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Aim: To evaluate real‐world abatacept retention and clinical outcomes in patients with rheumatoid arthritis in Taiwan. Methods: This prospective, observational study enrolled patients with rheumatoid arthritis aged ≥20 years who received abatacept in real‐world practice. The primary endpoint was the abatacept retention rate at 24 months. Patients were categorized into subgroups based on abatacept treatment status and previous biological disease‐modifying antirheumatic drug (bDMARD) therapy. Risk factors affecting abatacept retention were determined by regression analysis. Results: A total of 212 patients were enrolled. The overall abatacept retention rate at 24 months among all patients was 59.9% (95% confidence interval 53.0%–66.6%). Patients who were ongoing users of abatacept and bDMARD‐naïve had the highest retention rate (76.3%); of these, 31.6% achieved low disease activity or remission after 2 years. Previous treatment with bDMARDs was associated with an increased risk of abatacept discontinuation (hazard ratio 1.99; p =.002). The most common reasons for abatacept discontinuation were drug switch (11.3%) and loss to follow‐up (6.1%). Abatacept was well‐tolerated with no new safety signals. Conclusion: The 24‐month retention rate of abatacept was 59.9%; abatacept was associated with improved clinical outcomes and was well‐tolerated in the real‐world setting in Taiwan. [ABSTRACT FROM AUTHOR]

Summary: Most studies investigating the association between physical activity and osteoporosis prevention only focused on specific types of physical activity. This study's evidence regarding the combined effects or interaction of sleep duration and physical activity. The findings emphasize the role of sleep duration and physical activity in association with osteoporosis. Purpose: The associations between physical activity, sleep duration, and prevalent osteoporosis in Taiwanese adults were studied in this cross-sectional study. Methods: The Taiwan Biobank enrolled a community-based cohort of ~ 120,000 volunteers (as of April 30, 2020) between 30 and 76 years of age with no history of cancer. Amongst, bone mineral density (BMD) measures by dual-energy X-ray absorptiometry (DXA) were available in 22,402 participants. After excluding individuals who had no complete data of BMI (n = 23), MET score (n = 207), T-score (n = 8,826), and sleep duration (n = 16), 13,330 subjects were included as the primary cohort. Univariate and multivariable regression analyses were performed to determine the associations between the presence of osteoporosis, physical activity level, sleep duration, and other variables. Results: The results showed that after adjustment, subjects with physical activity < 20 METs/week and ≥ 20 METs/week (aOR = 1.017 and 0.767, respectively) were associated with risk of osteoporosis than those with zero MET. The odds of osteoporosis were not significantly lower in subjects who slept for ≥ 8 h/day (aOR = 0.934,p=0.266). In addition, compared to short sleepers with no physical activity, adults with increased physical activity ≥ 20 METs/week and sleep ≥ 8 h/day had a significantly lowest likelihood of osteoporosis (aOR = 0.702). Those with medium physical activity (< 20 METs/week) plus average sleep duration (6.5–8 h/day) did not have significant higher odds of osteoporosis (aOR = 1.129,p=0.151). Conclusion: The findings emphasize the joint role of sleep duration and physical activity in association with osteoporosis. Adults with high physical activity plus high sleep hours have the highest BMD and lowest risk of osteoporosis. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the relation between self-identity and health-related quality of life (HRQOL) in adolescence. This study assumed that four aspects (i.e. personal, social, ability, and academic identity) of identity firmness could predict adolescent's HRQOL more than four aspects of identity importance. Meanwhile, this study also hypothesized that psychological and social relationships domains of HRQOL could be largely explained by the concept of identity firmness. One hundred and ninety-eight female adolescents participated in this study. Each participant completed a booklet containing the measures of the Questionnaire of revised edition of identity importance (QII-R), the Questionnaire of revised edition of identity firmness (QIF-R), the WHOQOL-BREF Taiwan version, and Visual-analogue HRQOL items. This study administered multiple regression analyses to test our hypotheses. The results demonstrated the concept of identity firmness could predict adolescent's HRQOL more than the concept of identity importance. The results also supported our hypotheses that psychological and social relationships domains of HRQOL could be largely explained by the concept of identity firmness. In general, this study supported our hypotheses that the concept of identity firmness is a crucial predictor to adolescent's HRQOL.

The WHOQOL-BREF is one of the cross-cultural and widely used measures for assessing health-related quality of life (HRQOL). Previous studies of the HRQOL using the WHOQOL-BREF mainly focused on adult; however, there has been less work carried out on assessing the HRQOL on early adolescence. The goal of this study was to examine the applicability of the WHOQOL-BREF Taiwan version in early adolescent sample. A total of 365 junior high school students participated in this study. Participants completed the WHOQOL-BREF Taiwan version and five visual-analogue items on HRQOL evaluation. The results supported the originally designed four-factor model, and also indicated good item discrimination, internal reliability, factorial validity (by using confirmatory factor analysis) and construct validity (e.g., predictive validity, discriminant and convergent validity) after deleting two physical health items (i.e., "To what extent do you feel that your pain hinders you in doing what you need to do"; "Do you need medical treatment to cope with your daily life?") and one social relationships item (i.e., "Are you satisfied with your sex life?"). Overall, this study provides the applicability of the WHOQOL-BREF Taiwan version in early adolescence. In addition, the WHOQOL-BREF Taiwan version may be of use to health professionals in the assessment and comparison of different age groups from early adolescence to adulthood.

We aimed to investigate the association between preoperative body mass index (BMI) and postoperative long-term mortality in patients who underwent a vertebroplasty. We retrospectively enrolled patients with a vertebral compression fracture who underwent a vertebroplasty between May 2013 and June 2020 in a medical center in Taiwan. The survival status of the study sample was confirmed by the end of March 2021. Cox-proportional hazard models were conducted to examine the effects of being overweight/obese (≥25 kg/m2 vs. <25 kg/m2) and BMI (as a continuous variable) on all-cause mortality after adjusting for age, sex, history of smoking, diabetes, hypertension, chronic kidney disease, and osteoporosis. A total of 164 patients were analyzed (mean age 75.8 ± 9.3 years, male 25.6%, mean BMI 24.0 ± 4.1 kg/m2) after a median follow-up of 785 days. Compared with a BMI < 25 kg/m2, a BMI ≥ 25 kg/m2 was associated with a significantly lower risk of all-cause mortality (HR 0.297, 95% CI 0.101 to 0.878, p = 0.028). These findings were consistent when BMI was examined as a continuous variable (HR 0.874, 95% CI 0.773 to 0.988, p = 0.031). A low BMI (<22 kg/m2) should be considered as a risk factor for postoperative long-term mortality in this ageing population. [ABSTRACT FROM AUTHOR]

Special attention has been paid in recent years to the social and environmental implications of municipal solid waste. There are potential social and environmental issues associated with storing any waste in landfill. Soil, groundwater, and surface water contamination are issues related to landfill and the migration of contaminants by leaching to adjacent areas. The current research attempts to simulate the penetration of landfill contaminants through groundwater leaching, using PART modeling approaches. Multiple social factors, taken from five years of data from 20 counties and cities in Taiwan were used as predictors of groundwater arsenic content. The results indicate that the proposed model attains a precision rate of 87%. The findings suggest that county and city demographics and the volume of waste removed are two major factors in determining the arsenic content of groundwater. The proposed predictive model can be adopted by agencies as an effective early warning tool for groundwater arsenic levels. [ABSTRACT FROM AUTHOR]

Background: Patients with cervical radiculopathy typically present with shoulder pain and weakness; these symptoms are similar to those of rotator cuff disease. Studies investigating cervical spine pathology (CSP) as an independent risk factor for rotator cuff tear (RCT) are lacking in the literature. Purpose: To investigate the risk of RCT among patients with CSP who have undergone cervical diskectomy (CD) and to determine whether CD reduces this risk. Study Design: Cohort study; Level of evidence, 3. Methods: The authors queried the Taiwan National Health Insurance Research Database for patients diagnosed with CSP between 2004 and 2008 and followed up until the end of 2010. A control cohort comprised patients without CSP who were age- and sex-matched in a 4-to-1 ratio with patients with CSP through propensity score matching. A Cox multivariate proportional hazards model was applied to analyze the risk factors for RCT. After adjustment for confounders, the authors calculated the hazard ratio (HR) and adjusted HR (aHR) between the study and control cohorts. The effects of CD on the risk of RCT were also analyzed. Results: The study included 3245 patients and 12,980 matched controls. A higher RCT incidence rate was found in the CSP cohort, with an aHR of 1.52 (95% CI, 1.22-1.89; P <.001). Patients with CSP who underwent CD had a risk of RCT similar to that of the controls, with an aHR of 1.65 (95% CI, 0.90-3.03; P >.05). Conclusion: Patients with CSP had a 1.52-fold higher risk of RCT than healthy controls. Patients with CSP with CD did not have a high risk of RCT, possibly indicating a protective effect of diskectomy against RCT. [ABSTRACT FROM AUTHOR]

Background There is a lack of evidence that shows whether a report card can improve health outcomes in terms of infection rates or unscheduled readmission by using rigorous methods to evaluate its impact. Methods We used the National Health Insurance Administration's claims database from 1 January 2004 to 30 December 2013 and a time series analysis to evaluate the impact of the quality report card initiative on three negative outcomes of total knee replacement for each quarter of the year, including the rates of superficial infection of a knee replacement, deep infection of knee arthroplasty and unplanned readmissions for surgical site infection. Results These negative outcomes (original scale) do not show significant decreases in terms of superficial infection (−0.05‰, −0.63 to 0.53‰, P = 0.87), deep infection (−0.003‰, −0.19 to 0.18‰, P = 0.97) and unscheduled readmission (0.02‰, −0.21 to 0.25‰, P = 0.88). Conclusion The total knee replacement public report card initiative did not improve the rate of infection and unscheduled readmission for surgical site infection. This report card in Taiwan should involve physicians' participation in the design and be tailored to be suitable for reading by patients in order to further enhance the chance of improvement in these negative outcomes. [ABSTRACT FROM AUTHOR]

River-blocking events induced by tributary debris flows occur frequently in mountainous areas. If a dam formed by a river-blocking debris flow were damaged, a massive outburst flood could induce downstream hazards. Therefore, early identification of areas potentially at risk of river blocking is essential for hazard mitigation, particularly in extensive mountainous areas. This study proposed a dimensionless volume index (DVI) to evaluate river-blocking formation by considering the relationship between the deposition volume of a tributary debris flow in a river and the minimum river-blocking volume. The values of both parameters can be established based on the theory of debris flow run-out distance, deposition width, and deposition thickness with consideration of the effects of drag force, hydrostatic force, and buoyancy. The efficacy of the proposed method was demonstrated through two case studies of mainstream blocking/nonblocking by tributary debris flow events in Taiwan during Typhoon Morakot. The results indicated that early identification of river blocking could be achieved using the DVI based on a pre-established database of potential debris flow hazard areas, including local site information, rainfall intensities at potential debris flow hazard areas under varying recurrence periods, and mainstream discharge at varying recurrence periods. [ABSTRACT FROM AUTHOR]

Natural dams are formed when landslides are triggered by heavy rainfall during extreme weather events in the mountainous areas of Taiwan. During landslide debris movement, two processes occur simultaneously: the movement of landslide debris from a slope onto the riverbed and the erosion of the debris under the action of high-velocity river flow. When the rate of landslide deposition in a river channel is higher than the rate of landslide debris erosion by the river flow, the landslide forms a natural dam by blocking the river channel. In this study, the effects of the rates of river flow erosion and landslide deposition (termed the erosive capacity and depositional capacity, respectively) on the formation of natural dams are quantified using a physics-based approach and are tested using a scaled physical model. We define a dimensionless velocity index vde as the ratio between the depositional capacity of landslide debris (vd) and the erosive capacity of water flow (ve). The experimental test results show that a landslide dam forms when landslide debris moves at high velocity into a river channel where the river-flow velocity is low, that is, the dimensionless velocity index vde > 54. Landslide debris will not have sufficient depositional capacity to block stream flow when the dimensionless velocity index vde < 47. The depositional capacity of a landslide can be determined from the slope angle and the friction of the sliding surface, while the erosive capacity of a dam can be determined using river flow velocity and rainfall conditions. The methodology described in this paper was applied to seven landslide dams that formed in Taiwan on 8 August 2009 during Typhoon Morakot, the Tangjiashan landslide dam case, and the Yingxiu-Wolong highway K24 landslide case. The dimensionless velocity index presented in this paper can be used before a rainstorm event occurs to determine if the formation of a landslide dam is possible. [ABSTRACT FROM AUTHOR]

Maintenance of groundwater level is an important issue toward resolving land subsidence problems in delta regions; this process includes two major mechanisms: recharge and discharge. However, the overuse of groundwater in coastal aquaculture or agriculture, from the perspective of discharge, is still viewed as the major issue which causes the problem of land subsidence in many Asian countries. This article focused on the significant decrease in infiltration in history, from the perspective of recharge, to explore land subsidence. Through the three-by-three layer approach, we demonstrated that decisive intervention by man-made landscapes, including dike construction, river reclamation, and establishment of built areas, which can date back to the Japanese colonization about 100 years ago, has significantly changed waterways in Taiwan. This intervention induced a tremendous reduction in groundwater infiltration and subsequently has a close relationship with the serious land subsidence that is occurring in the southwestern coastal regions. The abuse of groundwater by fishermen for aquaculture in recent decades might just be the last factor in a series of events to cause a sinking land. This paper argues that a certain ratio of land should be restored for the purpose of groundwater recharge to amend the effect of the man-made intervention on the natural water system. In addition, in accordance with the sedimentation features of deltas, areas located at the top of the alluvial fan of a delta, which have porous soil structures, bear greater responsibility for infiltration. [ABSTRACT FROM AUTHOR]

The effect of comorbidity on lung cancer patients’ survival has been widely reported. The aim of this study was to investigate the effects of comorbidity on the establishment of the diagnosis of lung cancer and survival in lung cancer patients in Taiwan by using a nationwide population-based study design. This study collected various comorbidity patients and analyzed data regarding the lung cancer diagnosis and survival during a 16-year follow-up period (1995–2010). In total, 101,776 lung cancer patients were included, comprising 44,770 with and 57,006 without comorbidity. The Kaplan–Meier analyses were used to compare overall survival between lung cancer patients with and without comorbidity. In our cohort, chronic bronchitis patients who developed lung cancer had the lowest overall survival in one (45%), five (28.6%), and ten years (26.2%) since lung cancer diagnosis. Among lung cancer patients with nonpulmonary comorbidities, patients with hypertension had the lowest overall survival in one (47.9%), five (30.5%), and ten (28.2%) years since lung cancer diagnosis. In 2010, patients with and without comorbidity had 14.86 and 9.31 clinical visits, respectively. Lung cancer patients with preexisting comorbidity had higher frequency of physician visits. The presence of comorbid conditions was associated with early diagnosis of lung cancer. [ABSTRACT FROM AUTHOR]

Objectives There is no gold standard in diagnosing sarcopenia. We aimed to assess the validity of screening sarcopenia using SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). Design Prospective cohort study. Setting Community hospital in Taiwan. Participants Community-dwelling senior citizens. Measurements Participants were interviewed with a structured questionnaire annually. The questionnaire items were recoded into the 5 items of SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). In the baseline year, a subgroup was tested for grip strength and body composition. Healthcare utilization and mortality were based on self-report and hospital records. Our main outcome was 4-year mortality. Secondary outcomes included hospitalization, emergency care use, and quality of life (QOL) measured using the CASP-12 scale (control, autonomy, self-realization, pleasure (control, autonomy, self-realization, pressure). Results There were 670 participants. The mean age was 76.1 (standard deviation 6.36). One-half were men (n = 340, 50.7%). The prevalence of sarcopenia was 6.1% (n = 41). SARC-F scores were inversely associated with grip strength ( P = .001) and skeletal muscle composition ( P = .045). Participants with sarcopenia were mostly women ( P = .005) and older ( P < .001). In univariate analysis, sarcopenia was associated with 1- to 4-year mortalities ( P = .033, .001, .001, <.001, respectively), overall hospitalization ( P = .004), overall emergency care use ( P = .017), and QOL ( P < .001). In multivariate model, sarcopenia [odds ratio (OR) 7.35, 95% confidence interval (CI) 2.67-20.18], age (OR 1.19, 95% CI 1.09-1.29 for each year), and taking vitamin D supplements (OR 0.29, 95% CI 0.11-0.74) were factors associated with mortality. Conclusions Sarcopenia screened using SARC-F was associated with subsequent QOL, overall hospitalization, overall emergency care use, and 4-year mortality. SARC-F can serve as a quick screening tool of sarcopenia. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) are linked to the augmented risk of morbidity and mortality. Although polysomnography is considered a well-established method for diagnosing OSA, it suffers the weakness of time consuming and labor intensive, and requires doctors and attending personnel to conduct an overnight evaluation in sleep laboratories with dedicated systems. This study aims at proposing an efficient diagnosis approach for OSA on the basis of anthropometric and questionnaire data. The proposed approach integrates fuzzy set theory and decision tree to predict OSA patterns. A total of 3343 subjects who were referred for clinical suspicion of OSA (eventually 2869 confirmed with OSA and 474 otherwise) were collected, and then classified by the degree of severity. According to an assessment of experiment results on g-means, our proposed method outperforms other methods such as linear regression, decision tree, back propagation neural network, support vector machine, and learning vector quantization. The proposed method is highly viable and capable of detecting the severity of OSA. It can assist doctors in pre-diagnosis of OSA before running the formal PSG test, thereby enabling the more effective use of medical resources. [ABSTRACT FROM AUTHOR]

Brain metastases are commonly found in patients that are diagnosed with primary malignancy on their lung. Lung cancer patients with brain metastasis tend to have a poor survivability, which is less than 6 months in median. Therefore, an early and effective detection system for such disease is needed to help prolong the patients' survivability and improved their quality of life. A modified electromagnetism-like mechanism (EM) algorithm, MEM-SVM, is proposed by combining EM algorithm with support vector machine (SVM) as the classifier and opposite sign test (OST) as the local search technique. The proposed method is applied to 44 UCI and IDA datasets, and 5 cancers microarray datasets as preliminary experiment. In addition, this method is tested on 4 lung cancer microarray public dataset. Further, we tested our method on a nationwide dataset of brain metastasis from lung cancer (BMLC) in Taiwan. Since the nature of real medical dataset to be highly imbalanced, the synthetic minority over-sampling technique (SMOTE) is utilized to handle this problem. The proposed method is compared against another 8 popular benchmark classifiers and feature selection methods. The performance evaluation is based on the accuracy and Kappa index. For the 44 UCI and IDA datasets and 5 cancer microarray datasets, a non-parametric statistical test confirmed that MEM-SVM outperformed the other methods. For the 4 lung cancer public microarray datasets, MEM-SVM still achieved the highest mean value for accuracy and Kappa index. Due to the imbalanced property on the real case of BMLC dataset, all methods achieve good accuracy without significance difference among the methods. However, on the balanced BMLC dataset, MEM-SVM appears to be the best method with higher accuracy and Kappa index. We successfully developed MEM-SVM to predict the occurrence of brain metastasis from lung cancer with the combination of SMOTE technique to handle the class imbalance properties. The results confirmed that MEM-SVM has good diagnosis power and can be applied as an alternative diagnosis tool in with other medical tests for the early detection of brain metastasis from lung cancer. [ABSTRACT FROM AUTHOR]

Objectives:Little is known about the influence of routine laboratory measurements and lifestyle factors on generic quality of life (QOL) at older ages. We aimed to study the relationship between generic QOL and laboratory measurements and lifestyle factors in community dwelling older Chinese people. Methods:We conducted a cross-sectional analysis. Six hundred and ninety nine elders were randomly selected from the examinees of the annual health examination in Taipei City, Taiwan. Blood, urine and stool of the participants were examined and lifestyle data were collected. Participants completed the CASP-19 (control, autonomy, self-realization, pleasure) questionnaire, a 19-item QOL scale. The relationship between QOL and laboratory results and lifestyle factors was explored, using multiple linear regression and profile analysis. Results:The mean age of the participants was 75.5 years (SD = 6.5), and 49.5% were female. Male gender standardized β coefficients (β = 0.122) and exercise habit (β = 0.170) were associated with a better QOL, whereas advanced age (β = −0.242), blurred vision (β = −0.143), depression (β = −0.125), central obesity (β = −0.093), anemia (β = −0.095), rheumatoid arthritis (β = −0.073), Parkinsonism (β = −0.079), malignancy (β = −0.086) and motorcycle riding (β = −0.086) were associated with a lower QOL. Profile analysis revealed that young–old males, social drinkers, regular exercisers and car drivers had the best QOL (allp< 0.001). Conclusion:Of the many laboratory measurements, only anemia was associated with the lower QOL. By contrast, several lifestyle factors, such as social drinking, exercise habit and car driving, were associated with better QOL, whereas abdominal obesity and motorcycle riding were associated with lower QOL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Based on the high prevalence of people with problems in the wrist and hand simultaneously, it is of its importance to clarify whether hand joints exert extra motion to compensate for wrist motion while immobilized. OBJECTIVE: This study aimed to measure the compensatory movement of the thumb and index finger when people perform daily activities with an immobilized wrist. METHODS: Thirty healthy volunteers were recruited in this study. A wrist splint, the Jebsen-Taylor Hand Function Test, and the OptoTrak Certus motion tracking system were used. Seven inter-digit mean joint angles of the index finger and thumb were calculated. Paired sample t-test was used. RESULTS: (1) The compensatory motions were noted in the Metacarpophalangeal and Carpometacarpal joints of the thumb, and the proximal interphalangeal joints of the index finger; (2) The manifestation of compensatory motion was related to type of activity performed except when picking up light and heavy cans. CONCLUSIONS: The compensatory motions appeared while the wrist was immobilized and were found to be disadvantageous to the progression of disease. In the future, studies need to be done to understand how to select products with correct ergonomic design to enable people to reap greater benefits from wearing wrist splints. [ABSTRACT FROM AUTHOR]

Background: It is important to select appropriate targeted therapies for subgroups of patients with lung adenocarcinoma who have specific gene alterations. Methods: This prospective study was a multicenter project conducted in Taiwan for assessment of lung adenocarcinoma genetic tests. Five oncogenic drivers, including EGFR, KRAS, BRAF, HER2 and EML4-ALK fusion mutations, were tested. EGFR, KRAS, BRAF and HER2 mutations were assessed by MALDI-TOF MS (Cohort 1). EML4-ALK translocation was tested by Ventana method in EGFR-wild type patients (Cohort 2). Results: From August 2011 to November 2013, a total of 1772 patients with lung adenocarcinoma were enrolled. In Cohort 1 analysis, EGFR, KRAS, HER2 and BRAF mutations were identified in 987 (55.7%), 93 (5.2%), 36 (2.0%) and 12 (0.7%) patients, respectively. Most of these mutations were mutually exclusive, except for co-mutations in seven patients (3 with EGFR + KRAS, 3 with EGFR + HER2 and 1 with KRAS + BRAF). In Cohort 2 analysis, 29 of 295 EGFR-wild type patients (9.8%) were positive for EML4-ALK translocation. EGFR mutations were more common in female patients and non-smokers and KRAS mutations were more common in male patients and smokers. Gender and smoking status were not correlated significantly with HER2, BRAF and EML4-ALK mutations. EML4-ALK translocation was more common in patients with younger age. Conclusion: This was the first study in Taiwan to explore the incidence of five oncogenic drivers in patients with lung adenocarcinoma and the results could be valuable for physicians in consideration of targeted therapy and inclusion of clinical trials. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a relatively common disease in the general population. Patients with OSA have a high risk of various comorbid medical diseases. Polysomnography (PSG) is the current gold standard for diagnosing OSA but is time consuming and expensive. This study aims to identify a sensitive screening parameter that can be used by clinicians to determine the time of referral for PSG examination in Taiwan. Eighty-seven patients, including 67 males and 20 females, were included in this study. We divided the patients into two groups: training data ( n = 58) and testing group ( n = 29). Pearson χ test was used to perform bivariate analysis, and a decision tree was used to build a model. The decision model selected the frequency of desaturation > 4% per hour (DI4) as the indicator of OSA influence. The testing data accuracy of the C4.5 decision tree was 82.80%. External data were also used to validate the model reliability. The accuracy of the external data was 95.96%. Approximately one-third of patients with DI4 between 11 and 33 suffered from OSA. This population requires further diagnosis. Oximetry is an important and widely available screening method in Taiwan. This study proposes the need for PSG referral if DI4 is between 11 and 33. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate the motivations that affect middle management employees' knowledge-sharing intentions in the context of total quality management (TQM) implementations of Taiwan's information technology (IT) industry. A research model was developed based on TQM implementations and the theory of reasoned action. Survey samples were collected from 395 middle management employees in 50 Taiwanese ISO 9001:2000-certified firms in the IT industry, providing support for the proposed model. LISREL was applied to analyse the measurement and structural models. The analytical results showed that anticipated reciprocal relationships, perceived ethics and self-efficacy have significant direct effects on attitudes towards knowledge sharing and that subjective norms are significantly associated with knowledge-sharing intentions in the context of TQM implementations. However, subjective norms alone do not significantly influence attitudes towards knowledge sharing. Because this study only considered knowledge-sharing intention with regard to TQM implementation, whether these analytical results can be generalised to other research fields is unclear. We expect that future research can replicate this model. The contribution of the present study is the establishment of a model capable of lending an understanding to knowledge-sharing intention relationships for TQM implementation in the Taiwanese IT industry. This study also presents valuable recommendations for TQM literature and practice. [ABSTRACT FROM PUBLISHER]

This article describes how a college social service learning centre at a Catholic university created an opportunity for researchers, college students and elementary school teachers to learn about meaning in life together, through a social service learning program in Taiwan. The participants’ involvement benefitted their learning, indicating that the meaning in life perceived by the younger generation has changed in response to the context of an evolving Chinese culture, and that participants constrained their callings by developing realistic plans consisting of goals emphasised in traditional Chinese culture. Challenges were identified: specifically, the participants’ callings did not directly reflect the lessons that they learned through involvement in the program, and implementing the service program as a one-time activity limited its effect on the participants’ ability to find meaning in life. Future development of the service program was discussed, based on the lessons learned through this action research. [ABSTRACT FROM AUTHOR]

This paper theoretically and empirically investigates the home-country effects of a firm's outward foreign direct investment ( OFDI) activity, specifically OFDI motivated by lower labor costs in the host country. A two-country imperfect competition model is developed, and the interaction between a firm's R&D spending and its OFDI is examined. It is found that the relationship between a firm's OFDI and its domestic R&D is indeterminate because there is a complementary effect as well as a substitution effect induced by OFDI activity. Panel data on Taiwanese manufacturing firms from 1992-2005 are applied to test the validity of the theoretical results. The propensity score matching method is used to construct a comparison group without selection bias. Our empirical evidence reveals that a Taiwanese firm's OFDI is positively related to its domestic R&D spending, particularly in R&D-intensive industries. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Pesticides are the leading toxicants resulting in emergency department (ED) admission. Factors which help emergency physicians predict mortality from pesticide poisoning have rarely been elucidated. There is also a lack in epidemiologic data on pesticide exposure in eastern Taiwan. This study describes the characteristics of patients with pesticide poisoning in eastern Taiwan and identifies available ED predictors for mortality from pesticide poisoning. Materials and Methods: Patients with pesticide exposure who presented to the ED in the only medical center in eastern Taiwan between July 2001 and July 2008 were reviewed retrospectively. Clinical information was collected for comparison between survivors and nonsurvivors. Logistic regression was conducted to identify the predictors for poisoning-related mortality. Results: During the study period, a total of 573 patients with pesticide exposure presented to our ED. There were 145 poisoning-related fatalities (25.31%) with a mean survival of 3.63 days. Paraquat (37.5%) was the leading pesticide involved, followed by glyphosate (23.0%) and organophosphates (13.4%). The significant predictors for mortality from pesticide poisoning were paraquat intoxication [odds ratio (OR) = 83.39; p < 0.001], organophosphate intoxication (OR = 10.88; p = 0.009), suicide attempt (OR = 15.98; p < 0.001), and abnormal body temperature (OR = 2.76; p = 0.043). In paraquat poisoning cases, age over 60 years (OR = 4.64; p = 0.003), suicide attempt (OR = 9.27; p < 0.001) and abnormal body temperature (OR = 2.63; p = 0.038), especially hypothermia, were risk factors for death. In nonparaquat poisoning cases, suicide attempt (OR > 999; p < 0.001) and initial respiratory distress (OR = 23.25; p = 0.001) were predictors for mortality. Conclusion: Paraquat and organophosphates are the pesticides most associated with mortality. In paraquat exposure, elderly patients, those with suicidal intent and those presenting with an abnormal body temperature are at high risk for death. With nonparaquat pesticides, patients with suicidal intent and respiratory distress are at high risk for mortality. [Copyright &y& Elsevier]

The prevailing complex geological and ecological conditions of Taiwan have drawn considerable attention from various geo-ecological communities because of their vulnerability to produce various natural hazards at different scales. Located in the tropical/subtropical zone of the Pacific Rim, its ecological and rugged mountainous properties are environmentally sensitive making monitoring and observation especially difficult because of the high population density. In this article, we have investigated the land deformation in two adjacent industrial parks, Jhong-Li and Guei-Shan, in northern Taiwan using radar interferometry. The Interferometric Synthetic Aperture Radar technique for processing a series of data sets was first validated by comparison with ground levelling measurements over a test site. Excellent agreement was obtained in both deformation pattern and magnitude of subsidence rate. The period of observation dated from 1993 to 2000 with Synthetic Aperture Radar images from ERS-1 and ERS-2. The results, after least-squares adjustment, revealed that the maximum subsidence reached 10 cm and the subsidence rates were about 1.8 cm year−1 (at epicentres) since 1993 at both parks. It was also found that the subsidence rate slowed down after 1998 at Jhong-Li park while continuing at Guei-Shan park. This was strongly associated with local groundwater extraction activities. [ABSTRACT FROM AUTHOR]

Taiwan has started to liberalize its exchange rate and foreign investment policies since the mid 1980s. The subsequent considerable appreciation of its currency and increasing labor cost has stimulated many Taiwanese firms to actively undertake outward foreign direct investment (FDI). The possibility of the industrial hollowing-out induced by the FDI has been a great concern in Taiwan. The purpose of this paper is to establish a computable general equilibrium (CGE) model to investigate the impact of outward FDI by Taiwanese firms on its domestic economy. The efficiency wage theory is incorporated into the analytical framework. This paper first employs regression analysis to show that there exists severe wage rigidity in the labor market of Taiwan. Its simulation analysis then indicates that the outward FDI from Taiwan might reduce its income and employment to some extent. These results reveal that the outward FDI might hurt a distortion-ridden economy, which is consistent with the theoretical findings of Brecher and Choudhri (1987) and Basu (1998). However, it seems that the outward FDI could account for only a very small part of the recent increase in Taiwan's unemployment level. [ABSTRACT FROM AUTHOR]

The aim of this study was to discuss the influence of age, gender, obesity status, joint laxity, and the W-sitting habit on flatfoot in preschool-aged children. A total of 1,598 children (833 boys and 765 girls) between 3 and 6 years of age from kindergartens in the central area of Taiwan were studied. The children were divided into a normal group (n = 733), a unilateral flatfoot group (n = 266), and a bilateral flatfoot group (n = 599), and a multinomial logistic regression model was used to analyze the data. The prevalence of flatfoot decreased significantly with increasing age: 54.5% of 3-year-old but only 21% for 6-year-old children had bilateral flatfoot. In the bilateral flatfoot group, the risk decreased with increased age, increased with increasing weight beyond the normal range, and was higher for boys than girls. Age and obesity status were not significantly influential in the unilateral flatfoot group. Children with higher joint laxity and a habit of W-sitting also experienced higher risk in both flatfoot groups. In conclusion, this study demonstrates a significant association of age, gender, obesity status, joint laxity, and the W-sitting habit with the bilateral flatfoot in preschool-aged children. Children with unilateral flatfoot differ from those with normal feet and bilateral flatfoot. It is suggested that the unilateral flatfoot deserves special attention in future studies. [ABSTRACT FROM AUTHOR]

Uncertainties in the length of active faults and the styles of deformation often hamper the evaluation of seismic potentials in a region. In the area near Chiayi City of southwestern Taiwan, where historically there have been many strong earthquakes, complex fault and fold systems produced by regional tectonic forces and the subsequent deformation are frequently obscured by vegetation and anthropogenic effects; and therefore detailed deformation information has not been available for evaluation of the seismic potential. By stacking the results from Differential Interferometry and removing the ambiguity of interferograms using GPS data, we were able to retrieve surface deformation information about the area under consideration near Chiayi City. In our results, we found that the Meishan fault to the north of Chiayi City extended 10 km to the west of its currently documented area and served as a geological boundary separating the northern part, where sediments were thicker, from the southern part of the westward extension of the Meishan fault. Chiayi City was under active deformation by a double plunging fold with vertical uplift rate at approximately 1 cm/yr. Frequent seismicity and active deformation allowed the tectonic stress to permute between strike–slip and thrust in this area. Continuous folding of Chiayi City and episodic large earthquakes along the Meishan Fault posed a serious threat of seismic hazards in this region, and called for continuous monitoring of the area. [Copyright &y& Elsevier]

This paper examines the impact of exchange rate movements on foreign direct investment (FDI). We first employ a real options model to show that while the depreciation of a host country's currency tends to stimulate FDI activity of cost-oriented firms, the depreciation tends to deter FDI activity for market-oriented firms. With industry panel data on Taiwan's outward FDI into China over the period 1991–2002, our empirical findings indicate that the exchange rate level and its volatility in addition to the relative wage rate have had a significant impact on Taiwanese firms’ outward FDI into China. In general, the empirical results are consistent with the prediction of the theory. Our results reveal that the relationship between exchange rates and FDI is crucially dependent on the motives of the investing firms. Without considering this fact in an empirical model, the testing results might suffer from aggregations bias. [ABSTRACT FROM AUTHOR]

Nasal methicillin-resistant Staphylococcus aureus (MRSA) colonies are an essential reservoir of infection, especially for patients with diabetes. However, data on MRSA colonization in patients with type 1 diabetes are limited. We investigated the epidemiology of MRSA colonization in patients with type 1 diabetes. This prospective cross-sectional study was conducted in a medical center (Chang Gung Memorial Hospital) in Taiwan from 1 July to 31 December 2020. Nasal sampling and MRSA detection were performed. The molecular characteristics of MRSA isolates were tested, and factors associated with MRSA colonization were analyzed. We included 245 patients with type 1 diabetes; nasal MRSA colonization was identified in 13 (5.3%) patients. All isolates belonged to community-associated MRSA genetic strains; the most frequent strain was clonal complex 45 (53.8%), followed by ST59 (30.8%) (a local community strain). MRSA colonization was positively associated with age ≤ 10 years, body mass index < 18 kg/m2, and diabetes duration < 10 years; moreover, it was negatively associated with serum low-density lipoprotein cholesterol ≥ 100 mg/dL. No independent factor was reported. The nasal MRSA colonization rate in type 1 diabetes is approximately 5% in Taiwan. Most of these colonizing strains are community strains, namely clonal complex 45 and ST59. [ABSTRACT FROM AUTHOR]

Background and purpose There has been much discussion about the risk factors for osteoporosis, but studies involving elderly population in Taiwan are minimal. We aimed to describe variables related to osteoporosis among community dwelling older people in Taiwan. Methods This is a cross-sectional study. The 671 participants were randomly selected from 3680 examinees of the annual Senior Citizens Health Examination in year 2010. Participants were interviewed with a detailed questionnaire, and 91 of them were invited for dual-energy X-ray absorptiometry (DXA). Predictor variables included age, gender and clinical risk factors for osteoporosis. The main outcome was osteoporosis confirmed by DXA. Results The mean age of the participants was 75.7 ± 6.4 years old. Overall, the most prevalent variables for osteoporosis were height loss in adulthood (41.0%), lack of dairy products or calcium supplements (32.0%) and insufficient physical activity (10.4%). In multivariate models, we found that underweight (OR = 9.80) and lack of dairy products/calcium supplements (OR = 3.68) were the main variables for osteoporosis. In the subgroup analysis involving only women, underweight (OR = 14.60) was the main variable. Discussion Among community-dwelling older people in Taiwan, osteoporosis was mainly associated with underweight and lack of dairy products or calcium supplements. Conclusion We suggest using the key questions of underweight and dietary pattern in clinical settings to identify high risk people who are candidates for further BMD exam. [ABSTRACT FROM AUTHOR]

Classifying imbalanced data in medical informatics is challenging. Motivated by this issue, this study develops a classifier approach denoted as BSMAIRS. This approach combines borderline synthetic minority oversampling technique (BSM) and artificial immune recognition system (AIRS) as global optimization searcher with the nearest neighbor algorithm used as a local classifier. Eight electronic medical datasets collected from University of California, Irvine (UCI) machine learning repository were used to evaluate the effectiveness and to justify the performance of the proposed BSMAIRS. Comparisons with several well-known classifiers were conducted based on accuracy, sensitivity, specificity, and G -mean. Statistical results concluded that BSMAIRS can be used as an efficient method to handle imbalanced class problems. To further confirm its performance, BSMAIRS was applied to real imbalanced medical data of lung cancer metastasis to the brain that were collected from National Health Insurance Research Database, Taiwan. This application can function as a supplementary tool for doctors in the early diagnosis of brain metastasis from lung cancer. [ABSTRACT FROM AUTHOR]

Forests are the most important terrestrial carbon source and sink, with forest biomass and productivity influencing the level of carbon storage in the ecosystem. In this study, the carbon sequestration of Sugi (Japanese cedar) was estimated according to 25-year plantation forest inventory data in the Experimental Forest, National Taiwan University, Nantou County, Taiwan. The total biomass, trunk biomass, and shoot biomass were used to calculate the carbon sequestration potential of Sugi plantation forests for 8995 acres. Additionally, the potential for bioethanol production from the shoot biomass was also estimated after 25 years of plantation. The results show that the total aboveground biomass accumulation is 935,231 m 3 , with an average areal biomass accumulation of 838.17 m 3 /ha. Total trunk volume is tallied at 562,274 m 3 , with stem volume accumulation at 243,285 m 3 /ha. Carbon sequestration is estimated at 274,571 tons. Shoot biomass could be converted to 58,194 tons of bioethanol. Substitution of steel and aluminum by overall Sugi trunk volume could reduce CO 2 emissions by 72,9498 and 4,994,253 tons, respectively. Compared with other building materials, the consumption of wood board is relatively low. The greater use of wood products as building materials could thus reduce greenhouse gas emissions and have a lower environmental loading than other building materials. The long-term carbon sequestration and substitution potential of subtropical mountain Sugi plantation forests are identified by this study for the first time. [ABSTRACT FROM AUTHOR]

Introduction Smoking status is an important determinant of the prevalence of epidermal growth factor receptor ( EGFR ) mutations in lung cancer patients. However, it is unclear whether smoking status could also influence the spectrum of EGFR mutations. Methods We enrolled patients with lung adenocarcinoma from three medical centers in Taiwan. EGFR mutations were assessed by Sanger direct sequencing. The objective of this study was to evaluate the influence of smoking status on both the frequency and patterns of EGFR mutations. Results From 2001 to 2013, a total of 1175 patients with lung adenocarcinoma were enrolled for EGFR mutation analysis. The overall EGFR mutation rate was 59.6%, which was significantly higher in females than males (69.1% vs. 49.8%) and in non-smokers than current/former smokers (73.8% vs. 29.8%) (both P < 0.001). Among patients harboring EGFR mutations, smokers expressed L858R mutation less frequently (35.2% vs. 50.2%, P = 0.005) and exon 19 deletions more frequently (52.8% vs 38.8%, P = 0.008) than non-smokers. Smokers and non-smokers also had divergent exon 19 deletions subtypes (Del E746-A750 82.5% vs. 57.6%, respectively, P < 0.001). Among subgroup patients harboring the L858R mutation, smokers were associated with a higher rate of complex mutations than non-smokers (34.2% vs. 8.4%, P < 0.001). Conclusions Our results suggested that smoking status could influence not only the frequency but also the spectrum of EGFR mutations. These findings provide a clue for further investigation of EGFR mutagenesis. [ABSTRACT FROM AUTHOR]

Background: The clinical outcomes of patients with anaplastic lymphoma kinase-positive (ALK+) advanced lung adenocarcinoma vary according to real-world data., Objective: In this study, we aimed to investigate the treatment discontinuation (TTD) and overall survival (OS) of patients with ALK+ advanced lung adenocarcinoma treated with first-line ALK-TKIs in Taiwan., Patients and Methods: This retrospective study evaluated all advanced lung adenocarcinoma patients registered in the National Taiwan Cancer Registry from 2017 to 2020 who had ALK rearrangement and received ALK-TKI treatment, using data from Taiwan's National Health Insurance Research Database (NHIRD). The TKI treatment sequences were classified into first generation (G1: crizotinib), second generation (G2: ceritinib, alectinib, brigatinib), and third generation (G3: lorlatinib)., Results: A total of 587 patients were analyzed, with a median age of 60.0 years, 91 (15.5%) aged ≥ 74 years, 293 (49.9%) female, 397 (67.6%) never smoked, and 534 (91.0%) with stage IV disease. Patients who received next-generation ALK-TKIs during the treatment course had longer median time to ALK-TKI TTD and OS. The TTD of the G1, G1+2, G1+2+3, G2, and G2+3 groups was 7.5 (5.4-11.1), 40.6 (29.4-not calculated (NC)), 50.3 (41.3-NC), 34.3 (29.2-43.0), and 36.3 (22.4-NC) months, respectively (p < 0.001). The median OS of the patients in the G1, G1+2, G1+2+3, G2, and G2+3 groups was 10.6 (7.5-14.6), not reached (NR) (NC-NC), NR (NC-NC), 43.0 (36.3-NC), and NR (30.3-NC) months, respectively (p < 0.001). Compared with treatment with crizotinib alone, the multivariate analysis revealed that treatment with next-generation TKIs was independently associated with longer TTD (G1+2 (hazard ratio (HR), 0.24; 95% CI 0.17-0.33; p < 0.001), G1+2+3 or G1+3 (HR, 0.17; 95% confidence interval (CI), 0.10-0.28; p < 0.001), G2 (HR, 0.26; 95% CI 0.19-0.36; p < 0.001), and G2+3 (HR, 0.25; 95% CI 0.14-0.44; p < 0.001)) and median OS (G12 (HR, 0.24; 95% CI 0.17-0.35; p < 0.001), G1+2+3 or G1+3 (HR, 0.09; 95% CI 0.04-0.21; p < 0.001), G2 (HR, 0.22; 95% CI 0.15-0.31; p < 0.001), and G2+3 (HR, 0.20; 95% CI 0.10-0.42; p < 0.001))., Conclusions: For patients with ALK+ NSCLC, treatments including next-generation ALK-TKIs were independently associated with longer survival outcomes., Competing Interests: Declarations Funding This study was funded by Pfizer (tracking no. 75046155), the Ministry of Health and Welfare (MOHW112-TDU-B-222-124019), and Formatting the Risk Prediction Models for Never-Smoking Lung Cancer (FORMOSA). Conflict of interest Zhe-Rong Zheng, Jia-Jun Wu, Chun-Ju Chiang, Tzu-I Chen, Kun-Chieh Chen, Cheng-Hsiang Chu, Sheng-Yi Lin, Sung-Liang Yu, Wen-Chung Lee, Tsang-Wu Liu, and Gee-Chen Chang declare that they have no conflicts of interest that might be relevant to the contents of this manuscript. Ethics approval The study was approved by the Institutional Review Board (IRB) of CSMUH, Taiwan (IRB no. CS1-22160). Consent to participate Not applicable. Consent for publication All authors reviewed the manuscript and approved the version for publication. Availability of data and material The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Code availability Not applicable. Author contributions Zhe-Rong Zheng, Jia-Jun Wu, Chun-Ju Chiang, and Gee-Chen Chang contributed to the study conception and design. Material preparation and data collection were performed by Jia-Jun Wu and Chun-Ju Chiang. The analysis of the data was done by Jia-Jun Wu, Chun-Ju Chiang, Tzu-I Chen, Kun-Chieh Chen, and Gee-Chen Chang. The writing of the original draft was performed by Zhe-Rong Zheng, Jia-Jun Wu, Chun-Ju Chiang, Tzu-I Chen, Kun-Chieh Chen, Cheng-Hsiang Chu, Sheng-Yi Lin, Sung-Liang Yu, Wen-Chung Lee, Tsang-Wu Liu, and Gee-Chen Chang. Jia-Jun Wu and Gee-Chen Chang revised the manuscript critically for important intellectual content., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: In Taiwan, lung cancers occur predominantly in never-smokers, of whom nearly 60% have stage IV disease at diagnosis. We aimed to assess the efficacy of low-dose CT (LDCT) screening among never-smokers, who had other risk factors for lung cancer., Methods: The Taiwan Lung Cancer Screening in Never-Smoker Trial (TALENT) was a nationwide, multicentre, prospective cohort study done at 17 tertiary medical centres in Taiwan. Eligible individuals had negative chest radiography, were aged 55-75 years, had never smoked or had smoked fewer than 10 pack-years and stopped smoking for more than 15 years (self-report), and had one of the following risk factors: a family history of lung cancer; passive smoke exposure; a history of pulmonary tuberculosis or chronic obstructive pulmonary disorders; a cooking index of 110 or higher; or cooking without using ventilation. Eligible participants underwent LDCT at baseline, then annually for 2 years, and then every 2 years up to 6 years thereafter, with follow-up assessments at each LDCT scan (ie, total follow-up of 8 years). A positive scan was defined as a solid or part-solid nodule larger than 6 mm in mean diameter or a pure ground-glass nodule larger than 5 mm in mean diameter. Lung cancer was diagnosed through invasive procedures, such as image-guided aspiration or biopsy or surgery. Here, we report the results of 1-year follow-up after LDCT screening at baseline. The primary outcome was lung cancer detection rate. The p value for detection rates was estimated by the χ 2 test. Univariate and multivariable logistic regression analyses were used to assess the association between lung cancer incidence and each risk factor. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LDCT screening were also assessed. This study is registered with ClinicalTrials.gov, NCT02611570, and is ongoing., Findings: Between Dec 1, 2015, and July 31, 2019, 12 011 participants (8868 females) were enrolled, of whom 6009 had a family history of lung cancer. Among 12 011 LDCT scans done at baseline, 2094 (17·4%) were positive. Lung cancer was diagnosed in 318 (2·6%) of 12 011 participants (257 [2·1%] participants had invasive lung cancer and 61 [0·5%] had adenocarcinomas in situ). 317 of 318 participants had adenocarcinoma and 246 (77·4%) of 318 had stage I disease. The prevalence of invasive lung cancer was higher among participants with a family history of lung cancer (161 [2·7%] of 6009 participants) than in those without (96 [1·6%] of 6002 participants). In participants with a family history of lung cancer, the detection rate of invasive lung cancer increased significantly with age, whereas the detection rate of adenocarcinoma in situ remained stable. In multivariable analysis, female sex, a family history of lung cancer, and age older than 60 years were associated with an increased risk of lung cancer and invasive lung cancer; passive smoke exposure, cumulative exposure to cooking, cooking without ventilation, and a previous history of chronic lung diseases were not associated with lung cancer, even after stratification by family history of lung cancer. In participants with a family history of lung cancer, the higher the number of first-degree relatives affected, the higher the risk of lung cancer; participants whose mother or sibling had lung cancer were also at an increased risk. A positive LDCT scan had 92·1% sensitivity, 84·6% specificity, a PPV of 14·0%, and a NPV of 99·7% for lung cancer diagnosis., Interpretation: TALENT had a high invasive lung cancer detection rate at 1 year after baseline LDCT scan. Overdiagnosis could have occurred, especially in participants diagnosed with adenocarcinoma in situ. In individuals who do not smoke, our findings suggest that a family history of lung cancer among first-degree relatives significantly increases the risk of lung cancer as well as the rate of invasive lung cancer with increasing age. Further research on risk factors for lung cancer in this population is needed, particularly for those without a family history of lung cancer., Funding: Ministry of Health and Welfare of Taiwan., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors are the standard first-line treatment for patients with advanced and recurrent EGFR-positive non-small cell lung cancer., Objective: The main objective of the present study was to compare the clinical efficacies between osimertinib and afatinib as first-line treatment in patients with EGFR-mutant non-small cell lung cancer., Methods: We retrospectively analyzed patients with advanced and recurrent non-small cell lung cancer who harbored an exon 19 deletion or an exon 21 L858R mutation and were being given either osimertinib or afatinib as first-line treatment from January 2018 to December 2020., Results: A total of 128 patients were selected for this study. The osimertinib group included 47 patients, while 81 patients received afatinib. The median follow-up time was 20.1 months in the osimertinib group and 22.7 months in the afatinib group. The median progression-free survival was 18.8 months and 13.1 months in the osimertinib and afatinib groups, respectively (hazard ratio 0.75 [95% confidence interval 0.48-1.18]). The median overall survival was not reached in the osimertinib group and was 41.7 months in the afatinib group (hazard ratio 0.79 [95% confidence interval 0.36-1.72]). In patients without brain metastasis, the median progression-free survival was 17.9 months and 17.2 months in the osimertinib and afatinib groups, respectively (hazard ratio 1.02 [95% confidence interval 0.56-1.85]). In patients with brain metastasis at baseline, the median progression-free survival was 22.1 months in the osimertinib group, and 10.9 months in the afatinib group (adjusted hazard ratio 0.45 [95% confidence interval 0.21-0.96])., Conclusions: Our research demonstrates that there was no strong evidence showing that patients taking osimertinib as first-line treatment experienced longer median progression-free survival and overall survival than patients treated with afatinib. However, there was a statistical significance revealing that osimertinib provided better median progression-free survival than afatinib in patients with brain metastasis at baseline., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Abstract: Primary Sjören's syndrome (pSS) is an autoimmune disease characterized by the inflammatory infiltrate and progressive dysfunction of salivary glands. Dental amalgam with mercury has been raised the public concerns regarding its purported mercury toxicity from dental amalgam to possible systemic inflammatory and immune reactions.In this study, a nationwide population-based database was employed to investigate the association of amalgam filling (AMF) and the risk of pSS. A retrospective case-control study was sourced from the Taiwanese National Health Insurance Research Database (NHIRD) from 2000 to 2013. Case and control groups were matched by sex, age, urbanization level, monthly income, and comorbidities using the propensity score method with a 1:1 ratio. In this study, 5848 cases and 5848 controls were included.The results demonstrated no statistically significant differences between AMF and pSS (odds ratio [OR]: 0.974, 95% confidence interval [CI] = 0.904-1.049). In addition, pSS was also not associated with AMF for women (OR: 0.743, 95% CI = 0.552-1.000) and men (OR: 1.006, 95% CI = 0.670-1.509), respectively.Taken together, evidence demonstrated that the association of AMF and pSS was inconsistent from this robust register databank., Competing Interests: The authors have no conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

We previously identified 10 lung adenocarcinoma susceptibility loci in a genome-wide association study (GWAS) conducted in the Female Lung Cancer Consortium in Asia (FLCCA), the largest genomic study of lung cancer among never-smoking women to date. Furthermore, household coal use for cooking and heating has been linked to lung cancer in Asia, especially in Xuanwei, China. We investigated the potential interaction between genetic susceptibility and coal use in FLCCA. We analyzed GWAS-data from Taiwan, Shanghai, and Shenyang (1472 cases; 1497 controls), as well as a separate study conducted in Xuanwei (152 cases; 522 controls) for additional analyses. We summarized genetic susceptibility using a polygenic risk score (PRS), which was the weighted sum of the risk-alleles from the 10 previously identified loci. We estimated associations between a PRS, coal use (ever/never), and lung adenocarcinoma with multivariable logistic regression models, and evaluated potential gene-environment interactions using likelihood ratio tests. There was a strong association between continuous PRS and lung adenocarcinoma among never coal users (Odds Ratio (OR) = 1.69 (95% Confidence Interval (CI) = 1.53, 1.87), p=1 × 10 - 26 ). This effect was attenuated among ever coal users (OR = 1.24 (95% CI: 1.03, 1.50), p = 0.02, p-interaction = 6 × 10 -3 ). We observed similar attenuation among coal users from Xuanwei. Our study provides evidence that genetic susceptibility to lung adenocarcinoma among never-smoking Asian women is weaker among coal users. These results suggest that lung cancer pathogenesis may differ, at least partially, depending on exposure to coal combustion products. Notably, these novel findings are among the few instances of sub-multiplicative gene-environment interactions in the cancer literature., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Multiple sclerosis (MS) is an inflammatory neurological disease characterized by autoimmune-mediated demyelination of the central nervous system. Genetic and environmental factors may contribute to the development of MS. This has not been confirmed yet. Dental amalgam has long been controversial in MS due to its mercury content but the toxicological implications of mercury-containing amalgam fillings (AMF) for MS remain to be elucidated. We conducted a case-control study to investigate the association between AMF and the risk of MS from the Taiwanese National Health Insurance Research Database (NHIRD). Case ( n = 612) and control ( n = 612) groups were matched by sex, age, urbanization level, monthly income, and Charlson comorbidity index by propensity score matched with a 1:1 ratio from 2000 to 2013. Differences between cases and controls was not statistically significant (OR: 0.82, 95% CI = 0.65-1.05). In subjects stratified by gender, MS was also not associated with AMF for women (OR: 0.743, 95% CI = 0.552-1.000) and men (OR: 1.006, 95% CI = 0.670-1.509), respectively. In summary, this Taiwanese nationwide population-based case-control study did not find an association between MS and AMF.

Background: Our aim was to explore the concepts of health and well-being from the point of view of the people experiencing them. Most of the efforts to understand these concepts have focused on disease prevention and treatment. Less is known about how individuals achieve health and well-being, and their roles in the pursuit of a good life. We hoped to identify important components of these concepts that may provide new targets and messages to strengthen existing public health programs. An improved understanding of health and well-being - or what it means to be well - can guide interventions that help people lead healthier, more fulfilling lives., Methods: Using a grounded qualitative approach drawing from narrative inquiry, we interviewed 24 Taiwanese adults. Thematic inductive coding was employed to explore the nature of health and well-being., Results: Eight constituent domains emerged regarding well-being and health. While the same domains were found for both constructs, important frequency differences were found when participants discussed health versus well-being. Physical health and lifestyle behaviors emerged as key domains for health. Disease-related comments were the most frequently mentioned sub-category within the physical health domain, along with health care use and aging-related changes. For well-being, family and finances emerged as key domains. Family appears to be a cornerstone element of well-being in this sample, with participants often describing their personal well-being as closely tied to - and often indistinguishable from - their family. Other domains included work-life, sense of self, resilience, and religion/spirituality., Conclusions: Health and well-being are complex and multifaceted constructs, with participants discussing their constituent domains in a very interconnected manner. Programs and policies intended to promote health and well-being may benefit from considering these domains as culturally-appropriate leverage points to bring about change. Additionally, while the domains identified in this study are person-centered (i.e., reflecting the personal experiences of participants), the stories that participants offered provided insights into how well-being and health are influenced by structural, societal and cultural factors. Our findings also offer an opportunity for future refinement and rethinking of existing measurement tools surrounding these constructs.

Essential tremor (ET) is a common neurological disorder and the most common movement disorder. Low-level occupational exposure to mercury vapor is known to be a crucial factor that increases the risk of tremor. Dental amalgam is one of the main sources of mercury in those who possess amalgam restorations. However, the relationship between ET and amalgam filling (AMF) is not quite clear. The purpose of this study was to investigate the association between AMF and the risk of ET using a population-based administrative databank. The data for this study were sourced from the Taiwanese National Health Insurance Research Database (NHIRD). A retrospective case-control study was conducted using this databank from 2000 to 2013. Case and control groups were matched by sex, age, urbanization level, monthly income, and Charlson comorbidity index using the propensity score method with a 1:1 ratio. In this study, 3008 cases and 3008 controls were included. The results from this nationwide population-based case-control study did not indicate any association between ET and AMF in Taiwan. Although the results were not significantly statistical, the findings may be worthy to be valued.

Introduction: For never-smokers (smoked <100 lifetime cigarettes), lung cancer (LC) has emerged as an important issue. We aimed to investigate the effects of prevalence changes in tobacco smoking and particulate matter (PM) 2.5 (PM 2.5 ) levels on LC in Taiwan, in relation to contrasting PM 2.5 levels, between Northern Taiwan (NT) and Southern Taiwan (ST)., Methods: We reviewed 371,084 patients with LC to assess smoking prevalence and correlations between the incidence of adenocarcinoma lung cancer (AdLC) and non-AdLC. Two subsets were selected to assess different AdLC stage trends and the effect of PM 2.5 on survival of patients with AdLC., Results: From 1995 to 2015, the proportion of male adult ever-smokers decreased from 59.4% to 29.9% whereas the female smoking rate remained low (3.2% to 5.3%). AdLC incidence in males and females increased from 9.06 to 23.25 and 7.05 to 24.22 per 100,000 population, respectively. Since 1993, atmospheric visibility in NT improved (from 7.6 to 11.5 km), but deteriorated in ST (from 16.3 to 4.2 km). The annual percent change in AdLC stages IB to IV was 0.3% since 2009 (95% confidence interval [CI]: -1.9%-2.6%) in NT, and 4.6% since 2007 (95% CI: 3.3%-5.8%) in ST; 53% patients with LC had never smoked. Five-year survival rates for never-smokers, those with EGFR wild-type genes, and female patients with AdLC were 12.6% in NT and 4.5% in ST (hazard ratio: 0.79, 95% CI: 0.70-0.90)., Conclusions: In Taiwan, greater than 50% of patients with LC had never smoked. PM 2.5 level changes can affect AdLC incidence and patient survival., (Copyright © 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)

Recent evidence from several relatively small nested case-control studies in prospective cohorts shows an association between longer telomere length measured phenotypically in peripheral white blood cell (WBC) DNA and increased lung cancer risk. We sought to further explore this relationship by examining a panel of seven telomere-length associated genetic variants in a large study of 5,457 never-smoking female Asian lung cancer cases and 4,493 never-smoking female Asian controls using data from a previously reported genome-wide association study. Using a group of 1,536 individuals with phenotypically measured telomere length in WBCs in the prospective Shanghai Women's Health study, we demonstrated the utility of a genetic risk score (GRS) of seven telomere-length associated variants to predict telomere length in an Asian population. We then found that GRSs used as instrumental variables to predict longer telomere length were associated with increased lung cancer risk (OR = 1.51 (95% CI = 1.34-1.69) for upper vs. lower quartile of the weighted GRS, p value = 4.54 × 10(-14) ) even after removing rs2736100 (p value = 4.81 × 10(-3) ), a SNP in the TERT locus robustly associated with lung cancer risk in prior association studies. Stratified analyses suggested the effect of the telomere-associated GRS is strongest among younger individuals. We found no difference in GRS effect between adenocarcinoma and squamous cell subtypes. Our results indicate that a genetic background that favors longer telomere length may increase lung cancer risk, which is consistent with earlier prospective studies relating longer telomere length with increased lung cancer risk., (Published 2014. This article is a US Government work and, as such, is in the public domain of the United States of America.)

Purpose: Adenocarcinoma is the most dominant type of lung cancer in never-smoker patients. The risk alleles from genome-wide association studies have small odds ratios and unclear biologic roles. Here we have taken an approach featuring suitable medical actionability to identify alleles with low population frequency but high disease-causing potential., Patients and Methods: Whole-genome sequencing was performed for a family with an unusually high density of lung adenocarcinoma with available DNA from the affected mother, four affected daughters, and one nonaffected son. Candidate risk alleles were confirmed by matrix-assisted laser desorption ionization time of flight mass spectroscopy. Validation was conducted in an external cohort of 1,135 participants without cancer and 1,312 patients with lung adenocarcinoma. Family follow-ups were performed by genotyping the relatives of the original proband and the relatives of the identified risk-allele carriers. Low-dose computed tomography scans of the chest were evaluated for lung abnormalities., Results: YAP1 R331W missense mutation from the original family was identified and validated in the external controls and the cohort with lung adenocarcinoma. The YAP1 mutant-allele carrier frequency was 1.1% in patients with lung adenocarcinoma compared with 0.18% in controls (P = .0095), yielding an odds ratio (adjusted for age, sex, and smoking status) of 5.9. Among the relatives, YAP1-mutant carriers have overwhelmingly higher frequencies of developing lung adenocarcinoma or ground-glass opacity lung lesions than those who do not carry the mutation (10:0 v 1:7; P < .001). YAP1 mutation was shown to increase the colony formation ability and invasion potential of lung cancer cells., Conclusion: These results implicated YAP1 R331W as an allele predisposed for lung adenocarcinoma with high familial penetrance. Low-dose computed tomography scans may be recommended to this subpopulation, which is at high risk for lung cancer, for personalized prevention and health management., (© 2015 by American Society of Clinical Oncology.)

Background: Epidermal growth factor receptor (EGFR) mutation status in lung cancer can effectively predict EGFR-tyrosine kinase inhibitor (TKI) efficacy. We evaluated the role of dynamic plasma cell-free DNA EGFR mutation status in outcome prediction., Methods: Advanced lung adenocarcinoma patients were enrolled and prospectively observed for outcomes of EGFR-TKI treatment. Peptide nucleic acid-zip nucleic acid polymerase chain reaction clamp method was developed to assess EGFR mutations in matched tumor and serial plasma cell-free DNA specimens., Results: A total of 72 patients were enrolled in this study, of which 62 patients (86.1%) had EGFR-mutant tumors (34 patients with exon 19 deletions, and 28 patients with L858R). Pretreatment plasma used for EGFR mutation testing showed a sensitivity of 59.7% and a specificity of 100%. Detection sensitivity was significantly higher in stage IV-M1b patients compared with stage IIIb and IV-M1a patients (78.0% versus 23.8%, p < 0.001). All patients who presented with EGFR-mutant tumors received first-line EGFR-TKI therapy. The objective response rate and disease control rate were 74.2% and 82.3%, respectively. Median progression-free survival and overall survival were 8.8 months (95% CI: 6.6-11.0) and 20.5 months (95% CI 15.1-26.0), respectively. Failure to clear plasma EGFR mutations after EGFR-TKI treatment was an independent predictor of lower disease control rate (odds ratio 5.26 [95% CI: 1.13-24.44]; p = 0.034), shorter progression-free survival (hazard ratio: 1.97 [95% CI: 1.33-2.91]; p = 0.001), and shorter overall survival (hazard ratio: 1.82 [95% CI: 1.04-3.18], p = 0.036)., Conclusion: Changes in plasma EGFR mutation status can be successfully assessed using the peptide nucleic acid-zip nucleic acid polymerase chain reaction clamp method and can serve as an independent outcome predictor.

Introduction: Falls are common among older people. Previous studies have shown that falls were multifactorial. However, data regarding community-dwelling Chinese population are minimal. We aimed to study factors associated with falls among community-dwelling older Chinese people., Materials and Methods: We conducted a cross-sectional study in a community hospital in Taiwan in 2010. Our sample included 671 elders from the 3680 examinees of the free annual Senior Citizens Health Examination. Participants were interviewed with a detailed questionnaire, and 317 elders were further invited for serum vitamin D tests. The main outcome was falls in the previous 12 months. Predictor variables included sociodemographic characteristics, lifestyle risk factors, body stature, frailty, serum 25 (OH) D levels, and medications., Results: The mean age of the 671 participants was 75.7 ± 6.4 years old, and 48.7% of which were female. Fallers comprised 21.0% of the study population. In multivariate models, female gender (adjusted odds ratio (aOR): 2.32), loss of height in adulthood (aOR: 1.52), low body weight (aOR: 2.69), central obesity (aOR: 1.67), frailty (aOR: 1.56), polypharmacy (aOR: 2.18) and hyperglycaemia (aOR: 1.56) were factors associated with falls. Vitamin D insufficiency (serum 25 (OH) D levels <30 ng/mL) was not associated with falls (OR: 0.78; 95% CI, 0.38 to 1.60) (n = 317) in this study., Conclusion: Among community-dwelling older people in Taiwan, falls were mainly associated with female gender, polypharmacy, frailty, reduced body height, low body weight or central obesity, and hyperglycaemia. In addition to other risk factors, body stature should be considered as a novel risk factor when screening elders at risk for falls.