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The purpose was to explore the potential effects of nonapnea sleep disorders (NSDs) and hypnotic use on the incidence of common cold. This study adapted population-based retrospective cohort study designed. We used the data from the Taiwan National Health Insurance Research Database between 1998 and 2011. In total, 59,476 patients with NSDs were included in the study cohort, and the reference cohort comprised 59,476 propensity score-matched patients. We conducted a Poisson regression analysis to assess the incidence of common cold. The overall incidence of common cold was significantly higher than that in the reference cohort. Compared with the patients of the reference cohort without hypnotic use, those of the NSDs cohort with benzodiazepines and zolpidem use had higher incidence of common cold. In conclusion, study cohort had a higher incidence of developing common cold, and particularly pronounced in NSDs with hypnotic use. [ABSTRACT FROM AUTHOR]

Active Aging Learning Centers (AALCs) are scattered across various townships and districts in Taiwan and attract students with diverse backgrounds. Therefore, cultivating positive learning environments at AALCs is crucial. Influenced by Confucianism, ethnic Chinese societies emphasize interpersonal relationships, and traditional Confucian principles and norms inform class management strategies in such societies. This study explored the management of classes offered at AALCs in Taiwan. A total of 24 teachers (8 men and 16 women with an average age of 52.75 years [range: 28–71 years]) were interviewed. The interview data were analyzed using the constant comparative method, and the following results were obtained. (1) The interviewees managed their classes by presenting themselves as professionals, actively learning about and giving attention to their students, establishing class norms, and tracking their students' learning progress and adjusting their teaching methods accordingly. (2) The aforementioned methods enabled the interviewees to cultivate positive learning environments in which they and their students encouraged each other, learned together, and bonded emotionally, which promoted class cohesion. These findings suggest that class management at AALCs in Taiwan is based on the traditional Chinese conceptualizations of relationships, interactions, and interpersonal harmony and may serve as a reference for training AALC teachers in class management and promoting positive interpersonal interactions in and outside the classroom. [ABSTRACT FROM AUTHOR]

Aims: To examine how nurses' self‐efficacy impacts professional engagement (professional opportunities exploration and workplace improvement participation), nurses' turnover intention and further on actual turnover. Background: The problem of nursing shortage has become a common global issue. Nurses' self‐efficacy could reduce nurses' turnover intention. However, whether professional engagement could connect nurses' self‐efficacy and their actual turnover remains unknown. Design: This study adopts a three‐wave follow‐up design. Methods: This study uses proportionate random sampling to survey nurses in a large medical centre in Taiwan. Totally, 417 participants were enrolled from December 2021 to January 2022 (first wave) and followed up from February 2022 to March 2022 (second wave). The data of nurses' actual turnover (or not) were traced in May 2022 (third wave). STROBE statement was chosen as the EQUATOR checklist. Results: Self‐efficacy was positively linked to outcome expectation, which is positively linked to professional opportunities exploration. Self‐efficacy was positively linked to career interest and workplace improvement participation. Professional engagement was negatively linked to nurses' intention to leave the target hospital, which was positively linked to actual turnover. Conclusion: This study uniquely finds that professional engagement is the key to the mechanism underlying the influence of nurse' self‐efficacy on their actual turnover. Impact: Our findings impact nursing management that professional engagement is as well important as nurses' self‐efficacy, with an aim to maintain the professional nursing workforce. Patient or Public Contribution: Nurses complete the questionnaires, return them to the investigators and permit investigators to check their personnel data. [ABSTRACT FROM AUTHOR]

Aim: This quasi‐experimental study aimed to explore effects of walking exercise on disease activity, sleep quality, and quality of life among individuals with systemic lupus erythematosus. Methods: After recruiting people with systemic lupus erythematosus from a hospital in Taiwan between October 2020 and June 2021, participants were free to opt to receive one walking exercise programme plus standard care for 3 months or to membership of a control group receiving routine care. Primary outcomes included Systemic Lupus Erythematosus Disease Activity Score, the Pittsburgh Sleep Quality Scale, and a quality‐of‐life scale for patients with systemic lupus erythematosus, namely, LupusQoL. These scales were administered first, at baseline and later, within 1 week following completion of the intervention. Between‐group effects were compared using generalized estimating equations with adjustment for baseline variables. Results: The experimental and control groups each included 40 participants. Multivariate analysis indicated that adding the walking exercise programme into routine care elevated sleep quality and LupusQoL (the latter in the subscales of physical health, planning, and intimate relationships), except for disease activity. Conclusion: Findings of this study supported the addition of walking exercise as part of routine care for people with systemic lupus erythematosus and may be a reference in the provision of adequate care for these patients. Summary statements: What is already known about this topic? Systemic lupus erythematosus is a lifelong autoimmune disease that affects any organs throughout the body, thus insidiously causing negative impacts on the affected patients.Today, use of exercise programmes such as walking exercise has been studied as a remedy for many medical conditions, but its effectiveness in minimizing the symptoms of distress among people with systemic lupus erythematosus is unknown. What this study adds? Participants with systemic lupus erythematosus who opt to receive the walking exercise programme for 3 months in addition to routine care experience improved sleep quality and quality of life compared with those receiving routine care alone. The implications of this paper: In accordance with the belief that "an ounce of prevention is worth a pound of cure," early implementation of an exercise programme should be considered in addition to routine care for patients with systemic lupus erythematosus.Evidence from this research could provide empirically informed and robust data for healthcare policymakers and in turn might help to reduce the incidence of morbidity among patients with systemic lupus erythematosus. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are costly and common in older adults, but there is limited understanding of how treatment patterns and outcomes might differ between countries. Methods: We performed a retrospective serial cross‐sectional cohort study of adults aged ≥66 years hospitalized with hip fracture between 2011 and 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population‐representative administrative data. We examined mortality, hip fracture treatment approaches (total hip arthroplasty [THA], hemiarthroplasty [HA], internal fixation [IF], and nonoperative), and health system performance measures, including hospital length of stay (LOS), 30‐day readmission rates, and time‐to‐surgery. Results: The total number of hip fracture admissions between 2011 and 2018 ranged from 23,941 in Israel to 1,219,696 in the US. In 2018, 30‐day mortality varied from 3% (16% at 1 year) in Taiwan to 10% (27%) in the Netherlands. With regards to processes of care, the proportion of hip fractures treated with HA (range 23%–45%) and THA (0.2%–10%) differed widely across countries. For example, in 2018, THA was used to treat approximately 9% of patients in England and Israel but less than 1% in Taiwan. Overall, IF was the most common surgery performed in all countries (40%–60% of patients). IF was used in approximately 60% of patients in the US and Israel, but only 40% in England. In 2018, rates of nonoperative management ranged from 5% of patients in Taiwan to nearly 10% in England. Mean hospital LOS in 2018 ranged from 6.4 days (US) to 18.7 days (England). The 30‐day readmission rate in 2018 ranged from 8% (in Canada and the Netherlands) to nearly 18% in England. The mean days to surgery in 2018 ranged from 0.5 days (Israel) to 1.6 days (Canada). Conclusions: We observed substantial between‐country variation in mortality, surgical approaches, and health system performance measures. These findings underscore the need for further research to inform evidence‐based surgical approaches. [ABSTRACT FROM AUTHOR]

Background: Intellectual disability (ID) is a major developmental disability. However, data on changes in the prevalence over time at the national level are limited. Method: Using data from the national disability registry, we conducted an ecological study to evaluate the time trends of ID among children in Taiwan. We calculated the prevalence of ID by age, sex and severity, from 2000 to 2011, and assessed the time trends. Results: During the study period, the overall prevalence of ID in children aged 3–17 years increased from 3.60 to 5.91 per 1000 (β = 0.22, P < 0.001, r2 = 0.97). The prevalence of mild ID (MID, intelligence quotient: 50–69) increased from 1.30 to 3.60 per 1000 (β = 0.21, P < 0.001, r2 = 0.98). However, the prevalence of severe ID (SID, intelligence quotient: <50) was relatively constant, between 2.22 and 2.38 per 1000 (β = 0.01, P = 0.076, r2 = 0.96). Boys had a higher prevalence than girls, and the average boy‐to‐girl prevalence ratio was 1.42 for MID and 1.31 for SID. The boy‐to‐girl prevalence ratios of MID and SID decreased over time (β = −0.01, P < 0.001, r2 = 0.99 for MID; β = −0.01, P < 0.001, r2 = 1.00 for SID). Conclusion: The prevalence of ID in Taiwanese children increased from 2000 to 2011 and was largely attributable to increases in MID. Boys had a higher prevalence of ID and were more likely to have MID. [ABSTRACT FROM AUTHOR]

This cross‐sectional study explored the prevalence of sarcopenia in older adults with type 2 diabetes and investigated the effects of diet and physical activity on sarcopenia. In total, 577 older adults with diabetes were recruited from a teaching hospital in Taiwan. Diet and physical activity were assessed using self‐rated questionnaires, including the Healthy Diet Inventory, the Mini Nutritional Assessment‐Short Form, and the International Physical Activity Questionnaire‐Short Form. Sarcopenia was defined in accordance with the Asian Working Group for Sarcopenia 2019 guidelines. In total, 51.12% of participants had either possible sarcopenia, sarcopenia, or severe sarcopenia. Participants who were female, old age, prolonged sedentary times, poor nutritional status, and lower level of moderate‐to‐vigorous physical activity were identified as risk factors for possible to severe sarcopenia. Older adults with diabetes and possible to severe sarcopenia had poor nutrition status and engaged in inadequate physical activity. The findings indicate that sarcopenia may be related to nutrition status and physical activity, especially in older adults with diabetes. [ABSTRACT FROM AUTHOR]

Many studies have reported that gynecologic cancer diagnosis, surgery, adjuvant therapy, and survivorship can be extremely stressful for many people during their cancer journey, and most cancer survivors have experienced stress after cancer, which impacts their quality of life. Importantly, healthy stress management will assist patients in overcoming obstacles in their lives and enhance both the quality of life and the cancer adjustment process. This study aimed to investigate the relationships between stress, coping strategies, and quality of life among gynecologic cancer survivors and to assess the mediating effects of coping on the relationship between quality of life and stress. A series of regression models and Sobel test were conducted to investigate whether coping strategies mediated the relationship between stress and quality of life. Stress was a predictor of quality of life. Acceptance was the mediator between stress and quality of life. Tailored programs that foster coping strategies, such as the strategy of acceptance, to reduce stress and maintain quality of life in this vulnerable group need to be developed. [ABSTRACT FROM AUTHOR]

Background: Nurses with busy workloads lack the time to maintain health, leading to a decline in physical and mental health and quality of life. It is widely accepted that self-perception of health triggers health-promoting behaviors and impacts the quality of life; however, the relationship between these factors among nurses is unclear. The purpose of this study was to investigate the ability of a health-promoting lifestyle to mediate the relationship between self-perceived health and quality of life among nurses. Methods: A cross-sectional survey was conducted in four regional Taiwanese teaching hospitals with over 500 beds. The survey used stratified random sampling of 600 nurses who had worked for more than six months. The Self-Perceived Health Questionnaire, the Health-Promoting Lifestyle Profile, and the World Health Organization Quality of Life Scale were used to measure nurses' self-perceived health (SPH), health-promoting lifestyle (HPL), and quality of life (QoL). A Hayes PROCESS analysis and bootstrapping method were used for the mediation analysis. Results: A total of 518 nurses' data was included in the analysis. Nurses perceived their health status as less favorable than their colleagues, but frequently adopted health promotion behaviors. Nurses reported a moderate QoL. QoL and SPH were correlated (r =.33) and a high correlation between QoL and HPL (r =.64) was found. SPH and HPL both affect QoL (B = 0.077 and 0.070). SPH and HPL explained 42.6% of the variation in QoL. HPL played a partial mediation role. Conclusions: The study confirmed that HPL has an important role in mediating nurses' SPH and QoL. Nurse administrators are advised to encourage nurses to monitor their health status and provide health promotion mechanisms to improve their quality of life. [ABSTRACT FROM AUTHOR]

Background: The comparative efficacies of different generation tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR)‐mutated advanced non‐small cell lung cancer (NSCLC) remain largely unknown. Moreover, whether one EGFR‐TKI confers superior survival remains unclear, especially in East Asians. We conducted a network meta‐analysis (NMA) comparing the survival outcomes of East Asian patients with advanced NSCLC treated with first‐line EGFR‐TKIs. Methods: The NMA included observational real‐world evidence studies on adult patients with EGFR‐mutated advanced NSCLC who received first (gefitinib and erlotinib), second (afatinib), or third (osimertinib) generation EGFR‐TKIs as frontline therapy. Studies were identified through an online bibliographic search of Medline articles in the PubMed, SCOPUS, Web of Science, and Cochrane Library databases. Results: For overall survival (OS), afatinib had significantly better hazard ratios (HRs) than osimertinib (HR: 0.46, 95% confidence interval [CI]: 0.23–0.91), gefitinib (HR: 0.56, 95% CI: 0.43–0.72), and erlotinib (HR: 0.71, 95% CI: 0.54–0.92). For progression‐free survival (PFS), afatinib had significantly better HRs than gefitinib (HR: 0.45, 95% CI: 0.36–0.56) and erlotinib (HR: 0.63, 95% CI: 0.49–0.81). Moreover, afatinib was most likely to achieve the longest OS (81.3%), followed by erlotinib (13%), osimertinib, and gefitinib. Furthermore, afatinib was most likely to achieve the longest PFS (48.3%), followed by osimertinib (34.9%) and erlotinib. Conclusions: This real‐world evidence shows that afatinib confers better survival than other first‐line EGFR‐TKIs in East Asian patients with advanced NSCLC. [ABSTRACT FROM AUTHOR]

Simple Summary: Although fertility sparing surgery (FSS) may be a favorable surgical option for young women with early-stage borderline ovarian tumors (BOTs) or epithelial ovarian cancer (EOC) who wish to preserve their fertility, there still possessed risks of recurrence and disease progression during follow-up. The purpose of this retrospective article is to investigate the treatment outcomes in early-stage BOTs/EOC patients who underwent FSS. In this cohort, we found that the rate of pregnancy was higher among the married BOTs patients who had no prior live birth experience than among those who had prior live birth experience. The fertility and pregnancy outcome presented in this article may provide an important reference during pre-operative counseling. This study examined treatment outcomes, including preserved fertility, menstrual regularity, and pregnancy outcomes, in patients with stage I epithelial ovarian cancer (EOC) or borderline ovarian tumors (BOTs) who underwent fertility-sparing surgery (FSS). Patients with stage I EOC and BOTs who were aged 18–45 years and underwent FSS between 2007 and 2022 were retrospectively reviewed. Significant differences between various subgroups in terms of disease recurrence, menstrual irregularity due to the disease, and pregnancy outcomes were analyzed. A total of 71 patients with BOTs and 33 patients with EOC were included. In the BOT group, the median age was 30 (range, 19–44) years. Recurrence occurred in eight patients, with one case exhibiting a malignant transformation into mucinous EOC. Among the 35 married patients with BOTs, 20 successfully conceived, resulting in 23 live births and 3 spontaneous abortions. A higher pregnancy rate was observed in those without prior childbirth (82.4%) than in those who had prior childbirth (33.3%). In the EOC group, the median age was 34 (range, 22–42) years. Recurrence occurred in one patient. Menstrual regularity was maintained in 69.7% of the patients. Among the 14 married patients in this group, 12 achieved a total of 15 pregnancies (including 2 twin pregnancies), 16 live births, and 1 spontaneous abortion. The results of the study confirmed that FSS is a favorable surgical option for young women with early-stage BOTs or EOC who wish to preserve their fertility. However, additional investigations are needed to validate these findings. [ABSTRACT FROM AUTHOR]

In this study, we reported the patterns, epidemiology, and clinical features of anterior uveitis (AU) in Taiwan, an area of Eastern Asia. This prospective, cross-sectional case series study was performed to identify patients with AU at two tertiary medical centers (Kaohsiung Chang Gung Memorial Hospital and Kaohsiung Veterans General Hospital) located at the southern Taiwan between December 1, 2018, and March 31, 2020. The clinical diagnoses, ocular presentations, and laboratory data, including the results of the aqueous polymerase chain reaction tests, were investigated in these patients. A total of 112 patients, with a mean age of 48.9 years, were included. Most patients (87.5%) presented with unilateral eye disease, with 30 cases of ocular hypertension at the first presentation (27%). The most common clinical diagnoses were idiopathic AU (37.5%), human leukocyte antigen (HLA)-B27-associated acute AU (25.0%), and herpetic AU (18.8%). Among patients with herpetic AU, cytomegalovirus (CMV) was the most common pathogen (17/21, 81%). Compared to HLA-B27-associated acute AU, CMV-related AU was mostly observed in patients that were older in age, exhibited higher intraocular pressure, more keratic precipitates, greater iris atrophy, and more pseudophakia, but was least reported in those with posterior synechiae. This prospective study identified the pattern and clinical features of AU in southern Taiwan. [ABSTRACT FROM AUTHOR]

This study investigated the risk of post-COVID-19 conditions in older patients with COVID-19 compared to those with influenza, and how age impacts this relationship. Patients aged ≥65 years with COVID-19 or influenza were identified using the TriNetX network. The risk of post-COVID-19 conditions was compared between survivors of COVID-19 and influenza, followed by a comparison of post-COVID-19 conditions risk between patients aged 65–74 years and those aged over 75 years. Compared with influenza survivors, post-COVID-19 conditions were significantly more prevalent in patients with COVID-19 (hazard ratio [HR], 1.534; 95% confidence interval [CI]: 1.405–1.675). Specifically, COVID-19 survivors have a significantly higher risk of experiencing abnormal breathing (HR, 2.052; 95% CI: 1.757–2.397), fatigue (HR, 1.587; 95% CI: 1.322–1.905), anxiety/depression (HR, 1.587; 95% CI: 1.322–1.905), cognitive symptoms (HR, 1.667; 95% CI: 1.295–2.146) and cough (HR, 1.250; 95% CI: 1.006–1.553) compared with the influenza group. Contrastingly, no significant difference was observed in the risk of any post-COVID-19 condition between COVID-19 survivors aged 65–74 years and those aged over 75 years (HR, 0.994; 95% CI: 0.920–1.073). However, a lower incidence of cognitive symptoms was observed in patients aged 65–74 years compared to those aged ≥75 years (HR, 0.543; 95% CI: 0.445–0.661). In conclusion, compared with influenza, older patients have a higher risk of developing post-COVID-19 conditions after SARS-CoV-2 infection, and those aged over ≥75 years may have an increased risk of developing cognitive symptoms compared to those aged 65–74 years. [ABSTRACT FROM AUTHOR]

Cognitive impairment impacts the quality of life and increases morbidity and mortality rates. The prevalence of and factors associated with cognitive impairment have become important issues as the age of people living with HIV(PLWH) increases. In 2020, We conducted a cross-sectional study to survey the cognitive impairment among PLWH in three hospitals in Taiwan with Alzheimer Disease-8 (AD8) questionnaire. The average age of 1,111 individuals was 37.54 ± 10.46 years old, and their average duration to live with HIV was 7.12 ± 4.85 years. The rate of impaired cognitive function was 2.25% (N = 25) when AD8 score ≥ 2 was a positive finding for cognitive impairment. Aging (p =.012), being less educated (p = 0.010), and having a longer duration to live with HIV (p =.025) were significantly associated with cognitive impairment. Multivariate logistic regression analysis revealed that only the duration of living with HIV was a significant factor related to the tendency of cognitive impairment (p =.032). The risk of cognitive impairment increased by 1.098 times for every additional year to live with HIV. In conclusion, the prevalence of cognitive impairment among PLWH in Taiwan was 2.25%. Healthcare personnel should be sensitive to the changes in PLWH's cognitive function as they age. [ABSTRACT FROM AUTHOR]

We examined the unidimensionality and Rasch reliability of both Jenkinson's and MacIsaac's eight-item short versions of the Stroke Impact Scale (SF-SIS), a questionnaire for assessing overall health-related quality of life (HRQOL). This study was a secondary data analysis in which 263 persons with stroke completed the SIS. The 263 persons, on average, had age of 60 years, mild stroke, and moderate disability of self-care. The unidimensionality of both versions was validated via testing of model fitting and principal component analysis (PCA) of residuals using the Rasch analysis to determine the Rasch reliability and measures. The eight items in both SF-SIS versions met the criteria of infit and outfit MNSQ (<1.4 and >0.6), indicating good data-model fit. The PCA showed that no dominant factors existed in the residuals of the items. The person reliability of Jenkinson's and MacIsaac's SF-SIS versions was 0.80 and 0.79, respectively. The Rasch measures (i.e., person measure in logits) ranged from −1.06 to 1.87 in Jenkinson's SF-SIS and −0.82 to 1.88 in MacIsaac's version. The unidimensionality of both versions was supported. The Rasch measures of both appear valid for representing overall HRQOL levels. Both versions also showed acceptable reliability for research purposes. The unidimensionality was justified for both versions (Jenkinson's and MacIsaac's eight-item short-versions of Stroke Impact Scale). The Rasch scores of both versions appear valid for representing overall health-related quality of life. Both versions showed acceptable reliability for research purposes, but not sufficiently reliable for clinical use. [ABSTRACT FROM AUTHOR]

Evidence suggests increased mortality rates among autistic individuals. However, risks of mortality, including natural-cause, suicide, and accident mortalities, among autistic individuals remain unclear. Among the entire Taiwanese population (N = 29,253,529), between 2003 and 2017, 45,398 autistic individuals were identified and 1:4 matched to 181,592 non-autistic individuals based on birth year and sex. All-cause mortality, including natural-cause, accident, and suicide mortalities, was assessed from 2003 to 2017 between the two cohorts. Cox regression models were used to investigate the mortality risk between autistic and non-autistic individuals. Autistic individuals had increased likelihoods (hazard ratio, 95% confidence interval) of all-cause mortality (3.43, 3.00–3.92), natural-cause mortality (4.73, 3.99–5.60), and suicide mortality (3.67, 2.37–5.68) compared with non-autistic individuals. In particular, autistic males were more likely to die by suicide (hazard ratio: 3.81, 95% confidence interval: 2.37–6.13), and autistic females were more likely to die of accident (hazard ratio: 5.07, 95% confidence interval: 2.54–10.13) compared with non-autistic individuals. Appropriate and effective medical and mental health care is recommended for autistic individuals. Our study was the first population-based study in an Asian country to investigate the mortality rates among autistic individuals. Among the entire Taiwanese population (N = 29,253,529), between 2003 and 2017, 45,398 autistic individuals were identified and 1:4 age-/sex-matched to 181,592 non-autistic individuals. We found that autistic individuals had increased risks of all-cause mortality, natural-cause mortality, and suicide mortality compared with non-autistic individuals. Furthermore, autistic males were more likely to die by suicide, and autistic females were more likely to die of accident compared with the non-autistic individuals. [ABSTRACT FROM AUTHOR]

The association between autism spectrum disorder (ASD) and subsequent sexually transmitted infections (STIs) and the potential effects of medications on STI risk remain unknown. In all, 5076 adolescents and young adults with ASD and 57,060 age-/sex-matched individuals without ASD were enrolled between 2001 and 2009 and followed-up to the end of 2011 for identification of subsequent STIs. The results revealed that patients with ASD were prone to acquiring an STI [hazard ratio (HR) 3.36] compared with the comparison group. Long-term use of atypical antipsychotics was associated with a lower risk of acquiring an STI later in life compared with nonuse (HR 0.34). We recommend that clinicians closely monitor risky sexual behaviors and STI risk in patients with ASD. [ABSTRACT FROM AUTHOR]

INTRODUCTION The global tobacco epidemic poses a notable challenge to global health due to its association with various tobacco-related diseases. Although tobacco smoking is associated with depression, the exact mechanism by which tobacco smoking increases the risk of depression is unclear. This study explored the potential effects of tobacco smoking on depression. METHODS We used data in the analysis from the Taiwan Biobank of 27916 individuals recruited from 2015 to 2020. To investigate the associations between tobacco use and depression, the results of the depression-measuring subscale of the Patient Health Questionnaire-4 as well as data on participants' tobacco consumption and other relevant covariates, were analyzed. RESULTS Participants who smoked were more likely to report depression than those who did not smoke (AOR=1.50; 95% CI: 1.21-1.86). Furthermore, depression was significantly higher in women who smoked than in their male counterparts (females: AOR=1.68; 95% CI: 1.27-2.23, and males: AOR=1.32; 95% CI: 0.96- 1.80). Women aged <55 years and who smoked were more likely to report depression, whereas this trend was not observed in those aged ≥55 years (<55 years: AOR=1.75; 95% CI: 1.23-2.48), and ≥55 years: AOR=1.58; 95% CI: 0.97- 2.56). CONCLUSIONS Tobacco smoking is a significant factor associated with depression, particularly in younger women. The increasing prevalence of tobacco use for years among younger women in Taiwan might contribute to shifts in the associations between depression and tobacco use in women. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed (1) to describe how trends in pediatric palliative care (PPC) utilization changed from 2002 to 2017, and (2) to examine factors predicting PPC utilization among decedent children in Taiwan. Design: This retrospective, correlational study retrieved 2002–2017 data from three national claims databases in Taiwan. Methods: Children aged 1 through 18 years who died between January 2002 and December 2017 were included. Pediatric palliative care utilization was defined as PPC enrollment and PPC duration, with enrollment described by frequency (n) and percentage (%) and duration described by mean and standard deviation (SD). Logistic regression was used to examine the associations of various demographic characteristics with PPC enrollment; generalized linear regression was used to examine associations of the demographic characteristics with PPC duration. Findings: Across the 16‐year study period, PPC enrollment increased sharply (15.49 times), while PPC duration decreased smoothly (by 29.41%). Cause of death was a continuous predictor of both PPC enrollment and PPC duration. The children less likely to be enrolled in PPC services were those aged 1 to 6 years, boys, living in poverty, living in rural areas, and diagnosed with life‐threatening noncancer diseases. Conclusion: This study used nationwide databases to investigate PPC enrollment and PPC duration among a large sample of deceased children from 2002 to 2017. The findings not only delineate trends and predictors of PPC enrollment and PPC duration but also highlight great progress in PPC as well as the areas still understudied and underserved. This information could help the pediatric healthcare system achieve the core value of family‐centered care for children with life‐threatening diseases and their families. Clinical Relevance: Pediatric palliative care should be widely and continuously implemented in routine pediatric clinical practice to enhance quality of life for children and their families at the end of life. [ABSTRACT FROM AUTHOR]

Simple Summary: Proton pump inhibitors (PPIs) are commonly used for acid reduction in peptic ulcer diseases and esophageal reflux diseases. The effects of changing gut microbiota, and prolonged hypergastrinemia were reported. This study demonstrated that long-term PPI use in CRC patients was associated with an increased risk of death with dose–response effect but not for recurrence. PPIs may play a complex role in CRC patients. The dose–response effect of proton pump inhibitors on colorectal cancer prognosis is still under exploration. This population-based study in Taiwan was designed to examine the effect of proton pump inhibitors on overall death, colorectal cancer-specific death, and recurrence in colorectal cancer patients with different cumulative proton pump inhibitor dose levels. This cohort study was based on the Taiwan Cancer Registry and Taiwan National Health Insurance Research Database from 2005 to 2020. After frequency matching with a 1:1 ratio, a total of 20,889 users with proton pump inhibitors and 20,889 without proton pump inhibitors were analyzed. The cumulative defined daily dose level of proton pump inhibitor was stratified to explore the dose–response relationship. A proton pump inhibitor exposure cumulative defined daily dose > 60 after colorectal cancer diagnosis had higher risk of all-cause death than non-proton pump inhibitor users with adjusted hazard ratios of 1.10 (95% CIs: 1.04–1.18). For recurrence, a proton pump inhibitor exposure cumulative defined daily dose > 60 had reduced recurrence risk with an adjusted hazard ratio of 0.84 (95% CIs: 0.76–0.93). This study demonstrated that the long-term use of proton pump inhibitors in patients with colorectal cancer was associated with an increased risk of death that related to the proton pump inhibitor exposure cumulative defined daily dose > 60 and had different dose–response effect in various dose level. [ABSTRACT FROM AUTHOR]

Background: Mothers of children undergoing surgery for congenital heart disease experience significant stress. Therefore, finding a strategy to decrease this is vital. Aims: To examine whether adding educational digital video discs to routine education can reduce maternal anxiety and depression when their children undergo heart surgery and when surgical or post‐surgical complications occur. Study Design: In a teaching hospital, 120 mothers whose children underwent elective heart surgery were randomly and equally divided into two groups: mothers receiving routine education plus a digital video disc before surgery and mothers receiving only routine education. Mothers' anxiety and depression levels were compared before education, after education (before surgery), and on discharge day. The effect of watching the digital video disc on maternal anxiety and depression on discharge day was evaluated for the participants whose children had surgical or post‐surgical complications. Results: Compared with only routine education, mothers' anxiety after education and on the discharge day decreased more if digital video disc was added. Depression decreased more after education, but no difference was found on the discharge day. Anxiety levels of mothers whose children had surgical or post‐surgical complications on the discharge day decreased more if they watched the digital video disc, compared with those receiving only routine education (Beck anxiety inventory score 3.4 ± 1.9 and 6.1 ± 2.4 respectively; p‐value.001). Conclusions: Compared with only routine education, adding digital video disc could decrease mothers' anxiety, and until the day of discharge. Compared with only routine education, adding digital video disc could decrease mothers' anxiety on the discharge day if their child had surgical or post‐surgical complications. Relevance to Clinical Practice: Adding educational digital video disc to routine education could decrease mothers' anxiety until the day of discharge. It could also decrease mothers' anxiety if their child had surgical or post‐surgical complications. [ABSTRACT FROM AUTHOR]

Objectives: Otitis media with effusion (OME) is characterized by the presence of fluid in the middle ear without the presentation of signs or symptoms of acute ear infection. The point prevalence of OME reaches as high as 60% in children younger than 2 years of age. We used the National Health Insurance Research Database (NHIRD) to investigate the use of medication in children with OME before receiving ventilation tube insertion (VTI). Methods: Data of pediatric patients (age ≤ 12 years) who had OME and received VTI from January 1, 2011, to December 30, 2012, were retrieved from the Taiwan NHIRD. We surveyed the use of 4 medications to understand whether health care providers achieved the standards of medication use recommended by clinical practice guidelines. Results: This study examines the factors affecting the use of medication for pediatric OME. Overall, according to the study's operational definitions, the use of systemic antibiotics was most common (59.9%), followed by systemic antihistamines (23.4%), systemic steroids (8.8%), and intranasal steroids (9.6%). Systemic antibiotics use was associated with 12 factors. Ten of the 12 factors increase the use of systemic antibiotics, including namely age (age > 2 years), comorbidities, teaching hospital, and community hospital. In contrast, namely catastrophic illness and watchful waiting are the 2 factors that decrease systemic antibiotics use. For the use of systemic antihistamines, systemic steroids, and intranasal steroids were related to 6, 5, and 2 factors, respectively. Conclusions: The rate of drug use differs from the rate of use recommended by commonly used clinical practice guidelines. We found that the higher the number of factors that influenced the patients' drug use, the higher the rate of drug use. According to these results, drafting a treatment guideline for OME patients in accordance with current clinical practices in Taiwan is highly recommended. [ABSTRACT FROM AUTHOR]

Antrodia cinnamomea, a unique Taiwanese fungus (mushroom), has demonstrated the hepatoprotective activities in animals with liver injury. Nevertheless, there are few studies reporting the efficacy of the fungus in subhealth subjects (alanine aminotransferase (ALT) levels between 31 and 50 U/L and aspartate aminotransferase (AST) levels ≤ 50 U/L). In this study, we assessed the ameliorating effect of a A. cinnamomea mycelia extract (ACME) on liver health in asymptomatic individuals with marginally high ALT levels. Forty-four eligible Japanese adults were enrolled in this randomized, double-blind, placebo-controlled clinical study and instructed to take an ACME capsule (250 mg of ACME powder) or a placebo capsule daily for 12 weeks. The primary outcomes (i.e. ALT and AST) were analyzed at 0, 4, 8, and 12 weeks. No treatment-related adverse effects were observed throughout this study. In efficacy analyses with the per-protocol (PP) cohort of participants, there were no significant changes in ALT and AST levels within and between groups. However, subgroup analysis showed that ACME could significantly improve the mean ALT level of regular drinkers, consuming alcoholic drinks more than twice a week, after the study in comparison with the result of the placebo group. This exploratory study indicated that the ACME might effectively improve liver health in regular drinkers. [ABSTRACT FROM AUTHOR]

Background: Cyclin‐dependent kinases 4 and 6 inhibitors (CDK4/6i) have been shown to improve progression‐free survival (PFS) in patients with metastatic breast cancer (MBC) in randomized control trials. This study aimed to evaluate the efficacy and safety of CDK4/6i in patients with advanced breast cancer (ABC) in a clinical setting. Methods: Consecutive patients with ABC were treated between October 2019 and March 2023 at Taipei Tzu Chi Hospital, Taiwan. Patients who had received at least one dose of CDK4/6i were included in this retrospective study. The main outcome of this study was efficacy based on the treating physicians' assessments in terms of PFS, and overall survival (OS), as well as the factors associated with patient outcome. The secondary outcome was safety. Results: A total of 85 patients were included in the analysis, with a mean age of 66.8 years. After a median follow‐up of 16.1 months, the median PFS was 28.4 months (95% CI: 22.5–33.6) and the median OS could not yet be estimated. The most common adverse events (AE) were fatigue (50.8%), anorexia (45.9%), and leukopenia (44.7%). In multivariable analysis, treatment with CDK4/6i with any grade AE or response to treatment effect (CR/PR) was an independent predictor for longer PFS (hazard ratio [HR] = 0.27, 95% CI: 0.11–0.68; HR = 0.21, 95% CI: 0.06–0.67; p < 0.05). Conclusion: CDK4/6i administered in a real‐world setting exhibits a similar survival benefit with the clinical trials. [ABSTRACT FROM AUTHOR]

The study aimed to identify the factors associated with the 6-min walk distance (6MWD) and to provide reference values for the 6MWD in individuals with schizophrenia (SCZ) in Taiwan. A proportional stratified sampling method was utilized based on distribution of gender, age and body mass index (BMI) at the study hospital. The 6-minute walk test was conducted according to the American Thoracic Society protocol. A total of 237 patients with SCZ completed the 6-minute walk test. The 6MWD was significantly associated with age, height, weight, and length of the onset of SCZ. Stepwise linear regression revealed that height and age were significant determinants of 6MWD. The reference values for males and females at different age groups were determined. Notably, females over 60 walked substantially shorter than the age younger than 60. Height and age were the main predictors for 6MWD among people with SCZ in Taiwan. The established reference values can be used to identify those at risk of poor cardiorespiratory fitness and as a target outcome during exercise programs in psychiatric rehabilitation. Our results highlight that older females with SCZ may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness. Height and age were predictors of 6-min walk distance (6MWD) in schizophrenia (SCZ). The established age- and gender reference values for the 6MWD can be used to identify those at risk of poor cardiorespiratory fitness. Females with SCZ over age 60 may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness. [ABSTRACT FROM AUTHOR]

Simple Summary: The objective of this study was to investigate the association between IL-8 rs4073, rs2227306, rs2227543, and rs1126647 genotypes and the risk of colorectal cancer (CRC) in the Taiwanese population. Our findings reveal that the A allele and AA genotype of IL-8 rs4073 are significantly associated with an increased susceptibility to CRC in Taiwan. This observation provides further evidence of the complex interplay between inflammation and carcinogenesis in CRC development. Furthermore, individuals with the AA genotype exhibit significantly higher levels of serum IL-8 expression. Combining IL-8 rs4073 genotyping with the assessment of IL-8 levels may have potential benefits in terms of the precise risk evaluation and early detection of CRC among patients. Interleukin-8 (IL-8), a pro-inflammatory cytokine, is upregulated in CRC and plays an important role in its development and progression. Genetic variants in the IL-8 gene may impact the risk of CRC by modulating IL-8 levels. Our primary objective was to investigate the role of IL-8 genotypes in the development of CRC. To accomplish this, we employed the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method to analyze the genotypes of IL-8 rs4017, rs2227306, rs2227543, and rs1126647 in 362 CRC patients and 362 controls. Additionally, we evaluated the interactions between these genotypes and factors such as age, gender, smoking, alcohol consumption, and body mass index (BMI) status in relation to the risk of CRC. Furthermore, we utilized quantitative reverse transcription-PCR to measure the serum IL-8. The results demonstrated a significant difference in the distribution of rs4017 genotypes between the control and case groups (p for trend = 0.0059). Logistic regression analysis revealed that individuals with variant AA genotype had a 1.92-fold higher CRC risk (95% confidence interval [CI] = 1.28–2.89, p = 0.0023). Moreover, carriers of the IL-8 rs4017 AT + AA genotypes exhibited a significant association with CRC risk (odds ratio [OR] = 1.39, 95% CI = 1.02–1.91, p = 0.0460). Additionally, individuals with IL-8 rs4017 AA genotype displayed significantly elevated serum IL-8 compared to those with TT genotype at a 1.73–fold level (p < 0.0001), indicating a correlation between genotype and phenotype. In conclusion, the genotypes of IL-8 rs4017, along with their associated expression levels, can potentially serve as predictive markers for the risk of CRC. [ABSTRACT FROM AUTHOR]

Background: Aging leads to changes in the body system, such as sarcopenia. This can result in several health issues, particularly physical and mobility dysfunction. Asian people typically have little awareness of sarcopenia. Thus, this study incorporated nursing instruction into the mobile application design to allow users to easily learn about sarcopenia. Objective: This study evaluated a model for predicting high-risk populations for sarcopenia in home settings. We further developed a sarcopenia nursing guidance mobile application and assessed the effectiveness of this application in influencing sarcopenia-related knowledge and self-care awareness among participants. Methods: Using a one-group pretest–posttest design, data were collected from 120 participants at a teaching hospital in northern Taiwan. This study used an artificial intelligence algorithm to evaluate a model for predicting high-risk populations for sarcopenia. We developed and assessed the sarcopenia nursing guidance mobile application using a questionnaire based on the Mobile Application Rating Scale. Results: The application developed in this study enhanced participants' sarcopenia-related knowledge and awareness regarding self-care. After the three-month intervention, the knowledge and awareness was effectively increase, total score was from 4.15 ± 2.35 to 6.65 ± 0.85 and were significant for all questionnaire items (p values < 0.05). On average, 96.1% of the participants were satisfied with the mobile app. The artificial intelligence algorithm positively evaluated the home-use model for predicting high-risk sarcopenia groups. Conclusions: The mobile application of the sarcopenia nursing guidance for public use in home settings may help alleviate sarcopenia symptoms and reduce complications by enhancing individuals' self-care awareness and ability. Trial registration: NCT05363033, registered on 02/05/2022. [ABSTRACT FROM AUTHOR]

Background: Patients with serious mental illness (SMI) are more likely to have Type 2 diabetes mellitus (T2DM). However, studies that discuss the eating habits of patients with both T2DM and SMI are lacking. Purpose: This study was designed to explore the beliefs and experiences of Taiwanese patients with SMI who also have T2DM. Methods: Fieldwork for this study included 2 years of participant observation and individual interviews with 13 patients with SMI. Data from transcripts of observational field notes and interviews were transcribed verbatim and analyzed. Results: The participants described their experiences and concerns regarding dietary management during the period after receiving their T2DM diagnosis. The results of the data analysis were distinguished into three categories, including (a) increased difficulty in life, (b) positive view of dietary control, and (c) inability to abide by dietary restrictions. Conclusions: The findings suggest that healthcare professionals should work to better understand the challenges faced by patients with SMI and T2DM in implementing changes and resisting the temptation to eat unhealthy food and provide suggestions tailored to their cultural background, lifestyle, and eating characteristics. [ABSTRACT FROM AUTHOR]

Background: Because nurses often work in medical environments characterized by high workloads and high levels of stress and pressure, they are particularly vulnerable to workplace burnout and their well-being may suffer. Related studies on burnout, resilience, and well-being have focused primarily on teachers, social workers, and students, with few studies addressing the situation faced by nursing staff. It is important to understand the factors affecting the well-being of nursing staff. Purpose: This study explores the status quo and correlations among nursing-staff demographic characteristics, workplace burnout, well-being-related resilience, and the predictive factors of well-being in nurses. Methods: A cross-sectional, descriptive, correlational research design and purposive sampling were used in this study. Nursing staff who had worked for more than 6 months at a medical center in central Taiwan were recruited as participants, with data from 289 participants collected. A structured questionnaire was used to collect data on demographic characteristics, workplace burnout, resilience, and well-being. Results: The average scores for workplace burnout, resilience, and well-being were 40.40/(0- to 100-point scale), 26.79/(10- to 50-point scale), and 43.25/(24- to 96-point scale), respectively. The result of the regression analysis explained about 51.6% of the variance in well-being. Furthermore, resilience (28.4%), self-perceived health (14.3%), workplace burnout (4.5%), exercise frequency (1.8%), job title (1.2%), interpersonal pressure relief resilience (0.9%), and marital status (0.5%)were other important predictive factors of well-being in the participants. [ABSTRACT FROM AUTHOR]

Health literacy is a crucial factor in determining one's health outcomes. Individuals with high health literacy possess the ability to access, comprehend, evaluate, and utilize health information to maintain, enhance, and advocate for good health. This study aimed to develop and validate a tool called the Health Literacy Questionnaire for Older Adults (HLQ-OA) specifically designed to assess the health literacy of community-dwelling older adults in Taiwan. The development of the HLQ-OA occurred in two phases. Firstly, a systematic literature review was conducted, followed by the evaluation of content validity and face validity through expert and older adult assessments. Subsequently, a cross-sectional study was carried out, involving a convenient sample of 481 older adults from community-dwelling long-term care stations. The final version of the HLQ-OA comprised 16 items that assessed four competencies associated with accessing, understanding, appraising, and applying health-related information. The HLQ-OA demonstrated excellent internal consistency, with an overall Cronbach's α coefficient of 0.94. Additionally, the model fit indices indicated an acceptable fit: RMSEA = 0.046, GFI = 0.909, CFI = 0.945, TLI = 0.939. Furthermore, a high correlation was observed between the HLQ-OA and the HL-SF12 (r  = 0.832). These findings support the reliability and validity of the HLQ-OA as a tool for assessing the health literacy of older adults. In conclusion, the HLQ-OA is a reliable and valid instrument that can be effectively utilized to measure the health literacy levels of older adults. [ABSTRACT FROM AUTHOR]

Summary: This study aimed to assess the impact of drug adherence and treatment duration for denosumab on mortality risk after hip fracture surgery. Lower all-cause mortality risk was associated with drug intervals of 7 months or less and longer treatment duration. The study highlights the importance of proper denosumab administration. Purpose: Prescription of anti-osteoporotic medications (AOMs) after osteoporotic hip fracture may increase bone mineral density (BMD) and decrease mortality risk. However, few studies have been conducted on drug adherence and treatment duration for denosumab, a popular choice among AOMs. This study aimed to assess the impact of denosumab adherence and treatment duration on the mortality risk of hip fracture patients after surgery. Methods: We conducted a cohort study using nationwide population data from National Health Insurance Research Database (NHIRD) in Taiwan. Patients newly diagnosed with osteoporosis and hip fracture between 2008 and 2019 who used denosumab after surgery were included. We assessed drug adherence, treatment duration, and other parameters associated with patient outcomes. Results: A total of 21,316 patients diagnosed with osteoporotic hip fractures were included. Compared with a > 7-month drug interval for denosumab, an interval of ≤ 7 months led to lower all-cause mortality risk (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.57 ~ 0.64). Patients with denosumab treatment for over 1, 2, and 3 years had lower all-cause mortality risk (HR&CI: 0.68 (0.64 ~ 0.73), 0.48 (0.43 ~ 0.53), 0.29 (0.26 ~ 0.33)) than those with treatment duration < 1 year. Analysis after excluding short-term death yielded similar results. Analysis of causes of death also showed that good adherence and longer duration were associated with reduced mortality due to cancer and cardiovascular disease. Conclusion: Better drug adherence and longer duration of denosumab treatment are associated with lower all-cause mortality risk among hip fracture patients after surgery. Our study highlights the benefits of a proper time interval of denosumab administration. These findings provide important insight into management of osteoporotic hip fractures and may inform clinical practice and development of guidelines. [ABSTRACT FROM AUTHOR]

Summary: In this multi-institutional retrospective cohort study, we compared the long-term risk of osteonecrosis of the jaw following the use of denosumab vs. bisphosphonates in osteoporotic patients. After 2-year use, the likelihood of osteonecrosis of the jaw is lower with denosumab compared to bisphosphonates, and the difference increases with time. Purpose: To compare the long-term risk of osteonecrosis of the jaw (ONJ) between osteoporotic patients treated with bisphosphonates (BPs) and denosumab. Methods: This multi-institutional retrospective cohort study included patients aged > 40 years with osteoporosis between January 2010 and December 2018. Patients who met the eligibility criteria were divided into BPs and denosumab groups by propensity score matching (PSM). The risk of ONJ of denosumab vs. BPs was estimated using a Cox proportional hazards model and was described by the cumulative incidence rate using the Kaplan–Meier method. Results: A total of 84,102 patients with osteoporosis were enrolled, among whom, 8962 were eligible for inclusion based on their first-line drug use (denosumab, n = 3,823; BPs, n = 5,139). Following PCM matching (1:1), the BPs and denosumab groups included 3665 patients each. The incidence density of ONJ in the denosumab and BPs matching groups was 1.47 vs. 2.49 events (per 1000 person-years), respectively. The hazard ratio of ONJ in the denosumab vs. BPs group was estimated as 0.581 (95% confidence interval: 0.33–1.04, p = 0.07). The cumulative incidence rates of ONJ in both groups were similar for the first and second years of drug use (p = 0.062), but significantly different from the third year onwards (p = 0.022). The severity of ONJ was not significantly different between the two groups. Conclusion: In osteoporotic patients, after 2 years of use, the likelihood of ONJ being induced by denosumab is lower than that of BPs, and the difference increases with time. [ABSTRACT FROM AUTHOR]

Aims: To develop and psychometrically test Character Strengths Use in Diabetes Self‐management Scale in people with type 2 diabetes. Design: Cross‐sectional design. Methods: Based on literature reviews and examination by experts, a 20‐item scale was developed and administered to 350 participants with type 2 diabetes who were enrolled from two endocrine clinics by convenience sampling in Taiwan. Item analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), concurrent and predictive validity as well as reliability were used to examine the psychometric characteristics of the scale. Data were collected from November 2021 to March 2022. Results: EFA and CFA supported a 12‐item scale with three factors, namely learning proactively, taking on challenges and thinking positively, fit the data well. The total score of the 12‐item scale significantly and positively correlated with diabetes‐specific quality of life, and significantly and negatively correlated with baseline and 9‐month haemoglobin A1c levels. Cronbach's α for overall scale and subscales ranged between.78 and.91. Conclusion: The 12‐item Character Strengths Use in Diabetes Self‐management Scale demonstrated satisfactory validity and reliability in people with type 2 diabetes. Impact: Nurses could apply this new scale to identify the degree of using character strengths in self‐management in people with type 2 diabetes; accordingly, character strength‐based interventions could be provided to improve self‐management in such patients with diabetes. Furthermore, the 12‐item Character Strengths Use in Diabetes Self‐management Scale has the potential to be used to measure the effectiveness of strength‐based interventions in people with Type 2 diabetes. Patient or Public Contribution: Five patients with type 2 diabetes were invited to take the original 20‐item scale to evaluate the clarity, readability and comprehensiveness of the 20 items. [ABSTRACT FROM AUTHOR]

This study aimed to identify the influence factors for snacking-avoidance behavior among elementary schoolchildren. We recruited 940 Taipei schoolchildren and used five validated questionnaires to assess family affluence, snacking nutrition knowledge, attitude, and motivation to avoid unhealthy snacks. Social support from parents and peers for refusing unhealthy snacks, and adolescents' willingness to comply were also examined. Motivation to avoid unhealthy snacks or drinks was enhanced when support was given by parents, teachers, and peers. Participants who reported higher levels of social support were more likely to have a positive attitude towards healthy snacking and were more motivated to avoid unhealthy snack options. In conclusion, social support from significant others, attitudes, and nutrition knowledge all help schoolchildren to avoid unhealthy snacks. [ABSTRACT FROM AUTHOR]

Background: Previous research has examined the use of augmented reality (AR) and virtual reality (VR) in English language teaching. However, to the best of our knowledge, none of the earlier studies that investigated integrating AR and VR "wearables" into teaching and learning English based on the attention, relevance, confidence, and satisfaction (ARCS) motivation model compared the differences in learning motivation and performance between traditional teaching methods and those using AR‐ and VR‐based using wearables. Objectives: To create a thematic learning environment based on learners' lived experiences and provide them with an immersive English course that extends textbook knowledge using a technology‐assisted real‐life learning context. Method: This study used a quasi‐experimental research design. A total of 119 participants were spilt into three learning groups based on teaching tools: traditional methods and AR‐ and VR‐based wearable devices. The performance of each group was evaluated through three stages using appropriate educational tools for traditional, AR‐, and VR‐based classrooms, followed by semistructured interviews. Multiple regression analysis was conducted to investigate the inference learning performance (remembering and analysing) of the four ARCS dimensions with the three teaching methods. Results: The results showed that confidence and relevance were positively correlated with learning performance in the VR‐based wearable group. In the context of the ARCS model, learners' confidence predicted learning performance and the remembering subdimension when VR‐based learning materials were used. Implications: These results suggest that, compared to traditional teaching methods, VR‐based wearables make it easier to create a highly immersive learning environment and are more likely to help learners find the correct words, improve their accuracy, and increase their confidence and sense of accomplishment in the entire learning process. Lay Description: Augmented reality (AR) and virtual reality (VR) allow learners to apply memorized subject knowledge to real‐life scenarios.The attention, relevance, confidence, and satisfaction (ARCS) motivation model enhances learning. What this paper adds: The study proposed the integration of AR and VR with "wearables" for teaching English.The study investigated the differences between how the teaching materials designed to incorporate different technological devices with the four ARCS dimensions predict their learning performance (remembering and analysing). Implications for practice and/or policy: The ARCS motivation model‐based design allows learners using VR‐based wearables to learn English through multiple interactions in real‐time.Integrating daily life experiences with course materials can attract learners' attention in the early stages of teaching.VR‐based learning creates a virtual learning environment relevant to the learners, allows them to learn English thematically in an immersive environment, and allows them to interact with the system. [ABSTRACT FROM AUTHOR]

Low-carbohydrate (LC) diets are popular among general and athletic populations attempting to lose body mass. This study investigated the effect of a 7-day LC or moderate-carbohydrate (MC) calorie–restricted diet followed by 18-h recovery on body composition and taekwondo-specific performance. In this randomised cross-over study, 12 male taekwondo athletes consumed an LC (10% of carbohydrate, 41% of protein, 49% of fat, and 15.8 ± 0.4 kcal/kg/day) or an isocaloric MC diet (60% of carbohydrate, 30% of protein, and 10% of fat) for 7 days. The participants then consumed a carbohydrate-rich recovery dinner (39.2 ± 3.1 kcal/kg) followed by breakfast (6.2 ± 0.4 kcal/kg) in both the trials. Three repeated sprint ability (RSA) tests were conducted after breakfast. The taekwondo-specific reaction battery was administered before the first RSA test and after each RSA test. The participants experienced similar magnitudes of significant loss of body mass in the LC (−2.4 ± 1.7%) and MC (−2.3 ± 1.7%) trials. Fat mass and fat percentage significantly decreased in the MC trial but remained unchanged in the LC trial after body mass loss. Fat free mass was maintained in both the trials. The average and peak power in the RSA tests and the premotor reaction time were similar between the trials. The participants experienced significantly higher fatigue in the LC trial. In conclusion, both the diets can help athletes rapidly lose body mass while maintaining performance as long as an adequate amount of carbohydrate is consumed during the recovery period. [ABSTRACT FROM AUTHOR]

Teenage pregnancy is a major public health concern. However, few studies have investigated the relationship between pediatric bipolar disorder and early pregnancy, and whether bipolar disorder medications reduce the risk of early pregnancy remains unknown. In total, 3218 adolescent girls with bipolar disorder and 32,180 controls matched for age, family income, residence, and time of enrollment were enrolled in this study from 2001 to 2009. Early pregnancy, defined as pregnancy occurring in patients younger than 20 years old, was identified during the follow-up period from enrollment until the end of 2011. After adjustment for demographic data, psychiatric comorbidities, and bipolar disorder medications, adolescent girls with bipolar disorder had 20 times the risk of early pregnancy (hazard ratio [HR] = 20.63, 95% confidence interval [CI] [15.68, 27.16]) and about 25 times the risk of repeated early pregnancy (HR = 24.59, 95% CI [15.20, 39.78]) compared with those without bipolar disorder. Long-term use of both mood stabilizers (HR = 0.34, 95% CI [0.23, 0.52]) and atypical antipsychotics (HR = 0.32, 95% CI [0.20, 0.51]) was associated with a reduced risk of early pregnancy. Bipolar disorder was associated with an increased risk of early pregnancy in adolescent girls. Bipolar disorder medications reduced this risk. The results suggest that interventions targeting the vulnerable population of adolescent girls with bipolar disorder are warranted to prevent early pregnancies. [ABSTRACT FROM AUTHOR]

Dietary factors and chronic hyperglycemia are linked to the formation of advanced glycation end products (AGEs) and prostate cancer (PCa) risk. The activation of the receptor for AGEs (RAGE) acts as a bridge between various RAGE ligands and certain malignancies. This study showed that the interaction of AGEs and RAGE promoted PCa cell proliferation, invasion, and autophagy-mediated survival in response to chemotherapeutic agents. RAGE-overexpressed PCa cells underwent epithelial--mesenchymal transition and showed increased cancer stem cell-like properties. In mouse xenograft models, RAGE-overexpressed cells showed more substantial tumorigenic capacity than parental cells, whereas RAGE knockdown decreased tumorigenicity. The clinical data validated a positive correlation between high AGE and RAGE expressions with poor clinical outcomes. Our findings suggest that the AGE-RAGE axis facilitates PCa progression and aggressiveness. Prostatic AGEs and RAGE expression levels are associated with PCa prognosis. Adherence to a reduced-AGE diet and targeting RAGE are potential approaches to complement and synergize with the current PCa therapies. [ABSTRACT FROM AUTHOR]

The U.S. Food and Drug Administration's Sentinel System is a leading distributed data network for drug safety surveillance in the world. The National Health Insurance Research Database (NHIRD) in Taiwan was converted into the Taiwan Sentinel Data Model (TSDM) based on the Sentinel Common Data Model (SCDM) version 6.0.2. The goal of this study was to investigate the feasibility of applying the same study designs, analytic choices, and analytic tools as used by the U.S. Sentinel System to examine the same drug--outcome associations in the TSDM-formatted NHIRD. Four known drug--outcome associations previously examined by the U.S. Sentinel System were selected as the use cases: (1) use of angiotensin-converting enzyme inhibitors (ACEIs) and risk of angioedema, (2) use of warfarin and risk of gastrointestinal bleeding, (3) use of oral clindamycin and risk of Clostridioides difficile infection (CDI), and (4) use of glyburide and risk of serious hypoglycemia. We followed the same study designs and analytic choices used by the U.S. Sentinel System and applied the Sentinel Routine Querying Tools to answer the same study questions within the TSDM-formatted NHIRD. The results showed that ACEIs were associated with a non-significant increase in risk of angioedema compared to beta-blockers (hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 0.89-1.64); warfarin was associated with a higher risk of gastrointestinal bleeding compared to statins (HR: 1.72; 1.50-1.98); glyburide was associated with an increased risk of hypoglycemia compared to glipizide (HR: 1.61, 1.30-2.00). We were unable to evaluate the association between oral clindamycin and risk of CDI due to the low event number. Our study demonstrated that it was feasible to directly apply the publicly available Sentinel Routine Querying Tools within the TSDM-formatted NHIRD. However, sources of heterogeneity other than design and analytic differences should be carefully considered when comparing the results between the two systems. [ABSTRACT FROM AUTHOR]

Background: Death in hospital rather than at home is becoming more prevalent, even among terminally ill patients receiving home-based care. Identifying trends in places of death is crucial to care policy, especially for aging populations as in Taiwan. Aim: To identify changes in the places of natural death of Taiwanese individuals for various causes of death. Design: A population-based observational study was conducted. Setting: Anonymous data for the period 2000–2020 from the Death Database of Taiwan's National Center for Health Statistics Data were obtained and analyzed. Results: In 2000, 60.1% of natural deaths occurred in the home, whereas in 2020, this percentage was only 36.8%; conversely, the percentage of deaths in hospital increased from 34.4% in 2000 to 56.1% in 2020. Deaths in a nursing home or long-term care facility were found to account for only 3.8% of all natural deaths in 2020. Dementia was the cause of death for which the proportion of institutional deaths was highest, although this proportion was <10% for most years. We applied the joinpoint regression model to estimate trend changes in places of death. During the study period, the places of death in Taiwan changed significantly, the average annual percent changes for hospital deaths over the 21-year period was 2.54% (confidence interval [CI]: 2.04 to 3.03), and for home deaths was −2.69% (CI: −3.26 to −2.13). Conclusions: The detailed findings of this national study can offer insight into potential future clinical burdens and lead to better health policy decisions for Taiwan. [ABSTRACT FROM AUTHOR]

We explore the emerging issue of how communications technologies can be used by male perpetrators to facilitate intimate partner violence against their female partners. We analyzed interview narratives from 18 women survivors of intimate partner violence in Taiwan, informed by Stark's theory of coercive control. Our findings indicated that the male perpetrators of intimate partner violence against the survivors utilized communications technologies to further harm, control, and intimidate their victims. We found that the perpetrators harassed, stalked/monitored, and isolated the survivors and distributed defamatory messages about the survivors to other people using telephones, e-mail, social media, the Internet, broadcast media, and recording devices. [ABSTRACT FROM AUTHOR]

Age-period-cohort analysis involves 3 temporal factors: age (the length of time from birth to diagnosis), period (the calendar time of diagnosis), and cohort (the calendar time of birth). The application of age-period-cohort analysis in disease forecasting can help researchers and health authorities anticipate future disease burden. In this study, a synthesized age-period-cohort prediction method was proposed based on 4 assumptions: 1) no single model can dominate as the most accurate prediction model in all forecasting scenarios; 2) historical trends will not continue indefinitely; 3) a model with the most accurate forecast for the training data will also be appropriate for forecasting future data; and 4) a model dominated by the stochastic temporal change will be the best-selected model with the robust forecasting. An ensemble of age-period-cohort prediction models was constructed, and Monte Carlo cross-validation was performed to evaluate forecasting accuracy of these models. Data on lung cancer mortality from 1996 to 2015 in Taiwan were used and projected to the year 2035 to illustrate the method. The actual lung cancer mortality rates from 2016 to 2020 were then used to verify the forecasting accuracy. [ABSTRACT FROM AUTHOR]

Family involvement in mental healthcare is a key ingredient in the recovery of patients with mental illness. Research on the attitudes of mental health nurses regarding family involvement in mental healthcare remains limited. This study aimed to examine factors that affect the attitudes of mental health nurses towards the importance of family involvement in mental health nursing care. A descriptive, correlational study with a cross‐sectional design was conducted with 162 mental health nurses at two psychiatric hospitals in Taiwan. Descriptive statistics, independent t‐tests, one‐way analysis of variance, and stepwise multiple linear regression analyses were applied to analyse data. Mental health nurses generally demonstrated positive attitudes towards incorporating families into nursing care. Older age, more clinical experiences in mental healthcare, and workplace (such as working in chronic psychiatric inpatient wards) were found to be key factors for mental health nurses' attitudes. Particularly, greater competence in working with families and job satisfaction were the most significant factors associated with positive attitudes of mental health nurses towards involving families as important in nursing care. Insight into correlates of mental health nurses' attitudes towards the importance of focusing on families in care is pivotal for targeted interventions to improve nurses' attitudes towards families and, thus, implement family engagement in mental healthcare practices. [ABSTRACT FROM AUTHOR]

The traditional biomedical care approach has been unsatisfactory to meet the complex needs of seniors with long‐term multimorbidity and irreversible disability, particularly for those living in residential LTC facilities. This study aimed to develop and evaluate the effectiveness of an 8‐week biopsychosocial‐spiritual (BPS‐S) group intervention with the attempt to enhance quality of life (QoL) and meaning in life among senior residents with disability. This single‐blind randomized controlled trail was conducted in eight residential LTC facilities. The primary outcome, 'participants' overall and subdomain QoL', and the secondary outcome, 'meaning in life', were repeatedly assessed, including four time points: before, mid‐ and post‐intervention, and at a 1‐month follow‐up. A generalized linear mixed model (GLMM) was used to assess between‐group differences over time. The post‐intervention differences indicated significant higher improvement on senior residents' overall and all 4 domains of QoL, as well as their meaning in life, between the baseline and both times of post‐intervention and 1‐month follow‐up. On the other hand, participants' family QoL have improved immediately in the midst of intervention. This study provides preliminary evidence to support the feasibility and effectiveness of an 8‐week BPS‐S group therapy. We recommend the BPS‐S be integrated into routine institutional care activities to help maximize senior residents' own capacity for self‐healing, achieve a state of harmonious balance between body, mind, social and spiritual relationships; and in turn, enhance holistic health of this group. [ABSTRACT FROM AUTHOR]

Objectives: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in patients with Alzheimer's disease (AD), causing burdens on caregivers. Behavioral and psychological symptoms of dementia and subclinical epileptiform discharge (SED) increased with the disease course of AD. However, the interaction between them was still unknown. The present study aimed to evaluate the associations between SED and BPSD. Methods/Design: Patients with AD from Kaohsiung Municipal Ta‐tung Hospital were included in this study. International 10–20 system scalp electroencephalography (EEG) for 13 min was performed to detect SED. Behavioral and psychological symptoms of dementia was assessed by neuropsychiatric inventory (NPI) questionnaires. The occurrence of BPSD subsyndromes was compared between patients with and without SED. Results: Two hundred sixty‐three adult patients qualified for the inclusion criteria and were enrolled in this study. The mean age of patients was 80.2 years, and approximately 62% were women. 17.1% of patients showed SED on EEG. Apathy was the most commonly reported BPSD subsyndrome in this cohort. There was no significant difference in the prevalence of BPSD between patients with and without SED. (75.6% vs. 67.4%, p = 0.2806). However, the NPI score of irritability subsyndrome was significantly higher in the SED (+) group (2.6 ± 3.7 vs. 1.2 ± 2.7, p = 0.0028). In addition, subclinical epileptiform discharge in the frontal lobe was associated with a considerably higher occurrence of hyperactivity subsyndrome, including irritability. Conclusions: SED may not be a direct cause of BPSD, but the presence of SED may affect the manifestation of BPSD. Key points: Behavioral and psychological symptoms of dementia (BPSD) and subclinical epileptiform discharge (SED) increase with the progression of Alzheimer's disease.In the present study, we aimed to evaluate the associations between SED and BPSD.Apathy was the most commonly reported subsyndrome in our cohort, followed by nighttime behavior and irritability.There was no significant difference in the prevalence of BPSD between patients with and without SED. However, the NPI score for irritability subsyndromes was significantly higher in the SED (+) group.SED may not be a direct cause of BPSD, but its presence may affect the manifestation of BPSD. [ABSTRACT FROM AUTHOR]

Simple Summary: Oral cancer is a significant health problem in Taiwan, with high rates of occurrence and cancer-related deaths. Transoral robotic surgery (TORS) is an innovative surgical approach that might offer treatment advantages and improve outcomes. We conducted a study in a Taiwanese hospital with 72 patients in each group, comparing TORS to conventional open surgery over three years. After carefully matching the patients, we found that those who had TORS had a better overall survival compared to the open-surgery group. We used various analyses to confirm that TORS was linked to a lower risk of death. The TORS group had significantly better survival rates at all stages of cancer, and it was particularly effective for late stages, i.e., stage III and IV patients. In conclusion, our study suggests that TORS could be a better option for treating oral cancer in Taiwan, offering improved chances of survival and potential advantages over conventional surgery. Oral cancer poses a major health challenge in Taiwan, consistently ranking among the highest globally in both incidence and cancer-related mortality. Transoral robotic surgery (TORS) has potential advantages over open surgery, but its long-term oncologic outcomes are not well established. In this study, we sought to elucidate the role of TORS in improving treatment outcomes among oral cancer patients. A case–control study with propensity score matching was conducted in a single teaching hospital in Taiwan. It included 72 oral cancer patients in each group to analyze and compare survival outcomes between the surgical approaches. The TORS group demonstrated a higher negative resection margin rate, a lower mortality risk and better overall survival than the open-surgery group. Multivariate Cox regression analysis confirmed TORS's association with a reduced risk of death. Kaplan–Meier survival analysis and log-rank tests indicated significantly better survival outcomes for the TORS group across all cancer stages. Moreover, the TORS group exhibited improved overall survival rates for stage III and IV patients compared to the conventional open-surgery group. In conclusion, this study suggests that TORS may offer better overall survival rates and potential advantages over conventional surgery for oral cancer treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we used Taiwan's National Health Insurance Research Database to investigate the potential association between sleep disorder (SD) and colorectal cancer (CRC) after matching 177,707 patients with SD and without a history of CRC with 177,707 non-SD and non-CRC Taiwanese citizens without SD and without CRC based on age and gender. The results demonstrated a significantly higher likelihood of developing CRC in SD patients compared to the control group. Subgroup analysis revealed that among the four different types of SD, the insomnia group exhibited a significantly elevated risk of CRC. It should be noted that individuals simultaneously affected with sleep apnea and insomnia had a significantly higher risk of developing CRC than those with either condition alone. These research findings suggest a potentially higher risk of CRC in Taiwanese SD patients, underscoring the need to explore the relationship between SD and CRC risk. The impact of sleep disorders (SDs), particularly sleep apnea (SA), on the development of colorectal cancer (CRC) has been the subject of significant research. However, the potential contribution of other SDs to the incidence of CRC remains unexplored. The objective of this study was to examine the effects of SDs on the risk of developing CRC. This study assessed CRC risk among individuals diagnosed with SDs compared with age- and sex-matched unaffected individuals. A longitudinal, nationwide, population-based cohort study was conducted using data from the Taiwan National Health Insurance Research Database (NHIRD) encompassing 177,707 individuals diagnosed with SDs and 177,707 matched controls. Cox proportional hazard regression analysis was used to determine the relative increased risk of CRC in individuals with SDs and specific subgroups of SDs. The CRC incidences were 1.32-fold higher (95% CI 1.23–1.42) in the overall SD cohort, 1.17-fold higher (95% CI 0.82–1.68) in the SA cohort, 1.42-fold higher (95% CI 1.31–1.55) in the insomnia cohort, 1.27-fold higher (95% CI 1.17–1.38) in the sleep disturbance cohort, and 1.00-fold higher (95% CI 0.77–1.29) in the other SD cohort, after adjusting for age, sex, and comorbidities. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer with liver metastases (CRLM) has a poor prognosis. Systemic treatment alone, or worse, best supportive care, only affords patients limited survival. This study aims to provide evidence that aggressive local control through hepatic resection and/or radiofrequency ablation (RFA) can significantly prolong CRLM overall survival. Out of the 2612 patients enrolled in this study, 637 underwent hepatectomy, 93 had RFA, 92 were given combined hepatectomy and RFA, while 1790 received non-aggressive treatment. Based on the Kaplan–Meier curves and multivariate Cox's regression analysis as well as frequency matching analysis, we conclude that aggressive local control in CRLM patients has survival benefits, in addition to systemic therapy from a large multi-institutional database. Hepatectomy and/or local ablation therapy have been recommended for colorectal cancer liver metastases (CRLM). However, they still lack strong evidence for their survival benefits, in addition to systemic therapy. This study aims to evaluate the survival evidence of hepatectomy and/or radiofrequency ablation (RFA) therapy in CRLM patients from a large multi-institutional database. A total of 20,251 patients with colorectal cancer, 4521 of whom were with CRLM, were screened for eligibility. Finally, 2612 patients (637 hepatectomy, 93 RFA, 92 combined hepatectomy and RFA, and 1790 non-aggressive treatment) were enrolled. Frequency matching analysis was used to adjust for baseline differences. The 5-year overall survival (OS) was as follows: hepatectomy alone was 47.8%, combined hepatectomy plus RFA was 35.9%, RFA alone was 29.2%, and the non-aggressive treatment group was 7.4%. Kaplan–Meier curves showed that hepatectomy, RFA, and combination were significantly associated with a better OS compared to those without aggressive local therapy (p < 0.001). Multivariate Cox regression analysis showed that male gender (hazard ratio (HR) 0.89; 95% confidence interval (CI), 0.81–0.97; p = 0.011), old age (≥60 years) (HR 1.20; 95% CI, 1.09–1.32; p < 0.001), high CEA level (>5 ng/mL) (HR 2.14; 95% CI, 1.89–2.42; p < 0.001), primary right-sided cancer (HR 1.35; 95% CI, 1.22–1.51; p < 0.001), extrahepatic metastasis (HR 1.46; 95% CI, 1.33–1.60; p < 0.001), systemic therapy (HR 0.7; 95% CI, 0.62–0.79; p < 0.001), and aggressive local therapy (hepatectomy vs. non-local therapy HR 0.22; 95% CI, 0.20–0.26; p < 0.001; RFA vs. non-local therapy HR 0.29; 95% CI, 0.29–0.41; p < 0.001) were independent factors associated with OS. In the frequency matching analysis, patients receiving hepatectomy and/or RFA resulted in a better OS than those without (p < 0.001). In conclusion, aggressive local treatment provides survival advantages over systemic therapy alone among CRLM patients. [ABSTRACT FROM AUTHOR]

Real-world data sources can facilitate essential understanding of the epidemiological features of anaphylaxis. However, the accuracy of case-identifying definitions based on diagnosis codes for anaphylaxis in healthcare databases remains understudied. We conducted a cross-sectional study analyzing claims data from the largest multi-institutional healthcare system in Taiwan during 2017–2021. We included patients with incident anaphylaxis identified by either ICD-10-CM codes for anaphylaxis (Group 1) or ICD-10-CM codes for severe allergic or drug adverse events and additional modifier codes for acute allergy events (Group 2). We randomly selected 20% of the cases to determine the positive predictive value (PPV) of anaphylaxis case-identifying definitions in Groups 1 and 2 after review of electronic medical records by two physicians. From the original cohort (n = 2,176), we randomly selected 433 patients with either a diagnosis of anaphylaxis (Group 1), or a diagnosis of severe allergic and drug adverse events with additional modifier codes for acute allergy events (Group 2). In Group 1, we judged 135 / 170 patients as true anaphylaxis cases, giving a PPV of 79.4% (95% CI: 73.3–85.5). In Group 2, we judged 47 / 263 patients as true anaphylaxis cases, giving a PPV of 17.9% (95% CI: 13.3–22.5). In conclusion, acceptable PPVs were observed when anaphylaxis cases were identified by ICD-10-CM codes for anaphylaxis, but not by ICD-10-CM codes for severe allergic or drug adverse event with additional modifier codes for acute allergy events. Our multi-institutional findings could serve as a fundamental reference for further studies of anaphylaxis based on real-world healthcare databases. [ABSTRACT FROM AUTHOR]

Background: In December 2022, the Taiwan National Health Insurance Administration (NHIA) announced the reimbursement of three dosages of pemigatinib 4.5 mg, 9 mg, and 13.5 mg for treating advanced intrahepatic cholangiocarcinoma (ICC) with fibroblast growth factor receptor 2 (FGFR2) fusions/rearrangements and set the reimbursement price for pemigatinib 4.5 mg at NT$6600. This study aims to analyze the cost-effectiveness of pemigatinib 13.5 mg as a second-line treatment compared to mFOLFOX and 5-FU chemotherapy for advanced ICC patients with FGFR2 fusions/rearrangements from the perspective of Taiwan's NHIA. Methods: This study used a 3-state partitioned survival model to analyze the 5 year cost-effectiveness of pemigatinib as a second-line treatment for advanced ICC patients in whom first-line gemcitabine-based chemotherapy failed and to compare the results with those for the mFOLFOX and 5-FU chemotherapy regimens. Overall survival and progression-free survival were estimated from the FIGHT-202 trial (pemigatinib), ABC-06 trial (mFOLFOX), and NIFTY trial (5-FU). The price of pemigatinib 13.5 mg was set at the potentially highest listing price (NT$17,820). Other parameters of utility, disutility, and costs related to advanced ICC were obtained from the published literature. The willingness-to-pay threshold was three times the forecasted gross domestic product per capita in 2022 (NT$2,928,570). A 3% discount rate was applied to quality-adjusted life-years (QALYs) and costs. Several scenario analyses were performed, including a gradual price reduction for pemigatinib. Deterministic sensitivity analysis, probabilistic sensitivity analysis (PSA), and value of information were performed to assess uncertainty. Results: Pemigatinib was not cost-effective compared to mFOLFOX or 5-FU in the base-case analysis. When the price of pemigatinib was reduced by 50% or more, pemigatinib gained a positive net monetary benefit (mFOLFOX: NT$55,374; 5-FU: NT$92,437) and a 72% (mFOLFOX) and 77.1% (5-FU) probability of being cost-effective. Most of the uncertainty came from the medication cost of pemigatinib, health state utility, and the overall survival associated with pemigatinib. Conclusions: According to the NCCN guidelines, the daily use of pemigatinib 13.5 mg at the hypothesized NHIA price of NT$17,820/13.5 mg was not cost-effective compared to mFOLFOX or 5-FU. The price reduction scenario suggested a 50% price reduction, NT$8910 per 13.5 mg, for advanced ICC patients with FGFR2 fusions/rearrangements. Plain language summary: This study performed a cost-effectiveness analysis on the use of targeted therapy pemigatinib 13.5 mg daily in second-line treatment for Taiwanese patients with intrahepatic cholangiocarcinoma (ICC) harboring FGFR2 fusions/rearrangements. This regimen was approved by the U.S. Food and Drug Administration in 2020 and recommended by the National Comprehensive Cancer Network (NCCN). Taiwan's National Health Insurance Administration (NHIA) has announced the reimbursement of three pemigatinib dosages of 4.5 mg, 9 mg, and 13.5 mg to be listed in the NHI coverage in 2022. However, as of the middle of April 2023, only the listing price for pemigatinib 4.5 mg has been determined, while pricing for the other two dosages remains pending. Based on a hypothesized NHIA price of NT$17,820/13.5 mg, this study evaluated the cost-effectiveness of pemigatinib 13.5 mg as a second-line treatment for advanced ICC with FGFR2 fusions/rearrangements compared to mFOLFOX (a regimen recommended by NCCN) and 5-FU (a regimen fully covered by Taiwan NHIA) and recommended a listing price for NHIA as reference. Our study showed that the hypothesized price of NT$17,820/13.5 mg was not cost-effective compared to mFOLFOX or 5-FU. The price reduction scenario suggested a 50% reduction (NT$8910) in the hypothesized NHIA price for advanced ICC patients with FGFR2 fusions/rearrangements. Key points: Pemigatinib was associated with a positive INMB when the medication price was reduced by 50% to NT$8910 per pemigatinib 13.5 mg. Most of the uncertainty came from the medication cost of pemigatinib, utilities, and the overall survival associated with pemigatinib treatment. [ABSTRACT FROM AUTHOR]