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Objective: We examined whether firefighters in Taiwan have a sleep problem and investigated the related factors of poor sleep quality., Methods: In this cross-sectional study, 2123 male shift firefighters in the Greater Taipei area were invited, and 37.7% of them satisfactorily completed the questionnaire online. The Chinese version of Pittsburgh sleep quality index (PSQI) was used to evaluate sleep quality. Multiple logistic and linear regression analyses were used to determine the associations among demographic characteristics, work-related characteristics, and poor sleep quality., Results: As revealed by 801 valid questionnaires, 77.2% were poor sleepers (PSQI cutoff score > 6), and 61.2% reported incomplete off-duty in the past month. Moreover, 42.6% of incomplete off-duty workers reported extended overtime of more than 5 h on off-duty days in the past month. Poor sleep quality was associated with the following factors: (1) demographic characteristics: age, working tenure, having children, and chronotype and (2) work-related characteristics: shift schedule and incomplete off-duty. The final model for poor sleep quality as per PSQI included age, chronotype, shift schedule, and incomplete off-duty hours in the past month. Longer hours of incomplete off-duty work were associated with increased risks of overall poor sleep quality and of poor subjective sleep quality, long sleep latency, sleep disturbances, and daytime dysfunction., Conclusion: Firefighters are advised to have a complete off-duty day to avoid poor sleep quality, long sleep latency, short sleep duration, sleep disturbances, and daytime dysfunction. Our results confirm the need for implementing appropriate shift schedules to ensure adequate rest time for firefighters., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Improvements in medical treatment have contributed to rising health spending. Yet there is relatively little evidence on whether the spending increase is "worth it" in the sense of producing better health outcomes of commensurate value-a critical question for understanding productivity in the health sector and, as that sector grows, for deriving an accurate quality-adjusted price index for an entire economy. We analyze individual-level panel data on medical spending and health outcomes for 123,548 patients with type 2 diabetes in four health systems: Japan, The Netherlands, Hong Kong and Taiwan. Using a "cost-of-living" method that measures value based on improved survival, we find a positive net value of diabetes care: the value of improved survival outweighs the added costs of care in each of the four health systems. This finding is robust to accounting for selective survival, end-of-life spending, and a range of values for a life-year or fraction of benefits attributable to medical care. Since the estimates do not include the value from improved quality of life, they are conservative. We, therefore, conclude that the increase in medical spending for management of diabetes is offset by an increase in quality.

Background: The use of sedatives or hypnotics and the recurrence of depression have not been adequately explored. This study investigated the roles of sedative-hypnotics in patients with major depressive disorder (MDD). Various characteristics of sedative-hypnotic use were tested as risk factors for recurrence., Methods: Clinical records of 15,510 patients with major depressive disorder who prescribed selective serotonin reuptake inhibitors (SSR) during 1997-2009 were collected from the National Health Insurance Research Database (NHIRD). Cox proportional hazard regression models were used to analyze factors related to depression recurrence., Results: The risk of MDD recurrence was lower for patients using SED/HYP with an indication of both anxiolytics and hypnotics (AHR = 0.66; 95% CI = 0.59-0.72) than for those using SED/HYP with an indication of anxiolytics only. AHR was slightly greater in current users than in recent users (AHR = 0.77; 95% CI = 0.72-0.83) and past users (AHR = 0.70; 95% CI = 0.67-0.74). There was a higher AHR of MDD recurrence in patients who used SED/HYP over 1 DDD in 1 month than those who used SED/HYP less than 1 DDD in 1 month, with the highest-dose users having the highest risk of MDD recurrence (AHR = 7.91; 95% CI = 6.86-9.11)., Conclusions: Patterns and characteristics of sedative-hypnotic use may affect depression recurrence. These findings should be considered by clinicians when combining sedative-hypnotics with antidepressant treatment.

Cystobasidium keelungensis SN2 T (CBS 6949 = BCRC 920080), a new anamorphic basidiomycetous yeast species, is described in this paper. The strains belonging to this species were isolated from the sea surface microlayer and underlying water in Taiwan. These strains were identified by examining nucleotide sequences in the species-specific D1/D2 domains of the large subunit (LSU) ribosomal RNA (rRNA) and by evaluating their physiological characteristics. Phylogenetic analyses of D1/D2 sequences revealed that C. keelungensis was most closely related to the species C. slooffiae (LSU rRNA gene sequence divergence of 1.5%), and it belonged to the Erythrobasidium clade. No sexual reproduction was observed. This species differed from related species in carbon and nitrogen assimilation patterns and growth at 35 °C. Screening C. keelungensis for the presence of UV-absorbing compounds showed that mycosporine-glutaminol-glucoside and mycosporine-glutamicol-glucoside (maximum absorption: 310 nm) were the major UV-absorbing compounds, which differ from the compounds present in some freshwater yeast strains reported in previous studies. After UV induction, SN2 had a higher level of mycosporine production than other carotenogenic yeasts in this study.

Background: Larger earlobes, which are a symbol of "richness" in traditional Chinese culture, are favored by Chinese patients. The objective of this paper is to investigate the application of earlobe augmentation with hyaluronic acid (HA) filler injection and its clinical effects in the Chinese population., Methods: A total of 19 patients (38 ears) who received earlobe augmentation with HA filler injections between March 2013 and March 2015 were included. The clinical effects, duration, and complications of these cases were investigated., Results: All patients who received earlobe HA injections showed immediate postoperative effects with obvious morphological improvement of their earlobes. The volume of HA filler injected into each ear was 0.3-0.5 ml. The duration of the effect was 6-9 months. Two of the 19 cases (3 ears) demonstrated mild bruising at the injection site, but the bruising completely disappeared within 7 days after the injection. No vascular embolism, infection, nodule, or granuloma complications were observed in the studied group., Conclusion: The application of earlobe augmentation with HA filler injection is a safe, effective, simple procedure for earlobe shaping. It has an easy clinical application with good clinical prospects., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Although the technological change in medicine has been recognized widely as the major driver of rising healthcare costs, there is very little research that estimates this effect directly. This paper uses both a single-equation and a simultaneous equations approach to investigate empirically the interactive relationship between technological innovation and the growth of health expenditure in the context of the pharmaceutical market in Taiwan. Based on observing 182 therapeutic groups between 1997 and 2006, we find evidence to support the argument that technological innovation and health expenditure are determined simultaneously as technological innovation, and that the growth of health expenditure are endogenous rather than exogenous. Specifically, we find that therapeutic groups associated with higher pharmaceutical expenditure are likely to attract more new products to the market. Meanwhile, therapeutic groups with more new products are associated with higher pharmaceutical expenditures. An important implication of the paper is that cost containment policies will affect not only the growth of health expenditure, but also the progress of technological innovation in the health sector.

The c.G4883C variant in the leucine-rich repeat kinase 2 (LRRK2) gene (protein effect: Arg1628Pro) has been recently proposed as a second risk factor for sporadic Parkinson's disease in the Han Chinese population (after the Gly2385Arg variant). In this paper, we analyze the Arg1628Pro variant and the associated haplotype in a large sample of 1,337 Han subjects (834 patients and 543 controls) ascertained from a single referral center in Taiwan. In our sample, the Arg1628Pro allele was more frequent among patients (3.8%) than among controls (1.8%; p = 0.004, OR 2.13, 95% CI 1.29-3.52). Sixty heterozygous and two homozygous carriers of the Arg1628Pro variant were identified among the patients, of which only one was also a carrier of the LRRK2 Gly2385Arg variant. We also show that carriers of the Arg1628Pro variant share a common, extended haplotype, suggesting a founder effect. Parkinson's disease onset age was similar in patients who carried the Arg1628Pro variant and in those who did not carry it. Our data support the contention that the Arg1628Pro variant is a second risk factor for Parkinson's disease in the Han Chinese population. Adding the estimated effects of Arg1628Pro (population attributable risk [PAR] approximately 4%) and Gly2385Arg variants (PAR approximately 6%) yields a total PAR of approximately 10%.

The purpose of this paper is to describe the impact of metal pollution on the main seafood and assess the potential health risk from consuming the contaminated seafood in Taiwan. The results of geometric mean (GM) metal concentrations in various seafood showed that the copper, zinc, and arsenic concentrations in oysters were significantly (p < 0.001) higher than those in the other seafood by about 1,057, 74.3, and 56.2 times, respectively. The green color found in the oysters was due to high GM copper and zinc concentrations of 909 (ranging from 113-2,805) and 1,293 (ranging from 303-3,593) microg/g dry wt, respectively. In addition, using a maximum consumption rate of 139 g/day of oysters for individuals, calculations yield target hazard quotients (daily intake/reference dose) of below 1 for cadmium and mercury and high values of 1.61, 9. 33, and 1.77 for inorganic arsenic, copper, and zinc in adults, respectively. The various lifetime cancer risks for inorganic arsenic (maximum exposed individuals risk ranging from 9.93 x 10(-6) to 3.11 x 10(-4)) might be caused by consuming different seafood in Taiwan. The highest risk estimate for inorganic arsenic was 5.10 x 10(-4) for consumption of oysters by Machu Islands residents. The long-term exposure of metals through consumption of oysters, especially for some high-risk groups, could be dangerous. Taking inorganic arsenic for example, a 10(-6) upper limit on lifetime risk as the health protection standard would require maximum oyster residue levels of approximately 0.0076-0.056 microg/g wet wt, for consumption rates of 139-18.6 g/d. In the light of known risks to public health, the government should issue an immediate warning to the public to refrain from eating all seafood harvested from the Taiwan coastal areas, especially the Hsiangshan area and the Machu Islands.