Search

Universities in Taiwan can be divided into two major categories of comprehensive universities and technological universities. Students studying engineering majors in comprehensive universities are often recruited from academic high schools while those in technological universities tend to be recruited from vocational high schools. The purpose of this research was to investigate differences in learning efficacy between college students with academic backgrounds and those with vocational backgrounds. Results indicated no significant differences in cognition between the two groups of students. Additionally, students with vocational school backgrounds performed better in comprehension skills compared with those with academic backgrounds and were more able to apply acquired knowledge to practical tasks according to path analysis studies and the Mann-Whitney "U" test.

Low-carbohydrate (LC) diets are popular among general and athletic populations attempting to lose body mass. This study investigated the effect of a 7-day LC or moderate-carbohydrate (MC) calorie–restricted diet followed by 18-h recovery on body composition and taekwondo-specific performance. In this randomised cross-over study, 12 male taekwondo athletes consumed an LC (10% of carbohydrate, 41% of protein, 49% of fat, and 15.8 ± 0.4 kcal/kg/day) or an isocaloric MC diet (60% of carbohydrate, 30% of protein, and 10% of fat) for 7 days. The participants then consumed a carbohydrate-rich recovery dinner (39.2 ± 3.1 kcal/kg) followed by breakfast (6.2 ± 0.4 kcal/kg) in both the trials. Three repeated sprint ability (RSA) tests were conducted after breakfast. The taekwondo-specific reaction battery was administered before the first RSA test and after each RSA test. The participants experienced similar magnitudes of significant loss of body mass in the LC (−2.4 ± 1.7%) and MC (−2.3 ± 1.7%) trials. Fat mass and fat percentage significantly decreased in the MC trial but remained unchanged in the LC trial after body mass loss. Fat free mass was maintained in both the trials. The average and peak power in the RSA tests and the premotor reaction time were similar between the trials. The participants experienced significantly higher fatigue in the LC trial. In conclusion, both the diets can help athletes rapidly lose body mass while maintaining performance as long as an adequate amount of carbohydrate is consumed during the recovery period. [ABSTRACT FROM AUTHOR]

Context: An experimental Health Care Improvement Program (HCIP) was initiated by the Bureau of National Health Insurance in 1997 to improve the accessibility of health care in several rural, mountainous districts. Purpose: This longitudinal study evaluated service availability, utilization patterns, and effectiveness of services under the HCIP in the A-Li Mountain District. Methods: Outpatient claims made by residents in the A-Li Mountain District were extracted from the database of the National Health Insurance program. Changes in utilization pattern and volume were analyzed. Satisfaction levels were assessed by 2-stage face-to-face interviews with local residents. Findings: After the HCIP, the average population served by each doctor decreased 75%, and total outpatient visits increased 15.4%. The total number of in-district outpatient visits increased 83.6%. The proportion of in-district outpatient visits to all visits increased from 22.1% to 35.1%. The total in-district outpatient visit fee claimed increased 100.2%, and the total out-of-district outpatient visit fee claimed increased only 7.2%. About 60.4% of the residents were not satisfied with overall health care services before the HCIP. The proportion decreased to 32.4% after the HCIP. Conclusions: The HCIP improved accessibility, enriched local medical care resources, changed the utilization pattern of some residents, and increased residents' satisfaction level. A well-managed program with stabilized financial resources is more likely to succeed if it also respects cultural differences and responds to community needs.

The aim of this paper is to quantify the amounts of volatile organic compounds (VOCs) emitted from a coke oven in a steel plant in Taiwan and estimate the emission factors of VOCs using an innovative sampling technique. The identification of VOCs emissions was referred to in the AP-42 report issued by the USEPA and the field measurement data of fugitive emissions. VOCs were sampled using a self-designed closed sampling system. A total of six emission points, including quenching emissions, charge lid emissions, combustion stack emissions, door emissions, charging emissions, and coke pushing emissions, were identified in the coking process after comparing with the report of AP-42, and the emission factor of VOCs was 0.030 kg/ton-coke. It showed that the emission factor of VOCs via field measurement was approximately 56% of that reported by Taiwan EPA. Therefore, VOCs emissions estimated by the Taiwan EPA would be highly overestimated than those from the coke oven in the site. [ABSTRACT FROM AUTHOR]

Huang, J-H, Chiu, Y-C, and Chang, C-K. The influence of hot environment on pitching and hitting performance in professional baseball. J Strength Cond Res 35(11): 3251–3255, 2021—Baseball is usually played outdoors during the warmest months of the year. The long exposure to a hot environment may lead to hyperthermia and subsequent impaired cognitive function, which is crucial for hitting and pitching performance in baseball. The purpose of this study was to investigate the effect of apparent temperature on pitching and hitting performance in Chinese Professional Baseball League games in Taiwan. Each pitched and batted ball from a total of 480 regular season games in 2018 and 2019 was analyzed. Each game was categorized into one of the 4 groups on the basis of the average apparent temperature at which it was played: cold (below 21° C), warm (21–28° C), hot (28–34° C), or extremely hot (above 34° C). Differences in pitching and hitting variables were compared across the 4 groups. In the extremely hot environment, slugging percentage, isolated power, base on balls per 9 innings, home runs per 9 innings, and walks plus hits per inning were all significantly higher than those in the other 3 environments. The results suggest that offensive production was significantly increased in extremely hot environments in the Chinese Professional Baseball League. It is recommended that pitchers could adopt cooling interventions to alleviate the decline in performance in an extremely hot environment. [ABSTRACT FROM AUTHOR]

Background: The long-term effects of statin use on rehospitalization due to ischemic stroke (reHospIS) in hyperlipidemic patients are still unknown. Therefore, we aimed to assess the long-term risks of reHospIS for hyperlipidemic patients who were taking statins and nonstatin lipid-lowering medicines on a regular basis. Methods and Materials: The National Health Insurance Research Database in Taiwan was used to conduct a 6-year cohort study of patients >45 years old (n = 9,098) who were newly diagnosed with hyperlipidemia and hospitalized for the first or second time due to ischemic stroke (IS). The risk of reHospIS was assessed using Cox proportional hazards regression model. Results: Nonstatin lipid-lowering medicines regular users were associated with a higher risk of reHospIS compared to stains users (hazard ratio, HR = 1.29–1.39, p < 0.05). Rosuvastatin was the most preferred lipid-lowering medicine with lower HRs of reHospIS in hyperlipidemic patients whether they developed diabetes or not. Bezafibrate regular users of hyperlipidemic patients developing diabetes (HR = 2.15, p < 0.01) had nearly 50% lower reHospIS risks than those without diabetes (HR = 4.27, p < 0.05). Age, gender, drug dosage, comorbidities of diabetes and heart failure (HF), and characteristics of the first hospitalization due to IS were all adjusted in models. Moreover, increasing trends of HRs of reHospIS were observed from Rosuvastatin, nonstatin lipid-lowering medicines, Lovastatin, and Gemfibrozil to Bezafibrate users. Conclusion: Statins were associated with long-term secondary prevention of reHospIS for hyperlipidemic patients. Rosuvastatin seemed to have the best protective effects. On the other hand, Bezafibrate appears to be beneficial for hyperlipidemic patients developing diabetes. Further research into the combination treatment of statin and nonstatin lipid-lowering medicines in hyperlipidemic patients developing diabetes is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Healthcare professionals play an important role in the organ donation process. The aim of this study was to examine the organ donation registration rate and related factors among clinical nurses. Material and methods: In this cross-sectional, correlational study, we used mailed questionnaires to collect data from four geographical areas and three hospital levels in Taiwan from June 6 to August 31, 2018. Two thousand and thirty-three clinical nurses participated in this study. Results: Participants' mean age was 34.47 years, and 95.7% were women. Of them, 78.3% were willing to donate their organs and 20.6% had registered for organ donation after death. The results of logistic regression showed that in the personal domain, higher age (odds ratio (OR) = 1.03, p < 0.001), better knowledge of organ donation (OR = 1.09, p < 0.001), and a positive attitude toward organ donation (OR = 2.91, p < 0.001) were positively associated with organ donation registration, while cultural myths (OR = 0.69, p < 0.001) were negatively correlated. In the policy domain, the convenience of the registration procedure (OR = 1.45, p < 0.001) was positively associated with registration. A gap between willingness to donate and actual registration was observed. Conclusions: Personal factors played an important role in organ donation registration. Therefore, efforts to improve knowledge and inculcate positive cultural beliefs about organ donation among clinical nurses are recommended. There is also a need to cooperate with government policies to provide appropriate in-service training and policy incentives and establish an efficient registration process. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To examine the relationships of self‐care, symptoms, and a variety of demographic factors to quality of life (QOL), and to identify determinants of QOL in lung cancer patients undergoing chemotherapy. Design: A cross‐sectional, correlational study. Methods: 159 patients with lung cancer undergoing chemotherapy were recruited from three southern hospitals in Taiwan. Four instruments were used: the Quality of Life Questionnaire Core 30‐item (QLQ‐C30), M.D. Anderson Symptom Inventory (MDASI), Memorial Symptom Assessment Scale‐Short Form (MSAS‐SF), and Self‐Care Behavior Scale (SCBS). Findings: Lung cancer patients rated lower scores of self‐care behaviors on food choice and nutrition maintenance, regular exercise and sleep, and medical compliance. Being younger, having spouses as main caregivers, having food choice and nutrition maintenance, and getting regular exercise and sleep were associated with better QOL. Degree of interference with life, age, food choice and nutrition maintenance, and psychological symptoms were found to predict functional QOL and accounted for 43% of total variance. Conclusions: The findings identified factors influencing QOL and provided evidence for designing an intervention to enhance QOL in lung cancer patients undergoing chemotherapy. Clinical Relevance: The findings may be useful for guiding intervention development for early detection and management of symptom interference with daily living, and place greater focus on patient self‐care to promote food choice and nutrition maintenance, especially in older patients and those whose caregivers are not their spouses. [ABSTRACT FROM AUTHOR]

The increasing elderly population puts significant health, economic, and social burdens on society. Physical activity is one of the most cost-effective ways to maintain the health of the elderly. This study adopts a treatment effects model to investigate the causal relationship between environment attributes and physical activity among the elderly, while taking endogeneity into account. The data were collected from 274 participants by face-to-face interviews in Taichung, Taiwan. Performing physical activity regularly in parks is the most important measure of the amount of physical activity by the elderly. Providing sufficient and accessible parks in metropolitan residential neighborhoods could be one of the most cost-effective ways to promote physical activity for the elderly living in midsize Asian cities. [ABSTRACT FROM PUBLISHER]

Aim To examine the effect of self-efficacy, subjective work ability, depression and symptom distress on and to provide a description of, the employment and leisure activities of liver transplant recipients. Background Return to work and leisure activities have become an important aspect of life for liver transplant recipients worldwide. An investigation of the factors that influence the employment status and leisure activities has been recommended as a means to help transplant recipients restore their productivity. Design This was a cross-sectional, descriptive and correlational study in 2010. Methods A convenience sampling method was used. Data were collected using a set of questionnaires that were administered retrospectively. A total of 106 liver transplant patients were included in this study. Results The post-transplantation employment rate was 45·2%. The positive predictors of employment were higher subjective work ability and higher symptom distress. Gender (female), monthly family income (

Reservoirs are artificial ecosystems that modify the hydrological and environmental components nearby. The long-term monitoring of fish assemblages in reservoirs may provide key information to understand how these artificial ecosystems allow fish population fluctuations and identify proper conservation strategies. A sentinel-site approach method assessed changes in fish assemblages in the Feitsui Reservoir (1024 ha) over 14 years, including the periods 2006–2008, 2010–2011, 2016, 2018, and 2020. Fish assemblages, sampled using gill nets, were composed of 38 species (12 families and 8 orders) with Cyprinidae as the dominant family; the fish fauna were dominated by species of the family Cyprinidae (71%) and Cichlidae (20.3%). Principal component analysis and nonmetric multidimensional scaling categorized the assemblages into two groups (cold and warm seasons), and we identified three parameters that were significantly correlated with the season (p < 0.05): SD (R = −0.04), Chl-a (R = 0.01), and algal count (R = 0.19); the algal count was higher in the warm season than in the cold season. The fish assemblage in the cold and warm seasons contained no exclusive taxa, contributing to the dissimilarity between the groups. The fish assemblage for the years before and after 2010 indicated partial overlap between the two groups; S. macrops contributed greatly to the separation of the two periods (>10% each; SIMPER) and O. mossambicus was dominant in assemblage structures after 2010. Our findings show the importance of long-term fish monitoring for the investigation of the effects of nonnative fish species on native fish species composition. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the prevalence, types and sources of violence in the nursing workplace and to assess the factors related to violence. Background. Workplace violence in nursing is not a new phenomenon; in recent years, much more attention has been paid to the issue in Taiwan. Few studies, however, have investigated the overall distribution of violence and the reasons for not reporting these incidents in nursing workplaces. Design. This descriptive, correlational study used structured questionnaires to collecting information about workplace violence experienced by nurses over the last year. Methods. Nurses ( n = 880) working in a public hospital in southern Taiwan were invited to complete the questionnaires, with a response rate of 89·9%. Results. Nurses working in outpatient units and emergency rooms experienced more frequent violence than those on surgical wards and intensive care units. Conclusion. These findings provide evidence of workplace violence in hospitals and may aid hospital and nursing administration to reduce and control violence. Relevance to nursing practice. These results provide evidence in relation to the importance of effective communication training to nurses and will assist hospital administrations in establishing higher-quality, healthy workplace environments. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the cumulative effects intensive resistance training had on salivary immunoglobulin A (SIgA) and cortisol responses in elite male weightlifters. Researchers evaluated 11 elite male Taiwanese weightlifters. They found that prolonged intensive resistance training exerts cumulative effects on SIgA and cortisol responses in elite weightlifters.

Abstract: Despite the mandatory reporting by laws, the incompleteness of notifiable infectious disease reporting is well-documented in many countries for various diseases. The purpose of this study is to investigate the completeness of varicella reporting in Taiwan. Annual reports of National Notifiable Disease Surveillance System in Taiwan were compared to the annual outpatient claims of National Health Insurance (NHI) in the years of 2000, 2001, and 2002. Age and area-specific reporting rates of varicella were calculated by dividing the respective reported cases by the number of incidence cases. The reporting rate was the highest in aged 0 year in all years, followed by the 20–29- and 30–39-year groups. The reporting rate in each age group increased gradually during the study period. Other than Taipei City, the reporting rates in all regions were below 9% during this period. This study suggested that varicella reporting rate is very low in Taiwan. In addition, the reporting rates were inconsistent in 2000–2002, making the estimation of prevalence and vaccine efficacy using data from the National Notifiable Disease Surveillance System almost impossible. This study indicated that the physicians in Taiwan should improve their knowledge and attitude toward notifiable infectious diseases. [Copyright &y& Elsevier]

Fruits and vegetables have been known to contain a variety of antioxidant components. It has been suggested that antioxidants may protect biomolecules from oxidative damage and therefore be associated with reduced risks of cardiovascular disease and certain cancer. The antioxidant abilities of various parts of eight common fruits and vegetables produced in Taiwan were investigated, including tomato, guava, squash, tangerine, wax gourd, pineapple, chayote, and eggplant. Squash, wax gourd, tomato, and guava seeds showed the highest antioxidant activities in thiobarbituric acid assay. Wax guard and squash seeds showed the highest antioxidant activities in iodometric assay. At the level of 1 g fresh sample, low-density lipoprotein peroxidation was inhibited by at least 90% by tomato meat, guava meat, squash seed, wax gourd meat, core, and seed, and eggplant skin. The total phenolic content was significantly correlated with antioxidant activities measured by thiobarbituric acid (r = 0.715, P <0.01) and iodometric (r = 0.749, P <0.01) assays. The results of this study could be used for development of merchandise with potential health benefits from agricultural products. [ABSTRACT FROM AUTHOR]

Using 12 input-output tables compiled in Taiwan between 1964 and 1999, the role of the construction sector in the development of the Taiwanese economy is examined and analysed in relationship to other economic sectors. Analytical results reveal a two-stage inverted U-shaped relationship between the share of construction in GNP versus GNP per capita. The 'pull effect' of the Taiwanese construction sector is approximately equal to that of the Japanese construction sector over time, demonstrating that construction is more closely linked to the wider economy in Taiwan than elsewhere, like Italy, the UK and the USA. The 'push effect' increases significantly over time, indicating that the M&R (maintenance and repair) construction expenditures are growing in Taiwan. Finally, the direct and total construction input from manufacturing initially increased from 1969 and then declined after 1981, while the input from the service sector has been steadily growing. These findings confirm the increasing 'maturity' of the Taiwanese economy, a trend that mirrors the economic development of other AICs like Italy, Japan, the UK and the USA. [ABSTRACT FROM AUTHOR]

Atmospheric particulate matters (PMs) were measured in an industry-intensive region in central Taiwan in order to investigate the characteristics and possible sources of PMs. The samplings were simultaneously conducted using a 10- and 3-stage Micro Orifice Uniform Deposit Impactor (MOUDI) from 2017 to 2018. In this study, the characteristics of PMs in this region were evaluated by measuring the mass concentration of PMs and analyzing water-soluble ions and metallic elements, as well as dioxins. Additionally, principal component analysis (PCA) was used to identify the potential sources of PMs. The results showed that the mean concentration of coarse (>1.8 μm), fine (0.1–1.8 μm), and ultrafine (<0.1 μm) particles were 13.60, 14.38, and 3.44 μg/m3, respectively. In the industry-intensive region, the size distribution of ambient particles showed a bi-modal distribution with a high concentration of coarse particles in the spring and summer, while fine particles were dominant in the autumn and winter. The most abundant water-soluble ions of PMs were NO3−, Cl−, and SO42−, while the majority of metallic elements were Na, Fe, Ca, Al, and Mg in different particle sizes. The results of Pearson's correlation analysis for metals indicated that the particles in the collected air samples were related to the iron and steelmaking industries, coal burning, vehicle exhausts, and high-tech industries. The dioxin concentration ranged from 0.0006 to 0.0017 pg I-TEQ/Nm3. Principal component analysis (PCA) revealed that the contribution to PMs was associated with sea salt, secondary pollutants, and industrial process. [ABSTRACT FROM AUTHOR]

Background: Empowering personal health records (PHRs) provides basic human right, awareness, and intention for health promotion. As health care delivery changes toward patient-centered services, PHRs become an indispensable platform for consumers and providers. Recently, the government introduced "My health bank," a Web-based electronic medical records (EMRs) repository for consumers. However, it is not yet a PHR. To date, we do not have a platform that can let patients manage their own PHR.Objective: This study creates a vision of a value-added platform for personal health data analysis and manages their health record based on the contents of the "My health bank." This study aimed to examine consumer expectation regarding PHR, using the importance-performance analysis. The purpose of this study was to explore consumer perception regarding this type of a platform: it would try to identify the key success factors and important aspects by using the importance-performance analysis, and give some suggestions for future development based on it.Methods: This is a cross-sectional study conducted in Taiwan. Web-based invitation to participate in this study was distributed through Facebook. Respondents were asked to watch an introductory movie regarding PHR before filling in the questionnaire. The questionnaire was focused on 2 aspects, including (1) system functions, and (2) system design and security and privacy. The questionnaire would employ 12 and 7 questions respectively. The questionnaire was designed following 5-points Likert scale ranging from 1 ("disagree strongly") to 5 ("Agree strongly"). Afterwards, the questionnaire data was sorted using IBM SPSS Statistics 21 for descriptive statistics and the importance-performance analysis.Results: This research received 350 valid questionnaires. Most respondents were female (219 of 350 participants, 62.6%), 21-30 years old (238 of 350 participants, 68.0%), with a university degree (228 of 350 participants, 65.1%). They were still students (195 out of 350 participants, 56.6%), with a monthly income of less than NT $30,000 (230 of 350 participants, 65.7%), and living in the North Taiwan (236 of 350 participants, 67.4%), with a good self-identified health status (171 of 350 participants, 48.9%). After performing the importance-performance analysis, we found the following: (1) instead of complex functions, people just want to have a platform that can let them integrate and manage their medical visit, health examination, and life behavior records; (2) they do not care whether their PHR is shared with others; and (3) most of the participants think the system security design is not important, but they also do not feel satisfied with the current security design.Conclusions: Overall, the issues receiving the most user attention were the system functions, circulation, integrity, ease of use, and continuity of the PHRs, data security, and privacy protection. [ABSTRACT FROM AUTHOR]

Abstract: Background: Acupoint electrical stimulation (AES) is commonly used for pain management. However, its true or placebo effect to achieve pain relief needs to be verified. Objective: This study aimed to examine the true effect of AES to reduce postoperative pain in patients with spinal surgery receiving patient-controlled analgesia (PCA). Method: A placebo- and sham-controlled study was conducted. Participants were randomly assigned to intervention with AES at true acupoints (the AES group, n =30), AES at sham acupoints (the sham group, n =30), or no intervention with AES (the control group, n =30). Outcomes were assessed according to the amount of pain experienced and analgesics used. Results: There were significant differences among the three groups in pain relief across time, and the occurrence of PCA button pushed and amount of analgesics used. The beneficial effects of AES were discernible when compared to the sham and the control. Conclusions: AES at the true acupoints effectively reduced postoperative pain and analgesic usage. AES has now been implemented into healthcare and it is recommended that nurses be provided with the opportunity to earn their AES skills. More studies evaluating the effects of AES over a longer period and on pain after different surgical procedures are suggested. [Copyright &y& Elsevier]

Background: Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts. Purpose: The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families. Methods: This is a cross-sectional and correlational study. A stratified random sampling was conducted, and self-administered questionnaires were mailed to physicians, registered nurses, and social workers who work in long-term care facilities with accreditation ranks ≥ Grade A in Taiwan. Results: Questionnaires were returned by 478 participants (response rate = 94.1%). Fewer than 10% of the participants reported often discussing end-of-life care with residents with dementia and their families. Physicians were significantly more likely to discuss life-sustaining treatment than nurses and social workers. The frequency of professionals discussing advance directives and life-sustaining treatment for residents with dementia was predicted by higher confidence in end-of-life care skills and greater perceived facility support. Conclusions/Implications for Practice: Most professionals did not frequently discuss end-of-life care with residents with dementia and their caregivers. Discussions of end-of-life care in long-term care facilities should be promoted by enhancing the confidence of these professionals in providing end-of-life care and creating a supportive environment for end-of-life discussions and care. [ABSTRACT FROM AUTHOR]

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy is the primary treatment option for patients with non-small cell lung cancer (NSCLC). However, one of the major adverse effects associated with this therapy is skin toxicity, which impacts the patient's quality of life. This study aimed to describe the severities and locations of skin toxicity, and to analyze their association with the quality of life in patients with advanced NSCLC who received EGFR-TKI therapy as first-line treatment.This cross-sectional and correlation study was conducted at a tertiary medical center in northern Taiwan between July 2015 and March 2016. Skin toxicity was assessed and graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). The Skindex-16 scale was used to measure the skin disease-related quality of life.A total of 146 NSCLC patients who received EGFR-TKI therapy within the first 3 months of diagnosis were included in this study; 93.2% of these patients experienced skin toxicities. Approximately 70% of the patients developed xerosis and pruritus, while 50% had papulopustular eruptions and paronychia. The mean skin symptom impact score was 5.38 (standard deviation = 2.65). The skin-related quality of life varied widely among the participants but remained acceptable (mean score = 13.96, standard deviation = 16.55). Skin symptoms correlated significantly with poor quality of life (r = 0.50, P < .001). Younger patients and those treated with afatinib were the most affected, reporting the poorest quality of life. Patients who required EGFR-TKI dose reduction had experienced more severe skin symptoms than had patients who did not require it (7.35 vs 5.01, P < .001).Skin toxicity related to EGFR-TKI treatment impacts the quality of life in patients with NSCLC. During the treatment period, skin assessment and tailored management should be incorporated into the daily care plan.

To evaluate the association between the presence of asthma and allergy, and airborne endotoxin in homes of school-age children in Kaohsiung City, Taiwan, with a case-control study design by matching the age and class exposure. Data collection of home visits included an interviewer-administered questionnaire and air sampling of participants' homes for endotoxin, bacteria, and fungi, as well as temperature and relative humidity measurements. Endotoxin was detected in all air samples with a median value of 0.67 EU m -3 . In the adjusted logistic regression model, household airborne endotoxin was associated with higher prevalence of asthma and allergy; OR = 4.88 (95% CI 1.16-20.55) for Q3 (between 0.67 and 1.97 EU m  -3 ) vs. Q1 (< 0.31 EU m  -3 ), with statistical significance. Airborne fungi were associated with higher prevalence of asthma and allergy; OR = 4.47 (95% CI 1.13-17.69) for Q3 (between 314 and 699 CFU m  -3 ) vs. Q1 (< 159 CFU m  -3 ) in adjusted logistic regression models. Airborne endotoxin and fungi were significantly associated with children's asthma and allergy.

Exposure to phthalate esters (PAEs) poses health risks to humans. Much research has been performed evaluating PAE levels in foodstuffs, river sediment and drinking water, but little attention has been paid to their presence in urban outdoor environments where human activities are highly intense. Here we evaluated PAE presence and distribution in street dust in Kaohsiung, the most industrialized city in Taiwan. Our results showed that PAEs were ubiquitous in fifty-two street-dust samples (levels of total PAEs 5.4-989.2 mg kg -1 ). Di-(2-ethylhexyl) phthalate was the most abundant congener observed and made up 85.0%, 79.7%, and 97.2% of the total PAEs found in industrial, residential and commercial areas, respectively. PAE levels in street dust in commercial areas (night markets) were significantly higher, suggesting a higher risk of contamination on people present in these areas (H value > χ U 2 ). In residential and commercial areas, the higher the intensity of human activity, the higher the PAE content observed. PAE content decreased progressively from the center to the outskirts of the Houjing night market, suggesting that the increased human and consumer activities inside this commercial hotspot were the main PAE source in street dust. Children had higher estimated daily intakes (DIs) than adults and dermal absorption contributed more to these levels than oral ingestion. Although all calculated DIs were below referenced danger thresholds, street dust PAEs in the area should remain an environmental concern especially since night markets play an important role in Taiwanese/Asian culture and economy. Contrary to other studies, PAEs in this study were found less related to industrial manufacturing activities but highly linked to commercial activities. These findings are relevant for future pollution prevention efforts dedicated to mitigating public exposure to PAEs., Main Findings: PAE levels in street dust are related to commercial activities. Night markets, an important commercial activity in Taiwan, were found to contribute considerably to PAE contamination in street dust., (Copyright © 2018. Published by Elsevier B.V.)

Atmospheric particles are a major problem that could lead to harmful effects on human health, especially in densely populated urban areas. Chiayi is a typical city with very high population and traffic density, as well as being located at the downwind side of several pollution sources. Multiple contributors for PM 2.5 (particulate matter with an aerodynamic diameter ≥2.5 μm) and ultrafine particles cause complicated air quality problems. This study focused on the inhibition of local emission sources by restricting the idling vehicles around a school area and evaluating the changes in surrounding atmospheric PM conditions. Two stationary sites were monitored, including a background site on the upwind side of the school and a campus site inside the school, to monitor the exposure level, before and after the idling prohibition. In the base condition, the PM 2.5  mass concentrations were found to increase 15% from the background, whereas the nitrate (NO 3 - ) content had a significant increase at the campus site. The anthropogenic metal contents in PM 2.5 were higher at the campus site than the background site. Mobile emissions were found to be the most likely contributor to the school hot spot area by chemical mass balance modeling (CMB8.2). On the other hand, the PM 2.5 in the school campus fell to only 2% after idling vehicle control, when the mobile source contribution reduced from 42.8% to 36.7%. The mobile monitoring also showed significant reductions in atmospheric PM 2.5 , PM 0.1 , polycyclic aromatic hydrocarbons (PAHs), and black carbon (BC) levels by 16.5%, 33.3%, 48.0%, and 11.5%, respectively. Consequently, the restriction of local idling emission was proven to significantly reduce PM and harmful pollutants in the hot spots around the school environment., Implications: The emission of idling vehicles strongly affects the levels of particles and relative pollutants in near-ground air around a school area. The PM 2.5 mass concentration at a campus site increased from the background site by 15%, whereas NO 3 - and anthropogenic metals also significantly increased. Meanwhile, the PM 2.5 contribution from mobile source in the campus increased 6.6% from the upwind site. An idling prohibition took place and showed impressive results. Reductions of PM 2.5 , ionic component, and non-natural metal contents were found after the idling prohibition. The mobile monitoring also pointed out a significant improvement with the spatial analysis of PM 2.5 , PM 0.1 , PAH, and black carbon concentrations. These findings are very useful to effectively improve the local air quality of a densely city during the rush hour.

ABSTRACTBackground:Advance directives are important for nursing home residents with dementia; for those with advanced dementia, surrogates determine medical decisions. However, in Taiwan, little is known about what influences the completion of these advance directives. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan., Method: Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. Documentation of residents' advance directives, physical and cognitive status was obtained from medical charts. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Nursing home characteristics were obtained from each chief administrator., Results: Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider; nursing homes had policies for advance directives and a religious affiliation., Conclusions: Advance directives were uncommon for nursing home residents with dementia. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities; there was no association with characteristics of the nursing home resident. Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive.

Background: Factors affecting quality of life (QOL) ratings for people with dementia (PWD) have been well studied, but few studies have examined the effect of residence on PWD- and caregiver-rated QOL for PWDs. We designed this study to determine the factors related to PWD- and caregiver-rated QOL in dementia as well as factors related to the discrepancy in these ratings., Methods: For this cross-sectional study, we analyzed data from a convenience sample of 106 PWD-family caregiver dyads (58 community-dwelling dyads and 48 nursing-home dyads). PWDs' data included socio-demographic variables, QOL (assessed by the Quality of Life-Alzheimer's Disease [QOL-AD] scale), cognition, dementia severity, depression, comorbidities, and quality of the dyadic relationship. Caregivers' data included socio-demographic variables, depressive symptoms, and mutuality of the dyadic relationship., Results: QOL-AD scores were lower when rated by caregivers than by PWDs. The key factors positively related to both PWD- and caregiver-rated QOL for PWDs were fewer PWD depressive symptoms and higher quality of the PWD-caregiver relationship. The key factors related to the discrepancy in PWD- and caregiver-rated QOL in dementia were PWD residence in a nursing home and lower dementia severity, as well as higher caregiver depression, being an adult child caregiver, and lower caregiver-PWD mutuality., Conclusion: Caregiver-rated QOL for PWDs and the discrepancy in rated QOL were significantly associated with PWD residence. If caregiver-rated QOL is needed, the effect of residence of PWD should be taken into consideration. Caregivers' depressive status and mutuality with PWD must be also carefully assessed.

Background: Chinese culture plays a significant part in how Taiwanese families view life events. Caregivers envisage themselves as guardians of their children in all facets of family life, including wellness and strive to maintain harmonious relationships within the family. However, it remains unclear what impact caring for an adolescent with cancer has on family roles and relationships in Taiwanese families, nor are the processes for managing change in family roles and relationships associated with caregiving well understood., Objective: This study explores the impact of caregiving for an adolescent with cancer on the roles and relationships within Taiwanese families., Methods: Seven families were recruited from a medical hospital in Taiwan. Data were collected through qualitative interviews and analyzed following Strauss and Corbin's grounded theory., Results: The core category, underpinned by Chinese culture, proved to be experiencing the broken chain of family life. This was the central issue brought about by 4 consequences for the broken chain of family life. The expression "the broken chain of family life" encapsulates how important Chinese cultural values are in defining caregiver task performance., Conclusions: The findings have implications for Taiwanese families in perceiving, adjusting to, and fulfilling the altered roles and relationships associated with caring for an adolescent with cancer at home., Implications for Practice: The delivery of exceptional care and services depends on gaining insight into how caregiving influences family roles and relationships. How families failed to manage the process of caregiving provides valuable insight for informing and providing recommendations for services and support.

Unlabelled: The central nervous system plays a crucial role in the development of physical fatigue. The purpose of this study is to investigate the effect of combined supplementation of branched-chain amino acids (BCAA) and arginine on intermittent sprint performance in simulated handball games on 2 consecutive days., Methods: Fifteen male and seven female handball players consumed 0.17 g/kg BCAA and 0.04 g/kg arginine together (AA trial), or placebo (PB trial) before exercise. Each trial contained two 60-min simulated handball games on consecutive days. The game was consisted of 30 identical 2-min blocks and a 20 m all-out sprint was performed at the end of each block. The performance, measured by percentage changes of sprint time between day 1 and 2, was significantly better in the AA trial (first half: AA trial: -1.34 ± 0.60%, PB trial: -0.21 ± 0.69%; second half: AA trial: -1.68 ± 0.58%, PB trial: 0.49 ± 0.42%). The average ratings of perceive exertion throughout the 2-day trial was significantly lower in the AA trial (14.2 ± 0.3) than the PB trial (15.1 ± 0.4). Concurrently, post-exercise tryptophan/BCAA ratio on both days in the AA trial was significantly lower than the baseline. This study showed that BCAA and arginine supplementation could improve performance in intermittent sprints on the second consecutive day of simulated handball games in well-trained athletes by potentially alleviating central fatigue.

Background: Although the genetic basis of androgenic alopecia has been clearly established, little is known about its non-genetic causes, such as environmental and lifestyle factors., Objective: This study investigated blood and urine heavy metals concentrations, environmental exposure factors, personal behaviors, dietary intakes and the genotypes of related susceptibility genes in patients with androgenic alopecia (AGA)., Design: Age, AGA level, residence area, work hours, sleep patterns, cigarette usage, alcohol consumption, betel nut usage, hair treatments, eating habits, body heavy metals concentrations and rs1998076, rs913063, rs1160312 and rs201571 SNP genotype data were collected from 354 men. Logistic regression analysis was performed to examine whether any of the factors displayed odds ratios (ORs) indicating association with moderate to severe AGA (≥ IV). Subsequently, Hosmer-Lemeshow, Nagelkerke R(2) and accuracy tests were conducted to help establish an optimal model., Results: Moderate to severe AGA was associated with the AA genotype of rs1160312 (22.50, 95% CI 3.99-126.83), blood vanadium concentration (0.02, 95% CI 0.01-0.04), and regular consumption of soy bean drinks (0.23, 95% CI 0.06-0.85), after adjustment for age. The results were corroborated by the Hosmer-Lemeshow test (P = 0.73), Nagelkerke R(2) (0.59), accuracy test (0.816) and area under the curve (AUC; 0.90, 0.847-0.951) analysis., Conclusions: Blood vanadium and frequent soy bean drink consumption may provide protect effects against AGA. Accordingly, blood vanadium concentrations, the AA genotype of rs1160312 and frequent consumption of soy bean drinks are associated with AGA.

Pharmacologic agents are considered to be a cornerstone of cancer pain management. Patients' concerns about use of analgesics are likely to lead to poor pain management. The purpose of this study was to describe participants' responses to their beliefs regarding pain and prescribed opioids. Ninety-two outpatients age ≥18 years who had taken prescribed opioid analgesics for cancer-related pain in two teaching hospitals in the Taipei area completed the Pain Opioid Analgesics Beliefs Scale-Cancer. An important finding of this study is that large numbers of patients had misconceptions about using opioids for pain. Between 33.7% and 68.5% of the patients in this study held negative beliefs about opioids and beliefs about pain. Specifically, 68.5% of the patients agreed that "opioid medication is not good for a person's body." Many patients (62%) agreed that "the more opioid medicine a patient used, the greater the possibility that he/she might rely on the medicine forever," and 61.0% agreed that "if a patient starts to use opioid medicine at too early a stage, the medicine will have less of an effect later." Two-thirds (66.3%) of the sample agreed that adult patients should not use opioid medicine frequently. The findings provide empirical support for the need for better programmatic efforts to improve beliefs of pain and analgesics in Taiwanese oncology outpatients., (Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.)

Social and behavioral scientists have proposed that a person's belief system crucially influences his or her behaviour, and therefore may affect outcomes of pain management. The purpose of this study was to explore the relationship between analgesic beliefs, analgesic adherence and pain experience amongst Taiwanese cancer outpatients. The cross-sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Pain Opioid Analgesic Beliefs Scale-Cancer (POABS- CA), opioid adherence, and the Brief Pain Inventory-Chinese (BPI-Chinese). Beliefs about pain and opioids demonstrated a significant relationship with patients' opioid adherence (r = -0.30, p < 0.01). The more negative beliefs regarding opioids and pain the patient had, the worse their adherence to around the clock (ATC) analgesic regimen. However, there was no significant correlation between opioid belief and pain experience. As well, there were no significant relationships between adherence to opioid regimen and any of the measures of pain experience. The study highlights the potential importance of a patient's pain and opioid beliefs in adherence to pain medication.

Objective: Previous studies on the relationship between sleep duration and body mass index (BMI) have shown inconsistent results by using estimation strategies within the framework of ordinary least squares (OLS). This study examined the relationship between sleep duration and BMI by using quantile regression to account for the potential heterogeneous effect of sleep duration on BMI in different BMI categories., Methods: The data of 2,392 adults were from the 2005 Panel Study of Family Dynamics in Taiwan. The dependent variable was BMI of the respondents. Both OLS and quantile regression models were used for comparison., Results: The OLS model does not show significant relationship, while the quantile regression model shows a U-shaped relationship between sleep duration and BMI beyond the 90th percentile in men (BMI = 28.69) and an inverse U-shaped relationship at the 30th percentile of BMI in women (BMI = 21.37)., Conclusions: Quantile regression can provide information that may be masked by OLS in analyzing the relationship between sleep duration and BMI. Sleep modification with the aim to obtain the optimal sleep duration may help to reduce BMI in obese men.

Purpose: This study sought to evaluate the Chinese version of the eight-item Parkinson's Disease Questionnaire (PDQ-8), through standard psychometric techniques., Methods: A cross-sectional study was conducted on 100 Parkinson's disease patients attending a Movement Disorders Unit. Neurologists' assessments were based on Hoehn and Yahr, Schwab and England and Unified Parkinson's Disease Rating Scales. Patients' self-evaluations included the Taiwanese Depression Questionnaire, the 39-item Parkinson's Disease Questionnaire (PDQ-39) and PDQ-8, pain, and Pittsburgh Sleep Quality Index. Analyses for internal consistency, inter-rater reliability, and construct validity were performed., Results: There was no evidence of floor or ceiling effects. The alpha coefficient was 0.81. Correlation of social support and bodily discomfort with the PDQ-8 was modest (0.46 and 0.36, respectively). PDQ-8 convergent validity with the PDQ-39 was very high (r = 0.96), and known-groups validity proved satisfactory., Conclusions: The results of this study suggest the PDQ-8 is a valid and reliable disease-specific health-related quality-of-life instrument for Parkinson's disease in Taiwan when used independently of the PDQ-39.

Ozone sensitivity was investigated using CAMx simulations and photochemical indicator ratios at three sites (Pingtung City, Chao-Chou Town, and Kenting Town) in Pingtung County in southern Taiwan during 2003 and 2004. The CAMx simulations compared fairly well with the hourly concentrations of ozone. Simulation results also showed that Pingtung City was mainly a volatile organic compounds (VOC)-sensitive regime, while Chao-Chou Town was either a VOC-sensitive or a NOx-sensitive regime, depending on the seasons. Measurements of three photochemical indicators (H2O2, HNO3, and NOy) were conducted, and simulated three transition ranges of H2O2/HNO3 (0.5-0.8), O3/HNO3 (10.3-16.2) and O3/NOy (5.7-10.8) were adopted to assess the ozone sensitive regime at the three sites. The results indicated that the three transition ranges yield consistent results with CAMx simulations at most times at Pingtung City. However, both VOC-sensitive and NOx-sensitive regimes were important at the rural site Chao-Chou Town. Kenting Town, a touring site at the southern end of Taiwan, was predominated by a NOx-sensitive regime in four seasons.

Objectives: The purpose of this study was to evaluate the effect of acupoint electrical stimulation with patient-controlled analgesia (PCA) on reducing acute pain, nausea, and vomiting after surgery for nontraumatic spinal cord injury., Methods: A randomized, controlled, repeated measures research design was used. Ninety-nine patients undergoing lumbar spinal surgery were randomly assigned to one of three groups. Patients in experimental group 1 (EG1) received true acupoint electrical simulation three times, whereas those in experimental group 2 (EG2) received sham acupoint manually. Patients in the control group (CG) received no acupoint intervention. All patients were measured for pain, initial demand for PCA, demand for opiates, opiate dose, vital signs, and postoperative nausea and vomiting (PONV)., Results: Significant differences were found in postoperative pain, respiratory rate, blood pressure, and opiate doses across time in the three groups with better outcomes observed in EG1 than in EG2. However, no between-group difference was found in initial demand for PCA or in PONV., Conclusions: The study demonstrates that acupoint electrical stimulation improves acute postoperative pain management without adversely affecting vital signs after surgery for nontraumatic spinal injury. More studies are needed to evaluate the effects ofacupoint electrical stimulation on PONV and postoperative pain following other surgical procedures.

Aims: The aim of this study is to quantify the amount and causes of stress in renal transplant recipients., Background: After renal transplantation, patients may encounter physical and psychosocial problems. Through patient collaboration with healthcare professionals, treatment after transplantation is aimed at restoring and maintaining a 'normal' life. To achieve quality of life, research needs to quantify the amount and causes of stress of renal transplant recipients, from a patient-centred perspective., Design: A cross-sectional, descriptive study., Methods: The study was conducted in the outpatient department of a medical centre in northern Taiwan from September 2005-February 2006. The recipients were a convenience sample of 153 participants who had undergone renal transplantation., Results: The results showed that renal transplant recipients had low to moderate stress in four areas. Gender (male), self-efficacy and hospitalisation for infection explained 17% of the variance found for the stress of uncertainty; hospitalisation for rejection and infection explained 22% of the variance for complications; and gender (male) and self-efficacy explained 8% of the variance for the interactions with others. Post-transplant time was not found to be a predictor of stress., Conclusion: After renal transplantation, patients experience multi-dimensional stresses that previous research has not explored. Self-efficacy was shown to be a significant predictor of the stress of uncertainty and interactions with others. Enhancing recipients' self-efficacy of self-care behaviour can lower the stress that found in three areas., Relevance to Clinical Practice: Healthcare professionals should develop an evidence-based programme for stress management for renal transplantation patients that incorporates strategies to enhance patient's self-efficacy of self-care behaviour. Recipients' beliefs in their ability to successfully perform self-care behaviour can be promoted by a mastery experience, vicarious experience with other patients, social persuasion and re-explanation of somatic and emotional states by discussing coping methods with healthcare professionals., (© 2010 Blackwell Publishing Ltd.)

Purpose: This study evaluated the effects of a potentiality education program on potentiality and job satisfaction among psychiatric nurses., Design and Methods: This quasiexperimental study recruited 59 psychiatric nurses, of whom 26 were assigned to an experimental group, based on their interest in participating in the program, and 33 to a control group., Findings: The results indicated that the scores for job satisfaction were significantly higher in the experimental group than in the control group. Specifically, potentiality education promoted job satisfaction but had no significant influence on potentiality. PRACTICE APPLICATION: Increasing nurses' potentiality could help them to successfully cope with their large workload and the various challenges of their job.

Background: Epidemiological surveillance of infectious diseases through the mandatory-reporting system is crucial in the planning and evaluation of disease control and prevention program. This study investigated the reporting behavior, knowledge, and attitude to reporting communicable disease in private doctors in Taiwan. The differences between the reporting and non-reporting doctors were also explored., Methods: A total of 1250 clinics were randomly sampled nationwide by a 2-stage process. Data were collected from 1093 private doctors (87.4% response rate) using a self-administered structured questionnaire. Four hundred and six (37.2%) doctors reported having diagnosed reportable communicable diseases. Among them, 340 (83.5%) have the experiences of reporting., Results: The most common reasons for not reporting were "do not want to violate the patient's privacy", "reporting procedure is troublesome", and "not sure whether the diagnosed disease is reportable". Significantly higher proportions of the non-reporting doctors considered the reporting system inconvenient or were not familiar with the system. The highest percentage (65.2%) of the non-reporting doctors considered that a simplified reporting procedure, among all measures, would increase their willingness to report. In addition, a significantly higher proportion of the non-reporting doctors would increase their willingness to report if there has been a good reward for reporting or a penalty for not reporting., Conclusion: The most effective way to improve reporting rate may be to modify doctor's attitude to disease reporting. The development of a convenient and widely-accepted reporting system and the establishment of a reward/penalty system may be essential in improving disease reporting compliance in private doctors.

Aim: This paper is a report of a study to explore the self-management behaviours of patients with chronic obstructive pulmonary disease (COPD)., Background: Chronic obstructive pulmonary disease is a major cause of chronic morbidity and mortality throughout the world. A patient-centred perspective calls for the investigation of self-management behaviours as means to develop self-management programmes and enhance quality of life for patients with COPD., Method: The participants were a convenience sample of 18 patients with COPD of various severities. Interview data were collected in the thoracic ward, outpatient department and pulmonary rehabilitation unit of a medical centre in Taiwan from November 2006 to April 2007., Findings: Participants demonstrated the ability to choose suitable disease management behaviours to prevent symptoms and complications. Five themes of disease management behaviours were identified: symptom management, activity and exercise implementation, environmental control, emotional adaptation and maintaining a healthy lifestyle., Conclusion: Participants are experts on their lives and, as such, they adopt appropriate disease control behaviours, based on their experience and knowledge, as well as integrate the illness and its symptoms into their lives. With the worldwide increase in migration, an understanding of the cultural factors that influence patients' perspectives on self-management behaviours is necessary and can contribute to the development of an evidence-based programme for disease self-management with COPD.

The national hepatitis B vaccination program in Taiwan began in July 1984. The purpose of this repeated survey was to investigate the levels of anti-HBs (hepatitis B surface antibody) in the first-year students of a 5-year nursing program in Taiwan. Each year during 2000-2006, the entering students of the 5-year nursing program at Fooyin University, a vocational university located in southern Taiwan, were examined for their HBsAg and anti-HBs status using commercially available microparticle enzyme immunoassay. The seroprevalence of HBsAg (+) showed a significant trend of decrease, dropping 57% from 4.9% in 2000 to 2.1% in 2006. The seroprevalence of anti-HBs (+) also showed a significant trend of decrease, dropping 49% from 77.1% in 2000 to only 39.7% in 2006. With the relatively low seroprevalence of anti-HBs (+) of the future healthcare workers and high HBV endemicity in Taiwan, recommendation of serology test before boosting to nursing students before they proceed their clinical practice is prudent.

During 2003-2004, approximately 13% of birth in Taiwan was given by foreign-born females. The aims of this study were to compare the seroprevalence of rubella antibodies between Taiwan-born and foreign-born pregnant women and evaluate the effect of rubella vaccination program in Taiwan. We reviewed the rubella antibody test results of 5007 women during routine pregnancy check-ups at Fooyin University Hospital during 1999-2002. In Taiwan-born women, rubella antibody was undetectable in 29.2%, 7.3%, and 8.3% of the cohorts born before 1971, between 1971 and 1976, and after 1976, respectively. In the cohorts born between 1971 and 1976 and after 1976, pregnant women born in China, Vietnam, Indonesia, and Philippines had significant higher chances of being susceptible. Our results suggested that the voluntary adult vaccination program was not as effective as the school or wipe-out programs. Both Taiwanese women born before 1971 and foreign-born women were more likely to be susceptible to rubella. The introduction of 'catch-up' immunization program and enforcement of the checking of immunization record and/or blood test before pregnancy for these women are necessary in preventing CRS.

The aims of this study were to investigate the epidemiology of varicella and evaluate the effect of varicella vaccination on the burden of varicella in Taiwan. The outpatient and hospitalization claims made to the National Health Insurance (NHI) in public and private vaccination areas were compared during 2000-2002. In 2002, the outpatient visit rates for 1- to 5-year-old children in public vaccination areas were 66-78% lower than their counterparts in private vaccination areas. The reduction in outpatient visit rate was the greatest among preschool children. The reductions also occurred in every age group including infants and adults. This study showed significant evidence of vaccine impact with a marked decline in clinical cases in the short term.

This work analyzes the variations in daily maximum 1-hr ozone (O3) concentrations and the long-term trends in annual means of hourly ambient concentrations of O3, nitrogen oxides (nitrous oxide + nitrogen dioxide), and nonmethane hydrocarbons in the three administrative regions of Kao-Ping airshed in southern Taiwan over a recent 8-yr period. The annual or monthly means of all maxima, most 95th percentiles, and some 90th percentiles of the daily maximum 1-hr O3 concentrations exceed the daily limit of 120 parts per billion by volume in all three regions, namely, Kao-hsiung City, Kso-hsiung County, and P'ing-tung County. The monthly means of daily maximum 1-hr O3 concentrations exhibit distinct seasonal variations, with a bimodal form with the maxima in autumn and late winter to the middle of spring and a minimum in summer. The long-term variations in the annual means of hourly O3 concentrations in the three regions exhibit increasing trends. These increases in O3 are associated with the decline in ambient concentrations of nitrogen oxides and nonmethane hydrocarbons. High O3 episodes occur most often in autumn and most rarely in summer. The seasonal mean mixing heights in descending order follow the order of spring, summer, autumn, and winter. Meteorological parameters in autumn and winter indicate that the ground-level O3 tends to accumulate and trigger a high O3 episode on a warm day with sufficient sunlight and low wind in a high-pressure system, consistent with the low mixing heights in these two seasons.

Background: Japanese encephalitis (JE) occurs all over Asia, especially in southeastern regions. The aim of this study was to evaluate the current JE vaccination regimen in Taiwan by assessing the neutralizing antibody among people of various age groups from different living environments., Methods: From 1998 to 1999, 2365 (1016 male, 1349 female) students and home-visit volunteers were recruited from an industrialized city (Kaohsiung), and 712 (290 male, 422 female) students and volunteers from hospital outpatient and physical check-up units were recruited from country townships (Pintung County) for this study. Participants were between 6 and 74 years old. Serum JE neutralizing antibody was measured by the plaque reduction neutralization test with a 50% reduction as seroconversion. Incidence cases from 1971 to 1999 were collected from an active surveillance system run by the Center for Disease Control in Taiwan., Results: Seropositive prevalence peaked immediately after the second booster in first-grade students and declined as age increased. For those born before 1963, seropositive prevalence was significantly associated with age, sex, and living area. In the 1990s, the incidences of confirmed JE in Kaohsiung and Pintung County were 0.11 and 0.14 per 100,000 population, with only 2 and 1 patient age 10 years or younger, respectively. All but 2 patients had never been vaccinated., Conclusions: Seropositive prevalence decreased gradually after vaccination. A third booster (the fifth shot) before age 18 years may further enhance the antibody titers, especially if the odds of natural infections have significantly reduced. Follow up studies on the changes of antibody titers over time among immunized populations are warranted in Asian countries where natural infections become less common.

Background: Varicella vaccine was first available in Taiwan in 1997. The aims of this study were to investigate varicella vaccine safety and occurrence of breakthrough in Taiwan during the first 3 years. The adverse events, incidence of breakthrough, and factors associated with breakthrough were analyzed., Methods: A personal interview using a structured questionnaire was conducted for the parents of 1248 children less than 12 years old who were vaccinated between 1998 and 2000. Incidence of adverse events and breakthrough were presented and factors associated with breakthrough were estimated by logistic regression., Results: There were 27 (2.16%) breakthrough cases occurring during the maximum follow up period of 31 months, including 22 very mild or mild cases, 3 moderately severe cases, and 2 severe cases. Compared with those who did not have confirmed history of varicella exposure after vaccination, children with such exposure were approximately 28 times as likely to have breakthrough varicella develop (adjusted odds ratio = 27.75, 95% confidence interval: 6.12-125.78, P =.00). There were 91 (7.3%) reported cases of adverse events, including rash, fever, and pain or swelling, occurring within 2 weeks of vaccination., Conclusions: Although rare adverse events cannot be well-quantified in this study, the results suggest that, at least in the short term, varicella vaccine is well-tolerated and effective in Taiwan. Long-term monitoring program is necessary to ensure the safety of this vaccine.