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Background: Understanding demographic profiles is essential to the assessment of health burden imposed by motor vehicle crashes (MVCs) on pregnant women. However, Asian studies that have examined it are lacking. The study aimed to describe the demographic characteristics and prevalence of MVCs involving pregnant women in Taiwan. Methods: A cross-sectional study conducted by the Taiwan Birth Notification dataset from 2008 to 2017 was linked with the police-reported traffic collision registry to identify pregnant women involved in MVCs. The pregnant women were categorized according to their gestational age, age at delivery, the role of road user (driver, passenger, or pedestrian), and vehicle types (car, two-wheeled motor vehicle, or others). A chi-square test was performed for the significance test. Results: A total of 22,134 (1.13%) pregnant women were involved in MVCs in the study period. Two-wheeled motor vehicle (47.9%) and driver (81.4%) were the mainly reported vehicle type and road user at the crash scenes, respectively. The majority of MVCs occurred in pregnant women aged 28–34 years. The number of MVCs rapidly declined after 37 weeks of gestation, especially two-wheeled motor vehicle or car crashes. However, the number of pedestrian victims climbed up during the third trimester. Conclusion: Pregnant women are susceptible to MVCs regardless of their gestational age, role of a road user, or type of vehicle. The findings of this study emphasize the need for increased awareness of traffic collision prevention among pregnant women aged 28–34. In addition, improving pedestrian safety is essential for the reduction of pregnant victims. [ABSTRACT FROM AUTHOR]

Background Adverse events in fetuses are well researched but studies on the follow-up health outcomes of infants exposed to maternal motor vehicle crashes (MVCs) during pregnancy have yielded inconsistent results. This study aimed to investigate the association of maternal exposure to MVCs during pregnancy with the risk of adverse neonatal outcomes. Methods This population-based cohort study used data from birth notifications in Taiwan. A total of 19 277 offspring with maternal exposure to MVCs during pregnancy and 76 015 randomly selected comparison offspring without such exposure were selected. Neonatal adverse outcomes were identified from National Health Insurance medical claims data. Conditional logistic regression was used to estimate the unadjusted and adjusted odds ratios (aORs) of neonatal adverse outcomes. Results Offspring exposed to maternal MVCs during pregnancy had a higher risk of birth defects (aOR, 1.21; 95% CI, 1.04–1.41) than offspring without such exposure. This positive association was sustained with exposure to an MVC during the first or second trimester. A dose–response relationship (P  = 0.0023) was observed between the level of injury severity and the risk of birth defects. Conclusions In the early stages of pregnancy, maternal exposure to MVCs may entail a risk of birth defects in the offspring. The potential mechanisms for the associations of maternal exposure to MVCs with birth defects need further investigation. [ABSTRACT FROM AUTHOR]

Background: Most studies have focused on injuries sustained by intoxicated drivers themselves, but few have examined the effect of drunk driving on injury outcomes among VRUs (vulnerable road users) in developing countries. This study aims to evaluate the effect of drunk driving on fatal injuries among VRUs (pedestrians, cyclists, or motorcyclists). Methods: The data were extracted from the National Taiwan Traffic Crash Dataset from January 1, 2011, to December 31, 2019. Crashes involving one motorized vehicle and one VRU were considered. This study examines the effect of drunk driving by estimating multivariate logistic regression models of fatal injuries among VRUs after controlling for other variables. Results: Among 1,416,168 casualties, the fatality rate of VRUs involved in drunk driving was higher than that of general road users (2.1% vs. 0.6%). Drunk driving was a significant risk factor for fatal injuries among VRUs. Other risk factors for fatal injuries among VRUs included VRU age ≥ 65 years (adjusted odds ratio [AOR]: 5.24, 95% confidence interval [CI]: 5.53–6.07), a nighttime accident (AOR: 4.52, 95% CI: 4.22–4.84), and being hit by a heavy-duty vehicle (AOR: 2.83, 95% CI: 2.26–3.55). Subgroup analyses revealed a linear relationship between driver blood alcohol concentration (BAC) and the risk of fatal injury among motorcyclists. Motorcyclists exhibited the highest fatality rate when they had a BAC ≤ 0.03% (AOR: 3.54, 95% CI: 3.08–4.08). Conclusion: Drunk driving was associated with a higher risk of fatality for all VRUs. The risk of fatal injury among motorcyclists was linearly related to the BAC of the drunk drivers. Injuries were more severe for intoxicated motorcyclists, even those with BAC ≤ 0.03%, which is within the legal limit. [ABSTRACT FROM AUTHOR]

Background: Most studies have focused on injuries sustained by intoxicated drivers themselves, but few have examined the effect of drunk driving on injury outcomes among VRUs (vulnerable road users) in developing countries. This study aims to evaluate the effect of drunk driving on fatal injuries among VRUs (pedestrians, cyclists, or motorcyclists).Methods: The data were extracted from the National Taiwan Traffic Crash Dataset from January 1, 2011, to December 31, 2019. Crashes involving one motorized vehicle and one VRU were considered. This study examines the effect of drunk driving by estimating multivariate logistic regression models of fatal injuries among VRUs after controlling for other variables.Results: Among 1,416,168 casualties, the fatality rate of VRUs involved in drunk driving was higher than that of general road users (2.1% vs. 0.6%). Drunk driving was a significant risk factor for fatal injuries among VRUs. Other risk factors for fatal injuries among VRUs included VRU age ≥ 65 years (adjusted odds ratio [AOR]: 5.24, 95% confidence interval [CI]: 5.53-6.07), a nighttime accident (AOR: 4.52, 95% CI: 4.22-4.84), and being hit by a heavy-duty vehicle (AOR: 2.83, 95% CI: 2.26-3.55). Subgroup analyses revealed a linear relationship between driver blood alcohol concentration (BAC) and the risk of fatal injury among motorcyclists. Motorcyclists exhibited the highest fatality rate when they had a BAC ≤ 0.03% (AOR: 3.54, 95% CI: 3.08-4.08).Conclusion: Drunk driving was associated with a higher risk of fatality for all VRUs. The risk of fatal injury among motorcyclists was linearly related to the BAC of the drunk drivers. Injuries were more severe for intoxicated motorcyclists, even those with BAC ≤ 0.03%, which is within the legal limit. [ABSTRACT FROM AUTHOR]

Long-term exposure to air pollution results in a high incidence of cardiovascular disease. Many studies have found that short-term exposure to air pollution can trigger acute myocardial infarction. This study aims to determine whether results in areas with different levels of severity of air pollution are similar. The study design is a time-stratified case-crossover analysis. This was a retrospective study based on hospital medical records. The study period was since 1 January 2017 to 31 December 2018. Research data were collected from Taoyuan Hospital, located in an area with low severity of pollution, and Taichung Hospital, located in an area with high severity of pollution. The correlation between short-term air pollution exposure and acute myocardial infarction was analyzed. The correlation between short-term exposure to ambient air pollutants and acute myocardial infarction was not significant for the cases collected from Taoyuan Hospital (PM2.5 OR: 1.006 and 95% CI: 0.995–1.017; PM10 OR: 0.996 and 95% CI: 0.988–1.003). However, for the cases collected from Taichung Hospital, short-term exposure to ambient PM2.5 (odds ratio: 1.021; 95% confidence interval: 1.002–1.040) and PM10 (odds ratio: 1.010; 95% confidence interval: 1.001–1.020) resulted in high incidence of acute myocardial infarction. Short-term pollutant exposure will increase the incidence of acute myocardial infarction based on the severity of regional air pollution. In addition to addressing traditional cardiovascular disease risk factors, the government must formulate relevant policies for reducing air pollution and the resulting hazards to citizens' health. [ABSTRACT FROM AUTHOR]

Introduction. Unintentional injury remains the leading cause of death in children worldwide. Adequate parental supervision is a crucial strategy for preventing injury. Many factors, such as a large family size, poor socioeconomic status, and the caregiver being a single mother, contribute to unintentional injury in children. In addition, sleep deprivation in caregivers might be associated with injury in children because sleep deprivation causes impaired daytime cognitive function, wake-state instability, and negative moods, thereby impairing caregiver supervision. Therefore, this study determines the association between injury in children and the sleep quality of their primary caregivers. Method. This is a retrospective case–control study on unintentional injury in children aged 0 to 4 years who visited the emergency department (case group) and an age- and sex-matched control group. Sleep quality in caregivers was assessed using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was used to evaluate the association between aspects of the PSQI and injury. A propensity score model was used to generate a quasirandomized design. Results. This case-control study recruiting 277 injured and 274 noninjured children was conducted in Taiwan. There was no statistically significant difference in child's age and primary caregiver's age between the injured and noninjured groups. The primary outcome, Pittsburgh sleep quality index, was not significantly different between the two groups. The average scores of sleep duration and habitual sleep efficiency in the control group were higher than those in the case group. However, there was no difference between the two groups after adjusting via a propensity score model, including the following potential confounders, child's age, child's sex, number of previous injury, caregiver mental status, caregiver's sex and caregiver's age, and the number of children living together. Conclusion. Our study was the first to examine the association between injury in children and the sleep quality of their primary caregivers. We observed that no PSQI component significantly affected the risk of injury among children. [ABSTRACT FROM AUTHOR]

Background: Motorcycle full-coverage helmet use may reduce fatalities and head injuries.Methods: This retrospective cohort study extracted injury data from eight level-I trauma centres in Taiwan and performed a questionnaire survey to investigate injuries sustained by motorcyclists for the period between January 2015 and June 2017.Results: As many as 725 patients participated in the questionnaire survey and reported their helmet types or phone use during crashes. The results of multivariate logistic models demonstrated that nonstandard helmet (half or open-face helmet) use was associated with an increased risk of head injuries and more severe injuries (injury severity score ≥ 8). Drunk riding and phone use appeared to be two important risk factors for head injuries and increased injury severity. Anaemia was also found to be a determinant of head injuries."Conclusions: Compared to full-coverage helmets, nonstandard provide less protection against head injuries and increased injury severity among motorcyclists. [ABSTRACT FROM AUTHOR]

Several emerging smartphone location-based augmented-reality (AR) games require three primary tasks: training or battling a monster, capturing a monster, and searching for a monster, which involve different levels of perceptual load. Using the AR game originated from Japan as a single case study, this study examined inattentional blindness and deafness and risk-taking inclinations among participants concurrently descending stairs and engaging in these three tasks. Participants descending stairs in Taipei Medical University were observed through recordings obtained from Wi-Fi cameras to determine whether they engaged in risk-taking behaviors such as hopping, not using the handrail, and stopping suddenly. After the participants descended the stairs, they were interviewed to obtain additional information regarding demographics, game tasks (training or battling a monster, capturing a monster, or searching for a monster), data plan, and screen size. Inattentional blindness and deafness were investigated by determining whether participants saw something unusual, a police ascending the stairs, and heard the national anthem played by the police, respectively. In total, 1036 participants descended the stairs and underwent the interview between August 2016 and July 2018. Logistic regression models revealed that training or battling a monster was most associated with inattentional blindness, deafness, not using the handrail, and stopping suddenly, whereas hopping behavior was the commonest among those capturing a monster. Other contributory factors include a large smartphone screen (≥5 in), unlimited mobile data, being an undergraduate student, and an increase in the daily gaming hours. Development of smartphone apps toward detection of stair locomotion may be beneficial for curbing phone use in general and AR game playing in particular. [ABSTRACT FROM AUTHOR]

The bikeshare program in Taipei City and New Taipei City, called U-bike, was launched in August 2012 and has more than 7500 bicycles operating out of 769 stations. Research has suggested that bicycle helmet use is a means of reducing morbidity and mortality among bike users. Helmets, however, are not available for rent when a U-bike is rented. The current research conducted an observational study to examine the prevalence of helmet non-use by users of the bikeshare program, electric bicycles, racing bicycles, and personal bicycles in Taipei City and New Taipei City. Trained observers using compact video cameras collected helmet non-use data during various times of the day and on different days of the week. Observers collected data on cyclist attributes, bicycle types, and helmet use at several selected locations within Taipei City and New Taipei City. U-bike users were found to be the least likely to wear helmets. Other noteworthy findings include that violations such as phone use, red-light violations, and travelling at ≥25 km/h were associated with riding without a helmet. Male users of racing bikes tended not to wear helmets, while female users of other bicycle types were less likely to use a helmet. Carrying passengers by users of electric bikes and personal bikes was a determinant of helmet non-use. This paper concludes with a discussion and recommendations for future research. [ABSTRACT FROM AUTHOR]

Objectives: Crashes due to motorcyclists colliding with an open car door can cause devastating injuries. In Taiwan, such crashes typically occur when the motorcyclist is travelling alongside a row of parallel-parked cars, and a driver suddenly opens the door in front of or next to the motorcycle without determining whether it is safe to do so. Injuries resulting from motorcycle door crashes tend to be severe. This study examined the factors that contribute to motorcycle door crashes. Methods: By using linked data from the National Traffic Crash Dataset and Emergency Medical Service for Taipei City for the years 2010–2015, this study estimated a mixed multinomial logit model to predict the likelihood of three types of door crashes: driver-door crashes, left passenger-door crashes, and right passenger-door crashes. Results: Data on 8237 motorcycle door crashes were extracted from the two datasets and matched. The results from the mixed multinomial logit model revealed that illegal parking, older car occupants, teenage car occupants, intoxicated car occupants and motorcyclists, and motorcycle speeding contribute to driver-door crashes; and female passengers and taxis as the type of vehicle involved in crash are associated with left passenger-door crashes. Conclusions: Our study suggested that controlling motorcycle speed, and prosecuting illegal parking and drink driving/riding may constitute effective countermeasures. The “Dutch Reach” intervention measure, which is commonly adopted in Europe for bicycle door crashes, should be applied in Taiwan to curb motorcycle door crashes, especially for elderly car occupants. [ABSTRACT FROM AUTHOR]

The most typical and catastrophic car-motorcycle crash occurs when a car manoeuvres into the path of an approaching motorcycle at an intersection, which involves a car driver violating motorcycle’s right of way (ROW). In Taiwan, however, motorcyclists are frequently the ROW violator—they are observed to frequently infringe upon the ROW of oncoming vehicles at intersections. Such a ROW crash in which a left-turn motorcyclist crosses in front of approaching traffic appears to be a safety problem in terms of its frequency and accident consequence. Using the National Taiwan Crash Database, the present study estimates a logistic regression model to predict the likelihood of an approach-turn motorcycle-turning crash (relative to a car-turning crash). Results indicate that given a ROW crash where the rider was female, old, drunk, unlicensed, riding a moped, and on a NBU roadway, the likelihood of a motorcycle-turning crash tends to increase. Our study contributes to the existing motorcycle safety research by reporting the determinants of the unique crashes in which the motorcyclist is the ROW violator. [ABSTRACT FROM AUTHOR]

Purpose: To assess the reduction of 6 and 12 months postoperatively of Framingham risk score in morbidly obese patients with laparoscopic sleeve gastrectomy (LSG).Material and methods: In total, 870 morbid obesity patients received LSG in Taipei Medical University Hospital from June 2007 to June 2014 were retrospectively studied preoperatively, 6 and 12 months after surgery. The coronary heart disease risk was calculated using Framingham risk score.Results: The body mass index in men and women decreased from 43.3 ± 6.9, 39.2 ± 6.0 kg/m2 preoperatively to 32.9 ± 6.7, 31.0 ± 5.2 kg/m2 and to 30.4 ± 5.6 , 28.2 ± 4.7 kg/m2, respectively, at 6 and 12 months after surgery (P < 0.0001). At 6 and 12 months after LSG, there was a marked improvement on lipid profile as well as a significant decline in the prevalence of diabetes mellitus, systemic hypertension, and smoking. The Framingham risk score in men and women reduced from 3.2 ± 5.7, 6.1 ± 5.7 preoperatively to 1.4 ± 5.9, 3.3 ± 5.9 and 0.1 ± 6.2, 2.8 ± 6.1, respectively, at 6 and 12 months after surgery (P < 0.0001).Conclusions: Laparoscopic sleeve gastrectomy is efficient not only in the reduction of obesity and its related comorbidities but also in decreasing the long-term coronary event risk. Early intervention for the high-risk group is strongly recommended. [ABSTRACT FROM AUTHOR]

The objective of the study was to introduce the methodology and report on cohort description of Taiwan Adolescent to Adult Longitudinal Study (TAALS). TAALS is the first nationwide longitudinal survey among Taiwan adolescents, linked with the National Health Insurance Research Database (NHIRD) to obtain complete medical records of respondents in the future. The TAALS project employed the principle of probability proportional to size (PPS) sampling method. Data were collected by questionnaire from 18 064 school students participating in 2015 formal survey, with good sample representation via a goodness-of-fit test after weighting adjustments. Through expert evaluation and statistics tests, TAALS shows a well nationally representation, validity, and reliability. Results indicate that the vocational school students had poor healthy behavior than other education systems, supporting the hypothesis that different learning environment will develop different health behaviors. TAALS can serve as a foundation for analyzing health trajectories of Taiwan adolescents. [ABSTRACT FROM AUTHOR]

Objectives: Bicyclists and motorcyclists contribute substantially to the morbidity and mortality rates of road crash casualties. The objective of the study was to investigate the crash characteristics of bicyclist and motorcyclist casualties presented to hospitals in Taiwan resulting from crashes. Methods: By using linked data from The National Traffic Crash Dataset and the National Health Insurance Database between 2003 and 2012, logistic regression models were used to examine the determinants of hospitalisation among motorcyclist and bicyclist casualties. The examined variables include demographic characteristics, road and weather conditions, and vehicle characteristics. Results: A total of 1,998,606 two-wheelers were enrolled in the study, of whom 216,600 were hospitalised: 203,623 were motorcyclists and 12,964 were bicyclists. Bicyclists were more likely to be hospitalised than motorcyclists were (14.0% vs. 10.7%). The pooled logistic regression model shows that bicyclists had higher odds of hospitalisation than motorcyclists (adjusted odds ratio [AOR] = 1.11, 95% confident interval [CI] = 1.08–1.14). In the motorcyclist and bicyclist models, helmet non-use appears to be a determinant of hospitalisation for motorcyclists (AOR = 1.14, CI = 1.12–1.16), although insignificant for cyclists (AOR = 1.03, CI = 0.94–1.12). Other important determinants of hospitalisation for motorcyclists and cyclists include female riders, elderly riders, rural roadways, unlicensed riding (for motorcyclists only), curved roadways, defective roadways, alcohol consumption (only for motorcyclists), and single-vehicle crashes (for motorcyclists only). Conclusions: The result that bicyclists had an increased probability of being hospitalised than motorcyclists is particularly noteworthy, because there have recently been much more users of bikesharing systems in metropolitan cities where cycle helmets are not provided. We further found that helmet non-use was also a risk factor for motorcyclists, but insignificant for cyclists, possibly due to lower helmet utilization rates among bicyclists. Our findings regarding the increased hospitalisation percentage emphasize the importance of helmet use. [ABSTRACT FROM AUTHOR]

Pedestrians' head-turning behaviors are crucial to navigating streets safely. This research investigates the effects of phone use on pedestrians' street-crossing behaviors at an uncontrolled intersection where head-turning performances are important to identify a gap among the oncoming traffic. A field study using video cameras was conducted for evaluating pedestrians' head-turning behaviors (e.g., head-turning frequency, not looking at traffic before crossing, looking at the wrong traffic side), crossing time, and sudden movement while they were engaging in various smartphone activities (e.g., calling, texting, gaming, and listening to music). Data such as phone features, distraction types, and personal attributes of the pedestrians were obtained in the interviews conducted after pedestrians had completed crossing the street. The results indicate that the unsafe crossing behaviors (e.g., sudden movement, fewer head-turning frequencies, not looking at traffic before crossing, not looking at left side of traffic first) were more prevalent among those gaming with “Pokemon Go.” Web surfing appears to be the 2nd risky distraction event following gaming with “Pokemon Go.” Logistic regression models reveal several important correlates of unsafe crossing behaviors: being a student, large phone screen (5 in. or larger), and having un-restricted 4G Internet data allowance. The current research recommends that “Pokemon Go” gaming be prohibited while crossing the street. [ABSTRACT FROM PUBLISHER]

Objectives: Fourteen-day rehospitalization with new traumatic spinal cord injury (tSCI) diagnosis is used as an indicator for the diagnostic quality of the first hospitalization. In this nationwide population-based cohort study, we identified risk factors for this indicator. Methods: We conducted a nested case–control study by using the data of patients who received a first hospitalization for trauma between 2001 and 2011. The data were retrieved from Taiwan’s National Health Insurance Research Database. Variables including demographic and trauma characteristics were compared between patients diagnosed with tSCI at the first hospitalization and those receiving a 14-day rehospitalization with new tSCI diagnosis. Results: Of the 23 617 tSCI patients, 997 had 14-day rehospitalization with new tSCI diagnosis (incidence rate, 4.22%). The risk of 14-day rehospitalization with new tSCI diagnosis was significantly lower in patients with severe (injury severity score [ISS] = 16–24; odds ratio [OR], 0.17; 95% confidence interval [CI], 0.13–0.21) and profound (ISS > 24; OR, 0.11; 95% CI, 0.07–0.18) injuries. Interhospital transfer (OR, 8.20; 95% CI, 6.48–10.38) was a significant risk factor, along with injuries at the thoracic (OR, 1.62; 95% CI, 1.21–2.18), lumbar (OR, 1.30; 95% CI, 1.02–1.65), and multiple (OR, 3.23; 95% CI, 1.86–5.61) levels. Brain (OR, 2.82), chest (OR, 2.99), and abdominal (OR, 2.74) injuries were also identified as risk factors. In addition, the risk was higher in patients treated at the orthopedic department (OR, 2.26; 95% CI, 1.78–2.87) and those of other surgical disciplines (OR, 1.89; 95% CI, 1.57–2.28) than in those treated at the neurosurgery department. Conclusions: Delayed tSCI diagnoses are not uncommon, particularly among trauma patients with ISSs < 16 or those who are transferred from lower-level hospitals. Further validation and implementation of evidence-based decision rules is essential for improving the diagnostic quality of traumatic thoracolumbar SCI. [ABSTRACT FROM AUTHOR]

The paper investigates the effects of phone use (talking, texting, and listening to music) on the street-crossing behaviours of pedestrians and their inattentional blindness in Taiwan. Recent handsets with touchscreens, as well as more advanced features including multimedia, and mobile applications (apps), exacerbate problems relating to cognitive distraction and reduced situation awareness. A controlled field study using video cameras was conducted for observing pedestrians’ crossing behaviours (e.g. crossing time, sudden stops, looking both ways before crossing, and disobeying traffic signals). Pedestrians were classified into two groups: experimental group (talking, texting, and listening to music) and control group (no phone use). Pedestrians’ inattentional blindness was examined by evaluating whether they saw and heard an unusual object (i.e. a clown) nearby. The results indicate that the proportions of unsafe crossing behaviours (e.g. sudden stops, disobeying traffic signals, and not looking both ways before crossing) were higher among distracted individuals and more pronounced among those using instant-messaging apps. These instant-message app users were the least likely to see the clown, and music listeners were the least likely to hear the horn that the clown was honking. Contributing factors to unsafe behaviours include being a student, having a phone screen of 5 inches or larger, and having unlimited 3G Internet access. Texting message via apps was the leading factor on unsafe crossing behaviours of pedestrians and their inattentional blindness. [ABSTRACT FROM PUBLISHER]

This paper examines pedestrian anatomical injuries and crash characteristics in back-to-traffic and facing-traffic crashes. Pedestrian crashes involving pedestrians walking along streets (i.e. with their backs to traffic or facing traffic) have been overlooked in literature. Although this is not the most frequent type of crash, the crash consequence to pedestrians is a safety concern. Combining Taiwan A1A2 police-reported accident data and data from the National Health Insurance Database from years 2003-2013, this paper examines anatomical injuries and crash characteristics in back-to-traffic and facing-traffic crashes. There were a total of 830 and 2267 pedestrian casualties in back-to-traffic and facing-traffic crashes respectively. The injuries sustained by pedestrians and crash characteristics of these two crash types were compared with those of other crossing types of crashes (nearside crash, nearside dart-out crash, offside crash, and offside dart-out crash). Odds of various injuries to body regions were estimated using logistic regressions. Key findings include that the percentage of fatalities in back-to-traffic crashes is the highest; logistic models reveal that pedestrians in back-to-traffic crashes sustained more head, neck, and spinal injuries than did pedestrians in other crash types, and unlit darkness and non-built-up roadways were associated with an increased risk of pedestrian head injuries. Several crash features (e.g. unlit darkness, overtaking manoeuvres, phone use by pedestrians and drivers, and intoxicated drivers) are more frequently evident in back-to-traffic crashes than in other types of crashes. The current research suggests that in terms of crash consequence, facing traffic is safer than back to traffic. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Parental smoking has been identified as the major source of children's exposure to environmental tobacco smoke (ETS). Therefore, parental involvement is critical in ETS exposure prevention programs. This study examined the effects of a parent-child interactive program on reducing children's exposure to ETS at home and enhancing parents' and children's prevention strategies.Methods: A clustered randomized controlled trial was administered to 75 families of school-aged children from six primary schools in New Taipei City, Taiwan. Families in the intervention group received a parent-child interactive intervention, and parents in the control group received written materials on tobacco hazards. Data on children's exposure and the prevention of children's exposure to ETS at home were obtained at baseline, 8-week, and 20-week or 6-month assessments.Results: The percentage of children with urine cotinine levels greater than or equal to 6 ng/ml was significantly lower in the intervention group than it was in the control group at both the 8-week and 6-month assessments. The intervention significantly reduced parental smoking in the presence of children and increased parents' prevention of children's ETS exposure and children's ETS avoidance behavior from the baseline to the 20-week assessment.Conclusions: This is a preliminary study design aimed at creating a program for reducing children's ETS exposure at home. Further research to produce evidence supporting the application of the parent-child interactive program in primary schools is suggested. The theoretical basis of the intervention design can serve as a reference for nursing education and the design of health education programs. [ABSTRACT FROM AUTHOR]

Objectives: Recurrent falls not only have risk factors different from those of single falls but also have less favorable outcomes. The aim of our study was to determine the association between the injury characteristics of a first fall and the likelihood of recurrent injurious falls in a cohort of hospitalized patients. Methods: We designed a nationwide retrospective cohort study and selected hospitalized patients who had injurious falls between 2001 and 2010. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of recurrent injurious falls requiring hospitalization in the following year on the basis of the patients’ demographic characteristics, comorbidities, and the characteristics of injuries from the first injurious fall requiring hospitalization. Results: Among the 504 512 patients hospitalized for injurious falls, 19 442 experienced recurrent injurious falls requiring hospitalization. The 1-year incidence of recurrent injurious falls requiring hospitalization was 3.85%. The incidence density was the highest within the 3-month period after the first injurious fall. The risk of recurrent injurious falls among patients aged 40 to 64, 65 to 74, and ≥ 75 years increased progressively (HR: 2.11, 95% confidence interval [CI]: 1.90–2.34; HR: 2.80, 95% CI: 2.51–3.11; and HR: 3.80, 95% CI: 3.42–4.23, respectively). The length of hospitalization (LOH) ≥ 15 or ≥ 31 days (HR: 1.39, 95% CI: 1.30–1.48; and HR: 1.59, 95% CI: 1.43–1.77, respectively) and injury to the head (HR: 1.59, 95% CI: 1.53–1.65) or spine (HR: 1.66, 95% CI: 1.59–1.74) were also found to be major risk factors. Conclusions: Our findings show that the LOH and head and spine injuries are associated with an increased risk of recurrent injurious falls leading to hospitalization. The risk of recurrent injurious falls requiring hospitalization increased significantly among adults older than 40 years. We suggest further research on the effects of injury characteristics associated with the first injurious fall requiring hospitalization and resultant anatomical damages on the risk of recurrent injurious falls requiring hospitalization. High-risk patients should receive tailored rehabilitation addressing their respective injuries within 3 months after hospital discharge. [ABSTRACT FROM AUTHOR]

We developed and psychometrically tested four scales for measuring the perceptions of parental smokers and family members’ influences on smoking behavior in the presence of children in Taiwan. Data were collected from 309 parental smokers with school-aged children. The results of factor analysis revealed two to three factors within each scale, and the reliability was between 0.63 and 0.91, based on Cronbach’s alpha. Our findings provide preliminary support for the reliability and validity of the scales. The collective application of the scales is comprehensive that may constitute a feasible approach for preventing parental smoking. [ABSTRACT FROM PUBLISHER]

Introduction: Although public smoking restrictions have been implemented, children are still exposed to household smoking. Parental smoking is the main source of children’s exposure to secondhand smoke. This study was conducted to examine the factors associated with parents’ adoption of home smoking bans. Methods: A cross-sectional study was conducted using a self-administered questionnaire to collect data from 768 parents of school-aged children in Taiwan. The home smoking restriction status, parents’ perceptions of smoking in the presence of children and its influences, and parents’ sociodemographic characteristics were assessed. Hierarchical logistic regression analysis was used to determine the best-fit model. Results: More than 80% of the parents agreed with home smoking bans, whereas only approximately 26% of the parents actually restricted smoking at home completely. The crude odds ratios showed that parents who perceived the influence of parental smoking on children to be negative were more likely to adopt home smoking bans. Hierarchical logistic regression revealed factors associated with the adoption of home smoking bans, including a higher education level and older age of parents, a family composed of nonparent adults, and opposition to parental smoking in the presence of children. Conclusions: Children’s health is a major concern for parents considering home smoking bans. Helping parents clarify misunderstandings regarding parental smoking, emphasizing the adverse effects of children’s exposure to parental smoking, suggesting healthy substitutes for smoking, and providing effective strategies for maintaining a smoke-free home can motivate families to adopt home smoking bans. [ABSTRACT FROM PUBLISHER]

Aims and objectives To evaluate the effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and materials received by patients undergoing cardiac catheterisation. Background Cardiac catheterisation is one of the most anxiety-provoking invasive procedures for patients. However, informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored. Design A randomised experimental design with three-cohort prospective comparisons. Methods In total, 123 consecutive patients were randomly assigned to one of three groups: regular education; (group 1), accessibility-enhanced multimedia informational education (group 2) and instructional digital videodisc education (group 3). Anxiety was measured with Spielberger's State Anxiety Inventory, which was administered at four time intervals: before education ( T0), immediately after education ( T1), before cardiac catheterisation ( T2) and one day after cardiac catheterisation ( T3). A satisfaction questionnaire was administrated one day after cardiac catheterisation. Data were collected from May 2009- September 2010 and analysed using descriptive statistics, chi-squared tests, one-way analysis of variance, Scheffe's post hoc test and generalised estimating equations. Results All patients experienced moderate anxiety at T0 to low anxiety at T3. Accessibility-enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and materials received compared with patients in groups 1 and 3. A statistically significant difference in anxiety levels was only found at T2 among the three groups ( p = 0·004). Conclusions The findings demonstrate that the accessibility-enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation, to reduce anxiety and improve satisfaction with the information and materials received compared with the regular education and instructional digital videodisc education. Relevance to clinical practice As the accessibility-enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and materials received, it can be adapted to complement patient education in future regular cardiac care. [ABSTRACT FROM AUTHOR]

Aim and objectives To explore risk factors for coronary artery disease ( CAD) among middle-aged women in Taiwan. Background Coronary artery disease is a leading cause of death among females. Risk factors for CAD vary due to differences in ethnicity, gender and age. However, few studies have documented risk factors among middle-aged women. Design We employed a cross-sectional, comparative study design. Methods Sixty-five middle-aged women who were suspected of having CAD and who received cardiac catheterisation were purposively sampled and divided into a CAD group (with at least one coronary artery with > 50% stenosis) and a control group, according to the results of catheterisation. Individual questionnaires regarding their medical history, blood test results, sociodemographic characteristics, metabolism, biomarkers and lifestyle risk factors were administered and quantified. Results The mean age of the 65 women (31 CAD and 34 controls) was 56·2 years. Within the CAD group, there was a greater incidence of women with a history of diabetes mellitus ( DM), increased fasting blood glucose and increased diastolic blood pressure. Comparatively fewer women within the CAD category used dietary supplements or had a lower level of physical activity. After adjusting for other confounders, it was discovered that women who used dietary supplements ( OR = 0·28; p = 0·04) and engaged in physical activities ( OR = 0·16; p = 0·02) were less likely to develop CAD. Conclusions Use of dietary supplements and engaging in physical activities can significantly predict the incidence of CAD among middle-aged women in Taiwan. Relevance to clinical practice Middle-aged women should be encouraged to take appropriate dietary supplements and engage in physical activity in order to prevent CAD. [ABSTRACT FROM AUTHOR]

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Most smokers in developing countries begin smoking before age 18, and smoking prevalence is rising among adolescents. School personnel represent a target group for tobacco-control efforts because they interact daily with students, are role models for students, teach about tobacco-use prevention in school curricula, and implement school tobacco-control policies. The prevalence of teenage smoking has been examined in numerous studies, but few have focused on the influence of school personnel and the characteristics of school personnel who enforce school nonsmoking policy. The purpose of this study was to determine the factors associated with junior high school personnel advising students to quit smoking. School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel. [ABSTRACT FROM AUTHOR]

Objectives To gain an understanding of the accuracy of acuity assessment made by emergency department (ED) triage nurses, to compare the differences between the characteristics of triage nurses according to hospital variables and the accuracy of acuity ratings, and to explore the influence of nursing variables on the judgement of triages. Methods A cross-sectional questionnaire survey was conducted at the EDs of hospitals in northern Taiwan. Ten adult emergency case scenarios and a demographic sheet with high validity were developed to survey 279 triage nurses. Data were collected from April to October 2006. All data were analysed using percentage, mean, SD, independent t test, one-way ANOVA and a stepwise logistic regression analysis. Results The average score of rating accuracy was 5.62 points (out of a possible total of 10 points), which was considered low. Approximately 24.3% (n=68) of nurses' triage ratings were under-triaged and 19.7% (n=55) were over-triaged. Factors included years of ED experience, hours of triage education, level of hospital and triage mode of delivery. These factors were identified as significantly affecting the accuracy of nurses' judgement (p<0.05; adjusted R=40.0%). Conclusion The scores of accuracy ratings for triage nurses can be improved if factors contributing to inaccuracy can be altered. The findings of this study can be used to guide improvements. [ABSTRACT FROM PUBLISHER]

Title. Effect of supportive care on the anxiety of women with suspected breast cancer. Aim. This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period. Background. Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women’s psychological status during the breast cancer diagnostic period. Methods. For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group ( n = 62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group ( n = 60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis). Findings. After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy ( P = 0·017) and after diagnosis ( P = 0·001) than those of women receiving routine care. Conclusion. Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care. [ABSTRACT FROM AUTHOR]

The 2003 School Health Act of Taiwan stipulated that school campuses of senior high and below should be smoke free, but data from the Global Youth Tobacco Survey show that the majority of students are exposed to smoke in public and at home. More than 50% of nonsmokers indicated that they had been exposed to secondhand smoke (SHS) in public places, with the exposure rate as high as 90% among smokers. More than 40% of junior and senior high school students were exposed to SHS at home. Support for banning smoking in public places ranged from almost 60% to almost 80%. More than 60% of current smokers and almost 90% of never smokers think that smoke from others is harmful to them. With a clear body of evidence detailing the harmful effects, reduction and eventual elimination of exposure to SHS should be the goal of the tobacco control community. [ABSTRACT FROM PUBLISHER]

Background: Falls represent a global health issue among older adults and cause a considerable burden on medical systems. In this study, a fall-risk assessment profile was developed for community-dwelling older adults.Method: The data of survey participants aged > 65 years were obtained from three rounds (2005, 2009, and 2013) of the National Health Interview Survey in Taiwan. In total, 8356 older participants were included in this study. Logistic regression analyses were used to determine potential predictors associated with falls. The regression coefficients of the predictors in the final model were translated into scores (by multiplying by 5) and then summed to obtain a total risk-score for falls. A receiver operating characteristic (ROC) curve was used to evaluate the discriminative performance of the risk assessment profile.Result: Self-reported falls within 1 year accounted for 19.1% of the total falls. The predictors that were included in the risk profile according to the logistic regression analysis results were as follows: female sex (adjusted odds ratio = 1.57; risk-score = 2), living alone (adjusted odds ratio = 1.56; risk-score = 2), urinary incontinence (adjusted odds ratio = 1.36; risk-score = 2), perceived unhealthiness (adjusted odds ratio = 1.32; risk-score = 1), perceived pain (adjusted odds ratio = 1.51; risk-score = 2), hospital admission in the past year (adjusted odds ratio = 2.42; risk-score = 4), low activity of daily living (ADL) scores (adjusted odds ratio = 1.29; risk-score = 1), and low mobility function scores (adjusted odds ratio = 1.68; risk-score = 3). At a total risk-score cutoff point of 6 (range 0-17), the model predicted falls with a sensitivity and specificity of 75.16 and 52.75%, respectively (area under the ROC curve = 0.70).Conclusion: The fall-risk assessment profile comprising eight predictors-female sex, living alone, incontinence, perceived unhealthiness, perceived pain, hospital admission in the past year, low ADL scores, and low mobility function scores-may serve as an assessment tool for identification of older adults with a high risk of falling, and assessment results can be used to facilitate community-based intervention. [ABSTRACT FROM AUTHOR]

Background: Allowing contraflow cycling on one-way streets has been reported to reduce crash risks in Belgium and the United Kingdom. Similarly, walking against traffic on roadways without sidewalks substantially improves pedestrian safety. This study examined fatalities and head injuries sustained by pedestrians in against-traffic and with-traffic crashes.Methods: Using police-reported crash data in Taiwan between 2011 and 2016, fatalities and head injuries were compared for pedestrians involved in against-traffic and with-traffic crashes.Results: Of the 14,382 pedestrians involved in crashes, 10,749 and 3633 pedestrians in with-traffic and against-traffic crashes, respectively, were reported. Compared with pedestrians involved in against-traffic crashes, those in with-traffic crashes were more likely to sustain fatalities and head injuries. Results of logistic regression models revealed several influential factors on pedestrian fatalities and head injuries, including elderly pedestrians, male drivers, intoxicated drivers, rural roadways, unlit streets in darkness, limited sight distance, adverse weather conditions, midnight hours, and a heavy vehicle as the crash partner.Conclusions: Pedestrians in with-traffic crashes were more likely to sustain fatalities and head injuries compared with those in against-traffic crashes. Furthermore, the negative effect of walking with traffic on injuries was more pronounced in reduced-visibility conditions. [ABSTRACT FROM AUTHOR]

Background: Smartphone addiction has become a crucial social issue. Past studies have indicated that phone use such as talking or texting while walking constitutes a dual task that may cause pedestrians inattentional blindness and impair their awareness of surroundings.Methods: This study investigated the influence of various smartphone tasks (calling, music listening, texting, playing games, and web surfing) on the smartphone overuse and inattentional blindness of pedestrians in Taipei, Taiwan. Pedestrian smartphone overuse was observed and recorded via WiFi cameras to determine whether pedestrians were using their smartphones when crossing a street with a signal. After crossing the street, pedestrians were interviewed to obtain additional information regarding demographics, smartphone tasks, data plan, and screen size. Pedestrians were classified into the case (distracted) and control (undistracted) groups. By determining whether pedestrians saw something unusual-a clown walking the opposite direction-and heard the national anthem played by the clown, inattentional blindness and deafness were examined. Pedestrians' situational awareness was assessed by ascertaining whether they remembered how many seconds remained before the crossing signal upon arriving at the curb.Results: In total, 2556 pedestrians crossed the street and underwent the interview. Smartphone overuse and inattentional deafness were the commonest among music listeners. Playing Pokémon Go gaming was the task most associated with inattentional blindness. Logistic regression models revealed that contributing factors to smartphone overuse and inattentional blindness were a large smartphone screen (≥5 in), unlimited mobile Internet data, and being a student. The interactions of gaming with being a student and with unlimited data were significantly associated with smartphone overuse, inattentional blindness and deafness, and situational awareness.Conclusions: Listening to music was the smartphone task most associated with pedestrian smartphone overuse and inattentional deafness. Pokémon Go was the most associated task with inattentional blindness and reduced situational awareness. [ABSTRACT FROM AUTHOR]

Background: In 2009, the Tobacco Hazards Prevention Act (Taiwan) was amended to more effectively restrict smoking in indoor public places and workplaces in Taiwan. However, the lack of prohibitions for smoking in private homes may place family members at increased risk for exposure to environmental tobacco smoke (ETS). The aim of our study was to determine the factors associated with parental smoking in the presence of children at home.Methods: In 2010, we performed a cross-sectional study of factors associated with parental smoking in the presence of children at home in Taiwan using self-administered questionnaires. Quota sampling was used to select five primary schools from four different regions of Taiwan. Parents were surveyed to identify parental smokers and 307 parental smokers were selected for participation in our study. Questionnaire data regarding parental smoking in the presence of children at home and related interactions among family members were analyzed. Hierarchical logistic regression was used to determine the best-fit model for examining the relationships among the variables related to parental smoking in the presence of children at home.Results: Two-thirds of parents who smoked reported smoking in the presence of their children. The results of the hierarchical logistic regression analysis identified the smokers' compliance with their family's antismoking responses, mutual agreement with smoking bans, daily smoking, smoking more than 20 cigarettes per day, the education level of the parental smoker, and the annual family income as determinants of smoking in the presence of children at home.Conclusions: Households with smoking parents should be targeted for interventions to encourage the adoption and enforcement of home smoking bans. Educational interventions that promote smoke-free homes for children and provide support to help parents stop smoking are critical factors in reducing the frequency of children's ETS exposure in the home. [ABSTRACT FROM AUTHOR]