in the past few weeks were observed in Latin America, where some countries had implemented stringent lockdowns for more than three months since the second half of March 2020. In his comments, Idrovo expresses his suspicion on the reality of lockdowns implemented in Latin America and worries about the negative impacts of lockdowns on economies. We thank the Editor for providing us with the opportunity to respond to Idrovo's comments and explain parts of our study.

An Examination on the Transmission of COVID-19 and the Effect of Response Strategies: A Comparative Analysis.

The major purpose of this paper was to examine the transmission of COVID-19 and the associated factors that affect the transmission. A qualitative analysis was conducted by comparing the COVID-19 transmission of six countries: China, Korea, Japan, Italy, the USA, and Brazil. This paper attempted to examine the mitigation effectiveness for the transmission of COVID-19 and the pandemic severity. Time to reach the peak of daily new confirmed cases and the maximum drop rate were used to measure the mitigation effectiveness, while the proportion of confirmed cases to population and the mortality rate were employed to evaluate the pandemic severity. Based on the mitigation effectiveness, the pandemic severity, and the mortality rate, the six sample countries were categorized into four types: high mitigation effectiveness vs. low pandemic severity, middle mitigation effectiveness vs. low pandemic severity, high mitigation effectiveness vs. high pandemic severity, and low mitigation effectiveness vs. high pandemic severity. The results found that Korea and China had relatively higher mitigation effectiveness and lower pandemic severity, while the USA and Brazil had the opposite. This paper suggests that viral testing together with contacts tracing, strict implementation of lockdown, and public cooperation play important roles in achieving a reduction in COVID-19 transmission.

Methamphetamine Use Associated with Non-adherence to Antiretroviral Treatment in Men Who Have Sex with Men.

Methamphetamine is a prevalent recreational drug among men who have sex with men (MSM) living with HIV and could cause the cognitive impairment and memory loss. However, studies on the association between methamphetamine use and adherence to antiretroviral treatment (ART) are limited and had inconsistent findings. This study aimed to determine the impact of methamphetamine use on adherence to ART among MSM living with HIV. From December 2018 to October 2019, MSM living with HIV were recruited (N = 351) and non-adherence to ART was defined as a Medication Adherence Report Scale score of <23. Overall, 16.0% of the participants reported methamphetamine use in the prior three months and 13.4% of the participants had non-adherence to ART. The proportion of non-adherence to ART among HIV-positive MSM were 28.6% and 10.5% with and without methamphetamine use, respectively. After controlling for demographics, illicit drug use, and co-morbidities, methamphetamine use during the prior three months was associated with a higher risk of non-adherence to ART (adjusted odds ratio = 3.08; 95% confidence intervals: 1.24-7.69). Compared with HIV-positive MSM with non-adherence to ART, HIV-positive MSM with good adherence to ART had a higher CD4 counts and were more likely to achieve an undetectable viral load. Since poor adherence to ART is associated with an increased HIV viral load and the risk of HIV transmission to others, our study suggests that it is imperative to screen HIV-positive patients for methamphetamine use and to provide effective therapy to reduce methamphetamine use and the associated non-adherence to ART.

Factors Affecting Treatment with Life-Saving Interventions, Computed Tomography Scans and Specialist Consultations.

Background: Emergency treatments determined by emergency physicians may affect mortality and patient satisfaction. This paper attempts to examine the impact of patient characteristics, health status, the accredited level of hospitals, and triaged levels on the following emergency treatments: immediate life-saving interventions (LSIs), computed tomography (CT) scans, and specialist consultations (SCs). Methods: A multivariate logistic regression model was employed to analyze the impact of patient characteristics, including sex, age, income and the urbanization degree of the patient's residence; patient health status, including records of hospitalization and the number of instances of ambulatory care in the previous year; the Charlson Comorbidity Index (CCI) score; the accredited level of hospitals; and the triaged level of emergency treatments. Results: All the patient characteristics were found to impact receiving LSI, CT and SC, except for income. Furthermore, a better health status was associated with a decreased probability of receiving LSI, CT and SC, but the number of instances of ambulatory care was not found to have a significant impact on receiving CT or SC. This study also found no evidence to support impact of CCI on SC. Hospitals with higher accredited levels were associated with a greater chance of patients receiving emergency treatments of LSI, CT and SC. A higher assigned severity (lower triaged level) led to an increased probability of receiving CT and SC. In terms of LSI, patients assigned to level 4 were found to have a lower chance of treatment than those assigned to level 5. Conclusions: This study found that several patient characteristics, patient health status, the accredited level of medical institutions and the triaged level, were associated with a higher likelihood of receiving emergency treatments. This study suggests that the inequality of medical resources among medical institutions with different accredited levels may yield a crowding-out effect.

Low Socioeconomic Status Associated With Lower Utilization of Hospice Care Services During End-of-Life Treatment in Patients With Cancer: A Population-Based Cohort Study.

CONTEXT: Socioeconomic status (SES) is an important determinant of disparities in health services and may affect the utilization of hospice care services during end-of-life (EOL) treatment in patients with cancer. However, previous studies evaluating the association between SES and utilization of hospice care services among patients with cancer revealed inconsistent findings. OBJECTIVES: This study aimed to determine the association between SES and utilization of hospice care services during the last year of life in patients with cancer. METHODS: From January 1, 2006 to December 31, 2016, we identified adults with cancer diagnoses from the Registry for Catastrophic Illness in Taiwan. The cancer diagnoses in study subjects were proved by the pathohistological reports. The utilization of hospice care services during the last year of life in patients with cancer included hospice inpatient care, hospice-shared care, and hospice home care. RESULTS: In the follow-up period, 28.6% of 516,409 patients with cancer used hospice care services during the last year of life. After adjusting for other covariates, low SES significantly reduced the utilization of hospice care services by 18% during the last year of life in patients with cancer. Moreover, a positive trend between decreasing levels of SES and lower utilization of hospice care during EOL treatment was noted (P < 0.001). CONCLUSION: Low SES was associated with lower utilization of hospice care services during EOL care in patients with cancer. Our data support the need to target low SES patients with cancer in efforts to optimally increase hospice care services during EOL care.

An Examination of the Determination of Medical Capacity under a National Health Insurance Program.

This paper examines the capacity determination factors of medical services at a national level through the analysis of a mathematical model that maximizes social welfare, which consists of the consumption of private goods and the medical capacity provided by the society. A sensitivity analysis is conducted to investigate the impact of these factors on the medical capacity provided. Furthermore, a case example based on the data provided by the government is presented to discuss the results derived from the theoretical analysis. The results of the sensitivity analysis indicate that individual disposable income, the medical expenditure for each treatment, the level of premium payments, and substitution parameters have a positive impact on medical capacity, while the medical costs and preference parameter negatively affect medical capacity. The results of the correlation analysis based on the data of the case example are consistent with the findings of the theoretical analysis.

Data-Driven Approach to Improving the Risk Assessment Process of Medical Failures.

In recent decades, many researchers have focused on the issue of medical failures in the healthcare industry. A variety of techniques have been employed to assess the risk of medical failure and to generate strategies to reduce the frequency of medical failures. Considering the limitations of the traditional method-failure mode and effects analysis (FMEA)-for risk assessment and quality improvement, this paper presents two models developed using data envelopment analysis (DEA). One is called the slacks-based measure DEA (SBM-DEA) model, and the other is a novel data-driven approach (NDA) that combines FMEA and DEA. The relative advantages of the three models are compared. In this paper, an infant security case consisting of 16 failure modes at Western Wake Medical Center in Raleigh, North Carolina, U.S., was employed. The results indicate that both SBM-DEA and NDA may improve the discrimination and accuracy of detection compared to the traditional method of FMEA. However, NDA was found to have a relative advantage over SBM-DEA due to its risk assessment capability and precise detection of medical failures.

Postdischarge rehospitalization and in-hospital mortality among Taiwanese women with hip fracture.

OBJECTIVES: To explore the factors concerning postdischarge rehospitalization and in-hospital mortality among Taiwanese women older than 50 years with hip fracture. MATERIALS AND METHODS: The National Health Insurance database from 2000 to 2006 was used to identity relevant cases. Women inpatients aged over 50 years with new-onset hip fracture in 2003 were identified. We analyzed the factors affecting postdischarge rehospitalization and in-hospital mortality. RESULTS: In 2003, there were 9467 new-onset hip fracture inpatients claimed among Taiwanese women aged over 50 years. The 3-year cumulative rates of rehospitalization after discharge and in-hospital mortality rate were 11.01% (1043) and 7.10% (672), respectively. The factors determined to be related to rehospitalization were patient age, hospital level, length of stay of the initial hospitalization due to hip fracture, and Charlson comorbidity index (CCI) score. The factors determined to be related to in-hospital mortality were age, urbanization level of region where patients were insured, hospital level, length of stay of the initial hospitalization due to hip fracture, and CCI score. CONCLUSION: Characteristics of women aged over 50 years with hip fracture remain an important issue based on high rehospitalization and in-hospital mortality rates. We have identified related risk factors that may be helpful in treating hip fracture among this population segment.

The privatization effect of MSW incineration services by using data envelopment analysis.

This paper attempts to compare the relative efficiency across MSW incineration facilities under the three operating modes including government-owned government-operated (GOO), government-owned private-operated (GOPO), and private-owned private-operated (POPO) by using the Data Envelopment Analysis (DEA), and to examine the factor in affecting the efficiency variation. The results show that technical efficiency scores are 0.7538, 0.9046 and 0.9917 for GOO, GOPO and POPO, respectively. An ANOVA is conducted and the analysis result confirms that the operating mode has significant impact on technical efficiencies. A further examination on the operating contracts signed between governments and operating firms of GOPO facilities finds that both the price protection and quantity protection also play vital roles in affecting efficiencies.