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Cross-sectional research has demonstrated the overrepresentation of gender dysphoria in children and adults with autism spectrum disorder. However, the predictors and underlying mechanisms of this co-occurrence remain unclear. This follow-up study aimed to explore baseline (childhood/adolescence) predictors for the follow-up (adulthood) self-reported wish to be of the opposite sex and to investigate its mental health correlates in a sample of 88 autistic individuals as compared with 42 typically developing controls. An item on the Adult Self-Report Inventory-4, "I wish I was the opposite sex," was used. We compared mental health symptoms between adults with and without this item endorsement. We used prediction models to explore family and autism-related predictors in childhood/adolescence to endorse this item in adulthood. There were more adults endorsing the item in the autism spectrum disorder group compared with the typically developing group. Autistic adults who endorsed the item experienced more mental health challenges, more bullying victimization, more suicidal ideations, and worse quality of life. Lower parent-reported family support and more stereotyped/repetitive behaviors during childhood/adolescence predicted the self-reported wish to be of the opposite sex in adulthood in autistic individuals. It is necessary to raise more attention to gender development and related mental health impact in autistic individuals.

This study investigated how creative personality, psychological empowerment, and job stress affect creative self-efficacy and innovative behavior in hospitality employees. A hypothesized moderating role of knowledge-sharing role in the relationship between creative self-efficacy and innovative behavior was also tested. Three hundred and thirty-nine employees and 89 supervisors employed by International Tourist Hotels in Taiwan participated in the study. A structural equation modeling analysis indicated that creative self-efficacy significantly mediates the effects of creative personality and psychological empowerment on innovative behavior in the hospitality industry. The positive effect of creative self-efficacy on innovative behavior was larger in high knowledge-sharing work environments than in low knowledge-sharing work environments. Theoretical and practical implications are further discussed.

The purpose of this study is to describe the prevalence, trends, and associations of the use of outpatient prescription non-narcotic analgesics and proton pump inhibitors (PPIs) in Taiwan from 2010 to 2021. We identified the most commonly prescribed analgesics and PPIs, including paracetamol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs), in outpatient departments according to the data from Taiwan National Health Insurance Research Database and Taiwan's NHI Annual Statistical Report. This study shows that the traditional non-selective NSAIDs take the largest proportion of usage, representing over 60% of the annual usage of non-narcotic analgesics. Acetaminophen is the second and takes over 30% of annual usage. The selective COX-2 (coxibs) takes less than 10% of usage, but its use is growing rapidly. This study also shows that the annual usage of PPIs is growing rapidly and is not decreasing with the use of selective COX-2. The findings in this study can help us to focus on the most commonly prescribed drugs to investigate the prescription pattern of NSAIDs and PPIs, especially the combined use of selective COX-2 and PPIs, in future study. [ABSTRACT FROM AUTHOR]

Few studies have focused on the consequence of exposure to general anesthesia (GA) in children's early life with the risk of asthma and disease outcomes. The present study examines the correlation between exposure to GA under three years old and the subsequent course of asthma in a nationwide population-based cohort study. Our cases were acquired from Taiwan's National Health Insurance Research Database (NHIRD). Children under three years old with either GA exposure or not during in-patient treatment from 1997 to 2008 were included. The study group was age- and sex-matched with a ratio of 1:2 to create the control group for comparison. The cohort included 2261 cases with GA and 4522 cases without GA as a control group. The incidence of asthma onset was significantly reduced in patients with GA exposure under 3 three years old (hazard ratio 0.64 (95% confidence interval 0.57~0.72), p < 0.001). In addition, regardless of whether the asthmatic clinical visits were before or after GA exposure, asthma onset patients before GA exposure have significantly fewer clinical visits than those without GA exposure (both p < 0.001, respectively). Using the Kaplan–Meier method, we also demonstrated that GA exposure was associated with favorable clinical visits in patients with asthma, whether their asthma was onset before GA (p = 0.0102) or after GA exposure (p = 0.0418) compared to non-GA-exposed controls. In the present study, we demonstrated that children with early GA exposure under three years old were at a reduced risk of developing asthma compared to the general population. Furthermore, we first reported that GA exposure significantly reduced clinical visits in patients with asthma regardless of whether their asthma onset was before or after GA exposure. It is indicated that GA exposure at a younger age could have potential clinical benefits for asthma than non-GA-exposed controls. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether polymorphisms of haptoglobin (Hp) modify the relationship between dietary iron and the risk of gestational iron-deficiency anemia (IDA). Methods: This study analyzed 1430 singleton pregnant women aged 20 ~ ≤ 48 years from the 2017–2019 National Nutrition and Health Survey of Pregnant Women in Taiwan. Sociodemographic, blood biochemical, Hp phenotype, and 24-h dietary recall data were collected. Erythropoiesis-related total prenatal supplementation was defined as the reported use of multivitamins and minerals, vitamin B complex, folate, and iron. Results: Distributions of the Hp 1-1, Hp 2-1, and Hp 2-2 phenotypes were 13.6, 39.8, and 46.5%, respectively. Women with the Hp 1-1 phenotype had the lowest mean levels of serum ferritin (p-trend = 0.017), the highest prevalence of gestational ID (p-trend = 0.033) as well as the highest prevalence of gestational IDA (did not reach statistical differences, p-trend = 0.086). A gene–diet interaction on serum ferritin was observed between the Hp 1 and Hp 2 (2-1/2-2) alleles (p < 0.001). An adjusted multivariate logistic regression showed that compared to those with a normal blood iron status and who reported using erythropoiesis-related total prenatal supplements, those who did not had a 4.05-fold [odds ratio (OR) = 4.05 (95% confidence interval (CI) 2.63–6.24), p < 0.001] increased risk of gestational IDA. The corresponding ORs for carriers of the Hp 1 and Hp 2 alleles were 4.78 (95% CI 1.43–15.99) and 3.79 (95% CI 2.37–6.06), respectively. Conclusion: Pregnant women who are Hp 1 carriers are at increased risk for developing IDA if they do not meet the recommended dietary allowance for iron or use erythropoiesis-related prenatal supplements. [ABSTRACT FROM AUTHOR]

Aims: Ivabradine is indicated for heart failure (HF) patients with reduced ejection fraction (HFrEF), but limited data are available with regards to the use of ivabradine in those with a history of paroxysmal atrial fibrillation (AF). To assess the effect of ivabradine in HFrEF patients with paroxysmal AF, we analysed heart failure (HF) hospitalization and mortality from multiple‐centre registry database. Methods and results: We conducted a multicentre observational matched cohort study, and this study enrolled patient with symptomatic HFrEF from 1 January 2015 to 31 December 2018 who had a history of paroxysmal AF in Chang Gung Memorial Hospital medical database in Taiwan. A total of 2042 patients were eligible for the study, of whom 887 were prescribed with ivabradine and 1115 were not. The primary outcome, including HF hospitalization and cardiovascular death, and individual outcome during the 12 month observation period were analysed after inverse probability of treatment weighting. The ivabradine group had significantly lower mean heart rate after 12 months follow‐up than the non‐ivabradine group (P < 0.05). The primary outcome was significantly higher in the ivabradine group than the non‐ivabradine group after 12 months follow‐up (hazard ratio [HR] = 1.58; 95% confidence interval [CI], 1.26–2.00, P < 0.001). Moreover, the ivabradine group had a significantly higher event rate of HF hospitalization (HR = 1.56; 95% CI, 1.40–1.75, P < 0.001) and HF death (HR = 1.67; 95% CI, 1.14–2.44, P = 0.009) than the non‐ivabradine group. Conclusions: Ivabradine treatment was associated with an increased risk of HF hospitalization in symptomatic HFrEF patients with a history of paroxysmal AF. Further prospective randomized studies are warranted. [ABSTRACT FROM AUTHOR]

Childhood asthma has become one of the most common chronic diseases in children and adolescents. However, few case–control studies investigating the relationship between phthalate exposure and asthma in children and adolescents have been conducted, especially in Asia. Therefore, we assessed the potential associations between phthalate exposure and asthma among children and adolescents in Taiwan. Because various demographic and environmental variables may influence the incidence and prognosis of asthma, we performed a case–control study with propensity score matching. Out of 615 Childhood Environment and Allergic Diseases Study participants, we conditionally matched 41 children with clinically diagnosed asthma with 111 controls. We then analyzed 11 phthalate metabolites by using liquid chromatography with tandem mass spectrometry. Compared with the control group, the median urinary phthalate levels for most phthalate metabolites in the case group were slightly increased, including monomethyl phthalate, mono-n-butyl phthalate, monobenzyl phthalate, monoethylhexyl phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate, and mono-(2-carboxymethylhexyl) phthalate. Hence, our results suggest that phthalate exposure may be associated with the development of asthma. In addition, prenatal environmental factors, such as active or passive smoking during pregnancy, may increase the risk of asthma. [ABSTRACT FROM AUTHOR]

Objective: The coexistence of underweight (UW) and overweight (OW)/obese (OB) at the population level is known to affect iron deficiency (ID) anaemia (IDA), but how the weight status affects erythropoiesis during pregnancy is less clear at a population scale. This study investigated associations between the pre-pregnancy BMI (pBMI) and erythropoiesis-related nutritional deficiencies. Design: Anthropometry, blood biochemistry and 24-h dietary recall data were collected during prenatal care visits. The weight status was defined based on the pBMI. Mild nutrition deficiency-related erythropoiesis was defined if individuals had an ID, folate depletion or a vitamin B12 deficiency. Setting: The Nationwide Nutrition and Health Survey in Taiwan (Pregnant NAHSIT 2017–2019). Participants: We included 1456 women aged 20 to 45 years with singleton pregnancies. Results: Among these pregnant women, 9·6 % were UW, and 29·2 % were either OW (15·8 %) or OB (13·4 %). A U-shaped association between the pBMI and IDA was observed, with decreased odds (OR; 95 % CI) for OW subjects (0·6; 95 % CI (0·4, 0·9)) but increased odds for UW (1·2; 95 % CI (0·8, 2·0)) and OB subjects (1·2; 95 % CI (0·8, 1·8)). The pBMI was positively correlated with the prevalence of a mild nutritional deficiency. Compared to normal weight, OB pregnant women had 3·4-fold (3·4; 95 % CI (1·4, 8·1)) higher odds for multiple mild nutritional deficiencies, while UW individuals had lowest odds (0·3; 95 % CI (0·1, 1·2)). A dietary analysis showed negative relationships of pBMI with energy, carbohydrates, protein, Fe and folate intakes, but positive relationship with fat intakes. Conclusion: The pre-pregnancy weight status can possibly serve as a good nutritional screening tool for preventing IDA during pregnancy. [ABSTRACT FROM AUTHOR]

Background/purpose: With globalization, transnational marriages become more and more common in the world. The mental health of the offspring of immigrants is a significant public health issue. The present study aimed to investigate whether children of immigrant mothers demonstrate more emotional and behavioral problems than those of native mothers in Taiwan.Methods: In a sample of 6242 children in grade 3, grade 5, and grade 7 from a national epidemiological study of child mental disorders, 617 (9.9%) children were born by immigrant mothers (Chinese, Vietnam, Indonesia, and other countries) and 5625 children by Taiwanese parents. The children reported on Achenbach Youth Self-report, and their parents reported about them on the Child Behavior Checklist, Parental Bonding Inventory, and Family APGAR for assessing emotional and behavioral problems, mother's parenting style, and perceived family support.Results: Compared with children of native mothers, children of immigrant mothers reported themselves and were reported by their parents to have more externalizing and internalizing problems. However, after considering the effects of sociodemographics, parenting style, and family function, only significant differences in externalizing problems between children with native or immigrant mothers were found.Conclusion: Our findings indicate that right parenting style and family support; may offset emotional and behavioral problems in children of immigrant mothers, and suggest that improving maternal parenting and family function is beneficial to child development, regardless of immigrant or native mothers. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the impact of age-at-onset on clinical outcomes in bipolar-spectrum disorders, including the development of alcohol or substance use disorder, suicidality, and psychiatric hospitalization.Methods: This population-based study enrolled newly-diagnosed bipolar-spectrum patients, including 4,367 patients with early-onset bipolar disorder (EOBD), 64,787 patients with adult-onset bipolar disorder (AOBD), and the same number of age-controlled comparison subjects without bipolar disorder, from Taiwan's National Health Insurance Research Database. Time-dependent covariate Cox regression models were used to estimate the effect of age-at-onset on clinical outcomes with adjustment for pre-existing psychiatric comorbid conditions and pharmacological treatment patterns. Sensitivity analyses using different definitions of study sample and age cutoffs were conducted.Results: The average follow-up duration was 5.7 years. After adjustment with time-dependent covariates and chronological age, there were no significant differences in the risks for developing new-onset alcohol or substance use disorders and psychiatric hospitalization between EOBD and AOBD patients. Although EOBD patients had a higher risk of hospitalization for suicide and self-harm than did AOBD patients in primary analysis, this finding did not replicated in the sensitivity analyses.Limitations: The symptom profile and severity of bipolar disorder was not available in the NHIRD; therefore, surrogate indicators of clinical outcome might not be sensitive enough to detect the subtle differences.Conclusions: EOBD and AOBD patients had similar risks for developing alcohol or substance use disorders. Their risk of psychiatric hospitalization was similar. Whether EOBD patients might have a higher risk of hospitalization for suicide and self-harm warrants further investigations. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the effects of the two‐month breathing‐based walking intervention and its follow‐up on anxiety, depression, dyspnoea and quality of life in patients with chronic obstructive pulmonary disease. Background: Mind–body‐related exercises improve bio‐psychological symptoms and quality of life in chronic diseases, but these improvements are not proven for chronic obstructive pulmonary disease. Design: This was a randomised controlled study and applied the Consolidated Standards of Reporting Trials (CONSORT) statement. Methods: Outpatients diagnosed with chronic obstructive pulmonary disease were recruited from a medical centre in Taiwan and randomly assigned to two groups. The walking group (n = 42) received breathing, meditation and walking for two months, and the control group (n = 42) did not. Data from the outcomes of anxiety, depression, dyspnoea and quality of life were collected at baseline and in Month 1, Month 2 and Month 3. Clinical trial registration was done (ClinicalTrials.gov.: NCT03388489). Findings: The results showed significant changes in anxiety, depression, dyspnoea and quality of life in the walking group across three months, compared to those in the control group and at baseline. Conclusion: This breathing‐based walking intervention is promising to achieve bio‐psychological well‐being for patients with chronic obstructive pulmonary disease. Relevance to clinical practice: This breathing‐based walking, as a mind–body exercise, could serve as an evidence‐based nursing care that contributes to improving anxiety, depression, dyspnoea and quality of life in stable chronic obstructive pulmonary disease outpatients. The feasibility and acceptability of the breathing‐based walking were met the requirement of the chronic obstructive pulmonary disease outpatients, which could be considered as home‐based exercise. [ABSTRACT FROM AUTHOR]

Objective: Whether dysrhythmia is a risk factor of sudden sensorineural hearing loss (SSNHL) remains unclear. In this study, we aimed to investigate the risk of developing SSNHL among patients with dysrhythmia in different age and gender groups by using population-based data in Taiwan. Methods: We conducted a matched cohort study by analyzing data between January 2000 and December 2013 obtained from the Taiwan National Health Insurance Research Database. 41,842 newly diagnosed dysrhythmia patients and 83,684 comparison subjects without dysrhythmia were selected from claims. The incidence of sudden sensorineural hearing loss at the end of 2013 was determined in both groups. Univariate and multivariate logistic regression analyses were used to investigate the risk of SSNHL among patients with dysrhythmia. Results: The incidence of SSNHL was 1.30-fold higher in the dysrhythmia group compared with the control group (53.2 versus 40.9 per 100,000 person-years), and using Cox proportional hazard regressions, the adjusted hazard ratio (HR) was 1.40 (95% confidence interval [CI], 1.15–1.70). Gender-stratified analysis revealed a significantly higher risk of SSNHL in patients with dysrhythmia than in those without dysrhythmia for both men and women (HR = 1.34, 95% CI = 1.02–1.76, P = 0.039, HR = 1.35, 95% CI = 1.02–1.78, P = 0.035, respectively). Age-stratified analysis revealed remarkable associations between dysrhythmia and SSNHL among those aged less than 40 years and more than 65 years (HR = 2.18, 95% CI = 1.03–4.64, P = 0.043 and HR = 1.54, 95% CI = 1.14–2.09, P = 0.006, respectively). Conclusions: Our findings support dysrhythmia as an independent risk factor for SSNHL. Based on the study results, clinicians managing patients with dysrhythmia should be aware of the increased risk of developing SSNHL, especially among patients aged <40 and >65 years, and counsel patients to seek medical advice immediately if they experience any acute change in their hearing ability. [ABSTRACT FROM AUTHOR]

Enterovirus 71 (EV71) infection can cause airway symptoms, brainstem encephalitis, neurogenic shock, and neurogenic pulmonary edema with high morbidity and mortality. There is no proven therapeutic modality. Flos Farfarae is the dried flower bud of Tussilago farfara L. that has been used to manage airway illnesses for thousands of years. It has neuro-protective activity and has been used to manage neuro-inflammatory diseases. However, it is unknown whether Flos Farfarae has activity against EV71-induced neuropathy. The current study used both human foreskin fibroblast (CCFS-1/KMC) and human rhabdomyosarcoma (RD) cell lines to test the hypothesis that a hot water extract of Flos Farfarae could effectively inhibit EV71 infection. The authenticity of Flos Farfarae was confirmed by HPLC-UV fingerprint. Through plaque reduction assays and flow cytometry, Flos Farfarae was found to inhibit EV71 infection (). Inhibition of viral replication and protein expression were further confirmed by reverse transcription polymerase chain reaction (RT-PCR) and quantitative RT-PCR (qRT-PCR), and western blot, respectively. The estimated ICs were 106.3g/mL in CCFS-1/KMC, and 15.0g/mL in RD cells. Therefore, Flos Farfarae could be beneficial to inhibit EV71 infection by preventing viral replication and structural protein expression. [ABSTRACT FROM AUTHOR]

Objective: The transition from childhood to teenaged years is associated with increased testosterone and a decreased iron status. It is not clear whether higher testosterone levels cause the decreased iron status, and to what extent, obesity-related inflammation influences the iron-testosterone relationship. The aim of the present study was to examine relationships of testosterone, iron status, and anti-/proinflammatory cytokines in relation to nutritional status in boys and young adolescent Taiwanese males. Methods: In total, 137 boys aged 7~13 yr were included. Parameters for obesity, the iron status, testosterone, and inflammatory markers were evaluated. Results: Overweight and obese (ow/obese) boys had higher mean serum testosterone, interleukin (IL)-1β, and nitric oxide (NO) levels compared to their normal-weight counterparts (all p<0.05). Mean serum ferritin was slightly higher in ow/obese boys compared to normal-weight boys, but this did not reach statistical significance. A multiple linear regression showed that serum ferritin (β = -0.7470, p = 0.003) was inversely correlated with testosterone, while serum IL-10 (β = 0.3475, p = 0.009) was positively associated with testosterone after adjusting for covariates. When normal-weight boys were separately assessed from ow/obesity boys, the association between testosterone and serum ferritin became stronger (β = -0.9628, p<0.0001), but the association between testosterone and IL-10 became non-significant (β = 0.1140, p = 0.4065) after adjusting for covariates. In ow/obese boys, only IL-10 was weakly associated with serum testosterone (β = 0.6444, p = 0.051) after adjusting for age. Conclusions: Testosterone and serum ferritin are intrinsically interrelated but this relationship is weaker in ow/obese boys after adjusting for age. [ABSTRACT FROM AUTHOR]

ObjectivesAsians and Pacific Islanders have higher circulating serum ferritin (SF) compared with Caucasians but the clinical significance of this is unclear. There is a higher prevalence of metabolic syndrome (MetS) in Taiwanese Indigenous than Han Chinese. Genetically, Indigenous are related to Austronesians and account for 2 % of Taiwan's population. We tested the hypothesis that accumulation of Fe in the body contributes to the ethnic/racial disparities in MetS in Taiwan.DesignA population-based, cross-sectional study.SettingNational Nutrition and Health Survey in Taiwan and Penghu Island.SubjectsA total of 2638 healthy adults aged ≥19 years. Three ethnic groups were included.ResultsHan Chinese and Indigenous people had comparable levels of SF. Austronesia origin was independently associated with MetS (OR = 2·61, 95 % CI 2·02, 3·36). After multiple adjustments, the odds for MetS (OR = 2·49, 95 % CI 1·15, 5·28) was significantly higher among Indigenous people in the highest SF tertile compared with those in the lowest tertile. Hakka and Penghu Islanders yielded the lowest risks (OR = 1·08, 95 % CI 0·44, 2·65 and OR = 1·21, 95 % CI 0·52, 2·78, respectively). Indigenous people in the highest SF tertile had increased risk for abnormal levels of fasting glucose (OR = 2·34, 95 % CI 1·27, 4·29), TAG (OR = 1·94, 95 % CI 1·11, 3·39) and HDL-cholesterol (OR = 2·10, 95 % CI 1·18, 3·73) than those in the lowest SF tertile.ConclusionsOur results raise the possibility that ethnic/racial differences in body Fe store susceptibility may contribute to racial and geographic disparities in MetS. [ABSTRACT FROM PUBLISHER]

This research is concerned with how knowledge creation influences new product performance through creativity, which includes novelty and appropriateness. The following relationships are examined in our proposed model: (1) the influence of knowledge creation on new product performance; (2) the influence of novelty and appropriateness on new product performance; and (3) the influence of knowledge creation on novelty and appropriateness. A questionnaire was designed and mailed to the sampled Taiwanese manufacturing companies. The analysis results show that knowledge creation helps research and development personnel create novel and appropriate products, which in turn increase new product success. New product performance is affected by both novelty and appropriateness, the former of which has a greater influence. Through additional exploratory analyses, in which socialization, externalization, combination, and internalization are antecedents, we show that socialization's effect on new product performance is fully mediated by novelty and appropriateness, but internalization's influence is only partially mediated. Meantime, the influence of externalization on performance is fully mediated by novelty, but not by appropriateness. Combination has a direct influence on new product performance. Finally, this research provides theoretical and managerial implications based on these results. [ABSTRACT FROM AUTHOR]

This research surveyed a total of 323 local and foreign university students in Taiwan to examine the relationships of on- and off-the-team embeddedness with team behaviors by using the job embeddedness scale (JES) developed and validated by Lee et al. (Acad Manag J 47(5):711-722, ) and Mitchell et al. (Acad Manag J 44(6):1102-1121, ). The two composites of team embeddedness were measured with a total of 28 items, which asked students the extent to which they valued the attachment to their class team and school. For both local and foreign students, this research found that on-the-team embeddedness would affect team trust and team potency significantly while team trust would cause a positive direct effect on team potency. For foreign students, however, off-the-team embeddedness would not affect team potency significantly until team trust was introduced as a mediator. Moreover, significant differences were found in the relationships of nationality and years in university with off-the-team embeddedness. This study provides original evidence for the application of JES to school team relationships, and the link between school embeddedness and team effectiveness. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Xiao-Qing-Long-Tang (XQLT, TJ-19, Sho-seiryu-to, so-cheong-ryong-tang) has been used against acute airway diseases for thousands of year in ancient China. Most of the acute airway illnesses are caused by virus. However, without activity against influenza virus, XQLT has been questioned to manage respiratory tract viral infection. Nevertheless, XQLT might be active against airway viruses other than influenza. Human respiratory syncytial virus (HRSV) is one of the most common respiratory viral pathogens without effective management. However, it is unknown whether XQLT has anti-HRSV activity. Aim of the study: We tested the hypothesis that XQLT can effectively minimize HRSV-induced plaque formation in respiratory tract mucosal cell lines. Materials and methods: Anti-HRSV activity of a hot water extract of XQLT was examined by plaque reduction assay in both human upper (HEp-2) and low (A549) respiratory tract cell lines. Its effects on syncytial formation and viral fusion (F) protein were examined directly by microscopy and by western blot, respectively. Ability of XQLT to stimulate IFN-β was evaluated by enzyme-linked immunosorbent assay (ELISA). Results: Hot water extract of XQLT dose-dependently inhibited HRSV-induced plaque formation in both HEp-2 and A549 cells (P<0.0001), particularly when given before viral inoculation (p<0.0001). XQLT inhibited viral attachment (p<0.0001) and internalization (p<0.0001). 300μg/ml XQLT could decrease both the number and the size of HRSV-induced syncytium without clear effect on the production of viral F protein. XQLT could stimulate epithelial cells to secrete IFN-β before and after viral inoculation to counteract viral infection (p<0.0001). Conclusions: XQLT is effective against HRSV infection on airway epithelia by preventing viral attachment, internalization, syncytial formation, and by stimulating interferon secretion. [Copyright &y& Elsevier]

Abstract: Ethnopharmacological relevance: Cinnamomum cassia Blume is a popular traditional Chinese herbal medicine that has been used to manage respiratory tract disease, including common cold and chronic bronchitis for thousand years. Human respiratory syncytial virus (HRSV) is one of the leading causes of severe lower respiratory tract illness worldwide. No effective therapeutic modality against HRSV infection has been proved. It is unknown whether Cinnamomum cassia is effective against HRSV. Aim of the study: This study tested the hypothesis that Cinnamomum cassia can effectively decrease HRSV-induced plaque formation and syncytium formation in respiratory mucosal cell lines. Materials and methods: Antiviral activity of the hot water extract of Cinnamomum cassia against HRSV was tested by plaque reduction assay in both human upper (HEp-2) and low (A549) respiratory tract cell lines. Its ability to inhibit the synthesis of viral fusion (F) protein was examined by Western blot assay. Results: Cinnamomum cassia dose-dependently inhibited HRSV-induced plaque formation in both HEp-2 and A549 cell lines (p<0.0001). Cinnamomum cassia was more effective when given before viral infection (p<0.0001) mainly by inhibition of viral attachment (p<0.0001) and internalization (p<0.0001). Cinnamomum cassia could inhibit F protein production and syncytium formation to interfere with HRSV spreading. Conclusions: Cinnamomum cassia prevented airway epithelia from HRSV infection through inhibiting viral attachment, internalization and syncytium formation. Cinnamomum cassia could be a candidate to develop therapeutic modalities to manage HRSV infection in the future. [Copyright &y& Elsevier]

This study investigated the background levels of PCDD/Fs and dioxin-like PCBs (dl-PCBs) in fresh foods around Taiwan. In 1,029 foodstuffs, the highest PCDD/F level based on per gram fat was found in duck eggs (1.956 pg WHO-TEQ/g fat), followed by beef (1.263 pg WHO-TEQ/g fat), and egg products ( 1.067 pg WHO-TEQ/g fat), and the lowest was in grape seed oil (0.068 pg WHO-TEQ/g fat). The highest dl-PCB level was found in beef (0.782 pg WHO-TEQ/g fat), followed by duck eggs (0.632 pg WHO-TEQ/g fat), and mutton (0.506 pg WHO-TEQ/g fat), and the lowest was in peanut oil (0.011 pg WHO-TEQ/g fat). The average intake of boys and girls (> 6, < 12 years old) were 0.70 and 0.62 pg WHO-TEQPCDD/Fs+dl-PCBs'/kg bw/day, respectively; for adolescents (> 13, < 18), 0.34 (male) and 0.30 (female) pg WHO-TEQPCDD/Fs+dl.pcBs/kg bw/day, respectively; for adults (19-64), 0.33 (male) and 0.31 (female) pg WHO-TEQPCDD/Fs+di_PCBs/kg bw/ day, respectively; and for seniors (> 65), 0.42 (male) and 0.37 (female) pg WHO-TEQPCDD/Fs+di-PCBs/kg bw/day, respectively. The greatest contribution (%) to the total daily intake came from meat fish, and fishery products, especially in adults (men: 51.6%; women: 47.5%) and seniors (men: 64.8%; women: 61.8%). In the Hsinchu-Miaoli area, PCDD/F concentrations were found the highest in beef and mutton, while in Keelung-Taipei-Taoyuan area the highest in mutton, duck, and goose. The distribution of dl-PCB concentrations in beef, mutton, and goose meat throughout Taiwan showed a similar trend with PCDD/Fs. The mean dioxin level in milk concurrently decreased with total dioxin emissions in Taiwan between 2004 and 2008. It is concluded that, generally, PCDD/Fs and dl-PCBs in food pose little health risk in Taiwan, except for occasionally high PCDD/F levels in beef and mutton. These data suggested that the environment near where the livestock was raised should be examined. [ABSTRACT FROM AUTHOR]

Aim. This study investigated intensive care unit nurses' knowledge, attitudes and practices of oral care for intubated patients together with the associated factors of the same. Background. Effective oral care improves patient comfort and prevents oral infection. Although oral care is a common requirement of nursing practice, providing intubated patients with oral care is a challenging task. Design. A descriptive, cross-sectional design. Methods. This study applied purposive sampling method at 12 adult intensive care units in one medical centre in northern Taiwan. Two hundred and five nurses were recruited. Data were collected by structured questionnaires which consisted of four sections: knowledge, attitudes and practices of oral care for intubated patients and demographic information for the nurses. Results. The average percentages indicating the intensive care unit nurses' oral care knowledge, attitudes and practices were 58·8, 79·4 and 49·8%, respectively. Higher scores on oral care knowledge were associated with nurses performing oral care more frequently. Nurses learning about oral care from reading related studies and materials of their own accord may increase the frequency with which they provide oral care to intubated patients. The nurses' age and the type of intensive care unit they work in were significant factors related to the frequency of performing practices related to oral care. Conclusion. Findings show that nurses who have more resources for learning about oral care have greater knowledge about it and provide oral care to intubated patients more frequently. Relevance to clinical practice. Encouraging nurses to learn more about oral care using diverse educational resources will enhance their knowledge and improve their practice. Nursing administrators are encouraged to establish policies and procedures for oral care of intubated patients based on the type of patients cared for, in addition to holding in-service training, with a view to enhancing the quality of oral care for critically ill patients. [ABSTRACT FROM AUTHOR]

Photoinitiators used in ultraviolet-cured ink may migrate from food packaging materials into food products. Therefore, we conducted a dietary risk assessment of exposure to benzophenone (BP)-type photoinitiators by quantifying and reducing uncertainties associated with the risk characterization. A total of 362 food packaging samples including 180 cereals, 136 fruit and vegetable juices, and 46 milk samples were subjected to fast pesticides extraction to determine photoinitiator residues. The average daily dose (ADD) of BP was the highest in the age group of zero to three years, with a P97.5 ADD of 2.56 × 10−4 mg/kg bw/day. The ADD of 2-hydroxybenzophenone (2-OHBP) was the highest in the age group of three to six years, with a P97.5 UB ADD of 3.52 × 10−5 mg/kg bw/day. The estimated UB P97.5 ADD for each age group was below the toxicological concern threshold of 0.0015 mg/kg bw/day. The cumulative toxicity of all BPs, evaluated using the MOET value, was at an acceptable level. Although the MOET value of BPs was above the safety limit in the foodstuffs studied herein, this result may be different if Taiwan were to follow regulation guidelines for BP-type photoinitiators based on the specific migration limit for the unmeasured BP residues in other foodstuffs. [ABSTRACT FROM AUTHOR]

Introduction. The nationwide epidemiology of organophosphate pesticide (OP) poisoning has never been reported in detail for Taiwan. Methods. This study retrospectively reviewed all human OP exposures reported to Taiwan's Poison Control Centers (PCCs) from July 1985 through December 2006. Results. There were 4799 OP exposures. Most OP exposures were acute (98.37%) ingestions (74.50%) of a single OP (80.37%) to attempt suicide (64.72%) in adults (93.25%). Males were the most common gender (64.95%). Most patients (61.97%) received atropine and/or pralidoxime. The mortality rate for all 4799 OP exposures was 12.71%. Exposures to single OPs without co-intoxicants caused 524 deaths; of these, 63.36% were due to dimethyl OPs. Conclusion. Dimethyl OPs cause the majority of deaths in Taiwan. [ABSTRACT FROM AUTHOR]

The author reflects on the documentary film "Our Life Saving Vinegar" which tackles the issue of providing help for sex workers so they can regain their basic labor rights. The abolishment of the licensed prostitute system in Taiwan has made many sex workers unemployed. Some of these women have made a career move by establishing a vinegar production line.

This study introduced satellite-derived aerosol optical depth (AOD) in land use regression (LUR) modeling to predict ambient concentrations of fine particulate matter (PM2.5) and its elemental composition. Twenty-four daily samples were collected from 17 air quality monitoring sites (N = 408) in Taiwan in 2014. A total of 12 annual LUR models were developed for PM2.5 and 11 elements, including aluminum, calcium, chromium, iron, potassium, manganese, sulfur, silicon, titanium, vanadium, and zinc. After applied AOD and a derived-predictor, AOD percentage, in modeling, the number of models with leave-one-out cross-validation R2 > 0.40 significantly increased from 5 to 9, indicating the substantial benefits for the construction of spatial prediction models. Sensitivity analyses of using data stratified by PM2.5 concentrations revealed that the model performances were further improved in the high pollution season. [ABSTRACT FROM AUTHOR]

Chewing betel quid has been linked to the development of oral cancer. In Taiwan, fresh Piper betle inflorescence is uniquely added to betel quid, and hydroxychavicol is the major phenolic components of P.betle inflorescence. In this study, we tested the mutagenic potential of hydroxychavicol in Salmonella typhimurium TA97, TA98, TA100 and TA102 with and without Aroclor-1254 induced S9 fraction. The results showed that hydroxychavicol was positive in S.typhimurium TA102 without metabolic activation. This increase in revertants was partially inhibited by catalase and superoxide dismutase. In Chinese hamster ovary (CHO-K1) cells, hydroxychavicol induced chromosome aberrations in a dose-dependent manner (10–50 μM) and the majority were chromosome-type aberrations. Hydroxychavicol also significantly increased the frequency of micronuclei in CHO-K1 cells up to 3-fold at a concentration of 40 μM) In addition, hydroxychavicol dose-dependently (0.1–20 [μM] induced copper-dependent strand breaks in plasmid DNA. We further tested the oxidative DNA damage potential of hydroxychavicol by measuring 8-hydroxydeoxyguanosine (8-OH-dG) formation in CHO-K1 cells following an 18-h incubation and found that hydroxychavicol (6.25–100 μM) induced 8-OH-dG levels dose-dependently. The increase of 8-OH-dG formation was positively correlated (r = 0.79) with the hydroxychavicol-induced cytotoxicity. In conclusion, hydroxychavicol may exert its genotoxic potential through oxidative DNA damage. [ABSTRACT FROM AUTHOR]

• The efflorescence appearance of structures was effectively reduced using calcium carbonate crystallization from the water purification and softening process to fill the pores in generic high-pressure bricks. • The effect of the curing age, the curing environment and the brick type on the hardness, solidity and appearance of efflorescence of the bricks were analyzed in using Paint.net. • EDS analysis showed that Ca was the main element in efflorescence, at 6.64%. To summarize the results, curing in a cling film seal can inhibit efflorescence crystallization. Taiwan has witnessed rapid economic development in recent years, and with urban development, the planning and design of compressed paving units and pervious ground tile structures are focused on the demand for esthetic appearance in addition to practical functioning and legal requirements for strength and water permeability. In this study, the efflorescence appearance of structures was effectively reduced using calcium carbonate crystallization from the water purification and softening process to fill the pores in generic high-pressure bricks. The same water-to-binder ratio of 0.35 was used for three different mix proportions, and 20 cm × 20 cm × 6 cm general high-pressure bricks, calcium carbonate high-pressure bricks, and pervious bricks were made under a 50 kg/cm2 molding pressure at a concrete-brick-making plant. The samples were cured in five different environments with curing times of 2, 7, 28, 56 and 91 days. The effect of the curing age, the curing environment and the brick type on the hardness, solidity and appearance of efflorescence of the bricks were analyzed in terms of the compressive strength, the ultrasonic pulse velocity, and the coefficient of permeability, using Paint.net image analysis, scraping rate tests, SEM analysis and EDS analysis. The test results showed that the compressive strengths of the general high-pressure bricks, the calcium carbonate high-pressure bricks and the pervious bricks were 46.78 MPa–84.97 MPa, 56.89 MPa–100.23 MPa and 35.38 MPa–59.20 MPa, respectively. The ultrasonic pulse velocities were 3296 m/s–4524 m/s, 3567 m/s–5703 m/s and 2623 m/s–4319 m/s, respectively. The coefficient of permeability of the pervious bricks was larger than 1 × 10–2 cm/sec. Quantitative analysis of efflorescence using Painet.net image analysis and scraping rate tests showed that the ratio of the efflorescence to the total area at the surface or bottom of the bricks and the scraping rate were larger for curing on hardened concrete than under other curing conditions. The efflorescence that was generated on the bottom layer of the bricks was higher than that on the surface layer by 5.31%–19.82%. Microscopic analysis of the specimens (SEM) showed the existence of many crystalloid Ca (OH) 2 colloids that accounted for 20–25% of the cement volume. EDS analysis showed that Ca was the main element in efflorescence, at 6.64%, which was much higher than the percentage of other elements. To summarize the results, curing in a cling film seal can inhibit efflorescence crystallization. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite the serious risks of diabetes with hepatitis C virus (HCV) infection, this preventable comorbidity is rarely a priority for HCV elimination. We aim to examine how a shared care model could eliminate HCV in patients with diabetes (PwD) in primary care. METHODS: There were 27 community-based Diabetes Health Promotion Institutes in each township/city of Changhua, Taiwan. PwD from these institutes from January 2018 to December 2020 were enrolled. HCV screening and treatment were integrated into diabetes structured care through collaboration between diabetes care and HCV care teams. Outcome measures included HCV care continuum indicators. Township/city variation in HCV infection prevalence and care cascades were also examined. RESULTS: Of the 10,684 eligible PwD, 9,984 (93.4%) underwent HCV screening, revealing a 6.18% (n 5 617) anti-HCV seroprevalence.Among the 597 eligible seropositive individuals, 507 (84.9%) completed the RNA test, obtaining 71.8% positives. Treatment was initiated by 327 (89.8%) of 364 viremic patients, and 315 (86.5%) completed it, resulting in a final cure rate of 79.4% (n 5 289). Overall, with the introduction of antivirals in this cohort, the prevalence of viremic HCV infection dropped from 4.44%to 1.34%, yielding a 69.70% (95% credible interval 63.64%--77.03%) absolute reduction. DISCUSSION: Although HCV prevalence varied, the care cascades achieved consistent results across townships/ cities. We have further successfully implemented the model in county-wide hospital-based diabetes clinics, eventually treating 89.6% of the total PwD. A collaborative effort between diabetes care and HCV elimination enhanced the testing and treatment in PwD through an innovative shared care model. [ABSTRACT FROM AUTHOR]

Background and Objectives: Alanine aminotransferase (ALT) is generally used for evaluating liver function, and its concentrations are closely associated with sex and nutritional status. This study investigates the relationships between dietary components and serum ALT activity in Taiwanese adolescents.Methods and Study Design: Data were collected from 1,941 adolescents aged 13-18 years who participated in the fourth National Nutrition and Health Survey in Taiwan (2010-2011, adolescents).Results: The mean age was 15.3±0.1 y (15.3±0.1 y for boys and 15.2±0.1 y for girls). Mean serum ALT was 14.8±13.3 U/L (17.7±16.3 U/L for boys and 12.1±8.7 U/L for girls; p<0.001). Multivariate analysis revealed that, among girls, a single-unit increase in dietary zinc was associated with 1.12- and 1.11-fold increases in risk for increased serum ALT tertile 2 (T2) and T3, respectively, compared with T1; and a single-unit increase in vitamin B-2 intake increased risk by 1.71- and 1.54-fold, respectively. Further analysis revealed that the risk increase for boys and girls who consumed the highest amounts of dietary zinc and vitamin B-2 (T3) was 1.97- and 2.62-fold, respectively; they were also more likely to have higher serum ALT (>11 U/L for boys and >9 U/L for girls) than those of the reference (presented as zinc T1 and vitamin B-1 T1).Conclusions: Increased dietary zinc and vitamin B-2 intake is associated with higher serum ALT in adolescents. [ABSTRACT FROM AUTHOR]

This paper examines the resilience of Taiwan's oral healthcare system in response to COVID-19, focusing on pre-pandemic conditions, pandemic impacts, and policy recommendations for future resilience. In Taiwan, oral diseases were prevalent, with 80.48% of adults affected by periodontitis in 2016, and 65.43% of 5-year-old children experiencing dental caries. Taiwan's National Health Insurance (NHI) covers over 99% of the population, providing comprehensive dental care. The global budget (GB) payment system, implemented in 1998, ensured financial stability. During the pandemic, dental visits in Taiwan decreased by 5.1% in 2021 compared to 2019. Despite reduced visits, the GB system maintained financial stability, mitigating financial impacts on healthcare institutions. The pandemic generally negatively affected healthcare workers' well-being, increasing resignation intentions. However, the number of practicing dentists in Taiwan remained stable from 2016 to 2022, with slight increases. Urban-rural disparities persisted, and workplace transitions increased, indicating greater mobility among dental professionals. To enhance resilience, the following recommendations are proposed: 1. Strengthen hierarchy of oral healthcare system: Balance dental resources across regions, and improve referrals between hospital and clinics; 2. Provide integrated patient-centered care: Integrate oral health into disease prevention and offer comprehensive services across all stages of life; 3. Integrate digital technology: Promote teledentistry and leverage Taiwan's strengths in information and communication technology (ICT)., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Objectives: To explore burden and its related factors among primary caregivers of patients with cancer., Sample & Setting: This study was conducted in an oncology ward at a medical center in southern Taiwan. A total of 137 dyads of patients with cancer and their primary caregivers were recruited., Methods & Variables: This cross-sectional correlational study used a structured questionnaire to assess the burden of primary caregivers. Data on patients' basic characteristics and disease profiles were extracted from medical records from January to June 2019. Linear regression analysis was used to identify factors associated with the burden of primary caregivers., Results: The majority of primary caregivers were female (70%) and aged younger than 65 years (85%). Overall, the mean primary caregiver burden score was 38.83 (SD = 12.86), with spiritual burden ranking highest among the four domains assessed. Factors related to overall primary caregiver burden included psychiatric symptoms, daily care hours, patient age, and the lack of rotational support., Implications for Nursing: Hospice and oncology nurses can actively identify psychiatric symptoms in primary caregivers, targeting high-risk groups to provide timely resources or psychiatric referrals, aiming to alleviate future caregiver burden.

Background: The inconsistent relationship between chemical exposure and estimated glomerular filtration rate (eGFR) has been examined in only a few studies. We investigated the association between paraben exposure and indicators of renal function in a total of 361 individuals recruiting from a representative study., Method: The levels of urinary parabens, including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP), were measured using UPLC-MS/MS. The association between paraben exposure and indices of renal function was assessed using multiple logistic regression and Bayesian Kernel Machine Regression (BKMR)., Results: The median levels of urinary parabens in the adult group were significantly higher than those in the minor group, that is, 397 vs. 148 ng/mL for MeP, 38.8 vs. 13.6 ng/mL for EtP, 117 vs. 57.7 ng/mL for PrP, and 6.61 vs. 2.79 ng/mL for BuP (all P < 0.001). In the adult group, multivariate regression models confirmed a positive association between the albumin-to-creatinine ratio and urinary MeP (β = 0.580) and a positive association of BUN (β = 0.061) and a negative association of eGFR (β = -0.051) with urinary EtP (all P < 0.001). In the adult group, compared with the lowest tertile group, the adjusted odds ratio in the third tertile (T 3 ) of urinary EtP levels indicated a 3.08 times increased risk of eGFR abnormalities, followed by the second tertile (T 2 ) with a 2.63 times increased risk. The generalized additive model (GAM) and BKMR models showed a non-linear correlation between urinary EtP levels and early CKD, as well as reduced eGFR. We observed a significant positive cumulative effect of urinary paraben on eGFR, and a significant positive single exposure effect of urinary EtP with eGFR abnormality., Conclusion: We found a significant association between exposure to EtP and an increased risk of high BUN levels and decreased eGFR., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Background: Controlling saturated fat and cholesterol intake is important for the prevention of cardiovascular diseases. Although the use of mobile diet-tracking apps has been increasing, the reliability of nutrition apps in tracking saturated fats and cholesterol across different nations remains underexplored., Objective: This study aimed to examine the reliability and consistency of nutrition apps focusing on saturated fat and cholesterol intake across different national contexts. The study focused on 3 key concerns: data omission, inconsistency (variability) of saturated fat and cholesterol values within an app, and the reliability of commercial apps across different national contexts., Methods: Nutrient data from 4 consumer-grade apps (COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!) and an academic app (Formosa FoodApp) were compared against 2 national reference databases (US Department of Agriculture [USDA]-Food and Nutrient Database for Dietary Studies [FNDDS] and Taiwan Food Composition Database [FCD]). Percentages of missing nutrients were recorded, and coefficients of variation were used to compute data inconsistencies. One-way ANOVAs were used to examine differences among apps, and paired 2-tailed t tests were used to compare the apps to national reference data. The reliability across different national contexts was investigated by comparing the Chinese and English versions of MyFitnessPal with the USDA-FNDDS and Taiwan FCD., Results: Across the 5 apps, 836 food codes from 42 items were analyzed. Four apps, including COFIT, MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, significantly underestimated saturated fats, with errors ranging from -13.8% to -40.3% (all P<.05). All apps underestimated cholesterol, with errors ranging from -26.3% to -60.3% (all P<.05). COFIT omitted 47% of saturated fat data, and MyFitnessPal-Chinese missed 62% of cholesterol data. The coefficients of variation of beef, chicken, and seafood ranged from 78% to 145%, from 74% to 112%, and from 97% to 124% across MyFitnessPal-Chinese, MyFitnessPal-English, and LoseIt!, respectively, indicating a high variability in saturated fats across different food groups. Similarly, cholesterol variability was consistently high in dairy (71%-118%) and prepackaged foods (84%-118%) across all selected apps. When examining the reliability of MyFitnessPal across different national contexts, errors in MyFitnessPal were consistent across different national FCDs (USDA-FNDSS and Taiwan FCD). Regardless of the FCDs used as a reference, these errors persisted to be statistically significant, indicating that the app's core database is the source of the problems rather than just mismatches or variances in external FCDs., Conclusions: The findings reveal substantial inaccuracies and inconsistencies in diet-tracking apps' reporting of saturated fats and cholesterol. These issues raise concerns for the effectiveness of using consumer-grade nutrition apps in cardiovascular disease prevention across different national contexts and within the apps themselves., (© Dang Khanh Ngan Ho, Wan-Chun Chiu, Jing-Wen Kao, Hsiang-Tung Tseng, Cheng-Yu Lin, Pin-Hsiang Huang, Yu-Ren Fang, Kuei-Hung Chen, Ting-Ying Su, Chia-Hui Yang, Chih-Yuan Yao, Hsiu-Yueh Su, Pin-Hui Wei, Jung-Su Chang. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org).)

Introduction: Ever since the use of bisphenol A (BPA) has been restricted, concerns have been raised regarding the use of its substitutes, such as bisphenol S (BPS) and bisphenol F (BPF). Meanwhile, the EU European Food Safety Authority (EFSA) issued the new tolerable daily intake (TDI) after the latest re-risk assessment for BPA, which enforced the need for cumulative risk assessment in the population. This study was conducted to identify BPA and its substitute's exposure characteristics of the general Taiwanese population and estimate the cumulative risk of bisphenol exposure., Methods: Urine samples ( N  = 366 [adult, 271; minor, 95]) were collected from individuals who participated in the Taiwan Environmental Survey for Toxicants 2013. The samples were analyzed for BPA, BPS, and BPF through ultraperformance liquid chromatography-tandem mass spectrometry. Daily intake (DI) levels were calculated for each bisphenol. Hazard quotients (HQs) were calculated with the consideration of tolerable DI and a reference dose. Additionally, hazard index (HI; sum of HQs for each bisphenol) values were calculated., Results: Our study found that the median level of BPA was significantly higher in adults (9.63 μg/g creatinine) than in minors (6.63 μg/g creatinine) ( p  < 0.001). The DI of BPS was higher in female (0.69 ng/kg/day) than in male (0.49 ng/kg/day); however, the DIs of BPF and BPS were higher in boys (1.15 and 0.26 ng/kg/day, respectively) than in girls (0.57 and 0.20 ng/kg/day, respectively). Most HI values exceeded 1 (99% of the participants) after EFSA re-establish the TDI of BPA., Discussion: Our study revealed that the exposure profiles and risk of BPA and its substitute in Taiwanese varied by age and sex. Additionally, the exposure risk of BPA was deemed unacceptable in Taiwan according to new EFSA regulations, and food contamination could be the possible source of exposure. We suggest that the risk of exposure to BPA and its substitutes in most human biomonitoring studies should be reassessed based on new scientific evidence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lin, Chen, Chang, Huang, Chang and Huang.)

Introduction: Despite the serious risks of diabetes with hepatitis C virus (HCV) infection, this preventable comorbidity is rarely a priority for HCV elimination. We aim to examine how a shared care model could eliminate HCV in patients with diabetes (PwD) in primary care., Methods: There were 27 community-based Diabetes Health Promotion Institutes in each township/city of Changhua, Taiwan. PwD from these institutes from January 2018 to December 2020 were enrolled. HCV screening and treatment were integrated into diabetes structured care through collaboration between diabetes care and HCV care teams. Outcome measures included HCV care continuum indicators. Township/city variation in HCV infection prevalence and care cascades were also examined., Results: Of the 10,684 eligible PwD, 9,984 (93.4%) underwent HCV screening, revealing a 6.18% (n = 617) anti-HCV seroprevalence. Among the 597 eligible seropositive individuals, 507 (84.9%) completed the RNA test, obtaining 71.8% positives. Treatment was initiated by 327 (89.8%) of 364 viremic patients, and 315 (86.5%) completed it, resulting in a final cure rate of 79.4% (n = 289). Overall, with the introduction of antivirals in this cohort, the prevalence of viremic HCV infection dropped from 4.44% to 1.34%, yielding a 69.70% (95% credible interval 63.64%-77.03%) absolute reduction., Discussion: Although HCV prevalence varied, the care cascades achieved consistent results across townships/cities. We have further successfully implemented the model in county-wide hospital-based diabetes clinics, eventually treating 89.6% of the total PwD. A collaborative effort between diabetes care and HCV elimination enhanced the testing and treatment in PwD through an innovative shared care model., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Background: The aging population in Taiwan has resulted in an increase in the dependent population and the care load on caregivers. Shared care is an interpersonal process in which support is "traded" to "handle" chronic illnesses by home-care patients and family caregivers. The scale of shared care has received little attention in the Taiwanese cultural context. Thus, this study examined the reliability and validity of the Taiwanese versions of Shared Care Instrument-Revised (SCI-R)., Methods: The content validity, construct validity, and discriminant validity were used to test the validity of the translated questionnaires. The Cronbach's α was used to examine reliability. A total of 500 older adults and their caregivers were recruited from three counties in Taiwan., Results: The reliability and validity of the Chinese version of the scale were within the acceptable range. The Cronbach's α was between 0.838 and 0.95. However, the scale's reliability was higher than that of the original version. This might be because of the inclusion of participants with less severe diseases than the participants in the original study, high social expectations in the Chinese traditional culture, and a large number of similar items. Future research should simplify the items and consider adopting diverse participant selection criteria., Conclusions: The results of this study can be used to understand shared care in Taiwan., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We investigated a COVID-19 cluster involved seven case-patients lived in a high-rise building in September 2021. We used a simplified tracer-gas experiment and virus sequencing to establish the link between case-patients. Vertical transmission among vertically aligned apartments on different floors in a building was the most likely route of transmission., Competing Interests: Declaration of competing interest All authors report no conflicts., (Copyright © 2023. Published by Elsevier B.V.)

Several studies have suggested that some endocrine disruptors such as synthetic phenols, parabens and phthalates may disrupt thyroid hormone signaling and associated negative feed-backs with the central hypothalamic-pituitary-thyroid (HPT) axis. Therefore, we investigated urinary paraben and blood thyroid hormone levels in the Taiwanese population. Our sample comprised 264 adults (aged 18-97 years) and 75 minors (aged 7-17 years) from Taiwan Environmental Survey for Toxicants 2013. Urinary levels of methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) were assessed. Hormones of particular interest include: thyroid-stimulating hormone (TSH), triiodothyronine (T 3 ), and thyroxine (T 4 ). We sought integrated parameters to describe the transfer of thyroid hormones in homeostatic models. The geometric mean urinary paraben levels of the adults were higher than those of the minors (adults vs. minors; MeP: 383 vs. 62.4 ng/mL; PrP: 109 vs. 8.00 ng/mL; EtP: 39.5 vs. 2.38 ng/mL, and BuP: 6.36 vs. 2.13 ng/mL). In the male adults, we discovered that 0.253% (p = 0.032), 0.256% (p = 0.041) and 0.257% (p = 0.037) decreases in the TSH, TSH/T 4 and TSH/FreeT 4 ratio was associated with 1% EtP increases, respectively. In the female minors, 0.093% (p = 0.044), 0.072% (p = 0.047) and 0.156 (p = 0.004) increases in the TSH ratios were associated with a 1% MeP, EtP and BuP increase, respectively. Moreover, 0.151% (p = 0.008) and 0.177% (p = 0.001) increases in TSH/T 4 and TSH/free T 4 ratios were associated with a BuP 1% increase, respectively. Finally, EtP was positively associated with SPINA-GT (β: 15.66, p = 0.036) in the male adults. By contrast, EtP were positively associated with Jostel's TSH index and sTSHI (β: 0.072, p = 0.049; β: 0.107, p = 0.049) in the female minors. The Taiwanese population is commonly exposed to parabens, which can potentially lead to alteration of thyroid hormone homeostasis., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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, r 2  = 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, r 2  = 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, r 2  = 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, r 2  = 0.99 for MID; β = -0.01, P < 0.001, r 2  = 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., (© 2022 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Objectives: Metabolic syndrome (MetS) and hepatitis C virus (HCV) are associated with a higher risk of impaired pulmonary function (iPF). This study aimed to investigate the relationships among MetS, iPF, and viral hepatitis., Methods: This community-based study enrolled participants undergoing annual health check-ups in southern Taiwan between March and December 2019. We performed multivariable logistic regression analyses adjusted for demographics and characteristics to identify the factors associated with iPF., Results: A total of 2337 participants completed examinations, of whom 928 (39.7%) had iPF. The participants with iPF were elderly (68.8  ±  12.8 years old) and predominately female (63%). MetS increased the risk of iPF (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.27-1.81, p  < 0.001). Beyond age (OR 1.03, 95% CI 1.02-1.04) and smoking (OR 1.309, 95% CI 1.004-1.705), female sex (OR 0.74, 95% CI 0.59-0.93) and high education level (OR 0.96, 95% CI 0.94-0.98, p  < 0.001) protected against iPF. HCV was not significantly associated with iPF (OR 1.17, 95% CI 0.90-1.52, p   =  0.235) in multivariable analysis. MetS was associated with a higher risk of iPF in the non-HBV/HCV group (OR 1.86, 95% CI 1.54-2.26) and HBV alone group (OR 3.44, 95% CI 1.89-6.28), but not in the HCV alone group (OR 1.02, 95% CI 0.64-1.62)., Discussion: MetS was an independent predictor of iPF, especially the restrictive type, and had different effects in the HBV/non-viral hepatitis and HCV groups. Female sex and education were inversely associated with iPF., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Globally, anemia affects 56 million pregnant women, especially women with a low household income. Functional erythropoiesis requires a constant supply of micronutrients, and the demands significantly increase during fetal development. This study aims to identify dietary patterns for preventing gestational erythropoiesis-associated micronutrient deficiencies (e.g., iron, folic acid, and vitamin B 12 ). A Nationwide Nutrition and Health Survey in Pregnant Women, Taiwan (NAHSIT-PW), was conducted between 2017 and 2019. Data on baseline information, diet, anthropometrics, and blood biochemistry were collected during a prenatal visit. Dietary patterns were identified using a reduced rank regression (RRR). Erythropoiesis-related micronutrient deficiencies were defined as single, double, and triple micronutrient deficiencies of an iron deficiency, folate depletion, and a vitamin B 12 deficiency. In total, 1437 singleton pregnancies aged ≥20-48 years were included in the analysis. Prevalences of normal nutrition, and single, double, and triple erythropoiesis-related micronutrient deficiencies were 35.7%, 38.2%, 18.6%, and 7.5%, respectively. Anemic pregnant women with a low household income had the highest prevalence rates of double (32.5%) and triple (15.8%) erythropoiesis-related micronutrient deficiencies. Dietary pattern scores were positively correlated with nuts and seeds, fresh fruits, total vegetables, breakfast cereals/oats and related products, soybean products, and dairy products but negatively correlated with processed meat products and liver, organs, and blood products. After adjusting for covariates, the dietary pattern had 29% (odds ratio (OR): 0.71; 95% confidence interval (CI): 0.055-0.091, p = 0.006)) and 43% (OR: 0.57; 95% CI: 0.41-0.80, p = 0.001)) reduced odds of having double and triple erythropoiesis-related micronutrient deficiencies for those pregnant women with a low household income. For those women with anemia, dietary patterns had 54% (OR: 046, 95% CI: 0.27-0.78) and 67% (OR: 0.33; 95% CI: 0.170.64) reduced odds of double and triple erythropoiesis-related micronutrient deficiencies. In conclusion, increased consumption of breakfast cereals and oats, nuts, and seeds, fresh fruits and vegetables, soybean products, and dairy products may protect women against erythropoiesis-related micronutrient deficiencies during pregnancy.

Vitamin D is involved in the pathophysiology of anemia. This cross-sectional study was conducted using the Nationwide Nutrition and Health Survey in Pregnant Women in Taiwan database. We investigated associations among dietary patterns (DPs), vitamin D, and iron-related biomarkers in pregnant women. The principal component analysis revealed four DPs. Linear and logistic regression analyses were performed to investigate the association of DPs with anemia-related biomarkers. Plant-based, carnivore, and dairy and nondairy alternatives DPs were positively associated with serum vitamin D levels. After adjusting covariates, the pregnant women consuming plant-based DPs at the mid-tertile (T2) were associated with reduced risks of low serum folate and vitamin D levels, and those consuming carnivore DPs at higher tertiles (T2 and/or T3) were correlated with an increased risk of low serum iron levels but decreased risks of low serum transferrin saturation, vitamin B 12 , and vitamin D levels. The pregnant women consuming dairy and nondairy alternatives DPs at the highest tertile (T3) were associated with reduced risks of low serum folate and vitamin B 12 levels. However, the processed food DP was not correlated with anemia-related biomarkers. Thus, plant-based, carnivore, and dairy and nondairy alternatives DPs were associated with the risk of low-serum-anemia-related variables.

Aims: The aim of the study was to investigate the socio-demographic factors and systemic conditions associated with non-arteritic anterior ischaemic optic neuropathy (NAION)., Methods: This was a nationwide population-based retrospective case-controlled study that recruited 9,261 NAION patients selected from the Taiwan National Health Insurance Research Database. The control group consisted of 9,261 age-, sex-, and index date-matched non-NAION patients recruited from the Taiwan Longitudinal Health Insurance Database, 2000. NAION was designated in the database by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as "code 377.41: ischaemic optic neuropathy without ICD-9-CM code 446.5: giant cell arteritis." Associated socio-demographic factors and systemic medical conditions were analysed using the McNemar's test, and continuous variables were analysed using the paired t test. The odds ratio (OR) and adjusted OR of developing NAION were compared using univariate logistic regression and multivariable logistic regression analyses, respectively., Results: Patients with systemic conditions such as diabetes mellitus, hypertension, hyperlipidaemia, chronic kidney disease, and hypotension were more likely to develop NAION than controls (adjusted OR = 1.81, 95% confidence interval [CI] = 1.67-1.97, p < 0.0001; adjusted OR = 1.46, 95% CI = 1.36-1.57, p < 0.0001; adjusted OR = 1.44, 95% CI = 1.33-1.57, p < 0.0001; adjusted OR = 3.26, 95% CI = 2.65-4.01, p < 0.0001; adjusted OR = 2.32, 95% CI = 1.31-4.10, p = 0.0039, respectively)., Conclusions: NAION is strongly associated with diabetes mellitus, hypertension, hyperlipidaemia, chronic kidney disease, and hypotension., (© 2022 S. Karger AG, Basel.)

Background: To investigate whether perceived attitudes of family and peers toward same-sex marriage (SSM) is a type of distal sexual minority stressor, as defined in minority stress theory, this cross-sectional study examined the associations of perceived attitudes of family and peers toward SSM with perceived sexual stigma from family and peers, internalized homonegativity, and mental health problems (e.g., depression, loneliness, anxiety) among gay and bisexual men in Taiwan., Methods: We recruited 400 gay and bisexual men and assessed their perceived attitudes of family and peers toward SSM; perceived sexual stigma from family and peers; internalized homonegativity; and severity of depression, loneliness, and anxiety., Results: Perceived attitudes of family and peers toward SSM (1) significantly correlated with various aspects of perceived sexual stigma from family and peers and (2) were significantly associated with internalized homonegativity, depression, loneliness, and anxiety., Conclusions: Perceived attitudes of family and peers toward SSM matched the characteristics of a distal sexual minority stressor, and as a new type of distal sexual minority stressor for lesbian, gay, and bisexual individuals, these perceived attitudes and related stress warrant greater attention from mental health professionals for the development of intervention programs., (© 2022. The Author(s).)

Background/purpose: Interfacility transfer (IFT) in Asian communities is seldom discussed. We aimed to describe the characteristics of IFT in Taiwan and to explore the adequacy of care during transfer., Methods: A retrospective, cross-sectional, descriptive study was conducted using standardized, paper-based interfacility ambulance transfer records between 1 January 2018 and 31 January 2018 from Tainan City, Taiwan. The mode of patient care needed was classified as advanced life support (ALS) or basic life support (BLS) cares based on clinical conditions. ALS providers were defined as physicians and EMT-Paramedics, while BLS providers were defined as nurse practitioners, nurses, EMT-1s and EMT-2s., Results: Of the 377 (227 [60.2%] were >65 years old; 219 [58.1%] were male) IFTs enrolled in the final analysis, 210 (55.7%) patients met the ALS transfer criteria, with poor consciousness (n = 158), tachypnea (n = 17), tachycardia (n = 5), bradycardia (n = 7), hypertension (n = 12), hypotension (n = 13), hypoxia (n = 4), endotracheal intubation (n = 18), a tracheostomy (n = 25), a precipitous labor (n = 1), and after resuscitation for out-of-hospital cardiac arrest (n = 10) or in-hospital cardiac arrest (n = 3). None of the patients who required ALS care had adequate ambulance staffing. Of the 167 BLS IFTs, 9 (5.4%) patients deteriorated and required ALS care during transportation, which included worsened consciousness (n = 2), tachycardia (n = 1), hypertension (n = 2), hypotension (n = 1), and hypoxia (n = 3). The rates of deterioration during BLS-transferals from the emergency departments, general wards, nursing facilities, and unknown areas were 4.8%, 4.7%, 7.7%, and 7.1%, respectively (p = 0.93)., Conclusion: The patient care during IFT in Taiwan is inadequate currently and should warrant attention., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2022 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

The UCLA Loneliness Scale, with different short versions, is widely used to assess levels of loneliness. However, whether the scale is valid in assessing loneliness among sexual-minority men is unknown. Additionally, it is unclear whether the 8-item and 3-item short versions are comparable to the full 20-item version. The present study compared the validity of the three versions of the UCLA Loneliness Scale (i.e., 20-item, 8-item, and 3-item versions) among gay and bisexual men in Taiwan. The participants comprised 400 gay and bisexual men in Taiwan who completed a cross-sectional online survey, which included the UCLA Loneliness Scale, Center for Epidemiological Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI). Confirmatory factor analysis was used to evaluate factorial validity. Convergent validity was examined between the three versions of the UCLA Loneliness Scale and the CES-D and STAI. Known-group validity was investigated with participants' sexual orientation and educational levels. The unidimensional construct was supported in all three versions of the UCLA Loneliness Scale tested in the present study. Convergent validity was supported as the level of loneliness was correlated with the level of depression and anxiety for all three versions. There were no significant differences between gay and bisexual men, although significant differences were found across different educational levels. The study confirmed that all three versions of the UCLA Loneliness Scale were comparable with satisfactory reliability and validity in Taiwanese sexual-minority men.

Purpose: To investigate the association of comorbidities including hyperparathyroidism and sociodemographic factors with band keratopathy., Methods: This retrospective, population-based, matched case-control study recruited 2,545 patients suffering from band keratopathy. They were selected from the Taiwan National Health Insurance Research Database, based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 371.43. The control group included 15,270 sex-, age-, and index date-matched non-band keratopathy patients collected from the Taiwan Longitudinal Health Insurance Database 2000. To compare band keratopathy patients with controls, McNemar's test was used for nominal data and paired t- tests were used for continuous variables. Univariate conditional logistic regression analysis and multivariable conditional logistic regression were used to obtain the odds ratio (OR) and adjusted OR of developing band keratopathy., Results: Patients with hyperparathyroidism were more likely to develop band keratopathy than controls (OR, 43.5; 95% confidence interval [CI], 23.789-79.544; P < 0.001) even after conditional logistic regression (adjusted OR, 11.28; 95% CI, 5.461-23.33; P < 0.001). Other conditions that increased the odds of scleritis development included systemic diseases such as chronic kidney disease (CKD) and diabetes mellitus (DM) and ocular conditions such as iridocyclitis, phthisis bulbi, and ever silicone oil retention. Regarding sociodemographic factors, >40% of patients with band keratopathy were aged ≥65 years old. Moreover, patients living in Eastern Taiwan and fishermen had higher odds of developing band keratopathy., Conclusions: Band keratopathy is significantly associated with hyperparathyroidism, CKD, DM, iridocyclitis, phthisis bulbi, and ever silicone oil retention., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Jan, Wang, Tseng and Chang.)