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Abstract This study investigates the correlation between body mass index (BMI) and osteoporosis utilizing data from the Taiwan Biobank. Initially, a comprehensive analysis of 119,009 participants enrolled from 2008 to 2019 was conducted to assess the association between BMI and osteoporosis prevalence. Subsequently, a longitudinal cohort of 24,507 participants, initially free from osteoporosis, underwent regular follow-ups every 2–4 years to analyze the risk of osteoporosis development, which was a subset of the main cohort. Participants were categorized into four BMI groups: underweight (BMI

Abstract Smoking is the most important risk factor for chronic obstructive pulmonary disease (COPD), however evidence from large-scale studies on whether secondhand smoke (SHS) increases the risk of COPD is still lacking. We conducted this large longitudinal study to investigate the association between SHS and the development of COPD. This is a longitudinal study. Data on 6519 subjects who were never-smokers, had no history of COPD, and had complete lung function records were extracted from the Taiwan Biobank. They were divided into two groups according to SHS exposure: no exposure and exposure groups. Data were collected when participants enrolled in the study and during regular follow-up. Cox proportional hazards regression models were used to estimate the relative risk (RR) and 95% confidence interval (CI) for the association between SHS and the risk of developing COPD. At 48 months of follow-up, 260 (4%) participants in the no exposure group and 34 (7%) participants in the exposure group developed COPD. The RR of incident COPD development was significantly higher in the exposure group than that in the no exposure group after adjusting for confounders (RR = 1.49; 95% CI 1.04 to 2.14; P value = 0.031). There is a dose–response relationship between the duration of exposure to SHS and the risk of incident COPD, which demonstrates that an additional hour of exposure to SHS per week was associated with a 1.03-fold increased likelihood of developing COPD after adjusting for confounders (RR = 1.03; 95% CI 1.00 to 1.05; P value = 0.027). SHS exposure contributes to the development of COPD. This finding can help raise awareness of the harms of SHS and provide a reference for formulating anti-smoking policies.

Abstract Background Tobacco use and secondhand smoke (SHS) are risk factors of kidney stone disease (KSD). The hypothesis is that tobacco produces chemicals that increase oxidative stress and vasopressin, which leads to decreased urine output, and contributes to stone formation. The aim of this study was to examine the effects of smoking and SHS on the development of KSD. Materials and methods We analyzed a total of 25,256 volunteers with no history of KSD participated in the Taiwan Biobank. The presence of underlying and follow-up KSD was surveyed by a self-administrated questionnaire. They were classified into three groups on the basis of smoking and SHS exposure, accessed with survey questionnaires; never-smokers with no SHS exposure, never-smokers with SHS exposure and ever-smokers groups. Results KSD was noted in 352 (2.0%), 50 (3.3%) and 240 (4.1%) subjects in the never-smokers with no SHS exposure, never-smokers with SHS exposure and ever-smokers groups, respectively, with a mean follow-up of 4 years. The odds ratio (OR) of KSD was higher in the never-smokers with SHS exposure (OR, 1.622; 95% confidence interval [95% CI], 1.225 to 2.255) and ever-smokers groups (OR, 1.282; 95% CI, 1.044 to 1.574) than in the never-smokers with no SHS exposure group after adjustment of confounders. In addition, never-smokers with SHS exposure had similar effects on the development of KSD than ever-smokers (OR, 1.223; 95% CI, 0.852 to 1.756). Conclusion Our study suggests that both smoking and SHS are a risk factor for developing KSD and that the impact of SHS is not inferior to that of smoking. Trial registration The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20,210,058).

Abstract Obesity has become a major public health issue which relate to numerous physical problems and highly comorbid with depression and anxiety. Recently, some studies of technology-based interventions for weight reduction emerged to overcome the barriers from time, cost and distance. Mood component and eating behavior related to obesity are less discussed so far with technology-based intervention though. This pilot study was aimed to investigate the effect of telehealth assisted intervention on weight reduction, mood status, and eating behavior change under a smartphone application (app) with novel 3D food picture recognition and incorporated with cognitive behavioral training programs. Adult aged 30–60 years old with overweight were recruited and randomly assigned to control-first group and intervention-first group. In period 1, control-first group had regular life and intervention-first group underwent app intervention; in period 2, two groups went crossover. Body composition and psychological/behavioral questionnaires were collected at baseline, end of period 1, and end of period 2. Nonparametric statistics was performed for data analyzing. A total of 20 participants were enrolled. In control-first group, there were statistically significant reduction in body weight (− 0.55 kg, p = 0.02) and change of body weight percentage (− 0.6%, p = 0.02) after App use. In intervention-first group, the fat percentage decreased by 0.4% after App use in period 1, and increased by 0.05% in period 2. The integrated crossover data revealed that subjects of App group had significant improvements in mindful eating behavior. This pilot study showed the effectiveness in using CogniNU app for weight control and eating behavior. The difference of short-term and long-term effectiveness of technology-based weight control intervention deserves more investigation in the future. Clinical Trial Registration: ISRCTN16082909.

Background: The current study aimed to assess the prevalence of bullying victimization (BV) and its association with psychopathology and suicidality in a nationwide general population. Methods: The target population were all the people living in Taiwan, the study samples were obtained by the following processes. A computer-assisted telephone interview was performed to identify potential respondents using telephone numbers selected with the stratified proportional randomization method. Self-reported data were evaluated. Moreover, data obtained using the validated Brief Symptom Rating Scale (BSRS-5) and Concise Mental Health Checklist (CMHC) were used to evaluate psychopathological symptoms and overall suicidal risks, respectively. Results were further analyzed using the chi-square tests and logistic regression model. Results: In total, 1930 respondents from a national general population survey were included in the analysis. The weighted prevalence of lifetime BV in the general population was 13.5%. Based on the chi-square analysis, individuals exposed to BV were at high risk for psychopathology (a BSRS-5 score of ≥6 (x2 = 45.5, P ≤ .001) and high BSRS-5 scores for all five items). Bullying exposure was significantly associated with lifetime suicide ideation and suicide attempt (x2 = 85.7, P ≤ .001; x2 = 17.0, P ≤ .001, respectively). The help-seeking behavior of respondents exposed to bullying did not differ significantly (x2 = 4.6, P = .327). Conclusion: Bullying exposure is associated with recent psychopathology and lifetime suicidality. Multifactorial interactive processes contribute to long-term harmful health implications in adulthood. Nevertheless, further research on the relevant mechanisms associated with bullying and potential interventions that can decrease morbidity must be conducted.

The purpose of this study was to investigate genetic factors associated with metabolic syndrome (MetS) by conducting a large-scale genome-wide association study (GWAS) in Taiwan, addressing the limited data on Asian populations compared to Western populations. Using data from the Taiwan Biobank, comprehensive clinical and genetic information from 107,230 Taiwanese individuals was analyzed. Genotyping data from the TWB1.0 and TWB2.0 chips, including over 650,000 single nucleotide polymorphisms (SNPs), were utilized. Genotype imputation using the 1000 Genomes Project was performed, resulting in more than 9 million SNPs. MetS was defined based on a modified version of the Adult Treatment Panel III criteria. Among all participants (mean age: 50 years), 23% met the MetS definition. GWAS analysis identified 549 SNPs significantly associated with MetS, collectively mapping to 10 genomic risk loci. Notable risk loci included rs1004558, rs3812316, rs326, rs4486200, rs2954038, rs10830963, rs662799, rs62033400, rs183130, and rs34342646. Gene-set analysis revealed 22 associated genes: CETP, LPL, APOA5, SIK3, ZPR1, APOC1, BUD13, MLXIPL, TOMM40, GCK, YKT6, RPS6KB1, FTO, VMP1, TUBD1, BCL7B, C19orf80 (ANGPTL8), SIDT2, SENP7, PAFAH1B2, DOCK6, and FOXA2. This study identified genomic risk loci for MetS in a large Taiwanese population through a comprehensive GWAS approach. These associations provide novel insights into the genetic basis of MetS and hold promise for the potential discovery of clinical biomarkers.

BackgroundDepression is a common psychiatric health issue affecting an estimated 5% of adults worldwide, and it can lead to disability and increased economic burden. Consequently, identifying the factors associated with depression as early as possible is a vital issue. The aim of this study was to explore these associations in a large cohort of 121,601 Taiwanese participants in the Taiwan Biobank, and also to identify sex differences in the associations.MethodsThe study cohort included 77,902 women and 43,699 men (mean age, 49.9 ± 11.0 years), who were further classified into those with depression (n = 4,362; 3.6%) and those without depression (n = 117,239; 96.4%).ResultsThe results of multivariable analysis showed that female sex (vs. male sex; odds ratio = 2.578; 95% confidence interval = 2.319–2.866; p < 0.001) was significantly associated with depression. Older age, diabetes mellitus (DM), hypertension, low systolic blood pressure (SBP), smoking history, living alone, low glycated hemoglobin (HbA1c), high triglycerides, and low uric acid were significantly associated with depression in the men. In the women, older age, DM, hypertension, low SBP, smoking history, alcohol history, education level of middle and high school (vs. lower than elementary school), living alone, high body mass index (BMI), menopause, low HbA1c, high triglycerides, high total cholesterol, low estimated glomerular filtration rate (eGFR), and low uric acid were significantly associated with depression. Further, there were significant interactions between sex and DM (p = 0.047), smoking history (p < 0.001), alcohol use (p < 0.001), BMI (p = 0.022), triglyceride (p = 0.033), eGFR (p = 0.001), and uric acid (p = 0.004) on depression.ConclusionIn conclusion, our results showed sex differences in depression, and the women were significantly associated with depression compared to men. Furthermore, we also found sex differences among the risk factors associated with depression.

IntroductionWe aim to explore the association between chronic kidney disease (CKD) and cataracts.MethodsA total of 121,380 participants with adequate information collected from 29 community-based recruitment centers since 2008 were analyzed. The association between CKD and self-reported diagnosed cataracts was examined in a cross-sectional cohort and was validated in a longitudinal cohort of 25,263 participants without cataracts at baseline.Results and discussionOf all participants, cataracts occurred in 503/1,947 (26%) and 10,464/119,433 (9%) subjects in the CKD and non-CKD groups, respectively. Multivariate logistic regression showed that CKD was significantly associated with a higher prevalence of self-reported diagnosed cataracts. In the validation cohort, a higher incidence of cataracts was also noted in the CKD group (65/317, 21%) compared to the non-CKD group (1,964/24,252, 8%) during a mean 47-month follow-up. After adjusting for confounders, subjects with CKD had a 1.498-fold higher risk of incident cataracts than those without CKD (95% confidence interval = 1.114 to 2.013, p value = 0.007). We found that CKD was associated with a higher prevalence of cataracts as well as incident cataracts, which suggests CKD patients and their primary physicians should be aware of this disease and can provide a clue for further exploration of the possible mechanisms and treatments.

Abstract Research indicates smoking increases the risk of various kidney diseases, although the risk of developing kidney stone disease in non-smokers exposed to secondhand smoke is unknown. This study analyzed a total of 19,430 never-smokers with no history of kidney stone disease who participated in the Taiwan Biobank from 2008 to 2019. They were divided into two groups by secondhand smoke exposure; no exposure and exposure groups; the mean age of participants was 51 years, and 81% were women. Incident kidney stone development was observed in 352 (2.0%) and 50 (3.3%) participants in the no exposure and exposure groups during a mean follow-up of 47 months. The odds ratio (OR) of incident kidney stone was significantly higher in the exposure group than the no exposure group [OR, 1.64; 95% confidence interval (95% CI) 1.21 to 2.23]. Participants with > 1.2 h per week exposure were associated with almost twofold risk of developing kidney stones compared with no exposure (OR, 1.92; 95% CI 1.29 to 2.86). Our study suggests that secondhand smoke is a risk factor for development of kidney stones and supports the need for a prospective evaluation of this finding.

BackgroundLiving alone has been linked to poor mental health, however large-scale epidemiological studies on the association between living alone and psychiatric morbidity including depression and anxiety are lacking. The aim of this study was to investigate this issue in a large Taiwanese cohort.MethodsIn this cross-sectional study, we enrolled 121,601 volunteers from 29 community recruitment stations in Taiwan and divided them into two groups based on whether or not they lived alone. Psychiatric morbidity was defined as a Generalized Anxiety Disorder 2-item score ≥ 3, Patient Health Questionnaire 2-item score ≥ 3, or self-reported depression. Logistic regression was used to explore the associations between living alone and psychiatric morbidity.ResultsThe participants who lived alone had a higher prevalence of psychiatric morbidity [odds ratio (OR) = 1.608, 95% confidence interval (CI) = 1.473 to 1.755] after adjusting for potential confounders. In a subgroup analysis, married subjects who lived alone and divorce/separation (OR = 2.013, 95% CI = 1.763 to 2.299) or widowing (OR = 1.750, 95% CI = 1.373 to 2.229) were more likely to have psychiatric morbidity than those who were married and not living alone.ConclusionsOur findings suggest that living alone is a risk factor for psychiatric morbidity, especially for married subjects who live alone in concordance with divorce, separation, or the death of a spouse.

Regular exercise can regulate bone maintenance and improve bone health. However, large-scale epidemiological studies on the association between regular exercise and incident osteoporosis in menopausal women are still lacking. We aimed to examine the relationship between exercise and the risk of osteoporosis in menopausal women. In cross-sectional analysis, we enrolled 30,046 postmenopausal women with available information from the database of the Taiwan Biobank (TWB). We divided them into two groups according to their status of regular exercise, i.e., no exercise and regular exercise groups. A t-score of −2.5 or more standard deviations (SDs) below that of a young adult was defined as osteoporosis. Logistic regression after adjusting for confounding factors was used to analyze the association between regular exercise and the prevalence of osteoporosis. Furthermore, the risk of incident osteoporosis development was analyzed in a longitudinal cohort of 6,785 postmenopausal women without osteoporosis at baseline using a Kaplan-Meier analysis and a log-rank test. The mean age of subjects in the cross-sectional cohort was 59 years old. Fifty-six percent of them were exercising regularly. Osteoporosis was observed in 1,886 (14.2%) and 2,254 (13.4%) participants in the no exercise and regular exercise groups. Lower risk of osteoporosis was noted in postmenopausal women with regular exercise when compared with those without regular exercise [odds ratio (OR), 0.76; 95% confidence interval (95% CI), 0.71–0.81]. In the longitudinal cohort, incident osteoporosis was found in 430 (10.5%) women with regular exercise and 299 (11.2%) women without exercise during a mean follow-up of 45 months. Cox regression analysis revealed that the risk for incident osteoporosis was lower in postmenopausal women with regular exercise than those without exercise [hazard ratio (HR), 0.83; 95% CI, 0.71–0.97]. Our study suggests that regular exercise is associated with a reduced risk of osteoporosis in postmenopausal women and strengthens the importance of exercise for the prevention of osteoporosis.

Abstract Using a self‐administered questionnaire (the five‐item Brief Symptom Rating Scale, BSRS‐5), determine the prevalence of suicide ideation (SI), psychiatric morbidity (PM), and the factors associated with these conditions in a general hospital in Taiwan. All individuals aged 12 years or older, who were admitted to a Medical University Hospital between August 2014 and December 2016, were asked to fill out the BSRS‐5 at admission. The study was conducted in a medical inpatient setting, excluding Intensive Care Units and the Emergency Service Department. The 93,129 participants were recruited for analysis. Pearson's correlation, regression analysis and path analysis were performed to test the association between SI and each item of psychopathology and to determine the discrimination validity of individual BSRS‐5 items for predicting SI. The prevalence rate was 2.3% for SI and 2.0% for PM among all participants. PM was more prevalent in females and those aged 25–54 years. Individuals with PM had a significantly higher rate of SI (44.6%) than did others (1.4%). The prevalence of PM was varied by department, e.g., Psychiatry (44.3%), Rehabilitation Medicine (7.9%), and Nephrology (5.2%). The regression analysis and path analysis with structural equation model indicated that depression, hostility, anxiety, and inferiority were significant independent predictors of SI. The BSRS‐5 is an efficient and useful screening tool to identify psychological distress and SI among inpatients in a general hospital. Its integration into the electronic medical chart facilitates identifying patients at risk.

This research was a quasi-experiment that examined the effects of CLIL in an educational context in Taiwan's higher education. Two groups of first-year undergraduate students were involved. One (65 students) was taught with CLIL; the other (59), the conventional approach. Their knowledge of the content and learning attitudes (self-efficacy and motivation) were quantitatively compared through achievement tests and a questionnaire. A qualitative semi-structured survey asked both groups for their perspectives on and perceptions of the treatments. The quantitative results show that both approaches were significantly effective for improving students' knowledge of the content of the target subject (literary text), but the EG outperformed the CG. Likewise, both groups had positive learning attitudes to their treatments, but the EG also outweighed the CG. Furthermore, the qualitative accounts generated diverse results, reflecting the underlying difference between the approaches but showing that both approaches were welcomed. However, the conventional method was more favored than CLIL, mostly because of the participants' learning preferences or because of the learning patterns which they had formed over years of studying in the specific cultural-education system (i.e., that of Taiwan) chosen for the study.

In this paper, we aimed to examine the protective role of hyperuricemia in the prevalence of osteoporosis in a large Asian cohort. A total of 119,037 participants from 29 recruitment centers in Taiwan were enrolled onto our study. Participants with serum uric acid greater than 7.0 mg/dL in men and 6.0 mg/dL in women were classified as the hyperuricemia group whereas the others were the control group. The mean age of all participants was 50; there were 23,114 subjects (19%) with hyperuricemia. Osteoporosis was observed in 8243 (9%) and 1871 (8%) participants in the control and hyperuricemia groups, respectively. After adjusting for confounders, a lower risk of osteoporosis was found in the hyperuricemia group compared with the control group (odds ratio, 0.916; 95% confidence interval, 0.864 to 0.970). A subgroup analysis showed that hyperuricemia was associated with a lower risk of osteoporosis in females, but not in males. Women with serum uric acid greater than 8.0 mg/dL were not associated with a greater risk of osteoporosis. Our study suggests that hyperuricemia decreases the risk of osteoporosis in females, but not in males. The protective role was no longer apparent when the serum uric acid level was greater than 8 mg/dL.

Suicide is a major concern in public health worldwide. Early identification of individuals at risk is critical for suicide prevention. The present study revised the 5-item Brief Symptom Rating Scale (BSRS-5) to a checklist format (BSRS-5R) and validated the BSRS-5R into a screening tool for psychiatric morbidity and suicide ideation in the general public. Methods: The study participants consisted of two subsets of sample from community residents and psychiatric patients. The community subjects were recruited from stratified proportional randomization sampling in a nationwide community survey, while the psychiatric patients were from psychiatric outpatient service and psychiatric daycare unit in a teaching hospital in northern Taiwan. All participants responded to the questionnaire investigating the BSRS-5, personal experience with suicide, and demographic information. Results: In total, 2147 community respondents and 700 respondents from psychiatric settings completed the survey questions. The BSRS-5R was highly correlated to BSRS-5 with good internal consistency in our study sample. For the community subjects, receiver operating characteristic curve analysis revealed an optimal cutoff of 2/3 for BSRS-5R to discriminate psychiatric morbidity or suicide ideation. The BSRS-5R could also identify psychiatric morbidity in psychiatric outpatients and daycare patients. In addition, the cutoff of 4/5 for BSRS-5R to determine suicide ideation yielded moderately good predictive validity in psychiatric outpatients and in daycare patients. Conclusion: The BSRS-5R was validated as an efficient checklist to screen for psychiatric morbidity and suicide ideation in the general public. The result is valuable in translating into general medical and community settings for early detection of suicide ideation.

The aims of this cross-sectional study were to examine the associations between body weight and mental health indicators including depression, social phobia, insomnia, and self-esteem among Taiwanese adolescents in Grades 7–12. The body mass index (BMI) of 5254 adolescents was calculated based on self-reported weight and height measurements. Body weight status was determined by the age- and gender-specific International Obesity Task Force reference tables. By using participants of average weight as the reference group, the association between body weight status (underweight, overweight, and obesity) and mental health indicators (depression, social phobia, insomnia, and self-esteem) were examined by using multiple regression analysis. The possible moderating effects of sociodemographic characteristics on the association were also examined. After controlling for the effects of sociodemographic characteristics, both overweight (p

Background: Critically ill neonates receive care in the neonatal intensive care unit (NICU). Unfortunately, some neonates pass away in the NICU. Providing comprehensive neonatal palliative care and hospice services is crucial in supporting parents through the loss of their offspring. In our NICU, we identified that only 74.5% of nurses are able to properly recognize the need for palliative care and only 55% are able to implement the necessary procedures. Purpose: A project was designed and implemented to enhance the ability of nursing staff to recognize the need for and properly implement palliative care to improve the quality of this care in the NICU. Resolutions: We organized an on-the-job education and training program within our NICU with the goals of heightening awareness among nursing staff. In addition, a specialist palliative care operation flow chart, process preparation checklist, and palliative-care-related tools were created to facilitate the care process. Results: After program implementation, among nursing staff in our NICU, the palliative care recognition accuracy rate rose to 100% (from 74.5%) and the implementation rate rose to 94.8% (from 55%). The quality of provided neonatal palliative care and hospice services was significantly improved. Conclusion: The developed program was shown to significantly improve nursing staff recognition and implementation of neonatal palliative care in our NICU. This experience provides a reference for improving palliative care quality and for helping families effectively manage end-of-life challenges. [ABSTRACT FROM AUTHOR]

This article, published in Frontiers in Pharmacology, provides an overview of therapeutic strategies for combating communicable and noncommunicable diseases. The authors discuss pathogens such as group B streptococcal and drug-resistant tuberculosis, highlighting factors that allow these pathogens to evade the immune system and potential treatments. The article also explores the pharmacodynamics of combinatorial therapies against gonorrhea and chlamydia coinfections, as well as the efficacy and safety of drugs like Paxlovid, tocilizumab, and baricitinib in treating COVID-19. The authors emphasize the importance of repurposing existing drugs and the need for further research in the field of infectious diseases. The document also includes references to two scientific articles, one examining the cardiac safety of the drug bedaquiline and the other discussing the biological synthesis of ursodeoxycholic acid. These articles provide valuable information for researchers interested in these specific topics. [Extracted from the article]

The article presents a case study of a patient with psoriasis who developed nodal T-follicular helper cell lymphoma, angioimmunoblastic-type, following COVID-19 vaccination while on adalimumab treatment. Topics discussed include the potential association between adalimumab and lymphoma risk, the impact of messenger ribonucleic acid (mRNA) COVID-19 vaccines on lymphoproliferative disorders, and the role of Epstein-Barr virus reactivation in lymphomagenesis.