Impact of a cultural belief about ghost month on delivery mode in Taiwan

How Cultural Behaviors and Superstitions Associate the Willingness to Undergo Cataract Surgery in Taiwan: A Nationwide Survey

Background and Objectives: Cultural beliefs influence the conceptualization, adaptation, and coping strategies for diseases. This study aimed to investigate the impact of cultural beliefs and customs on the willingness to undergo cataract surgery in Taiwan. Materials and Methods: The data were retrospectively retrieved from the national Longitudinal Health Insurance Database 2000 (LHID2000). From the national database, we enrolled patients that were diagnosed with cataracts and underwent cataract surgery from 2001 to 2010. All the patients were stratified according to their gender and living area. Gender was categorized as male or female, and the living area was classified as urban or rural. We compared the difference in the number of surgeries between stratified patient groups in each Chinese lunar month. Results: The number of cataract surgeries decreased significantly in the seventh and twelfth lunar months for both genders. There was a significant reduction in cataract surgeries in both the urban and rural groups during the seventh lunar month. Interestingly, only the seventh lunar month had an association with sex in different living areas, which meant that in the seventh month, there was a gender-specific difference in the surgical numbers. Conclusions: The Taiwanese population holds a belief that surgical procedures, including cataract surgery, during the lunar ghost month is inauspicious. Citizens tend to avoid elective surgery due to cultural practice, resulting in a decrease in surgical numbers during the period of the Chinese New Year. The authorities should consider these cultural behaviors when developing medical policies and allocating resources. Healthcare providers should be aware of these superstitions and take them into account when providing medical care and advice to patients.

Influence of Admission Time on Health Care Quality and Utilization in Patients with Stroke: Analysis for a Possible July Effect and Weekend Effect

(1) Purpose: Undesirable health care outcomes could conceivably increase as a result of the entry of new, less experienced health care personnel into patient care during the month of July (the July effect) or as a result of the less balanced allocation of health care resources on weekends (the weekend effect). Whether these two effects were present in Taiwan’s National Health Insurance (NHI) system was investigated. (2) Methods: The current study data were acquired from the NHI Research Database. The research sample comprised ≥18-year-old patients diagnosed as having a stroke for the first time from 1 January 2006 to 30 September 2012. The mortality rate within 30 days after hospitalization and readmission rate within 14 days after hospital discharge were used as health care quality indicators, whereas health care utilization indicators were the total length and cost of initial hospitalization. (3) Results: The results revealed no sample-wide July effect with regard to the four indicators among patients with stroke. However, an unexpected July effect was present among in-patients in regional and public hospitals, in which the total lengths and costs of initial hospitalization for non-July admissions were higher than those for July admissions. Furthermore, the total hospitalization length for weekend admissions was 1.06–1.07 times higher than that for non-weekend admissions; the total hospitalization length for weekend admissions was also higher than that for weekday admissions during non-July months. Thus, weekend admission did not affect the health care quality of patients with stroke but extended their total hospitalization length. (4) Conclusions: Consistent with the NHI’s general effectiveness in ensuring fair, universally accessible, and high-quality health care services in Taiwan, the health care quality of patients examined in this study did not vary significantly overall between July and non-July months. However, a longer hospitalization length was observed for weekend admissions, possibly due to limitations in personnel and resource allocations during weekends. These results highlight the health care efficiency of hospitals during weekends as an area for further improvement.

Impact of superstitious beliefs on the timing of marriage and childbirth: Evidence from Denmark

We study the influence of numerological superstitions on family-related choices made by people in Denmark. Using daily data on marriages and births in Denmark in 2007-2019 we test hypotheses associated with positive perception of numbers 7 and 9 and a negative perception of number 13, as well as the impact of February, 29, April 1, St. Valentine’s Day and Halloween. There is significant negative effect of the 13th on the popularity of both wedding and birth dates. However, some other effects associated with special dates and the cultural representations of unofficial holidays have a stronger effect. In addition, after controlling for many factors, February 29 and April 1 turn out to be desirable for weddings, but not for childbirth, implying the context dependence of cultural stereotypes. Evidence of birth scheduling for non-medical reasons is especially worrisome because of the associated adverse health outcomes associated with elective caesarian sections and inductions.

The sociocultural effects on orthopedic surgeries in Taiwan

Various sociocultural factors affect healthcare-seeking behaviors. In Taiwanese society, superstitions and lunar festivals play important roles in people’s lives. We investigated the impact of “Ghost Month” (the 7^th lunar month) and Chinese New Year (the 12^th lunar month and the 1^st lunar month of the following year) on the number of elective surgeries and emergent surgeries in Taiwan. The number of total knee replacement (TKR) surgeries and proximal femur fracture (PFF) surgeries in each lunar month from 2000 to 2011 were extracted from the Taiwan National Health Insurance Database, a computerized and population-based database. Patients were then sorted by location of residence or gender. The average number of TKR surgeries performed was significantly lower during the 1^st, 7^th, and 12^th lunar months in urban areas, whereas in rural areas this trend was only evident in the 7^th and 12^th lunar months. There was however, no significant difference in the average number of PFF surgeries in each lunar month except for an increase seen in the 1^st lunar month in rural patients (p<0.05). When sorted by gender, the average number of TKR surgeries was significantly decreased in the 7^th and 12^th lunar months in male patients, and decreased in the 1^st, 7^th, and 12^th lunar months in female patients. In contrast, there was no difference in the average numbers of PFF surgeries in the 7^th and 12^th lunar months either in male or female patients. We proposed that the timing of elective surgeries such as TKR might be influenced by Ghost Month and Chinese New Year; however, emergent PFF surgeries were not significantly influenced by sociocultural beliefs and taboos in Taiwan.

Auspicious birth dates among Chinese in California

The number eight is considered lucky in Chinese culture, e.g. the Beijing Olympics began at 8:08 pm on 8/8/2008. Given the potential for discretion in selecting particular dates of labor induction or scheduled Cesarean section (C-section), we consider whether Chinese-American births in California occur disproportionately on the 8th, 18th, or 28th day of the month. We find 2.3% "too many" Chinese births on these auspicious birth dates, whereas Whites show no corresponding increase. The increase in Chinese births is driven by higher parity C-sections: the number of repeat C-sections is 6% "too high" on auspicious birth dates. Sons born to Chinese parents account for the entire increase; daughter deliveries do not seem to be timed to achieve "lucky" birth dates. We also find avoidance of repeat C-section deliveries on the 4th, 14th, and 24th of the month, considered unlucky in Chinese culture. Finally, we replicate earlier work finding that Friday the 13th delivery dates are avoided and document a particularly large decrease among Chinese. For Whites and Chinese in California, mothers with higher levels of education are particularly likely to avoid delivering on the 13th.

Caesarean delivery before 39 weeks associated with selecting an auspicious time for birth in Taiwan

BACKGROUND

Caesarean delivery before 39 weeks of gestation increases the risk of morbidity among infants. Taiwan has one of the highest caesarean rates in the world, but little attention has been paid to this issue. This study aimed to describe the rate of caesarean delivery before 39 weeks gestation among women who did not have labour signs and had a non-emergency caesarean delivery in Taiwan and to examine whether the phenomenon was associated with the Chinese cultural practice of selecting an auspicious time for birth.

METHODS

We recruited women at 15-28 weeks of pregnancy at 5 hospitals in northern Taiwan and followed them at 4 or 5 weeks after delivery using structured questionnaires. This analysis included 150 primiparous mothers with a singleton pregnancy who had a non-emergency caesarean delivery without the presence of labour signs.

RESULTS

Ninety-three of these women (62.0%) had caesarean deliveries before 39 weeks of gestation. Logistic regression analysis showed that women who had selected an auspicious time for delivery (OR=2.82, 95% CI: 1.15-6.95) and delivered in medical centres (OR=5.26, 95% CI: 2.25-12.26) were more likely to deliver before 39 weeks of gestation.

CONCLUSION

Non-emergency caesarean delivery before 39 weeks of gestation was common among the study women, and was related to the Chinese cultural practice of selecting an auspicious time for birth. Further studies are needed to examine the risks and benefits associated with timing of caesarean delivery in Taiwan in order to generate a consensus among obstetricians and give pregnant women appropriate information.

A study on personal mode of delivery among Chinese obstetrician-gynecologists, midwives and nurses

BACKGROUND

Medical staff, especially those working in the Department of Gynecology and Obstetrics, have been considered to mostly influence pregnant women on the decision making of delivery mode.

OBJECTIVE

To investigate mode of delivery among Chinese female obstetrician-gynecologists, midwives and nurses and to explore reasons why they choose cesarean section (CS) for themselves and their advice on mode of delivery.

METHODS

Questionnaires including demographic characteristics, their mode of delivery and the reason as well as their suggestion when consulted by pregnant women were administered to 293 participants.

RESULTS

69.7 % was the overall CS rate and 49.0 % without any medical indications. The main reasons for CS were safety for both fetus and mother, easier and quicker labor, fear of injury to the fetus in vaginal delivery (VD), worrying about various unpredicted risk problems in VD and disbelief of VD skills. Those who had experienced CS were more likely to agree with the maternal request for CS or even gave a suggestion straightly for CS.

CONCLUSIONS

There is a high rate of CS among Chinese medical staff working in the Department of Gynecology and Obstetrics. Future efforts to reduce the national CS rate would focus on the delivery practice of medical staff, modification of national policies including the one-child policy and promotion of VD skills.

Women's preference for cesarean delivery and differences between Taiwanese women undergoing different modes of delivery

BACKGROUND

The rate of cesarean delivery was 35% in 2007 in Taiwan. It is unclear how many of the cesarean deliveries were without medical indications. Women's preference for cesarean delivery during their course of pregnancy has rarely been studied and therefore our objectives were to examine rate of cesarean deliveries without medical indications, to explore women's preference for cesarean delivery as their gestation advances, and to compare background and perinatal factors among women who underwent different modes of delivery in Taiwan.

METHODS

This prospective study applied a longitudinal design. The study participants were 473 women who received prenatal care at four hospitals in Taipei and answered structured questionnaires at 20 to 24 weeks of pregnancy, 34 to 36 weeks of pregnancy, and 5 to 7 weeks after delivery.

RESULTS

Of the 151 women (31.9%) who had cesarean deliveries, 19.9% were without medical indication. Three indications: malpresentation, prior cesarean section, and dysfunctional labor together accounted for 82.6% of cesarean section with medical indications. The prevalence of maternal preference for cesarean delivery was found to be 12.5% and 17.5% during the second and third trimester, respectively. Of the women who preferred cesarean delivery during the second trimester, 93.2% eventually had a cesarean delivery. Women who were older, with older spouses, and who had health problems before or during pregnancy were more likely to have cesarean deliveries.

CONCLUSIONS

About 20% of cesarean deliveries were without medical indications. Women's preference for cesarean delivery during the second trimester predicts subsequent cesarean delivery. Counseling regarding mode of delivery should be offered early in pregnancy, especially for women who are older or with older spouses, have health problems, or had a prior cesarean section.

Student nurses' experiences and challenges in providing health education in Hong Kong

Despite a call for increased emphasis on health education within the Hong Kong acute healthcare setting, in reality nurses conduct only minimal health education and do not model good educational practice for students. At the baccalaureate level, nursing education programmes aim to provide students with practical experience of best practice and international standards of care. This study describes the experiences of nursing students in providing health education to in-patients at an obstetric unit in Hong Kong. A qualitative research study using a phenomenological approach was conducted at a major public hospital. Data were collected using participant observation, debriefing notes, students' reflective journals and semi-structured interviews. Four themes emerged from the data: (a) effective knowledge building, (b) being a professional nurse, (c) refining learned skills, and (d) greater cultural awareness. The student experiences were further influenced by the patients' responses, the expectations of both patients and nurses concerning the health educator's role, and the role of the clinical teacher. Study findings highlight the experience of the students in conducting health education, something which has not been adequately examined previously, and demonstrates the benefits of independent clinical learning.

Belief in ghost month can help prevent drowning deaths: a natural experiment on the effects of cultural beliefs on risky behaviours

Studies have suggested that cultural beliefs, such as those underlying religious social occasions and superstitions, have both positive and negative effects on mortality rates. Many people in Southern China believe that there are wandering ghosts who were released from hell during the lunar month of July (ghost month: mostly August in the Gregorian calendar): people therefore avoid unnecessary risky activities during ghost month. The aim of this study was to examine whether unintentional drowning deaths decreased during ghost month, using a matched control design and mortality data of Taiwan between 1981 and 2005. Results show that overall days-adjusted monthly death rate in ghost month days in Gregorian August was 1.37 (per 1,000,000). This was significantly lower than those in non-ghost month days, which was 1.67. The mean number of deaths in ghost months was lower than that in the matched controls, which was -3.2 deaths (-2.6 to -3.5) during weekends and -4.5 deaths (-2.2 to -7.2) during weekdays. The differences were more prominent in men than in women. For other main causes of death, we did not find persistent significant differences throughout the four matched controls. In conclusion, our findings support the death-dip hypothesis. Possible mechanisms are that people who believe in the ghost month might either decrease their exposure to water-related activities or involve themselves less in risky behaviours during ghost month, as a kind of risk compensation, consequently resulting in a reduction in the number of drowning deaths. As such we conclude that cultural factors should be taken into consideration when designing injury prevention programs.

Minding the shop: The case of obstetrics conferences

We estimate the impact of annual obstetricians and gynecologists' conferences on births in Australia and the United States. In both countries, the number of births drops by 2-4 percent during the days on which these conferences are held. Since it is unlikely that parents take these conferences into account when conceiving their child, this suggests that medical professions are timing births to suit their conference schedule. We argue that for this reason professional obstetrics societies should reconsider the timing of their annual conferences to accommodate the lowest natural birth rate in the year.

Impact of SARS on healthcare utilization by disease categories: implications for delivery of healthcare services

Objective

To assess the impact of the SARS epidemics in Taiwan on ambulatory care and inpatient utilization by disease categories and accreditation levels of hospital.

Methods

The National Health Insurance claims data of Taipei were analyzed. We calculated the changes in utilization between June 2002 and June 2003 to estimate the impact that SARS had on utilization.

Results

The top three disease categories with the most significant drop in utilization were gastroenteritis (−53%), acute bronchitis (−45%), and tonsillitis (−40%) in ambulatory care and acute bronchitis (−82%), gastroenteritis (−72%), and pneumonia (−64%) in inpatient care. On the other hand, the disease categories with the smallest reduction were allergic reactions (−4%), skin infections (−6%), and anxiety (−10%) in ambulatory care and respiratory failure (+40%), delivery (−2%), and fractures of lower limbs (−5%) in inpatient care.

Conclusions

Disease categories could be classified into three groups according to the extent of change in utilization during the SARS outbreaks. Diseases with a prominent reduction were respiratory diseases, minor problems, and elective procedures. Diseases with a moderate reduction were mainly chronic diseases. Diseases with a limited reduction were acute conditions, difficult mental disorders, or procedures that could not be postponed. The utilization of some diseases shifted significantly from medical centers to district hospitals or clinics.