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Extreme weather events, such as heavy rainfall and typhoons, are becoming more frequent due to climate change and can significantly impact coastal microbial communities. This study examines the short-term alterations in microbial food webs-viruses, bacteria, picophytoplankton, nanoflagellates, ciliates, and diatom-following Typhoon Krathon in Taiwan's coastal waters in October 2024. Daily in situ sampling revealed a significant post-typhoon increased in viral, nanoflagellate, and Synechococcus spp. abundance. Furthermore, viral, Synechococcus spp., and nanoflagellate abundance increased by approximately 4.2 to 12.8-fold, 33.3 to 160 fold, and 0.5 to 9.4 fold in response to these weather events, compared to periods pre-typhoon, respectively. Modified dilution experiments showed that, before the typhoon, nanoflagellate grazing was the major cause of bacterial mortality, while viral lysis was the main cause of Synechococcus spp. mortality. Post-typhoon, there was a notable shift, with nanoflagellate grazing increasing mortality rates of bacteria and Synechococcus spp., suggesting that grazing became the dominant top-down control mechanism after the disturbance. Our findings suggest that extreme weather events shift microbial mortality dynamics, increasing the role of grazing in controlling microbial populations, with potential implications for carbon cycling in coastal ecosystems., Competing Interests: Declaration of competing interest All authors have declared that: (i) no support, financial or otherwise, has been received from any organization that may have an interest in the submitted work; and (ii) there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Background: Global populations are aging, and the numbers of stroke survivors is increasing. Consequently, the need for caregiver support has increased. Because of this and demographic and socioeconomic changes, foreign caregivers are increasingly in demand in many developed countries. Therefore, the perspectives of older adult care recipients regarding foreign caregivers warrants attention. This study explored the experiences of older stroke survivors receiving care from foreign caregivers in Taiwan, examining their expectations, needs, and challenges., Methods: This study employed a descriptive qualitative approach, conducting in-depth interviews with 23 older stroke survivors (mean age, 73.4 years; women, 47.8%). Thematic analysis was applied to transcribed data, with reflective memos aiding in meaning derivation. Methodological rigor was ensured through member checking, triangulation, and auditing., Results: Three major themes emerged: the motivations for hiring a foreign caregiver, expectations of stroke survivors toward foreign caregivers, and challenges related to employing foreign caregivers. Stroke survivors expected foreign caregivers to be obedient, embrace the local language and culture, and be proficient in caregiving and homemaking. Various challenges, including communication difficulties, cultural differences, skill gaps, and unfavorable attitudes and behaviors among caregivers, were noted., Conclusions: Foreign caregivers are a major part of the long-term care workforce and play a crucial role in stroke rehabilitation in aging Asian societies. Older stroke survivors often hire foreign caregivers to alleviate caregiving burdens, and they typically expect foreign caregivers to conform to their needs. However, employing foreign caregivers can be frustrating and stressful. Government intervention and open dialogue is necessary to improve care quality and prevent recurring caregiving problems and conflicts., Competing Interests: NO authors have competing interests., (Copyright: © 2025 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Strategy training is a rehabilitation intervention that aims to enhance problem-solving skills with respect to daily activity-related challenges and has achieved favorable results in Western countries. This study explored the perspectives of individuals with acquired brain injury (ABI) in Taiwan who received strategy training., Materials and Methods: Semi-structured interviews with community-dwelling adults with ABI were conducted, and reflective memos made by research team members were recorded. Interviews and memos were analyzed through thematic analysis., Results: This study included 55 participants. The analysis of the participants' interview responses and memos yielded nine themes under three categories: 1) expectations regarding strategy training, 2) perceived benefits of strategy training, and 3) barriers affecting the process and outcomes of strategy training., Conclusions: All the participants endorsed strategy training through different gains. Most participants' expectations before the intervention were uncertain. Including family members into the strategy training is of key importance for a successfulness of their goals. The participants' experiences about strategy training were affected by various barriers (i.e., health and medical problems, the physical environment, and natural events). Clinicians and researchers should consider these expectations, benefits, and barriers when studying and implementing strategy training in non-Western contexts.IMPLICATIONS FOR REHABILITATIONStrategy training provides clients the opportunity to actively engage in their own goal setting and decision making.Strategy training increases the client's confidence in their ability to participate in the community, communicate, and perform daily living and physical activities.Therapists should consider the health conditions and physical environment of clients when helping them set goals and before facilitating their engagement in the community.Taiwanese family members play a crucial role in supporting acquired brain injury survivors in strategy training.

Purpose: Strategy training is a promising stroke rehabilitation intervention commonly delivered in Western countries. We examined the perspectives of rehabilitation therapists who have delivered strategy training in Taiwan and the United States to understand the influence of culture on strategy training implementation., Materials and Methods: In this rapid ethnographic study, the maximum variation sampling approach was used to recruit seven therapists in Taiwan and seven therapists in the United States with experience delivering strategy training. Data was collected from multiple sources, including interviews, study documents, therapist notes, and reflective memos. Interviews with the recruited therapists in Taiwan and the United States were conducted in Mandarin and English, respectively. Data were analyzed using a constant comparative approach., Results: The following two themes were generated: (1) differences between conventional rehabilitation and strategy training, namely that conventional rehabilitation is therapist-directed and emphasizes impairment reduction, whereas strategy training empowers clients and focuses on real-life generalization, and (2) challenges in implementing strategy training in practice, including difficulty in achieving client buy-in and disengagement., Conclusions: Therapists from both countries shared similar perspectives on the perceived advantages of strategy training, such as enhancing client empowerment and engagement, and the generalization of strategies. Family involvement was more prominently discussed by therapists in Taiwan than by those in the United States.IMPLICATIONS FOR REHABILITATIONStrategy training differs from conventional rehabilitation in its emphasis on clients' life participation and empowerment, generalization of strategies, and enhancement of their engagement, confidence, and problem-solving skills.Therapists may face challenges related to client buy-in and disengagement as well as difficulties in establishing a therapeutic rapport at the beginning of strategy training because clients have different expectations from those of conventional rehabilitation.Cultural differences in norms and expectations and the clinical experiences of therapists may influence the delivery of strategy training to clients.Family support may influence the success of strategy training.Thoughtful conversations to reach a mutual understanding regarding the expectations of strategy training among clients, family, and rehabilitation practitioners are necessary prior to implementing strategy training.

Purpose: To learn about the experiences of stroke recovery among young stroke survivors in Taiwan and to elucidate the beliefs, goals, and facilitators of and barriers to their recovery., Methods: A qualitative approach was used for data collection, and data were obtained from five focus groups consisting of stroke survivors aged 20-64 years ( n  = 25). Data were transcribed verbatim and analyzed thematically by two independent coders using NVivo version 10., Results: "Returning to prestroke status" was a common belief of recovery for stroke survivors; their goals of recovery changed overtime from regaining physical functions, independent living, and participating in work and leisure activities to maintaining functions or returning to normality. Their perceived personal and environmental facilitators of recovery included positive attitude, family and friends, and rehabilitation, whereas barriers to recovery included psychological factors, social stigma, and physical environment., Conclusion: These findings provide useful insights for rehabilitation clinicians to develop culturally tailored interventions to improve poststroke recovery outcomes in young stroke survivors.Implications for rehabilitationRehabilitation clinicians should understand stroke survivors' beliefs and goals of recovery to provide tailored services.Optimizing the goal-setting process and patient-provider communication may help clinicians and survivors examine and adjust their expectations toward recovery during rehabilitation.Interventions will be needed to address personal and environmental supports and barriers, such as motivation, psychological factors, social support, and the physical environment to help survivors achieve their recovery goals.

Abstract: Despite the increasing popularity of table tennis worldwide, few studies have focused on table tennis injuries.This study aimed to investigate the injury profiles, including the injury rate, types, locations, and risk factors, among nonprofessional collegiate table tennis athletes in Taiwan.We performed an online investigation among collegiate table tennis athletes of the nonprofessional category in the 2019 National Intercollegiate Athletic Games in Taiwan. Participants provided general information, and data on the characteristics of their play style, training, and injuries were collected. We then categorized these participants into injured and noninjured groups. Injuries were classified as mild, moderate, and severe, based on the time loss in playing table tennis. The risk factors for table tennis-related sports injuries were then identified through between-group comparisons.In total, 150 participants responded to the questionnaire. The average participant age was 21.3 years. Gender differences existed in age categories, forehand rubber, backhand style of play, and average days of training per week. Over the 6 months before the study, 76 of 150 participants experienced at least one injury. The handedness for play was associated with the occurrence of injury. Factors associated with injury severity included using rubber other than inverted rubber for the forehand and not qualifying for the national round of the team category of the National Intercollegiate Athletic Games.With a considerably high injury rate among nonprofessional collegiate athletes, further studies are required on table tennis-related injuries. Playing styles such as handedness and type of rubber used might be associated with the injury. The lower limb was the most common site of injury. These results may provide insights into trainers and coaches for further measures on injury prevention., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To determine whether dextrose prolotherapy offers clinical benefits in patients with shoulder pain and bursitis., Design: Double-blinded, randomized controlled trial., Setting: Outpatient rehabilitation department of a single medical center., Participants: Patients (N=50) who had received a diagnosis of shoulder pain and bursitis through clinical tests and ultrasound examination., Interventions: Participants were randomly assigned to the 15% dextrose injection (D15W) group or the placebo group to receive either D15W or normal saline injection, respectively. All participants received ultrasound-guidance bursal injection every 2 weeks for a total of 3 injections., Main Outcome Measures: The primary outcome was maximal pain level while performing activities. The secondary outcomes included resting pain level, function and disability assessment results, and ultrasonographic parameters. Participants were followed up for 3 months after completion of the injection course., Results: No significant differences in baseline characteristics were observed between the D15W and placebo groups. Significant time effects were observed for all outcome parameters (all P<.05); however, time × group effects were nonsignificant for all outcomes, except for tissue elasticity (P=.026)., Conclusions: Supporting evidence is insufficient regarding the clinical benefits of 15% dextrose bursal injection administered through 3 sessions in patients with chronic shoulder pain and bursitis. The findings indicate that these injections may increase the tissue stiffness of the supraspinatus tendon, as indicated by elastography assessment results, but further research is required to determine the nature of such changes in elastography findings., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Stroke can lead to life-long disability and constitutes a huge financial burden on the family and society. Stroke survivors with cognitive impairment often experience considerable challenges in the process of recovery and returning to society. Interventions that effectively help individuals resume essential daily activities and return to active participation in their communities are lacking. This study examines the efficacy of a newly-developed intervention programme, the Optimising Participation after Stroke through Strategy-training (OPASS) programme, for improving community participation among stroke survivors with cognitive impairment., Methods and Analysis: A single-blind, parallel-group randomised controlled trial with allocation concealment and assessor blinding will be implemented to assess the efficacy of the OPASS programme. An expected 210 adults with cognitive impairment following stroke will be randomly assigned to either the experimental intervention (OPASS) group or the attention control group. In addition to their usual rehabilitation, both groups will receive 45 min sessions, twice weekly for a total of 12-15 sessions. The primary outcome is change in participation performance, which will be measured using the participation measure-three domains, four dimensions scale. Additional measures include the Activity Measure for Post-Acute Care generic outpatient short forms, Montreal Cognitive Assessment, Stroop Test, Trail Making Test and General Self-Efficacy Scale. These scales will be administered at baseline, post-intervention, 3-month follow-up, 6-month follow-up and 12-month follow-up. Their results will be analysed using multiple linear regression models and mixed-effects regression models. Further assessment of feasibility and acceptability of the intervention will be conducted through structured interviews with participants, caregivers and therapists. These interviews will be transcribed and thematically analysed., Ethics and Dissemination: Ethics approval was obtained from the Ethics Committee of Taipei Medical University (approval number: N201804055). The findings will be disseminated through presentations at scientific conferences and through publication in peer-reviewed journals., Trial Registration Number: NCT03792061; pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: A standardized functional measure that can be used across rehabilitation care settings in Taiwan is urgently needed., Objective: To generate a Mandarin version of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" for patients in acute care., Design: Mixed-methods study with a cross-sectional design., Setting: Acute care wards of three teaching hospitals in Taiwan., Participants: A sample of 231 neurological patients in acute care (62.3% female; mean age = 63.2 yr, standard deviation = 14.6)., Outcomes and Measures: The 6-Clicks consist of three subscales: Basic Mobility, Daily Activity, and Applied Cognition. They were translated into Mandarin, and their internal consistency, test-retest reliability, interrater reliability, and convergent validity were tested., Results: All subscales of the Mandarin version of the 6-Clicks showed good internal consistency (α = .97-.98). Test-retest and interrater reliabilities were excellent for all subscales (intraclass correlation coefficients >.8). Convergent validity was supported by strong correlations of the Basic Mobility and Daily Activity subscales with the Barthel Index (r = .73 and .72, respectively) and between the Applied Cognition subscale and the Montreal Cognitive Assessment (r = .82)., Conclusion: Our results provide psychometric evidence supporting the use of the Mandarin version of the 6-Clicks in acute care settings in Taiwan., What This Article Adds: This study confirms the appropriateness of the use of the Mandarin version of the AM-PAC "6-Clicks" with patients in acute rehabilitation, making it a valuable addition to validated measures available for use by occupational therapists in Taiwan., (Copyright © 2019 by the American Occupational Therapy Association, Inc.)

Importance: Before introducing strategy training into a cross-cultural (Chinese) context, it is necessary to evaluate its feasibility., Objective: To examine the feasibility of applying strategy training to improve participation outcomes of rehabilitation patients in Taiwan and evaluate the potential intervention effects., Design: A single-group, repeated-measures study., Setting: Rehabilitation outpatient settings., Participants: A convenience sample of adults (N = 20) with a primary diagnosis of acquired brain injury (ABI) and with cognitive impairment received the intervention and were assessed before and after it., Intervention: The participation-focused strategy training intervention, a modified version of the strategy training intervention, was provided to participants in 1-2 sessions weekly for a total of 10-20 intervention sessions., Outcomes and Measures: Feasibility indicators, Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), and Canadian Occupational Performance Measure (COPM)., Results: Eighteen participants completed 100% of the scheduled intervention sessions. Participants had very good engagement in the intervention sessions with sufficient comprehension. Participants reported moderate to high satisfaction. Positive score changes were observed for the PM-3D4D (d = 0.46-1.25) and COPM scales (d = 1.82 and 2.12)., Conclusions and Relevance: This study demonstrated the feasibility of delivering participation-focused strategy training in Taiwan to people with cognitive impairment after ABI. The preliminary evidence also showed that participants who received the strategy training intervention had positive changes in participation outcomes and in performance of their self-identified goals. On the basis of this study's findings, a larger clinical trial is warranted to evaluate the efficacy of the strategy training intervention., What This Article Adds: Participation-focused strategy training is feasible and acceptable for Taiwanese community-dwelling adults with cognitive impairment after ABI. However, because strategy training is quite different from traditional rehabilitation delivered in Taiwan, additional instructions and discussion among the therapist, client, and caregiver may be needed before the intervention is provided., (Copyright © 2020 by the American Occupational Therapy Association, Inc.)

Purpose: The purpose of this study was to investigate the cultural and semantic equivalence of the Activity Measure Post-Acute Care (AM-PAC) outpatient short forms after they were translated from American English to Mandarin Chinese. Method: This study was conducted with a composite sample of a group of 483 American adults (mean age 63.1 years, 42.4% males) and 553 Taiwanese adults (mean age 60.6 years, 47.2% males) who were undergoing home care or outpatient rehabilitation services. A confirmatory factor analysis tested the cultural equivalence of the AM-PAC dimensions between the US and Taiwanese samples. Semantic equivalence was tested through an item response theory-based differential item functioning (DFI) analysis. Results: Results of the confirmatory factor analysis demonstrated good model-data fit of the AM-PAC in both the US and Taiwanese samples. Significant DFI was found for six Basic Mobility items, two Daily Activity items, and four Applied Cognition items. A DFI adjusted conversion table was generated to transform the raw scores of the measure for comparisons between the two countries. Conclusions: This study provides evidence to support the conceptual equivalence of the AM-PAC when used in rehabilitation patients between American and Taiwanese cultural contexts. Some DFI items between the two groups were found, suggesting that some differences in semantic understanding of these items between cultures require cross-cultural adjustments. Implications for Rehabilitation Cultural equivalence needs to be tested before applying a clinical measure to another context. The findings of this study supported the three activity domains that the Activity Measure Post-Acute Care measures: Basic Mobility, Daily Activity, and Applied Cognition, which are all important rehabilitation outcomes that need to be assessed and monitored across rehabilitation settings. Differential item functioning was observed between the English and Chinese versions of the Activity Measure Post-Acute Care, indicating that linguistic and cultural differences across countries need to be adjusted for before using the translated measure in clinical practice.

Purpose: To explore the perceptions and attitudes among people with disabilities towards the newly implemented International Classification of Functioning, Disability and Health-based disability evaluation system (the new system) in Taiwan., Method: Using a self-administered questionnaire, we conducted a nationwide survey. The questionnaire focused on the domains of quality, satisfaction, and revision of the new system. In total, 1073 persons (age, ≥18 years) with disabilities or their primary caregivers, who experienced both the old and the new system, responded to the questionnaire., Results: Most participants were satisfied with the new system overall (58.7%) and the subscale of quality of structure (91.3%) and quality of outcome (63.6%). However, only 20.5% of the participants were favourable to the quality of process. The probability of being satisfied with the system overall was low for the quality of process subscale (adjusted odds ratio range, 0.3 ∼ 0.4) and its item of long interval (0.2 ∼ 0.6). Contrariwise, the probability was high for the other subscales (3.9 ∼ 13.7) and the item of identifying needs (21.9 ∼ 23.4)., Conclusions: Persons with disabilities and their primary caregivers have positive attitudes towards the new system. It is important to simplify the assessment tools and procedures to improve the system's quality of process and facilitate its usability. IMPLICATIONS FOR REHABILITATION Persons with disabilities have positive attitudes towards the newly implemented International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan. The system that provides comprehensive information about functioning and disability of persons with disabilities is able to capture the difficulties and needs of those individuals in their daily lives. The system hence helps people to mitigate the effects of disability and guide rehabilitation. The assessment items and processes of the system, however, were perceived to be complicated, time-consuming, and inconvenient. Simplifying the assessment items and processes, such as developing a short form version of the assessment tool and increasing the service time, may facilitate the usability of the system.

Purpose Since the vocational outcomes of people with schizophrenia should be viewed in a holistic way, the second edition of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) might provide an evaluation regarding employment potential. To determine whether the WHODAS 2.0 scores can be used to predict employment status, we examined the probabilistic cut-off values of the scores and analyzed the relationship between work status and demographic characteristics. Methods We selected 31,793 people aged between 18 and 65 with schizophrenia or schizoaffective disorder from the disability evaluation database in Taiwan and separated them into two groups based on employment status (employed and unemployed). We used logistic regression to explore the association between employment and demographic characteristics. Moreover, we conducted a receiver operating characteristic (ROC) analysis to determine the cut-off point to assist in determining employment potential based on the WHODAS 2.0 score. Results Among the 31,793 participants, 3367 were employed and 18,801 were unemployed. The unemployed participants accounted for a higher percentage of disability in each domain of the WHODAS. The ROC analysis revealed that the optimal cut-off point of the WHODAS score to distinguish the people who were employed and unemployed was 25.78 (area under curve = 0.80). Conclusions The present study indicated that work status can be determined by the total score across the six domains of the WHODAS score. Furthermore, the probability of employment may be determined initially by the cut-off point of the WHODAS score in order to economize evaluation time and prepare prevocational training for those with scores above 25.78.

Patients with traumatic brain injury (TBI) often present with disabilities associated with a high burden of care for caregivers or family members at home. When family members cannot afford to care for patients with TBI, they are often required to find them residence in long-term care institutions. To date, there are no quantitative assessment tools developed to predict institutionalization. Therefore, this study analyzed the accuracy of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for predicting the institutionalization of patients with TBI. We designed a cross-sectional study using a nationwide disability database. We analyzed the data of 8630 patients with TBI with injury for more than six months from the Taiwan Data Bank of Persons with Disability during July 2012-October 2018. The demographic data and WHODAS 2.0 standardized scores of patients with TBI who resided in community and long-term care institutions were analyzed. Receiver operating characteristic curve (ROC) analysis was performed to investigate the predictive accuracy of WHODAS 2.0 for being institutionalized, and the optimal cut-off point was determined using the Youden index. Binary logistic regression was employed to determine the predictors of the participants being institutionalized. The WHODAS 2.0 scores in each domain were lower in the community group than in the institutionalized group. ROC analysis revealed the highest accuracy for the summary scores of WHODAS 2.0 (area under the curve = 0.769). Binary logistic regression revealed that age, gender, work status, urbanization level, socioeconomic status, severity of impairment, and WHODAS 2.0 domain scores were factors associated with the institutionalization status of patients with TBI. Our results suggest that WHODAS 2.0 may be a feasible assessment tool for predicting the institutionalization of patients with TBI.

Objective: The Quality of Life after Brain Injury (QOLIBRI), a cross-cultural instrument, has been validated in several languages; however, traditional psychometric approaches have critical limitations. Therefore, we applied the Rasch model for validating the 37-item QOLIBRI scale among a Chinese population with traumatic brain injury., Participants and Setting: In total, 587 participants (mean age: 44.2 ± 15.4 years; women, 46.3%) were surveyed in neurosurgery departments at 6 hospitals in Taipei, Taiwan., Main Outcome Measure: The QOLIBRI., Results: Of the 6 subscales of the QOLIBRI, 4 (cognition, self, daily life and autonomy, and social relationships) were unidimensional, valid, and reliable, whereas the remaining 2 (emotions and physical problems) exhibited poor unidimensionality, item and person reliability, and person-item targeting. Five items (energy, concentrating, getting out and about, sex life, and achievements) showed considerable differential item functioning among age groups, disability levels, and time since traumatic brain injury., Conclusion: According to item response theory, we identified psychometric issues in the emotions and physical problems subscales of the QOLIBRI as well as several differential item functioning items. Future research is required to determine whether similar results are observed in other language versions of the QOLIBRI or in other countries.

This study monitored the carbon dioxide (CO2) concentrations and temperatures of three 43-seat tour buses with high-passenger capacities in a course of a three-day, two-night school excursion. Results showed that both driver zones and passenger zones of the tour buses achieved maximum CO2 concentrations of more than 3000 ppm, and maximum daily average concentrations of 2510.6 and 2646.9 ppm, respectively. The findings confirmed that the CO2 concentrations detected in the tour buses exceeded the indoor air quality standard of Taiwan Environmental Protection Administration (8 hr-CO2: 1000 ppm) and the air quality guideline of Hong Kong Environmental Protection Department (1 hr-CO2: 2500 ppm for Level 1 for buses). Observations also showed that high-capacity tour bus cabins with air conditioning system operating in recirculation mode are severely lacking in air exchange rate, which may negatively impact transportation safety. Moreover, the passenger zones were able to maintain a temperature of between 20 and 25°C during travel, which effectively suppresses the dispersion of volatile organic compounds. Finally, the authors suggest that in the journey, increasing the ventilation frequency of tour bus cabin, which is very beneficial to maintain the travel safety and enhance the quality of travel.

The definition of disability had been unclear until the International Classification of Functioning, Disability, and Health was promulgated in 2001 by the World Health Organization (WHO). Disability is a critical but relatively neglected public-health concern. We conducted this study to measure disabilities by using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and identify the factors that contribute to disabilities. We obtained and analyzed the data on people who applied to Taiwan's disability registration system between September 2012 and August 2013. A total of 158,174 cases were selected for this study. Among the people included in this study, 53% were male, and the females were on average 3 years older than the males. More males than females were of a low socioeconomic status, but the rate of employment was higher among the males than among the females. Age, sex, place of residence, and types and severity of impairment were all determined to be factors that independently contributed to disability. This study has demonstrated that disability can be measured and compared using WHODAS 2.0. Increasing the public-health attention devoted to disability and identifying the factors associated with disability can promote independence and social participation in people with disabilities.

Acute myocardial infarction is a highly prevalent cardiovascular disease in Taiwan. Among several etiological risk factors, obesity and inflammation are strongly associated with the frequency of hypertension, cardiovascular disease, diabetes, and myocardial infarction. To discriminate obesity- and inflammation-related genes and the onset of acute myocardial infarction (AMI), a case-control study was conducted to investigate the association of the -308G/A polymorphisms of tumor necrosis factor (TNF)-α and the C825T polymorphism of guanidine nucleotide binding protein 3 (GNB3) with the onset of AMI among Taiwanese cohorts. A total of 103 AMI patients and 163 matched normal control samples were enrolled in the present study. The genomic DNA was extracted and subjected into polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) analysis. An association between the A homozygosity of the TNF-α-308G/A polymorphism and the onset of AMI was observed among the male subjects (p = 0.026; Spearman index = 0.200, p = 0.008). An association between the T homozygosity of GNB3 C825T polymorphism and obesity was also observed (Fisher's exact, p = 0.009). The TT genotype has a protective effect against acquiring AMI among the obese female population in Taiwan (Fisher's exact, p = 0.032). In conclusion, TNF-α-308G/A and the GNB3 C825T polymorphisms are associated with obesity and AMI in the Taiwanese population.

Food frequency questionnaire is an important assessment tool for public health nutrition research. We describe the development history and conducted the validity and reproducibility studies for a meal-based Chinese food frequency questionnaire (Chinese FFQ) by five meal sequences. A total of 51 subjects were recruited to collect dietary information twice (6 months apart) with one 24-hr recall, 7-day food records and the Chinese FFQ. Combining data from both time sets, Chinese FFQ showed strong correlations of macro and micronutrients with 7-day records (n = 60, r = 0.29-0.50, p < 0.05), but not with 24-hr recalls (n = 60, r = 0.01-0.23, p > 0.05). The reproducibility of this Chinese FFQ (n = 22) was consistently high for most nutrients, with Spearman correction coefficients between 0.42 for vitamin A to 0.79 for vitamin B12. From a larger sample of 231 subjects who completed the Chinese FFQ and one 24-hr recall, we found the energy distributions of breakfast, lunch, dinner, afternoon and evening snacks combined from Chinese FFQ were 20%, 37%, 37% and 6%, and from 24-hour recalls were 19%, 36%, 44% and 1%, respectively. These results showed acceptable reproducibility and relative validity of this meal-based Chinese FFQ.

The soil metal contamination arising from the discharge of the high density of electroplating factories in the geographic center of Taiwan has prompted concern about human exposure to harmful metals. This study aimed to determine the levels of nickel (Ni) in urine of residents living in the high vs. low factory-density areas, and to examine how these levels relate to gender and age. A total of 660 subjects, resident in the area for the last five years, were sampled according to the stratified random sampling approach, at ages 35-44, 45-54, and 55-64years for both genders. Metals in urine samples were analyzed by inductively coupled plasma mass spectrometry (ICPMS). The geometric mean (95% confidence interval (CI)) of urinary Ni was 6.30 (5.99-6.62)mug/l. The 0.95 parametric reference interval (90% CI) of urinary Ni was estimated to be 1.74 (1.62-1.88) to 22.73 (21.14-24.44)mug/l. Subjects in the areas with a high density of electroplating factories had significantly higher urinary Ni levels than those in the low-density areas, but both types of areas had obviously higher urinary Ni levels when compared to the non-occupationally exposed population from western countries. The health significance of elevated urinary Ni and its causative factors remain to be determined.

During the SARS outbreak in Taiwan, the number of ambulatory patients and inpatients treated at one medical center decreased by 40%-70% because of the increasing number of SARS patients. At the peak of the epidemic, the amount of hospital infectious waste had increased from a norm of 0.85 kg per patient-day to 2.7 kg per patient-day. However, the hospital was able to return the generation of waste to normal levels within 10 days.

The high density of electroplating factories in the geographic middle of Taiwan has prompted concern over the potential for exposure to harmful metals. The present study aimed to determine the levels of chromium in whole blood (B-Cr) of residents living in the high vs. low factory-density areas, and to examine the relations to gender and age. A total of 660 residents who had not moved within the 5 years preceding the study were sampled according to the stratified random sampling approach, at ages 35-44, 45-54, and 55-64 years, for both genders. Chromium determinations (n=641) were made using a graphite furnace atomic absorption spectrometer. The geometric mean (95% C.I.) of B-Cr was 0.357 (0.34-0.38) microg/l. The International Federation of Clinical Chemistry (IFCC) nonparametric 0.95 reference limits of B-Cr was estimated to be <0.905 microg/l. B-Cr levels decreased with increasing age. Subjects in the areas with a high density (0.38 microg/l, 95% C.I.: 0.36-0.40) of electroplating factories had significantly higher B-Cr levels, compared to residents of the low-density (0.27, 0.25-0.30) areas and to the general population from western countries. The health significance of the elevated B-Cr remains to be determined.

Background and Purpose: The prevalence of Angle Class III malocclusion is relatively high in Taiwan. For children who suffer from maxillary retrognathia, face mask therapy is a promising treatment modality. The purpose of this study was to evaluate the changes in midfacial configuration after face mask therapy in skeletal Class III growing patients by morphometric analysis techniques., Methods: Thirty children who had been treated with face masks were compared with a group of 30 gender-matched, age-matched, observation period-matched, and craniofacial configuration-matched subjects with untreated Class III malocclusions. Average geometries, scaled to an equivalent size, were generated by means of Procrustes analysis. Graphical analysis, utilizing thin-plate spline analysis and strain tensor methods, was performed for localization of differences in shape and size changes. Maximum and minimum principal extensions were drawn to express the directions of shape change., Results: Maxillary protraction-induced changes resulted from a combination of both orthopedic and dental effects. A significant increase in size (7.7% to 9.9%) was noted at the supero-anterior region of the midfacial configuration (rhinion-orbitale-midpalatal point-anterior nasal spine) when subjected to an extraoral traction force; 7.7% to 12.1% of increase in size and 14.4% to 33.4% of change in shape were found at the anterior portion of the maxillary alveolar bone. The directions and amount of principal strain tensors could express the magnitudes and directions of morphological changes within the midfacial complex in an efficient way., Conclusions: We conclude that morphometric analysis techniques can be used to evaluate the changes in midfacial configuration after face mask therapy and can provide a valuable supplement for conventional cephalometric analysis.

Purpose: The p53 tumor suppressor gene plays two important roles in genomic stability: blocking cell proliferation after DNA damage until it has been repaired, and starting apoptosis if the damage is too critical. A recent report suggests that a polymorphism of the p53 tumor suppressor gene that results in the substitution of a proline residue with an arginine residue at position 72 of the p53 protein might act as a risk factor in the malignant transformation of colorectal adenoma to cancer., Methods: In our study, the samples consisted of 150 patients were analyzed for the mutation in the p53 gene. The age of 150 patients (46 women and 104 men) ranged from 30 to 91 years (mean age 68.46 years)., Results: The polymorphism showed 52.04% mutant in the codon 72 of exon 4 in the Taiwanese population. Both of the chi-square for trend test (chi-square = 4.97, p = 0.034) and logistic regression (p = 0.037, odds ratio = 1.699) showed significant differences in the distribution of polymorphism of codon 72 in the p53 gene and Dukes classification of colorectal cancer., Conclusions: There were significant relationship between the polymorphism of codon 72 and the malignancy of colorectal cancer in Taiwanese population. There is 1.70 times in each grade change (Dukes A-D) more risk of CCC polymorphism than that of CCG polymorphism of codon 72 of exon 4.

Thirty-five patients with ovarian germ cell malignancies presenting from 1982 to 1992 were studied. The pathologic diagnoses were immature teratoma in 11 patients, endodermal sinus tumor in eight, dysgerminoma in 12, and mixed germ cell tumor in four. The median age at presentation was 20 years. Postoperative multiple-agent chemotherapy was given to 28 patients. Five out of 35 (14%) patients died of malignancy, three with endodermal sinus tumors with stage Ia, Ic, and IIIc, respectively, one with stage IIIc dysgerminoma, and one with stage IIIc mixed germ cell tumor. The other 30 patients were alive without evidence of disease from 14 to 124 months, with a median follow-up of 52 months. All eleven patients with immature teratoma were alive with no evidence of disease at 20 to 104 months of follow-up. Four patients with stage I, grade 1 immature teratoma were successfully treated with surgery alone. The other seven patients were treated with adjuvant chemotherapy and were disease-free. One patient with stage IIIc dysgerminoma was treated with surgery and radiotherapy but died of disease. The other eleven patients were safely treated with surgery and adjuvant chemotherapy with vincristine, actinomycin-D and cyclophosphamide (VAC) or platinum-based chemotherapy. For the more virulent tumors such as endodermal sinus tumor and mixed germ cell tumor, platinum-based chemotherapy should be used exclusively in view of the high failure rate of the VAC regimen. Preservation of fertility for young patients with malignant ovarian germ cell tumors is possible in the early stages of disease and in selected cases of advanced disease.