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Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Usually, patients survive for approximately 2–4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in patients with ALS. This cross-sectional study included patients diagnosed with ALS between January 2015 and December 2019 in a Taipei City hospital. We recorded patients' age at disease onset; sex; presence of diabetes mellitus, hypertension, cancer, or depression; use of invasive positive pressure ventilator (IPPV) or non-IPPV (NIPPV); use of nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) tube; follow-up years; and number of hospitalizations. Data from 162 patients were recorded (99 men). Fifty-six (34.6%) signed a DNR. Multivariate logistic regression analyses revealed that the factors associated with DNR included NIPPV (OR = 6.95, 95% CI = 2.21–21.84), PEG tube feeding (OR = 2.86, 95% CI = 1.13–7.24), NG tube feeding (OR = 5.75, 95% CI = 1.77–18.65), follow-up years (OR = 1.13, 95% CI = 1.02–1.26), and number of hospital admissions (OR = 1.26, 95% CI = 1.02–1.57). The findings suggest that end-of-life decision making among patients with ALS may often be delayed. DNR decisions should be discussed with patients and their families during the early stages of disease progression. Physicians are advised to discuss DNR with patients when they can speak and to offer palliative care options. [ABSTRACT FROM AUTHOR]

An outbreak occurred in Wanhua District of Taipei City. It was traced to a cluster infection originating from a teahouse. To prevent further large-scaled community spread, the Taipei City Government established the first community rapid test screening station. This report describes the station's strategy and performance and key factors that contributed to its operation. The project involves collaboration among various departments of Taipei City Government, including the health, environmental, police, transportation, and fire departments. The station provides rapid screening, polymerase chain reaction (PCR) testing, and immediate isolation and follow-up medical services upon the detection of a positive case. These services are accessible to local residents and are intended to ease hospitals' burdens. In 36 days, a total of 8532 people were tested, and 419 confirmed cases were identified. Over the same period, the weekly number of positive cases in Wanhua District decreased from 356 to 40, and the PCR positive rate decreased from 21.7% to 1.2%. The policy of establishing rapid screening station, contact tracing and mask wearing policy are key strategies for interrupting chains of transmission of COVID-19. This intervention has become a model for preventing the spread of the epidemic and establishing community rapid screening stations in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Although advance directives (AD) have been implemented for years in western countries, the concept of AD is not promoted extensively in eastern countries. In this study we evaluate a program to systematically conduct advance care planning (ACP) communication for hospitalized patients in Taiwan and identify the factors associated with AD completion. Methods: In this retrospective evaluation of a clinical ACP program, we identified adult patients with chronic life-limiting illness admitted to Taipei City Hospital between April 2015 and January 2016. Trained healthcare providers held an ACP meeting to discuss patients’ preference regarding end-of-life care and AD completion. A multiple logistic regression was performed to determine the factors associated with the AD completion. Results: A total of 2878 patients were determined to be eligible for ACP during the study, among which 1798 (62.5%) completed ACP and data was available for 1411 patients (49.1%). Of the 1411 patients who received ACP communication with complete data, the rate of AD completion was 82.6%. The overall mean (SD) age was 78.2 (14.4) years. Adjusting for other variables, AD completion was associated with patients aged ≥ 85 years [adjusted odds ratio (AOR) = 1.80, 95% CI 1.21–2.67], critical illness (AOR = 1.17, 95% CI 1.06–1.30), and social workers participating in ACP meetings (AOR = 1.74, 95% CI 1.24–2.45). Conclusion: The majority of inpatients with chronic life-limiting illness had ACP communication as part of this ACP program and over 80% completed an AD. Our study demonstrates the feasibility of implementing ACP discussion in East Asia and suggests that social workers may be an important component of ACP communication with patients. [ABSTRACT FROM AUTHOR]

A worldwide movement to empower communities to support their members to care for each other at the end of life (EoL) has emerged since Kellehear published the Compassionate City Charter. This current report discusses the implementation experiences and preliminary outcomes of Compassionate Communities (CC) in Taipei City. Using the guidance of the Charter and international experiences, we have developed and multiplied a culturally sensitive, sustainable, and holistic CC program that composes municipal hospital, social, and other services, partnering with community leaders, non-governmental organizations, university students, and volunteers. Innovative campaigns, such as workshops, conferences, and the Life Issue Café, have been delivered to facilitate engagement, public education, and leadership with reverence to folk beliefs and the use of existing social networks. We have identified a model with strong collaborative leadership, high participation rates, and ongoing commitment. The gaps between asking/accepting and providing help were bridged when social connectedness was strengthened. We also integrated home-based medical care, home-based palliative care, and advance care planning to help the vulnerable who live alone, with poor status, or with limited resource access, and continue to support the community throughout the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Irritability is not uncommon after traumatic brain injury (TBI). Unfortunately, no instruments are available to directly measure this clinical feature. This study thus aimed to develop a specific scale to evaluate the irritability for patients with TBI. A total of 144 participants, which include 80 healthy participants and 64 patients suffering from TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale (NTUIS). Our results showed the NTUIS has good reliability. The factor analysis further revealed 2 different components: annoyance, and verbal aggression. Moreover, both self-reported and family-reported irritability postinjury were significantly higher than the irritability reported by the healthy participants. Indeed patients with TBI have significant problems with irritability after injuries, and thus a more specific assessment tool to carefully evaluate patients' irritability should be used. [ABSTRACT FROM AUTHOR]

Objective Patients who experience a mild traumatic brain injury (MTBI) may have a headache condition preceding injury, develop a post-traumatic headache after injury, or experience headache neither before nor after injury. This study examined whether MTBI patients with no headache, pre-existing headache, and post-traumatic headache differed in acute-to-subacute outcomes. Method Patients with MTBI were recruited from an outpatient neurosurgery clinic in Taipei, Taiwan after emergency department referral (N = 291; 40.2% men; M = 37.9 ± 13.9 years-old; Mdn = 7 days-since-injury, range = 0–21), completing neuropsychological tests of attention, memory, and verbal fluency and questionnaires evaluating depression, anxiety, and post-concussion symptoms. Participants with no headache (reported neither pre- or post-injury), pre-existing headache (reported pre-injury headache, of whom some reported worsened post-injury headache), and post-traumatic headache (denied pre-injury headache, reported post-injury headache) were compared using non-parametric ANCOVA, controlling for gender and days-since-injury. Results Neuropsychological test performances did not differ between headache groups. Participants with pre-injury headache and post-traumatic headache had greater change in self-reported physical (F = 25.52, p < 0.011, η2 = 0.15) and cognitive symptoms (F = 3.74, p = 0.025, η2 = 0.03) than participants with no headache. Participants with pre-injury headache reported worse post-injury anxiety symptoms than participants with post-traumatic headache (F = 12.02, p < 0.011, η2 = 0.08). Conclusion(s) Participants with pre-injury and post-traumatic headache did not differ in outcome within 21 days of injury but had worse self-reported physical and cognitive symptoms than participants with no headache. Most participants with pre-injury headache experienced worsened headache following MTBI (53.7%). Future research is needed to assess whether more specific headache subtypes are differentially associated with MTBI outcome. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare patients with acute-to-subacute mild traumatic brain injury (mTBI) on post-concussion symptom reporting based on whether they retrospectively recalled experiencing pre-injury anxiety or depression. Patients with mTBI (n = 297; 40.4% men; mean = 38.2 years old, standard deviation [SD] = 14.0, range = 17–65), referred from an emergency department in Taipei, Taiwan, were seen in a neurosurgical outpatient clinic on average 7.7 days since injury (SD = 5.7, range = 0 – 21 days), at which time they completed a checklist of post-concussion symptoms. Patients rated their current symptom severity and retrospectively rated their pre-injury symptom severity on 15 physical, cognitive, and emotional symptoms. Patients were grouped based on whether they did or did not have mild or greater pre-injury anxiety or depression based on this scale. Those with pre-injury anxiety or depression had greater pre-injury (all p's < 0.001, d range: 0.92–2.03) and post-injury (all p's < 0.001, d range: 0.65–1.00) symptom severity. However, when analyzing perceived change in symptoms (i.e., post-injury ratings minus pre-injury ratings), only perceived change in cognitive symptoms differed across groups (p = 0.018, d = 0.29), which became non-significant after controlling for gender. Greater post-concussion symptom severity in patients with pre-existing mental health problems may be mostly attributable to elevated symptoms before injury. These findings demonstrate the clinical value of retrospective pre-injury symptom assessment in mTBI management. Greater post-concussion symptom severity in patients with pre-injury mental health problems may represent a continuation of greater pre-injury symptom severity rather than a greater increase in symptom severity after mTBI. [ABSTRACT FROM AUTHOR]

• Riding on minor roads reduced exposure to BTEXs and PM 2.5. • Scooter commuters were exposed to more BTEXs than bicycle commuters. • Due to their ubiquity, scooters contributed the most to PM 2.5. • Single-pollutant health impact modeling may result in underestimation. Bicycle and scooter commuters are known to expose to more traffic-related pollutants. Benzene, toluene, ethylbenzene, xylenes (BTEXs), and PM 2.5 were measured along four routes during rush hour and non-rush hour periods by cyclists and motorcyclists in Taipei, Taiwan. The health impacts were also evaluated using health impact modeling (HIM) approach. The average exposures of total BTEX and PM 2.5 were 20.07 ppb and 23.27 μg/m3 for the cyclists and 33.96 ppb and 27.65 μg/m3 for the motorcyclists, respectively. Riding on an "alternative" route resulted in lower exposure. Scooters could contribute more to PM 2.5 exposure than buses/trucks and passenger cars. Cyclists could have a lower risk of all-cause mortality and a single-pollutant HIM was found to result in underestimations. In conclusion, the number of scooters in traffic should be reduced, and commuters should be encouraged to shift from gasoline scooters to bicycles to reduce air pollution. [ABSTRACT FROM AUTHOR]