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Highlights • Police crash data and hospital data were analysed to investigate injuries sustained by riders in approach-turn crashes. • Higher percentage of death within 30 days, hospitalisation, and longer hospital stay when riders were ROW violators. • Determinants of motorcyclist fatalities and head and neck injuries include drink riding and unlicensed riding. • Helmet use was associated with a decreased risk of head and neck injuries. Abstract Objectives In western countries, a typical car-motorcycle crash occurs at an intersection where a car manoeuvres into the path of an oncoming motorcycle, which involves a car driver violates motorcycle's right of way (ROW). In Taiwan, however, a unique type of crash (approach-turn crash) occurs when a turning (including U-turn) motorcycle frequently infringes upon a car's ROW. The primary objective of this study was to examine injuries sustained by motorcyclists in this unique type of crash. Method Using the linked data from the National Taiwan Crash Database and the National Health Insurance Research Data from 2003 to 2015, this study examined several anatomical injuries (e.g., head and face, neck, chest and abdomen, spine, and lower extremities), as well as the resulting injury severity (e.g., death within 30 days, hospitalisation, and emergency visit only/outpatient, and length of hospital stay). Variables examined include demographic data (sex, age, alcohol use, license status, and helmet use), vehicle attributes (engine size, type of crash partner, and crash type), road and environmental factors (curvature, crash location, day of week and time of crash). Injuries sustained by motorcyclists in an approach-turn motorcycle-turning crash (motorcycle is a ROW violator) were compared with those sustained by motorcyclists in an approach-turn car-turning crash (car is the ROW violator). Results A total of 21,919 motorcyclists were enrolled, of whom 18,041 and 3878 were motorcyclists involved in approach-turn car-turning and motorcycle-turning crashes, respectively. The percentage of death within 30 days; hospitalisation; length of hospital stay; and injuries to the head and face, neck, and chest and abdomen were significantly higher for motorcyclists in approach-turn motorcycle-turning crashes. Results of logistic regression models revealed that riding under the influence of alcohol and riding without a licence were associated with death/hospitalisation, and injuries to particular body regions (head and face, neck, and chest and abdomen). Helmet use was associated with a decreased likelihood of head and face and neck injuries. Conclusion Motorcyclists tended to be more severely or fatally injured and had increased head and face, neck, and chest and abdomen injuries when they were ROW violators than when their ROWs were violated at an intersection. Efforts to curb drunk riding and unlicensed riding may constitute effective intervention points. [ABSTRACT FROM AUTHOR]

Objectives Past studies have concluded that racing games may induce car drivers' risk-taking behaviours. Limited research has been conducted to investigate whether such an effect applies to pedestrians when crossing a street. This study investigates the effects of smartphone racing games on pedestrian's risk-taking inclinations. Materials and Methods Using WiFi video cameras, pedestrians’ risk-taking inclinations such as game playing when crossing the street, red-light violation, and walking outside the crosswalk at a signalised intersection in Taipei City were observed. Data such as their phone features, smartphone game types, and personal attributes were obtained in the interviews conducted after pedestrians had completed crossing the street. Effects of racing games (RCG) were compared with those of several other games (e.g., Pokemon, RPG: Role-Playing Game, ACT: Action Game, SPG: Sports Game, FTG: Fighting Game, STG: Shooting Game, PZG: Puzzle Game, ETC: Other Game). Results A total of 1480 participants completed crossing the street and were interviewed between April 2017∼March 2018. Pokemon Go was most associated with game playing when crossing, running the red light, and walking outside the crosswalk. Logistic regression models reveal several other important determinants of risk-taking inclinations: being a student, larger smartphone screen size, unlimited Internet allowance. Student players of Pokemon GO, and playing Pokemon with unlimited Internet allowance, appear to contribute to pedestrian's risk-taking inclinations. Conclusions RCG appears not to be associated with pedestrian's risk-taking behaviours as much as Pokemon Go does. Instead, compared to other smartphone games, Pokemon Go is most associated with pedestrian's risk-taking inclinations. [ABSTRACT FROM AUTHOR]

Since the launch of the smartphone game “Pokemon Go”, the worldwide craze has led to numerous traffic crashes and injuries resulting from falling or tripping. This paper investigates the effects of several smartphone distracting activities (gaming, talking, texting, Web surfing, and listening to music) on the street-crossing behaviours of pedestrians in Taipei City, Taiwan. A field study using video cameras was conducted to observe pedestrian crossing behaviours (e.g., crossing time, sudden movements, running a red light, and walking outside the crosswalk) at a selected signalised intersection. Data such as phone features, distracting activities, and personal attributes of the pedestrians were obtained in interviews conducted after pedestrians had completed crossing the street. In total, 1995 pedestrians engaging in various smartphone activities were observed. Results indicate that unsafe crossing behaviours were more prevalent among those playing “Pokemon Go”. Texting via instant-message apps appeared to be the second-most risk distracting activity. Results of the logistic models reveal that contributing factors to unsafe behaviours include being a student, phone screen of 5 in. or larger, and having an unrestricted 4G Internet data allowance. Two interaction terms (gaming × students, and gaming × unlimited 4G data allowance) in the models appear to be important determinants of unsafe crossing behaviours. The current research suggests that to prevent potential crashes and injuries, smartphone gaming while crossing the street should be prohibited. [ABSTRACT FROM AUTHOR]

Literature has suggested that angle/rear-end collisions would arise from the reality that motorists and motorcyclists tended to accelerate aggressively in response to the remaining seconds of green signal countdown device (GSCD). One safety concern, while GSCD has gradually been removed for safety in Taiwan, is pedestrian green signal countdown device (PGSCD) that is used by approaching motorists and motorcyclists that may adopt the information to travel aggressively – an unintended consequence that is detrimental to safety. Research has reported that there appeared no negative effect of PGSCD on motorist behaviours but the effect on motorcyclists’ behaviours has been rarely investigated. Using video/speed cameras, the current research investigates motorcyclists’ RLV (red-light violation) behaviours. The descriptive analyses indicate that the percentage of RLV at PGSCD intersection is higher than that at typical intersection, and the violating motorcycles appear to have higher travelling speeds at PGSCD intersection. Several interaction terms were examined with the binary logit framework, and the results reveal that several factors are associated with RLV, notably male/young riders, moped/large motorcycle users, higher approaching speeds of motorcycles, those with tropical helmets, and lower traffic volume. Similar determinants of early-start behaviours (for those waiting at reds and could view the PGSCDs for the crossing pedestrians at the same time) were identified. Implications of the research findings, the concluding remarks, and recommendations for future research are finally provided. [ABSTRACT FROM AUTHOR]

Background: Social acceptance of smoking is associated with smoking prevalence. Higher smoking rates and ETS exposure might be considered as important indicators for pro-tobacco social norms or social climate. Among studies indicating the association between youth smoking and adult smoking behaviors, most were from individual-level study designs. Objectives: An ecological study was conducted to determine the role of social climate, i.e., adult smoking behaviors and exposure to environmental tobacco smoke (ETS), on youth smoking behaviors. Methods: Data on the smoking behavior and ETS of 16,688 Taiwanese adults were collected in 2004 by telephone administration of the Taiwan Adult Smoking Survey. Similar data on 22,339 junior high school students were collected in 2004 by school-based administration of the Taiwan Youth Tobacco Survey. City/county-level data were analyzed across 25 counties by descriptive statistics, Pearson's' correlation, and hierarchical multiple regression. Results: In both adult and youth populations, overall or gender-specific smoking prevalence and ETS varied widely across counties/cities. The current youth smoking rate within counties was significantly positively correlated with the current adult smoking prevalence as well as home ETS exposure in adults or youth. For male youth, a 1% increase in the rate of home ETS exposure reported by youth increased the current male youth smoking rate by 0.20% after controlling the female youth smoking rate and home ETS exposure reported by adults (p =0.0197). For female youth, male youth smoking prevalence was the only variable that contributed significantly (Beta=0.46, p <0.001). Conclusions: Community health nurses should develop tobacco-control interventions that are tailored to support smoke-free environments by decreasing the social acceptability of smoking. [Copyright &y& Elsevier]

• National Taiwan Traffic Crash Dataset for the period from 2011 to 2015 were used in this study. • Alcohol-involved and un-helmeted riders were approximately 18 times more likely to sustain fatal injuries than sober and helmeted riders. • The other risk factors of motorcyclist fatalities include head-on crashes and approach-turn motorcycle crashes. Alcohol-involved riders tend to engage in other risk-taking behaviours such as un-helmeted riding which could further increases injury severity. The combined effect of alcohol-involved and un-helmeted riding on fatal injuries is rarely investigated. This study investigated the interaction effect between blood alcohol concentration and helmet use on fatal injuries. This study used the National Taiwan Traffic Crash Dataset for the period from 2011 to 2015. Data on road crashes involving a motorcycle and an automobile were extracted and analysed. Multiple logistic regression models were used to calculate the adjusted odds ratio (AOR). We calculated an interaction effect for blood alcohol concentration and helmet use based on STROBE guidelines. There were a total of 669,292 motorcyclist casualties; among these casualties, 3459 (0.5 %) motorcyclists sustained fatal injuries. Alcohol-involved riders were 9.47 times (AOR = 9.47; 95 % CI = 8.75–10.25) more likely than sober ones to sustain fatal injuries. Alcohol-involved and un-helmeted riders were approximately 18 times (AOR = 18.1; CI: 15.9–20.4) more likely to sustain fatal injuries than sober and helmeted riders. Riders involved in head-on crashes and approach-turn motorcycle crashes had an increased probability of sustaining fatal injuries by 240 % (AOR = 3.4; 95 % CI = 2.91–4.09) and 132 % (AOR = 2.3; 95 % CI = 2.016–2.67), respectively. This study found that alcohol-involved riding acts synergistically with un-helmeted riding to increase motorcyclist injury severity. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although there is a significant correlation between the degree of family support and clinical outcome, little research has focused on the effectiveness of family partnership intervention care (FPIC) for patients with poorly controlled type 2 diabetes. Objectives: This study aimed to compare FPIC with conventional care (CC) across a number of outcome measures in patients with poorly controlled type 2 diabetes. Design: The study was performed using a randomized controlled trial design. Participants: Patients with poorly controlled type 2 diabetes who were solely treated with oral antidiabetic agents and had at least two out of three hemoglobin A1C readings equal to or above 7% in the previous 12 months, were randomly assigned to the FPIC group (n =28) and to the CC group (n =28). Methods: Baseline and 6-month follow-up scores were compared using the following outcome measures: (1) hemoglobin A1C, (2) BMI, (3) lipid profile, (4) family supportive behaviours, (5), knowledge of and attitudes toward diabetes, and (6) diabetes self-care behaviours. Descriptive and non-parametric statistics were employed to compare differences in outcome measures between the groups. Results: There were no significant differences in the reduction of hemoglobin A1C levels (p =0.46), lipid profile values (p >0.05), and improvement of diabetes self-care behaviours (p =0.61) between the groups at 6 months post-intervention. However, there were significant differences in the scores of family supportive behaviours (p =0.031) and patients’ knowledge of and attitudes toward diabetes between the groups (p <0.05). Conclusion: These findings support the use of FPIC to enhance family supportive behaviours, and to improve patients’ knowledge of and attitudes toward diabetes. Thus, the study is of value in helping policy decision-makers to develop more effective diabetes control intervention programmes. [Copyright &y& Elsevier]

Objective: To investigate the correlation of blood flow detected by color Doppler sonography in the endometrial-subendometrial unit with pregnancy outcome of IVF-ET treatments.Design: Prospective clinical study.Setting: University setting.Patient(s): Six hundred twenty-three patients selected prospectively on the day of ET.Intervention(s): Transvaginal ultrasound examination was performed before ET.Main Outcome Measure(s): Association between pregnancy outcome and distribution of endometrial-subendometrial blood flow (primary outcome measure) and between pregnancy rate and endometrial measurements as well as uterine arterial blood flow (secondary outcome measures).Result(s): The overall pregnancy rate was 28.4% (177/623) per ET. The pregnancy and implantation rates of patients with the presence of both endometrial and subendometrial flow were 47.8% (64/134) and 24.2% (94/388); for patients with subendometrial flow only, 29.7% (102/343) and 15.8% (153/967); and for patients with no detectable endometrial-subendometrial flow, 7.5% (11/146) and 3.5% (13/376), respectively. The presence of both endometrial and subendometrial blood flow is indicative of good endometrial receptivity, whereas the absence of both represents a poor uterine environment. Nondetectable endometrial-subendometrial flow was associated with women who were older, had a thinner endometrium, and had higher uterine arterial resistance compared with those women who had detectable flow.Conclusion(s): Endometrial-subendometrial blood flow distribution pattern assessed by transvaginal color Doppler before ET is correlated with the implantation and pregnancy rate of IVF treatment. [ABSTRACT FROM AUTHOR]

• Women encountered a reduced risk of MVCs after they became pregnant. • The most reduced risk of MVCs during pregnancy was in younger women. • The risk of MVCs was much lower for scooter crashes than for car crashes during pregnancy. • The overall MVC event rate decreased during pregnancy, but it was still lower than the pre-pregnancy event rate. Changes in risk of motor vehicle crashes (MVCs) during pregnancy are less known, and very few studies have assessed this issue by using unselected population-based datasets and adopting a before-and-during design. The study aimed to address the risk of MVC events in association with pregnancy using a national pregnant women cohort in Taiwan. We conducted a self-matched design in which each woman served as a driver before and during pregnancy. A total of 1,372,664 pregnant women with live birth(s) at 18–50 years of age between 2008 and 2017 were identified from the Birth Notification dataset. MVC events as a driver were ascertained from the Police-reported Traffic Accident Registry dataset. We calculated the rate ratio (RR) with a 95 % confidence interval (CI) using the conditional Poisson regression model to compare the MVC event rates between pre-pregnancy and pregnancy periods. The overall rate of MVC events was significantly reduced during pregnancy (RR = 0.69, 95 % confidence interval (CI) = 0.68–0.71). Mothers with alcoholism during pregnancy were associated with an increased RR at 2.00 but with a very wide CI. Reduction in RR was primarily attributed to the reduced MVC event rate involving scooter crashes (0.60, 95 % CI = 0.58–0.62). Although MVC event rates decreased during women became pregnant, many women drivers were still involved in MVCs during pregnancy. Their potential maternal and perinatal conditions along with their offspring's health outcomes need further investigations. [ABSTRACT FROM AUTHOR]

Introduction Trauma admissions are associated with weather and temporal factors; however, previous study results regarding these factors are contradictory. We hypothesised that weather and temporal factors have different effects on specific trauma events in an emergency medical service (EMS) system. Methods EMS data from January 1, 2009, to December 31, 2010, were obtained from the fire department of Taipei City and associated with the local weather data. EMS trauma events were categorised into total trauma, traffic accidents (TAs), motorbike accidents (MBAs), and falls. Hourly data on trauma patients were analysed using the zero-inflated Poisson model. Results The hourly incidence of total trauma increased with the magnitude of precipitation (incidence rate ratio [IRR] = 1.06, 1.09, and 1.11 in light, moderate, and heavy rain, respectively), and this effect was more prominent in fall patients than in patients with other injuries (IRR = 1.07, 1.21, and 1.32). However, the hourly incidence of TAs and MBAs was associated only with light rain (IRR = 1.11 and 1.06, respectively). An hour of sunshine exposure was associated with an increase in the hourly incidence of all groups, and higher temperatures were associated with an increased hourly incidence of total trauma, TAs, and MBAs, but not falls. The hourly incidence of falls increased only in late fall and winter. Compared with the hourly incidence between 3 am and 7 am, the hourly incidence of all groups plateaued between 7 am and 11 pm and declined from 11 pm to 3 am. During the plateau period, 2 peaks in the incidence of TAs (IRR = 5.03 and 5.07, respectively) and MBAs (IRR = 5.81 and 5.51, respectively) were observed during 7–11 am and 3–7 pm. The hourly incidence of total trauma, TAs, and MBAs plateaued during workdays, peaked on Fridays, declined on Saturdays, and troughed on Sundays. The incidence of falls increased only on Mondays (IRR = 1.09). Conclusions Weather and temporal factors had different impacts on the incidence of traffic-related accidents and falls. Therefore, EMS data may have implications in preventing injuries and planning resource use for prehospital trauma rescue. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To develop and evaluate a Web-based, patient-orientated diabetic education management (POEM) system. Methods: The POEM system has been developed to extend hospital patient education by integrating patients’ medical care data into their education program components and presenting them on the Web. Since most patients are concerned about their medical care data, the POEM system can provide the incentives for patients to continuously and persistently log in and learn the required knowledge and skills, improving their clinical outcomes. A quasi-experimental method that uses control groups and pretests was used to evaluate the outcomes of the system intervention. We recruited patients with type-2 diabetes and alternatively assigned them to intervention and control groups. We compared laboratory test results including fasting blood glucose, HbA1c, total cholesterol, triglyceride (TG), and HDL between the two groups from the first visit through each follow-up visit. The study period progressed from September 2003 to May 2004 at the Metabolism Center of a medical teaching hospital in Taipei. Results: In this study, we recruited 274 participants: 134 (57% males and 43% females) in the intervention group and 140 (46% males and 54% females) in the control group. The patients’ laboratory test results from the first visit for fasting blood glucose, HbA1c, total cholesterol level, TG, and HDL in the intervention and control groups were respectively 187.54±77.10 and 189.99±73.49mg/dl, 9.03±2.79% and 8.95±2.23%, 193.29±47.93 and 202.52±58.45mg/dl, 152.48±70.85 and 157.37±74.88mg/dl, and 44.97±12.09 and 45.32±12.08mg/dl. There were three follow-up visits during the study period. We collected laboratory test results of the two groups through each of the following visits and analyzed them using ANCOVA. We discovered a significant difference in fasting blood glucose levels between intervention and control group as early as the first follow-up. At the second follow-up, both fasting blood glucose and HBA1c levels were significantly different between intervention and control group. At the third follow-up, there was a significant difference in fasting blood glucose, HBA1c, and total cholesterol between intervention and control group. We also monitored the number of logins for the patients in the intervention group during the follow-up period. The result showed the patients had consistently logged into the POEM system (about 8.5±3.7 logins per person per month after 3 months enrollment). Thus, the patients in the intervention group had better control of their fasting blood glucose, HbA1c and total cholesterol levels than those in the control group due to the assistance of the system. Conclusions: The POEM system can help patients control their glucose, HbA1c and total cholesterol levels to manage their diabetes, providing an easy and inexpensive way to extend hospital-based patient education services for community-based continuous patient education. [Copyright &y& Elsevier]