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Objective:Sugar-sweetened beverages (SSB) are linked to increased metabolic risk. However, the sex differences in the relationship between SSB intake and adverse health effects remain unclear. Therefore, the present study examined the association between SSB consumption and metabolic risks among working-age males and females from Taiwanese communities.Design:A community-based study utilised data from a comprehensive health screening project conducted by the Public Health Bureau in Changhua County, Taiwan. Metabolic risks included waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, TAG, LDL cholesterol and fasting glucose level using serum tests.Setting:Participants were recruited in Changhua County, Taiwan.Participants:Between 2005 and 2014, 92 724 citizens participated in the health screening; our data analysis included 75 278 respondents between 30 and 64.Results:The results showed that the frequency of SSB consumption was associated with abnormal waist circumference and elevated total cholesterol, TAG, LDL and glucose in both men and women. Increased SSB consumption frequency was associated with elevated glucose and hypertension in women. Even a slight increase in SSB intake frequency was related to raising the metabolic risks. Similar patterns were evident when models included BMI; however, the associations were attenuated. In the BMI-stratified subgroup analysis, the relationship between SSB consumption and metabolic risks was more pronounced in participants without obesity.Conclusion:The present study suggests that SSB consumption carries metabolic risk among working-age Taiwanese, particularly women and those without obesity. Health promotion programmes should raise awareness of the health hazards associated with SSB.

Objective:To explore the factors influencing Taiwanese adolescents’ consumption of sugar-sweetened beverages (SSB) and sugary snacks from a socio-ecological perspective.Design:This study adopted a qualitative design by using face-to-face, in-depth interviews guided by a semistructured questionnaire.Setting:Eight junior high schools in New Taipei City and Changhua County, Taiwan, September to November 2018.Participants:Fifty-nine participants aged 12–14 years participated in this study.Results:Reflexive thematic analysis was used to analyse the data. This study identified four themes to address the multifaceted factors that influence adolescents’ consumption of SSB and sugary snacks. At the intrapersonal level, physiological factors, psychological factors, individual economic factors and taste preferences were mentioned in connection with people’s consumption of SSB and sugary snacks. Positive or negative influences of parents, siblings, peers and teachers on SSB and sugary snack intake were identified at the interpersonal level. The availability of SSB and sugary snacks at home, their availability in vending machines or in school stores in the school environment and participants’ access to convenience stores and hand-shaken drink shops in the broader community influenced SSB and sugary snack consumption. Additionally, food culture and food advertising were identified as influencing societal factors.Conclusions:Overall, this qualitative study determined not only that the consumption of SSB and sugary snacks is influenced by intrapersonal factors but also that interpersonal, environmental and societal factors affect adolescents’ increased sugar intake. The findings are helpful to broaden the options for designing and developing interventions to decrease SSB and sugary snack consumption by adolescents.

Adolescents with obesity are more likely to be isolated by peers, but whether they also choose to disengage from their peers remains unclear.This study examined a sample of 646 adolescents between the age of 13 and 16 across 34 classrooms in 3 junior high schools in Taiwan, with data collected from May to June 2019. The sociometric network nomination method assessed peer relationships, such as unpopularity, unsociability, and alienation. Multilevel models were applied to explore the extent to which the class-level prevalence of overweight and obesity and peer support moderate the relationship between student-level obesity and peer relationships.Overall, students with obesity were more likely to experience unpopularity, unsociability, and alienation from their peers in classroom settings (adjusted odds ratio [AOR] = 1.904, 2.208, 2.777, p .05). Regardless of their obesity status, students in high classroom peer support were less likely to report unsociability (AOR = 0.124, p .05). No cross-level interactions were observed, indicating that students with obesity did not experience a reduction of peer rejection in high peer support classrooms. Neither did obese students in classrooms with higher rates of overweight and obesity.Students with obesity were more likely to experience interpersonal problems. Classroom peer support can increase peer acceptance for typical students but has no beneficial influence on adolescents with weight problems. Classroom peer support needs to be directed to become adequate support for students with obesity.

Yu-Ching Lin,1,2,&ast; Chung-Ying Lin,3– 6,&ast; Chia-Wei Fan,7 Chieh-Hsiu Liu,8 Daniel Kwasi Ahorsu,9 Duan-Rung Chen,10 Hui-Ching Weng,3,11 Mark D Griffiths12 1Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Department of Occupational Therapy, AdventHealth University, Orlando, FL, USA; 8Department of Geriatrics and Gerontology, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 9Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; 10Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan; 11Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 12International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK&ast;These authors contributed equally to this workCorrespondence: Hui-Ching Weng, Institute of Allied Health Sciences and Institute of Gerontology, College of Medicine, National Cheng Kung University, 1 University Road, East District, Tainan City, 70101, Taiwan, Tel +886-6-2353535 ext. 5986, Fax +886-6-3028175, Email hc6127@mail.ncku.edu.twPurpose: The present study compared two nationally representative cohort datasets concerning Taiwan residents’ healthy behaviors, subjective health outcomes, generalized trust, and accessibility to health promotion resources.Patients and Methods: The Taiwan Social Change Survey (TSCS) was conducted in two waves ten years apart: 2011 cohort (n = 1021; 48.4% males) and 2021 cohort (n = 1425; 47.4%) cohorts. Descriptive statistics were calculated to compare the two TSCS datasets. Then, multiple regression models were constructed with health outcome as the dependent variable, and demographics and other key components as independent variables.Results: The 2011 TSCS cohort showed higher prevalence for cigarette smoking (30.8% vs 25.2%; p=0.002), alcohol drinking (52.5% vs 24.3%; p< 0.001), exercise habits (52.7% vs 48.0%; p=0.02), and better fruit and vegetable accessibility (Mean=3.91 vs 3.82; p=0.04). The 2021 TSCS cohort reported higher body mass index (Mean=24.20 vs 23.63; p< 0.001), less residency in urban areas (22.4% vs 31.1%; p< 0.001), better jogging accessibility (4.14 vs 4.05; p=0.006), higher generalized trust (2.26 vs 2.17; p=0.001), and greater internet usage (3.43 vs 2.89; p< 0.001). The regression model showed that exercise habits (standardized coefficient=0.20 and 0.10; p< 0.001) and generalized trust (standardized coefficient=0.11 and 0.11; p=0.004 and < 0.001) were consistently associated with health outcomes in both cohorts. Additionally, internet use (standardized coefficient=− 0.07; p=0.026) and alcohol drinking behaviors (standardized coefficient=− 0.07; p=0.0022) were negatively associated with health outcomes in the 2021 cohort.Conclusion: The present study demonstrated the trends and changes over 10 years regarding multiple health-related components among Taiwan residents. The study’s findings provide insight into education promotion programs to reduce unhealthy behaviors as well as enhancing generalized trust building and developing healthy behaviors for Taiwan residents.Keywords: health behavior, health promotion, COVID-19, Taiwan, trust

Stigmatization of overweight and obese individuals is common in interpersonal relationships. This study investigated longitudinal weight change patterns among Taiwanese adolescents and the relationship of weight change patterns with delayed romantic experience from late adolescence to young adulthood by using a representative panel survey. Individuals were divided into six weight change pattern categories according to changes in their body mass index. Two-stage stratified and clustered sampling was used to obtain a representative student sample, and 1,834 junior high school students were followed up over 7 years. Persistent obesity and a change from an underweight to a normal weight status over 7 years were independently associated with delayed romantic experience in both sexes. Moreover, females but not males who changed from an underweight or normal weight status to an overweight or obese status had increased odds of delayed romantic experience. Persistent obesity should be addressed early in life because it plays a crucial role in delayed romantic experience.

Background : There is strong evidence to support the association between bullying and the onset of mental health conditions in students with ASD. In Taiwan, seventh grade marks the first year in middle school after elementary school. It is also a period when peers tend to affiliate with one another to perform bullying behaviors to establish status among the peer group. Therefore, it is considered one of the most challenging times for students with ASD due to several adjustments within the school environment and the developmental changes that arise at this age.. To assess the association between school environment and bullying victimization among students with autism spectrum disorder (ASD) studying in regular classes in the first year of middle school. Methods: Data were obtained from the Special Needs Education Longitudinal Study database located in the Survey Research Data Archive of Academia Sinica. One hundred and eighty-four seventh-graders with ASD in regular classes across Taiwan were included in the analysis. The primary variables under study were whether they had experienced social exclusion, insults or teasing, extortion, or sexual harassment over the past semester.Results: Participants with a higher positive friendship quality (P = 0.027) and who had received more peer support upon encountering difficulties in school (P = 0.041) were less likely to experience social exclusion. Participants with higher positive friendship quality (P = 0.001) and a more positive learning environment in the classroom (P = 0.031) were less likely to have experienced insults or teasing. However, participants with more friends were more likely to be extorted (P = 0.015) and sexually harassed (P = 0.001) than those with fewer friends. Furthermore, participants in regular classes on a part-time basis were 2.59 times more likely to report sexual harassment than those in regular classes on a full-time basis (P = 0.021). Conclusions : This study suggests that a supportive school environment reduces the likelihood that seventh-graders with ASD are bullied. Clinicians should consider the association between the school environment and bullying victimization among adolescents with ASD in regular classes during their first year of middle school.

This study examined the association between adolescents’ obesity and sociometric status among their peers across 1 year. The participants were 2,528 junior high school students from Taiwan (mean age = 13.31 years). The negative associations discovered between obesity and sociometric status were both concurrent and cumulative. Moreover, the adolescents who changed from nonobese to obese were more likely to have lower social acceptance and be isolated in their classrooms. These findings inform concerns regarding the sociometric status of adolescents who are (or are becoming) obese.

This randomized controlled trial explored the effects of a Ving Tsun (VT) Chinese martial art training program on reactive standing balance performance, postural muscle reflex contraction latency, leg muscle performance, balance confidence and falls in community-dwelling older adults. We randomly assigned 33 healthy older adults to either a VT group (mean age = 67.5 years) or a control group (mean age = 72.1 years). The VT group received two 1-hour VT training sessions per week for three months (24 sessions). Primary outcome measures collected before and after the intervention period were electromyographic muscle activation onset latencies of the hamstring and gastrocnemius and the center of pressure path, length and movement velocity in standing (reactive balance performance). Secondary outcome measures included isometric peak force and time to isometric peak force of the knee extensors and flexors, the Activities-Specific Balance Confidence Scale score, and fall history. Results revealed that the mean gastrocnemius muscle activation onset latency was significantly longer (22.53 ms) in the VT group after the intervention. The peak force of the knee flexors significantly increased (by 1.58 kg) in the control group over time but not in the VT group. The time to reach peak force in the knee flexors was significantly longer (by 0.51 s) in the control group (but not the VT group) at posttest compared with the pretest value. No other significant group, time, or group-by-time interaction effects were noted. We discussed possible reasons for the failure of three months of martial art training to benefit fall risks among these older adults.

The FES-I is widely used to measure the fear of falling. However, studies linking the Chinese version of the FES-I to frailty and quality of life among older adults are still limited. Thus, this study examined the association of the full 16-item FES-I and the 7-item short FES-I with fall history, physical frailty, and quality of life among older Taiwanese adults. A total of 751 community-dwelling older adults in Taipei City participated in this study. Data analyses included logistic and linear regression models. The 16-item and the short FES-I were strongly correlated (Spearman rho = 0.963), and both scales are reliable. The 7-item FES-I was positively associated with fall history and physical frailty and negatively associated with the physical (b = -0.65, p 0.001) and mental (b = -0.59, p 0.001) components of health-related quality of life, independent of physical frailty. Thus, the short FES-I can be used to increase the feasibility of health screenings of older adults in Chinese-speaking contexts.

This study was performed to investigate the predictors of sugar-sweetened beverage (SSB) consumption in adolescents, including knowledge of SSBs, self-efficacy, and perceived benefits and barriers, using the structural equation modeling approach. This cross-sectional study was conducted from March to June 2019 in New Taipei City, Taiwan. The participants were 633 adolescents from 23 classes at three junior high schools in New Taipei City. A structured self-administered questionnaire was developed for data collection. The overall model predicted SSB consumption well, suggesting that SSB consumption was associated with self-efficacy and perceived barriers and benefits. Self-efficacy was the strongest predictor of SSB consumption. Both perceived barriers and self-efficacy sequentially and fully mediated the effect of knowledge on SSB consumption. This study confirms that self-efficacy is associated with SSB intake in both male and female adolescents. However, knowledge of SSBs was not associated with SSB consumption. Relying on nutritional education alone may not be adequate to change SSB consumption. The results suggest that future health promotion programs should improve self-efficacy to decrease SSB consumption in adolescents.

In Taiwan, children’s physical activity (PA) levels have been declining, which leads to a higher risk for chronic disease in adulthood. Children’s PA habits are formed within environmental and social contexts in which parents play a fundamental role. Most studies that evaluate parental factors are Western and use single or unidimensional measures. There are few Asian studies, especially of young children, on this topic. Hence, we developed a culturally sensitive and multidimensional scale to determine how parents in Taiwan can effectively promote children’s PA. We based our scale on the Activity Support Scale (ACTS) and processed it using a World Health Organization (WHO) protocol. We recruited 428 parents of school-aged children and used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to test its content validity. We then distributed the verified scale to a new group of 615 parents for criteria-related validation using multivariate logistic regression. We finally developed a multidimensional scale comprised of three major factors of parental support for children’s PA: (1) modeling, (2) logistic support—the first two are based on the ACTS—and (3) parental regulation, a newly found factor. This scale provides a culturally sensitive measure of parental influence on children’s physical activity.

Pin-Kuei Fu,1–4 Yu-Chi Tung,1 Chen-Yu Wang,2 Sheau-Feng Hwang,5,6 Shin-Pin Lin,7 Chiann-Yi Hsu,8 Duan-Rung Chen9 1Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan; 2Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 3Department of Biotechnology, Hungkuang University, Taichung, Taiwan; 4School of Chinese Medicine, China Medical University, Taichung, Taiwan; 5Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan; 6Palliative Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan; 7Computer and Communications Center, Taichung Veterans General Hospital, Taichung, Taiwan; 8Biostatistics Task Force, Taichung Veterans General Hospital, Taichung, Taiwan; 9Institute of Health Behaviors and Community Sciences, National Taiwan University, Taipei, Taiwan Purpose: The unpredictable trajectory of COPD can present challenges for patients when faced with a decision regarding a do-not-resuscitate (DNR) directive. The current retrospective analysis was conducted to investigate factors associated with an early DNR decision (prior to last hospital admission) and differences in care patterns between patients who made DNR directives early vs late. Patients and methods: Electronic health records (EHR) were reviewed from 271 patients with terminal COPD who died in a teaching hospital in Taiwan. Clinical parameters, patterns of DNR decisions, and medical utilization were obtained. Those patients who had a DNR directive earlier than their last (terminal) admission were defined as “Early DNR” (EDNR). Results: A total of 234 (86.3%) patients died with a DNR directive, however only 30% were EDNR. EDNR was associated with increased age (OR=1.07; 95%CI: 1.02–1.12), increased ER visits (OR=1.22; 95%CI: 1.10–1.37), rapid decline in lung function (OR=3.42; 95%CI: 1.12–10.48), resting heart rate ≥100 (OR=3.02; 95% CI: 1.07–8.51), and right-sided heart failure (OR=2.38; 95% CI: 1.10–5.19). The median time period from a DNR directive to death was 68.5 days in EDNR patients and 5 days in “Late DNR” (LDNR) patients, respectively (P

Background Previous studies have suggested that social and economic spatial polarization is associated with various health outcomes. However, few studies have examined the joint effect of income inequality and spatial polarization on health. Methods Data on mortality in 2008-12 were from the Ministry of Health and Welfare. We constructed economic spatial polarization using the Index of Concentration at the Extremes (ICE) by tax data from the Ministry of Finance. The Gini coefficient was from the Family Income and Expenditure Survey. Using multilevel datasets of 352 townships nested within 20 cities in Taiwan, we examined the association between township-level ICE and mortality, and further examined whether city-level income inequality moderate this association. Results In 2008-12, the average age-standardized mortality in Taiwan was 470.5 per 100 000 populations. As compared to the highest income-based ICE quintile, the lowest ICE quintile was associated with an excess 171.7 deaths per 100 000 people (95% CI = 116.1, 227.3) after controlling for income inequality and population size. One unit rise in the Gini coefficient further increased 29.9 deaths (95% CI = 12.4, 47.5) for the lowest ICE quintile, as compared to the highest. Conclusion The joint effect of income inequality and small-scale economic polarization may shed light on how inequalities increase mortality.

Objective. Frailty has received increasing attention as a way of understanding gradual losses in one or more domains of human functioning (physical, psychological, and social) in older adults. Studies suggested that frailty is related to lower quality of life (QoL) and the fear of falling (FoF). The most commonly used frailty criteria is the Fried Phenotype, which solely focuses on physical dimension of frailty. This study aims to evaluate the three-dimensional frailty index (namely, physical, psychological and social), and its association with QoL and FoF in a sample of community-dwelling Taiwanese older people. Methods. A total of 751 older adults aged 65 years and older (mean age 73.69 yrs ; SD=6.6) were included from May 2019 to Jan 2020 in Taipei City. The 8-Item Short-Form Health and the Falls Efficacy Scare International (FES-I) were used. Structural equation models (SEM) were employed to examine the association of the three-dimensional frailty index with QoL and FoF. Results. The SEM results confirmed a three-dimensional frailty index (physical, psychological and social frailty), and it is significantly associated with OoL and FoF. Physical frailty had the strongest association with PCS and FES-I, yet social frailty with MCS. Conclusion. Public health efforts to prevent elderly frailty should not solely focusing on physical aspect of frailty.

Supplemental material, Supplemental Material4 for Chinese Martial Art Training Failed to Improve Balance or Inhibit Falls in Older Adults by Ada W. W. Ma, Hsing-Kuo Wang, Duan-Rung Chen, Ya-Mei Chen, Yvonne T. C. Chak, Joan W. Y. Chan, Timothy T. T. Yam, Yoyo T. Y. Cheng, Balasankar Ganesan and Shirley S. M. Fong in Perceptual and Motor Skills

Objectives The aims of this study were to investigate (1) whether and (2) the extent to which Taiwanese older adults' leisure time activity (LTA) trajectories mediated the potential association between their sociodemographic factors and their functional disability trajectories. Methods Longitudinal data from four waves of the Taiwan Longitudinal Study on Aging (TLSA), collected between 1996 and 2007, were used for analysis (N = 3,429). Parallel-process latent growth curve modeling was adopted to evaluate the process by which LTA mediated between sociodemographic factors (age, gender, education, self-rated health, comorbidities, and depression) and the outcome process of functional disabilities. Results When mediated by baseline level of LTA, five sociodemographic factors-age, gender, education level, self-rated health, and number of comorbidities-had significant and negative mediating effects on baseline or change in functional disability, thus improving disability outcomes. However, four of the sociodemographic factors (age, education level, and number of comorbidities), when mediated through the rate of change in LTA, were found to have significant and positive mediating effects, which increased disability levels. The proportion of effects mediated by the LTA trajectory ranged from 0% to 194%. Discussion The large proportion of effects mediated through the LTA process underlines the importance of LTA to public health policy and health programs for older adults. The study's findings shed light on how to better target populations of older adults to promote an active lifestyle and achieve more successful aging in late life in Asian countries.

Objective. Playing games has become a new way to enhance the physical activity, quality of life, social engagement of older adults. This study aims to conduct a 6-month somatosensory game program, inviting older adults to play Microsoft Xbox Kinect games and study whether games can bring benefits to them. Methods. A total of 70 community-dwelling older adults (35 as experimental group, 35 as controls) were recruited. The experiment group played somatosensory games twice per week in a local health center. These games contained three types of categories: 1) Tournament games (for upper limb and lower limb); 2) Single games (for aerobic exercise and muscle training);3) Puzzle games (for collaboration and group dynamics): Results. After 6 months, in the experiment group, the body mass index decreased from 23.45 to 23.29 (p

Associations of neighborhood‐level workplace violence with workers’ mental distress problems: a multilevel analysis of Taiwanese employees: Li‐Chung Pien, et al. Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan OBJECTIVE: Workplace violence is known to pose mental health risks. However, whether or not workplace violence in a surrounding area might further increase the risk of mental distress in workers has rarely been examined. METHODS: The study subjects were 9,393 male and 7,716 female employees who participated in a nationwide survey in 2010. Their personal experiences of workplace violence over the past 1 year were ascertained by a standardized questionnaire. Also assessed were their psychosocial work characteristics and mental distress problems. Neighborhood‐level workplace violence was computed based on aggregated data at the county level and was categorized into low‐, medium, and high‐level categories. Multilevel logistic regression models were constructed to examine the associations between neighborhood‐level workplace violence and individual‐level mental distress problems, with adjustment of individual‐level experience of workplace violence. FINDINGS: The neighborhood‐level prevalence of workplace violence ranged from 4.7 to 14.7% in men and from 6.4 to 14.8% in women across 22 counties. As compared with those who live in counties of the lowest tertile of workplace violence, female workers who lived in counties of the highest tertile of workplace violence had a 1.72‐fold increased risk for mental distress problems after controlling for individual experience of workplace violence and other psychosocial work characteristics. CONCLUSION: Neighborhood‐level workplace violence was associated with poor mental health in female workers. Preventative strategies targeting workplace violence should pay attention to neighborhood factors and gender‐specific effects that might influence societal tolerance of abusive work practices and workers’ vulnerability to mental health impacts of workplace violence.

OBJECTIVES: This study aims to identify peers and social network characteristics associated with drinking occasions through early adolescence. METHODS: The study sample of 1808 middle school students (aged 13-15 years) in northern Taiwan was collected via a two-wave longitudinal study of the Alcohol-Related Experiences among Children (AREC). Data concerning individual sociodemographics, family characteristics, peer influence, and alcohol drinking behaviors were collected via web-based self-administered questionnaire. Building upon the maximum of five friends nominated by young respondents at 7th grade, class-based social network was first constructed via the UCINET and Pajek; the network position (i.e., member, bridge, and isolate) for each student was subsequently ascertained. Complex surveys analyses and negative binominal regression models were used to evaluate concurrent and prospective relationship estimates. RESULTS: Effects of peers and social network were found to operate differentially by childhood alcohol experience. For the alcohol naive youngsters, receiving higher peer's nomination at baseline was linked with subsequent increased drinking occasions (adjusted Incidence Rate Ratio [aIRR]=1.06; 95% CI=1.01-1.10), whereas having peers against alcohol drinking may reduce drinking occasions at 9th grade (aIRR=0.59; 95% CI=0.41-0.87). For the alcohol experienced youngsters, having parental alcohol offer, drinking peers, and attending classes of higher drinking norms may increase future drinking occasions by 90%, 80% and 44%, respectively. CONCLUSIONS: Our results demonstrated that parental alcohol offer, peer norms, and social network may affect adolescent drinking occasions differentially depending on childhood drinking experience. The findings have implications for the interventions to reduce alcohol consumption in underage population. Language: en

OBJECTIVE The Friedewald equation has been used as the standard formula for the estimation of very low-density lipoprotein cholesterol (VLDL-C) to calculate the serum levels of low-density lipoprotein cholesterol (LDL-C). However, the usefulness of this formula in non-Caucasians has been challenged in recent years. The aim of this study was to assess the validity of the conventional and modified Friedewald equation in an ethnic Chinese adult population. METHODS We prospectively recruited 938 subjects from the Lipid Clinic of the National Taiwan University Hospital. The fasting lipids, including cholesterol, high-density lipoprotein cholesterol, LDL-C, VLDL-C, and triglycerides (TGs), of each participant were measured and we constructed a prediction model for the estimation of LDL-C by the modified Friedewald equation. RESULTS The constant values, used to estimate the VLDL-C concentration, were different in the Friedewald equation in the subgroups exhibiting different cardiovascular characteristics, ranging from 4.45 to 6.63, if we calculated the equation by a direct LDL-C measurement. According to the results of a stepwise multiple linear regression analysis excluding the TG levels ≥400 mg/dL, an equation for the individual constant Y estimation was as follows: Constant Y = 4.39 + (-0.59) if the age ≥50 years + 0.98 if men + TG group (2.06 if the TG levels were between 150-399 mg/dL; 1.07 if the TG levels were between 100-149 mg/dL) + (-0.49) if the cholesterol levels ≥240 mg/dL + the body mass index (BMI) group (0.8 if BMI ≥27 kg/m(2); 0.48 if BMI =24-27 kg/m(2)). CONCLUSION This modified Friedewald formula provides a new and simple equation for calculating the LDL-C levels in ethnic Chinese people.

Purpose: The health of physicians can have a strong impact on the quality and safety of the health care they provide. Studies have shown a link between work stress, burnout, and depression. The aim of this study was to examine the association between malpractice dispute experiences and the well-being of physicians. Methods: We conducted a cross-sectional survey to collect information about the malpractice experiences of primary care physicians in 2004. Data on sociodemographic and clinical characteristics and SF-36 measures were also collected. We used propensity score matching to estimate the association of medical malpractice experience with the general health, mental health, and vitality of physicians. Results: Among the 1206 primary care physicians who completed the survey (response rate of 13.4%), 25.2% reported having ever experienced a malpractice dispute. After adjustment for baseline variables, physicians who had experienced a malpractice dispute had significantly worse health-related quality of life with regard to general health [−4.85; 95% confidence interval (CI), −7.61 to −1.80; P = 0.0016], mental health (−2.68; 95% CI, −5.03 to −0.34; P = 0.0252), and vitality (−3.28; 95% CI, −6.10 to −0.47; P = 0.0224). The effects were particularly strong among physicians specializing in surgery or obstetrics and gynecology. Conclusion: The results reveal that a malpractice dispute can have a long-term negative effect on the health of physicians. Harm reduction programs for physicians involved in malpractice disputes should be implemented. Keywords: Health-related quality of life, Medical malpractice, Physician, Propensity score matching

Studies have shown that difficult life events in family have adverse impact on family members. However, most studies focused on a particular health outcome at certain point of time, usually the endpoint of a follow-up period. This study aims to understand: 1) the trajectories of self-rated health change from 2005 to 2014 in a sample of middle-aged and elderly subjects in Taiwan, 2) the impact of family difficulties on the trajectories of self-rated health change, and whether there are age and gender-specific pattern of health change trajectories.

Background: Obesity is highly correlated with the development of chronic diseases and has become a critical public health issue that must be countered by aggressive action. This study determined whether data from Google Trends could provide insight into trends in obesity-related search behaviors in Taiwan. Objective: Using Google Trends, we examined how changes in economic conditions—using business cycle indicators as a proxy—were associated with people’s internet search behaviors related to obesity awareness, health behaviors, and fast food restaurants. Methods: Monthly business cycle indicators were obtained from the Taiwan National Development Council. Weekly Taiwan Stock Exchange (TWSE) weighted index data were accessed and downloaded from Yahoo Finance. The weekly relative search volumes (RSV) of obesity-related terms were downloaded from Google Trends. RSVs of obesity-related terms and the TWSE from January 2007 to December 2011 (60 months) were analyzed using correlation analysis. Results: During an economic recession, the RSV of obesity awareness and health behaviors declined (r=.441, P

Obesity is a problem with global health and economic consequences. This study assesses the impact of social origins and socio-economic disadvantages on mid-life body weight. Hypotheses of both critical early life period and social trajectory were tested using a sample of 845 adults, aged 45 to 69 years, from a nationally representative sample in 2009 Taiwan Social Change Survey. The study found evidence of a significant gender-specific heterogeneity of social origins on obesity risk. Men with accumulated disadvantage had increased BMI, but no significant accumulative trajectories were found among women. Obesity prevention must consider factors beyond behavioral change, and include a focus on social origins and gender identity.

Objective. In Taiwan as well as in many other aging societies, decreasing disability is a key public health priority. Gender is known to be a significant factor for developing disability. Our study aimed to examine gender disparities in disability trends as well as how sociodemographic factors influence these disparities. Methods. We used multiple-group latent growth curve modeling (MG-LGM) to examine data drawn from the Taiwanese Longitudinal Study of Aging, a longitudinal and nationally representative survey database. Four waves of survey data and 3,429 older adults (mean ages = 50-96) were included for analysis. Disability trajectories among men and women were modeled separately using MG-LGM. Equality constraints were imposed on the six factors assessed: age, education, leisure activities, perceived (self-rated) health, health behaviors, and comorbidities. Results. Baseline disability levels were not significantly different between the two groups, but once disability began, the progression toward greater disability was almost 50% faster among older women. Greater age and more comorbidities added significantly more to baseline disability and speed of progression among older women than among older men (p < 0.001). However, having better health behaviors (e.g., no alcohol, more leisure activities) reduced baseline disability significantly more among women (p < 0.05). Particularly interesting findings include that perceived health reduced baseline disability only among men (p < 0.05), while having a better social network reduced baseline disability only among women (p < 0.05). Conclusion. For older women, disability prevention is crucial, and promoting positive health behaviors and strong social networks are promising strategies.

In October 2001, a pay-for-performance (P4P) program for diabetes was implemented by the National Health Insurance (NHI), a single-payer program, in Taiwan. However, only limited information is available regarding the influence of this program on the patient’s health-related quality of life. The aim of this study was to estimate the costs and consequences of enrolling patients in the P4P program from a single-payer perspective. A retrospective observational study of 529 diabetic patients was conducted between 2004 and 2005. The data used in the study were obtained from the National Health Interview Survey (NHIS) in Taiwan. Direct cost data were obtained from NHI claims data, which were linked to respondents in the NHIS using scrambled individual identification. The generic SF36 health instrument was employed to measure the quality-of-life-related health status and transformed into a utility index. Patients enrolled in the P4P program for at least 3 months were categorized as the P4P group. Following propensity score matching, 260 patients were included in the study. Outcomes included life-years, quality-adjusted life-years (QALYs), diabetes-related medical costs, overall medical costs, and incremental cost-effectiveness ratios (ICERs). A single-payer perspective was assumed, and costs were expressed in US dollars. Nonparametric bootstrapping was conducted to estimate confidence intervals for cost-effectiveness ratios. Following matching, no significant difference was noted between two groups with regard to the patients’ age, gender, education, family income, smoking status, BMI, or whether insulin was used. The P4P group had an increase of 0.08 (95 % CI 0.077–0.080) in QALYs, and the additional diabetes-related medical cost was US$422.74 (95 % CI US$413.58–US$435.05), yielding an ICER of US$5413.93 (95 % CI US$5226.83–US$5562.97) per QALY gained. Our results provides decision makers with valuable information regarding the impact of the P4P program of diabetes care through a direct comparison of equivalent groups of patients receiving regular care. Under the single-payer NHI system, the use of financial incentives under the DM-P4P program may be an effective means to ensure the quality of follow-up treatment.