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Multidimensional theory of mind assessments should include items assessing both explicit theory of mind (theory of mind knowledge) and applied theory of mind (application of theory of mind knowledge in real-life contexts). However, the two theory of mind scores cannot be interpreted collectively to identify children having mismatched explicit and applied theory of mind due to the lack of links between the two scores. To map the information between two theory of mind scores, data of 221 autistic children aged 3-12 years were extracted. Items of the Theory of Mind Task Battery and Theory of Mind Inventory-2 were used to respectively assess the explicit and applied theory of mind. Rasch analysis and correlation coefficients were used to examine the model fits/dimensionality and relationships. After the removal of misfit items, the remaining 45 items showed satisfactory model fits (infit and outfit mean squares < 1.35). Large correlation (r = 0.63) was found between the Rasch scores of the two theory of mind constructs. The scatter plots highlighted that each applied theory of mind score could reflect multiple explicit ToM scores. Accordingly, the information from each theory of mind measure is unique and irreplaceable. Moreover, cutoff scores for identifying children with mismatched explicit and applied theory of mind were proposed to determine the priority of interventions.

Objective. The Fugl-Meyer assessment for upper extremity (FMA-UE) is a measure for assessing upper extremity motor function in patients with stroke. However, the considerable administration time of the assessment decreases its feasibility. This study aimed to develop an accumulative assessment system of upper extremity motor function (AAS-UE) based on the FMA-UE to improve administrative efficiency while retaining sufficient psychometric properties. Methods. The study used secondary data from 3 previous studies having FMA-UE datasets, including 2 follow-up studies for subacute stroke individuals and 1 test-retest study for individuals with chronic stroke. The AAS-UE adopted deep learning algorithms to use patients' prior information (ie, the FMA-UE scores in previous assessments, time interval of adjacent assessments, and chronicity of stroke) to select a short and personalized item set for the following assessment items and reproduce their FMA-UE scores. Results. Our data included a total of 682 patients after stroke. The AAS-UE administered 10 different items for each patient. The AAS-UE demonstrated good concurrent validity (r =0.97-0.99 with the FMA-UE), high test-retest reliability (intra-class correlation coefficient=0.96), low random measurement error (percentage of minimal detectable change=15.6%), good group-level responsiveness (standardized response mean=0.65-1.07), and good individual-level responsiveness (30.5%-53.2% of patients showed significant improvement). These psychometric properties were comparable to those of the FMA-UE. Conclusion. The AAS-UE uses an innovative assessment method, which makes good use of patients' prior information to achieve administrative efficiency with good psychometric properties. Impact. This study demonstrates a new assessment method to improve administrative efficiency while retaining psychometric properties, especially individual-level responsiveness and random measurement error, by making good use of patients' basic information and medical records. [ABSTRACT FROM AUTHOR]

Introduction: Few real-world studies have investigated drug-drug interactions (DDIs) involving non-vitamin-K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation (NVAF). The interactions encompass drugs inducing or inhibiting cytochrome P450 3A4 and permeability glycoprotein. These agents potentially modulate the breakdown and elimination of NOACs. This study investigated the impact of DDIs on thromboembolism in this clinical scenario. Method: Patients who had NVAF and were treated with NOACs were selected as the study cohort from the National Health Insurance Research Database of Taiwan. Cases were defined as patients hospitalised for a thromboembolic event and who underwent a relevant imaging study within 7 days before hospitalisation or during hospitalisation. Each case was matched with up to 4 controls by using the incidence density sampling method. The concurrent use of a cytochrome P450 3A4/permeability glycoprotein inducer or inhibitor or both with NOACs was identified. The effects of these interactions on the risk of thromboembolic events were examined with univariate and multivariate conditional logistic regressions. Results: The study cohort comprised 60,726 eligible patients. Among them, 1288 patients with a thromboembolic event and 5144 matched control patients were selected for analysis. The concurrent use of a cytochrome P450 3A4/permeability glycoprotein inducer resulted in a higher risk of thromboembolic events (adjusted odds ratio [AOR] 1.23, 95% confidence interval [CI] 1.004-1.51). Conclusion: For patients with NVAF receiving NOACs, the concurrent use of cytochrome P450 3A4/permeability glycoprotein inducers increases the risk of thromboembolic events. [ABSTRACT FROM AUTHOR]

Background: Outpatient clinics in medical centers are the most common location where people seek medical treatment. Because they must provide patients with treatment information in a timely manner, good communication skills are a key competency for outpatient nurses. However, the tools available for communication behavior assessment are general and rarely tailored for outpatient settings. Purpose: The purpose was to develop a communication behavior inventory for outpatient nurses and to examine its reliability and validity. Methods: During phase one, the authors conducted a literature search and synthesis, using the findings to develop the Outpatient Nurses Communication Behavior Inventory. During phase two, two expert validation rounds were conducted to confirm content validity. During phase three, 220 licensed outpatient nurses were recruited from a medical center in northern Taiwan to complete the instrument (December 2018 -- January 2019.) The construct validity and internal consistency of the inventory were evaluated. Results: The literature search and synthesis identified six domains of communication, including connect, introduce, communicate, ask, respond, and exit. A total of 25 items were generated. Following the two expert panel validation rounds, the six domains remained but the inventory items were reduced to 21. Both item-content validity index and scale-level content validity index were 1.0. In phase three, the results of the confirmatory factor analysis retained six factors with a total of 16 items. Model three showed that the inventory demonstrated goodness of fit (χ² = 155.75, p < .001, RMSEA = .06, GFI = .92, AGFI = .87, N NFI = .97, NFI = .95, Model AIC = 253.75). Internal consistency was demonstrated with a Cronbach's α of .89. Conclusion/ Implications for Practice: The Outpatient Nurses Communication Behavior Inventory exhibits good reliability and validity and may be used to assess outpatient nurses' communication behaviors and as a basis for education. The six CICARE (connect, introduce, communicate, ask, respond and exit) domains may be utilized to remind outpatient nurses to demonstrate effective communication consistently, promote outpatient nurses' communication with patients, and improve quality of care. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity and polypharmacy increase the risk of hospitalization in older adults receiving potentially inappropriate medication (PIM). The current study compared the ability of PIM-Taiwan, PRISCUS, and Beers criteria to predict 90-day rehospitalization in older patients with and without PIM. Methods: The retrospective cohort study used Taiwan's Longitudinal Health Insurance Database to retrieve quarterly information about prescribed medication for adults aged =65 years hospitalized between 2001 and 2018. We analyzed the association of PIM with 90-day rehospitalization using logistic regression. Results: The study cohort included 206,058 older adults (mean age: 72.5 years). In the analysis, 133,201 (64.6%), 97,790 (47.5%), and 147,450 (71.6%), were identified as having PIM exposure in PIM-Taiwan, PRICUS, and Beers criteria, respectively. PIM-Taiwan criteria found exposure to PIM affecting the cardiovascular (adjusted OR [aOR] 1.37, 95% confidence interval [CI] = 1.32-1.41), gastrointestinal (aOR 1.26, 95% CI = 1.23-1.30), central nervous (aOR 1.11, 95% CI = 1.08-1.14), and respiratory (aOR 1.16, 95% CI = 1.12-1.20) systems significantly increased the risk of 90-day rehospitalization, after adjustment for covariates. In PRISCUS criteria, exposure to PIM affecting the respiratory (aOR 1.48, 95% CI = 1.41-1.56), central nervous (aOR 1.12, 95% CI = 1.09-1.15), and cardiovascular (aOR 1.20, 95% CI = 1.16-1.24) systems significantly increased the risk. In Beers criteria, exposure to PIM affecting the cardiovascular (aOR 1.37, 95% CI = 1.32-1.41), gastrointestinal (aOR 1.38, 95% CI = 1.35-1.42), central nervous (aOR 1.18, 95% CI = 1.15-1.21), endocrine (aOR 1.10, 95% CI = 1.06-1.15), and respiratory (aOR 1.09, 95% CI = 1.04-1.13) systems significantly increased the risk. Patients with 90-day rehospitalization had higher rates of the potentially harmful drug-drug interaction (DDI) pairs of serotonin syndrome (n = 19; 48.8%), QT prolongation (n = 4; 30.8%), extrapyramidal symptoms (EPS) (n = 102; 24.5%), and hypokalemia (n = 275; 20.1%). Conclusion: Beers criteria was more efficient in predicting 90-day rehospitalization among older adults experiencing PIM in Taiwan than either PIM-Taiwan or PRISCUS. The risk of 90-day rehospitalization was associated with the potentially harmful DDI classes of serotonin syndrome, QT prolongation, EPS, and hypokalemia. [ABSTRACT FROM AUTHOR]

Introduction: Autoimmune thyroid disease (AITD) is the most common associated autoimmune disorder in type 1 diabetes (T1D). Early detection of AITD is crucial to optimize glycemic control, growth, and intellectual development. In this prospective cohort study, we sought to characterize the prevalence, incident ages and risk factors of AITD in children and adolescents with T1D. Materials and methods: Patients with T1D diagnosed at ≤ 18 years at MacKay Children's Hospital, Taipei, from 1990 to 2019 underwent annual screening for AITD. Institutional Review Board-approved data on age, sex, and disease profile are collected. Statistical analysis was performed by using independent sample t test for continuous variables, chi-squared test for categorical variables, and Kaplan-Meier estimates of cumulative incidence of AITD were calculated. A p value of <0.05 was considered statistically significant. Results: We prospectively followed up 808 patients with T1D, 761 patients were included in the study. Of these patients, 197 (25.9%) of them had thyroid autoimmunity, meaning positivity of thyroid autoantibodies. Females had a higher prevalence of thyroid autoimmunity than males (59.9%, p = 0.012). Altogether, 5.5% patients developed AITD (4.1% had Graves disease; 1.4% had Hashimoto disease), at a mean age of 17.8 ± 8.5 years. The cumulative incidence of AITD at 30 years of disease duration was 0.29 in the total group and was significantly higher in females (0.39, n = 397) than in males (0.15, n = 364, p<0.001). Discussion: In Taiwan, the prevalence of AITD in pediatric population with T1D increases with age, a longer disease duration and female sex. For early detection of autoimmune thyroid disease in Taiwanese children and adolescents with T1D, an annual AITD screening program should be implemented. [ABSTRACT FROM AUTHOR]

Ovarian cancer is the second most common cause of death from gynecologic cancer. The aim of this study was to estimate the incidence of ovarian cancer and the trend of mortality in different histological subtypes of ovarian cancer in Taiwan. Patient information regarding ovarian cancer was provided by the Taiwan National Health Insurance database. The histological subtypes of ovarian cancer were retrieved from the Taiwan Cancer Registry database, while the survival rates were extracted from the National Death Registry database. In this population-based cohort study, the annual prevalence, incidence, and overall mortality of ovarian cancer during 2002–2015 were determined. The trend in the incidence and the mortality rate of different histologic subtypes were estimated using joinpoint regression analysis. It was found that age-standardized incidence of ovarian cancer increased from 9.46 in 2002 to 11.92 per 100,000 person-years in 2015, with an average annual percentage change of 2.0 (95% CI = 1.5–2.5). The 1-, 3-, and 5-year mortality rates of overall ovarian cancer declined progressively during the study period, especially the group of Charlson comorbidity index ≤ 1. Ovarian serous carcinoma was the most common histological subtype in Taiwan, comprising 30.9% of ovarian cancer patients in 2002–2015. This study provides valuable information for use in developing healthcare policies for ovarian cancer. [ABSTRACT FROM AUTHOR]

Cancer, the primary cause of death in Taiwan for 40 years, remains a disease that cannot be completely controlled by modern medicine. Although medical techniques are improving, involving family caregivers in the treatment of patients with cancer is very important to improving treatment outcomes. Family caregivers participate in the treatment process and help ensure treatment compliance and care continuity for patients. Cancer represents a major crisis not only for patients but also for their primary family caregivers. Family members often serve as informal caregivers to patients with cancer while also dealing with the related medical costs and physical and psychological burdens (Seo & Park, 2019). Providing care and support for family members is an extraordinary challenge during the treatment journey. Many family caregivers ignore their own needs and emotions, and focus their full attention on their beloved family members with cancer. However, this situation may impact their health-related quality of life (Abbasi et al., 2020). Cancer patients and family caregivers often have unmet needs related to cancer care, psychosocial health, daily activities, social life, and cancer- treatment knowledge (Tang, 2019; Wang et al., 2018). The important role shouldered by family caregivers is significantly related to their unmet needs and loadings, which may negatively impact their quality of life and care-delivery ability (Abbasi et al., 2020; Mirsoleymani et al., 2017). Therefore, healthcare providers should intervene to reduce both the burden on family caregivers and the indirect, negative impact on the health-related quality of life of care recipients. In light of the above, we have invited four experts in cancer nursing to share articles in this issue on patients and their family caregivers dealing with pancreatic, pediatric, and gynecological cancers as well as on the topic of cancer immunotherapy. We hope professional nurses and medical health caregivers obtain new and useful information from these articles and apply it in clinical practice. [ABSTRACT FROM AUTHOR]

Deep learning networks (DLNs) use multilayer neural networks for multiclass classification that exhibit better results in wind-power forecasting applications. However, improving the training process using proper parameter hyperisations and techniques, such as regularisation and Adam-based optimisation, remains a challenge in the design of DLNs for processing time-series data. Moreover, the most appropriate parameter for the DLN model is to solve the wind-power forecasting problem by considering the excess training algorithms, such as the optimiser, activation function, batch size, and dropout. Reinforcement learning (RN) schemes constitute a smart approach to explore the proper initial parameters for the developed DLN model, considering a balance between exploration and exploitation processes. Therefore, the present study focuses on determining the proper hyperparameters for DLN models using a Q-learning scheme for four developed models. To verify the effectiveness of the developed temporal convolution network (TCN) models, experiments with five different sets of initial parameters for the TCN model were determined by the output results of Q-learning computation. The experimental results showed that the TCN accuracy for 168 h wind power prediction reached a mean absolute percentage error of 1.41%. In evaluating the effectiveness of selection of hyperparameters for the proposed model, the performance of four DLN-based prediction models for power forecasting—TCN, long short-term memory (LSTM), recurrent neural network (RNN), and gated recurrence unit (GRU) models—were compared. The overall detection accuracy of the TCN model exhibited higher prediction accuracy compared to canonical recurrent networks (i.e., the GRU, LSTM, and RNN models). [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate the association between acupuncture therapy and the risk of fracture in patient with osteoarthritis (OA). Design: The authors performed a 1:1 propensity score-matched cohort study to analyze patient with OA between January 1, 1997 and December 31, 2010 through the Taiwanese National Health Insurance Research Database. Patients who received acupuncture therapy from the initial date of diagnosis of OA to December 31, 2010 were included in the acupuncture cohort. Patients who did not receive acupuncture during the same follow-up period were defined as the no-acupuncture cohort. A Cox regression model was used to adjust for sex, age, comorbidities, prescription, and surgical experiences. Hazard ratios (HRs) were compared between the two cohorts. Results: A total of 3416 patients were identified after 1:1 propensity score matching. The patients had similar basic characteristics. In the final analysis, 292 patients in the acupuncture cohort (30.06 per 1000 person-years) and 431 patients in the no-acupuncture cohort (56.08 per 1000 person-years) developed fractures (adjusted HRs 0.57, 95% confidence interval 0.49-0.67). A reduced cumulative incidence of fracture was found in the acupuncture cohort (log-rank test, p < 0.001). The association between acupuncture and reducing the fracture incidence was independent of sex, comorbidities, drugs use, and surgical experiences. Conclusion: Their results revealed the association between acupuncture therapies and a reduced incidence of fracture development in patients with OA. This finding provides noteworthy ideas for further research. [ABSTRACT FROM AUTHOR]

Purpose. Urinary tract infections (UTIs) are the most common infections among hospitalized patients. Cystoscopy is a minimally invasive procedure to check bladder disease, among the patients receiving procedure, approximately 10% of patients may experience UTI. In this study, a neural network model with high accuracy, sensitivity, and specificity was developed to predict the probability of UTIs caused by cystoscopic procedures. To reduce antibiotic overuse during cystoscopic procedures, the model can provide clinicians with a rapid assessment of whether patients require prophylactic antibiotics. Materials and Methods. Patients who underwent cystoscopic procedures at China Medical University Beigang Hospital from 2016 to 2019 were retrospectively reviewed. A total of 1647 patients were enrolled, and 147 cases of urinary tract infection occurred. An artificial neural network (ANN) and logistic regression analysis were used to develop the prediction models, and the two models were compared. Results. The logistic regression analysis model had an accuracy of 91%, sensitivity of 2%, and specificity of 99%, indicating that the logistic regression model predicted that most patients had a low risk of infection. The neural network model had a high accuracy of 85%, sensitivity of 80%, and specificity of 88%. Conclusions. Because the logistic regression model had low sensitivity and missed most cases of UTI, the logistic regression model is inappropriate for clinical application. The neural network model has superior predictive ability and can be considered a tool in clinical practice. [ABSTRACT FROM AUTHOR]

Genomic changes in Mycoplasma pneumoniae caused by adaptation to environmental or ecologic pressures are poorly understood. We collected M. pneumoniae from children who had confirmed pneumonia in Taiwan during 2017-2020. We used whole-genome sequencing to compare these isolates with a worldwide collection of current and historical clinical strains for characterizing population structures. A phylogenetic tree for 284 strains showed that all sequenced strains consisted of 5 clades: T1-1 (sequence type [ST]1), T1-2 (mainly ST3), T1-3 (ST17), T2-1 (mainly ST2), and T2-2 (mainly ST14). We identified a putative recombination block containing 6 genes (MPN366‒371). Macrolide resistance involving 23S rRNA mutations was detected for each clade. Clonal expansion of macrolide resistance occurred mostly within subtype 1 strains, of which clade T1-2 showed the highest recombination rate and genome diversity. Functional characterization of recombined regions provided clarification of the biologic role of these recombination events in the evolution of M. pneumoniae. [ABSTRACT FROM AUTHOR]

Background. Nurses’ knowledge regarding palliative and end-of-life (EOL) care has been documented, but the competence of nurses in Taiwan has not been deeply analyzed and may affect the use of EOL care. Purpose. We aimed to (1) assess the palliative care knowledge, competence and attitude of nurses in a general hospital and (2) examine the paths connecting nurses’ demographic characteristics, previous experiences, knowledge, competence, and attitude. Method. A correlational, cross-sectional survey design was implemented to recruit 682 eligible nurses. The questionnaires included demographic information and palliative and EOL care knowledge, attitude, and competence scales. Path analysis was employed for statistical analysis using structural equation modeling. Results. Overall, 76% of the questions assessing palliative and hospice knowledge were answered correctly. Nurses’ palliative attitudes were divided into ‘‘positive perception’’ and ‘‘negative perception’’. ‘‘Positive perception’’ was highly correlated with competence (r = 0.48, p < 0.001), but ‘‘negative perception’’ was not significantly correlated with competence (r = −0.07, p = 0.25). ‘‘Positive perception’’ (β = −0.01, p = 0.84) and competence (β = 0.02, p = 0.80) were not related to palliative knowledge. ‘‘Negative perception’’, however, was negatively associated with palliative knowledge (β = −0.20, p < 0.01). Conclusions. This study suggests continuing education to decrease nurses’ ‘‘negative perception’’ attitude regarding the provision of information to patients and families to provide better palliative and EOL care. Implications for Practice. Nurses’ attitudes and competences with respect to palliative care and EOL care are critical. Areas for further research and advanced palliative and EOL care-related education and training are suggested and may be applied in future clinical interventions. [ABSTRACT FROM AUTHOR]

Background. Cholecystectomy is one of the most common surgical procedures performed worldwide. The objective of this large, population-based cohort study is to explore the risk factors of pneumonia after cholecystectomy in Taiwan. Methods. From the Taiwanese National Health Insurance Research Database, we selected all patients who underwent cholecystectomy by using ICD-9-codes, from January 1, 1998, to December 31, 2016. The patients were separated into two groups based on the presence or absence of postoperative pneumonia. Basic information, comorbidities, and postoperative complications were evaluated using a t -test or chi-square test. There were 6056 patients in the pneumonia group and 24224 patients in the control group. These two groups were shown in a ratio of 1 : 4 and were matched by age and sex. The log-rank test was used to examine differences in postoperative mortality between patients with and without pneumonia. Preoperative risk factors were analyzed using logistic regression analysis, after adjusting for age and sex. Results. The final dataset included 282184 cholecystectomy patients. Of these patients, 6056 (2.15%) had postoperative new-onset pneumonia. The patient-related risk factors for pneumonia after cholecystectomy in the order of relevance were chronic obstructive pulmonary disease, congestive heart failure, cerebrovascular disease, diabetes mellitus, surgical type, hemodialysis, coronary artery disease, and liver cirrhosis. Compared to patients without postcholecystectomy pneumonia, those with postcholecystectomy pneumonia had higher rates of mortality (within first month, 1.72% vs. 2.28%, P < 0.005) and admission to intensive care unit (15.02% vs. 41.80%, P < 0.0001) and longer hospital stays (10.71 vs. 18.55 days, P < 0.0001). Conclusion. Our results show that postcholecystectomy associated with pneumonia had higher rates of morbidity and mortality in this clinical population. Early identification and possible management of risk factors for pneumonia could improve outcomes of cholecystectomy and lower the risk for patient comorbidities after surgery. [ABSTRACT FROM AUTHOR]

Incidence of invasive pneumococcal disease caused by antimicrobial-resistant Streptococcus pneumoniae types not included in pneumococcal conjugate vaccines has increased, including a penicillin- and meropenem-resistant serotype 15A-ST63 clone in Japan. During 2013-2017, we collected 206 invasive pneumococcal isolates in Taiwan for penicillin and meropenem susceptibility testing. We found serotypes 15B/C-ST83 and 15A-ST63 were the most prevalent penicillin- and meropenem-resistant clones. A transformation study confirmed that penicillin-binding protein (PBP) 2b was the primary meropenem resistance determinant, and PBP1a was essential for high-level resistance. The rate of serotype 15B/C-ST83 increased during the study. All 15B/C-ST83 isolates showed an ermB macrolide resistance genotype. Prediction analysis of recombination sites revealed 12 recombination regions in 15B/C-ST83 compared with the S. pneumoniae Spain23F-ST81 genome. Pneumococcal clones rapidly recombine to acquire survival advantages and undergo local expansion under the selective pressure exerted by vaccines and antimicrobial drugs. The spread of 15B/C-ST83 is alarming for countries with high antimicrobial pressure. [ABSTRACT FROM AUTHOR]

Purpose. Lung cancer has been the top-ranking cause of cancer deaths in Taiwan for decades. Limited data were available in global cancer surveillance regarding lung cancer epidemiology in Taiwan, and previous reports are outdated. Patients and Methods. This population-based cohort study extracted data of patients with lung cancer from the Taiwan National Health Insurance database and determined the lung cancer incidence and prevalence during 2002–2014. Histological subtypes were retrieved from the Taiwan Cancer Registry database; survival rates were gathered from the National Death Registry. Average annual percentage changes (APCs) of prevalence, incidence, and overall survival were estimated by joinpoint regression analysis. Results. Age-standardized incidence of lung cancer increased from 45.04 per 100,000 person-years in 2002 to 49.86 per 100,000 person-years in 2014, with an average APC of 0.7 (95% CI = 0.3–1.1; 0.2 in males, 2.0 in females). Lung cancer was more prevalent in male patients, but this increase gradually slowed down. Socioeconomic analysis showed that lung cancer has higher prevalence in patients with higher income level and urban residency. Adenocarcinoma was the most abundant histological subtype in Taiwan (adenocarcinoma-to-squamous cell carcinoma ratio = 4.16 in 2014), with a 2.4-fold increase of incident cases during 2002–2014 (from 43.47% to 64.89% of all lung cancer cases). The 5-year survival rate of lung cancer patients in 2010 was 17.34% (12.60% in male, 25.40% in female), with an average APC of 9.3 (6.3 in male, 11.8 in female) during 2002–2010. Conclusion. Average APCs of prevalence and incidence of lung cancer were 3.1 and 0.7, respectively, during 2002–2014 in Taiwan. The number of female patients and number of patients with adenocarcinoma have increased the most, with incident cases doubling in these years. Facing this fatal malignancy, it is imperative to improve risk stratification, encourage early surveillance, and develop effective therapeutics for lung cancer patients in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Benign prostate hyperplasia, a common disease in elderly men, can be surgically treated with transurethral resection of the prostate (TURP). Postoperative sexual dysfunction is a major issue and is influenced by many factors. The present study aimed to assess whether the intraoperative resected prostate weight influences the probability of postoperative sexual dysfunction.Methods: This population-based study included 41,574 patients from the Nation Health Insurance Research Database who had undergone TURP once between 1997 and 2013. All patients were divided into three groups according to the resected prostate weight (low, medium, and high groups). Perioperative risk factors influencing sexual function were analyzed. The chi-squared test and Fisher's exact test were used to analyze differences in demographic data. The Cox proportional hazard regression analysis was used to analyze the HRs. All statistical analyses were two-sided, and a P-value <0.05 was considered statistically significant.Results: Of the 41,574 patients, 1,168 had postoperative sexual dysfunction after surgery. The incidence was not significantly different among the three resected prostate weight groups. Younger patients and patients with histories of chronic renal disease, ischemic heart disease, and obesity had higher prevalence of postoperative sexual dysfunction. Additionally, the onset time of sexual dysfunction was not significantly different among the three resected prostate weight groups.Conclusion: Among patients undergoing TURP in Taiwan, the resected prostate weight does not seem to be related to the presence or onset time of postoperative sexual dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: Atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is associated with increased mortality, mainly mediated by increased thromboembolic events and progressive heart failure. Many studies suggested inhibition of renin-angiotensin-aldosterone system (RAAS) could reduce new AF in various clinical conditions. However, evidence concerning the effects of RAAS inhibitors on AF prevention remains unclear in HCM. Our study is to investigate whether treatment with ACE inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) could lower the risk of new AF in HCM.Methods: We conducted a retrospective study including subjects diagnosed HCM between January 1997 and December 2013 by using a nationwide database covering almost all Taiwanese from National Health Research Institute. All participants, aged 18 or older, had no ACEIs or ARBs exposure or AF diagnosis before enrolment. Propensity score matching and multivariate Cox hazard regression were employed to estimate the risk of new AF occurrence.Results: Total 18 266 subjects were included in the analysis with median follow-up duration 8.13 years. Patients taking ACEIs or ARBs are associated with lower risk of developing new AF than those without taking neither of medications (3.16% vs 5.65%, relative risk 0.56 (95% CI 0.49 to 0.64), HR 0.572 (95% CI 0.480 to 0.683)). The correlation is more prominent with longer ACEIs or ARBs treatment (HRs from T1 to T3: 0.741, 0.579, 0.337, P<0.001). These results remain consistent after propensity score adjustment.Conclusion: In patients with HCM, lower risk of new AF is observed in patients treated with either ACEIs or ARBs compared with those receiving neither of these medications. [ABSTRACT FROM AUTHOR]

Background: To evaluate the predictive validity of sarcopenia defined by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project among Asian older adults.Methods: Data of the I-Lan Longitudinal Aging Study were obtained for analysis. Overall, 1,839 community-dwelling people aged 50 years and older, capable of completing a 6-m walk, with life expectancy of more than 6 months, and not institutionalized at time of data collection were enrolled for study. Data for subjects aged 65 years and older were obtained for study. The outcome measures were all-cause mortality and a composite adverse outcome which includes hospitalizations, emergency department visits, institutionalization, and falls.Results: Data of 728 eligible elderly participants (73.4 ± 5.4 years; 52.9% males) were analyzed. The prevalence of FNIH-diagnosed sarcopenia was 9.5%: 11.9% males; 6.7% females. Participants having FNIH-defined sarcopenia were considerably older, frailer, more obese, with poorer physical performance than nonsarcopenic subjects (All p < .001); during mean follow-up of 32.9 ± 8.8 months, they also had 3.8 times higher risk of dying, independent of age, sex, multimorbidity, cognitive function, and nutritional status (hazard ratio = 3.8; 95% confidence interval = 1.26-11.45; p = .018). Moreover, sarcopenia defined by grip strength-BMI ratio (WeakBMI) showed stronger association with composite adverse outcomes than traditional handgrip strength (hazard ratio = 1.99; 95% confidence interval = 1.01-3.93; p = .047 vs hazard ratio = 1.80; 95% confidence interval = 0.89-3.62; p = .102 in fully-adjusted model).Conclusion: Among community-dwelling older people in Taiwan, participants with FNIH-defined sarcopenia had a significantly greater risk of all-cause mortality and composite falls, emergency department visits, institutionalization, and hospitalization. [ABSTRACT FROM AUTHOR]

Technology-based entrepreneurship education has recently been promoted in Taiwan. The promotion is based on the notion of how technology can enhance economic growth and innovation. The impact of educational programs on entrepreneurial intentions and learning, however, is an issue of discussion. This paper presents a case study of a technology-based entrepreneurship course at a Taiwanese research university. The study aims to investigate how the course aligns with the students' learning experiences. To this end, a qualitative research approach is utilized whereby interviews, focus group discussions, and class material are the main data sources. The findings suggest the difficulty in setting appropriate goals with technology-based entrepreneurship courses. Expectedly, it is difficult to achieve quick technology commercialization results due to the students' inexperience, short course lengths, and the (often) technological immatureness. Goals, such as interdisciplinary and reflective learning, understanding the entrepreneurial processes, and fostering entrepreneurial mindsets, should therefore be emphasized more. However, as the study is based on the findings of a single educational course, it is limited in its generalizability. Nonetheless, it offers an example of the merits and challenges with entrepreneurship education in Taiwan. As such, it provides suggestions for educational and policy action which would go beyond the researched course. [ABSTRACT FROM AUTHOR]

Although organ transplantation is the definitive treatment for end-stage organ failure, the post-transplant outcomes can be substantially influenced by cardiovascular complications. A national cohort study was performed to estimate risks of cardiovascular diseases in those with heart, lung, kidney, and liver transplantation. This cohort study consisted of 5978 solid organ transplantations identified using the Taiwan National Health Insurance Database. Cardiovascular and mortality risks in transplant recipients were evaluated using standardized incidence ratios, excess absolute risks, and standardized mortality ratios as compared to those in the general population. In heart, kidney, and liver recipients, the standardized incidence ratios of overall cardiovascular diseases were 9.41 (7.75-11.44), 3.32 (2.29-3.77), and 1.4 (1.15-1.7) and the overall standardized mortality ratios were 5.23 (4.54-6.03), 1.48 (1.34-1.63), and 3.95 (3.64-4.28), respectively. Except for heart organ recipients who were at highest risk for coronary artery disease with a standardized incidence ratio of 13.12 (10.57-16.29), kidney and liver organ recipients had a ninefold increased risk in developing deep vein thrombosis post-transplant. In conclusion, solid organ transplant patients are at risk of cardiovascular disease, in particular, deep vein thrombosis, which may warrant early identification of high-risk patients in addition to prompt and adequate thromboprophylaxis perioperatively. [ABSTRACT FROM AUTHOR]

Background/Aims: With the recent progress in medical treatment, surgery still plays a necessary and important role in treating ulcerative colitis (UC) patients. In this study, we analyzed the surgical results and outcomes of UC in Taiwan in the recent 20 years, via a multi-center study through the collaboration of Taiwan Society of IBD. Methods: A retrospective analysis of surgery data of UC patients from January 1, 1995, through December 31, 2014, in 6 Taiwan major medical centers was conducted. The patients' demographic data, indications for surgery, and outcome details were recorded and analyzed. Results: The data of 87 UC patients who received surgical treatment were recorded. The median post-operative follow-up duration was 51.1 months and ranged from 0.4 to 300 months. The mean age at UC diagnosis was 45.3±16.0 years and that at operation was 48.5±15.2 years. The 3 leading indications for surgical intervention were uncontrolled bleeding (16.1%), perforation (13.8%), and intractability (12.6%). In total, 27.6% of surgeries were performed in an emergency setting. Total or subtotal colectomy with rectal preservation (41.4%) was the most common operation. There were 6 mortalities, all due to sepsis. Emergency operation and low pre-operative albumin level were significantly associated with poor survival (P =0.013 and 0.034, respectively). Conclusions: In the past 20 years, there was no significant change in the indications for surgery in UC patients. Emergency surgeries and low pre-operative albumin level were associated with poor survival. Therefore, an optimal timing of elective surgery for people with poorly controlled UC is paramount. [ABSTRACT FROM AUTHOR]

Background/purpose: We aim to evaluate the accuracy of the new prehospital notification criteria for patients with potential acute stroke in the prehospital setting.Methods: We conducted a retrospective observational study from March 2011 to February 2013 of potential acute stroke patients prenotified using the new criteria which were: (1) positive Cincinnati Prehospital Stroke Scale (CPSS); (2) symptom onset within 3 hours; and (3) blood glucose level > 60 mg/dL. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the new criteria were calculated and outcomes of acute stroke patients were reported. Data of all patients with stroke or transient ischemic attack (TIA) transported to the destination hospital were also obtained to evaluate the compliance of emergency medical technicians.Results: There were 2888 patients suspected of stroke by emergency medical technicians and 221 patients prenotified due to meeting the criteria. The PPV, NPV, sensitivity, and specificity of the new criteria were 76.9%, 96.6%, 64.9%, and 98.1%, respectively. Onset time > 3 hours (24/51, 47.1%) and seizure (27.5%) were the two most common conditions leading to false prenotification. Of all prenotified patients, 23.1% (51/221) received thrombolytic therapy. Hemorrhagic stroke or ischemic stroke with hemorrhagic transformation (53.8%) and minor symptoms or rapid recovery (26.9%) were the most common reasons excluding correctly prenotified patients from thrombolytic therapy.Conclusion: The accuracy of the new prehospital stroke criteria has higher PPV and specificity compared to previous CPSS validation studies. [ABSTRACT FROM AUTHOR]

Due to worldwide concerns on the utilization of fossil fuels and the resulting increase in global carbon emissions, many governments have begun promoting renewable and green energies as alternatives to fossil energy. Wind power is currently one of the most mature renewable energy technologies. Although Taiwan is located in a region with abundant wind power, this energy industry still faces major challenges in growing the market. This study employs hidden Markov models (HMM) to analyze the development of the Taiwanese wind power industry. Because renewable energy development is determined by multiple time-series-related factors, we use a variation of the HMM, called the hidden Markov model with multiple feature streams (HMM/MFS), to simultaneously consider distinct factors influencing the development trends of renewable energy. The results show that our forecast model can make accurate projections of Taiwan's installed wind power capacity, which can be used to assist industry in making correct investment decisions and to provide recommendations to the government for setting suitable green energy policies. [ABSTRACT FROM AUTHOR]

Background: Resilience embodies the personal qualities that enable one to thrive in the face of adversity and is a significant factor affecting the health of patients with mental illness. Most research on resilience has focused on patients in high-risk groups. Thus, there is lack of research exploring the resilience of psychiatric patients and related factors. Purpose: The aims of the present study were to (1) explore the relationships among demographic characteristics, psychiatric symptoms, perceived stress, medical professional-patient interaction, social support, social adaptive function, and resilience and (2) identify indicators of resilience in psychiatric patients. Methods: A total of 180 psychiatric patients were recruited from a mental hospital in eastern Taiwan. The brief psychiatric rating scale, perceived stress scale, questionnaire of medical professional-patient interaction and social support, Connor-Davidson Resilience Scale (CD-RISC), and social adaptive function scale were used to collect data. Results: Participants in the present study showed an intermediate level of resilience. Resilience scores correlated positively with medical professional-patient interaction and social support and negatively with perceived stress, social adaptive function, and psychiatric symptoms. Stepwise multiple regression analysis indicated that perceived stress, social support, education, and social adaptive function collectively accounted for 45.3% of the total variance. Conclusion / Implications for Practice: For psychiatric patients, enhancing social support and social adaptive function and decreasing perceived stress improves their resilience and decreases the frequency of their psychiatric episodes, thus increasing their chances of returning to society. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhea is a major problem in the general gynecology clinic. It causes discomfort among healthcare staffs and significant losses in terms of time and finances. Purpose: The purpose of this study was to determine the affected factors of dysmenorrhea and evaluate the self-perceived efficacy of relief methods. Methods: A cross-sectional research design was used to collect data. Participants included 586 female students enrolled at a college in southern Taiwan. Data was analyzed using a t-test, one-way ANOVA, and Scheffe test. Results: Traditional Chinese medicine pattern identifications related significantly to dysmenorrhea frequency perception. Lifestyle characteristics related significantly to dysmenorrhea level perception. Using shenghua decoction, siwu and pig blood decoction, Angelica drink, ginger, ziziphus jujube, brown sugar tea, and analgesics all related significantly to dysmenorrhea relief efficacy. Conclusions / Implications for Practice: Strategies found to help relieve dysmenorrhea level perception include increasing the duration and regularity of sleep and avoiding the consumption of pungent foods. Seeking and adhering to physician recommendations can also increase dysmenorrhea self-care efficacy. Dysmenorrhea-relief courses should be improved in hospitals and schools to assist women to self-manage dysmenorrhea more effectively. [ABSTRACT FROM AUTHOR]

Background. Traditional Chinese medicine (TCM), when given as a therapy for symptom relief, has gained widespread popularity among diabetic patients. The aim of this study is to analyze the utilization of TCM among type 2 diabetic patients in Taiwan. Methods. The use of TCM for type 2 diabetic patients were evaluated using a randomly sampled cohort of 1,000,000 beneficiaries recruited from the National Health Insurance Research Database. Results. Overall, 77.9% (n = 31,289) of type 2 diabetic patients utilized TCM and 13.9% (n = 4,351) of them used TCM for the treatment of type 2 diabetes. Among the top ten most frequently prescribed herbal formulae, four remedies, Zhi-Bo-Di-Huang-Wan, Qi-Ju-Di-Huang-Wan, Ji-Sheng-Shen-Qi-Wan and Ba-Wei-Di-Huang-Wan ure derivative formulae of Liu-Wei-Di-Huang-Wan. In other words, Liu-Wei-Di-Huang-Wan and its derivatives were found to be the most common herbal formulae prescribed by TCM doctors for the treatment of diabetes in Taiwan. Conclusion. Although some evidence does support the use TCM to treat diabetes, the results from the current study may have been confounded by placebo effect, which emphasize the need for well conducted, double-blind, randomized, placebo-controlled studies in order to further evaluate the efficacy of Liu-Wei-Di-Huang-Wan on patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Lactobacillus plantarum K68 (isolated from fu-tsai) and fruit-vegetable ferment (FVF) have been tested for antidiabetic, antiinflammatory, and antioxidant properties in a rat model of insulin resistance, induced by chronic high fat-fructose diet. Fifty rats were equally assigned into control (CON), high fat-fructose diet (HFFD), HFFD plus K68, HFFD plus FVF, and HFFD plus both K68 and FVF (MIX) groups. Respective groups were orally administered with K68 (1 x 109 CFU/0.5mL) or FVF (180mg/kg) or MIX for 8 weeks. We found that HFFD-induced increased bodyweights were prevented, and progressively increased fasting blood glucose and insulin levels were reversed (P < 0.01) by K68 and FVF treatments. Elevated glycated hemoglobin (HbA1e) and HOMA-IR values were controlled in supplemented groups. Furthermore, dyslipidemia, characterized by elevated total cholesterol (TC), triglyceride (TG), and low-density lipoproteins (LDLs) with HFFD, was significantly (P < 0.01) attenuated with MIX. Elevated pro-inflammatory cytokines, interleukin-lβ (IL-1β), IL-6, and tumor necrosis factor-α (TNF-α), were controlled (P < 0.01) by K68, FVF, and MIX treatments. Moreover, decreased superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were substantially (P < 0.01) restored by all treatments. Experimental evidences demonstrate that K68 and FVF may be effective alternative medicine to prevent HFFD-induced hyperglycemia, hyperinsulinemia, and hyperlipidemia, possibly associated with anti-inflammatory and antioxidant efficacies. [ABSTRACT FROM AUTHOR]

Objectives. Endoscopic submucosal dissection (ESD) is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1) lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG) ?20mm and laterally spreading tumors-granular type (LST-G) ?30 mm; (2) lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3±12.9 years, and themale-female ratio was 1.8 : 1.Themean tumor size was 37.2±17.9 mm. The en bloc resection rate was 90.2% and the R0 resection rate was 89.1%. Perforations during ESD occurred in 11 patients (12.0%) and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESDis an effectivemethod for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD. [ABSTRACT FROM AUTHOR]

In Vietnam, Taiwanese (In this article, 'Taiwanese' refer to all the citizens in Taiwan, although Taiwanese may not be a perfect usage for all the inhabitants in Taiwan. For example, some 400,000 natives of JinMen County live and work in Taiwan Province who might not identify with Taiwan Province. Also, many Vietnamese women in the ROC marry 'Taiwanese.' Perhaps it will take a few decades, if not longer, for all the inhabitants in Taiwan to identify with "Taiwanese.") businesses have led the Taipei government in the movement to 'Go South.' They have served as pioneers, surrogates and middlemen for Taiwan's economic diplomacy in Vietnam. Vietnam's 'Doi Moi' (Open Door) policy, inaugurated in December 1986, encouraged greater openness to economic investment from abroad. Compared with China, Vietnam enjoys the privilege of better access to the European market. Vietnam has become the only country in Southeast Asia that can parallel China in terms of trade and investment at the turn of the century. [ABSTRACT FROM AUTHOR]

Background: Shivering during regional anesthesia is a common complication and is related to a decrease in the patient’s core body temperature. Previous studies have shown that acupuncture on specific acupoints can preserve core body temperature. The present study evaluated the effect of electroacupuncture in preventing the shivering caused by regional anesthesia, Methods: This prospective and randomized controlled study analyzed the data from 80 patients undergoing urological surgery, who were classified as ASA I or II. Spinal anesthesia was performed in all patients using 15 mg of bupivacaine. The patients were randomly allocated to receive either placebo acupuncture (Group P, n = 40) or electroacupuncture (Group A, n = 40) for 30 min before administration of spinal anesthesia. Shivering score was recorded at 5 min intervals, with 0 representing no shivering and 4 representing the most severe shivering possible. Heart rate, blood pressure, and tympanic temperature were recorded before the intrathecal injection, and again every 5 min thereafter until 30 min.Results: After spinal anesthesia, the decrease in tympanic temperature was less for Group A patients than Group P,with the difference being statistically significant. After 15 min, 13 patients in Group P attained a shivering score of 3or more, compared with 3 patients in Group A. Significantly more patients in Group P attained a shivering score of at least 1.Conclusions: The prophylactic use of electroacupuncture might maintain core body temperature, and may effectively prevent the shivering that commonly develops during regional anesthesia. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12612000096853. [ABSTRACT FROM AUTHOR]

To examine the relationships between depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Taiwan. Research suggests associations between depression, metabolic syndrome and quality of life. Despite this fact, few studies have investigated these relationships among Taiwanese. A cross-sectional descriptive correlational design was used to conduct this study. A convenience sample of 140 adults participated in the study. Data were analysed with descriptive statistics, Pearson's correlations, hierarchical regression and t-tests. Almost a half of the subjects (46·5%) had metabolic syndrome. The most common combination of metabolic syndrome criteria was elevated blood glucose, central obesity and high blood pressure (23·7%). A greater number of individuals had coronary artery disease (72·9%), type 2 diabetes (35%) and/or depression (21·4%). Type 2 diabetes and depression were significant predictors of overall quality of life (β = −0·16, p < 0·01 and β = −0·63, p < 0·001, respectively). In addition, there were significant differences between individuals with and without type 2 diabetes and/or depression regarding overall quality of life scores; t (138) = 3·50, p < 0·01); and t (138) = 7·80, p < 0·001), respectively. Coronary artery disease, type 2 diabetes and depression were common among our sample of individuals with metabolic syndrome. Those with diabetes and/or depression had worse quality of life than those without those diseases. Nurses need to be prepared to assess and intervene in preventing or treating depression among patients with chronic diseases, especially those with coronary artery disease, type 2 diabetes and metabolic syndrome. When individuals are treated for depression, they are more likely to engage in self-management of their diseases, which will prevent complications and improve their quality of life. [ABSTRACT FROM AUTHOR]

Aims. The purposes of this study were to examine the associations among social support, poststroke depression and quality of life among patients with first-time ischemic stroke and to further test the impact of the dimensions of social support on poststroke depression and quality of life. The proposed models included mediation hypotheses to examine the mediating roles of social support. Background. Although considerable attention has recently been devoted to explaining why poststroke depression and poor quality of life are frequent concomitants of stroke, little empirical work has been conducted to test predictions based on these models, especially in Taiwan. Design. A cross-sectional, descriptive correlation design was used. Methods. The 102 patients with first-time ischemic stroke aged 32-90 (mean = 64·5, SD 11·8) were recruited from a large general hospital in Taiwan and through face-to-face survey interviews. The participants were assessed using the Social Support Inventory, Centre for Epidemiologic Studies Depression Scale, Barthel Index, the Instrumental Activities of Daily Living and Quality of Life Index-Stroke Version. The models were tested and confirmed through the application of structural equations with proposed variables. Results. Nearly half of the Taiwanese patients with stroke felt depressed. Social support fully mediated the prediction of quality of life by age and partially mediated the prediction of quality of life by functional ability. Social support partially mediated the prediction of poststroke depression by functional ability. Conclusion. This study provides researchers and nurses with increased understanding of the mediating role of social support between functional ability and poststroke depression/quality of life. Social support may be a promising intervening variable in stroke outcome. Relevance to clinical practice. The results suggest several clinical implications. The inclusion of social support in poststroke depression and quality of life after stroke may help nurses in planning stroke programme development, patient education, effective and efficient use of health care resources and effective rehabilitation, especially in those individuals who lack support or who are involved in stressful situations. [ABSTRACT FROM AUTHOR]

Purpose - Imitative innovation, defined as applying innovation in the same way in another organization, has been adopted by many companies. This paper seeks to focus on how a competent follower of R&D capability can employ such an innovative strategy and minimize risk by using existing organizational resources to enhance innovation capabilities. Design/methodology/approach - An in-depth case study is applied of resource management experience at a Taiwanese optical storage media manufacturing outlet and then the Sirmon resource management model is extended to offer a process model for imitative innovation capability development. Findings - The imitative innovation process is deconstructed into four phases and three main sub-processes for effective resource management, namely, structuring, bundling and leveraging activities. The study also found that there are four modes of effective resource management for a successful imitative innovation process: identifying position and confirming innovation strategy; examining core competences and exploring gaps in imitative innovation; deploying specific resources and complementary assets; and restructuring an industry's ecological environment. Originality/value - The study offers researchers and practitioners a more detailed view of applicable resource management for successful imitative innovation. [ABSTRACT FROM AUTHOR]

Aims and objectives. This study examined the relationships among stressors, social support, depressive symptoms and the general health status of Taiwanese caregivers of individuals with stroke or Alzheimer’s disease. Background. Caring for a disabled or cognitively impaired person can be extremely stressful and often has adverse effects on caregivers’ health. While research on caregiving in Taiwan has examined caregivers’ characteristics, caregivers’ need and caregivers’ burden in caring for older people in general, little is known about Taiwanese caregivers of individuals with stroke or Alzheimer’s disease. Design. Cross-sectional, descriptive correlation design. Methods. Data were obtained from a convenience sample of 103 Taiwanese informal caregivers in the South of Taiwan and analysed using descriptive statistics, Pearson’s correlations, multiple and hierarchical regressions and t-tests. Results. Caregivers who had lower household incomes and were taking care of individuals with more behaviour problems had more depressive symptoms. In addition, caregivers who were older and were taking care of individuals with more behaviour problems had worse general health. Caregivers who had more emotional support had less depressive symptoms. Conclusions. Caregivers of persons with Alzheimer’s disease had more depressive symptoms and worse general health than caregivers of persons with stroke. Only emotional support moderated the relationship between one of the stressors (household income) and depressive symptoms. Relevance to clinical practice. The findings of this study may be helpful for nurses and other health care professionals in designing effective interventions to minimise the negative impacts of stressors on the psychological and general health of caregivers in Taiwan. [ABSTRACT FROM AUTHOR]

It is well recognized that patients with diabetes encounter a host of daily self-care issues, including controlling blood sugar and preventing and managing complications, which impact significantly upon quality of life. Studies have indicated that learned resourcefulness has a potentially positive effect in dealing with psychosocial and health problems. The purpose of this study was to test the relationship between learned resourcefulness and quality of life in type II diabetic patients. The mediating and moderating effects of learned resourcefulness on the relationship between metabolic control and quality of life of diabetic patients was also examined. This cross-sectional and correlational study included a convenience sample of 131 type II diabetic patients recruited from three hospitals in southern Taiwan. Data were collected through questionnaires, which included the Rosenbaum's Self Control Schedule and World Health Organization's Quality of Life (Short Version). Multiple regression techniques were used to analyze outcome predictors. Study findings include identification of a mediating effect of learned resourcefulness between metabolic control and quality of life. While most DM patients were not satisfied with their health, we found that those with greater learned resourcefulness enjoyed a better quality of life. Learned resourcefulness, gender, and HbAjC explained 35.2% of variance in DM patient quality of life. Male diabetic patients enjoyed a better quality of life than females, even though levels of learned resourcefulness between the two groups were not significantly different. Results indicate that poor metabolic control of diabetic patients has a detrimental effect on quality of life, and when diabetic patients use more self-control skills, they may achieve better quality of life. Results suggest that nurses who use cognitive behavior coping strategies (resourcefulness) may help diabetic patients achieve better metabolic control and promote better quality of life. [ABSTRACT FROM AUTHOR]

The main purpose of this study was to investigate the relationship between masturbatory knowledge and masturbatory attitudes among Taiwan adolescents. This study was based on a structured questionnaire survey that used the Adolescent Masturbatory Knowledge Inventory (AMKI) and the Adolescent Negative Attitude toward Masturbation Inventory (ANAMI). Subjects were recruited from the third grade of high school and vocational school students aged 17 --18 living in Kaohsiung (southern Taiwan) using stratified and cluster sampling approaches. Seven hundred and eighty questionnaires were sent out, with a 96.8% response rate. A total of 95.3% of male subjects and 30.3% of female subjects reported having masturbation experience. Masturbatory knowledge was significantly related to the variables "school system", "frequency of viewing pornographic media", "status of being sexually active", and "conversation about sex with friends". Masturbatory attitudes were significantly associated with the same variables as well as with gender and masturbatory behavior. Masturbatory attitudes were positively correlated with masturbatory knowledge. The school system explained 15.4% of masturbatory knowledge variance. Masturbatory knowledge, masturbatory behavior, frequency of viewing pornographic media and status of being sexually active explained 39.5% of masturbatory attitude variance. In conclusion, adolescents in Taiwan hold positive attitudes toward masturbation and reported having insufficient knowledge regarding masturbation. Results can assist school staffs and parents to gain a deeper understanding of adolescents' knowledge about and attitudes toward masturbation. [ABSTRACT FROM AUTHOR]

Aim: Several different genetic defects have been found to result in the characteristic phenotypic expression of Prader–Willi syndrome (PWS). Methods: We performed a retrospective analysis of 67 cases of molecularly confirmed PWS diagnosed from January 1980 through July 2006 in five medical centres in Taiwan. Clinical manifestations were compared between patients with deletion and those with maternal uniparental disomy (UPD). Results: Deletion was present in 56 (84%), UPD in 10 (15%), and a probable imprinting centre deletion or imprinting defect in 1 (1%). PWS with deletion was more likely than that with UPD to be characterized by hypogonadism (p < 0.001), small hands and feet (p < 0.001), and hypopigmentation (p < 0.002). Both maternal (p = 0.015) and paternal age (p = 0.021) were higher in the UPD group. No other clinical features differed significantly different between the two groups. Conclusion: In contrast to most Western populations with a higher incidence of UPD, this study of PWS in Taiwan shows a higher incidence of deletion. There may be subtle phenotypic differences between the UPD and deletion genotypes, but its not clear that these are important clinically. [ABSTRACT FROM AUTHOR]

Background: Prader–Willi syndrome (PWS) is a congenital disorder caused by absent expression of paternal genes in 15q11-13 affecting multiple systems. The information concerning the clinical features of this genetic disorder is incomplete in Taiwan. Methods: A retrospective analysis was carried out of 70 PWS patients (39 male, 31 females; age range, 1 month–22 years) seen in four major medical centers in Taiwan from January 1980 through June 2005. All cases were confirmed by methylation-specific polymerase chain reaction. The molecular characteristics, birth history, clinical presentation and laboratory studies were analyzed. Results: Complete genetic analysis was performed in 52 of the 70 patients with PWS. The abnormalities found included deletions in 45 (87%), maternal uniparental disomy (UPD) in five (10%), and a probable imprinting center deletion or an imprinting defect in two (4%). The average weight of the patients at birth was 2588 ± 540 g. Bone age delay of >2 years and growth hormone (GH) deficiency were noted in 11/40 (28%) and 12/20 (60%), respectively. In the 18 in whom both bone age and GH were assessed, abnormalities of both were found in two (11%). In 2000, Taiwan instituted the Rare Diseases and Orphan Drugs Act and mandated a three-phase screening protocol for PWS. Of the 41 patients diagnosed with PWS before 2000, only four (10%) were diagnosed before the age of 3 months; in the 29 patients diagnosed after 2000, in 15 (52%) the syndrome was confirmed before 3 months of age ( P < 0.001). Conclusions: The present finding is in contrast to that of most previous reports that indicated a higher incidence of UPD in PWS. It is unclear whether this discrepancy in the incidence of UPD arises from under-diagnosis or because of ethnic differences, a question worthy of further study. The three-phase screening protocol has generated notable improvement in the early diagnosis of PWS in Taiwan. [ABSTRACT FROM AUTHOR]

Sanfujiu is a treatment method of applying herbal paste onto the acupoints Fengmen and Feishu during the three hottest days of summer to treat patients with allergies. The objectives of this study were to determine the treatment efficacy at 1 year after the Sanfujiu treatment, and examine variations in the perceived efficacy of Sanfujiu among different subgroups, based on the patients' ages, diagnoses and number of reactive symptoms immediately after the treatment. We enrolled 105 patients who completed Sanfujiu treatment at a medical university hospital in Taipei as the subjects. One year after treatment, trained interviewers conducted telephone interviews with the patients. ApproximateIy 60% of them perceived the treatment as being effective at 1 year later, which was higher than that at I week after treatment (45.7%), Younger subjects (<19 years of age) and patients with asthma were more likely to report the treatment as being effective. Patients who had more reactive symptoms after the third Sanfujiu treatment were more likely to report the treatment as being effective. The results demonstrated that Sanfujiu was moderately effective, as perceived by patients in Taiwan, in treating their allergic symptoms. [ABSTRACT FROM AUTHOR]

Several criteria affect bidding decisions. Current bidding models determine a markup based on a fixed project construction cost. This work presents a novel bid price determination procedure that is built by integrating a simulation-based cost model and a multi-criteria evaluation model. The cost model is used to consider cost uncertainties and generate a bid price cumulative distribution, whereas the multi-criteria evaluation model applies pairwise comparisons and fuzzy integrals to reflect bidder preferences regarding decision criteria. The relationship between the two models is based on a practical phenomenon in that a bidder has a high probability of winning when criteria evaluations favor his bid, and, consequently, the bidder would bid a low price, and vice versa. The merits of the proposed procedure are demonstrated by its application to two construction projects in Taiwan. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the relationship of demographic characteristics, contextual factors, social support, and coping on health outcomes of family caregivers of older adults with dementia in Taiwan. This study also examined caregiving stress and whether support moderated the effects of caregiver stress on health. Lazarus and Folkman's (1984) Stress model guided this study. The descriptive cross-sectional study included subjects who were primary family caregivers of older adults with dementia from two settings in southern Taiwan. A convenience sample of 148 participants was interviewed. Data analysis consisted of Pearson's correlations, and simple and multiple regression analysis. Findings indicated that younger caregivers, those with paid assistants, and those with longer duration of caregiving had better health. Females with lower income and without assistants had more depressive symptoms. In addition, moderating effects of social support were supported. The results from this study provided a basis for developing interventions to minimize negative impacts on caregivers. [ABSTRACT FROM AUTHOR]

Researchers have often attributed the farm–wholesale price spread, after adjusting for marketing costs, as compensation for marketing firms' risk bearing. However, price spreads in excess of marketing costs can also be due to marketing firms' exercise of market power. In settings where both imperfect competition and marketer risk aversion are plausible, a modeling framework must be sufficiently general to accommodate both types of behavior. This article develops and estimates such a model in the context of fresh produce marketing and develops the implications for analysis of supply-control programs. The model is applied to the production and marketing of Chinese cabbage in Taiwan and specifically to the analysis of supply-control programs implemented in this industry by the Taiwanese government. The empirical results provide little support for the hypothesis that marketing firms exhibit risk averse behavior, but they do show that marketing firms exercise oligopsony power in procurement of the product from farmers, and that this power is positively related to the quantity supplied in each market period. This provides a heretofore unexplored impetus for supply controls intended to raise producer incomes. However, such controls are also rendered less effective by imperfect competition because marketing firms capture part of the benefits from supply reduction. [ABSTRACT FROM AUTHOR]

Fruits and vegetables have been known to contain a variety of antioxidant components. It has been suggested that antioxidants may protect biomolecules from oxidative damage and therefore be associated with reduced risks of cardiovascular disease and certain cancer. The antioxidant abilities of various parts of eight common fruits and vegetables produced in Taiwan were investigated, including tomato, guava, squash, tangerine, wax gourd, pineapple, chayote, and eggplant. Squash, wax gourd, tomato, and guava seeds showed the highest antioxidant activities in thiobarbituric acid assay. Wax guard and squash seeds showed the highest antioxidant activities in iodometric assay. At the level of 1 g fresh sample, low-density lipoprotein peroxidation was inhibited by at least 90% by tomato meat, guava meat, squash seed, wax gourd meat, core, and seed, and eggplant skin. The total phenolic content was significantly correlated with antioxidant activities measured by thiobarbituric acid (r = 0.715, P <0.01) and iodometric (r = 0.749, P <0.01) assays. The results of this study could be used for development of merchandise with potential health benefits from agricultural products. [ABSTRACT FROM AUTHOR]

Little information was found in studying Taiwanese children's pain experiences. Because pain is culturally shaped, health care providers should not assume Taiwanese children's pain to be identical to those of children in the US. Thus, a qualitative descriptive study with semi-structured interview of 90 hospitalized Taiwanese children with acute pain was conducted to understand Taiwanese children's pain experiences. Krippendorff's (1980) content analysis was used to guide the data analysis. Seven themes from the interview data were presented, including definition of pain, quality of pain, previous pain experiences, pain expectation, pain acceptance, causes of pain and meaning of pain. Surprisingly, the results of this study revealed few differences in the experiences and meanings of pain. Most results are consistent with the studies done in the US. Differences are minor, including the interpretation of children's crying and how Taiwanese parents talk with their children about pain, and are probably related to the sample sizes and methodology of the studies. Further research is necessary about the influence of culture upon children's pain experiences. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) recurrence after liver transplantation is associated with immunosuppressants. However, the appropriate immunosuppressant for HCC recipients is still debated. Data for this nationwide population-based cohort study were extracted from the National Health Insurance Research Database of Taiwan. A total of 1250 liver transplant recipients (LTRs) with HCC were included. We analyzed the risk factors for post-transplant HCC recurrences. Cumulative defined daily dose (cDDD) represented the exposure duration and was calculated as the amount of dispensed defined daily dose (DDD) of mycophenolate mofetil (MMF). The dosage effects of MMF on HCC recurrence and liver graft complication rates were investigated. A total of 155 LTRs, having experienced post-transplant HCC recurrence, exhibited low survival probability at 1-, 3-, 5-, and 10-year observations. Our results demonstrated increased HCC recurrence rate after liver transplantation (p = 0.0316) following MMF administration; however, no significant increase was demonstrated following cyclosporine, tacrolimus, or sirolimus administration. Notably, our data demonstrated significantly increased HCC recurrence rate following MMF administration with cDDD > 0.4893 compared with cDDD ≤ 0.4893 or no administration of MMF (p < 0.0001). MMF administration significantly increases the risk of HCC recurrence. Moreover, a MMF-minimizing strategy (cDDD ≤ 0.4893) is recommended for recurrence-free survival. [ABSTRACT FROM AUTHOR]

With changes in the political system and the economic explosion in the Great China region, sport business has gradually grown in the past two decades. Therefore, the purpose of this paper is to examine the evolution of the sport industry in the Great China region, specifically in China and Taiwan. The findings of this paper may be used as an information source for policy making in the sport industry and for curriculum design in sport management-related academic programmes. After a thorough analysis, several major conclusions are made as follows: 1. The export of sporting goods plays an important role in improving the national economy, but domestic demand on sporting goods is relatively weak. To sustain intensive competition, R&D and branding are the keys to the future. 2. The professional sport sector is still in the infant stage and only a few sports are organised under a professional sport structure. An essential task of the sector is to train young, talented athletes, and to enhance managerial competency of professional sport organisations. 3. The promotion of other sport industrial segments, such as venue construction and sport agencies, relies upon cooperation with foreign corporations and investment incentives from the government. [ABSTRACT FROM AUTHOR]

Ocimum gratissimum is used as a traditional folk medicine in many countries. The objective of this study was to evaluate the antioxidant activities of an aqueous O. gratissimum extract (OGE) and to evaluate its cytoprotective activity against hydrogen peroxide-induced toxicity in human HepG2 cells. The results revealed that the total phenolic content of the OGE reached 20%. In the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, the OGE reduced up to 80% of the free radicals at a plateau concentration of 66.7 mg/mL. This indicates that OGE contains considerable free radical scavenging activity. In a dose-dependent manner, OGE pretreatment counteracted the decrease in cell viability in H2O2-treated HepG2 cells ( p < 0.05), and at a concentration of 20e80 mg/mL, it effectively reduced thiobarbituric acid reactive substance (TBARS) formation. These findings indicated that the aqueous extract of O. gratissimum has an antioxidant capacity and protective effect on oxidative stress in HepG2 cells. This makes OGE a promising therapeutic agent in liver diseases. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) carries significant morbidity and mortality. No previous studies have investigated the long-term outcomes of ARDS patients in Taiwan. Objective; This study aimed to investigate the survival of ARDS patients after discharge from the hospital in Taiwan. Methods: Medical records from 150 ARDS patients discharged alive from the intensive care unit from January 2004 to June 2009 were reviewed. Survival of these patients was followed for 5 years, and prognostic factors were identified. Results: Cumulative survival rates were 81.4% at 6 months, 79.0% at 1 year, 67.2% at 2 years, and 45.7% at 5 years. Independent prognostic factors influencing both 1- and 5-year survival rates were age, previous lung disease, and disposition after discharge. For 5-year survival, renal disease was also an independent risk factor. Discussion: The mortality rate of ARDS survivors after intensive care unit discharge is still high in Taiwan. Three independent risk factors were found to affect the overall survival of these patients. [ABSTRACT FROM AUTHOR]

Abstract: Concentrations of 17 trace elements were analyzed using inductively coupled plasma-mass spectrometry (ICP-MS) in Formosan squirrels (Callosciurus erythraeus) of Taiwan and Japan to document trace element pollution in Taiwan. High concentrations of elements used to produce semiconductors – Ga, As, Cd, In and Tl – were found in animals captured in Miaoli County, which is the nearest site to Hsinchu City, a chief city of Taiwan’s semiconductor industry. Significant correlations between Ga, As, In and Tl were found in the kidney, liver, lung and muscle tissues of Taiwanese squirrels. Hierarchical cluster analysis indicated that Ga, As, In and Tl were of the same clade, indicating that Ga, As, In and Tl were discharged from an identical origin. Molar ratios of Ga/As concentration in lungs of animals captured in Miaoli resembled those of animals after intratracheal administration of particulate gallium arsenide (GaAs). This result might indicate that the higher concentrations of Ga and As in the specimens in Miaoli resulted from atmospheric exposure to GaAs. [Copyright &y& Elsevier]