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Atrial fibrillation (AF) commonly occurs in approximately 2% of cancer patients, and the incidence of AF among cancer patients is greater than in the general population. This observational study presented the incidence risk of AF among cancer patients, including specific cancer types, using a population database. The Taiwan Cancer Registry was used to identify cancer patients between 2008 and 2017. The diagnosis of AF was based on the International Classification of Diseases codes (ICD-9-CM: 427.31 or ICD-10-CM: I48.0, I48.1, I48.2, and I48.91) in Taiwan national health insurance research datasets. The incidence of developing AF in the cancer population was calculated as the number of new-onset AF cases per person-year of follow-up during the study period. The overall incidence of AF among cancer patients was 50.99 per 100,000 person-years. Patients aged older than 65 years and males had higher AF incidence rates. Lung cancer males and esophageal cancer females showed the highest AF incidence risk (185.02 and 150.30 per 100,000 person-years, respectively). Our findings identified esophageal, lung, and gallbladder cancers as the top three cancers associated with a higher incidence of AF. Careful monitoring and management of patients with these cancers are crucial for early detection and intervention of AF. [ABSTRACT FROM AUTHOR]

Objective: The healthcare challenge driven by an aging population and rising demand is one of the most pressing issues leading to emergency department (ED) overcrowding. An emerging solution lies in machine learning's potential to predict ED dispositions, thus leading to promising substantial benefits. This study's objective is to create a predictive model for ED patient dispositions by employing ensemble learning. It harnesses diverse data types, including structured and unstructured information gathered during ED visits to address the evolving needs of localized healthcare systems. Methods: In this cross-sectional study, 80,073 ED patient records were amassed from a major southern Taiwan hospital in 2018–2019. An ensemble model incorporated structured (demographics, vital signs) and pre-processed unstructured data (chief complaints, preliminary diagnoses) using bag-of-words (BOW) and term frequency-inverse document frequency (TF-IDF). Two random forest base-learners for structured and unstructured data were employed and then complemented by a multi-layer perceptron meta-learner. Results: The ensemble model demonstrates strong predictive performance for ED dispositions, achieving an area under the receiver operating characteristic curve of 0.94. The models based on unstructured data encoded with BOW and TF-IDF yield similar performance results. Among the structured features, the top five most crucial factors are age, pulse rate, systolic blood pressure, temperature, and acuity level. In contrast, the top five most important unstructured features are pneumonia, fracture, failure, suspect, and sepsis. Conclusions: Findings indicate that utilizing ensemble learning with a blend of structured and unstructured data proves to be a predictive method for determining ED dispositions. [ABSTRACT FROM AUTHOR]

Background: A growing population of individuals diagnosed with idiopathic pulmonary fibrosis (IPF) are receiving treatment with nintedanib and pirfenidone. The aim of our study was to assess the incidence of druginduced liver injury (DILI) associated with the use of pirfenidone and nintedanib in patients with IPF in Taiwan. Methods: We collected a cohort of adult patients diagnosed with IPF between 2017 and 2020. The research outcomes involved assessing the incidence of DILI in patients treated with nintedanib or pirfenidone. Poisson regression analysis was employed to estimate incidence rates, with and without adjustments for covariates, to calculate and present both unadjusted and adjusted incidence rate ratios (IRRs). Results: The risk of DILI was greater in patients who received nintedanib than in those who received pirfenidone during the 1-year follow-up. Patients treated with nintedanib exhibited a heightened risk of DILI based on inpatient diagnoses using specific codes after adjusting for variables such as gender, age group, comorbidities and concomitant medications, with an adjusted incidence rate ratio (aIRR) of 3.62 (95% confidence interval (CI) 1.11-11.78). Similarly, the risk of DILI was elevated in patients treated with nintedanib according to a per-protocol Poisson regression analysis of outcomes identified from inpatient diagnoses using specific codes. This was observed after adjusting for variables including gender, age group, comorbidities, and concomitant medications, with an aIRR of 3.60 (95% CI 1.11-11.72). Conclusion: Data from postmarketing surveillance in Taiwan indicate that patients who received nintedanib have a greater risk of DILI than do those who received pirfenidone. [ABSTRACT FROM AUTHOR]

There has been limited study of the link between victimization and the criminal offense in the correctional context, despite the extensive literature supporting the overlap of victims and offenders in the general population. In this study, 2,880 inmates in 12 institutional correction facilities in Taiwan were examined to explore the common factors of the victim–offender overlap, guided by the importation, deprivation, and low self-control theories. The results of bivariate probit regression analysis revealed the presence of the victim–offender phenomenon in Taiwanese inmates. Specifically, the inmates who had experienced violent victimization in childhood and those who held negative perceptions of corrections staff and management tended to be both victims and offenders as measured by various types of prison misconduct and victimization. The results also showed that importation and deprivation factors have similar explanatory power for both misconduct and victimization, and low self-control has greater explanatory power for misconduct than for victimization. [ABSTRACT FROM AUTHOR]

We explore the emerging issue of how communications technologies can be used by male perpetrators to facilitate intimate partner violence against their female partners. We analyzed interview narratives from 18 women survivors of intimate partner violence in Taiwan, informed by Stark's theory of coercive control. Our findings indicated that the male perpetrators of intimate partner violence against the survivors utilized communications technologies to further harm, control, and intimidate their victims. We found that the perpetrators harassed, stalked/monitored, and isolated the survivors and distributed defamatory messages about the survivors to other people using telephones, e-mail, social media, the Internet, broadcast media, and recording devices. [ABSTRACT FROM AUTHOR]

The global incidence of early-onset colorectal cancer (EO-CRC) is increasing. Although the mortality rate is relatively stable, some comorbidities have been associated with a higher mortality rate. This study estimated the mortality risk in patients with EO-CRC with various comorbidities using real-world data to identify the high-risk group using Cox proportional regression for overall and cancerspecific mortality. The incidence rate of EO-CRC significantly increased from 6.04 per 100,000 population in 2007 to 12.97 per 100,000 population in 2017. The fiveyear overall mortality rate was 101.50 per 1000 person year and the cancer-specific mortality rate was 94.12 per 1000 person year. Patients with cerebrovascular disease (CVD) had a higher mortality risk (hazard ratio (HR): 1.68; 95% confidence interval (CI): 1.25-2.28; p=0.0007). After subgroup analyses based on age, sex, clinical stage, and treatment type, patients with CVD had a higher overall mortality risk compared to non-CVD patients, except for patients undergoing surgery and chemotherapy. Patients with chronic kidney disease had a higher mortality risk in the early clinical stages (HR: 2.31; 95% CI: 1.08-4.96; p=0.0138). Patients who underwent radiotherapy had a higher overall mortality risk (HR: 1.38; 95% CI: 1.04-1.85; p=0.0285) than those without liver disease. Identifying specific comorbidity mortality risks in patients with EO-CRC allows for risk stratification when screening target groups and may lower disease mortality. [ABSTRACT FROM AUTHOR]

Shared decision making is a patient-centered clinical decision-making process that allows healthcare workers to share the existing empirical medical outcomes with patients before making critical decisions. This study aims to explore a project in a medical center of developing a mobile SDM in Taiwan. Chi Mei Medical Center developed the mobile SDM platform and conducted a survey of evaluation from healthcare workers. A three-tier platform that based on cloud infrastructure with seven functionalities was developed. The survey revealed that healthcare workers with sufficient SDM knowledge have an antecedent effect on the three perceptive factors of acceptance of mobile SDM. Resistance to change and perceived ease of use show significant effect on behavioral intention. We provided a comprehensive architecture of mobile SDM and observed the implementation in a medical center. The majority of healthcare workers expressed their acceptancem; however, resistance to change still present. It is, therefore, necessary to be eliminated by continuously promoting activities that highlight the advantages of the Mobile SDM platform. In clinical practice, we validated that the mobile SDM provides patients and their families with an easy way to express their concerns to healthcare workers improving significantly their relationship with each other. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of aspergillosis is increasing, and the risk factors for infection include cancer, admission to the intensive care unit, chronic pulmonary diseases, immunocompromised status, and taking immunomodulatory drugs. There are limited data about the incidence of aspergillosis in patients with different types of cancer. The aim of our study was to survey the incidence of aspergillosis in different cancer types from 2006 to 2017. Patients and Methods: Data were collected from the Taiwan Cancer Registry database and International Classification of Diseases, 9th, 10th Revision, and Clinical Modification codes for diagnosing aspergillosis. Patients with a history of aspergillosis before cancer were excluded, and the secondary outcome was the risk of mortality in cancer patients with and without aspergillosis after 1 year. Results: Among 951 cancer patients with a diagnosis of aspergillosis, there were 614 hematopoietic and reticuloendothelial system patients, 100 lung cancer patients, and 73 lymphoma cancer patients. The overall incidence rates of aspergillosis tended to increase significantly from 2006 to 2017 (from 3.50 to 13.37 per 10,000 person-years, p value: < 0.0001). Regarding sex, the incidence rates of aspergillosis in males and females were 12.52 and 7.53 per 10,000 person-years, respectively. Patients with a diagnosis of aspergillosis had a 2.30-fold (95% CI: 2.14– 2.48, p value: < 0.0001) higher risk of mortality than those without aspergillosis. Conclusion: The incidence of aspergillosis was increased in cancer patients, and cancer patients with aspergillosis had a significantly higher risk of mortality than those without aspergillosis. [ABSTRACT FROM AUTHOR]

Background: Overactive bladder (OAB) syndrome is defined as urinary urgency, with or without urge incontinence in the absence of an underlying pathological or metabolic cause. Treatment for OAB involves anti-muscarinic agents and beta 3-adrenoceptor agonists. As a previous study showed that treatment may increase the risk of urinary tract infection (UTI), we conducted a nationwide, population-based, retrospective study to assess UTI risk associated with OAB medication adherence, and different types of OAB medication. Methods: The source of data was medical records from National Health Insurance Research Database (NHIRD). Patients who were diagnosed with OAB in outpatient records from January 1, 2014 to December 31, 2016 were included. Outpatient visits included an attendance at primary care or the emergency department. The index date was the first prescription medication for OAB treatment after diagnosis. The targeted population was those diagnosed with OAB, and targeted drugs were anti-muscarinic agent (including flavoxate, oxybutynin, propiverine, solifenacin, tolterodine, and trospium) and mirabegron. Adherence was assessed based on the proportion of days covered in 12 months among mirabegron and anti-muscarinic agents. A multivariate Cox proportional-hazards model was used to compare the risk of UTI with OAB medication adherence, and different types of OAB medication. Results: There were 39,975 outpatients diagnosed with OAB in the database from 2014 to 2016. Excluding those younger than 20 years old and for whom the information was incomplete in the database, 21,869 patients were included in the final OAB cohort. Overall, risk of UTI was not influenced by the targeted drugs or adherence during the follow-up period, regardless of UTI history or sex. Conclusion: OAB is a common problem in Taiwan. After 12 months of follow-up, there was no difference between anticholinergic medications and beta-3 agonists, nor between high and low adherence in the risk of UTI. [ABSTRACT FROM AUTHOR]

This study was designed to explore the association among health literacy and cancer screening behaviors in Taiwanese females. A total of 353 community-dwelling females were recruited in this cross-sectional study from February to October 2015. Demographic, socioeconomic and personal behavior variables including physical activity, community activity, smoking, alcohol consumption, and betel nut chewing were recorded. Health literacy was evaluated using the Mandarin version of the European Health Literacy Survey Questionnaire. Data on screening behaviors for cervical, breast and colorectal cancers were confirmed by the Taiwanese National eHealth Database. Most respondents with inadequate or problematic general health literacy had no or irregular screening behaviors for cervical, breast and colorectal cancers. In multivariable regression analysis, women with inadequate health literacy were at a greater risk (Odds ratio = 5.71; 95% CI: 1.40–23.26) of having no previous Pap smear screening or >3 years screening interval regardless of education level. However, this association was not detected for breast or colorectal cancer. Women with inadequate health literacy were more likely to have irregular cervical cancer screening, however no associations among health literacy and breast or colorectal cancer were detected. The impact of health literacy on cancer screening behavior warrants further attention and research. [ABSTRACT FROM AUTHOR]

An increasing number of cybercrimes has presented new global challenges to law enforcement agencies that traditionally operate within designated geographical jurisdictions and patrol territories. The borderless nature of cyberspace has brought substantial opportunities-both legal and illegal-to its users, and many local law enforcement agencies have encountered motivated offenders taking advantage of the globally connected Internet and causing damage locally and transnationally. This study examines a high-profile case of European criminals who hacked into a Taiwanese financial institution-First Commercial Bank (FCB)-and programmed its ATMs to "spit out" cash netting the thieves $2.6 million US dollars in 2016 summer. Before the incident of FCB, this European criminal group committed more than a hundred similar ATMs hackings, victimizing dozens of financial institutions across several European countries, and profiting over one billion Euros. FCB is the only case revealing specific details about the modus operandi of ATM hacking thus far, in addition to disclosing reactions from law enforcement. By analyzing qualitative data collected from different branches of law enforcement involved in the investigations, this unique case study underscores the importance of national-local law enforcement collaboration in fighting transnational cybercrime. Empirical implications are particularly valuable in the law enforcement context of "turf jealousies" when defending homeland security. [ABSTRACT FROM AUTHOR]

Background: Respiratory system infections are prevalent in patients with depression. However, it remains unclear if patients with depression are at an increased risk of developing pleural empyema. Methods: We conducted a retrospective cohort study using data from the National Health Insurance Research Database of Taiwan. The depression group included 42,283 newly diagnosed patients between 2000 and 2012. The comparison group included the same number of individuals without depression, frequency matched for age, sex, comorbidities, and the year of diagnosis. The occurrence of pleural empyema was monitored until the end of 2013. Results: The overall incidence of pleural empyema was 1.32-fold higher in the depression group than in the comparison group (3.94 versus 2.97 per 10,000 person-years), with an adjusted hazard ratio of 1.33 (95% confidence interval, 1.27−1.40). Stratified analyses by age, sex, and comorbidity revealed that the crude and adjusted hazard ratios of pleural empyema associated with depression were significant in all subgroups. The 30-day mortality for pleural empyema was higher, but not significantly, in the depression group compared to the comparison group (10.7% versus 6.4%, adjusted odds ratio = 2.23, 95% confidence interval, 0.77−6.49). Conclusion: An association between depression and the development of pleural empyema may exist; however, more evidence is required to support this association. The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have utilized machine-learning techniques to predict the early onset of type 2 diabetes mellitus. However, fewer studies have been conducted to predict an appropriate diagnosis code for the type 2 diabetes mellitus condition. Further, ensemble techniques such as bagging and boosting have likewise been utilized to an even lesser extent. The present study aims to identify appropriate diagnosis codes for type 2 diabetes mellitus patients by means of building a multi-class prediction model which is both parsimonious and possessing minimum features. In addition, the importance of features for predicting diagnose code is provided. Methods: This study included 149 patients who have contracted type 2 diabetes mellitus. The sample was collected from a large hospital in Taiwan from November, 2017 to May, 2018. Machine learning algorithms including instance-based, decision trees, deep neural network, and ensemble algorithms were all used to build the predictive models utilized in this study. Average accuracy, area under receiver operating characteristic curve, Matthew correlation coefficient, macro-precision, recall, weighted average of precision and recall, and model process time were subsequently used to assess the performance of the built models. Information gain and gain ratio were used in order to demonstrate feature importance. Results: The results showed that most algorithms, except for deep neural network, performed well in terms of all performance indices regardless of either the training or testing dataset that were used. Ten features and their importance to determine the diagnosis code of type 2 diabetes mellitus were identified. Our proposed predictive model can be further developed into a clinical diagnosis support system or integrated into existing healthcare information systems. Both methods of application can effectively support physicians whenever they are diagnosing type 2 diabetes mellitus patients in order to foster better patient-care planning. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease is common in patients with end-stage renal disease (ESRD). Patients with ESRD are a high-risk group for cardiac surgery and have increased morbidity and mortality. Most studies comparing ESRD patients receiving coronary artery bypass grafting (CABG) or percutaneous coronary intervention have found that the long-term survival is good in ESRD patients after CABG. The aim of our study was to compare ESRD patients who underwent CABG with the general population who underwent CABG, in terms of prognosis and hospital costs.Methods: This study analyzed data from the National Health Insurance Research Database in Taiwan for patients who were diagnosed with ESRD and received CABG (ICD-9-CM codes 585 or 586) between January 1, 2004, and December 31, 2009. The ESRD patients included in this study all received catastrophic illness cards with the major illness listed as ESRD from the Ministry of Health and Welfare in Taiwan. The control subjects were randomly selected patients without ESRD after propensity score matching with ESRD patients according to age, gender, and comorbidities at a 2:1 ratio from the same dataset.Results: A total of 48 ESRD patients received CABG, and their mean age was 62.04 ± 10.04 years. Of these patients, 29.2% were aged ≥70 years, and 66.7% were male. ESRD patients had marginally higher intensive care unit (ICU) stays (11.06 vs 7.24 days) and significantly higher ICU costs (28,750 vs 17,990 New Taiwan Dollars (NTD)) than non-ESRD patients. Similarly, ESRD patients had significantly higher surgical costs (565,200 vs. 421,890 NTD), a higher perioperative mortality proportion (10.4% vs 2.1%) and a higher postoperative mortality proportion (33.3% vs 11.5%) than non-ESRD patients.Conclusions: After CABG, ESRD patients had a higher risk of mortality than non-ESRD patients, and ICU and surgery costs were also higher among the ESRD patients than among patients without ESRD. [ABSTRACT FROM AUTHOR]

The present study investigated factors associated with health literacy in community-dwelling Taiwanese women, particularly focusing on those associated with prevalent unhealthy behaviors. This cross-sectional study recruited 353 community-dwelling women aged 39–89 years from February to October 2015 in urban, suburban, and rural areas. Variables investigated included physical activity, community activity, tobacco usage, alcohol consumption, and betel-nut chewing. Degree of health literacy was evaluated using the Chinese-language version of the European Health Literacy Survey Questionnaire. Most respondents had inadequate (17.6%), or problematic (49.3%), general health literacy. Multiple logistic regression analyses showed that low educational attainment was closely associated with inadequate or problematic general health literacy. Women who did not engage in regular physical activity or direct community activity were more likely to have inadequate and problematic general health literacy, respectively. Selected unhealthy behaviors (tobacco usage, alcohol consumption, betel-nut chewing) were not associated with health literacy. Low health literacy was prevalent among participants. Lower educational attainment and a lack of physical or community activity were associated with low health literacy. Health literacy should be considered during the process of delivering health information, and health education programs must enhance health literacy tailored to address individuals' lifestyles. [ABSTRACT FROM AUTHOR]

Aims: To explore the child‐rearing experiences of immigrant mothers and their concerns about children's home environments in the contexts of transnational marriage families and non‐native culture. Background: Immigrant mothers are often disadvantaged by a relative lack of information on and access to children's healthcare, but little research exists on the experiences of mothers in transnational marriage families as they attempt to provide a secure home environment while navigate an unfamiliar culture. Design: A descriptive phenomenological research design based on intuition was employed to explore immigrant mothers' unique lived reality through their subjective experiences and perceptions. Methods: Semi‐structured interviews with 15 immigrant mothers from 15 transnational marriage families were conducted between May 2016–February 2017. Narratives were analyzed using the descriptive phenomenological method because it permits systematic discovery of the lived experiences from the perspective of the study's participants. Results: Three major themes were identified: (a) striving to maintain a secure home for children; (b) suffering and struggling with difficulties; and (c) trying to overcome difficulties and build an adequate family environment. The essential, prevailing concept of immigrant mothers' experience in child‐rearing was identified as 'Where my child is, is home.' Conclusion: Immigrant mothers bond emotionally and physically to their new land via their children. Their child‐raising experiences are interwoven with their roles in their new familial and cultural homes. Impact: Immigrant brides often become mothers soon after marrying to continue their husbands' family line. Understanding their unique child‐rearing experiences and challenges in providing a secure home in a non‐native culture will help nurses provide effective care. Study results will benefit paediatric/family nurses in any setting where care for transnational marriage families is provided, those families themselves, public policymakers and future researchers. [ABSTRACT FROM AUTHOR]

Background: Androgen deprivation therapy (ADT) in the treatment of prostate cancer may be associated with an increased risk of thromboembolic disease. The aim of our study was to investigate the association of ADT in the treatment of prostate cancer with ischemic stroke risk.Methods: We identified individuals older than 20 years of age who were newly diagnosed with prostate cancer between January 1, 2005, and December 31, 2012. Patients who experienced ischemic stroke or transient ischemic stroke before the index date were excluded. Patients who received at least one prescription for ADT within 6 months were defined as the ADT user group. Patients who did not receive at least one prescription for ADT within 6 months were defined as the ADT nonuser group. The patients were followed until the first occurrence of one of the primary outcome measures (ischemic stroke or death) or until December 31, 2013. The primary composite outcome was the time to any cause of death or ischemic stroke.Results: There was no significant difference in the primary composite outcomes in the prostate cancer patients between the ADT user and nonuser groups. Prostate cancer patients who received ADT had a higher mortality rate than those who were not treated with ADT, and the adjusted hazard ratio was 1.907 (95% confidence interval: 1.278-2.844; P = 0.0016) after adjusting for age, comorbidities and comedication use.Conclusion: ADT in the treatment of prostate cancer may not be associated with an increased risk of ischemic stroke. The differences in thromboembolic effects in cardiovascular disease and ischemic stroke secondary to ADT should be further discussed and evaluated prospectively. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community‐dwelling elderly participants. This cross‐sectional study enrolled 990 community‐dwelling elderly participants in three residential areas, with a mean age of 71.53 ± 7.22 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer‐administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β = 0.73, p <0.001), attitude (β = 0.06, p = 0.038) and decision (β = 0.14, p < 0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β = 0.57) than hospice knowledge (β = 0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β = 0.59) than hospice knowledge (β = 0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended. [ABSTRACT FROM AUTHOR]

Background: Coronary artery aneurysm (CAA) is a rare disease, and there are limited data on prescribing patterns for CAA. The aim of our study was to investigate prescribing patterns for CAA in Taiwan via the National Health Insurance Research Database (NHIRD).Methods: We included all CAA patients in Taiwan from 2005 to 2011. Data from 1 year before and after the CAA diagnosis were used to analyze examinations, comorbidities and prescribing patterns.Results: A total of 1397 patients diagnosed with CAA were enrolled in our study. Most pediatric patients with CAA were diagnosed with Kawasaki disease (95.7%). In pediatric CAA patients, the utilization rates of aspirin and gamma globulins were 82.9 and 53.6%, respectively, after CAA diagnosis. Among the antithrombotic agents, aspirin was used most commonly, followed by dipyridamole (16.9%), heparin (5.8%) and warfarin (4.6%). In adult CAA patients, common comorbidities included hypertension (63.4%), hyperlipidemia (39.6%), and diabetes mellitus (26.1%). Coronary atherosclerosis was identified in 72.5% of adult patients after CAA diagnosis. Antithrombotic agents, particularly aspirin, clopidogrel and heparin, were prescribed more frequently after CAA diagnosis. Among the prescribed medications, aspirin (75.8%), β-blockers (48.3%), statins (47.6%), metformin (14.4%), sulfonylureas (14.4%) and isosorbide mononitrate (32.9%) were frequently observed in each category.Conclusions: Kawasaki disease was the main cause of CAA in pediatric patients, and coronary artery disease was the most common comorbidity in adult CAA patients. The most commonly used antithrombic agent after CAA diagnosis was aspirin in both adult and pediatric patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to investigate factors that motivate nurses to protect privacy in electronic medical records, based on the Decomposed Theory of Planned Behavior.Methods: This cross-sectional study used questionnaires to collect data from nurses in a large tertiary care military hospital in Taiwan.Results: The three hundred two (302) valid questionnaires returned resulted in a response rate of 63.7 %. Structural equation modeling identified that the factors of attitude, subjective norm, and perceived behavioral control of the nurses significantly predicted the nurses' intention to protect the privacy of electronic medical records. Further, perceived usefulness and compatibility, peer and superior influence, self-efficacy and facilitating conditions, respectively predicted these three factors.Conclusions: The results of our study may provide valuable information for education and practice in predicting nurses' intention to protect privacy of electronic medical records. [ABSTRACT FROM AUTHOR]

The purpose of our study aimed to identify attributes capable of improving physicians’ satisfaction levels with the use of a hospital information system (HIS). A model inclusive of system quality, information quality, and service quality related to an HIS is used to form antecedents of user satisfaction. Survey methodology was used to collect an attributive set representing the system quality, information quality, and service quality made available from 150 physicians at a large health-care system in southern Taiwan. Responses were segmented into low and high satisfaction and analyzed with partial least squares and importance-performance analysis. The results reveal that system quality, information quality, and service quality may be used to significantly predict physicians’ satisfaction. Two system quality attributes (reliability and response time) were identified as the highest priorities for intervention by low- and high-satisfaction users. Low-satisfaction users further expect improvement of the HIS service quality to take place. The subject health-care system should produce coping interventions for those high priorities to enhance the satisfaction of physicians. [ABSTRACT FROM AUTHOR]

Background: Traditional Chinese medicine (TCM) has been used by Chinese patients and in many other countries worldwide. However, epidemiological reports and prescription patterns on children are few. Methods: A cohort of 178,617 children aged 18 and under from one million randomly sampled cases of the National Health Insurance Research Database was analyzed for TCM prescription patterns. SAS 9.1 was applied and descriptive medicine utilization patterns were presented. Results: The cohort included 112,889 children treated by TCM, with adolescents (12- to 18-year-olds) as the largest group. In the children's TCM outpatient visits, Chinese herbal remedies were the main treatment. The top three categories of diseases treated with Chinese herbal remedies were respiratory system; symptoms, signs, and ill-defined conditions; and digestive system. The top three categories using acupuncture were: injury and poisoning, diseases of the musculoskeletal system and connective tissue, and diseases of the respiratory system. Of the top ten herbal medicines prescribed by TCM physicians, the top nine herbal formulae and the top ten single herbs were associated with diseases of the respiratory system. Conclusion: This study identified patterns of TCM prescriptions for children and common disease categories treated with TCM. The results provide a useful reference for health policy makers and for those who consider the usage of TCM for children. [ABSTRACT FROM AUTHOR]

Aortic dissection is a life-threatening condition. However, the use of medication to treat it remains unclear in our population, particularly in patients with a type B aortic dissection (TBAD) who do not receive surgery. This retrospective cohort study evaluated antihypertensive prescription patterns and outcomes in patients with nonsurgical TBAD. We reviewed the hospital records of patients with TBAD at a medical center in Taiwan from January 2008 to June 2013 to assess the baseline information, prescribing pattern, event rate, and clinical effectiveness of different antihypertensive treatment strategies. A Cox proportional hazards model was used to estimate outcomes in different antihypertensive strategies. The primary endpoints were all-cause mortality and hospital admission for an aortic dissection. We included 106 patients with a mean follow-up period of 2.75 years. The most common comorbidity was hypertension followed by dyslipidemia and diabetes mellitus. Study endpoints mostly occurred within 6 months after the index date. Over 80% of patients received dual or triple antihypertensive strategies. Patients treated with different treatment strategies did not have a significantly increased risk of a primary outcome compared with those treated with a monotherapy. We found no significant difference in the primary outcome following the use of different antihypertensive medication regimes. [ABSTRACT FROM AUTHOR]

Background: Self-care management is becoming an important part of care for chronic patients. However, various kinds of self-management educational materials which government or healthcare institutions provide for patients may not achieve the expected outcome. One of the critical reasons affecting patients' use intention could be patients' perceived information overload regarding the self-management educational materials.Purpose: This study proposed an extended model of the Theory of Planned Behavior (TPB), which incorporated perceived information overload, to explore if information overload will prevent chronic patients from reading educational materials for self-care management. The independent variables are attitude, subject norm, perceived behavior control and perceived information overload while the dependent variable is behavior intention to use the self-management educational materials. Perceived information overload is also referred to as an antecedent variable which may has impacts on attitude and perceived behavior control.Methods: The cross-sectional study interviewed newly diagnosed chronic patients with coronary artery disease, who are the potential users of the self-management educational materials, in a medical center in Taiwan. Data were analyzed using descriptive statistics of the basic information distribution of the respondents, and structural equation modeling to study the reliability and validity for testing hypotheses.Results: A total of 110 respondents were enrolled in this study and successful interview data were collected from 106 respondents. The result indicates that the patients' perceived information overload of self-management educational materials was validated to have impacts on attitude and perceived behavioral control constructs of the TPB as well as contributing a direct impact on patients' intentions to use self-management educational materials. Besides, subjective norm and perceived behavioral control constructs were validated to have significant impacts on behavioral intentions, whereas the attitude construct was not. Finally, the relationships between information overload and attitude, information overload and intention, subjective norm and intention, as well as perceived behavioral control and intention varied significantly between highly- and less-educated respondents. Differing self-management educational materials for respondents of various educational levels could be formulated to substantially boost the use of self-management educational materials.Conclusions: This study demonstrated a comprehensive framework, which extended perceived information overload into the TPB model, to predict patients' behavioral intention of using self-management educational materials. We expect the results of this study will provide useful insights for studying self-management educational materials usage and information overload from the perspectives of academia, governments, and healthcare providers. [ABSTRACT FROM AUTHOR]

Acute bacterial meningitis causes high morbidity and mortality; the associated clinical symptoms often are insensitive or non-specific; and the pathogenic bacteria are geographically diverse. Clinical diagnosis requires a rapid and accurate methodology. This study aimed to develop a new multiplex polymerase chain reaction (mPCR) assay to detect simultaneously six major bacteria that cause adult bacterial meningitis in Taiwan: Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, and Acinetobacter baumannii. Species-specific primers for the six bacteria were developed using reference strains. The specificities of the mPCRs for these bacteria were validated, and the sensitivities were evaluated via serial dilutions. The mPCR assay specifically detected all of the six pathogens, particularly with sensitivities of 12 colony forming units (CFU)/mL, 90 CFU/mL, and 390 CFU/mL for E. coli, S. pneumoniae, and K. pneumoniae, respectively. This mPCR assay is a rapid and specific tool to detect the six major bacterial pathogens that cause acute adult meningitis in Taiwan, particularly sensitive for detecting E. coli, S. pneumoniae, and K. pneumoniae. The assay may facilitate early diagnosis and guidance for antimicrobial therapy for adult patients with this deadly disease in Taiwan. [ABSTRACT FROM AUTHOR]

The purposes of this study are threefold: 1) to find out what characteristics are required for the successful use of ePortfolios; 2) to discover what activities best represent reflective thinking during the use of ePortfolios; and, 3) to investigate the interrelationship between nursing staff users' perceived success levels with ePortfolios and with their reflective thinking activities. Survey methodology was used to gather responses from 78 nurses from a medical center located in southern Taiwan via questionnaires. Factor analysis and canonical correlation analysis were used to analyze the collected data. The results demonstrated that system quality, information quality, and user satisfaction are important variables in successful ePortfolio usage; while habitual action, understanding, reflection, and critical reflection are major variables of reflective thinking. Further, we found a significant relationship exists between the relative success of ePortfolios and reflective thinking activities of ePortfolios users. The subject hospital should pay special attention to important characteristics including system quality, information quality, and user satisfaction when employing ePortfolios to help nursing staff users to achieve their learning goals through this form of reflective thinking. [ABSTRACT FROM AUTHOR]

Background: The purposes of this study were to explore the factors influencing physicians' intention of adopting telemedicine and to conduct a multigroup analysis comparing the perceptions about telemedicine adoption between experienced and inexperienced physicians. Based on the Theory of Planned Behavior, we conducted a cross-sectional survey to collect data from 15 hospitals in Taiwan. Materials and Methods: In total, 106 valid questionnaires were returned. We used structural equation modeling to analyze the collected data. Results: Attitude (AT), subjective norm (SN), and perceived behavioral control (PBC) were found to be positively related to behavioral intention (BI) for combined data. Moreover, the relationships between AT→BI, SN→BI, and PBC→BI varied significantly between experienced and inexperienced physicians. Experienced physicians held stronger beliefs about the relationship between AT→BI than inexperienced physicians. Conclusions: According to the results, our study suggests that differing strategies for experienced and inexperienced physicians must be formulated to substantially boost the adoption of telemedicine technology. [ABSTRACT FROM AUTHOR]

Background: AIDS is a serious disease worldwide. Prevention has been shown to be more effective than treatment in the effort to control and end the threat of this disease. Purpose: The purpose of this study was to evaluate the effects of an HIV/AIDS prevention education program on adolescents living in a primarily indigenous area of Taiwan. Methods: This study used secondary data prepared by the Health Center of one indigenous township in 2011. Authors analyzed the dataset retrospectively. A 2-week HIV/AIDS prevention education program was arranged for a single group of 50 students from one junior high school and a pretest and posttest were conducted. A total of 45 valid questionnaires were completed. Data were analyzed using descriptive statistics, the McNemar test, and the Wilcoxon signed-rank test. Results: Results indicate that the education program improved the knowledge (p < .001) and attitude (p < .05) of participants significantly between pretest and posttest. The posttest score for knowledge (9.47 ± 3.24) was significantly higher than the pretest score (6.11 ± 3.84). The posttest score for positive attitude (3.72 ± 0.36) was also significantly higher than the pretest score (3.43 ± 0.34). Conclusions / Implications for Practice: This AIDS prevention education program significantly improved the related knowledge and attitudes of participants. Schools and health units may reference the results of this study to design materials for prevention of HIV/AIDS, particularly in the context of indigenous adolescents. [ABSTRACT FROM AUTHOR]

The introduction of electronic medical records (EMRs) can expose patients to the risk of infringement of their privacy. The purpose of this study was to explore the relationship between patients’ concerns about information privacy and their protective responses. A questionnaire survey conducted in a Taiwanese hospital revealed that, regarding information privacy, patients’ concerns about the collection of information about themselves, the secondary use of this information and the possibility of errors in the recorded information were associated with their information privacy-protective responses, while concern for unauthorised access to their information by other staff in the medical facility was not. Medical facilities should devote every effort to alleviate patients’ concerns about the invasion of their information privacy to avoid eroding the reputation of medical facilities and impeding the promotion of EMRs. [ABSTRACT FROM AUTHOR]

Background: With the increasing prevalence of Picture Archiving and Communication Systems (PACS) in healthcare institutions, there is a growing need to measure their success. However, there is a lack of published literature emphasizing the technical and social factors underlying a successful PACS. Methods: An updated Information Systems Success Model was utilized by radiology technologists (RTs) to evaluate the success of PACS at a large medical center in Taiwan. A survey, consisting of 109 questionnaires, was analyzed by Structural Equation Modeling. Results: Socio-technical factors (including system quality, information quality, service quality, perceived usefulness, user satisfaction, and PACS dependence) were proven to be effective measures of PACS success. Although the relationship between service quality and perceived usefulness was not significant, other proposed relationships amongst the six measurement parameters of success were all confirmed. Conclusions: Managers have an obligation to improve the attributes of PACS. At the onset of its deployment, RTs will have formed their own subjective opinions with regards to its quality (system quality, information quality, and service quality). As these personal concepts are either refuted or reinforced based on personal experiences, RTs will become either satisfied or dissatisfied with PACS, based on their perception of its usefulness or lack of usefulness. A satisfied RT may play a pivotal role in the implementation of PACS in the future. [ABSTRACT FROM AUTHOR]

Background: Taiwanese midwives began to receive professional training in 1907 during the Japanese Colonial Period. The profession of midwifery flourished until it was gradually sidelined by increasingly available professional obstetrics and medical care and changes in society and culture. Lee Chuan is a former professional midwife. She was born in 1921 in Tainan County and studied at the Midwifery Institute in Taichung, where she graduated in 1943. She worked as a midwife at the Jiangjyun Township Health Center in Tainan County in 1950. She joined the Kaohsiung Municipal Hospital in 1952 and retired from the Kaohsiung Municipal Ta-Tung hospital in 1978. She ended her midwifery career in 1989. Purpose: This study explores the career of midwifery, including initiation, the learning process, and career as a precious historical perspective on the development of maternal-infant care in Taiwan through the mid- and late-20th century, a timeline that covers Japanese and Republic of China administration of Taiwan and addresses social, and culture contexts. Methods: An oral history approach was adopted to explore the midwifery career. Research included literature review, photograph compilation, a review of formal documents, and 14 face-to-face, in-depth interviews with Lee Chuan. Content analysis was performed on collected information and triangulation was used to check rigor. Results: Three themes emerged, including: (1) growth and midwifery enlightenment; (2) midwifery learning experiences; (3) the career of midwifery. Conclusion / Implications for Practice: Results provide Lee Chuan's personal and professional history, under-scoring the meaningful implication and values of traditional midwifery. Results further reveal the merits of the midwife profession. Lee Chuan's profession, humanity, and ways of social communications may also have lessons and insights for maternal and infant care and nursing professionals today. [ABSTRACT FROM AUTHOR]

BACKGROUND: Double-triggering (DT) is a frequent type of patient-ventilator asynchrony and has potentially severe consequences, such as alveolar overdistention or the generation of intrinsic PEEP. However, the first breath of DT could be patient-triggered (DT-P), auto-triggered (DT-A), or ventilator-triggered (DT-V). OBJECTIVE: To differentiate DT-P, DT-A, and DT-V using airway pressure or flow changes during the trigger-delay phase in ventilated patients. METHODS: Fourteen mechanically ventilated patients with DT were included. All patients were on flow-triggered ventilation modes and received either continuous mandatory ventilation or pressure support ventilation. Breaths in which the first breath was associated with an esophageal pressure drop of > 1 cmH2O were categorized as DT-P. Breaths in which the first breath occurred at the ventilator set cycle were categorized as DT-V. Breaths in which the first breath occurred earlier than the ventilator set cycle without esophageal pressure drop were categorized as DT-A. The pressure drop and flow change at 0.13 s (PD0.13 and F0.13, respectively) in the trigger-delay phase were calculated from the nadir. RESULTS: There were 507 double-triggered breaths: 271 DT-V (53%), 50 DT-A (10%), and 186 DT-P (37%). The PD0.13 for DT-V, DT-A, and DT-P were 0.16 0.12 cm H2O, 0.25 0.17 cm H2O, and 1.34 0.67 cm H2O, respectively. The F0.13 for DT-V, DT-A, and DT-P were 2.11 2.31 L/min, 2.64 2.07 L/min, and 16.51 8.02 L/min, respectively. The best discriminatory criteria for differentiating DT-P from DT-V and DT-A, based on the Youden index (sensitivity specificity - 1) was PD0.13 > 0.49 cm H2O, which had a Youden index of 95%. CONCLUSION: DT-P can be distinguished from DT-V and DT-A by using airway pressure deflections in the trigger-delay phase. [ABSTRACT FROM AUTHOR]

Most prior studies have examined prosecutorial decision making from cognitive, organizational, and legal perspectives, with few studies applying a broad sociological model. This study attempts to address the gap by using Black’s Behavior of Law as a theoretical framework to explicate prosecutorial behavior. With analysis of aggregate-level data from Taiwan for the period 1973 to 2005, the results partially support Black’s propositions. Organization (martial law) and culture (educational attainment) are significantly associated with the levels of change in prosecutors’ behavior in the directions hypothesized using Black’s model. The remaining aspects of social life, however, do not have an effect on the prosecutors’ decisions during the time frame. The findings suggest that mediating variables, such as the extent of governmental autocracy and control over legislative policy, need to be considered in explaining the behavior of law. [ABSTRACT FROM PUBLISHER]

The purpose of this study was to learn about the experiences of Indonesian nannies in caring for Taiwanese children in Taiwan. An ethnography method was adopted, using in-depth interviews with 52 respondents, 20 of whom were Indonesians employed as caretakers for Taiwanese children and 32 of whom were general informants. Twenty-six of the general informants were Indonesian child caretakers, and six were employers. Audio-taping of interview sessions was permitted by all respondents. Transcriptions of the interviews were written up verbatim. Leininger's (1991) Phases of Analysis for qualitative data was adopted to analyze data. Four themes were extracted from the analysis, including "Learning diverse information from the beginning -- the employer's family," "Complying with the advice of the child's mother," "Maintaining the child's daily activities and health," and "Awareness of external context influences on child care." The findings indicated that Indonesian child caretakers carry with them the values, beliefs, and lifestyles of their own culture and have their own ingrained ideas regarding how best to provide care for their Taiwanese charges. Health care providers, by better understanding the general experiences of Indonesian caretakers in Taiwan, can apply competent intervention to help caretakers overcome the challenges of working within a different cultural environment. It is hoped that the results of this study can promote cultural competence in childcare within the context of internationalism. [ABSTRACT FROM AUTHOR]

We have performed genetic screening on the skeletal muscle chloride channel gene (CLCN1) in Taiwanese population. A total of four patients with myotonia congenita (MC) together with 106 normal individuals were examined. All 23 exons of the CLCN1 gene were analysed by direct sequencing of PCR products to detect the nucleotide changes. Five mutations and three polymorphisms were identified in this study. Among these, three missense mutations (S471F, P575S, D644G) and one polymorphism (T736I) are novel and could be unique to the Taiwanese. In addition, a previously documented recessive G482R mutation was identified in a heterozygous patient and his nonsymptomatic father, indicating that this mutation might indeed function recessively or dominantly with incomplete penetrance. In conclusion, this is the first report of MC in Taiwan with proven CLCN1 gene mutations and showing high molecular heterogeneity in Taiwanese MC patients. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and contributes to high morbidity worldwide. Patients with COPD have a higher risk for acute respiratory failure, ventilator dependence, and mortality after hospitalization compared with the general population. Accurate and early risk detection will provide more information for early management and better decision making. This study aimed to build prediction models using patients' characteristics, laboratory data, and comorbidities for early detection of acute respiratory failure, ventilator dependence, and mortality in patients with COPD after hospitalization. We retrospectively collected the electronic medical records of 5061 patients with COPD in three hospitals of the Chi Mei Medical Group, Taiwan. After data cleaning, we built three prediction models for acute respiratory failure, ventilator dependence, and mortality using seven machine learning algorithms. Based on the AUC value, the best model for mortality was built by the XGBoost algorithm (AUC = 0.817), the best model for acute respiratory failure was built by random forest algorithm (AUC = 0.804), while the best model for ventilator dependence was built by LightGBM algorithm (AUC = 0.809). A web service application was implemented with the best models and integrated into the existing hospital information system for physician's trials and evaluations. Our machine learning models exhibit excellent predictive quality and can therefore provide physicians with a useful decision-making reference for the adverse prognosis of COPD patients. [ABSTRACT FROM AUTHOR]

Healthcare Artificial Intelligence (AI) has the greatest opportunity for development. Since healthcare and technology are two of Taiwan's most competitive industries, the development of healthcare AI is an excellent chance for Taiwan to improve its health-related services. From the perspective of economic development, promoting healthcare AI must be a top priority. However, despite having many breakthroughs in research and pilot projects, healthcare AI is still considered rare and is broadly used in the healthcare setting. Based on a medical center in Taiwan that has introduced a variety of healthcare AI into practice, this study discussed and analyzed the issues and concerns in the development and scaling of medical AIs from the perspective of various stakeholders in the healthcare setting, including the government, healthcare institutions, users (healthcare workers), and AI providers. The present study also identified critical influential factors for the deployment and scaling of healthcare AI. It is hoped that this paper can serve as an important reference for the advancement of healthcare AI not only in Taiwan but also in other countries. [ABSTRACT FROM AUTHOR]

Purpose: Many comorbidities, including depression, anxiety, and insomnia, occur in patients with chronic obstructive pulmonary disease (COPD). These patients may be prescribed benzodiazepines (BZDs). However, there are some concerns that benzodiazepines increase the risk of drug overdose, hypercapnic respiratory failure, acute exacerbation and increased mortality. The aim of our study was to evaluate the drug safety of BZDs in patients with COPD. Methods: We used the National Health Insurance Research database in Taiwan from 2002 to 2016 to perform a retrospective cohort study. We enrolled patients who were exposed to the first prescription of BZDs, non-BZDs or a combination (mix user) after COPD diagnosis. We performed 1:1:1 propensity score matching in three groups. The outcomes were COPD with acute exacerbation and all-cause mortality. Poisson regression analysis was performed to evaluate the incidence rate ratios for the outcomes in the groups. Results: After propensity score matching, there were 2,856 patients in each group. After adjusting for confounding factors, we found that compared to BZD users, non-BZD and mix users had nonsignificant differences in outpatient management of acute exacerbations, hospitalization management of acute exacerbations, emergency department management of acute exacerbations and all-cause mortality. BZD and mix groups showed significantly increased admission for acute exacerbation of COPD compared with that of the nonuser group, with IRRs of 2.52 (95% CI, 1.52–4.18; p = 0.0004) and 2.63 (95% CI, 1.57–4.40; p = 0.0002), respectively. Conclusion: BZD, non-BZD, and mix users showed increased COPD-related respiratory events compared to nonusers in Asian subjects. [ABSTRACT FROM AUTHOR]

Growing cultural diversity among immigrants has challenged health care practice in Taiwan. This study used mixed methods to evaluate how the implementation of a course on cultural competence embedded in a nursing course affected nursing students' perceptions of their cultural care competency. An evaluation survey with a quantitative questionnaire comprising pre- and post-test measures of self-perceived cultural care competency was implemented for 48 participants at the commencement and completion of the course. A focus group interview (n = 10) was conducted and a thematic approach applied to analyze qualitative data. The results found a significant improvement in self-perceived cultural care competency (t = 7.15, p < 0.001). Two themes emerged from the qualitative analysis: (1) the thought-provoking nature of the course and (2) appreciation for the multiple learning strategies of the course. The findings suggest that embedding cultural competence education in nursing courses is essential to improving nursing students' perceptions of their cultural care competency. • Growing cultural diversity among immigrants has challenged nursing education. • Cultural care embedded in nursing courses informs students' cultural attitudes. • Cultural care-embedded courses increase perceptions of cultural care competency. • Students appreciated the multiple learning strategies of the cultural instruction. [ABSTRACT FROM AUTHOR]

Routine activities and lifestyle-exposure theories were shaped and substantially tested in Western societies; this study extended their application to a non-Western context in Taiwan. Using the most recent but underutilized 2005 Taiwan Areas Criminal Victimization Survey, responses from a random sample of 18,046 participants were analyzed for robbery, assault, and personal larceny victimization. The findings showed that the risk factors associated with criminal victimization in Taiwan resembled those in Western nations, but anomalies also appeared. Females faced a higher risk of being robbed than males; married and affluent persons were more likely to be victims of personal larceny than not married or less affluent persons; and those who stayed home at night were more likely to be assaulted than those who went out at night. The discussion of these findings suggest that explaining victimization patterns involve more than victims'' attributes or lifestyles; the social and cultural context should be considered as well. [Copyright &y& Elsevier]

Purpose: The adoption of electronic medical records (EMR) is expected to better improve overall healthcare quality and to offset the financial pressure of excessive administrative burden. However, safeguarding EMR against potentially hostile security breaches from both inside and outside healthcare facilities has created increased patients' privacy concerns from all sides. The aim of our study was to examine the influencing factors of privacy protection for EMR by healthcare professionals. Method: We used survey methodology to collect questionnaire responses from staff members in health information management departments among nine Taiwanese hospitals active in EMR utilisation. A total of 209 valid responses were collected in 2014. We used partial least squares for analysing the collected data. Results: Perceived benefits, perceived barriers, self-efficacy and cues to action were found to have a significant association with intention to protect EMR privacy, while perceived susceptibility and perceived severity were not. Conclusion: Based on the findings obtained, we suggest that hospitals should provide continuous ethics awareness training to relevant staff and design more effective strategies for improving the protection of EMR privacy in their charge. Further practical and research implications are also discussed. [ABSTRACT FROM AUTHOR]

Background: This study examines incidence, mortality, medical expenditure and prescription patterns for asthma on a national scale, particularly in Asian countries for asthma is limited. Our aim is to investigate incidence, mortality, prescription patterns and provide a comprehensive overview of healthcare utilization trends for asthma from 2009 to 2018., Methods: We included patients diagnosed with asthma between 2009 and 2018. We excluded patients with missing demographic data. Our analysis covered comorbidities, including diabetes mellitus, hypertension, allergic rhinitis, eczema, atopic dermatitis, coronary artery disease, congestive heart failure, chronic kidney disease, chronic hepatitis, stroke, and cancer. Investigated medications comprised oral and intravenous steroids, short-acting beta-agonists, inhaled corticosteroids (ICS), combinations of ICS and long-acting beta-agonists, long-acting muscarinic antagonists, and leukotriene receptor antagonists montelukast. We also assessed the number of outpatient visits, emergency visits, and hospitalizations per year, as well as the average length of hospitalization and average medical costs., Results: The study included a final count of 88,244 subjects from 1,998,311 randomly selected samples between 2000 and 2019. Over the past decade, there was a gradual decline in newly diagnosed asthma patients per year, from 10,140 to 6,487. The mean age annually increased from 47.59 in 2009 to 53.41 in 2018. Over 55% of the patients were female. Eczema was diagnosed in over 55% of the patients. Around 90% of the patients used oral steroids, with a peak of 97.29% in 2018, while the usage of ICS varied between 86.20% and 91.75%. Intravenous steroids use rose from 40.94% in 2009 to 54.14% in 2018. The average annual hospital stay ranged from 9 to 12 days, with a maximum of 12.26 days in 2013. Lastly, the average medical expenses per year ranged from New Taiwan dollars 5558 to 7921., Conclusions: In summary, both asthma incidence and all-cause mortality rates decreased in Taiwan from 2009 to 2018. Further analysis of medical expenses in patients with asthma who required multiple hospitalizations annually revealed an increase in outpatient and emergency visits and hospitalizations, along with longer hospital stays and higher medical costs., (© 2024. The Author(s).)

Introduction: Secondary spontaneous pneumothorax (SSP) is often linked to chronic obstructive pulmonary disease (COPD). The frequency of SSP occurrence in COPD patients varies among different research findings. SSPs are more commonly found in the elderly population diagnosed with COPD. Previous studies have reported a pneumothorax rate of 26 per 100,000 COPD patients. There is, however, a notable lack of detailed epidemiological information regarding SSP in Asia. Our study focused on determining the occurrence rate of SSP among COPD patients in Taiwan using an extensive national database. Additionally, this study aimed to identify comorbidities associated with SSP in this patient group., Methods: In this study, we used the Longitudinal Health Insurance Database, which contains records of 2 million people who were randomly chosen from among the beneficiaries of the Taiwan National Health Insurance program. The dataset includes information from 2005 to the end of 2017. Our focus was on individuals diagnosed with COPD, identified through ICD-9-CM codes in at least one hospital admission or two outpatient services, with the COPD diagnosis date as the index date. The exclusion criteria included individuals younger than 40 years, those with incomplete records, or those with a previous diagnosis of pneumothorax before the index date. We conducted a matched comparison by pairing COPD patients with control subjects of similar age, sex, and comorbidities using propensity score matching. The follow-up for all participants started from their index date and continued until they developed pneumothorax, reached the study's end, withdrew from the insurance program, or passed away. The primary objective was to evaluate and compare the incidence of pneumothorax between COPD patients and matched controls., Results: We enrolled 65,063 patients who were diagnosed with COPD. Their mean age (±SD) was 66.28 (±12.99) years, and approximately 60 % were male. During the follow-up period, pneumothorax occurred in 607 patients, equivalent to 9.3 % of the cohort. The incidence rate of SSP in COPD patients was 12.10 per 10,000 person-years, whereas it was 6.68 per 10,000 person-years in those without COPD. Furthermore, COPD patients with comorbidities such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer exhibited an increased incidence of SSP compared to COPD patients without such comorbidities. This was observed after conducting a multivariable Cox regression analysis adjusted for age, sex, and other comorbidities., Conclusion: Our study revealed an elevated risk of SSP in patients with COPD. It has also been suggested that COPD patients with comorbidities, such as atrial fibrillation, congestive heart failure, coronary artery disease, diabetes mellitus, hypertension, and cancer, have an increased risk of developing SSP., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Kuang-Ming Liao reports article publishing charges was provided by Chi Mei Medical Center, Chiali. Kuang-Ming Liao reports a relationship with Chi Mei Medical Center, Chiali that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable chronic condition characterized by progressive, partially reversible airflow obstruction. Osteoporosis represents a significant comorbidity in individuals with COPD. However, the incidence and prevalence of osteoporosis among the COPD population remain unclear in Taiwan. Therefore, our objective is to investigate the incidence and prevalence of osteoporosis in patients with COPD., Methods: In this cross-sectional study, we enrolled a COPD population retrieved from the Taiwan National Health Insurance Research Database (NHIRD) spanning the years 2003 to 2016. Osteoporosis patients were identified using diagnosis codes. The study included newly diagnosed COPD patients from 2003 to 2016. The case group comprised patients who developed osteoporosis or osteoporotic fractures after their COPD diagnosis. We calculated the prevalence and incidence of osteoporosis in individuals with COPD and conducted trend tests., Results: A total of 1,297,579 COPD patients were identified during the period from 2003 to 2016, with 275,233 of them in the osteoporosis group. The average prevalence of osteoporosis among individuals with COPD was 21.21% from 2003 to 2016 in Taiwan. The number of osteoporosis cases increased from 6,727 in 2003 to 24,184 in 2016. The prevalence of osteoporosis among COPD patients increased from 3.62% in 2003 to 18.72% in 2016. The number of osteoporosis cases among individuals with COPD continued to rise over the years, reaching its highest point in 2016 with 24,184 new cases. The incidence of osteoporosis fluctuated during the study period but generally remained around 3,000 cases per 100,000 person-years. Notably, there was a significant upward trend in incidence from 2003 to 2006, after which the trend stabilized and remained relatively constant., Conclusions: Our study highlights an increase in both the prevalence and incidence of osteoporosis in individuals with COPD. Given the significant medical, economic, and social implications associated with osteoporosis, a comprehensive and robust assessment of its healthcare burden can offer valuable insights for healthcare system planning and policymaking., (© 2024. The Author(s).)

Background: Chronic airway diseases have been associated with an increased risk of tuberculosis (TB); however, data in patients with bronchiectasis is limited. Statins have been shown to exhibit anti-inflammatory effects by modulating the inflammatory response. This study investigated whether statin treatment could reduce the risk of TB in patients with bronchiectasis., Methods: We conducted a retrospective cohort study using a nationwide population database of patients with bronchiectasis who did or did not receive statin treatment. The defined daily dose (DDD) of statin, current or past statin user and statin exposure time were measured for the impact of statin use. The primary outcome was the incidence of new-onset TB. Considering of potential immortal time bias due to stain exposure time, Cox regression models with time-dependent covariates were employed to estimate HRs with 95% CIs for TB incidence among patients with bronchiectasis., Results: Patients with bronchiectasis receiving statin treatment had a decreased risk of TB. After adjusting for age, sex, income, comorbidities and Charlson Comorbidity Index, statin users had a 0.59-fold lower risk of TB incidence compared with non-statin users (95% CI 0.40 to 0.88; p=0.0087). Additionally, compared with non-statin users, statin treatment was a protective factor against TB in users with a cumulative DDD greater than 180 per year, with an HR of 0.32 (95% CI 0.12 to 0.87; p=0.0255)., Conclusions: Statin treatment demonstrated a dose-dependent protective effect and was associated with a reduced risk of TB in patients with bronchiectasis. These findings suggest that statins may play a role in lowering TB risk by modulating airway inflammation in this patient population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Palliative care utilization among hospitalized patients with advanced chronic obstructive pulmonary disease (COPD) in Taiwan remains low despite its costs making it eligible for reimbursement since 2009. Few studies have examined the trends of palliative care utilization. We analyzed the annual rate, associated factors, and timing of the inpatient palliative care utilization by hospitalized patients with COPD., Patients and Methods: We conducted a cross-sectional observational study between 1 January 2007 and 31 December 2018. Population-based claims data were extracted from Taiwan's National Health Insurance Research Database to identify patients aged ≧40 years with COPD five years before the first instance of inpatient palliative care utilization., Results: There were 24,502 patients with COPD receiving inpatient palliative care. Our results indicated that older age, concomitant chronic conditions-especially cancer-and severity of comorbidities were associated with a higher rate of palliative care utilization by hospitalized patients with chronic obstructive pulmonary disease. In our study, the proportion of hospitalized patients with COPD receiving inpatient palliative care and having a Charlson comorbidity index score of 1-2 was lower than that of patients with cancer and a Charlson comorbidity index score ≧3 during the 12-year study-observation period. In addition, approximately 50% of hospitalized patients with COPD received palliative care within 18 months after their initial admission for COPD during the study period. However, individuals with a CCI score of 1-2 exhibited a slower entry into palliative care, with nearly 50% initiating it within the first two years., Conclusion: Inpatient palliative care utilization by hospitalized patients with advanced COPD remains low due to various causes. Our findings highlight that palliative care may be considered by professional care providers as routine care and as a way to manage problematic symptoms during hospitalization., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Kao et al.)

Objective: To investigate the impact of a multidisciplinary intervention on the clinical outcomes of patients with COPD., Methods: This study retrospectively extracted the data of patients enrolled in the national pay-for-performance (P4P) program for COPD in four hospitals. Only COPD patients who received regular follow-up for at least one year in the P4P program between September 2018 and December 2020 were included., Results: A total of 1081 patients were included in this study. Among them, 424 (39.2%), 287 (26.5%), 179 (16.6%), and 191 (17.7%) patients were classified as COPD Groups A, B, C, and D, respectively. Dual therapy with long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) was the most used inhaled bronchodilator at baseline (n = 477, 44.1%) patients, followed by LAMA monotherapy (n = 195, 18.0%), triple therapy with inhaled corticosteroid (ICS)/LABA/LAMA (n = 184, 17.0%), and ICS/LABA combination (n = 165, 15.3%). After one year of intervention, 374 (34.6%) and 323 (29.9%) patients had their pre- and post-bronchodilator-forced expiratory volume in one second (FEV1) increase of more than 100 mL. Both the COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) scores had a mean change of -2.2 ± 5.5 and -0.3 ± 0.9, respectively. The improvement in pulmonary function and symptom score were observed across four groups. The decreased number of exacerbations was only observed in Groups C and D, and not in Groups A and B., Conclusion: This real-world study demonstrated that the intervention in the P4P program could help improve the clinical outcome of COPD patients. It also showed us a different view on the use of dual therapy, which has a lower cost in Taiwan., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Cheng et al.)