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A farm at Taoyuan in Taiwan was highly contaminated with decabrominated diphenyl ether (BDE-209), a widely used commercial brominated flame retardant and persistent in the environment, more than 10 years. Since crops are able to absorb and accumulate BDE-209 from soils in our previous research, posing a hazardous risk for humans, it is essential to develop a practical method of soil treatment. Thermal treatment was studied among different approaches. In our previous study (Ko et al., 2022), we found that heating to 450 °C for 30 min achieved a complete removal of BDE-209 in soil. However, the high temperature significantly decreased the original soil organic matter (SOM) from 2.47% to 0.27%, altering the soil texture, damaging microbial biomass, and thus affecting the revegetation after the thermal treatment. Sugarcane bagasse, a common agricultural residue, served as an amendment to restore soil fertility. Current results indicate that 2.5% bagasse can improve the SOM in soil by up to 2.73% and restore its bacterial composition, making the plant growth conditions similar to those of the untreated contaminated soil. In light of the high removal efficiency provided by the 450°C-thermal treatment and the high recovery efficiency of sugarcane bagasse, the strategy presented in this study serves to be a promising method for sustainable remediation. [Display omitted] • The thermal removal of PBDE contaminated soil in the field is debromination mechanism. • Soil properties and soil microbial composition are related to temperature for thermal treatments. • Sugarcane bagasse, one of agricultural residues, recovers soil functions by evaluating plant growth. • This study achieved the goals of green remediation and environmental sustainability. [ABSTRACT FROM AUTHOR]

Efforts to advance health technology assessment (HTA) in Taiwan have aimed to optimize the allocation of National Health Insurance (NHI) resources. This study documents and analyzes the historical timeline of Taiwan's efforts in HTA, identifying areas to advance the HTA system, such as gaining broad stakeholder acceptance. We document ambitious plans to establish a larger, independent HTA center and how these plans did not materialize. The historical timeline also describes the primary focus of HTA shifting to serve the needs of decision-making authorities and committees. We argue that these changes resulted in growth of the HTA system, but also led to significant external criticism and potential compromise of its foundational principles. The inability to create a national HTA center can be attributed to several factors, including an immature ecosystem of HTA-Policy-Patient-Provider-Academic collaboration, a lack of a supportive culture, and challenging political and economic conditions. Nevertheless, if effectively managed, Taiwan's current HTA system could play a crucial role in rational decision-making, informed choices, and efficient NHI resource management. We argue that greater autonomy is crucial for enhancing financial sustainability and protecting against external influences to ensure objective and credible assessments. Additionally, we emphasize the importance of fostering a conducive learning environment to improve methodological expertise. [ABSTRACT FROM AUTHOR]

Background: Mediation is increasingly used for medical dispute resolution, and the particularity of such mediation necessitates specialized training. In response to the promotion of compulsory mediation ahead of a legislation in Taiwan, we invited experts with an interdisciplinary team to design a case-based mediator training workshop. Our study aimed to investigate the learning outcomes of trainees and analyze their perspectives.Methods: We recruited 129 trainees of a non-probability convenience sample who served as mediators or have dealt with medical dispute-related cases to undergo 2.5 h of lectures (introduction; procedure; roles of two mediators; principles and techniques of mediation; dispute arrangement; and issue analysis) and 1.5 h of case-based exercises. An after-class survey was conducted using a 4-point Likert-type scale to evaluate trainees' viewpoints and learning outcomes. A total of 104 questionnaires were collected (response rate: 80.6%).Results: The professions of the participants were medical (56%), law (16%), and administration and others (28%). Males considered the course more helpful (3.79 vs. 3.63, p = 0.053) and more important (3.88 vs. 3.74, p = 0.042) than did females. Participants with a legal background scored the highest in helpfulness (3.84), followed by medical (3.74) and administrative (3.63) professionals. Medical and administrative professionals scored the highest (3.85) and lowest (3.76), respectively, on importance. Respondents with more than 10 years (3.81) and less than 1 year (3.79) of experience produced higher scores in helpfulness. Respondents with 1-5 years of experience (3.68) were found to be less likely to agree with the practical importance of course content compared with other groups of trainees. Administrative professionals obtained the highest scores (89.68) in written examinations.Conclusions: There are variations in mediators' perspectives based on gender, occupation, and work experience. Our nationwide mediation training workshop can be utilized to cultivate capabilities of mediators for handling medical disputes to achieve the goal of non-litigation in medical disputes. [ABSTRACT FROM AUTHOR]

Background: Diffusion of new drugs in the health care market affects patients' access to new treatment options and health care expenditures. We examined how a new drug class for diabetes mellitus, thiazolidinediones (TZDs), diffused in the health care market in Taiwan. Methods: Assuming that monthly hospital prescriptions of TZDs could serve as a micro-market to perform drug penetration studies, we retrieved monthly TZD prescription data for 580 hospitals in Taiwan from Taiwan's National Health Insurance Research Database for the period between March 1, 2001 and December 31, 2005. Three diffusion parameters, time to adoption, speed of penetration (monthly growth on prescriptions), and peak penetration (maximum monthly prescription) were evaluated. Cox proportional hazards model and quantile regressions were estimated for analyses on the diffusion parameters. Results: Prior hospital-level pharmaceutical prescription concentration significantly deterred the adoption of the new drug class (HR: 0.02, 95%CI = 0.01 to 0.04). Adoption of TZDs was slower in district hospitals (HR = 0.43, 95% CI = 0.24 to 0.75) than medical centers and faster in non-profit hospitals than public hospitals (HR = 1.79, 95% CI = 1.23 to 2.61). Quantile regression showed that penetration speed was associated with a hospital's prior antidiabetic prescriptions (25%Q: 18.29; 50%Q: 25.57; 75%Q: 30.97). Higher peaks were found in hospitals that had adopted TZD early (25%Q: -40.33; 50%Q: -38.65; 75%Q: -32.29) and in hospitals in which the drugs penetrated more quickly (25%Q: 16.53; 50%Q: 24.91; 75%Q: 31.50). Conclusions: Medical centers began to prescribe TZDs earlier, and they prescribed more TZDs at a faster pace. The TZD diffusion patterns varied among hospitals depending accreditation level, ownership type, and prescription volume of Anti-diabetic drugs. [ABSTRACT FROM AUTHOR]

Three new species of bioluminescent fungi - Mycena jingyinga, M. luguensis, and M. venus - are proposed based on phylogenetic and morphological analyses. Of the three new species, the luminescence only admits from the mycelia instead of the fruiting bodies. The DNA sequences of RNA polymerase II second largest subunit (rpb2) and nuc rDNA ITS1-5.8S-ITS2 (ITS) were used for phylogenetic analyses. The three new species are characterized by small size, white or brown, adnate to subdecurrent lamellae, pubescent stipe with fibrils at bases, four-spored basidia, amyloid spores, cheilocystidia with various shapes, and pileipellis hyphae with short, simple, or diverticulate excrescences. These characteristics are congruent with those of Mycena section Fragilipedes. The three new species bring the total number of bioluminescent fungi to 108 and 15 species in the world and Taiwan, respectively. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) is a clinically significant complication that is well documented among Caucasian cancer patients. However, evidence regarding VTE incidence and treatment among Asian cancer patients is very limited. The objective of this study is to investigate the incidence, risk factors and management of VTE among Taiwanese cancer patients. Methods: Using Taiwan's National Health Insurance Research Database, we identified 43,855 newly diagnosed cancer patients between 2001 and 2008. Two alternative algorithms for identifying VTE event were explored to better quantify a range of incidence rates of VTE in our cancer patients. Multivariable logistic regression models were used to explore VTE risk factors. Results: The incidence rates of VTE were 9.9 (algorithm 1) and 3.4 (algorithm 2) per 1,000 person-years, respectively. The incidence rates were higher in certain cancers, particularly liver, pancreas, and lung. Significant risk factors for VTE were site of cancer, prior history of VTE, chemotherapy and major surgeries. Long-term anticoagulant therapy was initiated in 64.1% patients with VTE and 72.2% of them received warfarin alone. Approximately two-thirds of patients with VTE received ≤ 3 months of anticoagulant therapy. Conclusion: Incidence of cancer-related VTE is lower among Taiwanese compared to Caucasian populations. Nevertheless, risk factors for cancer-related VTE found in our study were consistent with current literature. [ABSTRACT FROM AUTHOR]

To investigate associations between isoniazid for latent tuberculosis and risk of severe hepatitis, affecting patients with rheumatoid arthritis or ankylosing spondylitis whose treatment includes tumor necrosis factor inhibitors. Our self-controlled case series study analyzed Taiwan's National Health Insurance Database from 2003 to 2015 to identify RA or AS patients, aged ≥ 20 years, receiving TNF inhibitors and a 9-month single isoniazid treatment. The outcome of interest was hospitalization due to severe hepatitis. We defined risk periods by isoniazid exposure (days): 1–28, 29–56, 57–84, 85–168, 169–252, and 253–280. To compare risk of severe hepatitis in exposed and non-exposed periods, we performed conditional Poisson regressions to generate incidence rate ratios (IRR) and 95% confidence intervals, with adjustment of patients' baseline covariates including age, sex, HBV, HCV and related medication. Of 54,267 RA patients and 137,889 AS patients identified between 2000 and 2015, 11,221 (20.7%) RA and 4,208 (3.1%) AS patients underwent TNFi therapy, with 722 (5%) receiving isoniazid for latent tuberculosis. We identified 31 incident cases (4.3%) of hospitalization due to severe hepatitis. Of these hospitalization events, 5 occurred in the exposed periods, 25 occurred in the INH unexposed periods, and 1 occurred in the pre-exposure period. Compared with non-exposure, the risk of severe hepatitis was higher in exposed periods (incidence rate ratio [IRR]: 5.1, 95% CI: 1.57–16.55), especially 57–84 days (IRR: 17.29, 95% CI: 3.11–96.25) and 85–168 days (IRR:10.55, 95% CI: 1.90–58.51). The INH related fatal hepatotoxicity was not identified in our study. Our findings suggest an association between risk of severe hepatitis and exposure to isoniazid in patients with RA or AS under TNFi therapy, particularly within the exposed period 57–168 days. A close monitoring of liver function is mandatory to minimize the risk, especially within the first 6 months after initiation of 9 months isoniazid. [ABSTRACT FROM AUTHOR]

Background: Previous animal studies have shown that perfluorinated compounds (PFCs) have adverse impacts on birth outcomes, but the results have been inconclusive in humans. We investigated associations between prenatal exposure to perfluorooctanoic acid (PFOA), perfluorooctyl sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluoroundecanoic acid (PFUA) and birth outcomes. Methods: In total, 429 mother-infant pairs were recruited from the Taiwan Birth Panel Study (TBPS). Demographic data were obtained by interviewing mothers using a structured questionnaire and birth outcomes were extracted from medical records. Cord blood was collected for PFOA, PFOS, PFNA, and PFUA analysis by ultra-high-performance liquid chromatography/tandem mass spectrometry. Results: The geometric mean (standard deviation) levels of PFOA, PFOS, PFNA, and PFUA in cord blood plasma were 1.84 (2.23), 5.94 (1.95), 2.36(4.74), and 10.26 (3.07) ng/mL, respectively. Only PFOS levels were found to be inversely associated with gestational age, birth weight, and head circumference [per ln unit: adjusted b (95% confidence interval, CI) =20.37 (20.60, 20.13) wks, 2110.2 (2176.0, 244.5) gm and 20.25 (20.46, 20.05) cm]. Additionally, the odds ratio of preterm birth, low birth weight, and small for gestational age increased with PFOS exposure [per ln unit: adjusted odds ratio (OR) (95%CI) = 2.45 (1.47, 4.08), 2.61(0.85, 8.03) and 2.27 (1.25, 4.15)]. When PFOS levels were divided into quartiles, a doseresponse relation was observed. However, PFOA, PFNA, and PFUA were not observed to have any convincing impact on birth outcomes. Conclusions: An adverse dose-dependent association was observed between prenatal PFOS exposure and birth outcomes. However, no associations were found for the other examined PFCs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of influenza vaccination on the reduction of the risk of outpatient visits for upper respiratory infection (URI) among the elderly in Taiwan. Methods: The data for this observational study, consisting of 1729 people aged 65 years or older, were drawn from Taiwan’s 2001 National Health Interview Survey. This survey data was then linked with National Health Insurance claim data for December 2001 to November 2002. Survival analysis of Cox proportional hazards model was performed to examine the risk of URI outpatient visits in elderly people vaccinated with the influenza vaccine and those not vaccinated during a year-long study period since the influenza season began. To adjust for potential self-selection bias, we used propensity score method to categorize individuals into two groups, based on the predicted probability of being vaccinated from a logistic regression of spatial random effect. Propensity score group 1 (PSG 1) were those with a predicted probability of being vaccinated lower than 0.5, and PSG 2 were those with a predicted probability of being vaccinated of 0.5 or higher. Results: The overall vaccination rate was 50%. Logistic regression showed the probability of being vaccinated was related to the number of outpatient visits for URI before the influenza season began (odds ratio (OR) 1.07; 95% confidence interval (CI) 1.04–1.10). Our first survival analysis showed that being vaccinated significantly reduced the risk of URI outpatient visits in PSG 2 during the 1-year study period (hazard ratio 0.89; 95% CI 0.81–0.97). Separate survival analysis showed that being vaccinated reduced the risk of URI outpatient visits for both PSG groups during the first 3 months of the study period. Conclusion: Being vaccinated could reduce the risk of outpatient visits for URI among the elderly during the influenza season. [ABSTRACT FROM AUTHOR]