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Individuals with severe burn injuries may develop depression, yet knowledge about psychological risk factors for depression following trauma is limited. This study investigated the prospective impact and interplay of prior depression and trauma-related cognitive processes (posttraumatic negative appraisals and trauma-related rumination) to depressive symptoms between 6 and 24 months after burn injury. Taiwanese adult survivors of burn (N = 118) participated in surveys immediately post-burn and at 6-, 12-, and 24-months follow-up. Participants were 7 5% men, with an average age of 41.8 years and an average of TBSA of 18.3%. A total of 8.5%, 5.9%, and 4.2% met criteria for probable major depression at 6, 12, and 24 months post-burn, respectively. The prevalence increased to 23.7%, 11.0%, and 5.9% using the cutoff on the PHQ-9. Prior depression and trauma-related cognitive processes immediately post-burn explained 13.5%, 20.5%, and 18.6% of the variance in depressive symptoms at 6, 12, and 24 months post-burn, respectively. Posttraumatic negative appraisals strongly predicted depressive symptoms post-burn across follow-ups. Moreover, posttraumatic negative appraisals significantly mediated the effect of prior depression on subsequent depressive symptoms across follow-ups. Prior depression significantly moderated the effect of trauma-related rumination on depressive symptoms at 6 months post-burn. Our results are the first to demonstrate the role and interplay of prior depression and trauma-related cognitive processes in post-burn depression. Findings highlight that pre-and post-trauma psychological factors jointly affect depression following trauma, broadening the applicability of cognitive theories of PTSD. • This study examined the contribution effect of early psychological risk factors to post-burn depressive symptoms. • Depression is relatively common at 6 months post-burn and then gradually decreased. • Posttraumatic negative appraisals strongly predicted depressive symptoms between 6 and 24 months post-burn. • Posttraumatic negative appraisals mediated the effect of prior depression on long-term depressive symptoms after burn. [ABSTRACT FROM AUTHOR]

The purposes of this study were to explore trajectories for patterns of postoperative pain intensity during the first year following hip fracture surgery and the relationships between pain trajectory groups, cognitive impairment, and depressive symptoms. A prospective cohort correlational study. A total of 325 patients aged 60 years or older who had received hip fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020. Data were collected before hospital discharge and at 1, 3, 6, and 12 months postdischarge. Pain intensity was measured using a numeric rating scale; cognitive function was measured with the Taiwan version of the Mini-Mental State Examination; and depressive symptoms were measured by the Geriatric Depression Scale–Short Form. Patients with similar postoperative pain trajectories were categorized into groups and compared with group-based trajectory modeling. Cognitive impairment and depressive symptoms associated with each group were identified by logistic regression. Three different pain trajectory groups were identified: drastic decline–minimum pain (47.7%), gentle decline–mild pain (45.5%), and slight decline–moderate pain (6.8%). Patients with cognitive impairment [odds ratio (OR) 11.01, 95% CI 2.99-10.51] and at risk for depression (OR 49.09, 95% CI 10.46-230.30) were more likely to be in the moderate pain group than the minimum pain group. Patients with cognitive impairment (OR 2.07, 95% CI 1.25-3.42) were more likely to be in the mild pain group than the minimum pain group. Patients at risk for depression (OR 9.68, 95% CI 3.16-29.63) were more likely to be in the moderate pain group than the mild pain group. Identifying postoperative pain trajectories can provide insight into the most appropriate pain management for older persons following hip fracture surgery. Attention should focus on assessments for cognitive impairment and risk of depression to prevent persistent postoperative pain. Future studies of older patients with clinically diagnosed cognitive impairment and depression are suggested. [ABSTRACT FROM AUTHOR]

This study aimed to establish an occupational disease surveillance system by identifying high-risk industries for silicosis in Taiwan using a national database linkage approach. The study was based on a comprehensive analysis of benefit claims from the National Labor Insurance Research Database and medical records from the National Health Insurance Research Database between 2004 and 2020, providing coverage for more than 88.5% of the workforce and 99.9% of citizens. Silicosis was defined as having received compensation for labor insurance benefits or having received a diagnosis of silicosis (International Classification of Diseases, 10th Revision : J62 or International Classification of Diseases, Ninth Revision : 502). The study used the International Standard Industrial Classification of All Economic Activities for industry-specific classification. Cox proportional hazard models were used to compare the silicosis incidence and risk among each industry and identify high-risk industries for silicosis. This study analyzed 1466 cases of silicosis between 2004 and 2020 and found that 28 industries had incidence rates of over 40 cases per 100,000 workers, indicating more than double the risk of developing silicosis. Of these industries, 14 were considered high risk (relative risk of over four times). Among these, this study identified industries rarely mentioned in the past, such as wholesale of brick, sand, cement, and products, artistic creation, landscape construction, and materials recovery. Stratification by years of work experience reveals those industries such as quarrying of stone, sand, clay, and other mining, construction of buildings, landscape construction, site preparation, foundation and structure construction, building completion and finishing, manufacture of ships, boats, and floating structures, and plumbing, heat, and air conditioning installation display higher hazard ratios for individuals with <10 years of work experience. The current surveillance system has identified certain industries that are at a higher risk of developing silicosis, which could be used for future occupational epidemiological surveys and targeted preventive measures in these sectors. [ABSTRACT FROM AUTHOR]

Relative deprivation has been linked to various adverse health outcomes. However, the potential mediating factors in the association between relative deprivation and health outcomes remain unclear. This study aimed to (1) examine the association between relative deprivation and self-rated health and health-related quality of life among the working-age population in Taiwan and (2) investigate the mediating effect of subjective social status. Cross-sectional study using nationally representative data. Data were obtained from the 2022 Taiwan Social Change Survey conducted from September 2021 to April 2022. We analyzed 1108 participants aged 25–64 years. Relative deprivation was measured using the Yitzhaki Index based on individual monthly income from all sources. Health-related quality of life was assessed using the 12-item Short Form Health Survey. After adjusting for all covariates and absolute income, least-squares regression models indicated a negative association between the Yitzhaki Index and self-rated health, as well as the physical and mental components of health-related quality of life. Furthermore, subjective social status partially mediates the association between relative income deprivation and poorer self-rated health and health-related quality of life. The findings support the psychosocial effect of the relative deprivation measure, emphasizing the importance of addressing relative deprivation to improve health-related quality of life among the working-age population. [ABSTRACT FROM AUTHOR]

Burn injuries can be traumatic and increase the risk of posttraumatic stress disorder (PTSD) and major depression (MDD). The current study examined the incremental contribution of established predictors of PTSD and theory-derived cognitive predictors to PTSD and depression early after burn. Participants were 118 adult burn patients consecutively admitted to the largest burn center in Taiwan who completed a baseline assessment, of which 101 (85.6%) were reassessed 3-month post-burn. Three months after the burn, 17.8% and 17.8% of participants met probable DSM-5 PTSD and MDD, respectively. The rates rose to 24.8% and 31.7% using a cut-off of 28 on the Posttraumatic Diagnostic Scale for DSM–5 and 10 on the Patient Health Questionnaire-9, respectively. After controlling for potential confounders, the model with established predictors uniquely explained 26.0% and 16.5% of the variance of PTSD and depressive symptoms 3-month post-burn, respectively. The model with theory-derived cognitive predictors uniquely explained 17.4% and 14.4% of the variance, respectively. Posttrauma social support and thought suppression remained significant predictors of both outcomes. A sizeable subset of burn patients suffer from PTSD and depression early after burn. Social and cognitive factors are implicated in the development and recovery of post-burn psychopathology. [ABSTRACT FROM AUTHOR]

Taiwan is a leading country regarding bariatric surgery in Asia-Pacific. Since 2010, the Taiwan Society for Metabolic and Bariatric Surgery (TSMBS) has been accountable for the national evolution of bariatric surgery and inaugurated a national database accordingly. This study aimed to analyze the bariatric surgery trends and progress in Taiwan from 2010 to 2021. The TSMBS database was collected on the basis of structured inquiries filled out by bariatric surgeons in Taiwan. All patients involving bariatric surgery were included. The data were stratified with the following objectives, including the types of bariatric procedures, demographic characteristics, and perioperative variables. A nationwide database was comprehensively analyzed and evaluated to determine the trends in the applications of the procedure. Data of 30,026 patients were enrolled. A 2.5-fold increase was observed in bariatric procedures, from 1218 in 2010 to 3005 in 2021. Within 12 years, female accounts for 61.8 %. The revisional rate was 3.40 % during the exploration stage (2010–2013), 2.77 % during the maturity stage (2013–2018), and 5.10 % during the expansion stage (2019–2021). The top five of primary bariatric surgery is sleeve gastrectomy (SG, 63.05 %), gastric clipping surgery (GC, 11.17 %), Roux-en-Y gastric bypass (RYGB, 9.34 %), one anastomosis gastric bypass (OAGB, 8.80 %), and sleeve plus surgery (SG plus, 4.43 %). The trends and progress of Taiwan's bariatric surgery within recent decades are presented in this article. Taiwan's bariatric surgery case number has increased steadily from 2010 to 2021. Amongst all, SG has become the most dominant procedure since 2011 while OAGB takes up second place in 2020. • Taiwanis the pioneer of bariatric surgery in the Asia Pacific since the late 20th century. • To comprehensively demonstrate a panorama of Taiwan's bariatric surgery development. • Several factors influencing the ebb and flow of various bariatric surgery procedures in Taiwan are discussed. • The trends of Taiwan's bariatric surgery may provide an insight of the evolvement of bariatric surgery in Asian population. [ABSTRACT FROM AUTHOR]

Friendship networks are relevant to adolescent weight status and lifestyle, but little is known about their relationship in an East Asian setting. Using a longitudinal cohort of Taiwanese adolescents, we studied how weight status and lifestyles might influence friendship. Simultaneously considering the influence of friendship networks, we further examined the effects of peers' lifestyles on the body weight status of adolescents. Data were retrieved from the first three waves of the Taiwan Youth Project (N = 2409; 51 % boys). Participants were asked to nominate their friends at school and to report their lifestyle factors (e.g. sleep habits, internet use, and athletic performance). Weight status was proxied by body mass index calculated from self-reported weight and height. Stochastic actor-based modeling was used for the friendship network analyses. Considering network structure, adolescents selected friends based on similarities in weight status (β = 0.147 [standard error = 0.044], p < 0.001) and lifestyle factors, such as athletic performance (β = 0.181 [0.034], p < 0.001), internet use (β = 0.156 [0.039], p < 0.001), and social jetlag (β = 0.055 [ ± 0.022], p < 0.05). In the behavior dynamics model, we did not observe any peer influence on changes in adolescents' weight status. These findings suggest a pervasive homophilic friendship selection explained by weight and lifestyle-based similarities, despite no evidence of peer influence on weight status. Stakeholders and care providers of adolescent health should be aware of the social network processes that underlie weight problems. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study identified developmental patterns of handwashing habit formation during childhood and examined their associations with later COVID-19 preventive practices. METHODS: We used data from the Taiwan Birth Cohort Study, which included 11,254 adolescents with complete data on childhood handwashing behavior and age-15 COVID-19 survey items. Bias-adjusted 3-step latent class analysis was used to test study hypotheses. RESULTS: The rates of handwashing and mask-wearing during the pandemic were 63.8% and 93.8%, respectively. Five distinct patterns of handwashing habit formation were identified: early formation (14.89%), delayed formation (17.73%), gradual formation (42.98%), inconsistent formation (9.78%), and nonformation (14.62%). Compared with adolescents with an early formation pattern of handwashing habits, those with other patterns exhibited lower odds ratios (ORs) of handwashing during COVID-19; these ORs were 0.67 (95% confidence interval [CI], 0.49-0.85), 0.60 (95% CI, 0.44-0.77), 0.29 (95% CI, 0.08-0.49), and 0.21 (95% CI, 0.01-0.40) for those with delayed formation, gradual formation, inconsistent formation, and nonformation patterns, respectively. Moreover, relative to that of adolescents with the early formation pattern, mask-wearing was less common among adolescents with gradual formation, inconsistent formation, and nonformation patterns, with ORs of 0.54 (95% CI, 0.16-0.92), 0.50 (95% CI, 0.03-0.96), and 0.26 (95% CI, 0.00-0.65), respectively. CONCLUSIONS! The early formation of hygienic habits is associated with higher adherence to pandemic preventive practices among adolescents. Our findings suggest that interventions to promote hygienic behaviors can start as early as age 3 through the introduction of healthy habits such as handwashing. [ABSTRACT FROM AUTHOR]

• Acute kidney injury (AKI) during the aging process is particularly of significant concern. • Increased AKI risk is linked to using multiple NSAIDs, the parenteral dosage form, and higher cumulative doses. • Dual combination of RAS blockade with NSAIDs or diuretics with NSAIDs, as well as triple therapy, heightens the AKI risk. Aging-related physiological changes, such as decline in renal function, not only exacerbates pre-existing comorbidities but also escalate the susceptibility to adverse events. Previous studies have shown that non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of acute kidney injury (AKI), and the concomitant use of renin-angiotensin system blockade or diuretics may further potentiate the risk. However, studies evaluating the risk of AKI associated with NSAIDs (including routes, concomitant use of different NSAIDs, categories (traditional NSAIDs or COX-2 inhibitors), and cumulative doses of NSAIDs) are limited, particularly the risk of AKI associated with the dual or triple combination of NSAIDs with renin-angiotensin system blockade (RAS blockades) and/or diuretics. A case-crossover study utilized two sets of longitudinal data from Taiwan's National Health Insurance Research Database (NHIRD). Newly admitted patients with a primary AKI diagnosis were included, with the index date defined as the first admission date. The 1–7 days and 181–187 days prior to the index date served as the case and control periods. Exposure to NSAIDs and co-exposures of RAS blockade and/or diuretics were assessed in both periods. Multivariable conditional logistic regression models, adjusting for potential confounders, estimated adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) for AKI associated with NSAIDs, dual, or triple combinations. Sensitivity analyses explored result robustness by varying case and control period lengths. The study included 1,284 newly diagnosed AKI patients. NSAIDs showed a 3.55-fold increased risk of AKI (aOR: 3.55; 95 % CI 2.70–4.65), with similar risks for traditional NSAIDs and COX-2 inhibitors. Use of multiple NSAIDs, parenteral dosage forms, and higher cumulative doses increased AKI risk. Dual combination with either RAS blockade or diuretics resulted in a 2.90-fold (aOR: 2.90; 95 %CI 1.47–5.70) and 12.68-fold (aOR: 12.68; 95 %CI 6.15–26.12) risk, respectively. The highest risk occurred with triple combination (aOR: 29.22; 95 %CI 12.82–66.64). NSAIDs, including both non-selective NSAIDs and COX2 inhibitors, elevate the risk of AKI. Increased AKI risk is linked to using multiple NSAIDs, the parenteral dosage form, and higher cumulative doses. Dual combination of RAS blockade with NSAIDs or diuretics with NSAIDs, as well as triple therapy, heightens the risk, with the latter associated with the highest risk of AKI. [ABSTRACT FROM AUTHOR]

This study aimed to use the Social Vulnerability Index (SVI) to encapsulate the complex and multidimensional nature of social determinants and their influence on alcohol intake and mortality in middle-aged and older individuals. Cohort study. Data were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with 3945 study participants aged 50 years and older. The TLSA questionnaire defined SVI (51 items including living conditions, social support, socially oriented activities of daily living, social engagement and leisure, empowerment of life, satisfaction about life, and socioeconomic status) and alcohol intake (behavior as well as type and frequency of alcohol intake). Multivariate Cox proportional hazard models were used to estimate the association between alcohol intake and mortality, stratified by sex and SVI groups. Men with high social vulnerability and high alcohol intake exhibit an elevated mortality risk [adjusted hazard ratio (aHR), 1.51; 95% CI, 1.01–2.24], whereas notably, women in similar social circumstances but with moderate alcohol intake face a quintupled mortality risk (>35 g/wk; aHR, 5.67; 95% CI, 2.37–13.61). The impact of alcohol and social vulnerability on mortality was more pronounced in men younger than 65. Among them, those with high social vulnerability and moderate (35–140 g/wk; aHR, 2.83; 95% CI, 1.50–5.36) to high (>140 g/wk; aHR, 2.24; 95% CI, 1.15–4.35) alcohol intake was associated with an increased risk of mortality. Various factors throughout the life course of both men and women significantly impact the risk of all-cause mortality due to alcohol intake, underscoring the importance of social vulnerability as a determinant of both alcohol intake behavior and mortality risk. [ABSTRACT FROM AUTHOR]

Before 2010, guidelines recommended adenosine 6, 12, and a repeat dose of 12 mg for paroxysmal supraventricular tachycardia (PSVT). After 2010, these doses were reduced to two. This study aims to outline adenosine using trend from 2000 to 2012 in Taiwan emergency departments (EDs). This was an ecological study. PSVT were drawn from one million individuals of the National Health Insurance Database. The χ2 test was used to determine an association between different adenosine doses and other antiarrhythmic drugs (OADs), including verapamil, diltiazem, amiodarone, digoxin, and labetalol. There were 3361 PSVT visits from 2000 to 2012; 834 (24.8%) did not receive an antiarrhythmic drug, and 2527 (75.2%) did, either adenosine with/without OADs or OADs alone. The use of an OAD was significantly different between the adenosine 6–18 mg and 19 + mg groups. Most PSVT episodes converted with adenosine within 18 mg, and the success conversion rate was 62.2%. It could be up to 65.2% if they received more. Of the patients who did not have their PSVT reverted with< 18 mg, 37.8% could have been successfully treated with more doses. The necessity of using the 3rd dose of adenosine is needed to be further explored. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the risk of mental disorders among the intensive care unit (ICU) survivors compared with the hospitalized non-ICU and non-hospitalized patients. We extracted data from the Taiwanese National Health Insurance Research Database (NHIRD) to conduct a retrospective cohort study. Multivariate Cox proportional hazard regression models were used to analyze the data. Identified from the NHIRD, we matched 15,918 patients with ICU admissions, 63,672 patients without any inpatient admission (non-inpatient department [non-IPD] cohort), and 63,672 patients admitted to a general ward but not the ICU (non-ICU cohort). The patient records were extracted between the periods of 2000–2015 to identify any occurrence of mental disorders. During the study period, the overall risk of mental disorder diagnosis was 1.68-fold higher in the ICU cohort than the non-IPD cohort (95% confidence interval (CI): 1.23–1.89, P < 0.001). Alternatively, there were no differences in risks for any mental disorders between the ICU and non-ICU cohorts. Both admissions to the ICU and the general ward cohorts were associated with a higher risk of any mental disorders compared to the general population. Further clinical studies are warranted to confirm this association due to residual or unmeasured risk factors. • Increased the risk of mental disorder in patients admitted to the ICU. • Increased the risk of mental disorder in patients admitted to the general ward. • Many unmeasured risk factors existed in the NHIRD may confound the study results. • Further clinical studies are warranted to confirm this association. [ABSTRACT FROM AUTHOR]

To study the prognostic features of Creutzfeldt-Jakob disease (CJD) and shed light on its future therapy. Retrospective cohort study of a longitudinal national cohort of the Taiwan Centers for Disease Control. All patients with suspected CJD are reported to the CJD surveillance unit of the Taiwan Centers for Disease Control. An expert committee discussed the reported cases and designated a consensus-based diagnosis. From 1996 to 2020, a total of 809 cases were referred to the CJD surveillance unit for confirmation; of these, 441 cases (women, n = 230) were determined to be sporadic CJD. We investigated the clinical manifestations and laboratory findings for 400 patients diagnosed with definite or probable sporadic CJD. We used Kaplan-Meier analyses and Cox proportional hazards model to identify prognostic factors. The mean age of onset was 67 ± 9.9 years. The mean survival duration was 13.3 ± 14.2 (median 10) months. The leading clinical symptoms were myoclonus (73%) and akinetic mutism (54%). For PRNP polymorphism, 99% of patients (195/197) showed a methionine homozygous genotype at codon 129 (M129M). The sensitivity of periodic sharp wave complexes (PSWCs) on electroencephalograms (EEGs) was 59.7%. The sensitivity of cerebrospinal fluid 14-3-3 protein and total tau protein (>1200 pg/mL) were 69.7% and 75.6%, respectively. Younger patients lived longer than those aged ≥65 years [hazard ratio (HR) 0.466, P <.001]. Women had a better survival probability in the first 3 years than their male counterparts (HR 0.712, P =.005). PSWCs had a persistent negative effect on survival (HR 0.788, P <.05). Although uncommon, epileptic seizures were the only clinical prognostic factor for survival time (HR 0.768, P <.05). PSWCs can be used as an EEG biomarker for prognosis. Epileptic seizures, though not common, are the only clinical prognostic factor for a short survival. We found that a lower age of onset and female gender favor the survival of patients with sCJD. PSWCs are EEG biomarkers unfavorable for survival, and so are epileptic seizures. [ABSTRACT FROM AUTHOR]

• The incidence of dementia increased slightly but the number of cases increased sharply. • A higher likelihood of multimorbidity after being diagnosed with dementia than before. • Dementia cases had increased healthcare usage 1 year before diagnosis, which peaked 1 year afterward. • Usage of psychotropic agents increased over 3 years before diagnosis of dementia. • The cumulative 5-year mortality was nearly 50 % among all identified dementia cases. This study aims to ascertain dementia incidence from 2004 to 2017 in Taiwan, and to examine the disease course in comorbidity, treatments, healthcare usage, and mortality among older people with incident dementia preceding the diagnosis of dementia and afterwards. Taiwan National Health Insurance data on people aged ≥ 65 years with incident dementia from January 2004 to December 2017 were excerpted to estimate annual incidence rates and annualized percentage changes(APCs). For people diagnosed before 2013, annual mortality rates and causes of death during 5-years' follow-up were determined. Changes in 22 diseases/conditions, hospital visits and admissions, and psychotropic medication prescriptions commonly associated with dementia, were examined from 3 years preceding the index diagnosis until 5 years afterwards. From 2004 to 2017, the annual incidence of dementia in Taiwan increased from 30,606 to 50,651, and by > 90 % in women; age-standardized annual incidence increased significantly, with an APC of 0.4 %(p = 0.02). For 372,203 incident cases from 2004 to 2013, annual mortality was∼12 % during 5-years' follow-up. The prevalence of most comorbidities increased by 65–150 % after being diagnosed with dementia. People with incident dementia had increased healthcare usage 1 year before diagnosis, which peaked 1 year afterwards. Psychotropic medication prescriptions increased gradually over 3 years before diagnosis, peaked 3 months afterwards, gradually declined during the next 2 years, then remained stable. The incidence of dementia in Taiwan has increased gradually over time, with an annual mortality risk of∼12 %. Older people with dementia had more healthcare needs and comorbid conditions after dementia diagnosis, highlighting the exigency of person-centered dementia care. [ABSTRACT FROM AUTHOR]

• Obesity exhibits various phenotypes and may have various effects on cancer risk. • We defined metabolic healthy obesity using the stricter criteria. • Metabolic healthy obesity may cause a modest increase in the risk of cancer. Many cancers are caused by overweight; however, cancer risk varies among individuals with obesity. Few studies are addressing the relationship between metabolic obesity phenotypes and cancer. This study investigates the association between metabolically healthy overweight (MHOW) or metabolically healthy obesity (MHO) and cancer incidence. In a nationwide, representative community-based prospective cohort study, 5734 Taiwanese adults were classified into eight phenotypes according to body mass index (underweight <18.5; normal weight 18.5–23.9; overweight 24–26.9; and obese ≥27 kg/m2) and metabolic status (healthy/unhealthy). Participants with healthy cardiometabolic blood profiles included in the metabolic syndrome criteria and an absence of hypertension, diabetes, and hyperlipidemia were considered metabolically healthy. We used the Cox proportional hazards models to estimate the adjusted hazard ratio (HR) and 95% confidence intervals (95% CI). During 73,389 person-years of follow-up, 428 incident cancers were identified. Compared to the participants with metabolically healthy normal weight, participants with MHOW (adjusted HR 1.39, 95% CI, 0.90–2.13) or MHO (adjusted HR 1.07, 95% CI, 0.51–2.22) had a tendency toward a higher risk of cancer. These associations were stronger in MHOW (adjusted HR 1.77, 95% CI, 1.09–2.86) or MHO (adjusted HR 1.39, 95% CI, 0.66–2.93) participants younger than 65 years. This study was the first to investigate the impact of metabolic obesity phenotype on the incidence of cancer in the Taiwanese population. Even in the absence of metabolic abnormalities, overweight, and obesity may cause a modest increase in the risk of developing cancer. [ABSTRACT FROM AUTHOR]

• English as a neutral language could be a language of connecting and/or excluding. • Mandarin was used as a language for converging and connecting. • Vietnamese as a language of divergence became a language of connecting. • Accommodation to others often came from international students. • Accommodation should also come from local students and internationalised universities. This study examines Vietnamese students' experiences of language choice practices in intercultural interactions with their local Taiwanese peers. Data were gathered from semi-structured interviews with students from five different Taiwanese universities where both English and Mandarin Chinese are used as mediums of instruction and communication. Findings suggest that the students frequently used English as a language of neutrality to communicate with local students, which either connected them with or disconnected them from their peers. They, whereas, considered Mandarin as a language of convergence, which helped them to get closer to their Taiwanese friends. They also occasionally made use of Vietnamese—a language of divergence—to a small extent to connect with their local peers. As international students seem to be the ones who often put more effort into addressing the linguistic and cultural gaps and improving the communication effectiveness compared with their local counterparts, it is recommended that local students should play a more proactive role in using proper accommodation strategies to connect with international students. Internationalised universities should also contribute to building a healthy and inclusive intercultural environment for international and local students and facilitating respectful and effective intercultural interactions among them. [ABSTRACT FROM AUTHOR]

Migrant workers are one of the most vulnerable population groups during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated knowledge and awareness of COVID-19 among Indonesian migrant workers (IMWs) in Macao (SAR), Hong Kong (SAR), and Taiwan. This was a cross-sectional study. Data were collected through an online survey in February and March 2020 to gain information on (1) participants' sociodemographic characteristics, (2) experience and awareness regarding COVID-19 information, and (3) knowledge and understanding of COVID-19. A series of Chi-squared, t -test, and logistic regression analyses were conducted. The survey was completed by 491 participants (92.1% female). Knowledge of COVID-19 was obtained from multiple sources, including a large proportion from online social media. However, participants who obtained information from their employer, local social networks, and migrant organisations answered a greater number of questions correctly. One-third of participants reported receiving hoax, fake news, and incorrect information and obtained information from unverified sources. Participants were most interested in information about how to cure COVID-19, and 57.8% knew that no specific drug or vaccine was currently available. Almost all participants correctly identified fever and wearing a facemask as the main COVID-19 symptom and prevention strategy, respectively. Participants with senior high school or higher education and who worked as domestic or care workers had a greater knowledge of COVID-19 than their counterparts. Public health communication strategies using multiple channels, including employers and community organisations, would help to minimise COVID-19 knowledge gaps. In addition, it is recommended that digital literacy content is added to public health campaigns. [ABSTRACT FROM AUTHOR]

Background Emerging evidence suggests that a dietary protein intake higher than the current recommended dietary allowance of 0.8 g/kg body weight (BW)/d may be needed to maintain optimal muscle mass, strength, and function in older adults. However, defining optimal protein intake in this age group remains a challenge. Objective In this study we sought to describe the dietary protein intake in frail, prefrail, and robust older Taiwanese adults Methods Data for 1920 older adults were collected from the Nutrition and Health Survey in Taiwan from 2014 to 2017. Dietary intake was assessed using the 24-h recall method. Frailty was determined using the modified Fried's criteria. Body composition was assessed using DXA. Sex-specific dietary protein intakes, measured as values/kg of BW, fat-free mass (FFM), and lean mass (LM), were estimated for the 3 age groups (65–69, 70–79, and ≥80y) and the 3 frailty levels. Results In both males (P for trend = 0.034) and females (P for trend = 0.015), there were significant downward trends for protein intake/kg of BW with the severity of frailty. The age-adjusted protein intake/kg of BW was still significant in males (P for trend = 0.009), but no longer in females. This phenomenon was also seen for protein intake at lunch and dinner but not at breakfast. Age-adjusted trends for protein intake/kg FFM or LM were not significant in either sex. The median protein intake in robust older males and females was 1.21 and 1.19 g/kg BW/d, respectively, and the mean intakes were even higher. Conclusion Median protein intake in robust Taiwanese older adults was approximately 1.2 g/kg BW/d, with higher mean values. The protein adequate intake in Taiwanese older adults was higher than the current recommended daily allowance (RDA) level but within the RDA range derived from the state-of art indicator amino acid oxidation technique. [ABSTRACT FROM AUTHOR]

Support care is rarely assessed and offered to people with long-term neurologic conditions, particularly Parkinson's disease. This study aimed to assess the symptom burden and unmet support care needs in people with mild to severe Parkinson's disease. Cross-sectional study. Patients with Parkinson's disease were recruited from neurologic outpatient clinics from 3 East and Southeast Asian regions, including Hong Kong, Taiwan, and Thailand. A standardized set of questionnaires assessing unmet care needs [Palliative care Outcome Scale (POS)], disease-specific symptom burden (POS–Symptoms–Parkinson's Disease), generic health-related quality of life (HRQOL) (EQ-5D-3L), and sociodemographic and clinical background. Completed questionnaires (n = 186) were collected from 64 Hong Kong Chinese, 64 Taiwanese, and 58 Thai patients. Their mean age was 67.23 ± 8.07, 54% were female, and 80% had mild-to-moderate disease. Their mean POS score was 10.48 ± 6.38, indicating moderate unmet support needs. Two-thirds of the participants rated constipation, fatigue, leg problem, and daytime somnolence as the most prevalent and burdensome symptoms. Patients from Hong Kong and Taiwan prioritized psychosocial and spiritual support, whereas Thai patients prioritized physical needs and emotional concerns. Multivariate adjustment for demographics and clinical characteristics showed that high psychological, spiritual, and practical burdens are associated with young age, male gender, and advanced disease stages. Patients experience significant symptom burden and moderate unmet support needs at the early to middle stage of Parkinson's disease. Routine assessment of changes in symptom burden should start early. The timely referral of support care services should provide appropriate psychospiritual and practical support in addition to motor training. Planning for support care services should consider cultural and health service contexts. [ABSTRACT FROM AUTHOR]

This study aimed to develop an equation model combining physical fitness and anthropometric parameters and compare its results with those of bioelectrical impedance analysis (BIA)-measured lean mass (LM) using dual-energy X-ray absorptiometry (DXA)-measured appendicular muscle mass (AMM) as reference. Observational analysis. Healthy community-dwelling older subjects. A total of 1020 participants were randomly allocated to the development group (development group, n = 510) or the cross-validation group (validation group, n = 510). Body composition was measured using both DXA and BIA, and physical fitness parameters, including grip strength, timed stepping test, sit-to-stand test, flexibility, and walking speed were also assessed. A prediction equation model of AMM by stepwise linear regression analysis that included or excluded 1 independent variable at each step, based on the P value of significance (P <.05), was developed. Using weight, sex, height, and handgrip strength as independent variables, the equation AMM = −9.833 + 0.397 × weight (kg) + 4.433 × sex + 0.121 × height (cm) + 0.061 × handgrip strength (kg) best predicts DXA-measured AMM (adjusted R 2 = 0.914, SEE = 2.062, P <.001). The predicted AMM was more highly correlated with DXA-measured AMM than the commonly used BIA-measured LM (R 2 = 0.9158 and 0.8427, respectively, both P <.001). Using DXA-measured AMM as reference, the Bland-Altman plot showed mean differences of −0.03 kg and −0.12 kg, with limits of agreement of −3.98 to 3.92 kg and −5.97 to 5.73 kg for the predicted AMM and BIA-measured AMM, respectively. The proposed equation offers a practical alternative method for estimating AMM that is less facility-dependent and more easy to use and affordable than instrumental studies. [ABSTRACT FROM AUTHOR]

• Household is an important physical activity resource in older adults' daily life. • Older adults' HPA and SWB had a positive association. • Engaging in HPA is a good approach for increasing old adults' self-rated health. • HPA is recommended for old couples to maintain marital satisfaction. • Older adults living in China and South Korea had higher HPA than others. Engaging in lifelong physical activity has multiple health benefits for older populations. Household physical activity occupies older adults' awake time, and they can be an important energy expenditure during the day. The purpose of this study was to investigate the association between older adults' household physical activity and subjective well-being in four East Asian societies. The study design was a secondary data analysis. Data were retrieved from the module of Families 2016 in the database of the East Asian Social Survey. Participants were community-dwelling older adults with a mean age of 70.30±7.50 years and who lived in China, Japan, Korea, and Taiwan. Data were collected by interviews via structured questionnaires between 2016 and 2018. Descriptive analyses, independent t -tests, and an analysis of covariance were performed for the statistical analyses. In total, there were 3,432 valid responses. Participants who lived in Taiwan had significantly lower levels of total household physical activity than those living in other societies. Older adults' household physical activity was found to significantly differ by age, educational degree, gender, religion, marital status, occupation, and whether living alone. Older adults with high levels of household physical activity had significantly higher self-rated health and marital satisfaction than those with low levels. Household physical activity has potential benefits for subjective well-being across international older adult populations. Increasing household physical activity is recommended for older married couples to maintain marital satisfaction. [ABSTRACT FROM AUTHOR]

This study investigated the association between morning pleasant anticipation (i.e., how pleasant will the day be?) and daily positive incidental affect (PIA, e.g., feeling enjoyable, energetic) on daily steps as measured by ecological momentary assessment (EMA) and accelerometry. A total of 152 adults in Taiwan (female = 67.1 %, age range = 18–59, M = 24.97) completed smartphone-based surveys upon waking and at three quasi-random times during the day for seven days during the COVID-19 outbreak (February–July 2022). They also wore accelerometers for the same seven days to measure physical activity (daily steps). The morning survey asked participants to self-report pleasant anticipation throughout the day, and the three quasi-random time surveys assessed current PIA. Multilevel modeling was used to examine day-level associations between morning pleasant anticipation, PIA, and daily steps. A list of key covariates (i.e., age, sex, educational attainment, marital status, living arrangement, chronic disease, body mass index [BMI], smoking, drinking, wellbeing, daily sleep quality, daily sleep hours, and accelerometer wear time) were included in the models to adjust for the covariates' potential effects on the study outcomes. The study sample consisted of 989 morning observations and 2714 quasi-random time observations (EMA response rate = 87.01 %). Findings suggest that higher-than-usual levels of pleasant anticipation in the morning were significantly associated with more same-day daily steps (b = 0.03, SD = 0.01, p =.03) after adjusting for covariates. In addition, daily PIA was a significant moderator between morning pleasant anticipation and daily steps (b = 0.02, SD = 0.01, p <.01), such that higher levels of daily PIA were associated with greater increases in daily steps in response to higher levels of morning pleasant anticipation. On days when participants had higher levels of pleasant anticipation in the morning, they took more steps per day. In addition, the association between morning pleasant anticipation and steps per day was stronger on days when participants had higher levels of PIA. These findings have practical implications for future EMA studies investigating the "anticipatory" affective processes on movement behaviors with the goal of promoting physical activity in daily life. • Smartphone and accelerometers measured pleasant anticipation and daily steps. • Greater pleasant anticipation upon waking was associated with more daily steps. • Higher positive incidental affect magnified relations between pleasant anticipation and steps. [ABSTRACT FROM AUTHOR]

To examine the effects of a delirium education module on undergraduate nursing students' knowledge of and perceived confidence and competence in delirium care. Delirium is common in intensive care units (ICUs) and leads to poor clinical outcomes. The under recognition of delirium is a major problem in ICU medicine. Nurses, as first-line health care providers, can address this by recognizing patients who are experiencing delirium. Since undergraduate nursing students will be the future ICU nurses, it is important to deliver the knowledge regarding delirium care. However, education about assessing delirium in ICUs among undergraduate nursing students is lacking. Quasi-experimental study. A total of 74 undergraduate students were divided into an intervention group (n=34) and a comparison group (n=40). A 2-hour simulation-based delirium education module integrated into a critical care curriculum was delivered to the intervention group only. The classroom-based intervention was administered at a medical university in northern Taiwan. Study outcomes were measured using a structured survey including (1) a 16-item delirium care knowledge quiz, (2) confidence in delirium care scale and (3) competence in delirium care scale. The survey was distributed to students before and after the module in December 2020. The Mann–Whitney U test, chi-square test and Fisher's exact test were adopted to test the differences of all variables between groups. A generalized estimating equation model was used to investigate the adjusted treatment effects. The participants had a median age of 22 years and 81% were female. The delirium education module yielded greater knowledge (B = 3.04, 95% confidence interval = 2.20–3.88), confidence (B = 4.20, 95% confidence interval = 2.67–5.73) and competence (B = 4.82, 95% confidence interval = 3.33–6.30) in delirium care when the treatment and control groups were compared. For undergraduate nursing students, simulation-based education module is effective in improving the knowledge of and confidence and competence in delirium care. It is recommended that this be included in critical care nursing curricula. [ABSTRACT FROM AUTHOR]

This study was conducted to examine the effectiveness of a virtual reality communication simulation (VRCS) in teaching communication skills in fundamentals of nursing practicum. Effective communication skills are an integral part of the nursing profession and the foundation of high-quality nursing care. Effective communication not only addresses the needs of patients but is also necessary for maintaining patient safety. Many studies have reported the inadequacy of nursing students in communicating with patients. Nursing students often experience stress due to their lack of adequate skills to communicate effectively with patients and their family members. A pragmatic randomized controlled trial research with four within-subjects assessments (at the baseline (T0), 1st week (T1) and 3rd week (T2) of the clinical practice and 1 week after the end of the clinical practice (T3)) and between-subjects assessments. Eighty-four nursing students at a university of Science and Technology in central Taiwan. The students were randomly assigned to an experimental group (n = 42) and a control group (n = 42). The experimental group received a VRCS, whereas the control group received the nurse–patient communication teaching video. The data were collected from April 2022 to August 2022. The Kalamazoo Essential Element Communication Checklist, Communication Self-Assessment Scale, Learning Satisfaction Questionnaire and Stress Scale for Nursing Students in Clinical Practice were used for data collection. At baseline, the control group had higher scores on communication ability and confidence compared with the experimental group (t = −3.91, p <.001; and t = −2.35, p =.021). In the first week of clinical practice, the experimental group had significantly higher mean scores for communication ability compared with the control group (β = 15.99, 95 % confidence interval [CI] 13.79, 18.18) and communication confidence and learning satisfaction compared with controls at T1, T2 and T3 of the clinical practice (all, p <.001). The clinical practice stress scores of the experimental group were significantly lower than those of the control group at T1, T2 and T3 of the clinical practice (all, p <.05). The newly developed VRCS is acceptable and worthwhile for training nursing students to develop communication abilities. This study suggests that VRCS practice should be arranged as early as possible in fundamentals of nursing practice courses and before the fundamentals of nursing practicum so as to facilitate the learning of effective communication. Follow-up research is needed to evaluate the long-term effects of virtual reality education in nursing practice. [ABSTRACT FROM AUTHOR]

Conflicting evidence underlies the controversial role of allogenic blood transfusion in recurrence of non–small cell lung cancer (NSCLC). Insufficient sample size and failure to measure effects of important confounders in previous studies contribute to the conflicting findings. To overcome these limitations, we applied robust statistics and weighted covariates in a large study cohort. Cox regression analyses were used to estimate the recurrence and survival in patients with NSCLC disease stages I through III who were transfused for a haemoglobin level less than 8.0 g/dL within seven days after surgical resection. Inverse probability of treatment weighting (IPTW) was used to balance covariates in the sequential cohort of patients receiving an incremental amount of blood. We applied restricted cubic spline functions to characterise dose-response effects of transfusion amount on recurrence and mortality. A total of 209 (11.6%) of 1803 patients received transfusions. Over a median of 42 months after surgery (interquartile range 24.9–71.9), patients who received blood had a greater risk of early recurrence (IPTW-adjusted HR: 1.81, 95% CI: 1.59–2.06, P < 0.001) and all-cause mortality (IPTW-adjusted hazard ratio, HR: 2.38, 95% CI: 1.97–2.87, P < 0.001). A non-linear dose-response occurred between transfusion amount and recurrence or mortality. The greater risk of disease recurrence and early mortality after surgical resection in NSCLC patients who receive blood transfusion supports use of clinical strategies to reduce exposure. Further studies are needed to identify benchmarks to guide evidence-based practices. • Transfusion effects on cancer outcomes are unclear because of the study design. • Rigorous statistics showed transfusion caused greater recurrence and mortality. • The adverse transfusion effects were primarily observed in early stages of disease. • Effects peaked at six units of transfusion and then stabilised. • Immune suppression by advanced disease and transfusion amount explain the findings. [ABSTRACT FROM AUTHOR]

Visceral adipose tissue dysfunction contributes to metabolic syndrome (MetS) and cardiovascular diseases. This study aims to investigate the association between visceral fat level measured by bioelectric impedance analysis (BIA) and MetS. This cross-sectional study recruited Taiwanese volunteers aged ≥20 years between 2012 and 2014. Anthropometric measurements and plasma concentrations of glucose, insulin, and lipid profiles were collected after at least 8 h of fasting. Insulin resistance was calculated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Visceral fat level (VFL, ranges: 1–59) and trunk fat percentage were measured through by the Body Composition Analyzer TANITA AB 140 Viscan. A total of 1086 volunteers (mean age = 44.2 ± 13.2 years) were enrolled. Multiple regression analyses showed that triglycerides levels and blood pressure increased while high-density lipoprotein-cholesterol decreased with VFL in both genders (p < 0.05). Increased HOMA-IR and VFL had a synergistic effect on MetS. Higher VFL was independently associated with MetS in both men (OR = 1.33, 95% CI: 1.19–1.48) and women (OR = 1.28, 95% CI: 1.17–1.39). Higher VFL is associated with MetS and its components. The portable BIA machine is easily applicable and useful tool to measure visceral fat in the community setting. [ABSTRACT FROM AUTHOR]

Women with terminal cancer are assumed to choose hospice care over aggressive treatment at the end of life. With new chemotherapy and target therapy options, it becomes more difficult to decide between hospice care and aggressive management. It is also crucial to consider the cost increases leading to severe financial burdens on healthcare systems. To better understand treatment options at the individual level, this study set out to describe trends in end-of-life care for the four leading cancers in women in Taiwan. This was a population-based retrospective cohort study. The data source was obtained between January 1, 2000, and December 31, 2013, from Taiwan's National Health Insurance Research Database. We identified 98,575 women with a diagnosis of breast (18,596), colorectal (23,734), liver and biliary (28,795) or lung (27,450) cancer who had died during the study period. Hospital data for services provided in the last 6 months of life, including hospice services and aggressive managements (chemotherapy, frequent hospitalisation, emergency room [ER] visits, intensive care unit [ICU] admission and endotracheal intubation), were collected. Hospice utilisation increased over the study period, with 25.85%, 25.34%, 21.23% and 26.55% of female patients with breast, colorectal, liver and biliary, and lung cancer receiving hospice care, respectively. However, the number of women undergoing aggressive treatments in the last 6 months of life remained high, with the breast cancer group having the highest chemotherapy rate, the colorectal cancer group having frequent hospitalisation and the liver and biliary cancer group having frequent ER visits and ICU admissions. Increasing hospice utilisation among women with the four most common cancers in Taiwan indicates that hospice services have gradually become well accepted over the past 13 years; however, the real focus is on the ineffective treatment preceding hospice care, and late referral was also a notable problem. • Women with terminal cancer are assumed to choose hospice care over aggressive treatment at the end of life. • Increasing hospice utilisation was observed in all four leading cancer groups in women between 2000 and 2013, partly owing to the shared-care programme. • Aggressive treatments preceding hospice care did not decrease with the increase in hospice utilisation. • Late referral to hospice care remains high. [ABSTRACT FROM AUTHOR]

In the context of universal health insurance coverage, this study aimed to determine whether urban–rural inequality still exists in preventive health care (PHC) amongst children in Taiwan. Prospective cohort study. A total of 184,117 mothers and their children born in 2009 were identified as the study cohort. The number of children born in urban, satellite and rural areas was 40,176, 57,565 and 86,805, respectively. All children were followed for 7 years, before which a total of seven times PHC were provided by Taiwan's National Health Insurance (NHI) programme. Ordinal logistic regression models were used to associate urbanisation level with the frequency of PHC utilisation. Stratified analyses were further performed in accordance with the children's birth weight and the mothers' birthplace. Children from satellite areas had higher utilisation for the first four scheduled PHC visits. Children living in urban areas received more PHC for the fifth and sixth scheduled visits. Compared with those from rural areas, children in satellite areas exhibited a small but significant increase in odds in PHC utilisation, with a covariate-adjusted odds ratio (aOR) of 1.04 and 95% confidence interval (CI) of 1.02–1.06. By contrast, no significant difference was observed between rural and urban areas (aOR = 1.01). Further stratified analyses suggest more evident urban–rural difference in PHC utilisation amongst children with low birth weight and foreign-born mothers. Given a universal health insurance coverage and embedded mechanisms in increasing the availability of healthcare resources in Taiwan, a slight urban–rural difference is observed in PHC utilisation amongst children. Hence, sociodemographic inequality in utilisation of PHC still exists. This issue should be addressed through policy intervention. • Urban-rural disparity in children's preventive care utilisation in Taiwan is small. • The universal health insurance coverage may help reduce the disparity. • Preventive care utilisation is relatively low amongst low birth weight children. • It is also low amongst children having foreign-born mothers. • Regular monitoring of utilisation by policymakers is strongly recommended. [ABSTRACT FROM AUTHOR]

• The escalating population of older adults and increasing life expectancy have brought attention to the critical issue of managing age-related chronic conditions and their associated polypharmacy and potentially inappropriate medications (PIMs). • Despite a slight decrease in the prevalence of polypharmacy and PIMs in Taiwan between 2014 and 2019, the rates remain significantly higher than those observed in Japan. • There is a call to improve the quality of pharmacotherapy and develop systematic approaches to ensure appropriate prescriptions for older populations. Polypharmacy and potentially inappropriate medications (PIM) are widely recognized as vital quality indicators of pharmacotherapy in older adults. As Taiwan and Japan grapple with the ongoing challenges of population aging, obtaining an accurate understanding of the prevalence of these indicators is crucial for developing effective strategies to optimize pharmacotherapy in older populations. The present study aims to comprehensively evaluate the prevalence of polypharmacy and PIMs in Taiwan and two Japanese cohorts, shedding light on the similarities and differences in prescribing practices across these populations. This study employed a cross-sectional design to investigate individuals aged ≥65 years in Taiwan, as well as two Japanese cohorts: Japan Cohort 1 (dispensing data from chain pharmacies; year 2014 and 2019) and Japan Cohort 2 (claims data; year 2017 and 2019). The prescription records of these participants were collected from the national claims database in Taiwan for the years 2014, 2017, and 2019. To identify polypharmacy and hyper-polypharmacy, the study defined the use of 5–9 and 10+ drugs, respectively. Furthermore, the study identified PIMs based on the STOPP-J criteria. Notably, the study further explored the most frequently used PIMs (by categories) in Taiwan. In the year 2019, the prevalence of polypharmacy exhibited similar rates in Taiwan (35.4%) and Japan Cohort 2 (33.1%), while surpassing that of Japan Cohort 1 (25.6%). Nonetheless, the incidence of PIMs in Taiwan was the highest (66.5%), exceeding those of the two Japanese cohorts (Cohort 1: 43.7% and Cohort 2: 40.2%) in the same year. Notably, the top three categories of commonly used PIMs in Taiwan comprised non-steroidal anti-inflammatory drugs (NSAIDs), antithrombotic drugs, and benzodiazepines. This study highlights the varying prevalence of polypharmacy and PIMs between Taiwan and Japan, but emphasizes the need for collaborative efforts towards optimizing pharmacotherapy in older adults. [ABSTRACT FROM AUTHOR]

Next-generation sequencing (NGS) of plasma cell-free DNA identifies driver mutations in advanced non-small cell lung cancer (NSCLC) and may complement routine molecular evaluation. The utility of liquid NGS at the start of tumour workup is undetermined. This is a randomised study of patients with suspected advanced NSCLC. All patients received blood liquid NGS testing at their first clinic visit and underwent standard histological diagnosis and tissue genotyping, encompassing polymerase chain reaction based methods for EGFR mutation, immunohistochemical (IHC) staining for ALK fusion and BRAF V600E mutation, and an IHC screening followed by confirmation using fluorescence in situ hybridization confirmation for ROS1 fusion. They were then randomly assigned to receive NGS results either after tissue genotyping (Group A) or as soon as possible after histological diagnosis of advanced NSCLC (Group B). The study measured time to start of systemic treatment as the primary endpoint and secondary endpoints included biomarker discovery rate, objective response rate (ORR), and progression-free survival (PFS). This study enroled 180 patients with suspected advanced NSCLC, randomised into two groups. 63 patients in Group A and 59 in Group B with advanced NSCLC were confirmed as advanced NSCLC and analysed. Most had adenocarcinoma (Group A: 77.8%, Group B: 79.7%). The prevalence of EGFR mutations in the two groups was similar (Group A: 57.1%; Group B: 56.6%). Other driver alterations were rare. The median time to treatment was shorter in Group B (20 days) than in Group A (28 days). ORR and PFS did not differ between groups significantly. Liquid NGS had high concordance with tissue testing and identified driver mutations in 42.6% (20/47) of tissue-negative cases. Performing liquid NGS at the initial clinic visit for suspected advanced NSCLC identifies more patients suitable for targeted therapies and shortens time to the start of treatment. • Liquid NGS finds treatable mutations in over 60% of East Asian NSCLC patients. • Upfront liquid NGS shortens the time to treatment by 8 days in advanced NSCLC. • Liquid NGS detects 42.6% of cases missed by four-gene tissue testing. [ABSTRACT FROM AUTHOR]

This study examined the association of changes in body weight with suicide mortality in 214,105 participants, aged 18–97 years, from the MJ cohort, Taiwan. During a mean follow-up of 15.0 ± 4.9 years, 239 participants died for suicide. Mean change in body weight was 0.29 ± 1.8 Kg/year. A nonlinear dose-response relationship between changes in body weight and suicide was detected (p < 0.001), so that incidence of suicide raised when body weight decreased. The HR (95%CI) per 1 kg/year of weight loss was 1.35 (1.03–1.75) for underweight participants. These findings highlight that weight loss could be a risk factor for suicide, especially among underweight people. [ABSTRACT FROM AUTHOR]

This study aimed to investigate whether weekend admissions to psychiatric wards in Taiwan were associated with different patient characteristics or worse clinical outcomes. Patients with acute psychiatric admissions between 1996 and 2012 were included based on the National Health Insurance Research Database. The patients' baseline characteristics were recorded. The study outcomes included inpatient mortality, length of stay, and readmission within 30 days. Multivariable linear regression and multivariable logistic regression with adjustment for age, sex, diagnosis, and compulsory hospitalization status were performed. Among 661,709 acute psychiatric admissions, there were 82,450 weekend admissions. The patients with weekend admissions tended to be younger and the proportion of patients with schizophrenia, bipolar affective disorder, substance use disorder, and compulsory hospitalization were higher. Weekend admissions were associated with a shorter length of stay (30.3 days vs. 33.3 days, p < 0.001), lower inpatient morality rate (0.07% vs. 0.11%, p = 0.007), but higher readmission rate (26.8% vs. 25.3%, p < 0.001). The impact of weekend admission on clinical outcomes was relatively small compared to the differences in demographic and clinical characteristics. Despite the small influence of weekend admission, evaluation of the quality of care provided at weekends requires further attention and research to improve mental health care. [ABSTRACT FROM AUTHOR]

Although hospice or palliative care for patients with advanced dementia has been implemented for more than 30 years, few studies have investigated the prognostic predictors of 6-month mortality in these patients. Prognostication has been a major obstacle, and 6-month prognostic predictors for patients with advanced dementia are still considered elusive. To better understand the dying trajectories of patients with advanced dementia, we performed a longitudinal prospective cohort study to investigate the predictors of 6-month mortality for residents with advanced dementia in long-term care facilities in Taiwan. Prospective cohort study. This study took place in 32 long-term care facilities selected from northern, central, and southern Taiwan. The study included 320 residents with advanced dementia. Measurements were obtained after determining study eligibility; the participants underwent follow-up assessments once every 3 months for 6 months or died during follow-up. The assessments included demographic characteristics, health and medical status characteristics, and death-related information. The Kaplan-Meier survival function estimation and the Cox proportional hazards model were used to estimate the survival rate and predict the prognostic factors. Baseline data from 320 residents with advanced dementia in long-term care facilities were obtained. The mean age was 82.7 years and 61.6% were female. The 6-month survival rate was 78.1%. The major cause of death was multiple organ failure related to pneumonia. The 6-month prognostic predictors were pneumonia (adjusted hazard ratio, 5.56; 95% confidence interval, 2.46–12.6; p -value <.001), reduction in nutrient intake >25% (adjusted hazard ratio, 5.05; 95% confidence interval, 2.37–10.8; p -value <.001), oxygen dependency (adjusted hazard ratio, 2.58; 95% confidence interval, 1.51–4.39; p -value =.001), treatment for electrolyte abnormalities (adjusted hazard ratio, 2.14; 95% confidence interval, 1.10–4.14; p -value =.025), severe pressure injuries (adjusted hazard ratio, 2.04; 95% confidence interval, 1.13–3.67; p -value =.018), and long-term indwelling urinary catheters (adjusted hazard ratio, 1.80; 95% confidence interval, 1.09–2.96; p -value =.021). Our results identified six prognostic predictors of 6-month mortality among residents with advanced dementia in Taiwan. These predictors may serve as risk assessment indicators for nursing staff who provide clinical care and can enable the identification of patients in recognized terminal decline, thereby allowing access to hospice palliative services. [ABSTRACT FROM AUTHOR]

Before launching large clinical trials to confirm the effects of statins in improving outcomes among men with prostate cancer (PC), the most appropriate target patient population and the type of statins need to be clearly identified. A retrospective cohort study was conducted using the Taiwan Cancer Registry of 2008–2014. This study included 5749 men with locally advanced and metastatic PC who received only androgen deprivation therapy (ADT) in the first year after their cancer diagnosis. Statin users were defined as anyone who was prescribed statins for >28 days. An inverse probability of treatment-weighted Cox model was used to estimate the effects of statin use on all-cause mortality and PC-specific mortality (PCSM) while treating the statin status as a time-dependent variable. Overall, 2259 patients died, and 1495 of them died of PC during a median follow-up of 3.6 years from 1 year after their diagnosis. Statin use was associated with significant reductions in all-cause mortality (hazard ratio [HR] = 0.78, 95% confidence interval [CI]: 0.70–0.86) and PCSM (HR = 0.76, 95% CI: 0.68–0.86) for metastatic disease and all-cause mortality (HR = 0.66, 95% CI: 0.54–0.81) for locally advanced disease. Patients who received atorvastatin, pravastatin, rosuvastatin or pitavastatin showed a stronger reduction in mortality than those who received other statins. Benefits of statins were consistently observed in men who received post-diagnostic statins, even in those with high comorbidities or an old age. Our results suggest that only atorvastatin, pravastatin and rosuvastatin were associated with improved survival in advanced PC patients receiving ADT. • Statins are potential candidates for secondary prevention in metastatic prostate cancer. • Atorvastatin, pravastatin, and rosuvastatin demonstrated greater survival benefits than other types of statins. [ABSTRACT FROM AUTHOR]

Abstract Background Nursing staff spend long periods in high-risk working environments. Objective The purpose of this study was to compare the hospitalization risk between nursing staff and the general population. Design This study adopted a retrospective observational design. Setting Data from the Taiwan National Health Insurance Research Database from 2011 to 2013 were analyzed. Method The standardized hospitalization ratio model was used to analyze the relative risk of hospitalization for various diseases between nursing staff and the general population. Results A total of 33,267 numbers of nursing staff in Taiwan were hospitalized, an overall crude hospitalization rate of 21.5%. After controlling for gender, calendar year, and age of nursing staff, the standardized hospitalization ratio of female nursing staff was significantly higher compared to the general population for infectious and parasitic diseases (SHR = 121.05, 95% CI = 112.66–129.89), diseases of the respiratory system (SHR = 105.12, 95% CI = 100.60–109.80), complications of pregnancy, childbirth, and the puerperium (SHR = 102.59, 95% CI = 100.85–104.35), and diseases of the skin and subcutaneous tissue (SHR = 109.71, 95% CI = 101.10–118.86). Conclusions Nursing staff have a significantly higher hospitalization risk compared to the general population for infectious and parasitic diseases, diseases of the respiratory system, complications of pregnancy, childbirth, and puerperium, and diseases of the skin and subcutaneous tissue. This may be associated with the job characteristics and environment of nursing staff. [ABSTRACT FROM AUTHOR]

The anatomic rearrangement of the gastrointestinal tract after bariatric surgery may result in alterations in the bile acid pool and consequently, gallstone disease. We aimed to investigate whether patients undergoing bariatric surgery are at risk of developing gallbladder disease postoperatively. We conducted a population-based cohort study by using claims data from the Taiwan National Health Insurance Research Database. The study cohort comprised 4197 patients diagnosed with morbid obesity. Among the morbidly obese patients, 2698 underwent bariatric surgery. Females and younger subjects were more prevalent in the surgical group than non-surgical group. Bariatric surgery reduced all obesity-related comorbidities. Cox proportional hazards regression was performed, which revealed increased risk of cholecystectomy after bariatric surgery among obese patients (adjusted hazard ratio, 3.43; p = 0.0165). After adjusting for sex and age, the incidence of cholecystectomy was increased in the females population (adjusted hazard ratio, 3.74; p < 0.05) and in 30–64 years-old-group (adjusted hazard ratio: 3.69, p < 0.05). The cumulative incidence rate of cholecystectomy showed an increased tendency in those undergoing bariatric surgery by log-rank test. Based on the Taiwan database population-based cohort study, bariatric surgery increases the risk of cholecystectomy among morbidly obese patients, especially in the female population and patients aged 30–64 years. [ABSTRACT FROM AUTHOR]

Abstract More than half of the world's population now lives in urban areas. Understanding the spatial distribution of suicide in these settings may inform prevention. Previous analyses of the spatial distribution of suicide in cities have largely been conducted in Western nations. We investigated the spatial pattern of suicide and factors associated with its spatial distribution in Taipei City, Taiwan. We estimated smoothed standardized mortality ratios for overall suicide and suicide by sex/age group across 432 neighborhoods (mean population size: 5500) in Taipei City (2004–2010) using Bayesian hierarchical models. A range of area-level characteristics including socioeconomic deprivation, social fragmentation, income inequality, and linking social capital were investigated for their associations with suicide mortality. Overall suicide rates were below average in the city center, whereas above average rates were found in some suburbs. The cartogram highlighted the concentration of suicide burden in one western area of the city. Male suicides demonstrated generally similar spatial patterning across age groups, while the geographic distribution of female suicides differed by age. After adjusting for other variables, two area characteristics were found to be associated with area suicide rates: the proportion of divorced/separated adults (rate ratio [RR] per one standard deviation increase = 1.08, 95% confidence interval 1.01–1.16), an indicator of social fragmentation; and median household income (RR = 0.80, 0.73–0.86), an indicator of socioeconomic deprivation. There was a 1.8-fold difference in suicide rates between neighborhood quintiles with the lowest and the highest median household income, with middle-aged males showing the largest gradient (3.2-fold difference). The geography of suicide in Taipei City showed spatial patterning and socioeconomic correlates distinct from cities in Western nations. There is a need for future research to better understand the correlates of change in the geographic distribution of suicide throughout the process of urban development. Highlights • Marked variations in suicide were found across neighbourhoods in Taipei City. • Low suicide rates were shown in the city center compared to some suburbs. • Around 60% of the variations could be explained by area characteristics studied. • Income and divorced/separated adults were linked with neighborhood suicide rates. • Socioeconomic inequality in suicide rates was strongest in middle-aged men. [ABSTRACT FROM AUTHOR]

Abstract Aim We explored the impact of gender role orientation (masculinity and femininity) on student nurses' caring behaviour and critical thinking. Background Caring and critical thinking are at the core of professional nursing education. Previous studies revealed inconsistent findings regarding the impact of gender roles on caring behaviour and critical thinking. Design and Methods We employed a quantitative correlational study. Nursing students (N = 449; female = 310, male = 139) who had at least had one month of clinical practice experience were recruited from four universities in Taiwan. Students' ages ranged from 19 to 29 years (Mean age = 21.24 years, SD = 1.28). Data were collected from August 2016 to July 2017, using three questionnaires: Taiwan Critical Thinking Disposition Inventory (CTDI), Caring Assessment Report Evaluation Q-sort Scale (CARE-Q), and Bem Sex Role Inventory (BSRI). Partial least squares structural equation modelling and generalized linear models were conducted to test the research model and hypotheses. Results Findings indicated that students who reported higher caring and masculinity presented greater critical thinking (ß =.37 and ß = 0.24, respectively; p s <.001). Students' gender, age, femininity, or clinical practice experience, however, were not significantly associated with critical thinking (ß = -0.01, ß = 0.09, ß =.10, and ß = 0.01, respectively; p s >.05). In addition, students who reported higher masculinity and femininity presented greater caring behaviour (ß =.22 and ß = 0.38, respectively; p s <.001). Students' gender, age or clinical practice experience were not significantly associated with caring behaviour (ß =.04, ß =.03, and ß = -0.05, respectively; ps > 0.05). The findings confirmed a direct influence of caring and masculinity on critical thinking. Masculinity indirectly affected critical thinking via caring behaviour. Caring and masculinity accounted for 34.4% of the variance in critical thinking, and masculinity and femininity accounted for 29.1% of the variance in caring behaviour. Conclusion Our study confirms the effect of age, gender role, and caring behaviour on critical thinking. We recommend that the cultivation of nursing care behaviour focus on students' gender role orientation. In addition, clinical nurse educators, when working with male students on patient caring, should consider their gender role orientation and support male nursing students' ways of presenting caring behaviours. [ABSTRACT FROM AUTHOR]

Abstract Background Heart failure is a complex syndrome that causes substantial functional impairment and poor outcomes. Although multidisciplinary disease management programmes are effective, the role of additional outpatient-based exercise training and the effects of multidisciplinary disease management programmes for patients with contraindications to exercise training are unclear. Objectives To compare the effects of the multidisciplinary disease management programme with and without exercise training on heart failure-related rehospitalization, disease knowledge, and functional capacity. Design Secondary analysis of a randomized controlled trial. Participants and Setting Data for 212 patients hospitalized for heart failure at a local teaching hospital in Taiwan were analysed. Methods Patients' data were assigned to three groups: control (n = 71), multidisciplinary disease management programme without exercise training (n = 70) or multidisciplinary disease management programme with exercise training (n = 71). The multidisciplinary disease management programme included comprehensive assessments, individualized education, optimizing medications, pre-scheduled clinic visits, and encouraging regular physical activity at home. Outpatient-based exercise training was performed only in the multidisciplinary disease management programme with exercise training group. The control and the multidisciplinary disease management programme without exercise training groups were further divided into subgroups with and without contraindications to exercise training. Patients were followed up monthly for heart failure-related rehospitalizations for 1 year. Cox proportional hazard models and Kaplan-Meier analyses were used to identify the significant predictors of heart failure-related rehospitalizations. A generalized estimation equation model was used to analyse the secondary outcomes, including disease knowledge and 6-min walking distance at baseline and 6 and 12 months after discharge. Results At 12 months after discharge, the multidisciplinary disease management programme with and without exercise training groups had significantly lower heart failure-related rehospitalization rates and better disease knowledge compared with the control group (p < 0.01). Only the multidisciplinary disease management programme with exercise training group had a significant improvement in 6-min walking distance (p < 0.05). For patients with contraindications to exercise, the multidisciplinary disease management programme significantly reduced heart failure-related rehospitalization rates at 12 months after discharge (p < 0.05). For those without contraindications, the event-lowering effect was only noted for the multidisciplinary disease management programme with exercise training group (p < 0.05). Conclusions Outpatient-based exercise training is recommended to be incorporated into multidisciplinary disease management programmes for patients without exercise contraindications to improve disease outcomes and functional capacity. For patients with contraindications to exercise, a multidisciplinary disease management programme is recommended to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Pregnant women tend to exercise less than women who have not yet been pregnant. In the present study, which involves two studies, we aimed to construct an effective, individualized exercise counseling model for pregnant women. In study 1, a three-round session that involved 10 multidisciplinary health care experts reached a consensus via the Delphi method. In the preliminary study, two healthy pregnant women were recruited from the prenatal outpatient departments of hospitals in Taipei, Taiwan. Both of them were 32 years old and primipara. The results of study 1, the established five stages of the individualized exercise counseling model for pregnant women were as follows: assessment, defining barriers that interfere with achieving the target, planning, implementation and monitoring, and evaluation. In the preliminary study, we applied this counseling model of study 1 to 2 healthy pregnant women. The 5-stage counseling model can encourage pregnant women to begin to exercise or to continue exercising. We believe that this exercise counseling model can potentially be used by nurses. It can help them to encourage pregnant women to regularly exercise, and to promote exercise as part of a healthy lifestyle. Highlights • The five stages of the Exercise Counseling Model for pregnant women are assessment, defining barriers, planning, implementation and monitoring, and evaluation. • The counseling model provides to be effective in encouraging pregnant women to begin to exercise or to continue exercising. • This exercise counseling model can provide guidelines for health care staff members to follow in their practice of encouraging women to exercise during pregnancy. [ABSTRACT FROM AUTHOR]

Methamphetamine (METH) is a Schedule II illicit drug in Taiwan. A 12-month legal–medical joint intervention program has been developed for first-time METH offenders during deferred prosecution. Risk factors associated with METH relapse use among these individuals were unknown. We enrolled a total of 449 METH offenders referred by the Taipei District Prosecutor's Office to Taipei City Psychiatric Center. The study defines relapse as having any positive urine toxicology result or self-report of METH use during 12-month treatment. We compared demographic and clinical variables between a relapse group and nonrelapse group and used a Cox proportional hazards model to determine variables associated with time to relapse. Of all participants, 37.8 % relapsed to use METH and 23.2 % were noncompleters in the one-year follow-up. Compared to the nonrelapse group, the relapse group had lower educational attainment, more severe psychological symptoms, longer duration of METH use, higher odds of polysubstance use, higher craving severity, and higher odds of positive baseline urine. The Cox analysis revealed individuals with positive urine results and higher craving severity at baseline were at higher risks of METH relapse (hazard ratio [95 % CI]: 3.85 [2.61–5.68] and 1.71 [1.19–2.46], respectively, p < 0.001). Baseline positive urine results and high craving could also predict a shorter length of time to relapse than their respective counterparts. Positive urine screening for METH at baseline and high craving severity are two indicators of an increased risk of drug relapse. Tailored treatment plans incorporating these findings to prevent relapse are warranted in our joint intervention program. • A joint legal–medical intervention program provides 12-month addiction treatment. • We followed 449 individuals with methamphetamine offense receiving the treatment. • 37.8 % had methamphetamine relapse and 26.5 % discontinued the 12-month treatment. • Baseline urine positive of methamphetamine and high craving increased relapse risk. • Tailored treatment incorporating these findings is warranted in the joint program. [ABSTRACT FROM AUTHOR]

The beneficial effects of multidisciplinary disease management programs have been demonstrated. The present study investigated the effects of a policy-driven, health insurance–reimbursed, heart failure (HF) post-acute care (PAC) program on mortality, health care service utilization, and readmission expenses for patients following hospitalization for HF. This was a retrospective propensity score–matched cohort study using the Taiwan National Health Insurance Research Database. In total, 4346 patients (2173 receiving HF-PAC and 2173 controls) with left ventricular ejection fraction of ≤40% who were discharged following hospitalization for HF were included for analysis. All patients were followed up after discharge for all-cause mortality, emergency visits within 30 days, and length of stay and medical expenses for readmission within 180 days after discharge. After propensity score matching, baseline characteristics of the HF-PAC and control groups were similar. During a mean follow-up period of 1.59 ± 0.92 years, according to the Cox multivariable analysis, HF-PAC reduced mortality by 48% compared with the control group, independent of traditional risk factors (hazard ratio = 0.520, 95% CI = 0.452-0.597, P <.001). Kaplan-Meier curves revealed that HF-PAC was associated with a higher cumulative survival rate (log-rank = 96.43, P <.001). HF-PAC also decreased the frequency of emergency visits after discharge by 23% in the 30 days post discharge and decreased length of stay and medical expenses related to readmission by 61% and 63%, respectively, in the 180 days post discharge (all P <.001). HF-PAC reduces short-term all-cause emergency visits, length of stay, and medical expenses for all-cause readmission and all-cause mortality in patients discharged following hospitalization for HF. Our findings suggest that PAC should include care continuity, optimal adaptation of transitional care components, and HF cardiologist engagement with multidisciplinary coordination. [ABSTRACT FROM AUTHOR]

Background Aging is a normal degenerative process that results in a decline in the gait and balance performance of older adults. Interactive cognitive motor training is an intervention that integrates cognitive and motor tasks to promote individuals’ physical and cognitive fall risk factors. However, the additive effects of the interactive cognitive motor training on objective quantitative data and comprehensive descriptions of gait and balance warrants further investigation. Objectives To investigate the effect of interactive cognitive motor training on older adults’ gait and balance from immediate to long-term time points. Design A double-blind randomized control trial. Settings Four senior service centers and community service centers in Taiwan. Participants 62 older adults who met the inclusion criteria. Methods The study participants were older adults without cognitive impairment, and they were randomly allocated to the experimental group or active control group. In both groups, older adults participated in three sessions of 30-min training per week for a total of 8 weeks, with the total number of training sessions being 24. The primary outcome was gait performance, which was measured using objective and subjective indicators. iWALK was used as an objective indicator to measure pace and dynamic stability; the Functional Gait Assessment was employed as a subjective indicator. The secondary outcome was balance performance, which was measured using iSWAY. A generalized estimating equation was used to identify whether the results of the two groups differ after receiving different intervention measures; the results were obtained from immediate to long-term posttests. Results Stride length in the pace category of the experimental group improved significantly in immediate posttest (p = 0.01), 3-month follow-up (p = 0.01), and 6-month follow-up (p = 0.04). The range of motion of the leg exhibited significant improvement in immediate posttest (p = 0.04) and 3-month follow-up (p = 0.04). The Functional Gait Assessment result indicated that statistically significant improvement was observed in immediate posttest (p = 0.02) and 12-month follow-up (p = 0.01). The results of balance performance showed that the experimental group attained statistically significant improvement in centroid frequency in the immediate posttest (p = 0.02). Conclusions The research results validated that the 24 sessions of the interactive cognitive motor training intervention significantly improved gait and balance performance. Future studies should extend the sample to communities to promote the gait and balance performance of community-dwelling older adults without cognitive impairment and reduce their risk of falling and developing gait-related diseases. [ABSTRACT FROM AUTHOR]

Objective: Autism Spectrum Disorders (ASD) have a significant genetic predisposition. The recurrence risk of ASD ranges from 3% to 18.7% for parents having one affected child. As recurrence risk perceptions have important implications for family planning, prenatal preparation, and future children managements, absolute and relative recurrence risk perceptions of having another affected child among Taiwanese parents of children with ASD were assessed.Methods: This study collected quantitative survey data from 415 Taiwanese parents who had one child with ASD.Results: Participants reported their absolute recurrence risk of having another child with ASD was 33.4%. Compared to other parents with normally-developing children, merely 49.8% of participants perceived higher relative recurrence risk. By controlling for the sociodemographic characteristics, participants' absolute recurrence risk perceptions were significantly predicted by their perceived genetic causes of ASD and family history of ASD. Yet, participants' relative recurrence risk perceptions were significantly associated with only the perceived genetic etiology.Conclusion: Taiwanese parents of children diagnosed with ASD had an incorrect understanding of their absolute and relative recurrence risks.Practice Implications: To facilitate informed decision-making in family planning, healthcare providers should discuss absolute and relative recurrence risks as well as genetic causes of ASD with this particular group. [ABSTRACT FROM AUTHOR]

Context: Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients.Objectives: To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan.Methods: This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan.Results: Among the 500 physicians surveyed, 383 responded (response rate 76.6%) and 346 valid questionnaires were included in the final analysis (effective response rate 69.2%). The most frequently identified ethical dilemma was "place of care," followed by "use of antimicrobial agents" and "artificial nutrition and hydration." The dilemma of "truth telling," which ranked first in the 2005-2006 survey, now ranked at the fourth place. Stepwise logistic regression analysis revealed that female gender and knowledge of palliative care were negatively correlated with the extent of dilemmas regarding issues of "life and death."Conclusion: The prevailing ethical dilemmas have changed in Taiwan 15 years after the enactment of the Natural Death Act, supporting that some previous strategies had worked. Our results suggest that education on the core values of palliative care, improvement of community-based hospice care program, and creating treatment guidelines with prognostication may resolve the current dilemmas. This type of survey should be adapted by individual countries to guide policy decisions on end-of-life care. [ABSTRACT FROM AUTHOR]

Context: Stroke is the second leading cause of death and the primary cause of disability worldwide. It is uncertain what care patients with stroke receive in their end of life and what trends in care are in recent years.Objectives: The objective of this study was to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with stroke in their last month of life during 2000-2010.Methods: Analysis of claims data of 55,930 patients with stroke obtained from the National Health Insurance Research Database was performed to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with stroke in their last month of life during 2000-2010.Results: Over the whole study period, 25.4% of patients with stroke were admitted to intensive care units in their last month of life. The percentages of patients receiving mechanical ventilation (77.4%-67.9%), cardiopulmonary resuscitation (53.8%-35.8%), and inotropic agents (73.5%-64.3%) decreased over time. The percentages of patients receiving artificial hydration and nutrition (65.9%-73.3%) and sedative or analgesic agents (34.7%-38.6%) increased over time. Patients under 85 years old were more likely to be admitted to intensive care units. Men were more likely to receive mechanical ventilation and cardiopulmonary resuscitation than women.Conclusion: Over time, the use of supportive procedures increased, and the use of intensive procedures decreased in patients with stroke in the last month of life. This study highlights a need for research, guidelines, and training in how to provide palliative care for end-stage patients with stroke. [ABSTRACT FROM AUTHOR]

Summary Objective Develop/validate a weight-specific health literacy instrument. Methods The development of weight-specific health literacy measurement consisted of seven phases: (a) a literature review; (b) consultation with weight management experts; (c) generation of an item pool; (d) selection of items via the Delphi method; (e) pilot testing; (f) a national survey; and (g) examination of the psychometric properties of the results. Results A random sample of 362 Taiwanese adults completed the face-toface survey. The results of factor analysis indicated reasonable good fit of a 2-factor model ( χ 2 /df = 1.1, p = 0.18; RMSEA = 0.02, CFI = 0.99, TLI = 0.99). Construct validity testing showed that the both factors were significantly correlated with s-MHLS ( γ = 0.71, p < 0.001; γ = 0.22, p < 0.001), comprehension ( γ = 0.32, p < 0.001: γ = 0.10, p < 0.05), and writing ( γ = 0.44, p < 0.001: γ = 0.11, p < 0.05). Predictive validity testing showed that the first factor had significant correlations with weight management efficacy ( γ = 0.16, p < 0.001), and three weight management behaviors. The second factor was significantly correlated with weight management efficacy ( γ = 0.11, p < 0.05) but not with the 3 weight management behaviors. Conclusions On the basis of the psychometric results, we conclude that the final version of Weight-Specific Health Literacy Instrument (WSHLI) includes the 13 items. It is a valid and reliable tool for weight management research and evaluation in Mandarin Chinese speaking populations. [ABSTRACT FROM AUTHOR]

Objective To investigate whether the Culturally Sensitive Collaborative Treatment (CSCT) would improve outcomes for patients with major depression who were managed in family medicine clinics in Taiwan. Method A single-blinded randomized trial was conducted in 26 family medicine clinics. Patients with major depressive disorder were consecutively randomized to either CSCT or treatment as usual (TAU). The primary outcome was the severity of depression. Secondary outcomes included treatment response, treatment remission, quality of life, and medication adherence. Outcomes were compared using hierarchical linear models (mixed-effects models) from baseline to 26-week follow-up assessments. Results Of the 280 patients, 141 were randomized to TAU and 139 to CSCT. Hierarchical linear modeling revealed that the CSCT group displayed significantly greater improvement in depressive symptoms over the study period when compared to the TAU group (B = − 2.60, P < 0.001). The odds of achieving the response, remission, and medication adherence were significantly greater for the CSCT group compared to the TAU group (odds ratio = 4.65, 4.12, and 2.06, respectively; all P s < 0.05). However, both groups did not differ significantly in quality of life. Conclusion CSCT is effective in improving treatment outcomes for major depression in family medicine clinics in Taiwan. [ABSTRACT FROM AUTHOR]

Objective Tinnitus is a common disorder that may cause psychological distress and anxiety. The aim of this study was to investigate the association between anxiety disorders (ADs) and tinnitus in a large population. Method We conducted a cross-sectional study using the National Health Insurance Research Database in Taiwan. Study subjects included 14,772 patients with tinnitus and 709,963 people in the general population who sought treatment in 2005. Distributions in ADs, age, sex, and medical comorbidities were compared between groups using chi-squared tests. Multivariate logistic regression models adjusted for age, sex, and medical comorbidities were used to analyze the association between tinnitus and ADs. Results Prevalence of ADs in tinnitus and general population groups was 3.9% and 1.5%, respectively, and this difference was significant ( P < 0.001). Diabetes mellitus, hypertension, hyperlipidemia, concussion or head injury, Meniere's disease, sensorineural hearing impairment, renal disease, coronary artery disease, and cerebrovascular disease were significantly more prevalent in the tinnitus group (all P -values < 0.001). Multivariate logistic regression model demonstrated that patients with tinnitus were significantly associated with increased risk of ADs (adjusted OR = 1.99; 95% CI = 1.81–2.19; P < 0.001). Conclusion Because the risk of ADs was significantly higher in patients with tinnitus than in the general population, physicians should be aware of the importance of psychological factors in tinnitus management. [ABSTRACT FROM AUTHOR]

Background Immigration is a global issue. Taiwan has a high proportion of immigrant spouses who take care of the aging parents-in-law at home mainly based on filial piety. Difficulties in communication in many aspects of daily life occur between the elderly and immigrant spouses, and result in the elderly becoming vulnerable and thus, influencing their psychological well-being. Although past studies demonstrated that due to cultural differences, employed foreign care providers negatively influenced elder care quality (e.g., care receipts’ health or mortality rates), no studies have explored whether immigrant spouses, as family caregivers, have any influence on elderly suicides due to cross cultural communication differences. Objective To address the above gap, this study was to examine the static relationship between immigrant spouses and elderly suicides. Method National-level authority data, comprising a 10-year longitudinal nationwide sample, were used. The number of immigrant spouses was treated as a proxy of cultural differences. Twelve models of outcomes with and without city- and time-fixed effects were conducted using panel data analysis. Results Descriptive statistics of the study variables are provided. The results revealed that overall the number of immigrant spouses had a positive correlation with suicides in older adults. Further, the gender of immigrant spouses had different impacts on elderly suicides. Conclusions This is the first study to examine relation between immigrant spouses and the elderly suicides. The study results provide another viewpoint of understanding of the role of immigrant spouses in elder care, while promoting elder-caregiver interactions for optimal elder health outcomes. [ABSTRACT FROM AUTHOR]