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Aims/Introduction Maternal hyperglycemia leads to adverse pregnancy outcomes, and also subsequently affects both mothers and their offspring in later life. The prevalence of type 2 diabetes mellitus is increasing worldwide, and gestational diabetes mellitus (GDM) is also believed to be increasing. More precise nationwide and up‐to‐date data on GDM are required. Materials and Methods A population‐based retrospective cohort study was carried out with the Birth Certificate Application database and linked to the National Health Insurance Research Database to explore trends in the annual crude prevalence of GDM in all women who gave birth between 1 January 2004 and 31 December 2015 in Taiwan and their pregnancy outcomes. The registry is considered complete, reliable and accurate. Results A total of 2,468,793 births from 2,430,307 pregnancies were reported between 1 January 2004 and 31 December 2015. Finally, 2,053,305 pregnancies were included for further analysis. The annual prevalence of GDM increased by 1.8‐fold during the 12 years from 2004 to 2015, with a significant continuous increasing trend (from 7.6% to 13.4%, P, The annual prevalence of gestational diabetes mellitus increased by 1.8‐fold in the 12‐year period from 2004 to 2015 in Taiwan, with a significant continuous increasing trend (from 7.6% to 13.4%, P

OBJECTIVE To investigate the association between the risk of stroke and exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) over various exposure periods. METHODS This was a nationwide population-based case-control study in which 10,035 incident patients with a primary diagnosis of ischemic stroke each were matched with two randomly selected controls for sex, age, Charlson Comorbidity Index, year of stroke diagnosis, and level of urbanization. Multiple logistic models adjusted for potential confounders were used to assess the association of PM2.5 with ischemic stroke incidence. RESULTS There were significant short-term, medium-term, and long-term relationships between PM2.5 exposure and ischemic stroke incidence. CONCLUSIONS This study supports existing evidence that PM2.5 should be considered a risk factor for ischemic stroke.

Importance New therapeutic classes of migraine-specific treatment have been developed, including 5-hydroxytryptamine1Freceptor agonists (lasmiditan) and calcitonin gene-related peptide antagonists (rimegepant and ubrogepant). Objective To compare outcomes associated with the use of lasmiditan, rimegepant, and ubrogepant vs triptans for acute management of migraine headaches. Data Sources The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to March 5, 2020. Study Selection Double-blind randomized clinical trials examining current available migraine-specific acute treatments were included. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to extract the data according to a predetermined list of variables of interest, and all network meta-analyses were conducted using a random-effects model. Main Outcomes and Measures The primary outcome was the odds ratio (OR) for freedom from pain (hereafter referred to aspain freedom) at 2 hours after the dose, and the secondary outcomes were ORs for pain relief at 2 hours after the dose and any adverse events. Results A total of 64 randomized clinical trials were included (46 442 participants; 74%-87% women; age range, 36-43 years). Most of the included treatments were associated with reduced pain at 2 hours compared with placebo. Most triptans were associated with higher ORs for pain freedom at 2 hours compared with lasmiditan (range: OR, 1.72 [95% CI, 1.06-2.80] to OR, 3.40 [95% CI, 2.12-5.44]), rimegepant (range: OR, 1.58 [95% CI, 1.07-2.33] to OR, 3.13 [95% CI, 2.16-4.52]), and ubrogepant (range: OR, 1.54 [95% CI, 1.00-2.37] to OR, 3.05 [95% CI, 2.02-4.60]). Most triptans were associated with higher ORs for pain relief at 2 hours compared with lasmiditan (range: OR, 1.46 [95% CI, 1.09-1.96] to OR, 3.31 [95% CI, 2.41-4.55]), rimegepant (range: OR, 1.33 [95% CI, 1.01-1.76] to OR, 3.01 [95% CI, 2.33-3.88]), and ubrogepant (range: OR, 1.38 [95% CI, 1.02-1.88] to OR, 3.13 [95% CI, 2.35-4.15]). The comparisons between lasmiditan, rimegepant, and ubrogepant were not statistically significant for both pain freedom and pain relief at 2 hours. Lasmiditan was associated with the highest risk of any adverse events, and certain triptans (rizatriptan, sumatriptan, and zolmitriptan) were also associated with a higher risk of any adverse events than the calcitonin gene-related peptide antagonists. Conclusions and Relevance For pain freedom or pain relief at 2 hours after the dose, lasmiditan, rimegepant, and ubrogepant were associated with higher ORs compared with placebo but lower ORs compared with most triptans. However, the lack of cardiovascular risks for these new classes of migraine-specific treatments may offer an alternative to triptans.

Monoclonal antibodies (mAbs) acting on the calcitonin gene-related peptide (CGRP) or on its receptor are new therapeutic biologics to prevent chronic migraine (CM). Four mAbs acting on the CGRP or on its receptor are new therapeutic biologics to prevent CM. The aim of current network meta-analysis (NMA) was to compare the efficacy and acceptability of CGRP mAbs with onabotulinumtoxinA or topiramate for CM. We included randomized controlled trials (RCTs) examining CGRP mAbs and onabotulinumtoxinA or topiramate in patients with CM. All network meta-analytic procedures were conducted using the frequentist model. The primary outcomes were changes in the monthly migraine days and the 50% response rate. The safety was evaluated with acceptability (i.e., drop-out rate) and rate of any adverse event. This NMA of thirteen RCTs, which, in total, consisted of 5634 participants, demonstrated that a single 300 mg of eptinezumab (mean difference = − 2.60 days, 95% confidence intervals (95% CIs) = − 4.43 to − 0.77 compared with placebo) demonstrated the best improvement in monthly migraine days among all interventions. In addition, 675 mg fremanezumab in the first month followed by 225 mg in the second and third months (odds ratio (OR) = 2.96, 95% CIs = 2.20 to 3.97 compared to placebo) was associated with the best response rate among all the interventions. Monthly 140 mg erenumab (MD = − 2.50 days, 95% CIs = − 3.83 to − 1.17 compared with placebo) was the best choice for reducing the number of acute migraine-specific medication use days. The safety analysis revealed that loading dose of 240 mg galcanezumab and monthly 240 mg (OR = 0.43, 95% CIs = 0.22 to 0.84) was associated with the lowest drop-out rate; loading dose fremanezumab 675 mg and monthly 675 mg (OR = 1.44, 95% CIs = 1.10 to 1.89), loading dose of 240 mg galcanezumab and monthly 120 mg (OR = 1.37, 95% CIs = 1.02 to 1.84), and single dose of fremanezumab 675 mg (OR = 1.35, 95% CIs = 1.00 to 1.83) were associated with significantly higher rates of AEs than the placebo/control groups. Our NMA indicated that all four CGRP mAbs demonstrated excellent safety, acceptability, and efficacy profiles compared to the traditional prophylaxis for CM. However, because there are several limitations, the findings of the current NMA should be taken into consideration with caution. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13311-021-01128-0.

To summarize the clinical neuroimaging evidence pertaining to the potential mechanisms of acupuncture for migraine prophylaxis. From a descriptive perspective, converging evidence from recent neuroimaging studies, mainly from functional MRI (fMRI) studies, has demonstrated that when compared with sham acupuncture, verum acupuncture could normalize the decrease of the functional connectivity of the rostral ventromedial medulla-trigeminocervical complex (RVM/TCC) network, frontal-parietal network, cingulo-opercular networks, and default mode network and could normalize sensorimotor network connectivity with sensory-, affective-, and cognitive-related brain areas. These areas overlap with those of the pain matrix. Verum acupuncture works in a more targeted and unique manner compared with sham acupuncture in patients with migraine. These findings from neuroimaging studies may provide new perspectives on the validation of acupoints specificity and confirm the central modulating effects of acupuncture as a migraine prevention treatment. However, the exact mechanism by which acupuncture works for migraine prophylaxis remains unclear and warrants investigation. Future studies with larger sample sizes are still needed to confirm the current results and to further evaluate the complex and specific effects of acupuncture by analyzing different stimulus conditions, such as verum vs. sham acupuncture, deqi vs. no deqi, different acupuncture points or meridians, and different manipulation methods. Moreover, instead of focusing on the changes in a single area of the brain, researchers should focus more on the relationships among the functional connectivity network of brain areas such as the RVM/TCC, thalamus, anterior cingulate cortex (ACC), superior temporal gyrus (STG), and supplementary motor area (SMA) to explore the underlying mechanism of the effects of acupuncture.

Background: Migraine is the most prevalent neurological disorder and the leading cause of disability in individuals under 50 years of age. Two types of migraine therapies have been defined: acute therapy (abortive or symptomatic treatment), the purpose of which is to interrupt migraine attacks, and preventive treatment (prophylactic treatment), the purpose of which is to reduce the frequency and severity of migraine attacks. Objective: This paper reviews research advances in new agents for acute therapy of migraine. Material and Methods: This review provides an overview of emerging new drugs for acute treatment of migraine based on clinical evidence and summarizes the milestones of different stages of clinical development. Results: Two new formulations of sumatriptan, DFN-11 (3 mg doses of subcutaneous sumatriptan) and DFN-02 (a nasal spray of sumatriptan 10 mg and a permeation-enhancing excipient), have been developed, and both of them showed a fast-onset action with efficacy for acute treatment of migraine with fewer adverse events. New drug discovery programs shifted the focus to the development of ditans, a group of antimigraine drugs targeting 5-HT1F receptors. Only lasmiditan has progressed to phase III clinical trials and was finally approved by the Food and Drug Administration (FDA) for acute migraine treatment. The other target for acute therapy is CGRP receptor antagonists, namely, gepants. Ubrogepant and rimegepant demonstrated statistically significant efficacy, and both were recently approved by the FDA. These 5-HT1F receptor agonists and CGRP receptor antagonists did not cause vasoconstriction, offering advantages over the current mainstay of specific acute migraine treatment. Conclusions: Overall, these new agents have expanded the available acute therapies for migraine treatment and will likely change the strategy with which we treat patients with migraine in the future.

Aim Nursing staff burnout threatens not only nurses' health but also the safety and health of their patients. Organizations should be aware of how work-related conflict can affect this burnout. This study examined the effect of supervisor support and work-family conflict on resource loss and burnout. Methods A cross-sectional method and quantitative approach were adopted. A total of 300 questionnaires were distributed to clinical nursing staff in two regional teaching hospitals, and 239 valid questionnaires were returned. Results Work-family conflict had a mediating effect on the relationship between supervisor support and emotional exhaustion. Emotional exhaustion fully mediated the relationships between depersonalization, work-family conflict, and reduced professional efficacy. Conclusion The mediating effect of emotional exhaustion in work-family conflict results from depersonalization and reduced professional efficacy, whereas work-family conflict mediated the effect of supervisor support on emotional exhaustion. The findings indicate that the medical industry should implement supervisor support strategies to reduce nursing staff work-family conflict and improve interventions for emotional exhaustion.

This study investigated the influences of nursing assistants’ job competency on their intrinsic and extrinsic satisfaction and intention to stay in the profession of long-term care institutions. Understanding the relationship between job competency and job satisfaction, both intrinsic and extrinsic, would enable institutions to strengthen service workers’ intention to stay and to retain essential personnel. This study was a cross-sectional study in which nursing assistants from 26 nursing homes and 15 elderly welfare institutions in Taiwan. The relationship between job competency and intention to stay was discovered to be significantly mediated by intrinsic and extrinsic job satisfaction. Given the staff shortages and difficulty retaining staff in long-term care environments, organizations must be able to strengthen employees’ intention to stay, one suggestion is to improve the employees’ competency, because higher competency results in higher quality of care and greater extrinsic job satisfaction. Furthermore, greater job competency is more likely to result in affirmation and accomplishment, both of which increase intrinsic job satisfaction and thus positively influence intention to stay.

The lack of an efficient approach in managing pharmaceutical prices in the procurement system led to a substantial burden on government budgets. In Thailand, although the reference price policy was implemented to contain the drug expenditure, there have been some challenges with the price dispersion of medicines and pricing information transparency. This phenomenon calls for the development of a potential algorithm to estimate appropriate prices for medical products. To serve this purpose, in this paper, we first developed the model by the sequential minimal optimization (SMO) algorithm for predicting the range of the prices for each medicine, using the Waikato environment for knowledge analysis software, and applying feature selection techniques also to examine improving predictive accuracy. We used the dataset comprised of 2424 records listed on the procurement system in Thailand from January to March 2019 in the application and used a 10-fold cross-validation test to validate the model. The results demonstrated that the model derived by the SMO algorithm with the gain ratio selection method provided good performance at an accuracy of approximately 92.62%, with high sensitivity and precision. Additionally, we found that the model can distinguish the differences in the prices of medicines in the pharmaceutical market by using eight major features—the segmented buyers, the generic product groups, trade product names, procurement methods, dosage forms, pack sizes, manufacturers, and total purchase budgets—that provided the highest predictive accuracy. Our findings are useful to health policymakers who could employ our proposed model in monitoring the situation of medicine prices and providing feedback directly to suggest the best possible price for hospital purchasing managers based on the feature inputs in their procurement system.