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Background: Obesity is a global concern, driving the search for alternative treatments beyond lifestyle changes and medications. Laser acupuncture (LA) shows promise in obesity management, yet few studies compare it with FDA-approved medications. This study aimed to assess and compare LA's impact with liraglutide on weight reduction in obese individuals. Methods: Data from the Chang Gung Research Database (CGRD) (2013–2018) were analyzed. Primary outcomes included changes in body weight and BMI within 180 days, with secondary outcomes measuring the proportion achieving 5%, 10%, and 15% weight loss. Adverse events were also assessed. Results: Of 745 subjects (173 LA users, 572 liraglutide users), LA users lost more weight by day 180 (5.82 ± 4.39 vs. 2.38 ± 5.75 kg; p < 0.001) and had a greater BMI reduction (−2.27 ± 1.73 vs. −0.93 ± 2.25 kg/m2; p < 0.001). More LA users achieved 5% and 10% weight loss compared to liraglutide users (64.2% vs. 22.7%, 26.6% vs. 4.2%; all p < 0.001). After balancing baseline differences, LA's benefits remained significant. No adverse events were reported with LA. Conclusions: LA may offer superior weight reduction compared to liraglutide. Future studies should explore LA alone or in combination with liraglutide for obesity management. [ABSTRACT FROM AUTHOR]

Background: The early detection of dementia depends on efficient methods for the assessment of cognitive capacity. Existing cognitive screening tools are ill-suited to the differentiation of cognitive status, particularly when dealing with early-stage impairment. Methods: The study included 8,979 individuals (> 50 years) with unimpaired cognitive functions, mild cognitive impairment (MCI), or dementia. This study sought to determine optimal cutoffs values for the Cognitive Abilities Screening Instrument (CASI) aimed at differentiating between individuals with or without dementia as well as between individuals with or without mild cognitive impairment. Cox proportional hazards models were used to evaluate the value of CASI tasks in predicting conversion from MCI to all-cause dementia, dementia of Alzheimer's type (DAT), or to vascular dementia (VaD). Results: Our optimized cutoff scores achieved high accuracy in differentiating between individuals with or without dementia (AUC = 0.87—0.93) and moderate accuracy in differentiating between CU and MCI individuals (AUC = 0.67 – 0.74). Among individuals without cognitive impairment, scores that were at least 1.5 × the standard deviation below the mean scores on CASI memory tasks were predictive of conversion to dementia within roughly 2 years after the first assessment (all-cause dementia: hazard ratio [HR] = 2.81 – 3.53; DAT: 1.28 – 1.49; VaD: 1.58). Note that the cutoff scores derived in this study were lower than those reported in previous studies. Conclusion: Our results in this study underline the importance of establishing optimal cutoff scores for individuals with specific demographic characteristics and establishing profiles by which to guide CASI analysis. [ABSTRACT FROM AUTHOR]

Objectives Research has suggested that subjective memory complaints (SMC) are predictive of cognitive decline in cases of Alzheimer's disease; however, multidimensional characteristics of SMC make it difficult to formulate causal links. The Subjective Memory Complaints Questionnaire (SMCQ) has proven effective in capturing the nature of SMC. In this study, we developed a revised version of SMCQ (SMCQ-R) with corresponding normative data for application in Taiwan. Methods This study recruited 100 cognitively normal participants (> 45 years) stratified according to demographic characteristics. Assessments were performed to evaluate test-retest reliability, criterion-related validity, and construct validity of SMCQ-R. SMCQ-R scores of 20 matched patients with mild cognitive impairment (MCI) were also compared with those of normal participants to test construct validity. Results Reliability of SMCQ-R was satisfactory (0.81–0.95). Factor analysis revealed a three-factor structure: everyday memory problems (EMP), recent severe memory problems (RSMP), and long-term memory problems (LTMP). EMP and RSMP scores were negatively associated with objective cognitive function (r  = −.20 to.39). Depressive symptoms were positively associated with all factors (r  = .23–.33). Age was positively associated with total (b  = 0.09, p  < .05) and EMP scores (b  = 0.06, p  < .01). MCI patients obtained higher scores (p  < .05) on all subscales. SMCQ-R scores discriminated between normal and MCI individuals (area under the curve = 0.77). This study established a norm based on scores adjusted to control for effects of age. Conclusions SMCQ-R has sound psychometric properties and could potentially be used as a tool to assess SMC in clinical settings. [ABSTRACT FROM AUTHOR]

Since the 1980s, modern shrimp aquaculture has been seriously affected by shrimp diseases worldwide. Shrimp aquaculture cooperates with scientists in the lab to develop biosecurity strategies and biotechnology products, such as specific-pathogen-free shrimp, vaccines and probiotics, to tackle the risk of shrimp disease. Securing shrimp health needs to manage the breeding environment, particularly water quality and water ecologies. Shrimp and water travel between the lab and the field for monitoring, experimentation and disease prevention. This article proposes the notion of hydro-social life to analyse how biosecurity strategies and biotechnology products are developed in the lab and deployed in the field by visiting private, governmental and university laboratories in the Vietnamese Mekong Delta, Hô' Chí Minh City, and Taiwan. I argue that scientists innovate biotechnology products to improve biosecurity strategies by reconfiguring hydro-social lives, like managing shrimp health and water quality. The development and deployment of biosecurity from the lab to the field are influenced by capitalist forms of life and social relations. [ABSTRACT FROM AUTHOR]

Recent studies have demonstrated a global decline in the age at menarche. Our study aimed to determine the age at menarche of Taiwanese women born between 1943 and 1989. Data were obtained from the Taiwan Biobank. To view the trends in age at menarche, we analyzed data from 74,799 women. The mean, standard deviation, and annual percentage change in age at menarche were calculated for birth-year cohorts. The mean age at menarche of Taiwanese women born in 1943 was 14.85 years. The age at menarche decreased to 12.20 years for those born in 1989. The mean age at menarche declined by 2.65 years across the 47-year study period; hence, the reduction rate was 0.56 years per decade. This study demonstrated a downward secular trend in the age at menarche of Taiwanese women born between 1943 and 1989. This trend occurred in three stages of decline: fast (1943–1953), slow (1953–1965), and moderate (1965–1989). The age at menarche decreased by 2.65 years among Taiwanese women born in 1943 compared with those born in 1989. This decline occurred in three stages: fast (1943–1953), slow (1953–1965), and moderate (1965–1989). This significant downward secular trend in age at menarche reflects Taiwan's socioeconomic development. [ABSTRACT FROM AUTHOR]

Climate change has exacerbated severe rainfall events, leading to rapid and unpredictable fluctuations in river water levels. This environment necessitates the development of real-time, automated systems for water level detection. Due to degradation, traditional methods relying on physical river gauges are becoming progressively unreliable. This paper presents an innovative methodology that leverages ResNet-50, a Convolutional Neural Network (CNN) model, to identify distinct water level features in Closed-Circuit Television (CCTV) river imagery of the Chengmei Bridge on the Keelung River in Neihu District, Taiwan, under various weather conditions. This methodology creates a virtual water gauge system for the precise and timely detection of water levels, thereby eliminating the need for dependable physical gauges. Our study utilized image data from 1 March 2022 to 28 February 2023. This river, crucial to the ecosystems and economies of numerous cities, could instigate a range of consequences due to rapid increases in water levels. The proposed system integrates grid-based methods with infrastructure like CCTV cameras and Raspberry Pi devices for data processing. This integration facilitates real-time water level monitoring, even without physical gauges, thus reducing deployment costs. Preliminary results indicate an accuracy range of 83.6% to 96%, with clear days providing the highest accuracy and heavy rainfall the lowest. Future work will refine the model to boost accuracy during rainy conditions. This research introduces a promising real-time river water level monitoring solution, significantly contributing to flood control and disaster management strategies. [ABSTRACT FROM AUTHOR]

Introduction: Arteriovenous fistula or arteriovenous graft is essential to long‐term survival and quality of life in patients receiving hemodialysis. To date, no research has examined the clinical impacts of different puncture methods. This study compared the rope ladder and area puncture techniques in terms of vascular patency, pain, and quality of life among patients receiving hemodialysis. Methods: A prospective longitudinal study was performed with 6‐month follow‐up. A total of 98 participants recruited from a hemodialysis center in Taiwan were randomly assigned to receive the rope ladder technique (experimental group) or the area puncture technique (control group). Vascular patency was assessed by examining access flow and percutaneous transluminal angioplasty rate. Pain and quality of life were measured using the Numerical Pain Rating Scale (NPRS) and Kidney Disease Quality of Life Instrument (KDQOL‐36™), respectively. All outcome variables were measured repeatedly and analyzed using a generalized estimating equation. Results: Overall, quality of life was significantly better for the experimental group than for the control group (β = 47.23, p < 0.001). The percutaneous transluminal angioplasty rate was lower for the experimental group than for the control group (12.0% vs. 18.8%). However, no significant differences were found in access flow and pain level between the two groups over time. Conclusion: Hemodialysis patients who received the rope ladder puncture technique had a lower percutaneous angioplasty rate and better quality of life than patients who received the area puncture technique, suggesting that the rope ladder technique could be implemented as a routine cannulation method in hemodialysis clinics. [ABSTRACT FROM AUTHOR]

Background: Blood shortage is a persistent problem affecting Taiwan's health-care system. The theory of planned behavior (TPB) has been commonly used in studies of health advocacy. The purpose of this study was to develop a questionnaire measuring clinicians' intention to prescribe transfusion based on the TPB. Method: A questionnaire comprising 15 items for assessing clinicians' intention to prescribe blood transfusion was developed, and it collected demographic characteristics, tested patient blood management (PBM) and perceived knowledge of PBM. Furthermore, the questionnaire contained four subscales related to the TPB. A total of 129 clinicians participated in this pilot study between July and December2020. Item analysis and exploratory factor analysis were conducted to examine the validity and reliability of this measurement instrument. Results: The results indicated no statistically significant correlations between the demographic characteristics and PBM test scores. Regarding perceived knowledge, the results of a one-way analysis of variance revealed that the effect of age, hierarchy of doctors, and education level were significant. In terms of subjective norms, a significant effect on education level was noted [t (129) = 2.28, p < 0.05], with graduate school graduates receiving higher scores than college graduates. An analysis of variance demonstrated the effects of hierarchy, education level, and medical specialty on perceived behavioral control. The results of the regression analyses revealed that perceived knowledge (β = 0.32, p < 0.01) and subjective norms (β = 0.22, p < 0.05) were significantly related to clinicians' behavioral intentions. Conclusions: This study revealed that factors affecting clinicians' blood transfusion management can be explained using the TPB-based questionnaire. This study demonstrated that physicians' perceptions of whether most people approve of PBM and their self-assessment of their PBM knowledge affect their intentions to proceed with PBM. According to this finding, a support system among physicians must be established and maintained to increase physicians' confidence in promoting PBM. [ABSTRACT FROM AUTHOR]

Peace of mind (PoM) is an index of mental health in Asian culture and emphasizes low arousal, happiness, harmony, and an internal state of peacefulness. While previous studies have found that mindful self-awareness can contribute to PoM, regular physical activity (PA) is also an important factor contributing to one's PoM due to its function in promoting one's resilience. The study aims to investigate a hypothetical model that assumes PA is associated with resilience while controlling for mindful self-awareness, contributing to PoM. The PoM scale, Connor-Davidson Resilience Scale, Chinese translation of Mindful Attention Awareness Scale, and PA self-report questionnaire were used. A path analysis was applied to test the association between these variables and the mediating role of resilience. A total of 436 students from a university in Taiwan were recruited; the mean age was 20.87, with 46.3% female and 73.6% engaging in over 150 min/week of moderate PA. Gender and age negatively correlated with PA. After controlling for age and gender, there was no direct effect of physical activity on PoM; both mindful self-awareness and PA predict resilience, which in turn predicts PoM, suggesting that both cognitive (i.e., mindful self-awareness) and PA are important to cultivate resilience and thus PoM. [ABSTRACT FROM AUTHOR]

VR has shown positive growth in the world in recent years, which is mainly due to projects such as learning, games, entertainment and experiential activities. VR has changed the way of life of users, providing users with more interesting interactions and immersive experiences. This study aims to investigate students' practical capabilities and learning effectiveness under the instruction strategy of integrating virtual reality into simulation games into the Vehicle Body Electrical System Comprehensive Maintenance and Repair Services Practice curriculum for students of the Dept. of Auto Mechanics in a skills-based senior high school. Two student classes of the Dept. of Auto Mechanics major in Electrical Engineering featuring practical subjects in one skills-based senior high school in central Taiwan were chosen as the participants for this study. By way of pretest–post-test research design and heterogeneous grouping, an 8-week instruction experiment was conducted in which ZPD (zone of proximal development) instruction strategies were used in the experimental group (with 43 persons), while traditional didactic instruction strategies were used in the control group (with 36 persons). ZPD instructional strategies analyze and collect quantitative and qualitative data to investigate the instructional effectiveness and feasibility in developing ZPD as the research material in the practical curriculum for the study area of the Power Machinery in Vehicle Body Electrical System Comprehensive Maintenance and Repair Services practice. According to the research objective, the results are concluded as follows. (1) Students achieved the best learning effectiveness when adopting ZPD (zone of proximal development) strategies in which virtual reality was integrated into the vehicle charging and starting system to investigate students' automotive diagnostic troubleshooting and fault-clearing capabilities. (2) Students attained the highest acceptance in learning phenomenon when adopting ZPD (zone of proximal development) strategies in which virtual reality was integrated into students' familiar practice factory environment and the tools and equipment operation process. (3) Students had a higher acceptance of learning effectiveness when using virtual reality simulation games in the disassembly and functional detection of vehicle charging and starting systems. (4) There is a positive effect when integrating virtual reality simulation games into ZPD instruction strategies in the knowledge, skills and attitude on students' overall inquiry practical capabilities and their learning effectiveness. [ABSTRACT FROM AUTHOR]

Objective The Paced Auditory Serial Addition Test (PASAT) is widely used to assess cognitive performance in clinical settings. However, availability of normative data for Revised Version of PASAT (PASAT-R) is often constrained by sample size among elderly individuals. In this study, we sought to establish normative data for PASAT-R for elderly individuals in Taiwan. Methods This study recruited 166 individuals aged over 65 years stratified in accordance with the general population in terms of demographic characteristics, including age, educational level, and sex. We assessed PASAT-R test results in terms of psychometric properties. Results PASAT-R demonstrated good internal consistency and test–retest reliability. Performance on PASAT-R was correlated with performance on the criterion tests. Performance on PASAT-R was negatively correlated with age and positively correlated with educational level. This study provides normative data for PASAT-R for elderly Taiwanese individuals. Conclusions PASAT-R is applicable to neuropsychological assessment among elderly Taiwanese individuals. [ABSTRACT FROM AUTHOR]

The 12-Year Basic Education Curricula not only follow the objectives of previous curriculum syllabus development, but they place more focus on competence-oriented instruction, which aims to emphasize the importance of combining the curriculum with life situations that are not solely based on learning knowledge and skills. This study aims to investigate the results of the students' learning effectiveness and learning engagement after adding competence-oriented instructional strategies into electrical engineering practical subjects offered by the Department of Electrical Engineering in skills-based senior high schools, and, at the same time, to figure out the difference in learning effectiveness using different instructional strategies. Two classes of students from the Department of Electrical Engineering major in electrical engineering practical subjects in one skills-based senior high school in Central Taiwan were chosen as the participants for this study. By way of pre-test–post-test research design and heterogeneous grouping, a 10-week instruction experiment consisting of two groups and occurring over the course of 30 classes was conducted, wherein competence-oriented instructional strategies were used in an experimental group, while traditional didactic instructional strategies were used in a control group. By analyzing the collection of quantitative and qualitative data through competence-oriented instructional strategies, the instruction effectiveness and feasibility of the basic electricity practical curriculum were developed as the study topic for understanding how competence-oriented instruction can be implemented into the practical curriculum of the electrical engineering and electronic engineering group. According to the research objective, the results were concluded as follows: (1) Students of the Department of Electrical Engineering have a slightly better learning effectiveness in electrical engineering practice under competence-oriented instructional strategies compared with those who learned under the traditional didactic instructional strategies; (2) there is a significant difference in the students' learning engagement in electrical engineering practice from the Department of Electrical Engineering under competence-oriented instructional strategies compared with those who learned under the traditional didactic instructional strategies. The conclusion of this study emphasizes designing questions based on life situations, thereby applying what students have learned to solve problems they encounter in their daily lives. Compared with traditional didactic instructional strategies, competence-oriented instructional strategies not only have a better learning effectiveness and provide flexibility for the students to solve problems and provide analysis for situations, they also have broader applicability and an increased number of positive benefits when it comes to students' group interactions and sharing. [ABSTRACT FROM AUTHOR]

This paper examines the cost efficiency (CE), technology gap ratio (TGR), and overall cost efficiency (OCE) of 43 banks and 27 life insurance companies operating in Taiwan. The use of the copula method to derive the joint probability density function for the cost functions of financial holding banks (FHBs) and financial holding life insurers (FHLIs) allows us to take into account the operational synergies enjoyed by the financial holding companies. Our empirical results are as follows. (1) A significant, positive correlation exists between the cost efficiencies of FHBs and FHLIs, supporting that both types of firms benefit from the synergy effect. (2) The omission of synergy effects leads to underestimated measures of CE and OCE for FHBs, but leaves the measure of TGR intact. (3) The absence of synergies results in underestimating the CE scores for FHLIs, but the TGRs of FHLIs and non-FHLIs are overestimated, exaggerating the OCE scores. [ABSTRACT FROM AUTHOR]

Previous studies had no consensus on whether a 'mandate-divide' exists between district and party-list legislators under the mixed-member system. I argued that previous studies ignored the role of the party. This article aims to explore the legislative consequences of the 2005 electoral reform and the role of parties in Taiwan. I analyzed the roll-call votes, considering abstention and absence as potential defection, along with interviews. The data cover from the fifth to eighth Legislative Yuan, two periods each before and after the electoral reform. The findings show that district legislators tended to defect from the party line than list proportional representation (PR) members in pre- and post-reform periods. However, district legislators only tended to be absent from the voting than list PR members after the electoral reform. Mandate-divide was present throughout the period, but differences were more salient before the reform. Besides, evidence stressing the influence of parties was revealed in the interviews. Party leaders enforce various punishments to enforce party discipline. The role of party became more important after the electoral reform. District legislators have higher absence rate after the electoral reform because they need to engage more in constituency service or avoid expressing their position on controversial issues. The ruling party tends to sanction the absence when they have majority in parliament. [ABSTRACT FROM AUTHOR]

Purpose: To examine the trajectory of decisional conflict and anxiety experienced by adolescents after the cancer diagnosis, and explore their perceptions on participation in shared decision‐making (SDM). Design: This longitudinal study used incorporated data from questionnaires and interviews. Methods: Participants recruited from an academic hospital in southern Taiwan ranged in age from 13 to 20 years with a cancer diagnosis within 1 month and received cancer treatment. Each participant completed questionnaires on decisional conflict and anxiety at diagnosis, 1, 3, and 6 months later. Individual interviews were to gain an in‐depth understanding of SDM. Findings: Total scores on decisional conflict changed significantly over time (F = 2.98, p = 0.039); the scores at 1 month were higher than 3 months (t = 2.18, p = 0.04) and 6 months (t = 2.97, p = 0.008). Participants perceived significantly different levels of values clarify (F = 9.49, p < 0.01) and support (F = 8.46, p < 0.01) over time. Only 27.3% of participants were anxiety‐free. No significant differences were found in anxiety over time. The perception of SDM was a situational involvement. Conclusions: Decisional conflict changed over time. Participants experienced greater decisional conflict at 4–8 weeks after diagnosis and their anxiety did not decrease over time. The different levels of participation in SDM during their treatment trajectory were found. Clinical Relevance: Participants experienced the highest decisional conflict during diagnosis, and highlighted how their roles in healthcare discussions varied from direct participation to indirect involvement. Further research is needed to develop an SDM model which accommodates different levels of needs and implements timely support. [ABSTRACT FROM AUTHOR]

A functional permanent vascular access (VA) is required to perform a successful hemodialysis procedure. Hemodialysis VA dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. Cardiovascular disease (CVD) is the leading cause of death in patients receiving chronic hemodialysis. Information about CVD associated with hemodialysis VA dysfunction is unclear. We analyzed the association between dialysis VA dysfunction and the risk of developing CVD in hemodialysis patients. This nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. One million subjects were sampled from 23 million beneficiaries and data was collected from 2000 to 2013. Patients with end-stage renal disease who had received permanent VA construction and hemodialysis and were aged at least 20 years old from 2000 to 2007 were included in the study population. The primary outcome was CVD, as defined by ICD-9-CM codes 410–414 and 430–437. A total of 197 individuals with permanent VA dysfunction were selected as the test group, and 100 individuals with non-permanent VA dysfunction were selected as the control group. Compared with the control group, the adjusted hazard ratio of CVD for the VA dysfunction group was 3.05 (95% CI: 1.14–8.20). A Kaplan–Meier analysis revealed that the cumulative incidence of CVD was higher in the permanent VA dysfunction group than in the comparison group. Permanent VA dysfunction is significantly associated with an increased risk of subsequent CVD. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the necessity of abdominal drainage after laparoscopic appendectomy in patients with complicated appendicitis. Methods: Patients with acute appendicitis undergoing laparoscopic appendectomy at two hospitals between January 2014 and December 2018 were retrospectively included. Complicated appendicitis was defined as the American Association for the Surgery of Trauma (AAST) grade ≥ II. The patients were classified according to the AAST grade and the indwelling of abdominal drainage. The postoperative surgical outcomes and recovery were compared among patient groups to evaluate the impact of abdominal drainage for patients with complicated appendicitis undergoing laparoscopic appendectomy. Results: A total of 1241 patients was retrospectively included. Among them, there were 820 patients with simple appendicitis (AAST grade I) and 421 patients with complicated appendicitis (AAST grade ≥ II). For complicated appendicitis, the drainage group (N = 192) tended to harbor more overall complications, intra-abdominal abscess formation, time to resume a soft diet, and the postoperative length of hospitalization (P = 0.0000 for all). Multivariate logistic regression confirmed that abdominal drainage increased the risk of overall complications [Odds ratio (OR) 2.439; 95% confidence interval (CI) 1.597–3.726; P ≤ 0.0001] and failed to decrease the risk of intra-abdominal abscess formation (OR 1.655; 95% CI 0.487–5.616; P = 0.4193). Multivariate linear regression analysis also showed that the drainage group harbored longer postoperative length of hospitalization (Coefficients: 20.697; 95% CI 15.251–26.143; P < 0.0001) and time to resume a soft diet (Coefficients: 45.899; 95% CI 34.502–57.297; P < 0.0001). Conclusions: Abdominal drainage did not prevent overall complications in patients with complicated appendicitis; paradoxically, it delayed the convalescence. Our results discourage the routine use of abdominal drainage and suggest that abdominal drainage should be performed sparingly. [ABSTRACT FROM AUTHOR]

Objectives: Patients with cleft lip–cleft palate (CLP) often require orthodontic treatment, with or without orthognathic surgery. Patient satisfaction is the most important outcome parameter in orthodontic treatment. This study aimed to (1) determine patient satisfaction and quality of life (QoL) after orthodontic treatment and (2) identify associated factors. Material and methods: This prospective cross-sectional study recruited patients with CLP who had completed orthodontic treatment at a craniofacial center in Taiwan. Participants (N=213) had received treatment for unilateral CLP (n=99), bilateral CLP (n=50), cleft lip and alveolus (n=39), and isolated cleft palate (n=25). Self-report questionnaires evaluated satisfaction with appearance and QoL; multiple regression analysis examined associated factors. Participants' expectations of treatment results were also reported. Results: Participants reported moderate satisfaction with facial appearance and QoL. Satisfaction with treatment was lower or much lower than expected for 13% of participants. Treatment for bilateral CLP was associated with the lowest satisfaction with overall appearance (r = −8.123, P < 0.05); participants who had received orthognathic surgery had the highest satisfaction (r = 5.534, P < 0.05). Treatment for unilateral and bilateral CLP was associated with low QoL for smile (both P < 0.05). Conclusions: Orthodontic treatment had a positive effect on facial appearance and quality of life in patients with CLP. Type of cleft and orthognathic surgery significantly influenced satisfaction with facial appearance. Clinical relevance: Efforts must be taken to modify treatment strategies for patients with bilateral CLP in order to improve satisfaction with appearance following treatment. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the impact of dental prophylaxis on 5-fluorouracil (5-FU)–related oral mucositis (OM) according to the head and neck cancer (HNC) locations and treatment times. Methods: A total of 13,969 HNC participants, including 482 5-FU–related OM subjects and 13,487 comparisons were enrolled from the Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan between 2000 and 2008. All subjects were stratified into subgroups based on the times to perform chlorhexidine use, scaling, and fluoride application before 5-FU administration. The dental prophylaxis related to 5-FU–related OM was estimated by multiple logistic regression and represented with odds ratio (OR) and 95% confidence interval (CI). Results: Fluoride gel application and scaling significantly impacted on OM development (p < 0.001), and the joint effect of fluoride gel and scaling induced 5-FU–related OM (OR = 3.46, 95% CI = 2.39–5.01). The risk of OM was raised 2.25-fold as scaling within 3 weeks before 5-FU–related chemotherapy (95% CI = 1.81–2.81), and a 3.22-fold increased risk of OM while fluoride gel was applied during 5-FU–related treatment (95% CI = 1.46–7.13). Conclusion: Dental prophylaxis significantly affected 5-FU–related OM in the HNC population. A short interval between dental scaling or fluoride application and 5-FU administration may be associated with higher prevalence of OM. Scaling simultaneously combined with chlorohexidine promoted 5-FU–related OM in specific HNC patients excluding the oral cancer and nasopharyngeal cancer population. Proper timing of the prophylactic dental treatments prior to 5-FU therapy could reduce the risk to develop 5-FU–related OM. [ABSTRACT FROM AUTHOR]

Cancer is the leading cause of death in Taiwan, and the overall incidence rate has gradually increased. The four most common cancers in Taiwan are colorectal, lung, breast and liver cancers. With the rise in incidence, the clinical use and costs of all anticancer drugs have steadily increased. The costs of novel therapeutics, such as targeted therapies and immunotherapy were accounted almost two-third of all antineoplastic agents in Taiwan. Moving forward, it will be necessary to discuss the economic impacts to clinical use of new therapeutics, while continuing to monitor and improve the quality of cancer therapy. In this review, we describe the epidemiology, disease screening policies and medication treatment policies for colorectal, lung, breast and liver cancer. We focus on the recent developments in cancer therapeutics, discuss the use of biomarkers, and finally consider the costs and the recent advances of anticancer medications in Taiwan. [ABSTRACT FROM AUTHOR]

Continuous strengthening of the safety of blood products to reduce the risk of transfusion-transmitted HCV in recipients is an important issue of Taiwanese government concern. Since 2013, highly sensitivity serology and NAT assays were simultaneously used for blood donation screening to shorten the window period of HIV, HBV and HCV infections. 15 cases of suspected transfusion-transmitted HCV infection were analyzed in 2015-2018. No HCV nucleic acid was detected among a total 91 bags of donated blood. Eleven cases among the 15 suspected recipients were positive for HCV nucleic acid, and 9 recipients had genotype results. Of these 9 recipients, five for genotype 1b (5/9, 55.6%), three for genotype 2a (3/9, 33.3%) and one for genotype 2b (1/9, 11.1%). We will continuously monitor the blood safety of recipients. There have been no confirmed cases of acute hepatitis C (AHC) infection due to transfusions of HCV contaminated blood product in 2015-2018 in Taiwan. [ABSTRACT FROM AUTHOR]

This study investigates the subjective experiences of terminal cancer patients who expedite their corneal donation decisions. The percentage of cancer patients who donate their corneas postmortem is low in Taiwan. The reasons are complex and needs further exploration. A qualitative design using content analysis was used. A semistructured interview approach was adopted to interview cancer patients recruited from a cancer ward in northern Taiwan. The study findings show that the factors contributing to an aversive preference of cancer patients included the necessity to consider the emotions of family members, traditional perceptions, religious reasons, disease, and no reason at all. Most cancer patients maintain a negative stance toward corneal donation. The results obtained in the present study can be used as a reference for future in-service education and promotional efforts regarding corneal donation. Discussing cornea donation needs to become a routine end-of-life care discussion. [ABSTRACT FROM AUTHOR]

This study provide an insight that the panel genes methylation status in different clinical stage tended to reflect a different prognosis even in matched normal tissues, to clinical recommendation. We enrolled 153 colorectal cancer patients from a medical center in Taiwan and used the candidate gene approach to select five genes involved in carcinogenesis pathways. We analyzed the relationship between DNA methylation with different cancer stages and the prognostic outcome. There were significant trends of increasing risk of 5-year time to progression and event-free survival of subjects with raising number of hypermethylation genes both in normal tissue and tumor tissue. The group with two or more genes with aberrant methylation in the advanced cancer stages (Me/advanced) had lower 5-year event-free survival among patients with colorectal cancer in either normal or tumor tissue. The adjusted hazard ratios in the group with two or more genes with aberrant methylation with advanced cancer stages (Me/advanced) were 8.04 (95% CI, 2.80–23.1; P for trend <0.01) and 8.01 (95% CI, 1.92–33.4; P for trend <0.01) in normal and tumor tissue, respectively. DNA methylation status was significantly associated with poor prognosis outcome. This finding in the matched normal tissues of colorectal cancer patients could be an alternative source of prognostic markers to assist clinical decision making. [ABSTRACT FROM AUTHOR]

Background/purpose: There is conflicting data regarding the utility of measuring apolipoproteins in addition to traditional lipid measures in risk assessment of cardiometabolic diseases. The aim of this study was to determine whether apolipoprotein measurements can improve the ability to predict the future development of type 2 diabetes beyond what is possible based on traditional type 2 diabetes risk factors and clinical routine lipid measurements.Methods: A total of 4,223 Chinese adults without diabetes were followed for a mean duration of 5.42 years. The hazard ratios (HRs) with 95% confidence intervals (CIs) derived from the Cox proportional hazards model were used to analyze the longitudinal associations of apolipoprotein B (apo B), apolipoprotein A-I (apo A-I), and the apo B/apo A-I ratio with the risk of type 2 diabetes. Further, the analysis of the area under receiver operating characteristics curves (AUC) was performed to test the predictive value of apolipoprotein measurements.Results: After adjusting for potential confounders, the HRs of diabetes consistently showed an increasing trend across both the apo B and the apo B/apo A-I ratio quartiles (p for trend = 0.004). In analyses of AUC, the predictive ability for type 2 diabetes risk for the apo B and the apo B/apo A-I ratio was superior to that of routine lipid and lipoprotein measurements.Conclusion: Apolipoprotein measurements significantly predict diabetes risk in an Asian population. Furthermore, the predictive ability of apo B alone to detect diabetes was comparable with that of the apo B/apo A-I ratio and better than the routine lipid measurements. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation (KT) correlates with an increased risk of developing several malignancies; however, the risk of colorectal cancer (CRC) after KT remains debatable and has been marginally explored. Hence, in this nationwide, retrospective, population-based cohort study, we aimed to examine the correlation between KT and CRC in a large-scale population-based Chinese cohort.Methods: We identified a total of 3739 regular hemodialysis patients undergoing KT (exposed cohort) and 42,324 hemodialysis patients not undergoing KT (non-exposed cohort) between 2000 and 2008 from Taiwan's National Health Insurance Research Database (NHIRD). Both cohorts were followed up from January 1, 2000, to the date of CRC diagnosis, death, or the end of 2013. Using Kaplan-Meier method, we measured the cumulative incidence of CRC in each cohort. Furthermore, Cox proportional hazards models were used to compute hazards ratios (HRs) and 95% confidence intervals (CIs) to estimate the correlation between KT and CRC in hemodialysis patients.Results: The Kaplan-Meier analysis revealed that the cumulative incidence of CRC was significantly higher in the exposed cohort than in the non-exposed cohort (log-rank test, P < 0.001). After adjusting for potential confounders, the exposed cohort exhibited a significantly increased risk of CRC compared with the non-exposed cohort (adjusted HR, 1.34; 95% CI, 1.11-1.62).Conclusions: Hemodialysis patients undergoing KT have a significantly higher risk of CRC than those not undergoing KT. Cancer should continue to be a primary focus of prevention during KT. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to (1) identify the changes of 5 domains of family caregiver (FC) burden, overall burden, and its subtrajectories when caring for newly diagnosed advanced lung cancer patients during the first 6 months following cancer diagnosis; and (2) identify the FC-related and patient-related factors most associated with the overall FC burden and each of its subtrajectories.Methods: A total of 150 newly diagnosed advanced lung cancer patient-FC dyads were recruited from a Taiwanese medical center. The overall FC burden was evaluated 4 times: before treatment, and 1, 3, and 6 months after treatment. The potential subtrajectory of the caregiver burden was investigated by latent class growth analysis. The FC-related and patient-related factors having the greatest effect on the overall FC burden and its subtrajectories over time were identified by generalized estimating equations.Results: The highest level of burden domain was "Impact on daily schedule" over time. Generally, most of the FC reported a moderate level of overall burden over the investigation period. Three subtrajectories of the overall FC burden over time (% caregivers) were identified: high burden (34.7%), moderate burden (56.0%), and low burden (9.3%), respectively. The self-efficacy of FC was the strongest factor related to the changes of the FC's burden and burden in each subtrajectory.Conclusion: The results support the existing and different types of subtrajectories of the FC's burden. Health care professionals should provide care based on those differences. Further research to test interventions which integrate those important factors related to FC's burden, particularly FC's self-efficacy, is strongly suggested. [ABSTRACT FROM AUTHOR]

Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. While ALL therapies are highly effective, western studies have shown excesses late life effects of therapies in survivors. In this survey, we recruited subjects being diagnosed as ALL before the age of 18‐year‐old and had been in complete continuous remission for at least 3 years. Subjects were arranged to receive three cognitive tests (Wechsler intelligence test, Conners' continuous performance test, and Wisconsin card sorting test). Standardized questionnaires were used to inquiry about attention problem in real life context. Treatment outcome were compared between the standard risk and high/very high risk groups. Final survivors were 42 subjects (26 males, 16 females) with median current age of 17.8 years. Subjects were diagnosed to be with ALL at a median age of 4.8 years. The median survival time (from discontinuation of ALL treatment to the study date) was 8.4 years. Results indicated that 17 subjects (40.5%) had chronic physical conditions in need of clinical management and six subjects (14.3%) had mental condition. For the performance‐based cognitive outcome, the average full scale intelligence quotient was 91.7 ± 13.8. Ten percent of the subjects had problem in test of attention, 20% had problem in test of impulsivity and 42.8% of the subject had problems in executive function. When judged from real life contexts, 19 subjects (42%) were with obvious attention problems. Group comparison between standard risk vs high/very high risk patients revealed no difference in neurocognitive outcomes. We hope that this information may benefit the implementation of follow‐up program for Taiwanese pediatric leukemia survivors. [ABSTRACT FROM AUTHOR]

Background The genetic background of patients with hemoglobin (Hb) H disease in Taiwan has been investigated; however, the clinical features and treatment outcomes were not reported. Objective To analyze the clinical features and genotypes of patients with HbH who reside in Taiwan. Methods We conducted a retrospective analysis of the clinical and molecular characteristics of 38 patients with HbH disease who were undergoing treatment at Kaohsiung Medical University Hospital, Taiwan. Results Initial Hb levels were lower and the numbers of patients requiring iron-chelation therapy were higher in the nondeletional HbH group than in the deletional HbH group (P <.05). Compared with the healthy population, the patients with HbH disease exhibited short body length, low body weight, and low body mass index (BMI). Conclusions Patients with nondeletional HbH disease had lower Hb levels and a higher requirement for splenectomy and iron-chelation therapy than did those with deletional HbH disease. Also, growth status was compromised in patients with HbH disease. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to report an HIV outbreak related to propofol-injection and the impact of regulating propofol on the HIV epidemic among people who inject drugs (PWID). Methods: A retrospective cohort study of 252 PWID who were diagnosed with an HIV infection between 2014 and 2017 in Taiwan. The propofol information was collected by routine epidemic surveillance and interviews. We linked several national databases to collect other related factors, including methadone maintenance treatment (MMT) attendance and incarceration. The serums were tested for recent infection by the LAg-avidity EIA assay and relationship of the trains by the Phylogenetic tree analysis. Analyses were conducted using the R Surveillance package for retrospective modeling for outbreak detection. A multiple logistic regression was used to evaluate the association between propofol-injection and other related factors. Results: There were 28 cases reported with propofol-injection, all of which were reported in Central Taiwan. A total of 11 (50%) cases among 22 propofol-injectors with serums were recent infections, which were higher than that 33 (23.4%) of non-propofol group. The phylogenetic tree indicated that 6 propofol-injectors were grouped together with the same cluster in circular. The HIV epidemic curve among PWID revealed an outbreak of 82 in 2015, which then decreased to 43 in 2016 after propofol began to be regulated as a Schedule 4 controlled drug in August 2015. In a multiple logistic regression, attendance at methadone clinics was associated with a significantly higher risk for propofol-injection (adjusted OR = 2.43, 95% CI = 0.98–5.98), and HIV reported in the year 2015 was associated with an increased risk of propofol-injection (adjusted OR = 4, 95% CI = 1.08–14.86). Conclusions: Our data indicate that the government regulation of propofol as a controlled drug strategy was associated with significant reduction in the spread of HIV among PWID. [ABSTRACT FROM AUTHOR]

Sambar (Rusa unicolor) in Taiwan experienced overexploitation by humans before the 1990s. In recent years, however, the population has recovered rapidly, and has become regionally abundant, resulting in damage to forests in some conservation areas. We investigated space use and habitat selection of sambar using global positioning system telemetry and resource selection function models. We collected sambar locations from 12 collared deer (6 males and 6 females) from December 2009 to March 2014 in Taroko National Park, Taiwan. Males had the largest mean home range size during the hot‐wet season (May–Oct, 95% fixed kernel method: 1.43 ± 0.23 km2). Males in the cold‐dry season (Nov–Apr) and females in both seasons had similar mean home range sizes of approximately 0.70 km2. Sambar moved to higher elevations during the hot–wet season and moved to lower elevations during the cold–dry season. Sambar preferred cypress (Chamaecyparis spp.) forest, pine (Pinus spp.) forest, fir (Abies spp.)‐hemlock (Tsuga spp.) forest, or thicket to broad‐leaved forest and open areas during both seasons. In addition, they preferred areas that were humid and had moderate solar radiation. We recommend estimating sambar population density in the cold–dry season when males and females have similar home range sizes. We predict that the rapid growth of the sambar population in Taiwan will be restrained as they expand to lower elevations because they prefer alpine landcover types and sambar habitats at lower elevations are fragmented. © 2018 The Wildlife Society. Although sambar in Taiwan move between higher and lower altitudes between seasons, they prefer alpine landcover types throughout the year. Therefore, the rapid growth of sambar populations may be restrained when they expand to lower elevations. [ABSTRACT FROM AUTHOR]

Banana is a popular fruit worldwide. The lactic acid bacteria (LAB) microflora in banana fruits has not been studied in detail. A total of 164 LAB were isolated from banana fruits in Taiwan. These isolates were initially divided into nine groups (r1 to r9) using restriction fragment length polymorphism analysis and 16S ribosomal DNA sequencing. Isolates belonging to Lactobacillus plantarum group were further divided into three additional groups using multiplex PCR assay targeting the recA gene. The most common bacterial genera found in banana fruits were Lactobacillus and Weissella. The distribution of LAB indicated that, in most cases, neighboring regions shared common strains, but there were still some differences between regions. On the basis of phylogenetic analysis of 16S rRNA, rpoA, and pheS gene sequences, two strains included in the genera Lactobacillus were identified as potential novel species or subspecies. In addition, a total 36 isolates were found to have bacteriocin-producing abilities. These results suggest that various LAB are associated with banana fruits in Taiwan. This is the first report describing the distribution and varieties of LAB associated with banana fruits. In addition, one potential novel LAB species was also found in this study. [ABSTRACT FROM AUTHOR]

Spiritual care is increasingly being recognized as an integral aspect of nursing practice. The aim of this study was to develop a new instrument, Spiritual Care Needs Inventory (SCNI), for measuring spiritual care needs in acute care hospital patients with different religious beliefs. The 21-item instrument was completed by 1,351 adult acute care patients recruited from a medical center in Taiwan. Principal components analysis of the SCNI revealed two components, (a) meaning and hope and (b) caring and respect, which together accounted for 66.2% of the total variance. The internal consistency measures for the two components were 0.96 and 0.91, respectively. Furthermore, younger age, female sex, Christian religion, and regularly attending religious activities had significantly higher mean total scores in both components. The SCNI was found to be a simple instrument with excellent internal consistency for measuring the spiritual care needs in acute care hospital patients. [ABSTRACT FROM AUTHOR]

Background/purpose: The purpose of this study was to determine the position of the mandibular canal in relation to the buccal cortical bone in Chinese patients with three dentofacial relationships: normal dentition, retrognathism, and prognathism.Methods: Cone-beam computed tomography and lateral cephalograms of patients with normal dentation, retrognathism, and prognathism (n = 32 each group) were reviewed. Measurements of the shortest distance from the outer/buccal edge of the mandibular canal to the inner surface of the buccal cortex, and the distance from the lingula of the ramus to the dorsal root of the first molar were recorded.Results: No significant difference was observed between the three groups in the distribution of contact or fusion of the mandibular canal, or in the course of the mandibular canal on the right or left side. When the shortest distance at the lingula on the left side was >2.1 mm, no instances of contact or fusion were observed. On the right side, 100% of the patients had no contact or fusion when the shortest distance was >2.7 mm at the lingula.Conclusion: The shortest distance from the outer/buccal edge of the mandibular canal to the inner surface of the buccal cortex measured at the lingula can predict contact or fusion. During sagittal split ramus osteotomy, great care should be observed at the point halfway between the lingula and the anterior ramus border where the inferior alveolar nerve is the closest to the cortical bone. [ABSTRACT FROM AUTHOR]

Spiritual care is essential to the well-being of patients, and nurses provide spiritual care as a fundamental part of nursing practice. In this study, we investigated the spiritual care needs of hospitalized patients to determine whether the perceived knowledge of nurses corresponded with these spiritual care needs. A cross-sectional study was conducted on 1351 hospitalized patients and 200 registered nurses recruited from a medical center in central Taiwan. A questionnaire, including the 21-item Spiritual Care Needs Inventory (patient and nurse version) and basic demographic information, was distributed to eligible participants. The top three items of the spiritual care needs expressed by the hospitalized patients were respect for privacy and dignity, showing concern, and guidance in gaining a sense of hope in life; the percentages of nurses not knowing how to provide these spiritual care needs were 0%, 1%, and 15%, respectively. The spiritual care needs of patients showed a significant relationship with the knowledge of nurses, suggesting that the perceived knowledge of the nurses generally corresponded with the spiritual care items that the patients required most. [ABSTRACT FROM AUTHOR]

Background Electroencephalogram (EEG) signal artifacts occur often in children, but an EEG valid rate (VR), constructed by excluding the artifacts, might be meaningful to evaluate children's neuropsychological functions. The aim of this study was to develop an easy screening index, the EEGVR, and to investigate attention function in children using this index. Methods The EEG was carried out during a 4 min simple reaction time (SRT) task as standard procedure in 50 children, consisting of 26 with attention-deficit-hyperactivity disorder (ADHD; mean age, 9.8 years; range, 8-11.3 years) and 24 without (mean age, 10.1 years; range, 7.8-12 years). An easy index was derived from the valid rate (VR) of EEG using area under the receiver operating characteristic curve. The index was applied to regroup the 50 children into high VR (HVR) and low VR (LVR) groups, while the Comprehensive Non-verbal Attention Test (CNAT) and four behavioral questionnaires were compared between the two groups in order to investigate the validity of this index. Results The EEGVR at 75% was optimal to identify HVR and LVR (sensitivity, 0.769; specificity, 0.792). The LVR group had significantly lower scores on both CNAT and the behavioral questionnaires, although the demographic variables and full-scale intelligence quotient (FSIQ) were similar between the two groups. Conclusions The EEGVR in an SRT task might be an easy and effective index to screen the attention function of children, and could consequently contribute to the early diagnosis of ADHD. [ABSTRACT FROM AUTHOR]

Patents are important knowledge assets that enable firms to compete successfully and earn returns. To control spending on patent renewal fees, firms carefully analyze the value of their patents to determine whether patent rights need to be maintained, thereby rendering renewal decisions an opportunity to examine patent values. This study incorporates social network analysis and traditional patent indicators to empirically investigate the determinants affecting patent valuation by firms and research institutes in the Taiwanese and South Korean biotechnology industries. Results indicate that firms and research institutes value their patents differently. Certain indicators derived from knowledge flow and traditional patent indicators significantly affect patent value. Based on the findings, this study provides suggestions for policy-making. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims and objectives To determine the effectiveness of an oral health care program for preventing ventilator-associated pneumonia ( VAP). Background Research has shown a significant correlation between oral bacteria and VAP, indicating that an oral health care program plays a very important role in VAP prevention. Design and methods A quasi-experimental study was used and conducted in the intensive care unit in a medical centre. A total of 199 mechanically ventilated patients were enrolled and divided into two groups: the experimental group ( n = 99) and control group ( n = 100). The experimental group was cared for using an evidence-based oral health care program, and the control group was cared for using routine nursing care procedures. Each group received the assigned treatment for four consecutive days. Results The incidence of VAP in the experimental group (4%, 4/95) was significantly lower than that in the control group (21%, 18/82). The oral assessment guide ( OAG) mean score (9.16 ± 2·07) of the experimental group was significantly different ( P < 0·05) from that of the control group (10·07 ± 1·79). The general estimated equation further showed that there was a significant difference between groups ( P < 0·01) for the third post-test data and no significant difference for the pre-test or the first and second post-test data between groups, indicating that an increased duration of intervention resulted in significant decreases in the OAG scores in the experimental group compared with the control group. Conclusions The evidence-based oral health care program effectively improved oral mucosal health and statistically reduced the incidence of VAP in this study. Relevance to clinical practice The study findings may be useful as an empirical reference for health care professionals performing an oral health care program in the future. Additionally, it may serve as a reference for long-term care policies aimed at reducing the ventilation duration, days of hospitalization and mortality rate to enhance patient safety and the quality of medical care. [ABSTRACT FROM AUTHOR]

This study estimates the risk of symptomatic nephrolithiasis within 5 years of newly diagnosed osteoporosis in a Taiwan population. This cohort study consisted of patients with a diagnosis of osteoporosis between Jan. 2003 and Dec. 2005 ( N = 1634). Four age- and gender- matched patients for every patient in the study cohort were selected using random sampling as the comparison cohort ( N = 6536). All patients were tracked for 5 years from the date of cohort entry to identify whether they developed symptomatic nephrolithiasis. Cox proportional hazard regressions were performed to evaluate the 5-year nephrolithiasis-free survival rates. During the 5-year follow-up period, 60 osteoporosis patients (3.7 %) and 165 non- osteoporosis patients (2.5 %) developed symptomatic nephrolithiasis. The adjusted HR of symptomatic nephrolithiasis was 1.38 times greater risk for patients with osteoporosis than for the comparison cohort (95% confidence interval (CI) 1.03-1.86; P < .05). Osteoporosis is very likely to be an independent risk factor for subsequent diagnosis of symptomatic nephrolithiasis. [ABSTRACT FROM AUTHOR]

Abstract: Background: The association between betel quid (BQ) chewing and oral cancer is well established. However, evidence regarding the relationship between BQ chewing and cardiovascular disease (CVD) is still insufficient. Methods: This cross-sectional study included 2002 men and 1175 women aged 50 and older in a city-level health examination survey of an agricultural and fishing population in 2013. In addition to anthropometric parameters, CVD risks were estimated using high-sensitivity C-reactive protein (hs-CRP), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index. Age, gender, smoking and alcohol drinking status were all incorporated into the multivariate logistic regression model to delineate the effect of BQ chewing on CVD risks. Results: Two hundred forty-one (12%) males and eight (0.7%) females were ever chewers. BQ chewing was an independent risk factor for general obesity (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.07–1.91, p =0.017), central obesity (OR 2.27, 95% CI 1.53–3.37, p <0.001) and an elevated hs-CRP level (OR 1.38, 95% CI 1.03–1.85, p =0.029). Subjects who chewed more frequently had a higher systolic blood pressure (p =0.025) and baPWV (p =0.006). The waist circumference (p =0.015) and waist-to-height ratio (p =0.022) were greater in current chewers than in former chewers. Conclusion: These findings suggest that BQ chewing is associated with obesity and a higher CVD risk as estimated by hs-CRP. Furthermore, potential beneficial effects of BQ chewing cessation on central obesity were also found. [Copyright &y& Elsevier]

Aims To evaluate the acceptability and efficacy of a psycho-educational intervention designed to improve effective coping and reduce symptom severity in children with cancer. Background Cancer treatments increase survival rates and also cause physical and psychological effects on children with cancer. A psycho-educational intervention is used to assist children and adolescents with these effects and its efficacy has been described in several studies. Design A randomized controlled trial. Methods Participants being treated were recruited and randomly assigned to two groups from September 2011-February 2013 in Taiwan. The intervention group received a psycho-educational intervention in addition to standard care, while the control group received only standard care. Each participant was assessed using a paediatric cancer coping scale and perceived symptom severity was evaluated at three time points (baseline, 1 month and 3 months). A repeated-measures analysis of variance was used to estimate the effects of intervention. Qualitative findings were analysed using content analysis. Results No significant difference in coping scores was found between groups, but the experimental group reported significantly lower scores in gastrointestinal problems and pain. Most symptoms decreased significantly over time in both groups, except for gastrointestinal problems. The scores in pain, bone marrow suppression and body image showed significant interaction effects between groups on changes over time. Qualitative results reported that participants evaluated the intervention positively, especially about receipt of psychological support and learnt coping skills. Conclusions The psycho-educational intervention administered was acceptable for children with cancer and was found to reduce gastrointestinal problems and pain. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To examine the changes in quality of life (QOL), symptoms, self-efficacy for coping with cancer, and factors related to those changes in patients with newly diagnosed advanced lung cancer.Design: Longitudinal and correlational.Setting: Oncology inpatient wards and outpatient departments of a medical center in northern Taiwan.Sample: 101 patients newly diagnosed with stage IIIB or IV lung cancer.Methods: Questionnaires were used to assess patients' QOL, symptoms, and self-efficacy before treatment and at one and three months following treatment. Factors related to the changes in global QOL and five functional dimensions were analyzed using six generalized estimating equation models.Main Research Variables: QOL, symptoms, and self-efficacy for coping with cancer.Findings: Patients reported moderate levels of global QOL, symptom severity, and self-efficacy for coping with cancer. They also reported high physical and cognitive functions, but relatively low role and social functions. Factors were significantly related to the most functional dimensions, including self-efficacy, fatigue, pain, sleep difficulties, and demographic- and disease-related factors. Self-efficacy was the most robust factor for predicting QOL.Conclusions: Patients with advanced lung cancer experience a compromised global QOL and relatively low social and role functioning during the first three months following cancer diagnosis. Levels of self-efficacy and symptoms significantly affected changes in QOL and functioning.Implications for Nursing: Applying a systematic assessment of changes in QOL and developing comprehensive interventions with self-efficacy training and symptom management are strongly recommended for clinical care to improve the QOL of patients with advanced lung cancer. [ABSTRACT FROM AUTHOR]

Background: Human enteroviruses contain over 100 serotypes. We have routinely conducted enterovirus surveillance in northern Taiwan; but about 10% of isolates could not be serotyped using traditional assays. Next-generation sequencing (NGS) is a powerful tool for genome sequencing. Methods: In this study, we established an NGS platform to conduct genome sequencing for the serologically untypable enterovirus isolates. Results: Among 130 serologically untypable isolates, 121 (93%) of them were classified into 29 serotypes using CODEHOP (COnsensus-DEgenerate Hybrid Oligonucleotide Primer)-based RT-PCR to amplify VP1 genes (VP1-CODEHOP). We further selected 52 samples for NGS and identified 59 genome sequences from 51 samples, including 8 samples containing two virus genomes. We also detected 23 genome variants (nucleotide identity < 90% compared with genome sequences in the public domain) which were potential genetic recombination, including 9 inter-serotype recombinants and 14 strains with unknown sources of recombination. Conclusions: We successfully integrated VP1-CODEHOP and NGS techniques to conduct genomic analysis of serologically untypable enteroviruses. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate how different timelines of various dental therapies were related to osteoradionecrosis development under consideration of radiotherapy dosage in patients with oral cancer.Materials and Methods: A total of 7,107 oral cancer patients were enrolled, including 88 osteoradionecrosis patients treated with low radiotherapy dosages (<60 Gy) or high radiotherapy dosages (≥60 Gy), from the Longitudinal Health Insurance Database for Catastrophic Illness Patients of Taiwan. Cox proportional hazard regression was used to compare the osteoradionecrosis risk of various dental treatment timelines under different irradiation dosages.Results: In the oral cancer population with low irradiation dosages (<60 Gy), performing periodontal therapy combined with irradiation significantly raised the risk of osteoradionecrosis by 2.21-fold. Starting radiotherapy within three months after dental surgery greatly increased the risk of developing osteoradionecrosis by 1.87-fold. The oral cancer patients treated with high radiation doses (≥60 Gy) receiving dental surgery within one month prior to radiotherapy had a significantly raised osteoradionecrosis occurrence by 1.60-fold. While the dental surgery was performed during the radiotherapy course, the risk of osteoradionecrosis was greatly increased by 2.21-fold.Conclusion: For oral cancer patients, performing dental surgery within three months before radiotherapy might significantly induce osteoradionecrosis. Patients that were treated with high irradiation dosages (≥60 Gy) had a higher tendency to develop osteoradionecrosis if they received dental surgery during radiotherapy. Those who were treated with low radiation dosages (<60 Gy) and received periodontal therapy during radiotherapy might have an increased risk in developing osteoradionecrosis. [ABSTRACT FROM AUTHOR]

Abstract: One-year series of hourly average ozone observations, which were obtained from urban and national park air monitoring stations at Taipei (Taiwan), were analyzed by means of descriptive statistics and fractal methods to examine the scaling structures of ozone concentrations. It was found that all ozone measurements exhibited the characteristic right-skewed frequency distribution, cyclic pattern, and long-term memory. A mono-fractal analysis was performed by transferring the ozone concentration time series (OCTS) into a useful compact form, namely, the box-dimension (D B)–threshold (T h) and critical scale (C S)–threshold (T h) plots. Scale invariance was found in these time series and the box dimension was shown to be a decreasing function of the threshold ozone level, implying the existence of multifractal characteristics. To test this hypothesis, the OCTS were transferred into the multifractal spectra, namely, the τ(q)–q plots. The analysis confirmed the existence of multifractal characteristics in the investigated OCTS. A simple two-scale Cantor set with unequal scales and weights was then used to fit the calculated τ(q)–q plots. This model fitted remarkably well the entire spectrum of scaling exponents for the examined OCTS. Because the existence of chaos behavior in OCTS has been reported in the literature, the possibility of a chaotic multifractal approach for OCTS characterization was discussed. [Copyright &y& Elsevier]

Background: Workplace bullying is commonly experienced by nurses worldwide. Purpose: This study was conducted to examine the determinants of different types of workplace bullying and their relationship to depression in female nurses. Methods: A cross-sectional correlational study was employed, and 484 female nurses from a large medical center in southern Taiwan completed the questionnaire. Data were analyzed using logistic regression analysis. Results: Being unmarried and working in medical/surgical units were found to be the major determinants of work-related bullying, whereas being unmarried was found to be the single determinant of person-related and physical-intimidation bullying. Moreover, work-related and person-related bullying were both found to be significant determinants of depression. Conclusions/Implications for Practice: Nursing administrators should establish workplace-bullying prevention and management strategies by setting reasonable and equal workloads for nurses, assigning tasks equitably, and building depression-related support and consultation groups. [ABSTRACT FROM AUTHOR]

Context: Undertreatment of cancer pain among outpatient cancer patients needs to be addressed to enhance care and improve patients' quality of life (QoL).Objectives: This prospective, cross-sectional, patient-focused study aimed to explore the prevalence of pain and undertreatment of cancer pain in outpatients in Taiwan.Methods: A total of 2652 non-selected outpatients with cancer and aged 20 years or older from 16 medical centers across Taiwan were included in this survey. All patients completed a questionnaire based on the Brief Pain Inventory. Pain management index (PMI) was used to evaluate the adequacy of pain management. Possible clinical variables of patients with positive PMI were examined by univariate and multivariate logistic regressions.Results: A total of 1659 (62.6%) outpatients had experienced some degree of pain; among these, 32.4% had negative PMI. Patients with a negative PMI score had significantly poor outcomes of QoL and a significantly higher tendency toward dissatisfaction with pain control by the physician and with the prescribed analgesic drugs. Female gender, primary tumor from breast, non-cancer-related cause of pain, and hospital locations from north Taiwan were independent variables that predicated patients with undertreatment of cancer pain. Most importantly, a forward trend of undertreatment of pain among patients who presented with lower prevalent rate of pain was observed.Conclusion: One-third of Taiwanese outpatients experienced pain because of undertreatment. Awareness of the prevalence of undertreatment of cancer pain and identification of the vulnerable subjects may assist in enhancing patient care and improving patient's QoL. [ABSTRACT FROM AUTHOR]

Summary: Objective: The focus of this study was to ascertain the factors associated with 2009 pandemic influenza H1N1 (pH1N1) infection during different phases of the epidemic. Methods: In central Taiwan, 306 persons from households with schoolchildren were followed sequentially and serum samples were taken at three sampling time-points starting in the fall of 2008, shortly after influenza vaccination. Participants who seroconverted between two consecutive blood samplings were considered as having serological evidence of infection. A generalized estimation equation (GEE) with a logistic link to account for household correlations was applied to identify factors associated with pH1N1 infections during the pre-epidemic (April–June) and epidemic (September–October) periods. Results: The results showed that receiving an inactivated seasonal influenza vaccine (ISIV) and having a hemagglutination inhibition assay (HI) titer of 40 or higher resulted in a significantly lower likelihood of pH1N1 infection during the pre-epidemic period only, for both children and adults (adjusted odds ratio (OR) 0.3, 95% confidence interval (CI) 0.12–0.9). Having a previous infection by pH1N1 with a baseline titer of 20 or higher resulted in a significantly lower likelihood of infection by pH1N1 during the epidemic period (adjusted OR 0.06, 95% CI 0.02–0.16). Conclusions: Our results provide the first serological evidence to suggest a protection effect from receiving an ISIV against pH1N1 infection only when the HI titer reaches 40 or higher during the pre-epidemic period. This study gives an important insight into the control and intervention measures required for preventing infections during future influenza epidemics. [ABSTRACT FROM AUTHOR]

Background: Airflow obstruction is a hallmark of disease severity and prognosis in bronchiectasis. The relationship between lung microbiota, airway inflammation, and outcomes in bronchiectasis with fixed airflow obstruction (FAO) remains unclear. This study explores these interactions in bronchiectasis patients, with and without FAO, and compares them to those diagnosed with chronic obstructive pulmonary disease (COPD)., Methods: This prospective observational study in Taiwan enrolled patients with either bronchiectasis or COPD. To analyze the lung microbiome and assess inflammatory markers, bronchoalveolar lavage (BAL) samples were collected for 16S rRNA gene sequencing. The study cohort comprised 181 patients: 86 with COPD, 46 with bronchiectasis, and 49 with bronchiectasis and FAO, as confirmed by spirometry., Results: Patients with bronchiectasis, with or without FAO, had similar microbiome profiles characterized by reduced alpha diversity and a predominance of Proteobacteria, distinctly different from COPD patients who exhibited more Firmicutes, greater diversity, and more commensal taxa. Furthermore, compared to COPD and bronchiectasis without FAO, bronchiectasis with FAO showed more severe disease and a higher risk of exacerbations. A significant correlation was found between the presence of Pseudomonas aeruginosa and increased airway neutrophilic inflammation such as Interleukin [IL]-1β, IL-8, and tumor necrosis factor-alpha [TNF]-α, as well as with higher bronchiectasis severity, which might contribute to an increased risk of exacerbations. Moreover, in bronchiectasis patients with FAO, the ROSE (Radiology, Obstruction, Symptoms, and Exposure) criteria were employed to classify individuals as either ROSE (+) or ROSE (-), based on smoking history. This classification highlighted differences in clinical features, inflammatory profiles, and slight microbiome variations between ROSE (-) and ROSE (+) patients, suggesting diverse endotypes within the bronchiectasis with FAO group., Conclusion: Bronchiectasis patients with FAO may exhibit two distinct endotypes, as defined by ROSE criteria, characterized by greater disease severity and a lung microbiome more similar to bronchiectasis without FAO than to COPD. The significant correlation between Pseudomonas aeruginosa colonization and increased airway neutrophilic inflammation, as well as disease severity, underscores the clinical relevance of microbial patterns. This finding reinforces the potential role of these patterns in the progression and exacerbations of bronchiectasis with FAO., (© 2024. The Author(s).)

Introduction: The purpose of this study was to assess the impact of telemedicine on ophthalmic screening and blood glucose control for patients with diabetes in remote areas of Northern Taiwan during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Telemedicine was implemented in Shiding and Wanli Districts using a 5G platform from April 2021 to December 2022. Patients with poorly controlled diabetes received real-time consultations from endocrinologists at Far Eastern Memorial Hospital, 50 km away, for medication adjustment, diet control, and lifestyle recommendations. The study also provided cloud-upload blood glucose meters for self-monitoring and regular medical advice from hospital nurses. Ophthalmic screenings included fundus imaging, external eye image, and intraocular pressure measurement, with instant communication and diagnosis by ophthalmologists through telemedicine. A satisfaction questionnaire survey was conducted. Results: The study enrolled 196 patients with diabetes. Blood glucose and glycosylated hemoglobin levels were significantly reduced after applying telemedicine ( p  = 0.01 and p  = 0.005, respectively). Ophthalmic screenings led to hospital referrals for 16.0% with abnormal fundus images, 15.6% with severe cataract or anterior segment disorders, and 27.9% with ocular hypertension or glaucoma. Fundus screening rates remained high at 86.3% and 80.4% in 2022, mainly using telemedicine, comparable with the traditional screening rate in the past 5 years. The overall satisfaction rate was 98.5%. Conclusions: Telemedicine showed effectiveness and high satisfaction in managing diabetes and conducting ophthalmic screenings in remote areas during the COVID-19 pandemic. It facilitated early diagnosis and treatment of ocular conditions while maintaining good blood glucose control and fundus screening rates.

Background: A pay-for-performance plan for rapid antiretroviral therapy (ART) commencement was initiated in 2018, while a modified testing algorithm offers immunochromatographic test (ICT) to replace Western blot (WB), and simultaneous testing with ICT and Nucleic Acid Amplification Test (NAAT) for HIV-positive sera was adopted in 2019 in Taiwan., Methods: Serum specimens collected from 1117 suspected or confirmed HIV infection cases in 2016-2019 were reassessed the performance of WB, ICT, and NAAT. We reviewed the medical records of 10,732 individuals diagnosed with HIV in 2015-2021 to determine the time from screening to confirmatory diagnosis, followed by ART commencement., Results: All 860 WB-positives were also positive by ICT and NAAT. The positive detection percentages were 37.0% by ICT and 51.4% by NAAT for 257 WB-indeterminate and -negative sera. The sensitivity for WB and ICT was 93.8% and 95.5%, respectively. In the people living with HIV (PLHIV) cohort, the median time from initial positive to confirmatory diagnosis decreased from 5 to 6 days before 2019 to 1 day in 2021. The median time from initial positive to ART initiation decreased from 37 days in 2015, 14 days in 2018, to 6 days in 2021. Compared to 2015-2017, the time to ART initiation was 91.48 days lower in 2018 (P < 0.001) and 100.66 days lower in 2019-2021 (P < 0.001) by the adjusted linear regression model., Conclusion: A significant decrease in the time to ART initiation was observed after initiation of the pay-for-performance program and optimized testing algorithm in Taiwan., Competing Interests: Declaration of competing interest The authors 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 © 2023. Published by Elsevier B.V.)