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Previous studies on spoken word production have shown that native English speakers used phoneme-sized units (e.g., a word-initial phoneme, C) to produce English words, and native Mandarin Chinese speakers employed syllable-sized units (e.g., a word-initial consonant and vowel, CV) as phonological encoding units in Chinese. With spoken word production, although spoken word recognition is a fundamental language skill of human beings, it is unknown whether a Chinese-English bilingual listener can adjust the phonological unit sizes depending on the language used. Using four mouse-tracking spoken word recognition experiments, participants listened to spoken words (either presented in English or Chinese) while viewing a display of two written words. In Experiment 1, Chinese-English bilinguals experienced a larger phonological competition in the CV condition than the control condition, indicating that they recruited syllables when listening to Chinese monosyllabic words. Experiment 2 extended the results of Experiment 1 with a set of Chinese disyllabic words and further revealed the temporal distribution of syllable overlap of a spoken word constrains phonological competition. In Experiment 3, Chinese-English bilinguals exhibited a greater phonological competition in both CV and C conditions that mirrored those reported with English monolinguals in Experiment 4. Our results across experiments demonstrated that Chinese-English bilinguals employed both phonemes and syllables to recognize English spoken words but exclusively relied on syllables to recognize Chinese words, suggesting that there is flexibility in selecting phonological units when recognizing spoken words in the two languages. Implications for models of monolingual and bilingual spoken recognition are also discussed.

Remote association requires players to use their mental transformation to identify objects' relationships by activating knowledge application. A Chinese Remote Association game was designed (example question: [characters omitted], where the answer is [character omitted]) to explore learners' cognitive and affective effects, and then eighth grade students were invited to play using their smartphones. Data were collected for confirmatory factor analysis with structural equation modeling. The results revealed that intrinsic cognitive load was negatively related to flow experience, while gameplay interest was positively related to flow experience, and flow experience was positively related to performance progress in Chinese association. The implication of this study is that using remote Chinese association as an application game can enhance players' flow experience and performance.

Background: Older patients with cardiovascular disease (CVD) are highly susceptible to adverse drug reactions due to age-related physiological changes and the presence of multiple comorbidities, polypharmacy, and potentially inappropriate medications (PIMs). Objective: This study aimed to develop a predictive model to identify the use of PIMs in older patients with CVD. Methods: Data from 2012 to 2021 from the Changhua Christian Hospital Clinical Research Database (CCHRD) and the Kaohsiung Medical University Hospital Research Database (KMUHRD) were analyzed. Participants over the age of 65 years with CVD diagnoses were included. The CCHRD data were randomly divided into a training set (80% of the database) and an internal validation set (20% of the database), while the KMUHRD data served as an external validation set. The training set was used to construct the prediction models, and both validation sets were used to validate the proposed models. Results: A total of 48,569 patients were included. Comprehensive data analysis revealed significant associations between the use of PIMs and clinical factors such as total cholesterol, glycated hemoglobin (HbA1c), creatinine, and uric acid levels, as well as the presence of diabetes, hypertension, and cerebrovascular accidents. The predictive models demonstrated moderate power, indicating the importance of these factors in assessing the risk of PIMs. Conclusions: This study developed predictive models that improve understanding of the use of PIMs in older patients with CVD. These models may assist clinicians in making informed decisions regarding medication safety. [ABSTRACT FROM AUTHOR]

Knowledge building is an innovative pedagogy aiming to transform students into expert-like knowledge workers. The purpose of this study was to foster teacher-education students' design performance (i.e., observation, synthesis, ideation and prototypes) in a knowledge-building environment. The participants were 38 college students from a Taiwanese university. They were randomly assigned to eight groups. Each group used the Knowledge Forum--a computer-supported collaborative knowledge-building environment--to develop and discuss the design products of their choice. Data analysis focused on the groups' online knowledge-building activities, online design thinking processes, and the relationship between them. In general, knowledge-building activities facilitated students' design thinking. Specifically, we considered the extent to which student groups' sustained online engagement and increased knowledge had a major impact on their design performance. Ways of applying knowledge-building principles to foster effective design processes are discussed.

Effective energy education depends on continuing research designed to identify instructional strategies that will proof effective in particular learning contexts. The aim of this study was to help Taiwanese students learn about energy-saving related concepts through idea-centered, collaborative knowledge-building activities carried out in an online environment. The participants were 34 fifth-grade Taiwanese students. The data were taken mainly from students' online interaction logs and discourse content. We found that knowledge-building activities helped to transform students into more collaborative, autonomous and creative learners, capable of working innovatively with ideas to address the energy-related issues under discussion. The students also demonstrated deeper understanding of the energy-related topics they explored. This study suggests that knowledge-building, an innovative pedagogical approach, was conducive to collaborative learning even in young students.

Background: An impaired ocular surface presents substantial challenges in terms of planning for cataract surgery. As a multifactorial ocular disorder, dry eye disease (DED) is common in the general population and prevalent in patients scheduled for lens replacement surgery. Cataract surgery can exacerbate DED and worsen several ocular parameters. Timely diagnosis and appropriate treatment of DED are vital to ensuring positive ophthalmic surgical outcomes. This consensus report of the Taiwan Society of Cataract and Refractive Surgeons (TSCRS) regarding the management of DED before, during, and after cataract surgery highlights the gaps between clinical guidelines and several aspects of DED, including diagnostic testing, diagnostic criteria, and clinical practice treatment. Methods: An expert panel of five specialists in the field of ophthalmology was recruited to develop consensus statements regarding the management of DED in both the general population and in patients undergoing cataract surgery in Taiwan. Two separate meetings of the five specialists, who were endorsed by the TSCRS, were convened for this purpose. A survey questionnaire consisting of binary or multiple-choice questions was developed through a consensus-driven formulation process. A percentage value was calculated for each statement, and a minimum of 60% agreement (equivalent to three out of five members) was required to achieve consensus. The second discussion meeting involved the presentation of the finalized consensus statements and concluded the consensus development process. Lastly, the finalized consensus statements were approved by all the experts, and the formulated recommendations for DED in the general population and prospective cataract surgery patients were accordingly presented. Results: The optimal algorithm for managing DED in the general population and in patients scheduled for cataract surgery was developed to address the unmet needs of this cohort in Taiwan. Conclusion: This report provides recommendations for managing dry eye disease. It is essential to screen and confirm DED through endorsed questionnaires and tests and then diagnose it. Treatment and management of DED should follow a stepwise approach. Screening and diagnosing DED is also recommended before cataract surgery. After cataract surgery, relatively aggressive treatment strategies are recommended to manage DED effectively. [ABSTRACT FROM AUTHOR]

Our study aims to compare the efficacy of oral antidiabetic therapy to early insulinization on glycemic control among newly diagnosed type 2 diabetes patients in real-world clinical practice. A retrospective cohort study conducted at a medical center in Taiwan analyzed 1256 eligible patients from January 2007 to December 2017. Propensity score matching resulted in well-balanced groups of 94 patients each in the oral antidiabetic drug (OAD) and early insulinization cohorts. Glycemic outcomes were assessed in both groups. Patients exclusively using OAD showed consistently lower glycated hemoglobin (HbA1c) levels at 3, 12, 24, and 36 months compared to insulin users. At later periods, 77.7% of OAD users achieved glycemic control versus 64.9% of insulin users, with a marginally significant difference. Subgroup analyses suggested a trend favoring well-controlled diabetes in the OAD group, though not statistically significant. Our study finds oral antidiabetic therapy is not inferior to early insulinization for glycemic control in newly diagnosed type 2 diabetes patients, irrespective of initial HbA1c levels. This supports oral therapy as a rational treatment option, even in cases with elevated HbA1c at diagnosis. [ABSTRACT FROM AUTHOR]

Parrot bornavirus (PaBV) is an infectious disease linked with proventricular dilatation disease (PDD) with severe digestive and neurological symptoms affecting psittacine birds. Despite its detection in 2008, PaBV prevalence in Taiwan remains unexplored. Taiwan is one of the leading psittacine bird breeders; hence, understanding the distribution of PaBV aids preventive measures in controlling spread, early disease recognition, epidemiology, and transmission dynamics. Here, we aimed to detect the prevalence rate of PaBV and assess its genetic variation in Taiwan. Among 124 psittacine birds tested, fifty-seven were PaBV-positive, a prevalence rate of 45.97%. Most of the PaBV infections were adult psittacine birds, with five birds surviving the infection, resulting in a low survival rate (8.77%). A year of parrot bornavirus surveillance presented a seasonal pattern, with peak PaBV infection rates occurring in the spring season (68%) and the least in the summer season (25%), indicating the occurrence of PaBV infections linked to seasonal factors. Histopathology reveals severe meningoencephalitis in the cerebellum and dilated cardiomyopathy of the heart in psittacine birds who suffered from PDD. Three brain samples underwent X/P gene sequencing, revealing PaBV-2 and PaBV-4 viral genotypes through phylogenetic analyses. This underscores the necessity for ongoing PaBV surveillance and further investigation into its pathophysiology and transmission routes. [ABSTRACT FROM AUTHOR]

Since 2018, Taiwan has included the human papillomavirus (HPV) vaccination into its national immunization program for junior high school girls. However, the reports of side effects following vaccination have increased parental concerns. This study investigated parental intentions regarding the HPV vaccination for their daughters and related factors in Taiwan. A total of 213 parents of girls aged between 12 and 15 years participated in an online survey. The survey collected data on various factors, including the parental intention to vaccinate their daughters against HPV; the motivation behind the vaccinations, as measured using the Motors of Human Papillomavirus Vaccination Acceptance Scale; an understanding of the reasons behind the government's promotion of HPV vaccinations; concerns regarding the side effects of vaccinations for their daughters; an awareness of the reported side effects of HPV vaccines experienced by some individuals; the exposure to information on HPV vaccines from social media; and mental health status, measured using the Brief Symptom Rating Scale. The associations between these variables and the parental intention to vaccinate their daughters against HPV were examined using a multivariable linear regression analysis model. The findings revealed a moderate to high level of intention among participants to vaccinate their daughters against HPV. Parents who perceived a greater value in HPV vaccination for their daughters' health (B = 0.524, standard error [se] = 0.039, p < 0.001) and had greater autonomy in decision-making regarding vaccination (B = 0.086, se = 0.038, p = 0.026) exhibited a higher intention to vaccinate their daughters against HPV. Conversely, parents who expressed greater concern regarding the side effects of HPV vaccines for their daughters had a lower intention to vaccinate (B = −0.762, se = 0.203, p < 0.001). Based on these findings, this study recommends integrating these factors into the design of intervention programs aimed at enhancing parental intentions to vaccinate their daughters against HPV. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between gifted students' academic self-concept (ASC) and academic achievement (AC) in earth science with internationally representative high-school students from the third International Earth Science Olympiad (IESO) held in Taiwan in 2009. The results of regression analysis indicated that IESO students' ASC was significantly correlated with their AC (R[superscript 2] = 0.53, p<0.01) with large effect size, even when compared to other Asian countries such as Korea and Japan. It was found that Taiwan's students had the lowest ASC and exhibited poor interaction with other IESO students. The unique pattern of Taiwanese students exhibited through the 3rd IESO leads to the conclusion that: For the top notch gifted students, their social and psychological character such as their popularity and interaction skills, have much strongly effect on their ASC than cultural factors.

Students of Southeast Asian Heritage Learning Chinese (SSAHLC) in Taiwan have frequently demonstrated difficulty with traditional Chinese (a graphical character) radical recognition due to their limited exposure to the written language form since childhood. In this study, we designed a Chinese radical learning game (CRLG), which adopted a drill and practice mode, for SSAHLC to practice recognizing Chinese radicals. To facilitate Chinese writing, non-native learners need to use aspects of the radical knowledge as cues to encode characters, from which the contents of the game were built up for SSAHLC to master the Chinese written forms by playing the CRLG with gesture-based interactions. In addition, the game was used to explore the students' intrinsic motivation relevant to online learning self-efficacy, as well as the experience of flow, to predict the degree of learning progress. Data were collected from 78 SSAHLC participating in the study, and 73 valid questionnaires were returned. After applying confirmatory factor analysis as well as structural equation modeling to the valid data, it was found that four constructs, namely intrinsic motivation, online learning self-efficacy, flow experience, and learning progress, were all positively correlated. Our results indicated that intrinsic motivation of Chinese learning predicted online learning self-efficacy, and that flow experience was relevant to the students' learning progress. Moreover, the degree of learning progress could be predicted by the mediating factors. These findings imply that heritage language teachers may utilize the CRLG to enhance learners' Chinese radical recognition ability, and eventually improve their Chinese character recognition ability.

There are no salient word spaces in Mandarin Chinese. Thus, it is unclear whether word spacing information differentially affects the reading speed of children with and without reading difficulties (RD). In the present study, native Chinese-speaking children of differential reading abilities were tested with Chinese text in un-spaced versus spaced versions at different time points during training. The results indicated that spaced texts slow down reading speeds in children without RD. In contrast, spaced texts improved reading speeds in children with reading difficulties after some training took place. These findings suggest that the effect of word spacing information on Chinese reading might vary as a function of individual differences in reading abilities. We argue that children with RD can accommodate to the spaced text better than children without RD and that they can take advantage of using bottom-up spacing information to segment and recognize words in text.

Background: Taiwan has a substantial number of veterans, but knowledge regarding their emergency department (ED) visits during the coronavirus disease 2019 (COVID-19) pandemic remains limited. This study examined the characteristics of veterans' ED visits during Taiwan's COVID-19 epidemic. Methods: This was a cross-sectional study conducted at the ED of a large veteran medical center located in Taipei, Taiwan, from May 2018 to October 2021. We analyzed the numbers and features of visits in summer and autumn according to the first wave of the COVID-19 epidemic in Taiwan in 2021. Results: Medical institutions were positively associated with veteran status. Emergency department complaints of trauma (adjusted odds ratio [AOR] = 1.15, 95% CI: 1.06-1.25; summer P < .01) and chest pain/tightness (AOR = 1.65, 95% CI: 1.45-1.87; summer P < .01; AOR = 1.4, 95% CI: 1.26-1.55; P < .01) were associated with increased odds of being a veteran. Triage levels above 2 were positively associated with veteran status in the autumn model (AOR = 1.14, 95% CI: 1.07-1.22; P < .01). Patients hospitalized after ED visits were associated with reduced odds of veteran status (P < .01). Those who spent a long time in the ED were more likely to be veterans than those who spent a shorter time in the ED (P < .01). Veterans were less likely to visit the ED regardless of the time frame of the study period (P < .01), except during the COVID-19 outbreak in the autumn (2019-2020). Conclusions: The distinctions in ED visits highlighted the individuality of veterans' medical needs. Our findings suggest that the veteran medical system can add to the focus on improving senior-friendly care, fall prevention, quality of life of institutionalized veterans, access for homeless veterans, and care for ambulatory care–sensitive conditions. [ABSTRACT FROM AUTHOR]

Dengue is one of the world's most rapidly spreading mosquito-borne viral diseases. As it is found mostly in urban and semi-urban areas, urbanization and associated human activities that affect the environment and larval habitats could become risk factors (e.g., lane width, conditions of street ditches) for the spread of dengue. However, there are currently no systematic studies of micro-scale urbanization-based risk factors for the spread of dengue epidemics. We describe the study area, two micro-scale environmental risk factors associated with urbanization, and meteorological data. Since the observations involve spatial and temporal correlations, we also use some statistical methods for the analysis of spatial and spatial-temporal data for the relationship between urbanization and dengue. In this study, we analyzed data from Kaohsiung, a densely populated city in southern Taiwan, and found a positive correlation between environmental risk factors associated with urbanization (ditches positive for mosquito larvae and closely packed streets termed "dengue lanes") and clustering effects in dengue cases. The statistical analysis also revealed that the occurrence of positive ditches was significantly associated with that of dengue lanes in the study area. The relationship between climate variables and positive ditches was also analyzed in this paper, indicating a relationship between dengue and both rainfall and temperature, with temperature having a greater effect. Overall, this work is immediately relevant and applicable for policymakers in government, who will need to reduce these favorable habitats for vector-born disease spreaders and implement regulations for new urban constructions to thus reduce dengue spread in future outbreaks. [ABSTRACT FROM AUTHOR]

Oral lichen planus (OLP) may contribute to the risk of chronic periodontitis, and no reports have shown whether OLP patients with periodontitis have a greater risk of oral precancerous lesions, Candida infection or other clinicopathological diseases. This study aimed to assess the risk factors for the development of oral precancerous lesions in a cohort of 293 OLP patients with or without chronic periodontitis in southern Taiwan. The current study recruited 293 OLP patients without preexisting periodontitis at a tertiary institution from 1995 to 2018. The patients were divided into two groups based on the presence or absence of periodontitis. The study compared various clinical and pathological characteristics between the two groups, and also estimated the odds ratio (OR) and the 10-year cumulative risk of chronic periodontitis in OLP patients using logistic regression models and Kaplan‒Meier analysis methods, respectively. After adjusting for age and gender, the significant contributors to oral precancerous lesions in OLP patients (P < 0.05) were periodontal disease (OR = 2.24) and the male gender (OR = 7.52). Betel nut consumption (OR = 2.61), smoking (OR = 2.46), and candidiasis infection (OR = 3.02) also showed significant associations. Older OLP patients had a lower lesion risk, while a longer OLP duration heightened the periodontal disease likelihood. The present study demonstrated that coexisting periodontal disease increases the likelihood of developing precancerous lesions in patients with OLP. Periodontal management with oral hygiene care and quitting betel nut consumption and smoking can reduce the risk. [ABSTRACT FROM AUTHOR]

Introduction: Emicizumab mimicking the cofactor function of activated factor VIII (FVIII) restores haemostasis. Methods: This nationwide observational study aimed to retrospectively investigate efficacy, safety, and cost in 1 year before and up to 3 years after emicizumab prophylaxis for haemophilia A (HA) patients with FVIII inhibitors. Results and discussion: A total of 39 severe HA patients with a median age of 23.0 years were enrolled. The median historical peak FVIII inhibitor titre was 174.2 BU/mL with an interquartile range of 56.5–578.8 BU/mL. The median annualized bleeding rate reduced from 24 to 0 events in the first year after emicizumab prophylaxis (p <.01) and sustained in the second and third years. The median annualized joint bleeding rate reduced to 0 and maintained up to 3 years (p <.01). Twenty‐seven patients (69.2%) had target joints before emicizumab prophylaxis and only seven patients (17.9%) of them had target joints after prophylaxis. Medical costs, including cost of haemostatic therapy, frequency of outpatient department visits, emergency room visits and hospital admission, were significantly reduced after emicizumab prophylaxis (p <.01). FVIII inhibitor titre decreased after emicizumab prophylaxis. Overall, three (7.7%) patients experienced 202 grade 1 drug‐related adverse events after emicizumab prophylaxis. No serious adverse events were reported during emicizumab prophylaxis period. The adherence to emicizumab prophylaxis was 100% up to 3 years. Conclusions: HA patients with FVIII inhibitors treated with emicizumab prophylaxis resulted in a significant reduction in treated bleeds and associated costs. No new safety events were observed. [ABSTRACT FROM AUTHOR]

Educational games can be viewed in two ways, "learning to play" or "playing to learn." The Chinese Idiom String Up Game was specifically designed to examine the effect of "learning to play" on the interrelatedness of players' gameplay interest, competitive anxiety, and perceived utility of pre-game learning (PUPGL). Data from 288 subjects were validated and analyzed using confirmatory factor analysis and structural equation modeling. Results indicated that players' pre-game learning attitude (PGLA) served positively to predict participants' gameplay interest and reflected a higher level of PUPGL of learning gameplay. PGLA was negatively correlated to competitive anxiety but was not significantly associated with players' PUPGL of learning gameplay. These results implied that by enhancing players' willingness to learn before engaging in a competitive game can contribute to increased gameplay interest and reduced competitive anxiety, thereby reinforcing the benefits of educational games.

In recent years information technology has been integrated into education to produce a series of trends, beginning with "electronic learning" (e-learning), through "mobile learning" (m-learning) and finally to "ubiquitous learning" (u-learning), which aims to improve learner motivation through overcoming the conventional limitations of time and location. U-learning practices are still being developed, and learners frequently experience difficulty focusing on learning objectives, and effective learning strategy tools are still lacking. This study reports the design of a context-aware astronomy learning system. The system integrates several technologies, including radio frequency identification, wireless communication networks, handheld mobile devices, and databases to help students learn astronomical concepts. Two content modules were developed in the context of natural science education for fifth-grade elementary school students in Taiwan. Indicators of user experience with the system were collected for further phenomenographic analysis, based on four perspectives of the Unified Theory of Acceptance and Use of Technology model to assess learner willingness to use this novel u-learning approach. Results show that ease-of-use and the availability of immediate operational or technical support are key factors in increasing learning motivation and performance.

Disease mapping is a research field to estimate spatial pattern of disease risks so that areas with elevated risk levels can be identified. The motivation of this article is from a study of dengue fever infection, which causes seasonal epidemics in almost every summer in Taiwan. For analysis of zero‐inflated data with spatial correlation and covariates, current methods would either cause a computational burden or miss associations between zero and non‐zero responses. In this article, we develop estimating equations for a mixture regression model that accommodates spatial dependence and zero inflation for study of disease propagation. Asymptotic properties for the proposed estimates are established. A simulation study is conducted to evaluate performance of the mixture estimating equations; and a dengue dataset from southern Taiwan is used to illustrate the proposed method. [ABSTRACT FROM AUTHOR]

Background: The number of emergency department (ED) visits has significantly declined since the COVID-19 pandemic. In Taiwan, an aged society, it is unknown whether older adults are accessing emergency care during the COVID-19 epidemic. Therefore, this study aimed to investigate the impact of COVID-19 on the ED visits and triage, admission, and intensive care unit (ICU) hospitalization of the geriatric population in a COVID-19-dedicated medical center throughout various periods of the epidemic. Methods: A retrospective chart review of ED medical records from April 9 to August 31, 2021 were conducted, and demographic information was obtained from the hospital's computer database. The period was divided into pre-, early-, peak-, late-, and post-epidemic stages. For statistical analysis, one-way analysis of variance followed by multiple comparison tests (Bonferroni correction) were used. Results: A statistically significant decrease in the total number of patients attending the ED was noted during the peak-, late-, and post-epidemic stages. In the post-epidemic stage, the number of older patients visiting ED was nearly to that of the pre-epidemic stage, indicating that older adults tend to seek care at the ED earlier than the general population. Throughout the entire epidemic period, there was no statistically significant reduction in the number of the triage 1& 2 patients seeking medical attention at the emergency department. In the entire duration of the epidemic, there was no observed reduction in the admission of elderly patients to our hospital or ICU through the ED. However, a statistically significant decrease was observed in the admission of the general population during the peak epidemic stage. Conclusions: During the peak of COVID-19 outbreak, the number of ED visits was significantly affected. However, it is noteworthy that as the epidemic was gradually controlled, the older patients resumed their ED visits earlier that the general population as indicated by the surge in their number. Additionally, in the patient group of triage 1& 2, which represents a true emergency, the number did not show a drastic change. [ABSTRACT FROM AUTHOR]

Museums in Taiwan have developed various digital archives, but few people have visited these digital archives. Therefore, this study designed a digital archaeology game for high school students to play. Based on the concept of "learning for playing" (i.e., players who want to win will study more), the digital archaeology game contest aims at attracting students to visit the natural science digital museum. In the game, researchers (players) reorient the artifacts, structures and architectures through excavation and assemblages to understand the world of natural science based on the saliency-based model. To examine whether this game prompts learners to visit the natural science digital museum to acquire knowledge, 80 students from three high schools were recruited and grouped into 40 pairs to compete against each other. After the contest, questionnaires were collected and analyzed using confirmatory factor analysis with structural equation modeling. The results indicated that the research participants' gameplay self-efficacy affected their perceived hedonic values and was mediated by the perceived ease of playing the game increased their intention to visit the digital archives of the natural science museum. The implications of this study could be used for promotion of digital archives or other digital museums. (Contains 4 tables and 4 figures.)

Categorization is one of the main mental processes by which perception and conception develop. Nevertheless, categorization receives little attention with the development of critical thinking in Taiwan elementary schools. Thus, the present study investigates the effect that individual differences have on performing categorization tasks. Same-object and Different-object identification and categorizing activities were conducted with students asked to perceive various chemical properties by comparing touch before and after washing hands with laundry soap and cosmetic soap. 135 fourth and sixth-grade elementary students from a Taipei County elementary school participated in this experiment. For the purposes of this study, students completed worksheets describing their perception and categorization activities. We then used a scoring rubric to convert data on the learning sheets into quantitated data, which we plotted on a mapping tree. The results of this study indicated that firstly, overall perception performance by female students was significantly superior to that of the male students. Secondly, students who had achieved higher scores in prior science activities displayed better overall categorization performance than those students with low prior science scores did. Teachers could apply our method to cultivate elementary student cognitive processing in science by assigning practice categorization practice to students. (Contains 2 tables.)

The contribution of genetic factors to the memory is widely acknowledged. Research suggests that these factors include genes involved in the dopaminergic pathway, as well as the genes for brain-derived neurotrophic factor (BDNF) and methylenetetrahydrofolate reductase (MTHFR). The activity of the products of these genes is affected by single nucleotide polymorphisms (SNPs) within the genes. This study investigates the association between memory and SNPs in genes involved in the dopaminergic pathway, as well as in the BDNF and MTHFR genes, in a sample of healthy individuals. The sample includes 134 Taiwanese undergraduate volunteers of similar cognitive ability. The Chinese versions of the Wechsler Memory Scale (WMS-III) and Wechsler Adult Intelligence Scale (WAIS-III) were employed. Our findings indicate that the BDNF Met66Val polymorphism and dopamine receptor D3 (DRD3) Ser9Gly polymorphism are associated significantly with long-term auditory memory. Further analysis detects no significant associations in the other polymorphisms and indices. Future replicated studies with larger sample sizes, and studies that consider different ethnic groups, are encouraged. (Contains 5 tables and 1 figure.)

Taiwan's National Health Insurance (NHI) is a widely acclaimed universal healthcare system. In the past few years, particularly following the COVID‐19 outbreak, challenges related to maintaining the NHI system have surfaced. Since 2020, NHI has faced a series of challenges, including excessive patient visits to the hospital emergency department, a lack of an effective primary care and referral system, and a high turnover rate of healthcare workers. We review major problems related to Taiwan's NHI, emphasizing input from frontline healthcare workers. We provide recommendations for potential policies addressing the concerns around NHI, for example, strengthening the role of primary care services under the NHI administration, reducing the high turnover rate of healthcare workers, and increase the premium and copayments. We hope that this policy analysis may allow policymakers and scholars to understand both the merits and critical problems related to NHI from the clinical perspective. [ABSTRACT FROM AUTHOR]

This study explored 1) whether there were any differences in the way medical students used library resources under problem-based learning (PBL) and scenario-based learning (SBL) curricula; and 2) what improvements the library could make to facilitate its use by medical students using the different curricula. Twenty medical students selected from two different medical universities in different countries were interviewed in depth. The study found that a) PBL and SBL students used the library significantly differently; b) SBL students presented a wider range of demands and behaviors in seeking information; c) more PBL students preferred using solely electronic resources to solve PBL problems; and d) more SBL students preferred using textbooks in their study and to solve the problems. It is concluded that the characteristics of the two learning approaches affect the medical students in their uses of library resources. The library staff must interact differently with students depending on the curriculum they are following. The study suggests several directions ("SHELTER") to the library and recommends it to provide service targeting students' needs after exploring the following three dimensions of the curriculum: students' perceptions of the library's collection related to the curriculum, course requirements for gathering information, and the librarian's role in the curriculum. When new reforms are initiated it is necessary for the library to undertake a comprehensive review and to gain understanding of the curriculum at the outset. (Contains 1 figure.)

Although many previous studies have begun to address the reproductive health needs of women with intellectual disabilities; however, the supportive behaviors of caregivers to assist their reproductive health is not well understood. Data from a cross-sectional survey of ""2009 National Survey on Reproductive Health Care Needs and Health Education Strategies for Women with Intellectual Disabilities in Taiwan"" were analyzed. Study sample consisted of 1152 caregivers who working in 32 disability institutions have been analyzed in the study. The results showed that the caregiver did not have adequate supportive behaviors towards reproductive health care for women with ID (mean score was 29.84 out of 60), particularly in the arrangement of preventive reproductive health services. We analyzed the potential significant variables in a multiple linear regression model to examine the factors which affect the caregiver's supportive behaviors of reproductive health for women with ID. The model revealed that the factor of respondent's gender, job category, working years in disability setting, helping experience of reproductive health for women with ID, perception of reproductive health knowledge, in-job training of reproductive health, perceived adequacy of public reproductive health service for the client, scores of reproductive health knowledge and reproductive health attitude were significantly correlated to their supportive behavioral score of reproductive health for women with ID. These factors can explain 23.6% of the variation of supportive behavioral score. The present study suggests the reproductive health interventions need to take into account the perspectives of health workers, caregivers and women, as well as the constraints they face in providing and receiving services, respectively. (Contains 5 tables.)

Although longevity among older adults with intellectual disabilities is increasing, there is limited information on their premature aging related health characteristics and how it may change with increasing age. The present paper provides information of the institutional manager's perception on early onset aging and service preparation for this population. We used purposive sampling to recruit 54 institutional managers who care for people with intellectual disabilities in Taiwan. The present study employed a cross-sectional design using a self-administrative structured questionnaire that was completed by the respondents in November 2009. The results showed that more than 90% of the respondents agreed with earlier onset aging characteristics of people with ID. However, nearly all of the respondents expressed that the government policies were inadequate and the institution is not capable of caring for aging people with ID, and more than half of them did not satisfy to their provisional care for this group of people. With regard to the service priority of government aging policy for people with ID, the respondent expressed that medical care, financial support, daily living care were the main areas in the future policy development for them. The factors of institutional type, expressed adequacy of government's service, respondent's job position, age, and working years in disability service were variables that can significantly predict the positive perceptions toward future governmental aging services for people with ID (adjusted R[squared]=0.563). We suggest that the future study strategy should underpin the aging characteristics of people with intellectual disabilities and its differences with general population to provide the useful information for the institutional caregivers. (Contains 7 tables.)

Nationwide data were collected concerning inpatient care use and medical expenditure of people with disabilities (N = 937,944) among national health insurance beneficiaries in Taiwan. Data included gender, age, hospitalization frequency and expenditure, healthcare setting and service department, discharge diagnose disease according to the ICD-9-CM coding system which has been used in Taiwan NHI diagnosis system. There were 27.88% of persons with disabilities have been hospitalized for treatments during the year 2005 and it was 3.5 times of the general population (7.95%). The mean of annual inpatient care expenditure was 163,544.21 NTD, and male patients use more inpatient care cost than female patients in people with disabilities. However, the hospitalization rate in female patients is statistical higher than male patients in the study (p less than 0.001). Infectious and parasitic diseases, mental disorders, diseases of the respiratory system, diseases of the circulatory system, injury and poisoning were the top five reasons for hospitalization among the subjects. Our study also found that psychiatry, internal medicine, orthopedic, surgery and neurosurgery are the top five clinical divisions which the cases used more frequently than other clinical departments in hospitalizations. The present study presents the first information of hospitalization care and medical costs in people with disabilities based on a nationwide data analyzes in Taiwan. We suggest the importance of supporting people with disabilities during hospitalizations, following up rehabilitation and there is an urgent need for cost-effective intervention programs for disability prevention, which could be offset against the cost for treating the disabled in the future. (Contains 4 figures and 7 tables.)

There is little information of hepatitis B vaccination coverage for people with intellectual disabilities (ID). The present paper aims to examine the completed hepatitis B vaccination coverage rate and its determinants of children and adolescents with ID in Taiwan. A cross-sectional questionnaire survey, with the entire response participants was composed of 495 primary caregivers of children and adolescents with ID (age 3-24 years) who studying in 3 special education schools in Taiwan. The results showed that coverage rate of completed hepatitis B vaccination was 74.34% in children and adolescents with ID. Although hepatitis B vaccination is a universal health policy in Taiwan, the uncompleted coverage rate of our study subjects was 2 times of the Taiwan general population at the same age. In the logistic regression analysis of hepatitis B vaccination coverage, we found that the factors of household income and ID individual's age were variables that can significantly predict they did not accept a completed vaccination. The present study suggests that parents and providers should routinely review immunizations of children and adolescents with ID. (Contains 7 tables.)

This study aims to establish evidence-based data to explore the perceptions and experience of primary care physicians in the Pap smear screening provision for women with intellectual disabilities (ID), and to analyze the associated factors in the delivery of screening services to women with ID in Taiwan. Data obtained by a cross-sectional survey by a structured, self-administered questionnaire (12 perceptional issues), and were posted to all primary care settings (N = 168) which provided Pap smear tests for women with ID in Taichung and I-Lan counties in Taiwan, Republic of China during the period of 2009. The vital primary care physician of each healthcare setting was the main respondent of the questionnaire. Finally, there were 69 valid questionnaires returned, giving a response rate of 41.7%. The main findings showed that 72.5% medical care settings provide Pap smear services and 51.5% have practical experience on conducting the tests for women with ID. Among the respondents, nearly 90% primary care physicians expressed that women with ID need Pap smear test regularly. With regard to the associated factors in the delivery of Pap smear screening services to women with ID. The study found that experienced healthcare settings in Pap smear tests for women with ID were more likely to be in public healthcare settings, felt confident in providing screening tests, having a rapid screening program and having a reminding follow-up system. Those respondents felt necessity in Pap smear test for women with ID were more likely to express it is needed to set up a special screening clinic for this group of women. The present study suggests that women with ID need thoughtful, well-coordinated care from primary care physicians, to increase access to health care providers may be helpful in improving Pap screening tests for this population. (Contains 3 tables.)

The present paper aims to assess the hypertension, hyperglycemia and hyperlipidemia prevalence of adolescents with intellectual disabilities, and to recognize the health disparities between the study participants and the general population. This study conducted a cross-sectional medical chart analysis of 856 students who participated in school enrollment health examinations in three special schools in Taiwan from 2005 to 2007. We found there were 11.7% cases had hypertension. The biochemical analyses results showed that the elevated or abnormal rates of each exam were the following: triglyceride (9.1%), total cholesterol (1.1%), and fasting plasma glucose (0.3%). The study found the prevalence of hypertension and elevated triglyceride were significantly higher than the general population at the same age, and the body mass index had significantly correlated to hypertension and elevated triglyceride tests. Based on the study findings, many potential risks for metabolic syndrome in adolescents with intellectual disabilities were higher than the general population. The present study suggests that it is necessary to monitor and set up a follow-up health policy for students with intellectual disabilities in healthcare system. (Contains 1 figure and 4 tables.)

The present study aimed to describe the kidney function profile--serum creatinine and estimated glomerular filtration rate (eGFR), and to examine the relationships of predisposing factors to abnormal serum creatinine in people with intellectual disabilities (ID). Data were collected by a cross-sectional study of 827 aged 15-18 years adolescents with ID who participated in annual health examinations as they enrolled into special education schools in Taiwan. We used serum samples to determine participants' creatinine profiles, and the Cockcroft-Gault formula to calculate the data of eGFR to present the chronic kidney disease. The results found 22% of the participants have abnormal serum creatinine value (creatinine greater than 1.0mg/dl) and 59.6%, 36.4% and 4.0% at chronic kidney disease (CKD) stage 1, 2 and 3 cases accordingly based on the Cockcroft-Gault formula. No CKD stage 4 and 5 cases in this study. That is, there were 4% CKD cases (eGFR less than 60mL/min/1.73m[superscript 2]; CKD stage 3, 4 and 5) in adolescents with ID in this study. The results also indicated that gender and BMI could significantly predict abnormal creatinine condition in multivariate logistic regression analysis. Those boys with ID were more likely to have abnormal creatinine value than girls with ID (OR=10.13, 95% CI=5.96-17.23). In term of BMI, those underweight adolescents with ID were less likely to have high creatinine value compared to normal weight group (OR=0.45, 95% CI=0.28-0.72). In summary, this study provides the preliminary information of creatinine and estimated GFR in people with ID; we suggest the public health policy should initiate appropriate management strategies to monitor kidney function and to improve treatment outcomes of chronic kidney disease for this vulnerable population. (Contains 5 tables and 3 figures.)

The present study analyzed national data from "Domestic Violence Report System" derived primarily from the Council of Domestic Violence and Sexual Assaults Prevention, Ministry of the Interior, Taiwan, to describe the reported prevalence of domestic violence in people with disabilities and to examine the time-effect on the prevalence from years 2006 to 2009. The annual reported prevalence of domestic violence victims in people with disabilities was slightly lower than the general population. However, the reported rate changed significantly in people with disabilities over the period of 2006-2009, the victim number and rate (per ten-thousand) of reported cases in different years were 1260 (12.84), 1725 (16.90), 2163 (20.79) and 3157 (29.48). People with voice or speech disability, chronic psychosis and intellectual disability were the most domestic violence reported prevalence among the disabilities in the study. Those disabilities, such as chronic psychosis, intellectual disability, vision disability, hearing disability and multi-disabilities show increased significantly in annual reported rate in curve estimation for linear model over the period of 2006-2009. Finally, we found the average increase rate of annual reported prevalence in people of disabilities was 3.7 times of the general population (9.79% vs. 36.08%). Intellectual disability (41.52%), vision or speech disability (38.59%) and chronic psychosis (37.96%) were the most increasing disability type in average of annual reported prevalence of domestic violence among disabilities during the period of 2006-2009. The present study suggests health and welfare authorities should play vital roles in identifying and providing appropriate services for people with disabilities who encounter domestic violence. (Contains 2 figures and 3 tables.)

Physical inactivity is a global public health problem, and it has been linked to many of the most serious illnesses facing many industrialized nations. There is little evidence examining the physical activity profile and determinants for the vulnerable population such as people with intellectual disabilities (ID). The present paper aims to describe the regular physical activity prevalence and to examine its determinants among adolescents with intellectual disabilities in Taiwan. Participants were recruited from 3 special education schools in Taiwan, with the entire response participants composed of 351 primary caregivers of adolescents with ID (age 16-18 years). There were 29.9% ID individuals had regular physical activity habits, and the main physical activities were walking, sports, and jogging. There were only 8% individuals with ID met the national physical activity recommendation in Taiwan which suggests at least exercise 3 times per week and 30 min per time. In a stepwise logistic regression analysis of regular physical activity habit, we found that the factors of caregiver's educational level and preference toward physical activity were variables that can significantly predict ID individuals who had regular physical activity habit in their daily livings after controlling other factors. To maximize the positive effect of physical activity on people with ID, the present study suggests that it is needed to initiate appropriate techniques used for motivation to participate in physical activity for this population. (Contains 6 tables.)

Anemia is known to be a significant public health problem in many countries. Most of the available information is incomplete or limited to special groups such as people with intellectual disability. The present study aims to provide the information of anemia prevalence and associated risk factors of children and adolescents with intellectual disability in Taiwan. We analyzed physical examination charts of 937 children and adolescents with intellectual disability at the age of 6-18 years from three special schools. We collected information on their demographic characteristics (age and gender), disability condition (type and level), BMI (weight and height) and measured blood hemoglobin concentration (Hb). There were 11.6% of children and adolescents with intellectual disability with anemia (boy less than 13 g/dl, girl less than 12 g/dl), and the factors of gender, age, disability level and BMI are significantly correlated to anemia in bivariant analyses in the study. In the logistic regression analysis, the model revealed that the factors of gender (OR = 0.63, 95% CI = 0.41-0.95), and age (OR = 3.21, 95% CI = 1.77-5.82) were variables that could significantly predict the anemia occurrence of the participants. The study highlights the anemia prevalence in children and adolescents with ID is a mild public health problem among people with intellectual disabilities, but to prevent the problems become worst; the health authority should include providing children and adolescents with adequate nutrition and appropriate health protections during early childhood. (Contains 1 figure and 5 tables.)

The elevated serum glutamic-oxaloacetic transaminase (GOT) and glutamic-pyruvic transaminase (GPT) rate among people with intellectual disabilities (ID) is unknown and have not been sufficiently studies. The present paper aims to provide the profile of GOT and GPT, and their associated relationship with other biochemical levels of children or adolescents with ID. A cross-sectional design was conducted in three Taiwanese public special schools to analyze annual health examination chart of students with ID. There were 1041 aged 3-21 years children and adolescents with ID participated in the study. The results show elevated rate of GOT and GPT were 3.7% and 7.2%, the study indicates the elevated GPT in children and adolescents with ID is higher than the general school aged children in Taiwan. In multiple linear regression models show that the factors of BMI, HBsAg, TC and UA can significantly explain the GOT value (R[superscript 2] = 0.275). Those factors of gender, BMI, HBsAg, TC and UA can significantly explain 44.4% variation of GPT value (R[superscript 2] = 0.444). To prevent the further liver disease burden in people with ID, the study highlights that the health care professionals should assess liver functions of this group of people, and to inform their caregivers the importance of implement regular liver health check-up. (Contains 8 tables.)

The aims of the preset study were to describe the profile of serum uric acid, the prevalence of hyperuricemia and its risk factors among children and adolescents with intellectual disabilities. We conducted a cross-sectional study of 941 children and adolescents with intellectual disabilities (aged 4-18 years) who participated in annual health examinations in three special schools in Taiwan. This study indicated 30.6% boys and 17.9% girls with intellectual disabilities were with hyperuricemia in Taiwan. The factors of gender, age and BMI were variables that can significantly predict the hyperuricemia occurrence in this vulnerable population. Those children and adolescents with intellectual disabilities were boys (OR = 2.93, 95% CI = 2.02-4.26) and older age (OR = 6.49, 95% CI = 2.19-19.21) were more likely to be hyperuricemia. With regard to BMI to hyperuricemia occurrence, those children and adolescents with intellectual disabilities were overweight (OR = 1.16-3.21, 95% CI = 1.16-3.21) and being obese (OR = 4.95-11.58, 95% CI = 4.95-11.58) was more likely to have a hyperuricemia than the normal weight group. This study provides the general profile of serum uric acid, hyperuricemia and its risk factors of children and adolescents with intellectual disabilities. Medical professionals should be highly alert to the possible consequences of hyperuricemia and provide useful information about the clinical manifestation of this condition for caregivers of children and adolescents with intellectual disabilities. (Contains 3 figures and 4 tables.)

Objective: Breast cancer is the most common cancer among women worldwide. In Taiwan, workers exposed to any of 31 hazardous chemicals or carcinogens in the work environment are designated as especially exposed workers (EEWs) by Taiwan's Ministry of Labor. We assessed the risk of breast cancer in this nationwide female EEW cohort. Methods: We conducted a nationwide retrospective study of 4,774,295 workers combining data collected from Taiwan's Ministry of Labor's EEW database between 1997 and 2018 and Taiwan's Cancer Registry between 1997 and 2016. Standardized incidence ratios (SIRs) for women exposed to different hazards and breast cancer incidence rate ratios (IRRs) were calculated by Poisson regression, adjusting for age and duration of exposure. Results: 3248 female workers with breast cancer and 331,967 without breast cancer were included. The SIRs and adjusted IRRs were 1.27 (95% CI 1.18–1.35) and 1.31 (95% CI 1.21–1.42) for lead, 1.74 (95% CI 1.23–2.24) and 1.52 (95% CI 1.13–2.04) for 1,1,2,2-tetrachloroethane, 1.47 (95% CI 1.12–1.82) and 1.42 (95% CI 1.12–1.81) for trichloroethylene/tetrachloroethylene), 1.40 (95% CI 1.23–1.57) and 1.38 (95% CI 1.22–1.57) for benzene, and 2.07 (95% CI 1.06–3.09) and 1.80 (95% CI 1.10–2.94) for asbestos. The results remained similar when factoring in a 2- or 5-year latency period. Conclusion: This study found possible correlations between occupational exposure to lead, chlorinated solvents (such as 1,1,2,2-tetrachloroethane, trichloroethylene, and tetrachloroethylene), benzene, and asbestos with breast cancer risk among female EEW, suggesting a need for regular screening for breast cancer for employees exposed to these special workplace hazards. [ABSTRACT FROM AUTHOR]

Background: Primary malignant mediastinal germ cell tumors (GCTs) are rare pediatric tumors that have a poorer prognosis compared to GCTs occurring elsewhere in the body. The current study aimed to assess the prognostic factors and treatment outcomes of children with primary malignant mediastinal GCT in Taiwan. Methods: The authors retrospectively reviewed children 0–18 years old who were newly diagnosed with primary malignant mediastinal GCT between January 1, 2005 and December 31, 2019 and were registered in the Taiwan Pediatric Oncology Group patient registry. The impact of presenting characteristics, including sex, age, tumor stage, histology subtype, surgical treatment, and chemotherapy regimens of the patients were analyzed. Results: This study enrolled 52 children with malignant mediastinal GCT who had a median age of 16.0 (range, 6.0–17.9) years at diagnosis. The most common histological subtypes were mixed GCTs (n = 20) and yolk sac tumors (n = 15). Advanced disease stage and choriocarcinoma histology subtype were associated inferior outcomes. Children who received surgical treatment exhibited better outcomes compared to those who did not (5‐year overall survival, 78% vs. 7%, p <.001). After comparing patients who received first‐line cisplatin‐ and carboplatin‐based chemotherapy, no difference in treatment outcomes was observed. Multivariate analysis showed that surgical management was the only independent predictor for superior OS. Conclusions: Surgical treatment is recommended for mediastinal GCT. Cisplatin‐based chemotherapy was not superior to carboplatin‐based chemotherapy as first‐line treatment and may be avoided due to toxicity concerns. Surgical treatment is recommended for pediatric malignant mediastinal germ cell tumors. Cisplatin‐based chemotherapy was not superior to carboplatin‐based chemotherapy as first‐line treatment. [ABSTRACT FROM AUTHOR]

A total of 30 kindergarten and second, fourth, and sixth grade students from Taiwan and the United States were asked to make category inclusion and typicality judgments for 6 categories. Findings suggested that cultural familiarity with instances plays an important role in the development of category knowledge. (RH)

Purpose: To examine the trajectory of decisional conflict and anxiety experienced by adolescents after the cancer diagnosis, and explore their perceptions on participation in shared decision‐making (SDM). Design: This longitudinal study used incorporated data from questionnaires and interviews. Methods: Participants recruited from an academic hospital in southern Taiwan ranged in age from 13 to 20 years with a cancer diagnosis within 1 month and received cancer treatment. Each participant completed questionnaires on decisional conflict and anxiety at diagnosis, 1, 3, and 6 months later. Individual interviews were to gain an in‐depth understanding of SDM. Findings: Total scores on decisional conflict changed significantly over time (F = 2.98, p = 0.039); the scores at 1 month were higher than 3 months (t = 2.18, p = 0.04) and 6 months (t = 2.97, p = 0.008). Participants perceived significantly different levels of values clarify (F = 9.49, p < 0.01) and support (F = 8.46, p < 0.01) over time. Only 27.3% of participants were anxiety‐free. No significant differences were found in anxiety over time. The perception of SDM was a situational involvement. Conclusions: Decisional conflict changed over time. Participants experienced greater decisional conflict at 4–8 weeks after diagnosis and their anxiety did not decrease over time. The different levels of participation in SDM during their treatment trajectory were found. Clinical Relevance: Participants experienced the highest decisional conflict during diagnosis, and highlighted how their roles in healthcare discussions varied from direct participation to indirect involvement. Further research is needed to develop an SDM model which accommodates different levels of needs and implements timely support. [ABSTRACT FROM AUTHOR]

Introduction: In Taiwan, given the discrepancy between current treatment guidelines and reimbursement options, patients might require a tool to support their decision-making process when selecting a regimen for metastatic colorectal cancer, especially therapeutic strategies, and subsequent costs, along with efficacy and safety outcomes. Therefore, we developed a patient decision aid (PDA) to support patients in choosing between treatment options recommended based on the current evidence and those reimbursed by the Taiwanese National Health Insurance. Methods: By carefully reviewing the updated data and then interpreting the clinical tool, we conducted a needs assessment using a serial questionnaire to test for a step-by-step adjustment of the PDA. Results: Patients, their relatives, and medical team members were most concerned about outcomes, such as overall survival, progression-free survival, objective response rate, tumor shrinkage to resectable status, total medical cost, severe gastrointestinal perforation, and severe skin reaction. After a serial alpha test for quality, we performed quantitative evaluation and beta tests, revealing average scores of more than 4 points (on a scale of 1–5) for both perceptibility and utility. Conclusions: The present findings suggest that PDAs are useful and supplement the shared decision-making practice, helping patients make decisions about preferences and consider the pros and cons of treatment regimens, along with insurance reimbursement options. [ABSTRACT FROM AUTHOR]

Introduction: Cognitive impairment (COIM) is a major challenge for healthcare systems and is associated with an increased risk of adverse outcomes in older people visiting emergency departments (EDs). Owing to global aging, both cognitive screening and comprehensive geriatric assessment (CGA) application in ED settings are developing areas of geriatric emergency medicine. Meanwhile, the association between clinical outcomes of COIM; cognitive impairment, no dementia (CIND); and dementia in the ED could be better investigated. Our study aims to identify individuals with COIM from older patients in the ED via CGA and to describe the association of CIND and dementia with prognosis in ED visits. Methods: A prospective cross-sectional study was conducted in the ED of the Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from August 2018 to November 2020. Patients aged ≥75 years with and without COIM were compared using data obtained from the CGAs conducted by trained nurses. Results: A total of 823 older patients were enrolled in the study and underwent CGA. Of these, 463 (56.3%) were diagnosed with COIM, of which 292 (35.5%) were diagnosed with dementia; and 171 (20.8%), CIND. Between the no-COIM and COIM groups, the COIM group had a higher rate of hospital admission (p = 0.002) and mortality at 3 months (p < 0.05). Among the no-COIM, CIND, and dementia groups, ED disposition (p = 0.001) and the rate of revisit/readmission (p < 0.05) showed significant differences. In particular, the dementia group had a significantly higher rate of revisit/readmission as compared to the CIND group among the three groups. Discussion/Conclusion: Older patients with COIM had a higher rate of hospital admission and mortality at the 3-month follow-up than older patients without COIM. Among the no-COIM, CIND, and dementia groups, patients with dementia had significantly increased risks of hospital admission and revisit/readmission. The early detection of COIM, and even dementia, could help ED physicians formulate strategies with geriatric specialists to improve mortality outcomes and revisit/readmission. [ABSTRACT FROM AUTHOR]

Serum potassium (K+) levels between 3.5 and 5.0 mmol/L are considered safe for patients. The optimal serum K+ level for critically ill patients with acute kidney injury undergoing continuous renal replacement therapy (CRRT) remains unclear. This retrospective study investigated the association between ICU mortality and K+ levels and their variability. Patients aged >20 years with a minimum of two serum K+ levels recorded during CRRT who were admitted to the ICU in a tertiary hospital in central Taiwan between January 01, 2010, and April 30, 2021 were eligible for inclusion. Patients were categorized into different groups based on their mean K+ levels: <3.0, 3.0 to <3.5, 3.5 to <4.0, 4.0 to <4.5, 4.5 to <5.0, and ≥5.0 mmol/L; K+ variability was divided by the quartiles of the average real variation. We analyzed the association between the particular groups and in-hospital mortality by using Cox proportional hazard models. We studied 1991 CRRT patients with 9891 serum K+ values recorded within 24 h after the initiation of CRRT. A J-shaped association was observed between serum K+ levels and mortality, and the lowest mortality was observed in the patients with mean K+ levels between 3.0 and 4.0 mmol/L. The risk of in-hospital death was significantly increased in those with the highest variability (HR and 95% CI = 1.61 [1.13–2.29] for 72 h mortality; 1.39 [1.06–1.82] for 28-day mortality; 1.43 [1.11–1.83] for 90-day mortality, and 1.31 [1.03–1.65] for in-hospital mortality, respectively). Patients receiving CRRT may benefit from a lower serum K+ level and its tighter control. During CRRT, progressively increased mortality was noted in the patients with increasing K+ variability. Thus, the careful and timely correction of dyskalemia among these patients is crucial. [ABSTRACT FROM AUTHOR]

The study explored whether the growth of food-delivery services has affected motorcycle accident patterns. When riders check their phones for directions and orders, safety risks rise. The study conducted analysis on the spatial pattern of motorcycle accidents. Separate models for food delivery and non-food delivery motorcycle accidents (FDMAs vs. NFDMAs) were built to detect differences, and the relative importance of spatial features particular to FDMAs is discussed. Trends in motorcycle accidents in Taiwan changed from 2012 to 2019. The cross-sectional analysis revealed that hotel and restaurant density along with FDMAs reported in the previous year can predict the number of FDMAs; whereas the number of NFDMAs can be determined by population density and the number of 3-legged intersections. The spatial analysis of motorcycle accidents help increase couriers' risk awareness in specific workplaces, provide insurance companies with a benchmark for regional pricing differentiation, and offer support for distracted riding regulations. [ABSTRACT FROM AUTHOR]

Background and Objectives: An outbreak of coronavirus disease 2019 (COVID‐19) occurred in mid‐May of 2021 in Taiwan. After 2 months of hard work, transmissions were successfully prevented and the number of newly confirmed COVID‐19 cases fell remarkably. We evaluated the impact of this outbreak on the massive transfusion protocol (MTP) in the emergency department (ED) of a trauma centre. Materials and Methods: We retrospectively compared the activation and efficacy of MTP before, during and after the outbreak by analysing the clinical data relevant to MTP activations. Results: There was no remarkable change in the average number of MTP triggers per month during the outbreak. The interval from an MTP trigger to the first unit of blood transfused at bedside was significantly increased during the outbreak compared to that before the outbreak (22.4 min vs. 13.9 min, p < 0.001); while the 24‐h survival rate decreased (57.1% vs. 71.1%, p = 0.938). There were no remarkable changes in blood unit return or wastage during the outbreak. Conclusion: The COVID‐19 outbreak limitedly affected MTP activation and waste of blood products, but significantly increased the interval from an MTP trigger to the first unit of blood transfused at bedside. [ABSTRACT FROM AUTHOR]

To determine the association between caregiver characteristics and behavioral and psychological symptoms of dementia (BPSD) in patients with dementia (PWD) in a Taiwanese community-dwelling population. This cross-sectional study was conducted using the data of 190 patients with Alzheimer's disease/dementia and 190 informal matched caregivers in Taiwan. BPSD were examined using the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Correlation and regression analyses were used to explore associations between caregiver characteristics and the presence, severity, and distress of NPI-Q items. Only spouse primary caregiver was positively associated with presence of delusions in PWD. Caregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference in PWD, while child primary caregiver was positively related to severity of disinhibition in PWD but negatively related to severity of anxiety in PWD. Spouse primary caregiver was positively related to severity of anxiety and appetite/eating in PWD while sole primary caregiver was positively related to severity of anxiety and nighttime behaviors in PWD. Caregiver education was positively correlated to distress of agitation/aggression in caregivers while child primary caregiver was positively related to distress of disinhibition in caregivers. Spouse primary caregiver was positively related to distress of anxiety and appetite/eating in caregivers while spouse caregiver was positively related to distress of nighttime behaviors in caregivers. Caregiver education, child and spouse primary caregiver were relevant to severity of PWD and distress of caregivers of BPSD. It is suggested that healthcare professionals provide caregivers with proper individualized interventions based on these results to enhance caring quality. Caregiver education was positively correlated to severity of hallucinations, agitation/aggression, and apathy/indifference, and distress of agitation/aggression. Child primary caregiver was positively related to severity and distress of disinhibition but negatively related to severity of anxiety. Spouse primary caregiver was positively related to severity and distress of anxiety and appetite/eating, and distress of nighttime behaviors [ABSTRACT FROM AUTHOR]

The earthquake early warning (EEW) system in Taiwan is the outcome of rigorous research work carried out at various levels after the occurrence of the 1986 Hualien earthquake that caused destruction. After more than 25 years of development, three different EEW systems exist in Taiwan. Currently, the nation wide regional EEW system is operated by the Central Weather Bureau (CWB), whereas, a hybrid (regional & onsite) system based on Micro-Electro-Mechanical System sensors is run by National Taiwan University (NTU). The third EEW (onsite system) is run by the National Center for Research on Earthquake Engineering (NCREE). Both CWB and NTU systems are capable of reporting the EEW warnings within 20 seconds of earthquake occurrence. The CWB system is incharge of providing earthquake alerts in Taiwan via text message through mobile phone, TV, and directly broadcasting system to schools and is providing earthquake alarms to the general public since 2016. During recently damaging earthquakes in Taiwan, the NTU system provided 2–8 seconds onsite warning (lead time) in the blind zone around the epicenter. The NTU system also can generate near real-time shake maps for rapid response purposes. The NCREE system consists of about 98 stations and can provide several seconds lead time in the area near the epicenter. The NCREE system also can receive CWB regional EEW messages for warning the regions away from the epicenter. Individually every system has its advantage, however, the hybrid approach will be one of the future systems for real operation. [ABSTRACT FROM AUTHOR]

This study addresses a capacitated vehicle routing problem with time windows and simultaneous pickup and delivery (VRPTWPD) for scheduling bus-type taxis formerly served by regular buses. The effects of varying the maximum number of passenger seats on service quality and costs are investigated. Taiwan's government has subsidized public transport in order to ensure consistency between service shifts and demands, improve the efficiency of public transport operations, and maintain an ongoing supply of services while reducing the number of scooters and/or private cars on roads to minimize traffic congestion. Ultimately, the intent is to reduce government subsidies further and maintain service quality at reasonable levels. Transit planners have also introduced the Demand Responsive Transit System (DRTS) to connect routes. Particularity in rural areas, local transit planners have replaced buses with taxis to form a bus-type taxi service that increases efficiency. As a consequence, the transit service in low-density or rural areas has not been abandoned. The study acknowledges that optimal routes for successful bus-type taxis services vary by area. Routing and scheduling results will assist route planners' efforts to provide sufficient transit services in rural areas. The study results also suggest that further reductions in government subsidies are possible. [ABSTRACT FROM AUTHOR]

The possibilities that medical students will take care of persons 65 years of age or older in hospitals and communities are increasing due to a growing aged population. This study marks one of the first in-depth attempts to explore willingness to care toward older peoples in Taiwan medical students. A cross-sectional research design was used. Stratified sampling was applied to recruit participants from six medicine colleges. There were 580 medical students who completed the questionnaire. A multiple regression analysis were conducted. The results found that the significant predictors of medical students' willingness to care for older adults were perceptions of getting together with older people, grandparents were major caregivers during childhood, and experienced of being a volunteer who served older people. The findings of this study can provide information to faculty members and clinical preceptors for designing curricula and related activities or arranging practica. [ABSTRACT FROM AUTHOR]