Search

Background: Understanding demographic profiles is essential to the assessment of health burden imposed by motor vehicle crashes (MVCs) on pregnant women. However, Asian studies that have examined it are lacking. The study aimed to describe the demographic characteristics and prevalence of MVCs involving pregnant women in Taiwan. Methods: A cross-sectional study conducted by the Taiwan Birth Notification dataset from 2008 to 2017 was linked with the police-reported traffic collision registry to identify pregnant women involved in MVCs. The pregnant women were categorized according to their gestational age, age at delivery, the role of road user (driver, passenger, or pedestrian), and vehicle types (car, two-wheeled motor vehicle, or others). A chi-square test was performed for the significance test. Results: A total of 22,134 (1.13%) pregnant women were involved in MVCs in the study period. Two-wheeled motor vehicle (47.9%) and driver (81.4%) were the mainly reported vehicle type and road user at the crash scenes, respectively. The majority of MVCs occurred in pregnant women aged 28–34 years. The number of MVCs rapidly declined after 37 weeks of gestation, especially two-wheeled motor vehicle or car crashes. However, the number of pedestrian victims climbed up during the third trimester. Conclusion: Pregnant women are susceptible to MVCs regardless of their gestational age, role of a road user, or type of vehicle. The findings of this study emphasize the need for increased awareness of traffic collision prevention among pregnant women aged 28–34. In addition, improving pedestrian safety is essential for the reduction of pregnant victims. [ABSTRACT FROM AUTHOR]

Background Adverse events in fetuses are well researched but studies on the follow-up health outcomes of infants exposed to maternal motor vehicle crashes (MVCs) during pregnancy have yielded inconsistent results. This study aimed to investigate the association of maternal exposure to MVCs during pregnancy with the risk of adverse neonatal outcomes. Methods This population-based cohort study used data from birth notifications in Taiwan. A total of 19 277 offspring with maternal exposure to MVCs during pregnancy and 76 015 randomly selected comparison offspring without such exposure were selected. Neonatal adverse outcomes were identified from National Health Insurance medical claims data. Conditional logistic regression was used to estimate the unadjusted and adjusted odds ratios (aORs) of neonatal adverse outcomes. Results Offspring exposed to maternal MVCs during pregnancy had a higher risk of birth defects (aOR, 1.21; 95% CI, 1.04–1.41) than offspring without such exposure. This positive association was sustained with exposure to an MVC during the first or second trimester. A dose–response relationship (P  = 0.0023) was observed between the level of injury severity and the risk of birth defects. Conclusions In the early stages of pregnancy, maternal exposure to MVCs may entail a risk of birth defects in the offspring. The potential mechanisms for the associations of maternal exposure to MVCs with birth defects need further investigation. [ABSTRACT FROM AUTHOR]

Background: Most smokers in developing countries begin smoking before age 18, and smoking prevalence is rising among adolescents. School personnel represent a target group for tobacco-control efforts because they interact daily with students, are role models for students, teach about tobacco-use prevention in school curricula, and implement school tobacco-control policies. The prevalence of teenage smoking has been examined in numerous studies, but few have focused on the influence of school personnel and the characteristics of school personnel who enforce school nonsmoking policy. The purpose of this study was to determine the factors associated with junior high school personnel advising students to quit smoking. Methods: School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. Results: Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. Conclusions: To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel. (Contains 5 tables.)

Background: Tobacco use is a major preventable cause of death in the world. This article describes and compares tobacco use prevalence for students attending junior high schools and senior high schools in Taiwan. Methods: This report uses data from the Global Youth Tobacco Survey (GYTS) completed among 4689 junior high school students and 4426 senior high school students in Taiwan in 2004-2005. The GYTS uses a 2-stage sampling design to produce nationally representative data for junior and senior high students in general and vocational schools. Results: Higher smoking prevalence was observed among senior high (10.1% general schools and 15.9% vocational schools) than junior high (5.5%) school students. Smoking prevalence of girls in junior high (3.2%) and senior high schools (4.6% general and 11.1% vocational) was almost as high or higher than adult females' (4.3%) smoking rates. The pattern of smoking intensity across school years and type of school shows that the percentage of smokers who were experimenters (47.1%) was higher in junior high school and the percentage of smokers who were regular/established smokers (over 50%) was higher in senior high school. Conclusions: Smoking prevalence described in this report shows that there are challenges facing the tobacco prevention and control program in Taiwan. The findings suggest that schools should increase their smoking initiation prevention efforts and make available cessation programs and counseling to help students quit smoking. If effective youth tobacco control programs are not developed and implemented in Taiwan, future morbidity and mortality attributed to tobacco will surely increase, especially among women. (Contains 3 tables and 1 figure.)

Background: Most studies have focused on injuries sustained by intoxicated drivers themselves, but few have examined the effect of drunk driving on injury outcomes among VRUs (vulnerable road users) in developing countries. This study aims to evaluate the effect of drunk driving on fatal injuries among VRUs (pedestrians, cyclists, or motorcyclists). Methods: The data were extracted from the National Taiwan Traffic Crash Dataset from January 1, 2011, to December 31, 2019. Crashes involving one motorized vehicle and one VRU were considered. This study examines the effect of drunk driving by estimating multivariate logistic regression models of fatal injuries among VRUs after controlling for other variables. Results: Among 1,416,168 casualties, the fatality rate of VRUs involved in drunk driving was higher than that of general road users (2.1% vs. 0.6%). Drunk driving was a significant risk factor for fatal injuries among VRUs. Other risk factors for fatal injuries among VRUs included VRU age ≥ 65 years (adjusted odds ratio [AOR]: 5.24, 95% confidence interval [CI]: 5.53–6.07), a nighttime accident (AOR: 4.52, 95% CI: 4.22–4.84), and being hit by a heavy-duty vehicle (AOR: 2.83, 95% CI: 2.26–3.55). Subgroup analyses revealed a linear relationship between driver blood alcohol concentration (BAC) and the risk of fatal injury among motorcyclists. Motorcyclists exhibited the highest fatality rate when they had a BAC ≤ 0.03% (AOR: 3.54, 95% CI: 3.08–4.08). Conclusion: Drunk driving was associated with a higher risk of fatality for all VRUs. The risk of fatal injury among motorcyclists was linearly related to the BAC of the drunk drivers. Injuries were more severe for intoxicated motorcyclists, even those with BAC ≤ 0.03%, which is within the legal limit. [ABSTRACT FROM AUTHOR]

Introduction. Unintentional injury remains the leading cause of death in children worldwide. Adequate parental supervision is a crucial strategy for preventing injury. Many factors, such as a large family size, poor socioeconomic status, and the caregiver being a single mother, contribute to unintentional injury in children. In addition, sleep deprivation in caregivers might be associated with injury in children because sleep deprivation causes impaired daytime cognitive function, wake-state instability, and negative moods, thereby impairing caregiver supervision. Therefore, this study determines the association between injury in children and the sleep quality of their primary caregivers. Method. This is a retrospective case–control study on unintentional injury in children aged 0 to 4 years who visited the emergency department (case group) and an age- and sex-matched control group. Sleep quality in caregivers was assessed using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was used to evaluate the association between aspects of the PSQI and injury. A propensity score model was used to generate a quasirandomized design. Results. This case-control study recruiting 277 injured and 274 noninjured children was conducted in Taiwan. There was no statistically significant difference in child's age and primary caregiver's age between the injured and noninjured groups. The primary outcome, Pittsburgh sleep quality index, was not significantly different between the two groups. The average scores of sleep duration and habitual sleep efficiency in the control group were higher than those in the case group. However, there was no difference between the two groups after adjusting via a propensity score model, including the following potential confounders, child's age, child's sex, number of previous injury, caregiver mental status, caregiver's sex and caregiver's age, and the number of children living together. Conclusion. Our study was the first to examine the association between injury in children and the sleep quality of their primary caregivers. We observed that no PSQI component significantly affected the risk of injury among children. [ABSTRACT FROM AUTHOR]

Background: Motorcycle full-coverage helmet use may reduce fatalities and head injuries.Methods: This retrospective cohort study extracted injury data from eight level-I trauma centres in Taiwan and performed a questionnaire survey to investigate injuries sustained by motorcyclists for the period between January 2015 and June 2017.Results: As many as 725 patients participated in the questionnaire survey and reported their helmet types or phone use during crashes. The results of multivariate logistic models demonstrated that nonstandard helmet (half or open-face helmet) use was associated with an increased risk of head injuries and more severe injuries (injury severity score ≥ 8). Drunk riding and phone use appeared to be two important risk factors for head injuries and increased injury severity. Anaemia was also found to be a determinant of head injuries."Conclusions: Compared to full-coverage helmets, nonstandard provide less protection against head injuries and increased injury severity among motorcyclists. [ABSTRACT FROM AUTHOR]

The bikeshare program in Taipei City and New Taipei City, called U-bike, was launched in August 2012 and has more than 7500 bicycles operating out of 769 stations. Research has suggested that bicycle helmet use is a means of reducing morbidity and mortality among bike users. Helmets, however, are not available for rent when a U-bike is rented. The current research conducted an observational study to examine the prevalence of helmet non-use by users of the bikeshare program, electric bicycles, racing bicycles, and personal bicycles in Taipei City and New Taipei City. Trained observers using compact video cameras collected helmet non-use data during various times of the day and on different days of the week. Observers collected data on cyclist attributes, bicycle types, and helmet use at several selected locations within Taipei City and New Taipei City. U-bike users were found to be the least likely to wear helmets. Other noteworthy findings include that violations such as phone use, red-light violations, and travelling at ≥25 km/h were associated with riding without a helmet. Male users of racing bikes tended not to wear helmets, while female users of other bicycle types were less likely to use a helmet. Carrying passengers by users of electric bikes and personal bikes was a determinant of helmet non-use. This paper concludes with a discussion and recommendations for future research. [ABSTRACT FROM AUTHOR]

Objectives Past studies have concluded that racing games may induce car drivers' risk-taking behaviours. Limited research has been conducted to investigate whether such an effect applies to pedestrians when crossing a street. This study investigates the effects of smartphone racing games on pedestrian's risk-taking inclinations. Materials and Methods Using WiFi video cameras, pedestrians’ risk-taking inclinations such as game playing when crossing the street, red-light violation, and walking outside the crosswalk at a signalised intersection in Taipei City were observed. Data such as their phone features, smartphone game types, and personal attributes were obtained in the interviews conducted after pedestrians had completed crossing the street. Effects of racing games (RCG) were compared with those of several other games (e.g., Pokemon, RPG: Role-Playing Game, ACT: Action Game, SPG: Sports Game, FTG: Fighting Game, STG: Shooting Game, PZG: Puzzle Game, ETC: Other Game). Results A total of 1480 participants completed crossing the street and were interviewed between April 2017∼March 2018. Pokemon Go was most associated with game playing when crossing, running the red light, and walking outside the crosswalk. Logistic regression models reveal several other important determinants of risk-taking inclinations: being a student, larger smartphone screen size, unlimited Internet allowance. Student players of Pokemon GO, and playing Pokemon with unlimited Internet allowance, appear to contribute to pedestrian's risk-taking inclinations. Conclusions RCG appears not to be associated with pedestrian's risk-taking behaviours as much as Pokemon Go does. Instead, compared to other smartphone games, Pokemon Go is most associated with pedestrian's risk-taking inclinations. [ABSTRACT FROM AUTHOR]

The objective of the study was to introduce the methodology and report on cohort description of Taiwan Adolescent to Adult Longitudinal Study (TAALS). TAALS is the first nationwide longitudinal survey among Taiwan adolescents, linked with the National Health Insurance Research Database (NHIRD) to obtain complete medical records of respondents in the future. The TAALS project employed the principle of probability proportional to size (PPS) sampling method. Data were collected by questionnaire from 18 064 school students participating in 2015 formal survey, with good sample representation via a goodness-of-fit test after weighting adjustments. Through expert evaluation and statistics tests, TAALS shows a well nationally representation, validity, and reliability. Results indicate that the vocational school students had poor healthy behavior than other education systems, supporting the hypothesis that different learning environment will develop different health behaviors. TAALS can serve as a foundation for analyzing health trajectories of Taiwan adolescents. [ABSTRACT FROM AUTHOR]

Objectives: Bicyclists and motorcyclists contribute substantially to the morbidity and mortality rates of road crash casualties. The objective of the study was to investigate the crash characteristics of bicyclist and motorcyclist casualties presented to hospitals in Taiwan resulting from crashes. Methods: By using linked data from The National Traffic Crash Dataset and the National Health Insurance Database between 2003 and 2012, logistic regression models were used to examine the determinants of hospitalisation among motorcyclist and bicyclist casualties. The examined variables include demographic characteristics, road and weather conditions, and vehicle characteristics. Results: A total of 1,998,606 two-wheelers were enrolled in the study, of whom 216,600 were hospitalised: 203,623 were motorcyclists and 12,964 were bicyclists. Bicyclists were more likely to be hospitalised than motorcyclists were (14.0% vs. 10.7%). The pooled logistic regression model shows that bicyclists had higher odds of hospitalisation than motorcyclists (adjusted odds ratio [AOR] = 1.11, 95% confident interval [CI] = 1.08–1.14). In the motorcyclist and bicyclist models, helmet non-use appears to be a determinant of hospitalisation for motorcyclists (AOR = 1.14, CI = 1.12–1.16), although insignificant for cyclists (AOR = 1.03, CI = 0.94–1.12). Other important determinants of hospitalisation for motorcyclists and cyclists include female riders, elderly riders, rural roadways, unlicensed riding (for motorcyclists only), curved roadways, defective roadways, alcohol consumption (only for motorcyclists), and single-vehicle crashes (for motorcyclists only). Conclusions: The result that bicyclists had an increased probability of being hospitalised than motorcyclists is particularly noteworthy, because there have recently been much more users of bikesharing systems in metropolitan cities where cycle helmets are not provided. We further found that helmet non-use was also a risk factor for motorcyclists, but insignificant for cyclists, possibly due to lower helmet utilization rates among bicyclists. Our findings regarding the increased hospitalisation percentage emphasize the importance of helmet use. [ABSTRACT FROM AUTHOR]

The paper investigates the effects of phone use (talking, texting, and listening to music) on the street-crossing behaviours of pedestrians and their inattentional blindness in Taiwan. Recent handsets with touchscreens, as well as more advanced features including multimedia, and mobile applications (apps), exacerbate problems relating to cognitive distraction and reduced situation awareness. A controlled field study using video cameras was conducted for observing pedestrians’ crossing behaviours (e.g. crossing time, sudden stops, looking both ways before crossing, and disobeying traffic signals). Pedestrians were classified into two groups: experimental group (talking, texting, and listening to music) and control group (no phone use). Pedestrians’ inattentional blindness was examined by evaluating whether they saw and heard an unusual object (i.e. a clown) nearby. The results indicate that the proportions of unsafe crossing behaviours (e.g. sudden stops, disobeying traffic signals, and not looking both ways before crossing) were higher among distracted individuals and more pronounced among those using instant-messaging apps. These instant-message app users were the least likely to see the clown, and music listeners were the least likely to hear the horn that the clown was honking. Contributing factors to unsafe behaviours include being a student, having a phone screen of 5 inches or larger, and having unlimited 3G Internet access. Texting message via apps was the leading factor on unsafe crossing behaviours of pedestrians and their inattentional blindness. [ABSTRACT FROM PUBLISHER]

This paper examines pedestrian anatomical injuries and crash characteristics in back-to-traffic and facing-traffic crashes. Pedestrian crashes involving pedestrians walking along streets (i.e. with their backs to traffic or facing traffic) have been overlooked in literature. Although this is not the most frequent type of crash, the crash consequence to pedestrians is a safety concern. Combining Taiwan A1A2 police-reported accident data and data from the National Health Insurance Database from years 2003-2013, this paper examines anatomical injuries and crash characteristics in back-to-traffic and facing-traffic crashes. There were a total of 830 and 2267 pedestrian casualties in back-to-traffic and facing-traffic crashes respectively. The injuries sustained by pedestrians and crash characteristics of these two crash types were compared with those of other crossing types of crashes (nearside crash, nearside dart-out crash, offside crash, and offside dart-out crash). Odds of various injuries to body regions were estimated using logistic regressions. Key findings include that the percentage of fatalities in back-to-traffic crashes is the highest; logistic models reveal that pedestrians in back-to-traffic crashes sustained more head, neck, and spinal injuries than did pedestrians in other crash types, and unlit darkness and non-built-up roadways were associated with an increased risk of pedestrian head injuries. Several crash features (e.g. unlit darkness, overtaking manoeuvres, phone use by pedestrians and drivers, and intoxicated drivers) are more frequently evident in back-to-traffic crashes than in other types of crashes. The current research suggests that in terms of crash consequence, facing traffic is safer than back to traffic. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Parental smoking has been identified as the major source of children's exposure to environmental tobacco smoke (ETS). Therefore, parental involvement is critical in ETS exposure prevention programs. This study examined the effects of a parent-child interactive program on reducing children's exposure to ETS at home and enhancing parents' and children's prevention strategies.Methods: A clustered randomized controlled trial was administered to 75 families of school-aged children from six primary schools in New Taipei City, Taiwan. Families in the intervention group received a parent-child interactive intervention, and parents in the control group received written materials on tobacco hazards. Data on children's exposure and the prevention of children's exposure to ETS at home were obtained at baseline, 8-week, and 20-week or 6-month assessments.Results: The percentage of children with urine cotinine levels greater than or equal to 6 ng/ml was significantly lower in the intervention group than it was in the control group at both the 8-week and 6-month assessments. The intervention significantly reduced parental smoking in the presence of children and increased parents' prevention of children's ETS exposure and children's ETS avoidance behavior from the baseline to the 20-week assessment.Conclusions: This is a preliminary study design aimed at creating a program for reducing children's ETS exposure at home. Further research to produce evidence supporting the application of the parent-child interactive program in primary schools is suggested. The theoretical basis of the intervention design can serve as a reference for nursing education and the design of health education programs. [ABSTRACT FROM AUTHOR]

Objectives: Recurrent falls not only have risk factors different from those of single falls but also have less favorable outcomes. The aim of our study was to determine the association between the injury characteristics of a first fall and the likelihood of recurrent injurious falls in a cohort of hospitalized patients. Methods: We designed a nationwide retrospective cohort study and selected hospitalized patients who had injurious falls between 2001 and 2010. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of recurrent injurious falls requiring hospitalization in the following year on the basis of the patients’ demographic characteristics, comorbidities, and the characteristics of injuries from the first injurious fall requiring hospitalization. Results: Among the 504 512 patients hospitalized for injurious falls, 19 442 experienced recurrent injurious falls requiring hospitalization. The 1-year incidence of recurrent injurious falls requiring hospitalization was 3.85%. The incidence density was the highest within the 3-month period after the first injurious fall. The risk of recurrent injurious falls among patients aged 40 to 64, 65 to 74, and ≥ 75 years increased progressively (HR: 2.11, 95% confidence interval [CI]: 1.90–2.34; HR: 2.80, 95% CI: 2.51–3.11; and HR: 3.80, 95% CI: 3.42–4.23, respectively). The length of hospitalization (LOH) ≥ 15 or ≥ 31 days (HR: 1.39, 95% CI: 1.30–1.48; and HR: 1.59, 95% CI: 1.43–1.77, respectively) and injury to the head (HR: 1.59, 95% CI: 1.53–1.65) or spine (HR: 1.66, 95% CI: 1.59–1.74) were also found to be major risk factors. Conclusions: Our findings show that the LOH and head and spine injuries are associated with an increased risk of recurrent injurious falls leading to hospitalization. The risk of recurrent injurious falls requiring hospitalization increased significantly among adults older than 40 years. We suggest further research on the effects of injury characteristics associated with the first injurious fall requiring hospitalization and resultant anatomical damages on the risk of recurrent injurious falls requiring hospitalization. High-risk patients should receive tailored rehabilitation addressing their respective injuries within 3 months after hospital discharge. [ABSTRACT FROM AUTHOR]

We developed and psychometrically tested four scales for measuring the perceptions of parental smokers and family members’ influences on smoking behavior in the presence of children in Taiwan. Data were collected from 309 parental smokers with school-aged children. The results of factor analysis revealed two to three factors within each scale, and the reliability was between 0.63 and 0.91, based on Cronbach’s alpha. Our findings provide preliminary support for the reliability and validity of the scales. The collective application of the scales is comprehensive that may constitute a feasible approach for preventing parental smoking. [ABSTRACT FROM PUBLISHER]

Aims and objectives To evaluate the effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and materials received by patients undergoing cardiac catheterisation. Background Cardiac catheterisation is one of the most anxiety-provoking invasive procedures for patients. However, informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored. Design A randomised experimental design with three-cohort prospective comparisons. Methods In total, 123 consecutive patients were randomly assigned to one of three groups: regular education; (group 1), accessibility-enhanced multimedia informational education (group 2) and instructional digital videodisc education (group 3). Anxiety was measured with Spielberger's State Anxiety Inventory, which was administered at four time intervals: before education ( T0), immediately after education ( T1), before cardiac catheterisation ( T2) and one day after cardiac catheterisation ( T3). A satisfaction questionnaire was administrated one day after cardiac catheterisation. Data were collected from May 2009- September 2010 and analysed using descriptive statistics, chi-squared tests, one-way analysis of variance, Scheffe's post hoc test and generalised estimating equations. Results All patients experienced moderate anxiety at T0 to low anxiety at T3. Accessibility-enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and materials received compared with patients in groups 1 and 3. A statistically significant difference in anxiety levels was only found at T2 among the three groups ( p = 0·004). Conclusions The findings demonstrate that the accessibility-enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation, to reduce anxiety and improve satisfaction with the information and materials received compared with the regular education and instructional digital videodisc education. Relevance to clinical practice As the accessibility-enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and materials received, it can be adapted to complement patient education in future regular cardiac care. [ABSTRACT FROM AUTHOR]

Aim and objectives To explore risk factors for coronary artery disease ( CAD) among middle-aged women in Taiwan. Background Coronary artery disease is a leading cause of death among females. Risk factors for CAD vary due to differences in ethnicity, gender and age. However, few studies have documented risk factors among middle-aged women. Design We employed a cross-sectional, comparative study design. Methods Sixty-five middle-aged women who were suspected of having CAD and who received cardiac catheterisation were purposively sampled and divided into a CAD group (with at least one coronary artery with > 50% stenosis) and a control group, according to the results of catheterisation. Individual questionnaires regarding their medical history, blood test results, sociodemographic characteristics, metabolism, biomarkers and lifestyle risk factors were administered and quantified. Results The mean age of the 65 women (31 CAD and 34 controls) was 56·2 years. Within the CAD group, there was a greater incidence of women with a history of diabetes mellitus ( DM), increased fasting blood glucose and increased diastolic blood pressure. Comparatively fewer women within the CAD category used dietary supplements or had a lower level of physical activity. After adjusting for other confounders, it was discovered that women who used dietary supplements ( OR = 0·28; p = 0·04) and engaged in physical activities ( OR = 0·16; p = 0·02) were less likely to develop CAD. Conclusions Use of dietary supplements and engaging in physical activities can significantly predict the incidence of CAD among middle-aged women in Taiwan. Relevance to clinical practice Middle-aged women should be encouraged to take appropriate dietary supplements and engage in physical activity in order to prevent CAD. [ABSTRACT FROM AUTHOR]

Most smokers in developing countries begin smoking before age 18, and smoking prevalence is rising among adolescents. School personnel represent a target group for tobacco-control efforts because they interact daily with students, are role models for students, teach about tobacco-use prevention in school curricula, and implement school tobacco-control policies. The prevalence of teenage smoking has been examined in numerous studies, but few have focused on the influence of school personnel and the characteristics of school personnel who enforce school nonsmoking policy. The purpose of this study was to determine the factors associated with junior high school personnel advising students to quit smoking. School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel. [ABSTRACT FROM AUTHOR]

Background: Social acceptance of smoking is associated with smoking prevalence. Higher smoking rates and ETS exposure might be considered as important indicators for pro-tobacco social norms or social climate. Among studies indicating the association between youth smoking and adult smoking behaviors, most were from individual-level study designs. Objectives: An ecological study was conducted to determine the role of social climate, i.e., adult smoking behaviors and exposure to environmental tobacco smoke (ETS), on youth smoking behaviors. Methods: Data on the smoking behavior and ETS of 16,688 Taiwanese adults were collected in 2004 by telephone administration of the Taiwan Adult Smoking Survey. Similar data on 22,339 junior high school students were collected in 2004 by school-based administration of the Taiwan Youth Tobacco Survey. City/county-level data were analyzed across 25 counties by descriptive statistics, Pearson's' correlation, and hierarchical multiple regression. Results: In both adult and youth populations, overall or gender-specific smoking prevalence and ETS varied widely across counties/cities. The current youth smoking rate within counties was significantly positively correlated with the current adult smoking prevalence as well as home ETS exposure in adults or youth. For male youth, a 1% increase in the rate of home ETS exposure reported by youth increased the current male youth smoking rate by 0.20% after controlling the female youth smoking rate and home ETS exposure reported by adults (p =0.0197). For female youth, male youth smoking prevalence was the only variable that contributed significantly (Beta=0.46, p <0.001). Conclusions: Community health nurses should develop tobacco-control interventions that are tailored to support smoke-free environments by decreasing the social acceptability of smoking. [Copyright &y& Elsevier]

Abstract: Objectives: Most smokers begin using tobacco in their teens and recent reports indicate that smoking prevalence is climbing among youth in Taiwan. The purpose of this paper was to determine the associated factors of susceptibility of youth smoking by different types of schools. Methods: A total of 4689 junior high students and 3918 senior high students participated in a school-based survey to determine the associated factors of susceptibility of youth smoking through anonymous self-administered questionnaire in 2004–2005. Results: Susceptibility to initiate smoking ranged from 11.3% for junior high to 12.7% for general senior high and 12.4% for vocational senior students. For all/male smoking-susceptible students, more junior high students had one or more parents or best friends who smoked than did general or vocational senior high students. For all/female smoking-susceptible students, significantly more junior high students experienced secondhand smoke in public places than did non-susceptible students. Conclusions: Developing tailored, comprehensive smoking-prevention programs for junior high students should involve establishing tobacco-free households and communities. [Copyright &y& Elsevier]

• National Taiwan Traffic Crash Dataset for the period from 2011 to 2015 were used in this study. • Alcohol-involved and un-helmeted riders were approximately 18 times more likely to sustain fatal injuries than sober and helmeted riders. • The other risk factors of motorcyclist fatalities include head-on crashes and approach-turn motorcycle crashes. Alcohol-involved riders tend to engage in other risk-taking behaviours such as un-helmeted riding which could further increases injury severity. The combined effect of alcohol-involved and un-helmeted riding on fatal injuries is rarely investigated. This study investigated the interaction effect between blood alcohol concentration and helmet use on fatal injuries. This study used the National Taiwan Traffic Crash Dataset for the period from 2011 to 2015. Data on road crashes involving a motorcycle and an automobile were extracted and analysed. Multiple logistic regression models were used to calculate the adjusted odds ratio (AOR). We calculated an interaction effect for blood alcohol concentration and helmet use based on STROBE guidelines. There were a total of 669,292 motorcyclist casualties; among these casualties, 3459 (0.5 %) motorcyclists sustained fatal injuries. Alcohol-involved riders were 9.47 times (AOR = 9.47; 95 % CI = 8.75–10.25) more likely than sober ones to sustain fatal injuries. Alcohol-involved and un-helmeted riders were approximately 18 times (AOR = 18.1; CI: 15.9–20.4) more likely to sustain fatal injuries than sober and helmeted riders. Riders involved in head-on crashes and approach-turn motorcycle crashes had an increased probability of sustaining fatal injuries by 240 % (AOR = 3.4; 95 % CI = 2.91–4.09) and 132 % (AOR = 2.3; 95 % CI = 2.016–2.67), respectively. This study found that alcohol-involved riding acts synergistically with un-helmeted riding to increase motorcyclist injury severity. [ABSTRACT FROM AUTHOR]

Background: Allowing contraflow cycling on one-way streets has been reported to reduce crash risks in Belgium and the United Kingdom. Similarly, walking against traffic on roadways without sidewalks substantially improves pedestrian safety. This study examined fatalities and head injuries sustained by pedestrians in against-traffic and with-traffic crashes.Methods: Using police-reported crash data in Taiwan between 2011 and 2016, fatalities and head injuries were compared for pedestrians involved in against-traffic and with-traffic crashes.Results: Of the 14,382 pedestrians involved in crashes, 10,749 and 3633 pedestrians in with-traffic and against-traffic crashes, respectively, were reported. Compared with pedestrians involved in against-traffic crashes, those in with-traffic crashes were more likely to sustain fatalities and head injuries. Results of logistic regression models revealed several influential factors on pedestrian fatalities and head injuries, including elderly pedestrians, male drivers, intoxicated drivers, rural roadways, unlit streets in darkness, limited sight distance, adverse weather conditions, midnight hours, and a heavy vehicle as the crash partner.Conclusions: Pedestrians in with-traffic crashes were more likely to sustain fatalities and head injuries compared with those in against-traffic crashes. Furthermore, the negative effect of walking with traffic on injuries was more pronounced in reduced-visibility conditions. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although there is a significant correlation between the degree of family support and clinical outcome, little research has focused on the effectiveness of family partnership intervention care (FPIC) for patients with poorly controlled type 2 diabetes. Objectives: This study aimed to compare FPIC with conventional care (CC) across a number of outcome measures in patients with poorly controlled type 2 diabetes. Design: The study was performed using a randomized controlled trial design. Participants: Patients with poorly controlled type 2 diabetes who were solely treated with oral antidiabetic agents and had at least two out of three hemoglobin A1C readings equal to or above 7% in the previous 12 months, were randomly assigned to the FPIC group (n =28) and to the CC group (n =28). Methods: Baseline and 6-month follow-up scores were compared using the following outcome measures: (1) hemoglobin A1C, (2) BMI, (3) lipid profile, (4) family supportive behaviours, (5), knowledge of and attitudes toward diabetes, and (6) diabetes self-care behaviours. Descriptive and non-parametric statistics were employed to compare differences in outcome measures between the groups. Results: There were no significant differences in the reduction of hemoglobin A1C levels (p =0.46), lipid profile values (p >0.05), and improvement of diabetes self-care behaviours (p =0.61) between the groups at 6 months post-intervention. However, there were significant differences in the scores of family supportive behaviours (p =0.031) and patients’ knowledge of and attitudes toward diabetes between the groups (p <0.05). Conclusion: These findings support the use of FPIC to enhance family supportive behaviours, and to improve patients’ knowledge of and attitudes toward diabetes. Thus, the study is of value in helping policy decision-makers to develop more effective diabetes control intervention programmes. [Copyright &y& Elsevier]

Abstract: Objectives: To provide a culturally and linguistically specific survey instrument for tobacco consumption in Taiwan, we evaluated the reliability and validity of a Chinese translation of the 1993 US Tobacco Use Subscale of Behavioral Risk Factor Surveillance System (TU-BRFSS). Methods: An integrative translation was followed by a pilot study of 100 randomly selected adults from throughout Taiwan. Telephone interviews took place in July, 2004. Validity was assessed by Content Validity Index (CVI) computed on the basis of expert review and the averaged scores of back-translation. Results: Of 29 questions, 25 met the CVI criteria for retention in the instrument. In the back-translation assessment, 85% of the average scores taken from the expert evaluations were above 4 (scale of 1–5). Three of four percent agreements between the referent question and 4 other questions were 100%. Conclusions: The Chinese version of the TU-BRFSS, with appropriate content, semantics, and conceptual equivalence, appears valid and reliable for future surveillance and research in Taiwan and other Chinese populations. [Copyright &y& Elsevier]

• Women encountered a reduced risk of MVCs after they became pregnant. • The most reduced risk of MVCs during pregnancy was in younger women. • The risk of MVCs was much lower for scooter crashes than for car crashes during pregnancy. • The overall MVC event rate decreased during pregnancy, but it was still lower than the pre-pregnancy event rate. Changes in risk of motor vehicle crashes (MVCs) during pregnancy are less known, and very few studies have assessed this issue by using unselected population-based datasets and adopting a before-and-during design. The study aimed to address the risk of MVC events in association with pregnancy using a national pregnant women cohort in Taiwan. We conducted a self-matched design in which each woman served as a driver before and during pregnancy. A total of 1,372,664 pregnant women with live birth(s) at 18–50 years of age between 2008 and 2017 were identified from the Birth Notification dataset. MVC events as a driver were ascertained from the Police-reported Traffic Accident Registry dataset. We calculated the rate ratio (RR) with a 95 % confidence interval (CI) using the conditional Poisson regression model to compare the MVC event rates between pre-pregnancy and pregnancy periods. The overall rate of MVC events was significantly reduced during pregnancy (RR = 0.69, 95 % confidence interval (CI) = 0.68–0.71). Mothers with alcoholism during pregnancy were associated with an increased RR at 2.00 but with a very wide CI. Reduction in RR was primarily attributed to the reduced MVC event rate involving scooter crashes (0.60, 95 % CI = 0.58–0.62). Although MVC event rates decreased during women became pregnant, many women drivers were still involved in MVCs during pregnancy. Their potential maternal and perinatal conditions along with their offspring's health outcomes need further investigations. [ABSTRACT FROM AUTHOR]

Objective: Whether pregnancy is associated with severe injuries from motor vehicle crashes (MVCs) remains unclear. This study aimed to investigate the potential relationship between pregnancy and severity of injuries from MVCs., Methods: We identified a total of 23,559 pregnant women victims who encountered MVCs during pregnancy as well as 94,236 age- and calendar year-at MVC matched non-pregnant women victims that are also involved in MVCs. Injury severity was assessed using the Maximum Abbreviated Injury Scale (MAIS) based on the diagnosis of medical claims after MVCs. Multinomial logistic regression models were used to estimate the odds ratio and corresponding 95 % CI of injury severity levels associated with pregnancy., Results: Pregnant women had a significantly higher risk of both severe (adjusted odds ratio, aOR = 1.79, 95 % CI = 1.54-2.08) and mild injuries (aOR = 8.63, 95 % CI = 8.21-9.07) following MVCs as compared to non-pregnant women victims. Particularly, pregnant women who were riding scooters had an increased risk of severe injury (aOR = 4.25, 95 % CI = 3.58-5.04). In addition, pregnant women who experienced MVC but without any injury were more likely to visit a clinic than non-pregnant MVC victims., Conclusion: Pregnant women victims, particularly those who were riding scooters involved in MVCs suffered from a higher risk of severe injury as compared to their non-pregnant counterparts. Our findings suggest that women should consider avoiding riding a scooter and must use restrictive devices during pregnancy, which would help reduce the severity of injuries sustained following an MVC., Competing Interests: Declaration of competing interest No potential conflicts of interest relevant to this article were reported., (Copyright © 2023 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: Heart attacks including acute ST-segment elevation myocardial infarction (STEMI) and acute decompensated heart failure (ADHF) caused from the particulate matter (PM) and air pollutant exposures are positively associated with regional air pollution severity and individual exposure. The exceptional coronavirus disease epidemic of 2019 (COVID-19) may enhance the air conditions in areas under COVID-19 pandemic. We sought to study the impact of COVID-19 pandemic on air particulate matter (PM) exposure and heart attacks in Taiwan., Methods: This retrospective cohort study was conducted in one teaching hospital in Taichung, Taiwan. We examined emergency patients diagnosed with acute STEMI and ADHF from January 1, 2017, to March 31, 2020, (i.e., before the COVID-19 pandemic) and from April 1, 2020, to December 31, 2021, (after the COVID-19 pandemic). The effects of particulate matter with a diameter of less than 2.5 micrometers (PM 2.5 ) and PM 10 as well as temperature and humidity on environmental air pollutants were recorded. The analysis was performed with a unidirectional case-crossover research design and a conditional logistic regression model., Results: Both PM 2.5 and PM 10 levels had a positive association with the risk of acute STEMI before the COVID-19 pandemic (PM 2.5 adjusted odds ratio (OR): 1.016, 95% confidence interval (CI): 1.003-1.032 and PM 10 adjusted OR: 1.009, 95% CI: 1.001-1.018) and ADHF (PM 2.5 adjusted OR: 1.046, 95% CI: 1.034-1.067 and PM 10 adjusted OR: 1.023, 95% CI: 1.027-1.047). Moreover, the results demonstrated that PM 2.5 and PM 10 were not associated with the risk of acute STEMI or ADHF after the COVID-19 pandemic. Reduction in PM 2.5 and PM 10 levels after the COVID-19 pandemic were noted. Hospital admissions for acute STEMI (7.4 and 5.8/per month) and ADHF (9.7 and 8.2/per month) also decreased (21.6 and 15.5%) after the COVID-19 pandemic., Conclusion: In Taiwan, paradoxical reductions in PM 2.5 and PM 10 levels during the COVID-19 pandemic may decrease the number of hospital admissions for acute STEMI and ADHF. As the COVID-19 pandemic eases, the condition of air pollution may gradually become worse again. The governments should formulate better policies to improve the health of the public and the quality of the air., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yen, Hsiao, Chu and Chen.)

Although past studies have identified predictors related to child injuries with developmental disorders, national-level research in Asia is limited. The objective of this study was to explore the risk factors for child injuries with developmental disorders in Taiwan using a national-level integrated database for the period between 2004-2015 (The Maternal and Child Health Database, National Health Insurance Research Database, Census Registry, and Indigenous Household Registration). Children younger than 12 years old who had records of visiting the ER or being hospitalized due to injury or without injury were included in this study. A 1:1 nested case-control study (injury vs. noninjury) to examine the risk factors for child injury with developmental disorder was performed. A total of 2,167,930 children were enrolled. The risk factors were associated with repeated ER visits or hospitalization: being indigenous (adjusted odds ratio [AOR]: 1.51; CI: 1.45-1.57); having a developmental disorder (AOR: 1.74; CI: 1.70-1.78); and having parents with illicit drug use (AOR: 1.48; CI: 1.32-1.66), alcohol abuse (AOR: 1.21; CI: 1.07-1.37), or a history of mental illness (AOR: 1.43; CI: 1.41-1.46). Being indigenous, having developmental disorders, and having parents with history of illicit drug use, alcohol abuse, or mental illness were predictors related to injuries in children.

Importance: Literature has suggested that trauma among pregnant women is associated with an increased risk of adverse pregnancy outcomes. However, limited research has investigated the association of trauma with adverse pregnancy outcomes by using a national data set., Objective: To investigate the association between traumatic injury and adverse pregnancy outcomes., Design, Setting, and Participants: This population-based cohort study of pregnant women in Taiwan linked 3 data sets, the Taiwan Birth Registry, Household Registration Information, and National Health Insurance Research Database, from January 1, 2004, through December 31, 2014. Data, including the characteristics of pregnant women and infants, were extracted from the Taiwan Birth Registry data set; to obtain trauma data, this data set and the Household Registration Information data set were collectively linked to National Health Insurance Research Database data. The combined data set was analyzed from January to July 2019. Adverse pregnancy outcomes and premature delivery were defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes., Exposures: The primary exposures of this study were 2 clinical variables related to injury during pregnancy: medical treatment in the emergency department (yes or no) and hospitalization (yes or no)., Main Outcomes and Measures: The main outcome variable was adverse pregnancy outcomes, and the secondary outcome variable was premature delivery. Multivariate logistic regression models were used to investigate the association of injuries with adverse pregnancy outcomes after controlling for demographic characteristics and other pregnancy-related variables., Results: A total of 2 973 831 pregnant women (2 475 805 [83.3%] aged 20-34 years) were enrolled between 2004 and 2014, of whom 59 681 (2.0%) sought medical treatments due to injuries. Results of multivariate logistic regression models showed that women receiving emergency treatments more than once were 1.08 times as likely (adjusted odds ratio, 1.08; 95% CI, 1.05-1.10) to have adverse pregnancy outcomes than women who received no emergency treatment. Women with injury-related hospitalization were 1.53 times more likely (adjusted odds ratio, 1.53; 95% CI, 1.41-1.65) to have adverse pregnancy outcomes than women who did not sustain injuries. Furthermore, recurrent injuries were associated with a 572% increase in odds of premature delivery (adjusted odds ratio, 6.72; 95% CI, 2.86-15.80)., Conclusions and Relevance: In this study, trauma among pregnant women was associated with an increased risk of adverse pregnancy outcomes, as were hospitalization and emergency department visits due to injury.

Background: Studies have suggested that trauma centre-related risk factors, such as distance to the nearest trauma hospital, are strong predictors of fatal injuries among motorists. Few studies have used a national dataset to study the effect of trauma centre-related risk factors on fatal injuries among motorists and motorcyclists in a country where traffic is dominated by motorcycles. This study investigated the effect of distance from the nearest trauma hospital on fatal injuries from two-vehicle crashes in Taiwan from 2017 to 2019., Methods: A crash dataset and hospital location dataset were combined. The crash dataset was extracted from the National Taiwan Traffic Crash Dataset from 1 January 2017 through 31 December 2019. The primary exposure in this study was distance to the nearest trauma hospital. This study performed a multiple logistic regression to calculate the adjusted odds ratios (AORs) for fatal injuries., Results: The multivariate logistic regression models indicated that motorcyclists involved in crashes located ≥5 km from the nearest trauma hospital and in Eastern Taiwan were approximately five times more likely to sustain fatal injuries (AOR = 5.26; 95% CI: 3.69-7.49)., Conclusions: Distance to, level of, and region of the nearest trauma centre are critical risk factors for fatal injuries among motorcyclists but not motorists. To reduce the mortality rate of trauma cases among motorcyclists, interventions should focus on improving access to trauma hospitals.

Background: Falls represent a global health issue among older adults and cause a considerable burden on medical systems. In this study, a fall-risk assessment profile was developed for community-dwelling older adults., Method: The data of survey participants aged > 65 years were obtained from three rounds (2005, 2009, and 2013) of the National Health Interview Survey in Taiwan. In total, 8356 older participants were included in this study. Logistic regression analyses were used to determine potential predictors associated with falls. The regression coefficients of the predictors in the final model were translated into scores (by multiplying by 5) and then summed to obtain a total risk-score for falls. A receiver operating characteristic (ROC) curve was used to evaluate the discriminative performance of the risk assessment profile., Result: Self-reported falls within 1 year accounted for 19.1% of the total falls. The predictors that were included in the risk profile according to the logistic regression analysis results were as follows: female sex (adjusted odds ratio = 1.57; risk-score = 2), living alone (adjusted odds ratio = 1.56; risk-score = 2), urinary incontinence (adjusted odds ratio = 1.36; risk-score = 2), perceived unhealthiness (adjusted odds ratio = 1.32; risk-score = 1), perceived pain (adjusted odds ratio = 1.51; risk-score = 2), hospital admission in the past year (adjusted odds ratio = 2.42; risk-score = 4), low activity of daily living (ADL) scores (adjusted odds ratio = 1.29; risk-score = 1), and low mobility function scores (adjusted odds ratio = 1.68; risk-score = 3). At a total risk-score cutoff point of 6 (range 0-17), the model predicted falls with a sensitivity and specificity of 75.16 and 52.75%, respectively (area under the ROC curve = 0.70)., Conclusion: The fall-risk assessment profile comprising eight predictors-female sex, living alone, incontinence, perceived unhealthiness, perceived pain, hospital admission in the past year, low ADL scores, and low mobility function scores-may serve as an assessment tool for identification of older adults with a high risk of falling, and assessment results can be used to facilitate community-based intervention.

Objectives: Sun glare is a serious driving hazard and increases crash risks. Relatively few studies have examined the effects of sun glare on pedestrian fatalities, given that a crash has occurred. The primary objective of this study was to investigate the effect of sun glare on pedestrian fatalities., Design: A population-based case-control study., Setting: Taiwan., Participants: Using the Taiwan National Traffic Crash Data and sunrise and sunset data from the National Oceanic and Atmospheric Administration for the period 2003 to 2016, 100 411 pedestrians involved in crashes were identified. Of these crashes, 13 355 and 87 056 were glare-related (case) and non-glare-related (control) crashes, respectively., Methods: To account for unobserved heterogeneity, mixed logit models were estimated to identify the determinants of pedestrian fatalities., Main Outcome Measures: Pedestrian fatalities., Results: Pedestrians involved in glare-related crashes were more likely to be fatally injured than those in non-glare-related crashes (β=0.527; t =3.21). Other contributory factors to fatal injuries among pedestrians were older pedestrians (β=0.553; t =2.33), male drivers (β=0.324; t =2.33), older drivers (β=0.218; t =2.14), intoxicated motorists (β=0.606; t =2.85), rural roadways (β=0.985; t =3.92), overtaking manoeuvres (β=0.472; t =3.58), heavy vehicle crash partners (β=0.248; t =2.78) and sunset hours (β=0.274; t =3.08). Walking against traffic appeared beneficial for decreasing injury severity (β=-0.304; t =-2.76)., Conclusions: Sun glare is associated with pedestrian fatalities. Older pedestrians, male drivers, older drivers and intoxicated motorists are prevalent determinants of pedestrian fatalities in glare-related crashes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

A growing literature indicates that electronic cigarette use increases the risk of subsequent initiation of conventional smoking among cigarette-naïve adolescents in several Western countries. This research assesses the same relationship in an Asian country, Taiwan. The Taiwan Adolescent to Adult Longitudinal Study is a school-based survey that was carried out in two waves in 2014 (baseline) and in 2016 (follow-up). It employs probability sampling to create nationally representative samples of students in junior high school (mean age 13, 7th grade at baseline) and in senior high school (mean age 16, 10th grade at baseline). Data from this survey were analyzed via logistic regression to estimate the association between ever use of e-cigarettes at baseline and smoking initiation at follow-up, accounting for susceptibility to smoking, socio-demographic profile, depression status, and peer support. Among the 12,954 cigarette-naïve students surveyed, those with e-cigarette experience at baseline exhibited higher odds of smoking initiation at follow-up (Odds Ratio = 2.14, 95% CI (1.66, 2.75), p < 0.001). For the first time, we confirmed, through a longitudinal survey, a prospective association between ever use of e-cigarettes and smoking initiation in an Asian adolescent population. The restrictive policy on e-cigarettes currently in force in Taiwan is justified to prevent both e-cigarette and cigarette use among adolescents.

Objectives: In western countries, a typical car-motorcycle crash occurs at an intersection where a car manoeuvres into the path of an oncoming motorcycle, which involves a car driver violates motorcycle's right of way (ROW). In Taiwan, however, a unique type of crash (approach-turn crash) occurs when a turning (including U-turn) motorcycle frequently infringes upon a car's ROW. The primary objective of this study was to examine injuries sustained by motorcyclists in this unique type of crash., Method: Using the linked data from the National Taiwan Crash Database and the National Health Insurance Research Data from 2003 to 2015, this study examined several anatomical injuries (e.g., head and face, neck, chest and abdomen, spine, and lower extremities), as well as the resulting injury severity (e.g., death within 30 days, hospitalisation, and emergency visit only/outpatient, and length of hospital stay). Variables examined include demographic data (sex, age, alcohol use, license status, and helmet use), vehicle attributes (engine size, type of crash partner, and crash type), road and environmental factors (curvature, crash location, day of week and time of crash). Injuries sustained by motorcyclists in an approach-turn motorcycle-turning crash (motorcycle is a ROW violator) were compared with those sustained by motorcyclists in an approach-turn car-turning crash (car is the ROW violator)., Results: A total of 21,919 motorcyclists were enrolled, of whom 18,041 and 3878 were motorcyclists involved in approach-turn car-turning and motorcycle-turning crashes, respectively. The percentage of death within 30 days; hospitalisation; length of hospital stay; and injuries to the head and face, neck, and chest and abdomen were significantly higher for motorcyclists in approach-turn motorcycle-turning crashes. Results of logistic regression models revealed that riding under the influence of alcohol and riding without a licence were associated with death/hospitalisation, and injuries to particular body regions (head and face, neck, and chest and abdomen). Helmet use was associated with a decreased likelihood of head and face and neck injuries., Conclusion: Motorcyclists tended to be more severely or fatally injured and had increased head and face, neck, and chest and abdomen injuries when they were ROW violators than when their ROWs were violated at an intersection. Efforts to curb drunk riding and unlicensed riding may constitute effective intervention points., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Smartphone addiction has become a crucial social issue. Past studies have indicated that phone use such as talking or texting while walking constitutes a dual task that may cause pedestrians inattentional blindness and impair their awareness of surroundings., Methods: This study investigated the influence of various smartphone tasks (calling, music listening, texting, playing games, and web surfing) on the smartphone overuse and inattentional blindness of pedestrians in Taipei, Taiwan. Pedestrian smartphone overuse was observed and recorded via WiFi cameras to determine whether pedestrians were using their smartphones when crossing a street with a signal. After crossing the street, pedestrians were interviewed to obtain additional information regarding demographics, smartphone tasks, data plan, and screen size. Pedestrians were classified into the case (distracted) and control (undistracted) groups. By determining whether pedestrians saw something unusual-a clown walking the opposite direction-and heard the national anthem played by the clown, inattentional blindness and deafness were examined. Pedestrians' situational awareness was assessed by ascertaining whether they remembered how many seconds remained before the crossing signal upon arriving at the curb., Results: In total, 2556 pedestrians crossed the street and underwent the interview. Smartphone overuse and inattentional deafness were the commonest among music listeners. Playing Pokémon Go gaming was the task most associated with inattentional blindness. Logistic regression models revealed that contributing factors to smartphone overuse and inattentional blindness were a large smartphone screen (≥5 in), unlimited mobile Internet data, and being a student. The interactions of gaming with being a student and with unlimited data were significantly associated with smartphone overuse, inattentional blindness and deafness, and situational awareness., Conclusions: Listening to music was the smartphone task most associated with pedestrian smartphone overuse and inattentional deafness. Pokémon Go was the most associated task with inattentional blindness and reduced situational awareness.

Objectives: Crashes due to motorcyclists colliding with an open car door can cause devastating injuries. In Taiwan, such crashes typically occur when the motorcyclist is travelling alongside a row of parallel-parked cars, and a driver suddenly opens the door in front of or next to the motorcycle without determining whether it is safe to do so. Injuries resulting from motorcycle door crashes tend to be severe. This study examined the factors that contribute to motorcycle door crashes., Methods: By using linked data from the National Traffic Crash Dataset and Emergency Medical Service for Taipei City for the years 2010-2015, this study estimated a mixed multinomial logit model to predict the likelihood of three types of door crashes: driver-door crashes, left passenger-door crashes, and right passenger-door crashes., Results: Data on 8237 motorcycle door crashes were extracted from the two datasets and matched. The results from the mixed multinomial logit model revealed that illegal parking, older car occupants, teenage car occupants, intoxicated car occupants and motorcyclists, and motorcycle speeding contribute to driver-door crashes; and female passengers and taxis as the type of vehicle involved in crash are associated with left passenger-door crashes., Conclusions: Our study suggested that controlling motorcycle speed, and prosecuting illegal parking and drink driving/riding may constitute effective countermeasures. The "Dutch Reach" intervention measure, which is commonly adopted in Europe for bicycle door crashes, should be applied in Taiwan to curb motorcycle door crashes, especially for elderly car occupants., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Trauma admissions are associated with weather and temporal factors; however, previous study results regarding these factors are contradictory. We hypothesised that weather and temporal factors have different effects on specific trauma events in an emergency medical service (EMS) system., Methods: EMS data from January 1, 2009, to December 31, 2010, were obtained from the fire department of Taipei City and associated with the local weather data. EMS trauma events were categorised into total trauma, traffic accidents (TAs), motorbike accidents (MBAs), and falls. Hourly data on trauma patients were analysed using the zero-inflated Poisson model., Results: The hourly incidence of total trauma increased with the magnitude of precipitation (incidence rate ratio [IRR]=1.06, 1.09, and 1.11 in light, moderate, and heavy rain, respectively), and this effect was more prominent in fall patients than in patients with other injuries (IRR=1.07, 1.21, and 1.32). However, the hourly incidence of TAs and MBAs was associated only with light rain (IRR=1.11 and 1.06, respectively). An hour of sunshine exposure was associated with an increase in the hourly incidence of all groups, and higher temperatures were associated with an increased hourly incidence of total trauma, TAs, and MBAs, but not falls. The hourly incidence of falls increased only in late fall and winter. Compared with the hourly incidence between 3 am and 7 am, the hourly incidence of all groups plateaued between 7 am and 11 pm and declined from 11 pm to 3 am. During the plateau period, 2 peaks in the incidence of TAs (IRR=5.03 and 5.07, respectively) and MBAs (IRR=5.81 and 5.51, respectively) were observed during 7-11 am and 3-7 pm. The hourly incidence of total trauma, TAs, and MBAs plateaued during workdays, peaked on Fridays, declined on Saturdays, and troughed on Sundays. The incidence of falls increased only on Mondays (IRR=1.09)., Conclusions: Weather and temporal factors had different impacts on the incidence of traffic-related accidents and falls. Therefore, EMS data may have implications in preventing injuries and planning resource use for prehospital trauma rescue., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background and Objectives: Chinese patients with ESRD have different comorbidity patterns than white patients with ESRD and require a validated comorbidity index. The objective of this study was to develop a new index for mortality prediction in 2006-2009 Taiwanese incident hemodialysis patients., Design, Setting, Participants, & Measurements: Data were retrieved from 2005 to 2010 Taiwan National Health Insurance claim records, and follow-up was available until December 31, 2010. The same comorbid conditions as the US Renal Data System (USRDS) index that occurred during a 12-month period from 9 months before to 3 months after dialysis initiation were used to construct the index. Integer weight of the comorbid conditions was derived from coefficient estimates of Cox regression for all-cause mortality, and the index was internally validated. The performance of the index was assessed by discrimination, calibration, and reclassification., Results: A total of 30,303 hemodialysis patients were included in this study. The weight for individual comorbid conditions of this index differed from that of the USRDS index. The performance of this index was similar to that of USRDS and Charlson indices in terms of model fit statistics, overall predictive ability, discrimination, and calibration. Hosmer-Lemeshow test showed that all three indices demonstrated significant differences between predicted and observed mortality rates. When patients were categorized by the predicted 2.5-year survival probabilities, the index achieved a net reclassification improvement of 4.71% (P<0.001), referenced to USRDS index., Conclusions: Compared with USRDS index, this new index demonstrated better reclassification ability, but future studies should address the clinical significance.

Background: In 2009, the Tobacco Hazards Prevention Act (Taiwan) was amended to more effectively restrict smoking in indoor public places and workplaces in Taiwan. However, the lack of prohibitions for smoking in private homes may place family members at increased risk for exposure to environmental tobacco smoke (ETS). The aim of our study was to determine the factors associated with parental smoking in the presence of children at home., Methods: In 2010, we performed a cross-sectional study of factors associated with parental smoking in the presence of children at home in Taiwan using self-administered questionnaires. Quota sampling was used to select five primary schools from four different regions of Taiwan. Parents were surveyed to identify parental smokers and 307 parental smokers were selected for participation in our study. Questionnaire data regarding parental smoking in the presence of children at home and related interactions among family members were analyzed. Hierarchical logistic regression was used to determine the best-fit model for examining the relationships among the variables related to parental smoking in the presence of children at home., Results: Two-thirds of parents who smoked reported smoking in the presence of their children. The results of the hierarchical logistic regression analysis identified the smokers' compliance with their family's antismoking responses, mutual agreement with smoking bans, daily smoking, smoking more than 20 cigarettes per day, the education level of the parental smoker, and the annual family income as determinants of smoking in the presence of children at home., Conclusions: Households with smoking parents should be targeted for interventions to encourage the adoption and enforcement of home smoking bans. Educational interventions that promote smoke-free homes for children and provide support to help parents stop smoking are critical factors in reducing the frequency of children's ETS exposure in the home.

Parental smoking is the major source of children's secondhand smoke exposure and is influenced by parents' perception of children's exposure. However, the factors associated with these perceptions remain unclear. The objective of this study was to examine factors associated with parents' perceptions about parental smoking in the presence of children and its consequences. We conducted a cross-sectional study on parents' perceptions of parental smoking and measured their evaluations of its consequences using a self-report questionnaire. Other variables include socio-demographic characteristics and smoking-related experience. Results show that parents' gender, education level, occupational type, smoking status, and agreement on a home smoking ban independently predict parents' evaluation of the consequences of parental smoking in the presence of children. Parents' gender, education level, annual family income, smoking status, agreement on a home smoking ban, and evaluation of the consequences of parental smoking independently predicted parents' perceptions. Findings indicated that a specific group expressed greater acceptance of parental smoking and was less aware of its risks. Motivating parents to create a smoke-free home and increasing awareness of the adverse consequences of parental smoking is beneficial in reinforcing attitudes opposed to parental smoking.

The purpose of this study was to explore parents' experience and perceptions of smoking in the presence of children. Findings regarding patterns of parents' smoking in the presence of children were situation specific. When thinking of smoking with children around, parents engaged in a process of weighing the importance of the need to smoke and adverse effects from exposure to environmental tobacco smoke, a consideration based mostly on their experience. A pattern of correspondence was identified between family's level of concern and promoting change among smokers. Many strategies participants used to prevent children's environmental tobacco smoke exposure were relatively ineffective and needed to be addressed.

Objectives: To gain an understanding of the accuracy of acuity assessment made by emergency department (ED) triage nurses, to compare the differences between the characteristics of triage nurses according to hospital variables and the accuracy of acuity ratings, and to explore the influence of nursing variables on the judgement of triages., Methods: A cross-sectional questionnaire survey was conducted at the EDs of hospitals in northern Taiwan. Ten adult emergency case scenarios and a demographic sheet with high validity were developed to survey 279 triage nurses. Data were collected from April to October 2006. All data were analysed using percentage, mean, SD, independent t test, one-way ANOVA and a stepwise logistic regression analysis., Results: The average score of rating accuracy was 5.62 points (out of a possible total of 10 points), which was considered low. Approximately 24.3% (n=68) of nurses' triage ratings were under-triaged and 19.7% (n=55) were over-triaged. Factors included years of ED experience, hours of triage education, level of hospital and triage mode of delivery. These factors were identified as significantly affecting the accuracy of nurses' judgement (p<0.05; adjusted R(2)=40.0%)., Conclusion: The scores of accuracy ratings for triage nurses can be improved if factors contributing to inaccuracy can be altered. The findings of this study can be used to guide improvements.

Aim: This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period., Background: Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women's psychological status during the breast cancer diagnostic period., Methods: For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group (n = 62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group (n = 60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis)., Findings: After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy (P = 0.017) and after diagnosis (P = 0.001) than those of women receiving routine care., Conclusion: Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care.

The 2003 School Health Act of Taiwan stipulated that school campuses of senior high and below should be smoke free, but data from the Global Youth Tobacco Survey show that the majority of students are exposed to smoke in public and at home. More than 50% of nonsmokers indicated that they had been exposed to secondhand smoke (SHS) in public places, with the exposure rate as high as 90% among smokers. More than 40% of junior and senior high school students were exposed to SHS at home. Support for banning smoking in public places ranged from almost 60% to almost 80%. More than 60% of current smokers and almost 90% of never smokers think that smoke from others is harmful to them. With a clear body of evidence detailing the harmful effects, reduction and eventual elimination of exposure to SHS should be the goal of the tobacco control community.

Background: Tobacco use is a major preventable cause of death in the world. This article describes and compares tobacco use prevalence for students attending junior high schools and senior high schools in Taiwan., Methods: This report uses data from the Global Youth Tobacco Survey (GYTS) completed among 4689 junior high school students and 4426 senior high school students in Taiwan in 2004-2005. The GYTS uses a 2-stage sampling design to produce nationally representative data for junior and senior high students in general and vocational schools., Results: Higher smoking prevalence was observed among senior high (10.1% general schools and 15.9% vocational schools) than junior high (5.5%) school students. Smoking prevalence of girls in junior high (3.2%) and senior high schools (4.6% general and 11.1% vocational) was almost as high or higher than adult females' (4.3%) smoking rates. The pattern of smoking intensity across school years and type of school shows that the percentage of smokers who were experimenters (47.1%) was higher in junior high school and the percentage of smokers who were regular/established smokers (over 50%) was higher in senior high school., Conclusions: Smoking prevalence described in this report shows that there are challenges facing the tobacco prevention and control program in Taiwan. The findings suggest that schools should increase their smoking initiation prevention efforts and make available cessation programs and counseling to help students quit smoking. If effective youth tobacco control programs are not developed and implemented in Taiwan, future morbidity and mortality attributed to tobacco will surely increase, especially among women.

A possible diagnosis of breast cancer imposes a huge psychological impact on most women, but few studies have addressed uncertainty and anxiety changes at different diagnostic stages in women with suspected breast cancer. Thus, this longitudinal study examined uncertainty and anxiety and predictive factors for uncertainty in women with suspected breast cancer. Data were collected on uncertainty (Uncertainty in Illness Scale) and anxiety (State Anxiety Inventory) from 127 women at 3 times: upon notice of a breast biopsy, before biopsy, and after diagnosis. The results showed that uncertainty and anxiety levels were significantly higher before than after diagnosis. At the 3 data collection times, uncertainty and anxiety were significantly lower for participants diagnosed with benign tumors than for those with malignant diagnoses. Uncertainty and anxiety were positively, moderately correlated. Uncertainty was predicted by age, marital status, education level, religious status, family history of benign breast tumor, regular breast self-examination, self-perceived probability of receiving a breast cancer diagnosis, and biopsy result. Therefore, nursing professionals should be aware of the uncertainty and anxiety changes and impact of personal attributes on women with suspected breast cancer during the diagnostic period and provide care programs to alleviate their psychological distress.

Background: Tobacco smoking poses public health concerns because of its high risk for many chronic diseases. Most smokers begin using tobacco in their teens and recent reports indicate that smoking prevalence is climbing among youth. The Global Youth Tobacco Survey (GYTS) is a worldwide, school-based, tobacco-specific survey, but cross-cultural differences limit its effectiveness in international studies. Specifically, the GYTS assesses not only the prevalence of smoking, but also tobacco-related attitudes, school curricula, and advertisements, which are culturally influenced. Therefore, we conducted this study to develop a Chinese version of the GYTS for both national surveillance and international comparison., Methods: The original English GYTS was translated and back translated using a cross-cultural adaptation process. The comprehensiveness and feasibility of using the Chinese-version GYTS were reviewed by a panel of 6 tobacco-control experts. The understandability and cultural relevance of the Chinese-version GYTS were discussed in a focus group of 5 schoolteachers and 8 students. The expert and focus group feedback was incorporated into a final Chinese version of the GYTS, which was administered to 382 students throughout Taiwan by multi-stage sampling from 10 randomly selected schools., Results: The internal consistency (Cronbach's alpha) for the GYTS subscales (smoking susceptibility, attitude toward smoking, and media messages about smoking) ranged from 0.70 to 0.94. The internal logical agreement of responses ranged from 85.3 to 99.2%., Conclusion: The Chinese version of the GYTS has good reliability and validity and can serve as the foundation for international comparison and tobacco control in Chinese-speaking communities.

Aim: This paper is a report of a study to investigate changes in the healthcare and support needs during the diagnostic period, and factors that affect these needs in women with suspected breast cancer., Background: Although the needs of women with breast cancer are well recognized, few studies have examined the needs of women with suspected breast cancer during the diagnostic period., Method: This longitudinal study used an investigator-developed, self-administered questionnaire to collect data from 127 women in Taiwan on three occasions: notification of need for breast biopsy, before biopsy and after diagnosis. The data were collected from November 2004 to April 2005., Findings: Participants had high need levels before and after diagnosis, with their top needs in the domains of healthcare services for diagnosis, follow-up and consultation, and information about the disease. They needed disease- and treatment-related information more than emotional support. Need levels were higher (P < 0.01) before diagnosis than after, highest before biopsy, and lowest after diagnosis. Furthermore, needs were higher (P < 0.01) before than after diagnosis for diagnostic services, disease information, and involvement of family and friends. Higher needs were found in married women with more education and no history of benign tumours. Need level did not differ statistically significantly by age, religious status, degree of social support, family history and breast symptoms., Conclusion: Need levels of women with suspected breast cancer vary during the diagnostic period, are highest before breast biopsy, and related to personal characteristics and cultural context. Therefore, during this period, nursing staff should provide patients and families with culturally sensitive, individualized, supportive care.

Purpose: To develop and evaluate a Web-based, patient-orientated diabetic education management (POEM) system., Methods: The POEM system has been developed to extend hospital patient education by integrating patients' medical care data into their education program components and presenting them on the Web. Since most patients are concerned about their medical care data, the POEM system can provide the incentives for patients to continuously and persistently log in and learn the required knowledge and skills, improving their clinical outcomes. A quasi-experimental method that uses control groups and pretests was used to evaluate the outcomes of the system intervention. We recruited patients with type-2 diabetes and alternatively assigned them to intervention and control groups. We compared laboratory test results including fasting blood glucose, HbA1c, total cholesterol, triglyceride (TG), and HDL between the two groups from the first visit through each follow-up visit. The study period progressed from September 2003 to May 2004 at the Metabolism Center of a medical teaching hospital in Taipei., Results: In this study, we recruited 274 participants: 134 (57% males and 43% females) in the intervention group and 140 (46% males and 54% females) in the control group. The patients' laboratory test results from the first visit for fasting blood glucose, HbA1c, total cholesterol level, TG, and HDL in the intervention and control groups were respectively 187.54+/-77.10 and 189.99+/-73.49 mg/dl, 9.03 +/- 2.79% and 8.95 +/- 2.23%, 193.29 +/- 47.93 and 202.52 +/- 58.45 mg/dl, 152.48 +/- 70.85 and 157.37 +/- 74.88 mg/dl, and 44.97 +/- 12.09 and 45.32 +/- 12.08 mg/dl. There were three follow-up visits during the study period. We collected laboratory test results of the two groups through each of the following visits and analyzed them using ANCOVA. We discovered a significant difference in fasting blood glucose levels between intervention and control group as early as the first follow-up. At the second follow-up, both fasting blood glucose and HBA1c levels were significantly different between intervention and control group. At the third follow-up, there was a significant difference in fasting blood glucose, HBA1c, and total cholesterol between intervention and control group. We also monitored the number of logins for the patients in the intervention group during the follow-up period. The result showed the patients had consistently logged into the POEM system (about 8.5 +/- 3.7 logins per person per month after 3 months enrollment). Thus, the patients in the intervention group had better control of their fasting blood glucose, HbA1c and total cholesterol levels than those in the control group due to the assistance of the system., Conclusions: The POEM system can help patients control their glucose, HbA1c and total cholesterol levels to manage their diabetes, providing an easy and inexpensive way to extend hospital-based patient education services for community-based continuous patient education., (2006 Elsevier Ireland Ltd)