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People in social life often underestimated the presence of migrant workers caused by low skills and lack of education. The decision to continue higher education while working in the host country had tremendous challenges. This study aimed to develop a deeper understanding of the reasons, the problem encountered, and the learning strategies of migrant workers pursuing higher education at Indonesian Open Learning University of Taiwan ("Universitas Terbuka Taiwan"). There were 11 students participated in this study. This study was descriptive qualitative research, and the interactive model was applied in the analysis method. The data were gathered through in-depth interviews, participant observation, and documentation. The finding of this study revealed that: i) The migrant workers had the high motivation to pursue higher education because they wanted to change the stereotype that they were left behind and to seek a better life when they came back to Indonesia; ii) Inadequate time was the main problem to manage the study time due to the high workload; iii) The learning strategies of migrant workers were peer learning, group discussion, and note-taking. However, Indonesian Open Learning University of Taiwan was the excellent choice for the migrant workers in Taiwan to pursue higher education due to the flexibility of learning.

Background: Hands-on activities and makerspaces have rapidly gained popularity in recent years. One of the reasons for this is that they have the potential to stimulate interest and identity development in STEM or STEAM. Taiwan has organized many technology and science competitions for students to raise their interest and creativity in the past years. Purpose: The iSTEAM contest in Taiwan plan to assist public schools in rural areas to develop students' capability in making activities. To motivate rural students to experience an integrated science, technology, engineering, art, and math (iSTEAM) contest, this study invited rural school students to prepare for and join a competition focusing on making miniature models. The related variables relevant to motivation orientation, such as participants' hands-on making self-efficacy, perceived value, cooperative attitude, and competition preparedness in the iSTEAM contest were explored. Expectedly, with an understanding of the correlates between those variables, the results of this study can be applied to successfully implement other STEAM contests. Sample: A total of 187 students who participated in the competition filled in the questionnaire for the survey participants. After invalid questionnaires were excluded, 167 valid questionnaires were obtained. Design and Methods: This study adopts the purposive sampling method, based on the value-attitude-behavior model, the quantitative research method was adopted. Results: The results showed that students who participated in the competition had high self-efficacy for making miniature models, appreciated the value that the competition brought them, and had a positive attitude about cooperating with team members as well as preparing for the competition. Conclusion: There is a close and positive correlation between the four constructs of self-efficacy, perceived value, cooperative attitude, and competition preparedness.

International marriages have increased the population of new immigrants in Taiwan. Most Taiwanese educators are unaware of the expectations of the new immigrant parents. This ethnographic research explored whether Taiwanese primary school teachers implemented culturally responsive teaching to help the children of new immigrants become academically accomplished from the perspectives of the new immigrant parents. The findings indicated that most Taiwanese primary school teachers were aware of the challenges the children of new immigrants faced but culturally responsive teaching approaches were rarely implemented in any meaningful way, and that Taiwan still lacked effective communication styles, multicultural curriculum design and culturally congruent teaching. While most Taiwanese teachers recognized cultural differences, they failed to pursue measures to achieve educational equity. The new challenges and relevant issues are discussed.

Based on the reminiscence therapy, the research aimed to develop the horticultural program with life contexts for the elderly in southern Taiwan, and to explore the effect on overall cognitive function of the elderly. The participants were 17 seniors in one community care center. The research adopted quasi-experimental research of one group pre-test and post-test design of time series, and data were collected by questionnaire surveys and semi-structured interviews. The objective of the program was to maintain cognitive function of the elderly. Twelve activities of the program were implemented once a week and 2 hours for each activity. The program included manual activity, group activity, and outdoor planting activity. The program content was based on farming experience of the elderly and integrated with diverse cognitive function trainings. It was found that the program showed immediate effect and two-week delay effect on promoting overall cognitive function of the elderly. Also, the elderly obtained new planting experience and their learning motivation was enhanced. Additionally, because of integrating with life contexts, the program was meaningful and encouraged the elderly to be engaged in the activities and recall the past. In the process, the elderly enjoyed the exchange of horticulture and life experience.

This study investigated the impact of thinking instruction on students' metacognition and thinking behavior. Higher-order thinking occurs when individuals use their underlying metacognitive strategies which increase the probability of achieving a desirable result. The study was designed as a case study of an intervention and a posttest-only control group design was adopted. Participants consisted of students with a variety of majors were recruited from a medium-size university located in southern Taiwan. Two classes of the Developing Thinking course, totaling 78 students, comprised the group receiving the intervention, while 196 students in six General English classes comprised the comparison group. The intervention students were introduced to thinking skills, facts and opinions, question stems, and thinking from different perspectives. The quantitative results show strong evidence that the thinking instruction exerts statistically significant positive effects on students' metacognition. Qualitative evidence also shows improvements in cognitive awareness with students demonstrating a more consistent application of thinking skills, an increased ability to think critically with thinking dispositions cultivated, and most importantly, a transfer of thinking behavior across the curriculum and in their personal lives. The researcher suggests the value of introducing thinking instruction to promote critical thinkers.

Lexical competence is considered as an important indicator of language proficiency. While learning vocabulary, learners need to remember various aspects of knowledge about the word (e.g., meaning, form and use). Many vocabulary learning strategies have been proposed to help learners consolidate vocabulary knowledge. Among them, grouping words belonging to the same meaning categories is conducive to recall (Schmitt, 1997). On the other hand, learning chunks is also a mnemonic device for increasing vocabulary. Taking into consideration these two important vocabulary memory strategies that help students learn faster and recall better, the current study proposes grouping and learning lexical phrases sharing semantic equivalence but differing in use (i.e., phrasal paraphrases) (e.g., "is worth reading", "is worthy of being read" and "is worthwhile reading"). For this, a corpus-based paraphrasing system, PREFER, was introduced because it provides a sufficient number of paraphrases and corresponding Chinese translations, usage patterns and example sentences. Such information could widen and deepen learners' vocabulary knowledge. A pre-and post-test was conducted on 49 college freshmen to examine their performance in phrasal paraphrase learning. The results showed that with the assistance of the introduced system, students achieved substantial gains regardless of their proficiency level. Furthermore, students' errors on the test sheets were thoroughly analyzed for the purpose of understanding students' learning difficulties while learning paraphrases. Despite its exploratory nature, the current study shed some light on the effects of learning phrasal paraphrases on vocabulary expansion.

English speaking is a challenging learning objective for EFL (English as Foreign Language) learners owing to the lack of practicing environments. In this study, Interactive Spherical Video-based Virtual Reality (ISVVR) was adopted as the learning mode to provide realistic sociocultural contexts for English speaking. In addition, an experiment was conducted to investigate the effects of the SVVR approach on the English speaking performances and anxiety of the EFL students with different cognitive styles. A pretest-posttest quasi-experimental design was conducted to investigate the effects of the interaction between cognitive style and multimedia learning mode on students' learning motivation, speaking anxiety, oral presentation, and move analysis. The student sample consisted of two classes of 93 students. All of the students took the Group Embedded Figures Test (GEFT) to identify whether their cognitive style was field dependent or independent. The results showed a significant effect for the interaction between the cognitive styles and the learning modes on the students' oral presentation and speaking anxiety. Their structural moves in oral presentations with the ISVVR learning mode showed more similar spoken genre patterns to those of TED speakers. Findings further support the benefit of incorporating cognitive styles into the ISVVR learning mode for EFL learners.

Introduction: Integrating assistive technology (AT) into occupational therapy (OT) education is critical to educating students to utilize AT to enhance individual independence. This study aims to describe the development of a science, technology, engineering, arts, and mathematics (STEAM)-based AT curriculum in OT and evaluate its effectiveness using the Kirkpatrick model. Methods: An 18-week STEAM-based AT curriculum was created with lectures, hands-on activities, and a simulation exam. A one-group pretest–posttest observational study was undertaken with 40 undergraduate students to gauge its effectiveness. Their professionalism was evaluated using a multidimensional checklist, whereas a satisfaction survey gathered their feedback on the curriculum experience. Results: Level 1: Participants reported high satisfaction (mean = 4.61, SD = 0.36), with a 97.5% agreement. Level 2: 95% (n = 38) passed the AT curriculum exam. Level 3: Therapists and patients expressed satisfaction with participants' AT skills (therapists: t (39) = 12.22, p < 0.001; patients: t (39) = 8.84, p < 0.001). Level 4: Participants showed significant improvement in professionalism (t (39) = 16.45, p < 0.001). Lastly, using the Kirkpatrick model, the STEAM-based AT curriculum passed the evaluation. Conclusions: The STEAM-based AT curriculum in OT enhances professionalism and potentially boosts patient satisfaction with AT services provision. [ABSTRACT FROM AUTHOR]

The ultimate goal of gifted education programs is to cultivate students' competences through challenging, enriching, and engaging opportunities for talent development. The purpose of this review is to present two main approaches of enrichment programs for gifted learners in Taiwan: the programs following the law and the alternative programs initiated by local authorities, private organizations, and researchers. The rationale and practice of program evaluation are also discussed to analyze Taiwan's gifted education program logics and qualities to reflect on the development of these programs. Finally, the prospects of program design and evaluation are proposed: (a) defining the criteria for success or effectiveness, (b) selecting or developing valid and reliable measurement tools and strategies, (c) conducting long-term evaluation plans and follow-up studies, and (d) promoting evidence-based decision-making in gifted education.

The purpose of the study was to investigate language learning strategies used by English as a Foreign Language (EFL) learners at different educational levels and explored the influence of age on the use of language learning strategies. A total of 1,023 students participated in the study. Out of the participants, there were 250 primary students (aged 10-12), 245 junior high school students (aged 13-15), 249 senior high school students (aged 16-18), and 279 tertiary students (aged 20-22). The instrument for data collection was the Strategy Inventory for Language Learning (SILL). Results showed that statistically significant relationships existed between different age groups and the use of memory strategies, compensation strategies, metacognitive strategies, and affective strategies. Specifically, secondary and tertiary students reported using compensation strategies more frequently than primary students (p = 0.000). Tertiary students used social and affective strategies more frequently than did other age groups. The result indicated that age increase is likely to encourage learners to use strategies with more emphasis on the social and functional strategies. Implications are that it is critical for teachers to be more aware of the differences in their students and adjust their teaching practices to meet the developmental needs of students.

It is not uncommon to see lists of semantically equivalent phrases in pedagogical materials. However, empirical investigations of the effect of synonymous phrase learning on vocabulary development are rarely attempted. The current study promotes computer-assisted synonymous phrase learning by introducing PREFER, a corpus-based paraphrasing system. The organized information including synonymous phrases, Chinese translations, usage patterns, and example sentences would help EFL learners develop vocabulary knowledge in terms of form, meaning, and use. The performances of 49 EFL first-year college students were evaluated using a 15-set multi-select test. The results showed that students consulting PREFER made greater progress than those consulting existing online tools. The improvements of the less proficient students were especially significant, which was to be expected. More importantly, the analyses of learners' errors indicated that their learning difficulties primarily resulted from the lack of attention to word form and the function words (i.e., word form and use) while learning vocabulary.

This retrospective study was conducted at a medical center in southern Taiwan to assess the accuracy of the Hendrich II Fall Risk Model (HIIFRM) in predicting falls. Sensitivity, specificity, accuracy, and optimal cutoff points were analyzed using receiver operating characteristic (ROC) curves. Data analysis was conducted using information from the electronic medical record and patient safety reporting systems, capturing 303 fall events and 47,146 non‐fall events. Results revealed that at the standard threshold of HIIFRM score ≥5, the median score in the fall group was significantly higher than in the non‐fall group. The top three units with HIIFRM scores exceeding 5 were the internal medicine (50.6%), surgical (26.5%), and oncology wards (14.1%), indicating a higher risk of falls in these areas. ROC analysis showed an HIIFRM sensitivity of 29.5% and specificity of 86.3%. The area under the curve (AUC) was 0.57, indicating limited discriminative ability in predicting falls. At a lower cutoff score (≥2), the AUC was 0.75 (95% confidence interval: 0.666–0.706; p < 0.0001), suggesting acceptable discriminative ability in predicting falls, with an additional identification of 101 fall events. This study emphasizes the importance of selecting an appropriate cutoff score when using the HIIFRM as a fall risk assessment tool. The findings have implications for fall prevention strategies and patient care in clinical settings, potentially leading to improved outcomes and patient safety. [ABSTRACT FROM AUTHOR]

Background: Newborn anogenital distance (AGD) has been associated with prenatal exposure of phthalates. The association between prenatal phthalate exposure and sex steroid hormones in newborns is unclear. Object: This study aimed to examine whether cord-blood sex hormone levels were associated with prenatal phthalate exposure and newborn anogenital distance (AGD). Methods: In the Taiwan Maternal and Infant Cohort Study, we recruited 1,676 pregnant women in their third trimester in 2012–2015 in Taiwan. We determined 11 urinary phthalate metabolites in pregnant women, three maternal and five cord-blood steroid sex-hormone concentrations. Five hundred and sixty-five mother-infant pairs with sufficient data were included. Trained neonatologists measured 263 newborns' AGD. We examined the associations of prenatal phthalate metabolite levels with AGD and hormones using linear regression models and evaluated correlations between maternal and cord-blood sex hormone levels and AGD. Results: Compared with the male newborns exposed to maternal phthalate metabolites at the first tertile, AGD was -3.75, -3.43, and -3.53 mm shorter among those exposed at the median tertile of di-2-ethylhexyl phthalate (DEHP) metabolites, monobenzyl phthalate (MBzP), and monomethyl phthalate (MMP), respectively. Compared with those who had exposed at the first tertile, cord-blood follicle-stimulating hormone (FSH) decreased among male newborns exposed at higher levels of MMP, mono-n-butyl phthalate (MnBP), MBzP and DEHP, and among female newborns exposed at higher levels of MMP, MBzP and mono(2-ethyl-5-hydroxyhexyl) phthalate. However, we did not observe significant correlations of maternal or cord-blood sex steroid hormones with newborns' AGDs. Conclusions: Alterations in cord-blood sex steroid hormone levels were associated with prenatal phthalate exposures, particularly in male newborns. Women aspiring to be pregnant should be alerted of the need of reducing phthalate exposure. [ABSTRACT FROM AUTHOR]

Background: Indoor residual spraying (IRS) capitalizes on the natural behavior of mosquitoes because Aedes aegypti commonly seeks indoor resting sites after a blood meal. This behavior allows mosquitoes to be exposed to insecticide-treated surfaces and subsequently killed. Combinations of deltamethrin and clothianidin with different modes of action have shown promise in IRS, effectively targeting both susceptible and pyrethroid-resistant malaria vectors. However, the effects of this approach on Aedes mosquitoes remain unclear. The present study tested the effects of deltamethrin–clothianidin mixture treatment on behavioral responses and life history traits of Taiwanese and Indonesian populations of Ae. aegypti. Methods: We adopted an excito-repellent approach to explore the behavioral responses of pyrethroid-resistant Ae. aegypti populations from Indonesia and Taiwan to a deltamethrin–clothianidin mixture used in contact irritancy and non-contact repellency treatments. We further evaluated the life history traits of surviving mosquitoes (i.e., delayed mortality after 7-day post-treatment, longevity, fecundity, and egg hatching) and investigated the potential transgenerational hormetic effects of insecticide exposure (i.e., development rate and survival of immatures and adult mosquitos). Results: All tested field populations of Ae. aegypti displayed strong contact irritancy responses; the percentage of escape upon insecticide exposure ranged from 38.8% to 84.7%. However, repellent effects were limited, with the escape percentage ranging from 4.3% to 48.9%. We did not observe immediate knockdown or mortality after 24 h, and less than 15% of the mosquitoes exhibited delayed mortality after a 7-day exposure period. However, the carryover effects of insecticide exposure on the survival of immature mosquitoes resulted in approximately 25% higher immature mortality than that in the control. By contrast, we further documented stimulated survivor reproduction and accelerated transgenerational immature development resulting from the sublethal effects of the insecticide mixture. In particular, the number of eggs laid by treated (both treatments) female mosquitoes increased by at least 60% compared with that of eggs laid by control female mosquitoes. Conclusions: IRS with deltamethrin–clothianidin effectively deters Aedes mosquitoes from entering residential areas and thereby reduces mosquito bites. However, the application rate (deltamethrin: 25 mg/m2; clothianidin: 200 mg/m2) may be insufficient to effectively kill Aedes mosquitoes. Insecticide response appears to vary across mosquito species; their behavioral and physiological responses to sublethal doses have crucial implications for mosquito control programs. [ABSTRACT FROM AUTHOR]

The purpose of the study was to investigate the effects of the use of children's literature and DVD films on EFL adult language learning. A total of 89 non-English majors enrolled in two Freshman English classes participated in the study. The study employed a quasi-experimental, pretest/posttest comparison group design. The participants in the experimental group were exposed to the children's literature and DVD films. In the control group, the participants were exposed to the English Language Teaching (ELT) textbook. The experiment was conducted for two hours per week over two months. Then the reading comprehension sections of the Elementary GEPT posttests were administered and their outcomes were compared with those of the pretests. At the end of the course, the questionnaires were administered to the participants in the experimental group to elicit their perceptions about the various aspects of the use the children's literature and DVD films. The findings of the study revealed that alternately, reading, viewing the film, and discussing a children's fantasy novel significantly increased the scores on the reading comprehension subtests over the control group with exposure to the ELT textbook. (Contains 2 tables.)

The purpose of this study was to employ complexity theory as a theoretical framework and technology to facilitate the development of a life-long learning model for non-working time in the interdependent homes for adults with Autism Spectrum Disorders (ASD). A "Shining Star Sustainable Action Project" of the ROC Foundation for Autistic Children and Adults in Taiwan (FACT) was selected as the research target, and the staff of the FACT, the medical team of the Hualian Yuli Veteran Hospital, adults with autism and their families were interviewed, observed and analyzed to develop this model during four short-stays of the project from July 2009 to December 2010. Participant field observation and informal conversations were employed and qualitative data were analyzed by using the constant comparison method through application of QSR Nvivo 9. The results showed that dynamic interaction, mutual adaptation, self-organization and co-evolution are four key elements for developing a viable life-long learning model for non-working time in the interdependent homes for adults with ASD to adapt to the impact of an aging society, to improve the quality of medical services, and to enhance the quality of life for the medical teams, patients and their families. The present study also found that the model help medical teams to avoid burnout by learning leisure skills and relaxation techniques, ways to release stress and how to enhance life-long learning for themselves and caregivers/patients' families. (Contains 5 figures and 1 table.)

Background: Chronic hepatitis C (CHC) virus infection is a global health concern that is associated with significant liver-related morbidity and mortality. Owing to the inflammatory pathway, CHC can causefatty liver, liver cirrhosis, and liver cancer and is associated with cardiometabolic diseases, such as hypertension and diabetes. Fatty liver is associated with metabolic disorders, cardiovascular diseases, diabetes, and liver cancer. Hence, the early detection of fatty liver through noninvasive screening in adults with CHC is important in primary healthcare settings. This study aimed to explore the prevalence of fatty liver and its association with metabolic syndrome amongrural adults with CHC. Methods: This was a series of cohort studies related to the elimination of the CHC burden around the western coastal Yunlin County, Taiwan, between August 2018 and July 2021. A cross-sectional study was conducted after hepatitis C virus RNA confirmation in a hepatitis C- endemic area. A gastrointestinal physician or radiologist assessed fatty liver by ultrasonography. Fatty liver was classified into four grades: normal, mild, moderate, and severe. Three liver enzyme biomarkers were identified. According to the Taiwan national standard, metabolic syndrome was defined based on the presence of three or more of the five abnormal biomarkers, including increased waist circumference, elevated blood pressure, elevated fasting blood glucose level, elevated triglyceride level, and low high-density lipoprotein cholesterol level. Results: A total of 256 rural adults with CHC were enrolled. The mean age of the participants was 67.5 (standard deviation = 11.8) years, with a low educational level. High prevalence of fatty liver (79%), central obesity (54.3%), elevated blood pressure (55.5%),elevated fasting blood glucose (FBG) level (44.9%), and metabolic syndrome (37.9%) were observed.The results showed that adults with CHC with moderate to severe fatty liver were significantly associated with an increased risk of increased waist circumference (P < 0.001), increased blood pressure (P < 0.001), low high-density lipoprotein cholesterol level (P < 0.05), and elevated liver enzyme biomarker levels (all P < 0.05) after adjusting for age, sex, and educational level. Furthermore, adults with CHC with moderate to severe fatty liver were significantly associated with a greater risk of metabolic syndrome (odds ratio = 2.85, 95% confidence interval = 1.66 to 4.92). Conclusions: The findings demonstrate a high prevalence of fatty liver in rural adults with CHC, which is significantly associated with obesity, metabolic syndrome, and elevated liver biomarker levels. Clinicians and primary healthcare providers must encourage patients with CHC to receive antiviral therapy combined with weight loss management and lifestyle modification, allowing general improvements in their liver and cardiometabolic health. [ABSTRACT FROM AUTHOR]

Aims: To assess the effectiveness of an unsupervised home‐based pulmonary rehabilitation with self‐management program in patients with chronic obstructive pulmonary disease (COPD). Background: A few recent studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with COPD. More studies are needed to prove its benefits. Design: This study used a quasi‐experimental design. Methods: Seventy‐two admitted COPD patients were assigned to experimental group or control group through purposeful sampling. Data were collected from March 2016 to November 2017 in the Thoracic Intensive Care Unit of a Medical Center in Taiwan. The Medical Research Council dyspnea scale, the COPD Self‐Efficacy Scale and the Clinical COPD Questionnaire were measured before education and at the first, second and third months after discharge. Results: The Medical Research Council dyspnea scale and COPD Self‐Efficacy Scale results in the experimental group were significantly improved compared with the control group in the third month after discharge. The Clinical COPD Questionnaire score continued to improve in both groups in the third month after discharge, and there was no difference between the two groups. Conclusion: A short‐term unsupervised home‐based pulmonary rehabilitation with self‐ management program had significant benefits for patients with COPD. The long‐term effects need to be confirmed. Summary statement: What is already known about this topic? The literature emphasizes the importance of alternative supervision of home‐based pulmonary rehabilitation rather than center‐based pulmonary rehabilitation for patients who find this inconvenient to access.Few studies have shown that unsupervised home‐based pulmonary rehabilitation can improve the clinical outcome of patients with chronic obstructive pulmonary disease (COPD). What this paper adds? This study demonstrates that a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program can improve dyspnea during physical activity, self‐care efficacy in certain activities and quality of life after discharge in patients with COPD. The implications of this paper: The findings of this study can be used as the basis for providing a short‐term unsupervised home‐based pulmonary rehabilitation with self‐management program for patients with COPD after discharge.We recommend that patients with COPD undergo unsupervised home‐based pulmonary rehabilitation with self‐management for 3 months after discharge, especially if regular hospital visits for this are not convenient.The effect of longer‐term unsupervised home‐based pulmonary rehabilitation can be further studied in the future. [ABSTRACT FROM AUTHOR]

Objectives: Metabolic syndrome (MetS) and hepatitis C virus (HCV) are associated with a higher risk of impaired pulmonary function (iPF). This study aimed to investigate the relationships among MetS, iPF, and viral hepatitis. Methods: This community-based study enrolled participants undergoing annual health check-ups in southern Taiwan between March and December 2019. We performed multivariable logistic regression analyses adjusted for demographics and characteristics to identify the factors associated with iPF. Results: A total of 2337 participants completed examinations, of whom 928 (39.7%) had iPF. The participants with iPF were elderly (68.8 ± 12.8 years old) and predominately female (63%). MetS increased the risk of iPF (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.27–1.81, p < 0.001). Beyond age (OR 1.03, 95% CI 1.02–1.04) and smoking (OR 1.309, 95% CI 1.004–1.705), female sex (OR 0.74, 95% CI 0.59–0.93) and high education level (OR 0.96, 95% CI 0.94–0.98, p < 0.001) protected against iPF. HCV was not significantly associated with iPF (OR 1.17, 95% CI 0.90–1.52, p = 0.235) in multivariable analysis. MetS was associated with a higher risk of iPF in the non-HBV/HCV group (OR 1.86, 95% CI 1.54–2.26) and HBV alone group (OR 3.44, 95% CI 1.89–6.28), but not in the HCV alone group (OR 1.02, 95% CI 0.64–1.62). Discussion: MetS was an independent predictor of iPF, especially the restrictive type, and had different effects in the HBV/non-viral hepatitis and HCV groups. Female sex and education were inversely associated with iPF. [ABSTRACT FROM AUTHOR]

Compared to other academic disciplines, interactive white board (IWB) research in early childhood education is still in its infancy. To add more knowledge base regarding the instructional effectiveness of IWB for young children, this study aimed to investigate educational phenomenon of using an IWB to teach visual art to kindergarten students. The study adopted a qualitative case study to fulfill the research purpose. The research participants were 25 children aged 5 to 6 years old from a public kindergarten in Taiwan. The qualitative study lasted for four months of one semester. Multiple qualitative data sources were collected from students, teachers, and parents. A qualitative analysis method identified seven major themes. The results indicate that the IWB is an effective learning tool for enhancing students' learning interest and motivation during visual art instruction. The IWB may facilitate discussion about learning process, resulting in more diverse elements in children's paper-based drawings. Schoolteachers and parents both witnessed the positive effect of IWB use on children's drawing instruction. In particular, IWB integration strongly supports students with special learning needs. Based on IWB implementation experiences, several instructional implications for early childhood educators who are interested in IWB adoption in classrooms are proposed.

Dementia is a leading cause of disability and dependence in older adults worldwide. The aim of this pilot study was to explore the effect of using a kazoo instrument to improve pulmonary function and cognitive reserve in middle-aged and older adults in rural areas. This quasi-experimental study was conducted at two community care stations selected using cluster sampling from a rural district in southern Taiwan. We enrolled 85 middle-aged and older adults who were randomly assigned into self-learner and in-class groups. Both groups received a 6-month kazoo program. Cognitive and pulmonary function were compared before and after the intervention between the two groups. Significantly improved pulmonary function with regards to forced vital capacity (p <.05) was found in the self-learner group, and significantly improved maximum expiratory flow 75% (p <.001) was found in both groups. Mini-Mental State Examination scores significantly improved in the self-learner group (p <.01), but there was no significant change in the in-class group. Our results suggest that community care stations could consider implementing wind instrument programs such as a kazoo to enhance pulmonary function and cognitive reserve in middle-aged and older adults residing in rural areas. [ABSTRACT FROM AUTHOR]

BACKGROUND: To gain a better understanding of how Pyricularia oryzae population shifts is important for selecting suitable resistance genes for rice breeding programs. However, the relationships between P. oryzae pathogenic dynamics, geographic distribution, rice varieties, and timeline are not well studied. RESULTS: Resistance genes Piz‐5, Pi9(t), Pi12(t), Pi20(t), Pita‐2, and Pi11 showed stable resistance to the Taiwan rice blast fungus over 8 years of observations. Furthermore, 1749 rice blast isolates were collected from 2014 to 2021 and categorized into five pathotype clusters based on their correlation analysis between the geographic sources and virulence of Lijiangxintuanheigu monogenic lines. A detailed map of their distributions in Taiwan is presented. Isolates collected from the western region of Taiwan had greater pathotype diversity than those from the east region. Isolates collected from the subtropical region had greater diversity than those from the tropical region. Rice cultivars carrying Pik alleles were highly susceptible to pathotype L4. Cultivars with Piz‐t were highly susceptible to pathotype L5, and those with Pish were highly susceptible to pathotype L1. The geographical distribution of each pathotype was distinct, and the population size of each pathotype fluctuated significantly each year. CONCLUSION: The regional mega cultivars significantly impact the evolution of Pyricularia oryzae in Taiwan within the span of 8 years. However, the annual fluctuation of pathotype populations likely correlate to the rising annual temperatures that selected pathotype clusters by their optimal growth temperature. The results will provide useful information for effective disease management, and enable the R‐genes to prolong their function in the fields. © 2023 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Aim: Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of coronavirus disease 2019 (COVID‐19) infection among frontline nurses. This study aimed to explore the relationships among teamwork, work environment and resources, work–life balance, stress perception and burnout among nurses working at a dedicated infectious disease control hospital. Methods: The participants were 389 nurses at a dedicated infectious disease control hospital in Taipei City, Taiwan. This study adopted survey design with a questionnaire using the Safety Attitude Questionnaire. Results: The work–life balance among nurses at the dedicated hospital significantly mediated the effects of teamwork and work environment and resources on burnout. In addition, stress perception had interaction effects on work–life balance and burnout. Conclusion: This study's results provide important recommendations for managing teamwork, work environment and resources, work–life balance, stress perception and burnout prevention in nurses to help them better prepare and cope with emergencies. Findings can serve as a reference for developing relevant hospital management policies. Summary statement: What is known about the topic? Organizational changes, information scarcity and shortages of personal protective equipment were the primary factors driving uncertainty when the pandemic began.Work environments can significantly affect burnout, job satisfaction and perceived stress among nurses.Teamwork is an important factor affecting nurse burnout. What this paper adds? Repeated occupational exposure and increased stress and fatigue levels contribute to a high risk of COVID‐19 infection among frontline nurses.Healthcare systems should emphasize the issues of teamwork, work environment and resources and work–life balance among nurses to help them prepare for and cope with emergencies.Nurse supervisors should constantly monitor for burnout among subordinates and eliminate their stressors. The implications of this paper: When teaching nursing management skills during an epidemic, it is essential to focus on strengthening the nursing supervisors' communication role, particularly during an outbreak.To reduce nurse burnout, key leadership and culture aspects in the work environment include prioritizing infection control measures, providing social support, encouraging strong multidisciplinary teamwork, ensuring adequate resources are available and receiving support from hospital superiors and the government. By addressing these factors, healthcare organizations can create a positive work environment that supports nurses' well‐being and promotes better patient outcomes.To manage nurses in the postpandemic era, healthcare organizations can implement routine training programs, new models of cross‐teamwork, emergency response plans, effective systematic monitoring and mental health intervention programs. These strategies can help promote collaboration, support nurses' mental health and ensure preparedness for future crises. Healthcare organizations can create a more effective healthcare system by adopting these measures. [ABSTRACT FROM AUTHOR]

Tobacco use is the most preventable cause of chronic diseases and cancers worldwide. In south-western Taiwan, tobacco use has become one of the top risk behaviors. Smoking in young people has been associated with alcohol addiction and drug abuse in later life; and most smokers start young. Initiation of cigarette smoking at an early age leads to more life-years of tobacco use, makes quitting harder, and increases the risk for serious health consequences. How adolescent boys effectively control their tobacco use is still uncertain. The article explores on the experience of 12 adolescent boys in south-western Taiwan controlling tobacco use as a result of participating in a smoking prevention education program. In addition to the use of interviews and focus groups as the traditional method of data gathering, the lead author also included the use of participants' paintings as representations of the participants' lived experience of the phenomenon. The findings of the study suggest that adolescent boys with smoking experience in Taiwan had the desire to control their smoking behavior after obtaining information through a local education program. In addition, they chose suitable methods for controlling their smoking based on the information that had been provided.

This study integrates augmented reality (AR) technology into teaching activities to design a learning system that assists junior high-school students in learning solid geometry. The following issues are addressed: (1) the relationship between achievements in mathematics and performance in spatial perception; (2) whether system-assisted learning can improve the spatial perceptions of students; (3) whether students with high, average and low academic achievement learn effectively after taught with system assistance; (4) system usability; (5) system task load; and (6) the relationship among various factors. Study participants were 76 students from Tainan City, Taiwan. Qualitative and quantitative data are obtained using pre- and post-system-assisted learning paper-pencil tests, a system usability scale, National Aeronautics & Space Administration Task Load indeX, and observations and focus group interviews. Analysis results indicate that students' math scores and spatial perception during the test closely correspond to each other. Additionally, system-assisted can improve the spatial perceptions of student. Regarding group differences related to the significance of impact, students with average and low academic achievements exhibit small and medium levels of effectiveness, but are insignificant in high academic achievement students. As for system usability, students with low academic achievements demonstrate a positive attitude toward the intensive programs provided by the system. However, the correlation between students' learning effectiveness and system usability/task load is low.

Aims: The study aimed to explore farmers' self‐care behaviours including oral hygiene, remaining natural teeth, cardiometabolic risks, hepatitis, risk of stroke and their determinant factors. Methods: This cross‐sectional study was conducted between June 2020 and March 2021 in the south‐western remote areas of Taiwan. We recruited current farmers who participated in an annual community health screening conducted by a collaborated local hospital. Data were collected through face‐to‐face interviews using a semi‐structured questionnaire. Blood samples were drawn and stored in the central laboratory of the cooperating hospital. The study outcomes included cardiometabolic risks, the remaining natural teeth, and farmers' self‐care behaviours including oral hygiene, adopting a healthy diet and substance use. Results: Overall, 183 current farmers (55.2% women, aged 66.9 ± 11.7 years) were enrolled. Abnormal blood pressure, high risk of stroke, metabolic syndrome and hepatitis C virus infection were found among the participants. The average remaining teeth were 12.1, 73.2% of participants had <20 teeth; 90.2% and 71% did not undergo regular dental check‐ups and scaling or use dental floss, respectively. The determinant factors associated with the remaining teeth included a high risk of stroke, teeth scaling and dental floss use. Although only 3.8% felt mentally distressed, many farmers were unaware of having potential cardiometabolic diseases and curable viral hepatitis, and only two had received antiviral treatment. Conclusion: The farmers in this study had a high prevalence of cardiometabolic risks, a high probability of stroke, inadequate number of remaining teeth and poor oral hygiene behaviours. These findings can provide evidence to develop health promotion programmes for farmers. Impact: This study demonstrates the health needs of farmers. We strongly recommend that community nurses empower farmers to engage in self‐care behaviours through tailored health promotion programmes. For instance, by discussing cardiometabolic risk prevention from the farmers' perspectives to improve their health literacy. [ABSTRACT FROM AUTHOR]

Formulaic language is important to language acquisition; however, English language learners are often reported to have problems with formulaic expressions. Several lists of formulaic sequences have been proposed, mainly for developing teaching and testing materials. However, their limited numbers and insufficient usage information seem unable to benefit formulaic language use. To address these issues we have developed GRASP, a reference aid for formulaic expressions, to promote learners' productive competence. Users are allowed multi-word inputs to target their desired phrases or collocations. Utilizing natural language processing techniques, our system categorizes and displays the structures and sequences in a hierarchical way. The corresponding example sentences are also provided. The formulaic structures serve as a quick access index. The formulaic sequences and corpus examples illustrate the real world language use. Importantly, automatic summarization from language data lends support to the idea of data-driven learning. A single-group pre-posttest design was adopted to assess the effectiveness of GRASP on 150 Chinese-speaking college freshmen. The results indicated that our reference aid made a substantial contribution to students' performance on formulaic expression use in a sentence completion task, compared with the existing tools. Notably, the less proficient students showed marked improvement.

A case study was undertaken in a junior high school that had won the highest award of the National PowerTech Contest in Taiwan. In the contest, students were required to create their own wooden robot (mechatronics project) in the morning and compete in the afternoon, in order to better avoid the intervention of parents and teachers in the process. The aim of the study was to realize how the after-school club operated to promote the motivation and skills in hands-on creation to win a national competition while advancing learning in science and technology. As a transition model of development, activity theory was used to examine how these developmental processes were structured. In particular, results showed that four major domain strategies were used in the science and technology club (STC): (1) to promote student engagement, (2) to transfer parents' attitudes, (3) to promote peer collaboration, and (4) to enhance expansive learning and creativity. (Contains 1 figure and 1 table.)

The venerable aphorism "an old dog cannot learn new tricks" implies that the elderly rarely learn anything new--in particular, scientific knowledge. On the basis of "learning by doing," the present study emphasized knowledge application (KA) as elderly subjects collaborated on the design of a toy flying saucer (UFO). Three types of KA were identified by questioning the work: Type 1--knowing neither how nor why; Type 2--knowing how, but not why; and, Type 3--knowing how and why. The results indicated that female elderly subjects more often exhibited Type 1 of KA compared with male elderly. The evidence supported a KA of Type 3 for those who had a science background, as they performed better than those without a science background. However, even those without a science background were able to produce science toys if they worked cooperatively, particularly when they could learn from others who had a science background. (Contains 5 tables and 2 figures.)

This study examines the perceptions of festival host residents of the Dajia Mazu Pilgrimage using the proposed model to evaluate the antecedent and outcome variables of place image. Using quantitative methods, this study proposes a model to determine host residents' perceptions based on fit, place image, quality of life, and behavioral intention. The findings showed that place image is vital in establishing a supportive perception toward the festival host city. Quality of life not only mediates the perceptions of residents' image and their residency but also independently contributes to the development of residents' behavioral intentions. The perceptions of place image or the quality of life of residents, especially place image, are significant predictors of residents' behavioral intentions. This study extends the concepts of fit and place image by taking a psychological perspective to provide strategies for festival management. To evaluate residents' quality of life and gain their intention to support for the festival, the present study suggests that event organizers and the local government take action on the characteristics of the festival and the host city represents. Providing entertainment activities combine with Mazu culture at nighttime is one of the suggestions. The exploratory model we proposed herein to explain host residents' viewpoints showed sufficient predictive power. The results underline the importance of fit, which can predict and explain place image. Furthermore, the present study contributes to existing research by applying the concept of fit in the festival context. [ABSTRACT FROM AUTHOR]

Breast cancer is the most commonly diagnosed cancer among women worldwide. Studies have reported minimal birth cohort effects on the incidence rates of breast cancer in Western countries but have reported notable birth cohort effects in some Asian countries. The risks of breast cancer may also vary within a country. In the present study, we abstracted female invasive breast cancer data from the Taiwan Cancer Registry for the period 1997–2016. We used the age–period–cohort model to compare birth cohort effects on breast cancer incidence rates between urban and rural regions in Taiwan. We identified a notable urban–rural disparity in birth cohort effects on breast cancer incidence rates in women in Taiwan. The incidence rates in the urban regions were higher than those in the rural regions across all cohorts. However, the incidence rates rose faster in the rural regions than in the urban regions across the cohorts. The risks of breast cancer observed for women born in 1992 were approximately 22 and 11 times than those observed for women born in 1917 in rural and urban regions, respectively. The observed gap in breast cancer incidence rates between the urban and rural regions gradually disappeared across the cohorts. Accordingly, we speculate that urbanization and westernization in Taiwan may be the drivers of female breast cancer incidence rates across birth cohorts. [ABSTRACT FROM AUTHOR]

Chronic disease following Nocardia seriolae infection in a wide range of aquatic animals has been reported in many Asian countries and recently in America and Mexico. This study aimed to investigate the epidemiological relationship among N. seriolae isolates in Taiwan by investigating their genotype and enzymatic activities. A total of 66 strains isolated from 14 known and four unknown host fish from five sites in Taiwan were characterized using five combined methods. High genotypic diversity was recognized among the isolates with 10 pulsotypes being identified from the pulsed‐field gel electrophoresis method and 21 reptypes from the repetitive extragenic palindromic amplification method; however, no natural plasmids were detected in this bacterial population. Pulsotypes A8 and RI analysed by PFGE and repPCR, respectively, were found to be predominant within five sites in Taiwan over 17 years of isolation. Enzymatically, the majority of isolates displayed high leucine arylamidase, β‐glucosidase and α‐glucosidase activities but were negative for lipase, α‐galactosidase, β‐glucuronidase, N‐acetyl‐glucosaminidase, α‐mannosidase and α‐fucosidase activities. We identified a strong association between genotype and enzymatic activity since the majority of pulsotypes displayed the same type of enzymatic profile. This study provides comprehensive and potential epidemiological data, which will aid the fish farming activities and prevention method development. [ABSTRACT FROM AUTHOR]

Background: Tic disorders are common neurodevelopmental disorders during childhood. Whether prenatal and postnatal exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) plays a role in the development of tic disorders remains unexplored. Objectives: To investigate the association of exposure between PM2.5 during the pregnancy and infancy periods and the risk of tic disorders. Methods: This birth cohort study recruited singleton live births at term gestations in central Taiwan from the Taiwan Maternal and Child Health Database between 2004 and 2012 and followed up to the end of 2017. New cases of tic disorders were defined using the ICD‐9‐CM (307.2) and ICD‐10‐CM (F95), which include all tic spectrum disorders. We assigned daily PM2.5 concentrations derived from a satellite‐based model to individuals based on maternal residential addresses at delivery. We fit Cox proportional hazard model and distributed lag non‐linear model to estimate the associations between PM2.5 and tic disorders, with hazard ratio (HR) with 95% confidence interval (CI) as the effect measure. Results: Of the 309,376 singleton live births at term gestations, we identified 5902 (1.9%) tic disorder cases. The HR of tic disorders was positively associated with a 10 μg/m3 increase in PM2.5: during pregnancy HR 1.09, 95% CI 1.04, 1.15 and during infancy HR 1.12, 95% CI 1.06, 1.18. The vulnerable time window for infants with increased risk of tic disorders was 6–52 weeks after birth. We observed a nonlinear relationship between PM2.5 and the risk of tic disorders, with exposure to PM2.5 between 16 and 64 μg/m3 being associated with the risk of tic disorders. The association was restricted to Tourette's disorder group. Infant sex did not modify these associations. Conclusions: Infants delivered at term and exposed to PM2.5 are associated with an increased risk of tic disorders (6–52 weeks). Further studies are needed to confirm these associations. [ABSTRACT FROM AUTHOR]

Snare polypectomy is commonly used to remove polyps during colonoscopy. For small to medium polyps, it can be done with (hot) or without (cold) applying electrical cautery. This trial examined whether cold snare is better than hot snare in reducing delayed bleeding after removal of small to medium polyps. Visual Abstract. Cold Snare Polypectomy for Small Polyps.: Snare polypectomy is commonly used to remove polyps during colonoscopy. For small to medium polyps, it can be done with (hot) or without (cold) applying electrical cautery. This trial examined whether cold snare is better than hot snare in reducing delayed bleeding after removal of small to medium polyps. Background: Although cold snare polypectomy (CSP) is considered effective in reducing delayed postpolypectomy bleeding risk, direct evidence supporting its safety in the general population remains lacking. Objective: To clarify whether CSP would reduce delayed bleeding risk after polypectomy compared with hot snare polypectomy (HSP) in the general population. Design: Multicenter randomized controlled study. (ClinicalTrials.gov: NCT03373136) Setting: 6 sites in Taiwan, July 2018 through July 2020. Participants: Participants aged 40 years or older with polyps of 4 to 10 mm. Intervention: CSP or HSP to remove polyps of 4 to 10 mm. Measurements: The primary outcome was the delayed bleeding rate within 14 days after polypectomy. Severe bleeding was defined as a decrease in hemoglobin concentration of 20 g/L or more, requiring transfusion or hemostasis. Secondary outcomes included mean polypectomy time, successful tissue retrieval, en bloc resection, complete histologic resection, and emergency service visits. Results: A total of 4270 participants were randomly assigned (2137 to CSP and 2133 to HSP). Eight patients (0.4%) in the CSP group and 31 (1.5%) in the HSP group had delayed bleeding (risk difference, −1.1% [95% CI, −1.7% to −0.5%]). Severe delayed bleeding was also lower in the CSP group (1 [0.05%] vs. 8 [0.4%] events; risk difference, −0.3% [CI, −0.6% to −0.05%]). Mean polypectomy time (119.0 vs. 162.9 seconds; difference in mean, −44.0 seconds [CI, −53.1 to −34.9 seconds]) was shorter in the CSP group, although successful tissue retrieval, en bloc resection, and complete histologic resection did not differ. The CSP group had fewer emergency service visits than the HSP group (4 [0.2%] vs. 13 [0.6%] visits; risk difference, −0.4% [CI, −0.8% to −0.04%]). Limitation: An open-label, single-blind trial. Conclusion: Compared with HSP, CSP for small colorectal polyps significantly reduces the risk for delayed postpolypectomy bleeding, including severe events. Primary Funding Source: Boston Scientific Corporation. [ABSTRACT FROM AUTHOR]

The rapid development of information and communication technology and the popularization of the Internet have given a boost to digitization technologies. Since 2001, The National Science Council (NSC) of Taiwan has invested a large amount of funding in the National Digital Archives Program (NDAP) to develop digital content. Some studies have indicated that most respondents had no confidence in particular digital archive websites. Thus, with the Technology Acceptance Model (TAM) as a theoretical basis, the focus of the present study was to identify the factors influencing usage. Extension of the roles of perceived playfulness and interface design was also explored to identify the reasons that digital archives might not be accepted by some users. The present study used a random sampling method to distribute questionnaires to digital archive users via e-mail. The Structural Equation Modeling (SEM) method was used to verify the appropriateness of the study model and whether the hypotheses were confirmed. Study results indicated that the "interface design" is an important factor that influences people to use the digital archives, and that it is separate from the "human factor" and the "human-computer interface" (HCI). Moreover, the results showed that HCI had a significant impact on the "perceived ease of use" and on "usage intentions." However, the human factor interface showed a significant impact only on "perceived ease of use." With respect to the hypotheses regarding "usage intentions," the "perceived usefulness," "perceived ease of use," "attitude," and "perceived playfulness" were not related to "usage intentions." Therefore, it is necessary to consider the quality of interface design in the development of digital archives in order to promote usage. (Contains 3 tables and 5 figures.)

The POWERTECH contest in Taiwan was established in an attempt to promote inventiveness and technology to elementary school pupils. The POWERTECH contest is designed as a collaborative learning system for project design. Project design is comprised of technical processes, which include the construction of an artifact and improvement of its functions. Thus, pupils learn scientific and technical knowledge through a collaborative design project. The purpose of the study was to examine how collaborative learning could be facilitated in technological project design, and whether and how pupils working collaboratively were able to share their design ideas. The study was carried out by analyzing the design portfolio compiled by a team of four elementary school pupils who were engaged in a collaborative design project that focused on making a robot rat for the POWERTECH contest. A portfolio analysis was used in this study to help researchers assess the actual collaboration process among the team members. The study indicated that collaborative learning in a contest facilitated the sharing of knowledge and resources among the team members. Furthermore, reflections essential for problem-solving among the team members were often raised during the design process. These reflections were also conducive to the reduction of mistakes during the contest.

The aim of the current study was to examine the role of satisfaction-with-event as a mediator in the relations between flow and life satisfaction based on the bottom-up theory (Andrews and Withey in "Social indicators of well-being: Americans' perceptions of life quality." Plenum, New York, 1976; Lee et al. in "J Macromarketing" 22(2): 158-169, 2002). Four hundred and thirty-four participants with a mean age of 35.60 (SD = 11.76) were recruited from the audience of a "Cirque du Soleil" acrobatics show, performed in Taiwan in 2009. Participants completed the flow scale (Csikszentmihalyi in "Flow: the psychology of optimal experience." Harper & Row, New York, 1990), a satisfaction-with-event scale (Lin and Hsu in "Mark Rev" 3(4): 497-528, 2008), and a satisfaction-with-life scale (Diener et al. in "J Pers Assess" 49:71-75, 1985) immediately after viewing the show. Structural equation modeling was conducted to examine our hypothesis that satisfaction-with-event levels would fully mediate the relationship between flow and overall life satisfaction. Results supported our prediction and are discussed in terms of bottom-up theory. Implications of the study are also provided for the leisure managers.

The aim of this study was to examine the psychometric properties of the Orientations to Happiness Questionnaire (OHQ; Peterson et al. in "J Happiness Stud" 6(1):25-41, 2005) in Taiwanese students. The participants were 578 undergraduate students (M[subscript age] = 18.64, SD = 1.02) and completed the OHQ, satisfaction with life scale (Diener et al. in "J Personality Assess" 49:71-75, 1985), and subjective happiness. Confirmation factor analysis indicated that a three-factor model with 17 items was the better fit model. Cross-validation also supported the modified Chinese version of the OHQ. Besides, the OHQ significantly predicted life satisfaction and subjective happiness with an exception of life of pleasure. Overall, it was concluded that the Chinese version of the OHQ would be useful for assessing individual's orientations to happiness.

The purpose of this study was to examine the psychometric properties of Wood's Job Satisfaction Questionnaire (JSQ) among Taiwanese workers. The participants were 341 nonprofit sport organization workers (M[subscript age] = 35.89, SD = 9.23) who completed the job satisfaction questionnaire, turnover intention scale, and organizational commitment. Confirmatory factor analysis was conducted to examine the validity of the JSQ. Results indicated that the model fit was satisfactory and a second-order factor accounts for the relationships among the first-order factors. In addition, the JSQ was, as expected, positively correlated with organizational commitment but is inversely correlated with turnover intention. The Cronbach's alpha was 76 for the JSQ, indicating a satisfactory validity and reliability in the Taiwanese worker sample. We conclude that the JSQ is useful for assessing an employee's satisfaction.

The present study based on World Health Organization quality of life (WHOQOL-BREF) scale to examine quality of life of the caregivers caring for their children/adolescents with intellectual disabilities in Taiwan, and the factors contributing to their quality of life. Structured interviews were conducted with 597 caregivers of children/adolescents with intellectual disabilities. The results found that the mean scores in each domain of WHOQOL-BREF of the caregivers as the followings: physical capacity (PC) was 13.71 [plus or minus] 2.35, psychological well-being (PW) was 12.21 [plus or minus] 2.55, social relationship (SR) was 12.99 [plus or minus] 2.43 and environment (EN) was 12.32 [plus or minus] 2.38. These mean scores were lower than the general population and slight higher than the caregivers of adults with intellectual disabilities in Taiwan. Finally, multiple stepwise regressions were conducted to examine the characteristics of caregiver and children/adolescents with intellectual disabilities will more likely explained the WHOQOL-BREF mean scores. The study found the following three factors: self-perceived health status, household income and stress from insufficient family support were significantly correlated to all four domains in multiple stepwise regression analyses. The results highlights that caregivers of children and adolescents with intellectual disabilities seem to display a lower WHOQOL-BREF mean score than the general population, probably for a combination of stress, health and household income factors. These finding must be taken into account in policy making to provide better and more specific supports and interventions for the caregivers of people with intellectual disabilities. (Contains 9 tables.)

Traumatic brain injury (TBI) causes several long-term disabilities, particularly headaches. An association between TBI and subsequent migraine has been reported. However, few longitudinal studies have explained the link between migraine and TBI. Moreover, the modifying effects of treatment remain unknown. This retrospective cohort study used records from Taiwan's Longitudinal Health Insurance Database 2005 to evaluate the risk of migraine among patients with TBI and to determine the effects of different treatment modalities. Initially, 187,906 patients, aged ≥ 18 years, who were diagnosed as TBI in 2000, were identified. In total, 151,098 patients with TBI and 604,394 patients without TBI were matched at a 1:4 ratio according to baseline variables during the same observation period. At the end of follow-up, 541 (0.36%) and 1491 (0.23%) patients in the TBI and non-TBI groups, respectively, developed migraine. The TBI group exhibited a higher risk of migraine than the non-TBI group (adjusted HR: 1.484). Major trauma (Injury Severity Score, ISS ≥ 16) was associated with a higher migraine risk than minor trauma (ISS < 16) (adjusted HR: 1.670). However, migraine risk did not differ significantly after surgery or occupational/physical therapy. These findings highlight the importance of long-term follow-up after TBI onset and the need to investigate the underlying pathophysiological link between TBI and subsequent migraine. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This study explored the effect of transdermal buprenorphine on quality of life and six symptoms in cancer patients with pain. Background: Transdermal opioids offer advantages over traditional routes of administration. The impact of transdermal buprenorphine on quality of life for patients with cancer in Asian populations is unknown. Design: This study employed a single‐arm observational repeated measures design. Cancer patients with pain were evaluated prior to treatment (baseline). Over a 4‐week treatment period, quality of life and symptoms were assessed at 2 and 4 weeks. This study adhered to the recommendations of STROBE guidelines. Methods: This multi‐site study was conducted in six hospitals located across northern, middle and southern Taiwan. Adult cancer patients whose pain was previously stable with opioid analgesics and, based on clinical judgement, were able to convert to transdermal buprenorphine treatment were invited to participate. Quality of life was measured with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ‐C30). Results: Generalised estimating equations showed participants who completed at least one follow‐up measurement (N = 80) over 4‐weeks had a significant improvement in overall quality of life. Functional status only improved for social functioning. However, symptom severity decreased significantly for nausea/vomiting, pain, insomnia and constipation. Conclusions: The study provides initial evidence supporting transdermal buprenorphine for providing beneficial effects of improving quality of life and reducing severity of symptoms in Asian patients with cancer. Relevance to clinical practice: The findings of this study can inform the clinical practice that the use of transdermal buprenorphine in cancer patients with pain may also reduce the severity of other symptoms and improve overall quality of life. Trial registration details: This study was registered in ClinicalTrials.gov. Identifier: NCT04315831. [ABSTRACT FROM AUTHOR]

Summary: Although more than one hundred studies have examined the prevalence of the use of benzodiazepines and benzodiazepine‐like Z‐hypnotics (BZDs) among pregnancy events, further analysis of the effects of dosage or type of BZDs is needed. The aim of this study was to examine the prevalence rate of BZDs use in pregnancy events, stratified by trimester over time, with characteristics of the dosage and type of BZDs. This is a retrospective population study based on linking three national databases. We examined the prevalence rates from 2004 to 2017, and contrasted the results based on >0 defined daily dose (DDD) and ≥0.5 DDD. We identified 2,630,944 pregnancy events with live births; 89,897 (3.4%) of the associated pregnancy events had used some form of BZD during pregnancy. The prevalence of BZDs use, as defined by >0 DDD, decreased from 4.1% in 2004 to 2.9% in 2017, indicating a decrease in sporadic use and an increase in stable use within therapeutic doses. Meanwhile, BZDs use defined by ≥0.5 DDD increased from 0.1% in 2004 to 0.4% in 2017. Zolpidem was the most frequently prescribed BZDs, as defined by >0 DDD or ≥0.5 DDD. This national cohort study demonstrates the importance of average dosage in the definition of BZDs use in pregnancy events, and it found opposite trends in the prevalence of use between different dosages. [ABSTRACT FROM AUTHOR]

Edwardsiella spp. is a gram‐negative, facultatively anaerobic, intracellular bacteria threatening the aquaculture industry worldwide. Noticeably, E. tarda is now genotypically classified into three distinct groups (E. tarda, E. piscicida and E. anguillarum), but morphologically, it is unclear due to varying degrees of virulence in different fish hosts. Hence, to reclassify E. tarda, we investigated differences in genotypes, phenotypes and pathogenicity. We collected Edwardsiella isolates from five different counties of Taiwan between 2017 and 2021. At first, gyrB gene was amplified for a phylogenetic tree from 40 isolates from different fish and one reference isolate, BCRC10670, from the human. Thirty‐nine strains clustered into E. anguillarum, 1 strain into E. piscicida and 1 strain into E. tarda from human strain. Second, all isolates were characterized using various phenotypic (API 20E biochemical profiles) and genotypic (pulsed‐field gel electrophoresis [PFGE], and virulence‐related gene detection). SpeI digestion revealed 10 pulsotypes and I‐CeuI into 7 pulsotypes. Virulent genes (citC, gadB, katB, mukF and fimA) confirmed in 35, 31, 28, 37 and 38 isolates, respectively. Finally, in vivo challenge test in milkfish (Chanos chanos) indicated the highest mortality from E. anguillarum. Overall, results revealed unique features with Edwardsiella spp. genotypes and pathogenicity, which are relevant to the host and provide useful insights for future vaccine development. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan. Materials and Methods: Adults naive to H. pylori eradication received 13C‐urea breath test (13C‐UBT), H. pylori stool antigen test, and serology test during 2019–2020 in this prospective screening program. Children and adolescent aged between 7 and 19 years received 13C‐UBT for H. pylori screening. We also conducted a systematic review and meta‐analysis to assess the secular trend of prevalence of H. pylori from 1990 to 2020 in Taiwan. The secular trends of age‐standardized incidence and mortality of gastric cancer were obtained from the Taiwan Cancer Registry. Results: A total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H. pylori infection by 13C‐UBT was 26.6% (397/1494), which was 30.8% in adults and 9.5% in adolescents/children. The age‐standardized prevalence of active H. pylori infection was 32.3% in adults after adjustment of the population structure in Taiwan. Of the 29 studies including 38,597 subjects eligible for the meta‐analysis, the pooled prevalence of H. pylori infection decreased from 63.8% (95% CI: 55.9%–71%) in 1990–2000 to 28.2% (95% CI:21.8%–35.6%) in 2016–2020. The age‐standardized incidence and mortality of gastric cancer have also declined from 15.2 to 10.75 per 100,000, respectively, in 1999 to 9.29 and 5.4 per 100,000, respectively, in 2019. Conclusions: The prevalence of H. pylori infection has declined in Taiwan, which correlates with the declining trends of age‐standardized incidence and mortality of gastric cancer in Taiwan. [ABSTRACT FROM AUTHOR]

To compare the test–retest reliability and random measurement errors of the Barthel Index (BI) and modified Barthel Index (MBI) in patients with chronic stroke. The intraclass correlation coefficient (ICC) and the minimal detectable change (MDC) were applied respectively to examine the test–retest reliability (about 2 weeks apart) and the random measurement errors. The MDC% was used to adjust the cut-off score for determining whether a real change had been achieved, if heteroscedasticity existed. A total of 60 patients participated. The BI and MBI both had high ICCs (0.94 and 0.94, respectively) with small MDCs (16.2 and 15.4, respectively) and MDC%s (21.2% and 19.0%, respectively), indicating that both measures have comparable reliability in repeated assessments. However, moderate associations (r = −0.47 for the BI and −0.59 for the MBI) were found between the means of tests and retests and the absolute values of change scores, indicating heteroscedasticity. These findings suggest that a fixed MDC value is not appropriate for determining the real change in both measures because the amount of random measurement error varies with the patients' ADL function. The MBI, which showed excellent test–retest reliability and relatively lower random measurement error than the BI, appears to be a better ADL measure. The MDC% adjusted value is recommended to determine whether the change scores are beyond random measurement error. The MBI is recommended for clinical and research applications because it has better test–retest reliability and relatively lower random measurement error than those of the original BI. The MDC% adjusted value is recommended to determine whether the change scores are beyond random measurement error when the MBI or the BI is used. [ABSTRACT FROM AUTHOR]

Background: Two antifibrotic medications, pirfenidone and nintedanib, have been approved as treatments for idiopathic pulmonary fibrosis (IPF)—a life-threatening interstitial lung disease. However, there are insufficient current data regarding clinical predictors of survival for patients with IPF in the era of antifibrotics. Methods: We retrospectively analyzed the medical records of patients with IPF treated between April 2017 and May 2020. Univariate and multivariate Cox proportional hazard models were used to identify independent predictors of mortality among these patients with IPF. Results: A total of 40 patients with IPF (average age, 75.58 ± 8.34 years) were included in the study, 27 (67.5%) of whom were treated with antifibrotic drugs. In the entire cohort, 14 (35%) patients died, and the overall survival of the study population was 48.52 ± 5 months (median, not applicable [NA] [29-NA] months). The univariate and multivariate Cox proportional hazard models indicated that chest tightness, finger clubbing, acute exacerbation after medication, decreased percentage forced vital capacity (%FVC), and decreased percentage 1-second forced expiratory volume were clinical factors linked to all-cause mortality among all patients, although without statistical significance at the multivariate level. Meanwhile, only finger clubbing was a significant mortality predictor among patients who received antifibrotic medications. A mortality scoring system was built upon the aforementioned risk factors, with the exclusion of %FVC, whose individual mortality score was nearly zero. Conclusion: Chest tightness, finger clubbing, acute exacerbation after medication, and decreased %FVC were clinical factors associated with mortality in patients with IPF, although without statistical significance. A scoring system including these factors can be used to predict all-cause mortality in patients with IPF. The mere intake of antifibrotic medications was not a significant mortality predictor in this study. This might be owed to the retrospective nature of the study, where many patients started the medications after the deterioration of their pulmonary function rather than from the start. [ABSTRACT FROM AUTHOR]