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This study explored the influence of using Curriculum-Based Readers Theater (CBRT) on promoting 12 sixth graders' oceanic knowledge and vocabulary learning in an elementary school in Taiwan. Based on the analysis of both quantitative (oceanic knowledge tests and vocabulary knowledge tests) and qualitative data (interviews, videos, and reflections), the study had the following major findings. First, CBRT instruction was effective for improving learners' oceanic knowledge through repeated reading. Second, CBRT was beneficial for learners' receptive ability in recognizing spoken forms of the target vocabulary. Suggestions on effective implementation of CBRT into content areas or issues were provided.

Our aim was to develop a machine learning-based predictor for early mortality and severe intraventricular hemorrhage (IVH) in very-low birth weight (VLBW) preterm infants in Taiwan. We collected retrospective data from VLBW infants, dividing them into two cohorts: one for model development and internal validation (Cohort 1, 2016–2021), and another for external validation (Cohort 2, 2022). Primary outcomes included early mortality, severe IVH, and early poor outcomes (a combination of both). Data preprocessing involved 23 variables, with the top four predictors identified as gestational age, birth body weight, 5-min Apgar score, and endotracheal tube ventilation. Six machine learning algorithms were employed. Among 7471 infants analyzed, the selected predictors consistently performed well across all outcomes. Logistic regression and neural network models showed the highest predictive performance (AUC 0.81–0.90 in both internal and external validation) and were well-calibrated, confirmed by calibration plots and the lowest two mean Brier scores (0.0685 and 0.0691). We developed a robust machine learning-based outcome predictor using only four accessible variables, offering valuable prognostic information for parents and aiding healthcare providers in decision-making. [ABSTRACT FROM AUTHOR]

We investigated the impact of the COVID-19 pandemic on call volumes and call characteristics using data from a national crisis helpline. Data were extracted for 215,066 calls to Taiwan's national suicide prevention hotline (January 2018–May 2020). We used negative binomial regression to investigate changes in the weekly number of calls during the early period of the COVID-19 outbreak (January 21, 2020–May 25, 2020), relative to that expected according to the pre-pandemic trend. The call characteristics during the pandemic period (February 18, 2020–May 31, 2020) were compared between COVID-19 related vs unrelated calls. Higher-than-expected call volumes started from the 6th week of the pandemic and reached a peak in the 14th week, which was 38% (rate ratio = 1.38, 95% confidence interval 1.26–1.51) higher than that expected based on the pre-pandemic trend. The higher-than-expected call volumes were mainly attributable to higher-than-expected calls from non-suicidal and male callers. Calls in which COVID-19 was mentioned (13.2%) were more likely to be from male and first-time callers, occur outside 12 am–6 am, last less than 5 min, and were less likely to be from callers who had previous suicide attempts, recent suicidal ideation or suicide plans or actions than COVID-19 unrelated calls. Callers who made COVID-19 related calls were more likely to request information than other callers. Crisis helplines should strategically adapt to the increased need and callers' specific concerns related to the outbreak. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is an important nutrient for maintaining cardiovascular, endocrine, immune, and nervous system health. Body mass index (BMI) is one of the factors influencing vitamin D levels. We aimed to study the factors that play a role in the outcomes and prognoses of critically ill patients. Method: This study was conducted at four teaching hospitals in Northern Taiwan between August 2018 and July 2020. A total of 1421 critically ill patients admitted to the intensive care units (ICUs) were eligible for assessment. Patients were classified into two groups based on serum 25(OH)D levels: sufficiency ( 20 ng/ml) and insufficiency (< 20 ng/ml); and into four groups according to BMI: underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obesity (BMI 30). Statistical analyses were performed, and a p-value < 0.05 indicated a significant difference. Results: More than half (57.9%) of the critically ill ICU patients had vitamin D deficiency (VDD); and VDD lengthened ICU stay by 2.5 days in vitamin D-deficit patients as compared to that in vitamin D-sufficient patients. Patients with obesity had a 4.2-day longer ICU stay (16.7 days) than that of the BMI < 30 group (12.5 days), which was significant (p = 0.009). They also had the lowest vitamin D levels (17.3 ng/mL) and the highest 90-day mortality rate (17.3%) compared to the other BMI groups. Conclusion: In caring for critical patients, physicians need to pay more attention to vitamin D levels and BMI factors, which may impact their outcome prediction. [ABSTRACT FROM AUTHOR]

Objective: We investigated recent trends in youth suicide and their associations with societal and psychological factors in Taiwan. Methods: Suicide data (1971–2019) for 10–24 year olds were extracted from Taiwan's national cause-of-death data files. We investigated changes in trends in youth suicide rates, societal factors (gross domestic product per capita, Gini index, overall and youth unemployment rates, divorce rates in people aged 40–59 years [i.e. the age of most 15–24 year olds' parents] and Internet use rates) and psychological distress indicators (youth self-harm rates and the prevalence of worry-related insomnia, and suicide ideation, plan and attempt) using joinpoint regression and graphic examinations. The associations of these factors with youth suicide rates were examined using Prais–Winsten regression. Results: Suicide rates in Taiwan's 10–24 year olds changed from a downward trend (2005–2014) to an upward trend in 2014 and increased 11.5% (95% confidence interval = [5.2%, 18.1%]) annually between 2014 and 2019. There was also an upturn in divorce rates among females aged 40–59 years in 2014 and self-harm rates among 15- to 24-year-old youth in 2013. The prevalence of self-reported insomnia and suicide ideation, plan and attempt in youth started to increase from 2013 to 2016. In the regression analysis, Internet use, female divorce rates and youth self-harm rates were positively associated with youth suicide rates. Conclusion: Suicide rates and the prevalence of suicidal behaviors began to increase in Taiwanese youth in the 2010s. These increases may be associated with concurrent rises in parental divorce rates, Internet use and poor sleep. Further research is needed to examine the mechanisms underlying recent increases in youth suicide risk. [ABSTRACT FROM AUTHOR]

Patients with asthma are treated in primary healthcare facilities (PHCFs) in Taiwan, where the asthma control status associated with acute exacerbation (AE) and use of oral corticosteroids (OCS) and short-acting β2-agonist (SABA) inhalers remains unclear. A cross-sectional, close-ended, face-to-face questionnaire survey invited board-certified physicians who treat adult asthma patients in PHCFs. The contents of the questionnaire included three parts: rescue OCS to treat AE, regular OCS for asthma control, and AE-related adverse outcomes. There were 445 out of 500 physicians who completed the questionnaire, with 61% of them being non-pulmonologists. A substantial proportion of asthma patients needed rescue OCS or regular OCS each month, or ≥3 canisters of SABA inhalers per year. Approximately 86% of physicians reported their patients with ≥2 AE-related unscheduled visits to clinics or emergency departments in the past year. A total of 41% of physicians reported their patients receiving intubation or intensive care in the past year. A total of 92% of physicians prescribed rescue OCS ≤ 40 mg/day. A total of 92% of physicians prescribed rescue OCS for a duration of ≤7 days for AEs. A total of 85% of physicians prescribed regular OCS ≤ 10 mg/day for asthma control. This is the first study to present the perceptions of asthma-treating physicians on the use of OCS in PHCFs. In summary, 31% of physicians reported ≥ 6% of their patients needed OCS for asthma control and 41% of physicians reported their patients with adverse outcomes in the past year. Thus, the need to improve asthma control in Taiwan is suggested by our study results. [ABSTRACT FROM AUTHOR]

In Taiwan, the Ministry of Education has been promoting University Social Responsibility (USR) since 2017. As every university differs in locations, specialties, features, and resources, how to choose and promote appropriate USR projects becomes an important issue. As stated above, this research has used hybrid multi-criteria decision-making methods to explore strategic indicators of USR promotion. First, based on the modified fuzzy Delphi Method, we conclude that 5 dimensions and 16 criteria are key factors for evaluation. Then through the fuzzy modified DEMATELbased analytic network process, we construct the interactions and relationships between all key factors and discuss their priority weights. Finally, through modified VIKOR, we have evaluated 3 USRSs’ performance from universities in northern Taiwan to find out key problems of the strategy execution so that we can assist in proposing better improving strategies for universities in the distribution and application of the teaching. [ABSTRACT FROM AUTHOR]

Background: The 25-item Dementia Knowledge Assessment Scale (DKAS2) is a widely used tool for measuring knowledge of dementia. To increase the applicability of the Chinese-language version of the tool (DKAS-TC) for the general public, this study aimed to develop a shortened version using the item response theory (IRT) approach.Methods: A total of 401 participants voluntarily completed a Chinese-language version of the DKAS2 questionnaire (DKAS-TC) at the start of dementia awareness training courses in 2020 and 2021. The four Rasch family models were used to analyze the dimensionality of the shortened scale (the DKAS-s) and to confirm its accuracy in measuring dementia knowledge.Results: The results justified supported the use of a dichotomous response scale for responding to the DKAS-s and demonstrated good fit of the data to a Rasch model with the four dimensions of "Causes and Characteristics", "Communication and Engagement", "Care Needs", and "Risks and Health Promotion". Moreover, we shortened the DKAS-TC by selecting items that had both above-average discriminative ability and above-average information. The DKAS-s retained 64.13% of the information contained in the DKAS-TC, resulting in a 16-item scale which retained four items in each of the original four dimensions. The DKAS-s also correlated highly (≥0.95) with the DKAS-TC and exhibited a sizeable range of difficulty of dementia knowledge.Conclusions: The DKAS-s is expected to be more efficient in field settings while retaining an acceptable level of psychometric properties when used as a survey instrument to measure the general public's knowledge of dementia. [ABSTRACT FROM AUTHOR]

Background: The use of statin has been encouraged in elderly high-risk patients; nevertheless, the prescription rates of statin have been shown to decline with age. Despite the current Taiwan lipid guidelines has been issued, the status for management of dyslipidemia among elderly high-risk patients in Taiwan remained unclear. The present study was aimed to investigate the prescription rates of highintensity statin (HIS)/ezetimibe and LDL-C goal attainment rates among elderly high-risk patients in a tertiary medical center. Methods: Between July 2018 and August 2019, 208 high-risk patients with suboptimal serum LDL-C levels, including 70 elderly patients (age ≥ 65 years) and 138 non-elderly patients (age < 65 years) received lipid-lowering therapy (LLT) and observation for a 12-month follow-up. The prescription rates of any statins/HIS/ezetimibe, the percentages of LDL-C reduction, and LDL-C goal attainment rates at 12-month follow-up were compared between elderly and non-elderly high-risk patients. Results: The serum LDL-C levels at baseline/12-month among elderly and non-elderly high-risk patients were respectively 128.8 ± 36.3/80.7 ± 46.3 and 138.5 ± 52.3/78.1 ± 37.0 mg/dL, with respectively LDL-C reductions of 34.1% and 39.6% at 12-month follow-up. The prescription rates of any statins/HIS/ezetimibe at 12-month follow-up in elderly and non-elderly high-risk patients were respectively 88.9%/68.3%/47.6% and 96.6%/72.7%/60.7%. The LDL-C goal attainment rates at 12-month follow-up in elderly and non-elderly high-risk patients were respectively 68.3% and 73.3%. All observed study outcomes were comparable between groups without significant statistical differences. Conclusion: Our findings highlight that the elderly high-risk patients in Taiwan received similar aggressive strategy of LLT with similar LDL-C attainment rates compared with non-elderly high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot is a common and costly complication of diabetes. No existing study has looked at the effect of continuity of care on amputations of diabetes (DM) patients while considering pay-for-performance (P4P) participation. We investigated the impact of the P4P program and the continuity of care index (COCI) on the incidence of lower extremity amputations (LEA) among diabetics in Taiwan.Methods: This was a population-based cohort study using insurance claims data from 1997 to 2013. We selected 15,650 DM patients in the P4P program along with age- and sex-matched non-P4P participants at a 1:4 ratio. Time-weighted average (TWA) of the COCI was calculated and included in the time-dependent Cox proportional hazard models to examine the impact of P4P and COCI on the risk of LEA, while controlling for individual and area level characteristics.Results: During four-year follow-up, 1816 subjects experienced LEA. The cumulative LEA hazard rate of the P4P group (n = 153) was significantly lower than that of the non-P4P group (n = 1663) (hazard ratio = 0.37, 95% CI = 0.31-0.43, p < 0.0001, by log-rank test). In the time-dependent Cox proportional hazard model, the adjusted hazard ratios (aHR) for the P4P group was 0.35, (p < 0.0001). With the low COCI (< 0.360) group as the reference, the aHR of LEA was 0.49 (p < 0.0001) for the middle COCI group, (p < 0.0001), and the aHR of LEA for the high COCI (≥0.643) group was 0.23 (p < 0.0001).Conclusions: Participating in the P4P program and increasing COCI might reduce the risk of amputation for DM patients, independently and synergistically. [ABSTRACT FROM AUTHOR]

Background: This study was to perform an economic evaluation to understand clinical outcomes and health resource use between hip fracture patients receiving hospital-based postfracture fracture liaison service (FLS) care and those receiving usual care (UC) in Taiwan.Methods: This cohort study included hospital-based data of 174 hip fracture patients who received FLS care (FLS group) from National Taiwan University Hospital, and 1697 propensity score-matched patients who received UC (UC group) of National Health Insurance claim-based data. Two groups had similar baseline characteristics but differed in hip fracture care after propensity score matching. Clinical outcomes included refracture-free survival (RFS), hip-refracture-free survival (HRFS), and overall survival (OS). Health resource use included inpatient, outpatient, and pharmacy costs within 2 years follow-up after the index of hip fracture. The economic evaluation of the FLS model was analyzed using the net monetary benefit regression framework based on the National Health Insurance perspective.Results: The FLS group had longer RFS than the UC group, with an adjusted difference of 44.3 days (95% confidence interval: 7.2-81.4 days). Two groups did not differ in inpatient and outpatient costs during follow-up, but the FLS group had a higher expenditure than the UC group on osteoporosis-related medication. The probability of FLS being cost-effective was >80% and of increasing RFS, HRFS, and OS was 95%, 81%, and 80%, respectively, when the willingness-to-pay threshold was >USD 65/gross domestic product per day.Conclusion: FLS care was cost-effective in reducing refracture occurrence days for patients initially diagnosed with hip fractures. [ABSTRACT FROM AUTHOR]

Background: Small blood stem cells (SB cells), isolated from human peripheral blood, demonstrated the ability to benefit bone regeneration and osseointegration. The primary goal of our study is to examine the safety and tolerability of SB cells in dental implantation for human patients with severe bone defects. Methods: Nine patients were enrolled and divided into three groups with SB cell treatment doses of 1 × 105, 1 × 106, and 1 × 107 SB cells, and then evaluated by computed tomography (CT) scans to assess bone mineral density (BMD) by Hounsfield units (HU) scoring. Testing was conducted before treatment and on weeks 4, 6, 8, and 12 post dental implantation. Blood and comprehensive chemistry panel testing were also performed. Results: No severe adverse effects were observed for up to 6-month trial. Grade 1 leukocytosis, anemia, and elevated liver function were observed, but related with the patient's condition or the implant treatment itself and not the transplantation of SB cells. The levels of cytokines and chemokines were detected by a multiplex immunological assay. Elevated levels of eotaxin, FGF2, MCP-1, MDC, and IL17a were found among patients who received SB cell treatment. This observation suggested SB cells triggered cytokines and chemokines for local tissue repair. To ensure the efficacy of SB cells in dental implantation, the BMD and maximum stresses via stress analysis model were measured through CT scanning. All patients who suffered from severe bone defect showed improvement from D3 level to D1 or D2 level. The HU score acceleration can be observed by week 2 after guided bone regeneration (GBR) and prior to dental implantation. Conclusions: This phase I study shows that treatment of SB cells for dental implantation is well tolerated with no major adverse effects. The use of SB cells for accelerating the osseointegration in high-risk dental implant patients warrants further phase II studies. Trial registration: Taiwan Clinical Trial Registry (SB-GBR001) and clinical trial registry of the United States (NCT04451486). [ABSTRACT FROM AUTHOR]

The Pteris fauriei group (Pteridaceae) includes Pteris with bipinnatisect laminae and entire pinnules. The taxonomic debate is led by morphological similarity and aggravated by the wide geographic distribution and a large number of involved taxa. We collected more than 500 plants and examined related herbarium specimens. Based on the evidence of morphology, molecular phylogeny, ecology, and reproductive biology, we propose the following taxonomic and nomenclatural novelties. 1) Two new species, Pteris austrotaiwanensis Y.S.Chao from Taiwan and Pteris pseudowulaiensis Y.S.Chao from China and Taiwan, are described. 2) The occurrence of Pteris wulaiensis in Japan is confirmed. 3) Pteris fauriei var. chinensis was treated as a synonym of Pteris latipinna Y.S.Chao & W.L.Chiou. 4) Pteris fauriei var. minor Hieron. is raised as species, Pteris minor (Hieron.) Y.S.Chao stat. nov. In this study, we clarify morphology of all known taxa in the P. fauriei group and provide a key. [ABSTRACT FROM AUTHOR]

BACKGROUND: Low back pain (LBP) is common in personal care attendants because this profession requires much physical work. Information about the prevalence of LBP and LBP-associated risk factors in this group is limited. OBJECTIVE: This study aimed to investigate the 1-year prevalence of LBP and identify LBP-associated factors in female hospital-based personal care attendants. METHODS: Forty-seven female hospital-based personal care attendants were recruited. The Nordic Musculoskeletal Questionnaire was used to investigate the prevalence of LBP during the recent 12 months. Participants completed a personal traits and associated factors questionnaire. Physical fitness and the knowledge test of body mechanics were assessed. Multivariable logistic regression analysis was used to explore LBP-associated factors. RESULTS: The 1-year prevalence of LBP was 46.8%. The strongest LBP-associated risk factor was poor abdominal muscle endurance, followed by insufficient knowledge on the test of body mechanics and higher psychological stress. CONCLUSIONS: The results demonstrate that the prevalence of LBP in female hospital-based personal care attendants appears to be high. Preventive programs should be initiated to reduce LBP-associated risk factors, such as improving abdominal muscle endurance, providing education in the proper use of body mechanics, and providing psychological intervention services for female hospital-based personal care attendants. [ABSTRACT FROM AUTHOR]

Background: The pandemic of SARS-CoV-2 (COVID-19), which began in December 2019, spread mostly from person to person through respiratory droplets. A recommendation was issued to postpone all elective surgical practices. However, some confirmed or suspected COVID-19 patients required life-saving emergent surgeries. Methods: To facilitate emergent surgical interventions for these patients, we have reviewed the current literature and established an algorithm of precautions to be taken by operating room team members during the COVID-19 pandemic. Results: The initial algorithm of preparation for surgical intervention during the COVID-19 pandemic was relatively simple. However, the abrupt increase of confirmed COVID-19 cases due to returned overseas travelers since mid-March 2020 disrupted the routine hospital clinical service. Due to the large number of febrile patients, the algorithm was therefore revised according to travel history, occupation, contact and cluster history (TOCC), unexplained fever/symptoms, and emergent/nonemergent surgery. TOCC (+) patients presenting with otherwise unexplained fever/symptoms would be regarded as belonging to the fifth category of "severe special infectious pneumonia." If the patient requires emergent surgery to relieve the non-life-threatening disorders, two times of negative COVID-19 tests are necessary before the operation is approved. For life-threatening situations without two negative results of COVID-19 tests, the operation schedule should be approved by the Chairman of Surgery Management Committee. Conclusion: The application of a clear and integrated algorithm for operating room team members aids in effective personal protective equipment facilitation to keep both healthcare providers and patients safe as well as to prevent hospital-based transmission of COVID-19. [ABSTRACT FROM AUTHOR]

The study was to compare the effectiveness of different epidermal growth factor receptor—tyrosine kinase inhibitors (EGFR‐TKIs) in patients with advanced non‐small‐cell lung cancer (NSCLC) and received EGFR‐TKIs as first‐line therapy. This retrospective cohort study was conducted using data from real‐world settings. Patients with stage IIIB and IV NSCLC and first received gefitinib, erlotinib, or afatinib between 2011 and 2015 were included. The date of the first claim for EGFR‐TKIs was set as the index date. Study endpoints were all‐cause death and treatment failure that was defined when patients added on or switched to chemotherapy or terminal care. A total of 5,940 patients, including 3,982 (67.0%) receiving gefitinib, 1,207 (20.3%) receiving erlotinib, and 751 (12.7%) receiving afatinib, were eligible for this study. The 1‐year overall survival (OS) rates for gefitinib, erlotinib, and afatinib groups were 74% (95% confidence interval [CI]: 72–75%), 75% (95% CI: 73–77%), and 80% (95% CI: 77–83%), respectively. Compared to gefitinib, afatinib was associated with a lower risk of all‐cause death (adjusted hazard ratio [aHR] = 0.82, 95% CI: 0.72–0.93) but not erlotinib (aHR = 0.95, 95% CI: 0.86–1.05). Similar results were also found regarding the effectiveness of treatment. All the three EGFR‐TKIs showed no differences for both outcomes among patients with an Eastern Cooperative Oncology Group Performance Score of 2. The real‐world data exhibited afatinib was more likely to be used for younger patients in a better condition than other EGFR inhibitors, and observed prolonged OS and treatment effectiveness compared to gefitinib after performing a multivariate Cox regression analysis. What's new? Patients in clinical trials have to meet specific criteria, but in the real world, doctors treat patients with a wide variety of age, comorbidities, and disease severity. In this paper, the authors sought to clarify criteria for selecting an EGFR‐TKI for lung cancer patients by collecting data from a real‐world patient cohort. They studied 5,940 patients who received either gefitinib, erlotinib, or afatinib between 2011 and 2015. The patients receiving afatinib showed longer survival than those receiving gefitinib. However, it is noted that physicians tend to prescribe afatinib to younger or healthier patients, which may contribute to improved outcomes. [ABSTRACT FROM AUTHOR]

A Gram-stain-negative, tyrosine-metabolizing, non-motile, strictly aerobic, non-spore-forming, rod-shaped marine bacterium, designated strain CC-PW-75T, was isolated from the estuarine water off Pintung, Taiwan. Strain CC-PW-75T formed a distinct phyletic lineage associated with Gemmobacter species, sharing the highest 16S rRNA gene sequence similarity with G. megaterium CF17T and G. straminiformis CAM-8T (96.0% each) followed by G. aquatilis IFAM 1031T and G. nectariphilus AST4T (95.8% each). Analysis of the draft genome (3.76 Mbp) revealed the presence of genes encoding light-harvesting complexes, photosynthetic reaction centers and proteins involved in the metabolism of CO, CO2, HCO3‒ and H2S. However, bacteriochlorophyll a was not detected. Average nucleotide identity values between the genome sequence of CC-PW-75T and the related Gemmobacter species (n = 6) were estimated to be 72.8–76.3%. Polar lipid analysis revealed the presence of phosphatidylglycerol, phosphatidylethanolamine and an unidentified lipid in major amounts, and phosphatidylmonomethylethanolamine, phosphatidylcholine, an unidentified aminolipid and an unidentified lipid in minor amounts. C18:1ω7c and/or C18:1ω6c, C18:0 and C18:1ω7c 11-methyl were identified to be major fatty acids. The DNA G + C content was 66.2 mol% (draft genome sequence). Ubiquinone-10 (Q-10) was the sole respiratory quinone. Based on the polyphasic taxonomic evidence, CC-PW-75T is most likely a novel species of the genus Gemmobacter, affiliated to the family Rhodobacteraceae, for which the name Gemmobacter aestuarii sp. nov. is proposed. The type strain is CC-PW-75T (= JCM 19754T = BCRC 80759T). Also, we propose the reclassification of Cereibacter changlensis as Gemmobacter changlensis Chen et al. 2013 using the polyphasic data presented in this study. [ABSTRACT FROM AUTHOR]

BACKGROUND: Prevalence of musculoskeletal disorders (MSDs) and psychological stress in home-based female migrant care workers (MCWs) remain unknown. OBJECTIVE: To 1) investigate the prevalence of MSDs and psychological stress and associations between subjective questionnaires on MSDs/psychological stress and biomedical examinations, and 2) identify the risk factors related to MSDs and psychological stress. METHODS: This study recruited 85 MCWs. Data was collected using questionnaires, urine analysis and X-ray examinations. Correlations between subjective questionnaires and biomedical examinations were investigated. Multivariable logistic regression analyses were used to explore risk factors. RESULTS: The prevalence of MSDs and psychological stress were 70.6% and 37.6%, respectively. MSDs were commonly reported over the neck, lower back, shoulders, and upper back. There was a moderate correlation between MSDs and abnormal X-ray findings. Risk factors associated with MSDs included higher education level, frequent transferring and bedside care activities, lacking caregiver training in Taiwan, inadequate sleep, and drinking tea or coffee. Risk factors associated with psychological stress included inadequate salary, lacking caregiver training in Taiwan, and insufficient knowledge of body mechanics techniques. CONCLUSIONS: MSDs and psychological stress were common among home-based female MCWs. Educational level, frequent transferring and bedside care activities, and lack of caregiver training in Taiwan, were the most dominant risk factors. [ABSTRACT FROM AUTHOR]

Ferns and lycophytes of Taiwan display an extraordinarily high diversity. Despite the detailed species documentation, the pteridophyte flora of Taiwan as a whole has never been organized into a phylogenetic framework. Here we provide an updated, phylogeny-based checklist that includes a total of 824 (infra)species taxa, of which eleven are first recorded. In addition, lectotypification of Phlegmariurus salvinioides and new combinations of 25 taxa were made in this study. Our classification scheme is based on the most recent phylogenetic evidence, and for all taxon names accepted here, we provide their best corresponding names in Taiwanese Mandarin. Our appendix and the online file also supply other details, such as synonyms, for the Taiwanese pteridophytes in order to track their nomenclatural changes from the previous floristic documentations. Finally, a discussion group for our community-Taiwan Pteridophyte Group (TPG)- is established online. This platform will allow more users to follow further updates of TPG or to provide any comments on new versions of Taiwan pteridophyte checklist. [ABSTRACT FROM AUTHOR]

Background: Mental distress patterns in first-time or experienced mothers and fathers during the transition to parenthood have been inadequately studied. This longitudinal study thus investigated changes in depression, anxiety, and health-related quality of life in both parents from early pregnancy until 1 year postpartum. Parity effects were specifically examined.Methods: In total, 531 pregnant women and their partners were recruited in Taiwan during early prenatal visits from 2011 to 2015, with five follow-ups from midpregnancy to 1 year postpartum. The participants' self-reported data were collected and analyzed using generalized estimating equation models.Results: Maternal mental distress levels were highest at 1 month postpartum. During postpartum periods, depression scores increased and social relations domain scores decreased in men. Although mental distress levels were higher in mothers than in fathers, parity evidently affected men. Experienced fathers were independently associated with a 70% higher risk of perinatal depression (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.2-2.3) and anxiety (OR = 1.7, 95% CI = 1.2-2.6). Experienced fathers also exhibited significantly lower perinatal scores than first-time fathers in the physical health and social relations domains.Limitations: Selection of both parents in metropolitan areas with higher socioeconomic status may restrict the generalizability of our findings.Conclusions: In addition to maternal mental distress during the transition to parenthood, we highlighted experienced fathers' psychological difficulties throughout perinatal periods. Such trends may indicate unsatisfied needs and could guide timely intervention to prevent adverse consequences. [ABSTRACT FROM AUTHOR]

This study examined the levels and rates of changes in psychological well-being for middle-aged adults of different statuses or marital transitions. The moderating effects of different leisure activities were also tested. Longitudinal data on 1,270 persons aged 50 to 65 years at baseline from the Taiwan longitudinal study on aging were analyzed. Adults who were stably unmarried or unpartnered reported worse mental health at baseline, but their psychological well-being improved over time. The trajectory of depressive symptoms fluctuated markedly in adults who became widowed during our observation period. Engagement in physical, cognitive, or social activities was significantly associated with participants’ psychological well-being. Participation in religious activities was significantly associated with life satisfaction and decreased depressive symptoms for those undergoing bereavement. Findings from this study suggest that social and physical activities, among the four selected leisure activities, have the greatest association between decreasing depressive symptoms and increasing life satisfaction, respectively. Religious activities, in particular, may improve psychological well-being in bereaved middle-aged and older adults. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and subsequent control measures may increase population suicide risk.1 The 2003 Severe Acute Respiratory Syndrome (SARS) outbreak is amongst previous infectious diseases epidemics most similar to the COVID-19 pandemic, as both were caused by coronaviruses and had a large-scale impact in affected countries.2 We investigated the impact of the SARS outbreak on suicide rates in Taiwan and Hong Kong, two regions most affected by the SARS epidemic,2 to inform concerns about the current pandemic's impact on suicide. Negative binomial regression models were used to estimate the rate ratios (RRs) and their 95% confidence intervals (CIs) for suicide rates during the SARS epidemic period (March-June 2003) and post-epidemic period (July-December 2003), relative to that expected based on pre-epidemic trends (January 1993-February 2003). The greater impact of the SARS epidemic on suicide rates was in parallel to higher SARS case and mortality rates and the epidemic's greater economic impacts in Hong Kong than in Taiwan. [Extracted from the article]

Despite the proliferation in understanding older adults’ acceptance and limitations of Internet technology, the learning needs of older adults living in low Internet usage areas and their acceptance of touchscreen-based apps have lagged behind. This study describes an embedded mixed-method research evaluation of an eight-week touchscreen mobile device training for thirty-nine older adults who were recruited from a community center in a low Internet usage area in southern Taiwan. Among the participants, 20 completed both the pre-test and the post-test and 16 attended the focus group interviews. The design of the training course was based on constructs informed by the diffusion of innovation theory and the technology acceptance model, and it incorporated both a classroom-based and small group tutoring approach. After the training session, the participants reported significantly lower depressive symptom scores compared to baseline. Qualitative interviews reveal the participants’ learning needs related to extended practice, usefulness, and compatibility in adopting touch-screen apps. Findings from this study shed light on the possibility of touchscreen-based apps, including health-, entertainment-, transportation-, and social media-related apps, for improving psychological well-being in older adults with limited Internet experience living in the community. Discussion on their learning needs was also provided. [ABSTRACT FROM AUTHOR]

Two fern taxa of Dryopteridaceae, Polystichum chunii and P. tenuius, are reported as new records of Taiwan. Morphological descriptions, synonyms, taxonomic notes, line-drawings and photographs of living material, and IUCN Red List Category are provided herein. [ABSTRACT FROM AUTHOR]

Pteris kawabatae Sa. Kurata was regarded as endemic to Japan. We here report its new distribution in China, Taiwan, and Vietnam. We also re-circumscribe P. arisanensis as an independent species and propose its Chinese name herein. A key is provided to compare those morphologically similar Pteris species in Taiwan, including P. arisanensis, P. biaurita, P. fauriei, P. linearis, P. kawabatae and P. wulaiensis. [ABSTRACT FROM AUTHOR]

Background: In recent years, intensive care for cancer patients has improved and treatment of critically ill cancer patients has become increasingly aggressive over time. However, not all cancer patients would benefit from aggressive care, especially those with late-stage cancer. Objective: We aimed to investigate the outcome of late-stage lung cancer patients with sepsis-related respiratory failure and identify predictors of mortality. Methods: From 2007 to 2008, consecutive stage III and IV lung cancer patients admitted to an intensive care unit (ICU) of a teritiary medical center in Taiwan for sepsis-related respiratory failure were retrospectively enrolled. Data at baseline and upon ICU admission were collected. In-hospital survival was analyzed. Variables of the survivors to hospital discharge and patients who died were compared by uni- and multivariate analyses. Results: Seventy patients were enrolled. During a mean follow-up period of 30.10 days, 29 (41.4%) patients survived to hospital discharge and 41(58.6%) died. Compared with the survivors, the patients who died had poor performance status, lower serum albumin level, higher percentage of disseminated intravascular coagulation, and more severe organ dysfunction as disclosed by higher Sequential Organ Failure Assessment (SOFA) scores. Multivariate analyses revealed that SOFA score ( p=0.026) was the only independent predictor of mortality; 44.8 % (13/29) of survivors were weaned from ventilator during hospitalization. Conclusion: Among late-stage lung cancer patients with sepsis-related respiratory failure, those with lower SOFA scores seemed to have better survival rate and may benefit from intensive care in the ICU. Early palliative care should be considered for all patients with advanced lung cancer, and hospice care is suggested for those with sepsis-respiratory failure and high SOFA scores. [ABSTRACT FROM AUTHOR]

This study surveys industrial design (ID) students' employment preparation in Taiwan, including career awareness, competency required, working attitudes and values and vocational choices. Both qualitative and quantitative approaches were adopted and data were collected in three stages: literature review, in-depth interviews and questionnaire survey. The findings show that approximately 37 per cent of 904 participants decide not to enter the ID profession after graduation. ID students' career awareness is fairly good in terms of knowledge, values, preferences and self-concepts, but approximately one-fourth of the surveyed items received low mean ratings. The students' awareness of some of the job tasks and competencies required of industrial designers does not match the reality, and their perception of the lifestyle tends to be unrealistically negative, which is an observation not previously reported in the literature. The above, perhaps unrealistically negative, perception might be related to the high proportion of students rejecting an industrial design career after graduation. The authors discuss these results in the contexts of the national and international design employment markets. The findings could help design educators to understand what information needs to be provided to ID students, and help plan career guidance programmes. [ABSTRACT FROM AUTHOR]

This article examines the complex and paradoxical relationships between sexuality and transnational marriages between Taiwan and Vietnam. On the basis of an examination of the websites of Taiwanese marriage agents and in-depth interviews with Vietnamese immigrant wives, I demonstrate that these marriage agents know the traditional expectations of their male clients, and hence frame Vietnamese women as images of “virtuous sexuality” in their advertisements. This advertising strategy subsequently encourages more and more Taiwanese men to seek Vietnamese wives. “Virtuous sexuality” becomes the main selling point which enables Vietnamese women to easily migrate into Taiwan as a wife, but it can constrain their lives in Taiwan. Although this representation places these women in inferior positions, they use their “virtuousness” to gain acceptance in the new home and resist discrimination. The paradoxical relationships between “virtuous sexuality” and Vietnamese women are situated not only in hierarchical economic differences between Taiwan and Vietnam but also in a landscape riddled with patriarchy and traditional gender norms. [ABSTRACT FROM PUBLISHER]

Afforestation or abandonment of agricultural fields to forest regeneration is a method of sequestering carbon to offset the increasing atmospheric concentration of CO2. We selected 11 sites with altitudes ranging from 14 to 2056 m and with paired forest regenerated and adjacent agricultural fields. Our objectives were to (1) examine the changes in soil organic carbon (SOC) concentration and stock after forest regeneration of agricultural fields and (2) identify the factors related to elevation and adjacent agricultural practices that affect the SOC accumulation rate. Our results demonstrated overall increases in both SOC concentrations and stocks after forest regeneration of the abandoned agricultural fields. The average increase rates of SOC concentrations in the forest regenerated soil samples were 1.65 and 0.95 g C kg−1 at 0–10 and 10–20 cm depths, respectively, representing 101% and 65% increases relative to those in the soil samples from agricultural fields. The average accumulation rates of SOC stocks in the regenerated forests were 13.0 and 6.7 ton C ha−1 at the 0–10 and 10–20 cm depths, respectively, representing 96% and 62% increases relative to those in the agricultural soil samples. The average annual sequestration rate was 1.03 Mg C ha−1 year−1 for the top 0–20 cm soils, which is greater than that observed by previous reviews and meta-analyses. The tropical/subtropical climate, sampling soil depth, forest regeneration period, and tree species in this study are likely to have contributed to the high average SOC accumulation levels. In addition, the SOC stock accumulation rates were higher at low-elevation sites than at middle-elevation sites, which could also be attributed to the favorable climatic conditions at the low-elevation sites. Along with the build-up of carbon sequestration in the forest floor and tree biomass, the afforestation/abandonment of agricultural fields to forest regeneration appears to be a promising carbon offset mechanism. [ABSTRACT FROM AUTHOR]

To examine both the between-person and within-person effects of sleep problems on the trajectory of suicidal ideation from ages 14 to 22 and investigate whether resilience moderates the effects. Age and sex differences were explored in the main and interaction effects of sleep problems and resilience on suicidal ideation. The study sample included 2491 adolescents (1260 males and 1231 females) who participated in a prospective study spanning 2009 through 2016 in northern Taiwan. Sex-stratified multilevel models were used to examine the between-person and within-person effects of sleep problems and the moderating effects of resilience on the trajectory of suicidal ideation in males and females. Across adolescents, higher levels of sleep problems contributed to an elevated risk of suicidal ideation for both sexes. Within individuals, a higher risk of suicidal ideation was observed when an adolescent's sleep problems exceeded their typical levels. The within-person effects of sleep problems were further determined to vary by age in males, with the effects gradually decreasing throughout late adolescence but increasing again in young adulthood. The buffering effects of resilience were only observed in females. The relationships between the within-person effects of sleep problems and suicidal ideation were only significant in female adolescents with low levels of resilience. Our findings extend the research by demonstrating both the between-person and within-person association between sleep problems and suicidal ideation. We further revealed age and sex differences in the within-person effects of sleep problems and the buffering effects of resilience. Prevention and intervention programs that target sleep problems could be tailored based on individuals' age, sex, and levels of resilience to prevent suicidal ideation. • Higher levels of sleep problems contributed to greater risks of suicidal ideation. • Within-person fluctuation in sleep problems affected the risks of suicidal ideation. • Age differences emerged for the within-person effects of sleep problems in males. • Resilience only buffered the within-person effects of sleep problems in females. [ABSTRACT FROM AUTHOR]

Cultural and creative industries have a crucial role in the postindustrial knowledge economy. However, our understanding of the importance of temples in connecting people with society is limited. To fill this gap, this study explores points of interest for tourists in Taiwan to analyse the design of cultural interest operation modes in temples' interactive kiosk interfaces. We also examine three cultural levels related to the design of interactive kiosks in temples. Results reveal that participants' levels of interest vary depending on temple complexity. Most participants prefer animated presentations of content related to two- and three-dimensional murals and the history and origins of temples. We illustrate how to develop a process for designing cultural and creative digital products. We construct a flowchart for guided temple tours and present an effective and suitable design method and its prototype product. Implications for the revitalisation of historic sites to create new value are discussed. • This paper illustrates in detail how to develop a process for designing cultural and creative digital products. • Interactive kiosks in temples can help visitors understand the cultural narratives and context of their location. • A flowchart for guided tours is constructed and an effective and suitable design method and prototype are presented. • The research serves as a reference for designs that incorporate culture or integrate physical and virtual components. • Integrating culture, tourism, technology, and gaming can aid development of design in tourism and related industries. [ABSTRACT FROM AUTHOR]

Bacteria belonging to the genus Chryseobacterium are ubiquitously distributed in natural environments, plants, and animals. Except C. indologenes and C. gleum, other Chryseobacterium species rarely cause human diseases. This study reported the whole-genome features, comparative genomic analysis, and antimicrobial susceptibility patterns of C. arthrosphaerae ED882-96 isolated in Taiwan. Strain ED882-96 was collected from the blood of a patient who had alcoholic liver cirrhosis and was an intravenous drug abuser. This isolate was initially identified as C. indologenes by using matrix-assisted laser desorption ionization–time of flight mass spectrometry. The analysis of 16S ribosomal RNA gene sequence revealed that ED882-96 shared 100% sequence identity with C. arthrosphaerae type strain CC-VM-7T. The results of whole-genome sequencing of ED882-96 showed two chromosome contigs and one plasmid. The total lengths of the draft genomes of chromosome and plasmid were 4,249,864 bp and 435,667 bp, respectively. The findings of both in silico DNA–DNA hybridization and average nucleotide identity analyses clearly demonstrated that strain ED882-96 was a species of C. arthrosphaerae. A total of 83 potential virulence factor homologs were predicted in the whole-genome sequencing of strain ED882-96. This isolate was resistant to all tested antibiotics, including β-lactams, β-lactam/β-lactamase inhibitor combinations, aminoglycosides, fluoroquinolones, tetracycline, glycylcycline, and trimethoprim-sulfamethoxazole. Only one antibiotic resistance gene was recognized in the plasmid. By contrast, many antibiotic resistance genes were identified in the chromosome. The findings of this study suggest that strain ED882-96 is a highly virulent and multidrug-resistant pathogen. Knowledge regarding genomic characteristics and antimicrobial susceptibility patterns provides valuable insights into this uncommon species. [ABSTRACT FROM AUTHOR]

Elizabethkingia meningoseptica and Elizabethkingia anophelis are two major pathogens in the genus Elizabethkingia. Studies have revealed that Elizabethkingia anophelis is frequently misidentified as E. meningoseptica. Therefore, our aim was to explore the clinical and molecular differences between these two species. The database of a clinical microbiology laboratory in a university-affiliated hospital of Taiwan was searched to identify patients with Elizabethkingia infections between January 2005 and June 2018. Species were reidentified using 16S ribosomal RNA gene sequencing. Twenty E. meningoseptica and 72 E. anophelis samples were collected from consecutive patients. E. meningoseptica was significantly more frequently isolated from the cerebrospinal fluid than was E. anophelis. The most susceptible antibiotic for all Elizabethkingia isolates was minocycline (91.3%), followed by levofloxacin (52.2%), tigecycline (23.9%), and piperacillin tazobactam (23.9%). Compared with E. anophelis, E. meningoseptica was significantly less susceptible to piperacillin tazobactam, minocycline, and levofloxacin. Regarding nonsynonymous substitutions in the quinolone-resistance determining regions of DNA gyrase, six sites were recognized in E. meningoseptica and one site was recognized in E. anophelis. E. meningoseptica had a significantly higher rate of fluoroquinolone target gene mutations than did E. anophelis. Because of less susceptibility to multiple antibiotics than E. anophelis, empirical antimicrobial therapy of E. meningoseptica should be more rigorous. [ABSTRACT FROM AUTHOR]

Porcine reproductive and respiratory syndrome virus (PRRSV) has been endemic in Taiwan since 1991. This study aimed to present a highly virulent PRRSV in Taiwan based on farm data collection and both in vitro and in vivo evaluations in virus challenge studies. This virulent PRRSV strain was first noticed on Farm TSYM due to continuously high nursery mortality rate and severe PRRSV-associated pneumonia. In phylogenetic surveillance, the PRRSV TSYM-strain remained in the predominant position for years, even with several other PRRSV strain invasions. In laboratory challenge trials, the TSYM-strain led to prolonged pyrexia, growth retardation, high mortality rates and high viremia titer that similar to the highly pathogenic PRRSV. The TSYM-strain isolate also triggered early interleukin-10 up-regulation and significantly higher infection rates under in vitro experiments. This study provides information of a comparably virulent strain in Taiwan and its appearance in both farm and laboratory levels. [ABSTRACT FROM AUTHOR]

We describe and illustrate a new species, Asplenium pifongia., currently known only from Taiwan. Although superficially similar to A. monanthe., this species is a sexual diploid and has little perforation on its spore surfaces. Phylogenetic analyses demonstrate that A. pifongia. is not closely related to A. monanthe., and is instead sister to the A. normal. complex. Asplenium pifongia. differs from A. normal. in having sori mostly only on, and parallel to, the basiscopic side of pinnae, a common feature in A. monanthes. [ABSTRACT FROM AUTHOR]

Fluoroquinolone-nonsusceptible Streptococcus pyogenes has rapidly emerged in several countries. The aim of this study was to survey the epidemiology and molecular characteristics of fluoroquinolone-nonsusceptible S . pyogenes in Taiwan. A total of 350 consecutive S . pyogenes isolates were collected between January 2005 and December 2012, including 152 (43.4%) invasive and 198 (56.6%) noninvasive isolates. Thirty-nine isolates (11.1%) of S . pyogenes were nonsusceptible to fluoroquinolones, including one emm 1/ST28, 4 emm 4/ST39, 33 emm 12/ST36, and 1 emm 87/ST62. Of all the isolates, emm 12 (50%) demonstrated the highest prevalence of fluoroquinolone nonsusceptibility. Alterations of Ser79Phe and Ala12Val in ParC were the most frequently mutations in fluoroquinolone-nonsusceptible S . pyogenes isolates. There were no amino acid substitutions in GyrB, and 1 emm 87 isolate exhibited 3 nonsynonymous mutations in ParE. Our study reveals the emergence of fluoroquinolone-nonsusceptible S . pyogenes emm 12/ST36 in Taiwan. Regular surveillance of fluoroquinolone susceptibility in S . pyogenes is suggested. [ABSTRACT FROM AUTHOR]

Bullying remains a pervasive issue in educational settings worldwide. This study examined the effect of teacher training and self-efficacy on teachers' responses to school bullying with the moderating effect of age. Drawing on data from 585 Taiwanese primary and secondary school teachers, the study revealed six distinct response patterns to bullying among Taiwanese teachers. The results underscore the critical role of self-efficacy in enabling proactive responses to bullying, highlighting that training programs that boost teachers' self-efficacy can be effective across different age groups. Furthermore, the research points to the necessity of differentiated training approaches that consider teachers' age to enhance responses of mediating involvers. This study contributes to the broader discourse on bullying prevention, emphasizing the importance of teacher training and the need for further research into the nuanced relationships between teacher characteristics, self-efficacy, and intervention strategies in diverse cultural settings., (© 2024 John Wiley & Sons Ltd.)

Background: Data from some countries showed a worrisome increase in domestic violence but a paradoxical decrease in divorce during the early months of the COVID-19 pandemic. We investigated the impact of the pandemic on domestic violence and divorce in Taiwan in 2020-2021., Method: Data for reported domestic violence and divorce by month and county/city (2017-2021) were from Taiwan government's registries. We used random-effects negative binomial regression to estimate the rate ratios (RRs) and their 95% confidence intervals (CIs) between the observed numbers of domestic violence cases and divorces in 2020-2021 and the expected numbers based on prepandemic trends (2017-2019). We calculated RRs for the two outbreak periods (First: January-May 2020; Second: May-July 2021) and the two postoutbreak periods (First: June 2020-April 2021; Second: August-December 2021) and each month in 2020-2021., Results: The number of overall domestic violence cases was greater than expected during the first COVID-19 outbreak-a 3% increase (95% CI [0.3%-6%])-and the two postoutbreak periods-a 9% increase ([6%-12%]) and a 12% increase ([8%-16%]), respectively. Intimate partner violence was the main contributor to the increases. The number of divorces was lower than expected throughout the pandemic (a 5%-24% decrease)., Conclusion: Reported domestic violence cases were higher than expected during the pandemic, particularly during the postoutbreak periods when the outbreak control measures were relaxed and people's movement resumed. Tailored prevention and intervention measures may be needed to address the increased vulnerability to domestic violence and restricted access to support during the outbreaks. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The goal of this study is to investigate the association between chronic non-cancer pain (CNCP) and mild cognitive impairment (MCI)/Alzheimer's disease and related dementias (ADRDs) development among adults aged ≥50 using administrative claims data from a national commercial health insurance company during 2007-2017. To reduce selection bias, propensity-score matching was applied to select comparable CNCP and non-CNCP patients. Time-dependent Cox proportional-hazards regressions were conducted to estimate the hazard ratios (HRs) of incident MCI/ADRDs. Of 170,900 patients with/without CNCP, 0.61% developed MCI and 2.33% had been diagnosed with ADRDs during the follow-up period. Controlling for potential confounders, CNCP patients had a 123% increase in MCI risk (HR = 2.23; 95% CI = 1.92-2.58) and a 44% increase in ADRDs risk (HR = 1.44; 95% CI = 1.34-1.54) relative to non-CNCP patients. CNCP is a risk factor for MCI/ADRDs. Promoting awareness and improving early CNCP diagnosis in middle-aged and older adults should be incorporated into cognitive impairment and dementia prevention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Importance: With the rising prevalence of mental disorders among children and adolescents, identifying modifiable associations is critical., Objective: To examine the association between physical fitness and mental disorder risks., Design, Setting, and Participants: This nationwide cohort study used data from the Taiwan National Student Fitness Tests and National Health Insurance Research Databases from January 1, 2009 to December 31, 2019. Participants were divided into 2 cohorts targeting anxiety and depression (1 996 633 participants) and attention-deficit/hyperactivity disorder (ADHD; 1 920 596 participants). Participants were aged 10 to 11 years at study entry and followed up for at least 3 years, had a nearly equal gender distribution, and an average follow-up of 6 years. Data were analyzed from October 2022 to February 2024., Exposures: Assessments of physical fitness included cardiorespiratory fitness (CF), muscular endurance (ME), muscular power (MP), and flexibility, measured through an 800-m run time, bent-leg curl-ups, standing broad jump, and sit-and-reach test, respectively., Main Outcomes and Measures: Kaplan-Meier method calculated the cumulative incidence of anxiety, depression, and ADHD across fitness quartiles. Additionally, multivariable Cox proportional hazards models were used that included all 4 fitness components and explored sex and income as modifiers., Results: The anxiety and depression cohort had 1 996 633 participants (1 035 411 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years), while the ADHD cohort had 1 920 596 (975 568 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years). Cumulative incidence of mental disorders was lower among participants in better-performing fitness quartiles, suggesting a dose-dependent association. Gender-specific analyses, controlling for confounders, revealed that improved CF, indicated by a 30-second decrease in run times, was associated with reduced risks of anxiety, depression, and ADHD in female participants, and lower risks of anxiety and ADHD in male participants (adjusted hazard ratio [aHR] for ADHD risk for female participants, 0.92; 95% CI, 0.90-0.94; P < .001; for male participants, 0.93; 95% CI, 0.92-0.94; P < .001). Enhanced ME, marked by an increase of 5 curl-ups per minute, was associated with decreased risks of depression and ADHD in female participants, and lower anxiety and ADHD risks in male participants (aHR for ADHD risk for female participants, 0.94; 95% CI, 0.92-0.97; P < .001; for male participants, 0.96; 95% CI, 0.95-0.97; P < .001). Improved MP, reflected by a 20-cm increase in jump distance, was associated with reduced risks of anxiety and ADHD in female participants and reduced anxiety, depression, and ADHD in male participants (aHR for ADHD risk for female participants, 0.95; 95% CI, 0.91-1.00; P = .04; for male participants, 0.96; 95% CI, 0.94-0.99; P = .001)., Conclusions and Relevance: This study highlights the potential protective role of cardiorespiratory fitness, muscular endurance, and muscular power in preventing the onset of mental disorders. It warrants further investigation of the effectiveness of physical fitness programs as a preventive measure for mental disorders among children and adolescents.

The utilization rate of respite care in Taiwan is low, and past studies that evaluated the effects of in-home respite care on caregiver burden are few. This two-wave panel study used Taiwan's long-term care plan 1.0 database and included 2342 care recipient-caregiver dyads who used home services to examine the impact of in-home respite care on caregiver burden. Propensity score matching was used to select 323 in-home respite service users matched with 646 nonusers as control groups (1:2 matching). The mixed effect model was applied to estimate the effects of receiving in-home respite care on caregiver burden. Results showed that compared with those of nonusers, caregiver burden scores of service users decreased significantly after receiving in-home respite care for more than 14 days (adjusted B = -0.14, SE = 0.05). The government should prioritize increasing the number of days of in-home respite care for those in need to reduce the caregiver burden.

Background: The pandemic of SARS-CoV-2 (COVID-19), which began in December 2019, spread mostly from person to person through respiratory droplets. A recommendation was issued to postpone all elective surgical practices. However, some confirmed or suspected COVID-19 patients required life-saving emergent surgeries., Methods: To facilitate emergent surgical interventions for these patients, we have reviewed the current literature and established an algorithm of precautions to be taken by operating room team members during the COVID-19 pandemic., Results: The initial algorithm of preparation for surgical intervention during the COVID-19 pandemic was relatively simple. However, the abrupt increase of confirmed COVID-19 cases due to returned overseas travelers since mid-March 2020 disrupted the routine hospital clinical service. Due to the large number of febrile patients, the algorithm was therefore revised according to travel history, occupation, contact and cluster history (TOCC), unexplained fever/symptoms, and emergent/nonemergent surgery. TOCC (+) patients presenting with otherwise unexplained fever/symptoms would be regarded as belonging to the fifth category of "severe special infectious pneumonia." If the patient requires emergent surgery to relieve the non-life-threatening disorders, two times of negative COVID-19 tests are necessary before the operation is approved. For life-threatening situations without two negative results of COVID-19 tests, the operation schedule should be approved by the Chairman of Surgery Management Committee., Conclusion: The application of a clear and integrated algorithm for operating room team members aids in effective personal protective equipment facilitation to keep both healthcare providers and patients safe as well as to prevent hospital-based transmission of COVID-19., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2020, the Chinese Medical Association.)

Importance: Obstructive sleep apnea (OSA) has been proposed as a risk factor in infertility. However, to date, the association between OSA and male infertility has not been examined in a population-based study., Objective: To investigate the risk factor of OSA in male infertility and the outcome of OSA treatment for the risk of male infertility., Design, Setting, and Participants: This case-control population-based study collected data from the Longitudinal Health Insurance Database, a subset of the National Health Insurance Research Database in Taiwan. Male patients with a diagnosis of infertility and at least 3 outpatient visits or 1 hospitalization between January 1, 2000, and December 31, 2013, were included and matched by age, sex, and date of infertility diagnosis with individuals without an infertility diagnosis. Data analysis was performed from October 22, 2018, to April 22, 2019., Exposures: Patients with male infertility and randomly selected patients without male infertility were matched using a 1:4 propensity score matching ratio., Main Outcomes and Measures: A primary outcome was the risk factor of OSA (diagnosed through polysomnography). A secondary outcome was the association of the risk of male infertility with OSA exposure time interval (short term, middle term, and long term) and OSA management (ie, none, continuous positive airway pressure, uvulopalatopharyngoplasty, or both)., Results: A total of 4607 male patients with infertility (mean [SD] age, 34.18 [5.44] years) and 18 428 control patients (mean [SD] age, 34.28 [5.81] years) were included. In the multivariate conditional logistic regression analysis, OSA was an independent risk factor associated with infertility (adjusted odds ratio [OR], 1.24; 95% CI, 1.10-1.64; P = .003). The absolute risk was 0.204 (95% CI, 0.092-0.391). For patients with OSA in the group without treatment, the adjusted OR was 1.80 (95% CI, 1.56-2.07; P < .001) for infertility compared with patients without OSA., Conclusions and Relevance: Results of this study support the hypothesis that OSA increases the risk of infertility in male patients, and the risk is associated with the OSA exposure time. Furthermore, no OSA management or treatment is associated with a higher infertility risk.

Objectives: Little is known about the experience of family caregivers of patients who require prolonged mechanical ventilation (PMV). We examined the perspectives of caregivers of patients who died after PMV to explore the role of palliative care and the quality of dying and death (QODD) in patients and understand the psychological symptoms of these caregivers., Methods: A longitudinal study was performed in five hospitals in Taipei, Taiwan. Routine palliative care family conferences and optional consultation with a palliative care specialist were provided, and family caregivers were asked to complete surveys., Results: In total, 136 family caregivers of 136 patients receiving PMV were recruited and underwent face-to-face baseline interviews in 2016-2017. By 2018, 61 (45%) of 136 patients had died. We successfully interviewed 30 caregivers of patients' death to collect information on the QODD of patients and administer the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS) and Center for Epidemiologic Studies Depression (CES-D) scale to caregivers. We observed that more frequent palliative care family conferences were associated with poorer QODD in patients (coefficients: -44.04% and 95% CIs -75.65 to -12.44), and more psychological symptoms among caregivers (coefficient: 9.77% and 95% CI 1.63 to 17.90 on CES-D and coefficient: 7.67% and 95% CI 0.78 to 14.55 on HADS). A higher caregiver burden at baseline correlated with lower psychological symptoms (coefficient: -0.35% and 95% CI -0.58 to -0.11 on IES and coefficient: -0.22% and 95% CI -0.40 to -0.05 on CES-D) among caregivers following the patients' death. Caregivers' who accepted the concept of palliative care had fewer psychological symptoms after patients' death (coefficient: -3.29% and 95% CI -6.32 to -0.25 on IES and coefficient: -3.22% and 95% CI -5.24 to -1.20 on CES-D)., Conclusions: Palliative care conferences were more common among family members with increased distress. Higher caregiver burden and caregiver acceptance of palliative care at baseline both predicted lower levels of caregiver distress after death., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Suicide rates are higher in men than in women in most countries, although the gender ratios vary markedly worldwide. We investigated long-term trends in suicide rates and the male-to-female ratios in relation to age, method and economic factors in Taiwan during the Japanese colonial (1905-1940) and postwar (1959-2012) periods., Methods: Suicide data were from the Statistical Reports of Taiwan Governor's Office (1905-1940), Vital Statistics (1959-1970) and cause-of-death mortality data files (1971-2012). Annual age-standardised and age-specific/method-specific suicide rates by gender and the gender ratios were calculated and examined graphically. The associations between trends in economic indicators, suicide and suicide gender ratio were investigated using Prais-Winsten regression., Results: The male-to-female suicide rate ratio increased from below 1 in the 1900s to around 2 by 2000; the reversal was mainly due to a marked reduction in suicide rates in young women coupled with a rise in male suicide between 1905 and 1940. The gender ratio increased again from the 1980s onwards. Poisoning was the most common method in the 1970s-1980s, but its use decreased afterwards, more in women than in men proportionally. The use of gassing for suicide increased markedly in the 2000s and contributed to the rises in overall suicide and the gender ratio. Unemployment rates were more strongly associated with male suicide than female suicide in 1959-2012. Unemployment rates and gross domestic product per capita were positively associated with suicide gender ratios., Conclusions: Gender differences in suicide changed remarkably in Taiwan over the past century; such change may be related to cultural, socioeconomic and method-specific factors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The impact of serum phosphorus concentration on metabolic syndrome were limited. Therefore, this study aimed to explore the association between the serum phosphorus and incident metabolic syndrome in the elderly in Taiwan., Methods: We included 1491 participants who had health check-ups in the Tri-Service General Hospital for the period 2007 to 2015 and divided them based on age to assess the incidence of metabolic syndrome. We performed the COX regression model to explore the impact of serum phosphorus for metabolic syndrome, diabetes mellitus, and hypertension by an age-specific group., Results: Our result showed that higher serum phosphorus concentration was noted in the elderly in the baseline characteristics. In the group older than 60 years, serum phosphorus concentration was correlated with the incidence of metabolic syndrome (hazard ratios (HR) = 1.39, 95% CI 1.11-1.74) and diabetes mellitus (HR = 1.49, 95% CI 1.15-1.92) after adjustment. We further found the relationship between serum phosphorus and incidence of the components of metabolic syndrome, including higher waist circumference, high-density lipoprotein (HDL), serum triglyceride, and fast glucose., Conclusions: Our study might provide an epidemiological evidence that serum phosphorus was related with the incidence of metabolic syndrome in the elderly in Taiwan.