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Previous research has focused on examining embarrassment in sensitive product purchase situations. Although embarrassment is a widespread emotion in consumption situations, few studies have explored its impact on service encounters, especially in the service failure context. This study examines how customers react to different service failures that cause embarrassment and explores whether self-serving bias exists when customers perceive higher embarrassment in service failure. This study uses a 2 (source of failure) × 2 (level of embarrassment) scenario experimental method to examine the effect of two sources of failure on consumer locus attributions, negative emotions, and negative behaviors, considering the moderating effects of the level of embarrassment. Data were collected from 218 student subjects in Taiwan. The results show that embarrassment is important in service failure contexts. Specifically, when consumers perceive higher embarrassment, they attribute more responsibility to the service provider. These attributions, in turn, influence customers' emotions and behavioral responses. These findings have several important theoretical and practical implications in terms of embarrassing service failures. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the relationships between destination attachment, tourists' experiences of historical guesthouses, satisfaction and revisit intention. Historical guesthouses of Kinmen County, Taiwan were the setting for the investigation. A total of 346 questionnaires were collected and analyzed. Results showed that accommodation experiences can significantly mediate the relationships between destination attachment and the evaluations of historical guesthouses. Perceptions of human interactions between tourists and the service providers at historical guesthouses were critical for creating a highly favorable accommodation experience. The physical environment, human interactions, and satisfaction all had significant positive effects on revisit intention, with the perceptions of human interactions greatly influencing revisit intention. This study provides meaningful management implications for both the hospitality and tourism industries. [ABSTRACT FROM AUTHOR]

Liver transplant recipients have an increased risk of osteoporosis and fractures. The aim of this study was to identify risk factors for fractures after liver transplant in a Taiwanese population. We identified newly diagnosed liver transplant recipients from the National Health Insurance Research Database in Taiwan between 2003 and 2015. Risk factors of post-transplant fractures were analyzed using a Cox proportional hazards model. A total of 4821 patients underwent liver transplantation, of whom 419 (8.7%) had post-transplant fractures. Independent predictors of post-transplant fractures were age ≥65 years at transplantation (hazard ratio (HR): 1.566; 95% confidence interval (CI) 1.122–2.186), female sex (HR: 1.648; 95% CI 1.319–2.057), fractures within 1 year prior to transplant (HR: 3.664; 95% CI 2.503–5.364), hepatitis C carriers (HR: 1.594; 95% CI 1.289–1.970), alcoholism (HR: 1.557; 95% CI 1.087–2.230) and daily prednisolone dose >1.61–3.78 mg/day (HR: 1.354; 95% CI 1.005–1.824), >3.78–9.18 mg (HR: 4.182; 95% CI 3.155–5.544) and >9.18 mg (HR: 13.334; 95% CI 9.506–18.703). Post-transplant fractures were inversely correlated with tacrolimus (HR: 0.617; 95% CI 0.417–0.913) and sirolimus/everolimus (HR: 0.504; 95% CI 0.391–0.650) treatment. The liver transplant recipients, and especially those who were aged ≥65 years, female, hepatitis C carriers, had a history of fractures within 1 year prior to transplant, alcoholism, and higher daily prednisolone dose were associated with an increased risk of post-transplant fractures. Conversely, the use of tacrolimus and sirolimus/everolimus was associated with a decreased risk of fractures. This study identified risk factors for fractures after liver transplant in a population-based study in an area with high prevalence of hepatitis B and hepatitis C. Recipients who were aged ≥65 years, female, hepatitis C carriers, had a history of fractures within 1 year prior to transplant, alcoholism, and higher daily prednisolone dose were independent risk factors for post-transplant fractures. Our findings highlight the importance of identifying individuals at high risk of fractures and concomitant tacrolimus and sirolimus/everolimus treatment to avoid the use of high-dose steroids and prevent post-transplant fractures. [ABSTRACT FROM AUTHOR]

This study examines the perceptions of festival host residents of the Dajia Mazu Pilgrimage using the proposed model to evaluate the antecedent and outcome variables of place image. Using quantitative methods, this study proposes a model to determine host residents' perceptions based on fit, place image, quality of life, and behavioral intention. The findings showed that place image is vital in establishing a supportive perception toward the festival host city. Quality of life not only mediates the perceptions of residents' image and their residency but also independently contributes to the development of residents' behavioral intentions. The perceptions of place image or the quality of life of residents, especially place image, are significant predictors of residents' behavioral intentions. This study extends the concepts of fit and place image by taking a psychological perspective to provide strategies for festival management. To evaluate residents' quality of life and gain their intention to support for the festival, the present study suggests that event organizers and the local government take action on the characteristics of the festival and the host city represents. Providing entertainment activities combine with Mazu culture at nighttime is one of the suggestions. The exploratory model we proposed herein to explain host residents' viewpoints showed sufficient predictive power. The results underline the importance of fit, which can predict and explain place image. Furthermore, the present study contributes to existing research by applying the concept of fit in the festival context. [ABSTRACT FROM AUTHOR]

Marine fisheries are undeniably important to Taiwan in terms of economic development and industrial strategies. In the past 10 years, Taiwan's fishery GDP accounted for 14% to 21% of all agriculture, forestry, fishery, and animal husbandry, which is higher than both animal husbandry and forestry. Since the domestic population structure of Taiwan has changed, the domestic fishery industrial labor force has gradually been replaced by migrant fishing workers. The issue of migrant fishing workers' protection has received attention from non-governmental organizations, and cross-national recruitment administration has become the greatest challenge faced by Taiwan's authority. Therefore, this paper describes the necessary protection of the labor conditions and interests of migrant fishermen by analyzing their status and human rights protection in the historical development of Taiwan's marine fisheries. In addition, considering the well-being of migrant fishing workers, this paper conducts a feasibility assessment on the operation of the "Nan-Fang-Ao Fishermen's Hostel" at the Nan-Fang-Ao Fishing Harbor and illustrates the urgent need to re-examine the migrant fishing workers' protection. This paper suggests that the government agencies should actively advise employers to accept migrant fishermen's requests for better living environments onshore and guarantee basic living conditions. [ABSTRACT FROM AUTHOR]

Background: Neuropsychiatric disturbances are common manifestations of dementia disorders and are associated with caregiver burden and affiliate stigma. The present study investigated affiliate stigma and caregiver burden as mediators for the association between neuropsychiatric symptoms of people with dementia (PWD) and caregiver mental health such as depression and anxiety. Methods: A cross-sectional survey study was carried out with 261 dyads of PWD and informal caregivers from the outpatient department of a general hospital in Taiwan. The survey included the Caregiver Burden Inventory (CBI), the Affiliate Stigma Scale (ASS), the Taiwanese Depression Questionnaire (TPQ), and the Beck Anxiety Inventory (BAI). Mediation models were tested using the Hayes' PROCESS macro (Model 4 for parallel mediation model; Model 6 for sequentially mediation model). Results: Caregiver burden, affiliate stigma, caregiver depression, and caregiver anxiety were significantly associated with neuropsychiatric symptoms. After controlling for several potentially confounding variables, it was found that PWD's neuropsychiatric symptoms, caregiver burden and affiliate stigma significantly explained 52.34% of the variance in caregiver depression and 37.72% of the variance in caregiver anxiety. The parallel mediation model indicated a significantly indirect path from PWD's neuropsychiatric symptoms to caregiver mental health through caregiver burden and affiliate stigma, while the direct effect was not significant. Moreover, there was a directional association between caregiver burden and affiliate stigma in the sequential mediation model. Conclusions: These findings show that it is imperative to improve caregivers' perception of those with dementia to reduce internalized stigma and to improve caregivers' mental health. Implementation of affiliate stigma assessment in clinical practice would allow distinctions to be made between the impact of affiliate stigma and the consequences of caregiver burden to help inform appropriate intervention. [ABSTRACT FROM AUTHOR]

Existing studies on the urban heat island (UHI) effect tend to focus on the planar scale. However, the UHI effect has obvious three-dimensional properties. This research focuses on the vertical structure of UHI. The study combined big data from sounding balloon and surface measurements in the Database for Atmospheric and Hydrologic Research, Taiwan. Data organization and classification were conducted using the Python programming language, the NumPy mathematical function library, and the Pandas data manipulation library. Results confirmed the existence of the atmospheric boundary layer and the canopy. Furthermore, the temperature inversion of the atmospheric boundary layer fell between heights of 130 m and 667 m. The height of the inversion is affected by the wind speed and cloudiness. Thereby demonstrating that the inversion fluctuates with weather scenario changes. The research results can be applied as the direction of urban planning thinking for urban heat island countermeasures. [ABSTRACT FROM AUTHOR]

In recent years, Taiwan has firmly committed itself to pursue the green energy transition and a nuclear-free homeland by 2025, with an increase in renewable energy from 5% in 2016 to 20% in 2025. Offshore wind power (OWP) has become a sustainable and scalable renewable energy source in Taiwan. Maritime Spatial Planning (MSP) is a fundamental tool to organize the use of the ocean space by different and often conflicting multi-users within ecologically sustainable boundaries in the marine environment. MSP is capable of definitively driving the use of offshore renewable energy. Lessons from Germany and the UK revealed that MSP was crucial to the development of OWP. This paper aims to evaluate how MSP is able to accommodate the exploitation of OWP in Taiwan and contribute to the achievement of marine policy by proposing a set of recommendations. It concludes that MSP is emerging as a solution to be considered by government institutions to optimize the multiple use of the ocean space, reduce conflicts and make use of the environmental and economic synergies generated by the joint deployment of OWP facilities and fishing or aquaculture activities for the conservation and protection of marine environments. [ABSTRACT FROM AUTHOR]

Background: Renal cell carcinoma (RCC) is the most common neoplasm in kidneys, and surgical resection remains the mainstay treatment. Few studies have investigated how the postoperative pain changes over time and what has affected its trajectory. This study aimed to characterize the variations in postoperative pain over time and investigate associated factors after RCC surgery. Methods: This retrospective study was conducted in a single medical center in Taiwan, where maximal pain scores in a numeric rating scale were recorded daily in the first five postoperative days (PODs) after RCC surgery. Latent curve models were developed, using two latent variables, intercept and slope, which represented the baseline pain and rate of pain resolution. These models explain the variations in postoperative pain scores over time. A predictive model for postoperative pain trajectories was also constructed. Results: There were 861 patients with 3850 pain observations included in the analysis. Latent curve analysis identified that female patients and those with advanced cancer (stage III and IV) tended to have increased baseline pain scores (p = 0.028 and 0.012, respectively). Furthermore, patients over 60 years, without PCA use (both p < 0.001), and with more surgical blood loss (p = 0.001) tended to have slower pain resolution. The final predictive model fit the collected data acceptably (RMSEA = 0.06, CFI = 0.95). Conclusion: Latent curve analysis identified influential factors of acute pain trajectories after RCC surgery. This study may also help elucidate the complex relationships between the variations in pain intensity over time and their determinants, and guide personalized pain management after surgery for RCC. [ABSTRACT FROM AUTHOR]

Purpose: Children with vesicoureteral reflux (VUR) are at an increased risk of recurrent urinary tract infections (UTIs). Early detection and treatment of VUR are important to prevent renal function impairment. Therefore, the aims of this study were to determine the epidemiology of VUR and to identify clinical factors associated with VUR in Taiwanese children with a first documented UTI. Patients and Methods: We conducted this nationwide retrospective study using the Longitudinal Health Insurance Database 2010. Children ≤ 6 years of age who were admitted and received intravenous antibiotics for a newly diagnosed UTI were included. Multivariate logistic regression analysis was used to identify independent factors associated with VUR. Results: Overall, 388 (10.2%) of the children had VUR. The median (interquartile range) age at diagnosis of VUR was 0.5 (0.3– 1.3) years. Among the children with VUR, the age at first UTI and the age at diagnosis of VUR were significant lower in the males than in the females. Age ≤ 1 year at the first UTI (odds ratio (OR), 1.3; 95% confidence interval (CI): 1.0– 1.7), renal agenesis and dysgenesis (OR, 4.1; 95% CI: 1.3– 13.1), hydronephrosis (OR, 2.2; 95% CI: 1.7– 2.9), duplex collecting system/ectopic kidney/ectopic ureter (OR, 13.0; 95% CI: 8.1– 20.8), neuropathic bladder (OR, 4.7; 95% CI: 2.0– 11.1) and spina bifida (OR, 5.9; 95% CI: 1.3– 27.8) were independent factors for VUR. Conclusion: The children with VUR were more likely to have small kidneys and progression to end-stage renal disease. VUR was common in the children with a UTI and who were ≤ 1 year of age. Clinicians should arrange ultrasound to diagnose urinary tract anomalies. Infants with urinary tract anomalies, neuropathic bladder and spina bifida should receive further voiding cystourethrography to diagnose VUR early, as this may help to prevent renal damage. [ABSTRACT FROM AUTHOR]

The Tatun Volcanic Group (TVG), located in northern Taiwan, is characterized by acidic hot springs where the outflow of the hot springs may affect the properties of the associated lotic water bodies. We investigated the bacterial diversity and functional profiles of the Peihuang (PHC), HuangGang (HGC), and Nanhuang Creeks (NHC) located in the TVG basin using 16S rRNA gene sequencing coupled with statistical analyses. Water samples were collected from various streams of the creeks for two months of the year. The NHC showed the highest diversity, richness, and a unique number of phyla, which was followed by the HGC. A reduced number of phyla and a lower diversity was noticed in the PHC. The NHC was found to be abundant in the genera Armatimonas, Prosthecobacter, Pirellula, and Bdellovibrio, whereas the HGC was rich in Thiomonas, Acidiphilium, Prevotella, Acidocella, Acidithiobacillus, and Metallibacterium. The PHC was abundant in Thiomonsa, Legionella, Acidocella, and Sulfuriferula. The samples did not show any strong seasonal variations with the bacterial diversity and abundance; however, the relative abundance of each sampling site varied within the sampling months. The iron transport protein- and the sulfur metabolism-related pathways were predicted to be the key functions in all the creeks, whereas the heavy metal-related functions, such as the cobalt/nickel transport protein and the cobalt–zinc–cadmium efflux system were found to be abundant in the HGC and PHC, respectively. The abundance of Bdellovibrio in the NHC, Diplorickettsia in the HGC, and Legionella in the PHC samples indicated a higher anthropogenic impact over the creek water quality. This study provides the data to understand the distinct bacterial community structure, as well as the functional potentials of the three major watersheds, and helps the knowledge of the impact of the physicochemical properties of the TVG hot springs upon the watersheds. [ABSTRACT FROM AUTHOR]

Background: This study was to perform an economic evaluation to understand clinical outcomes and health resource use between hip fracture patients receiving hospital-based postfracture fracture liaison service (FLS) care and those receiving usual care (UC) in Taiwan.Methods: This cohort study included hospital-based data of 174 hip fracture patients who received FLS care (FLS group) from National Taiwan University Hospital, and 1697 propensity score-matched patients who received UC (UC group) of National Health Insurance claim-based data. Two groups had similar baseline characteristics but differed in hip fracture care after propensity score matching. Clinical outcomes included refracture-free survival (RFS), hip-refracture-free survival (HRFS), and overall survival (OS). Health resource use included inpatient, outpatient, and pharmacy costs within 2 years follow-up after the index of hip fracture. The economic evaluation of the FLS model was analyzed using the net monetary benefit regression framework based on the National Health Insurance perspective.Results: The FLS group had longer RFS than the UC group, with an adjusted difference of 44.3 days (95% confidence interval: 7.2-81.4 days). Two groups did not differ in inpatient and outpatient costs during follow-up, but the FLS group had a higher expenditure than the UC group on osteoporosis-related medication. The probability of FLS being cost-effective was >80% and of increasing RFS, HRFS, and OS was 95%, 81%, and 80%, respectively, when the willingness-to-pay threshold was >USD 65/gross domestic product per day.Conclusion: FLS care was cost-effective in reducing refracture occurrence days for patients initially diagnosed with hip fractures. [ABSTRACT FROM AUTHOR]

Background: The unusual high dialysis prevalence and upper urinary tract urothelial carcinoma (UTUC) incidence in Taiwan may attribute to aristolochic acid (AA), which is nephrotoxic and carcinogenic, exposure. AA can cause a unique mutagenic pattern showing A:T to T:A transversions (mutational Signature 22) analyzed by whole exome sequencing (WES). However, a fast and cost-effective tool is still lacking for clinical practice. To address this issue, we developed an efficient and quantitative platform for the quantitation of AA and tried to link AA detection with clinical outcomes and decipher the genomic landscape of UTUC in Taiwan. Patients and Methods: We recruited 61 patients with de novo onset of UTUC after kidney transplantation who underwent radical nephroureterectomy. A liquid chromatography-tandem mass spectrometry (LC-MS/MS) platform was developed for the quantitation of AA. Pearson's chi-square test, Kaplan–Meier method, and Cox proportional hazard model were utilized to assess the correlations among AA detection, clinicopathological characteristics, and clinical outcomes. Seven tumors and seven paired normal tissues were sequenced using WES (approximately 800x sequencing depth) and analyzed by bioinformatic tool. Results: We found that high level of 7-(deoxyadenosin-N6-yl)aristolactam I (dA-AL-I) detected in paired normal tissues was significantly correlated with fast UTUC initiation times after renal transplantation (p = 0.035) and with no use of sirolimus (p = 0.046). Using WES analysis, we further observed that all tumor samples were featured by Signature 22 mutations, apolipoprotein B mRNA-editing enzyme, catalytic polypeptide (APOBEC)-associated gene mutations, p53 mutations, no fibroblast growth factor receptor 3 (FGFR3) mutation, and high tumor mutation burden (TMB). Especially, mammalian target of rapamycin (mTOR) activation predominated in dA-AL-I-detected samples compared with those without dA-AL-I detection and might be associated with UTUC initiation through cell proliferation and suppression of UTUC progression via autophagy inhibition. Conclusion: Accordingly, dA-AL-I detection can provide more direct evidence to AA exposure and serve as a more specific predictive and prognostic biomarker for patients with de novo onset of UTUC after kidney transplantation. [ABSTRACT FROM AUTHOR]

Medical technology is undergoing rapid transformations, and the classifications of medical devices have also expanded greatly; therefore, it is necessary to develop appropriate reimbursement policies and pricing mechanisms in a timely manner. This paper aims to introduce the reimbursement coverage and pricing rules for medical devices in Taiwan. In addition, this paper identifies and evaluates available health technology assessments (HTA) and literature on published websites concerning medical device decision-making processes and pricing systems in South Korea and Japan, which are near Taiwan and have similar reimbursement coverage processes. Reimbursement policy and pricing mechanisms are constantly being revised in Taiwan, Japan, and South Korea. Recently, all three countries attempted to establish new reimbursement coverage decision-making and pricing rules, adopting a differentiated approach based on the level of evidence required for the appropriated reimbursement in terms of a feasible evaluation mechanism for providing patients with more effective medical devices. This article is expected to contribute to providing references to new reimbursement coverage decision-making and pricing rules. [ABSTRACT FROM AUTHOR]

Acanthamoeba spp. are opportunistic human pathogens that cause granulomatous amoebic encephalitis and keratitis, and their accurate detection and enumeration in environmental samples is a challenge. In addition, information regarding the genotyping of Acanthamoeba spp. using various PCR methods is equally critical. Therefore, considering the diverse niches of habitats, it is necessary to develop an even more efficient genotyping method for Acanthamoeba spp. detection. This study improved the sensitivity of detection to avoid underestimation of Acanthamoeba spp. occurrence in aquatic environmental samples, and to accurately define the pathogenic risk by developing an efficient PCR method. In this study, a new nested genotyping method was established and compared with various PCR-based methods using in silico, lab, and empirical tests. The in silico test showed that many PCR-based methods could not successfully align specific genotypes of Acanthamoeba, except for the newly designed nested PCR and real-time PCR method. Furthermore, 52 water samples from rivers, reservoirs, and a river basin in Taiwan were analysed by six different PCR methods and compared for genotyping and detection efficiency of Acanthamoeba. The newly developed nested-PCR-based method of genotyping was found to be significantly sensitive as it could effectively detect the occurrence of Acanthamoeba spp., which was underestimated by the JDP-PCR method. Additionally, the present results are consistent with previous studies indicating that the high prevalence of Acanthamoeba in the aquatic environment of Taiwan is attributed to the commonly found T4 genotype. Ultimately, we report the development of a small volume procedure, which is a combination of recent genotyping PCR and conventional real-time PCR for enumeration of aquatic Acanthamoeba and acquirement of biologically meaningful genotyping information. We anticipate that the newly developed detection method will contribute to the precise estimation, evaluation, and reduction of the contamination risk of pathogenic Acanthamoeba spp., which is regularly found in the water resources utilised for domestic purposes. [ABSTRACT FROM AUTHOR]

This study investigated the effect of environmental physical factors on the relative abundance of bacteria and the consequential landscape evolution in karst topography, focusing mainly on the effects of ureolytic microbial CaCO3 precipitation. The narrow-sky located in the upper part of Tangshan is a small gulch of Pleistocene coralline limestone formation in southern Taiwan. A 16S-metagenomic approach was used to determine the relationship of microbial community structures on the landscapes in various habitats. Our results showed that the biomass of habitats in the opening of the gulch was two times higher than the inside where light penetration was lower. We also found that speleothems only occurred at the inner wall inside the gulch, where the environment exhibited water drips running through the surface of speleothems and less light penetration. The sequence reads of operational taxonomic units relative to urease-producing bacteria and weathering-associated bacteria from each habitat were determined by NCBI database. Our data revealed that the 16S-metagenomics of the inner wall and water samples exhibited more sequences that were similar to those of urease-producing bacteria, whereas the outer wall showed more sequences that were similar to those of weathering-associated bacteria, suggesting that bacteria facilitated the formation of limestone weathering and calcite precipitation for various habitats. The semi-quantitative PCR for determining bacterial urease gene (ureC) levels confirmed that the inner limestone habitat had higher ureC gene levels than the outer limestone habitat. This study revealed the pivotal role of microorganisms in governing the geological evolution in the lightless limestone landscape. [ABSTRACT FROM AUTHOR]

What is known and objective: Starting 1 August 2013, the eligible cholesterol level for statin reimbursement in patients with atherosclerotic cardiovascular disease (ASCVD) or cardiovascular disease (CVD)‐related risk factors changed from LDL‐C ≥ 130 mg/dl (or TC ≥ 200 mg/dl) to LDL‐C ≥ 100 mg/dl (or TC ≥ 160 mg/dl) in Taiwan, which may modify clinician prescribing behaviours. We aimed to evaluate the impact of changing reimbursement criteria on statin treatment patterns. Methods: A before–after cohort design was conducted using Taiwan's National Health Insurance Research Database. Differences in statin treatment patterns between the pre‐ and postregulation periods were compared. Two prespecified study cohorts were identified to examine the impacts of this change on those who need statins for "secondary prevention" (patients newly diagnosed with ASCVD) and those who need statins for "primary prevention" (patients newly diagnosed with CVD‐related risk factors, such as diabetes mellitus [DM]). Treatment patterns measured in this study included initiation, discontinuation, switching, dose increase, dose decrease and dose maximization. Results: The proportion of patients who initiated statins during the postregulation period was higher than that of patients who initiated statins during the preregulation period (eg coronary heart disease (CHD) patients, pre‐ vs. postregulation: 41.23% vs. 48.25%). Notably, only 30%‐40% of patients initiated statin use in the postregulation period across different conditions. In addition, the proportion of patients who discontinued statins remained very high. Even in the postregulation period, more than half of CHD patients discontinued statins during the 1‐year follow‐up period (eg CHD patients, pre‐ vs. postregulation: 59.07% vs. 52.75%). What is new and conclusion: The new reimbursement criteria started on 1 August 2013 seemed to lower the barriers of access to the first statin prescription among patients with CHD, cerebrovascular disease (CBVD) and DM. Nevertheless, the proportion of patients who initiated statin use was suboptimal, and the proportion of patients who discontinued statins was very high in the postregulation period. [ABSTRACT FROM AUTHOR]

Taiwan is a hepatitis C virus (HCV) endemic country with geographic variation of prevalence and main genotypes(GTs) are 1 b and 2a. We recently reported high GT6 prevalence in Tainan of southern Taiwan. To clarify this special genotype as a local endemic disease and its geographic variation, the prevalence rates of HCV GTs of 37 districts of Tainan were analyzed. A total of 3040 patients with HCV viremia were enrolled. The prevalence rates of HCV GT 1a, 1 b, 2, 3, 4, 6 and mixed types were 3.9%, 31.6%, 45.9%, 0.6%, 0.2%, 17.1% and 0.5% respectively. GT6 prevalence showed marked variation from 0 to 39.2%. Four districts with GT6 prevalence >30% are located between Jishui and Zengwen rivers. Preliminary subtyping data were 6 g/a/w. This geographic variation with spatial restriction by two rivers with 6 g/w is suggestive of local endemic infection of preexisting GT 6 HCV for centuries. [ABSTRACT FROM AUTHOR]

Gestational risk factors such as birth weight, gestational age and parity have been repeatedly found to be related to pediatric cancers, but few reports have emerged from Asian countries. Here we report on demographic and gestational factors in a Taiwanese cohort. Our study included all children born in Taiwan 2004–2014 for whom there was a birth record (n = 2,079,037), of which 1900 children had been diagnosed with cancer prior to age 12. We conducted multivariable hazard regression to examine associations between demographic and gestational factors with cancer. Greater parity (family with 2+ older children) was related to acute myeloid leukemia [Hazard ratio (HR) = 2.15, 95% confidence interval (CI): 1.31, 3.55), central nervous system tumors (HR = 1.67, CI: 1.13, 2.48) and neuroblastoma (HR = 1.67, CI: 1.07, 2.63). Hepatoblastoma cases had a higher risk of low birth weight (<2,500 g; HR = 3.01, CI: 1.85, 4.91), very preterm birth (<33 weeks gestation; HR = 13.71, CI: 7.45, 25.23), plural pregnancies (HR = 2.37, CI: 1.10, 5.14) and both small (HR = 2.13, CI: 1.23, 3.67) and large (HR = 1.83, CI: 1.01, 3.32) for gestational age. Germ cell tumors were more common among children born in rural areas (HR = 1.63, CI: 1.02, 2.60). Despite that Taiwan has lower rates of both high and low birthweight compared to other developed nations, we observed several similar associations to those reported in Western Countries. Further research should examine unique exposures in Taiwan that may be contributing to higher incidence of certain cancer types. What's new? The incidence of childhood cancers is notably high in Taiwan, where unique risk factors, including low prevalence of high birth weight and endemic hepatitis, potentially impact cancer incidence. Nonetheless, the present study shows that for children born in Taiwan between 2004 and 2014, associations between childhood cancer risk and factors such as birth weight and size at gestational age generally are similar to associations reported in studies of Western populations. Several cancers were frequently linked to plural pregnancies and greater parity in Taiwanese mothers. Further investigation is needed to more fully explain recent increases in childhood cancers in Taiwan. [ABSTRACT FROM AUTHOR]

Aesthetic education is currently an educational issue receiving substantial attention, and to increase the accessibility of aesthetic education, working to implement aesthetic education programs should be for all age groups. The aesthetic education for senior citizens, providing the participants with positive aesthetic experiences not only increases sensory stimulation but also facilitates new connections to the world, are critical in maintenance of senior citizens' physical and social functions. In the literature, few aesthetic education studies have targeted senior citizens, despite the increase in senior-activity-center-related projects and programs since 2015 in Taiwan. Most individuals who attend programs at senior activity centers are senior citizens from nearby communities. Systematic arrangement and planning of aesthetic courses at these centers may further community-based aesthetic education efforts. This study chose a Taipei City senior activity center for an action study exploring design approaches for aesthetic education community-based classes and activities for 25 senior citizens. The findings include understanding the initial experiences of senior citizens in collective art projects, adjustment of instruction method through reflection and conversation, senior citizens' class participation and feedback enhanced aesthetic literacy and interpersonal interaction, future course improvement and enrichment. The researcher reviewed feasible approaches for promoting senior aesthetic education to provide useful information to community senior activity centers and their managers and senior aesthetic education promoters. [ABSTRACT FROM AUTHOR]

Background: Psychiatric disorders such as attention-deficit/hyperactivity disorder may negatively impact drug compliance and the prognosis of enuresis. However, existing studies regarding associations between lifetime psychiatric disorders and childhood enuresis are primarily from Western countries, and studies from Taiwan are lacking. Methods: We conducted a population-based retrospective cohort analysis using the Taiwan Longitudinal Health Insurance Database 2010. A total of 1,146 children with enuresis (ICD-9-CM code: 307.6) and 4,584 randomly selected sex- and age-matched controls were identified between January 1, 1997 and December 31, 2011. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the development of psychiatric disorders in the children with enuresis. Results: Enuresis was more common in the younger children, and the rate was significantly higher in boys (58.7%) than in girls (41.3%). A total of 171 patients (14.9%) in the enuresis group had at least one psychiatric diagnosis vs 259 (5.7%) in the control group (p< 0.001). Multivariate analysis showed that the presence of enuresis increased the odds of developing major depressive/dysthymic disorder (OR=2.841, 95% CI: 1.619, 4.987), attention-deficit/hyperactivity disorder (OR=3.156, 95% CI: 2.446, 4.073), autism spectrum disorder (OR=2.468, 95% CI: 1.264, 4.822), anxiety disorders (OR=3.113, 95% CI: 2.063, 4.699), intelligence disability (OR=3.989, 95% CI: 2.476, 6.426), disruptive behavior disorders (OR=3.749, 95% CI: 1.756, 8.004), and tic disorder (OR=2.660, 95% CI: 1.642, 4.308). Conclusion: Children with enuresis are likely to have psychiatric disorders, and physicians should consider this during their evaluation. [ABSTRACT FROM AUTHOR]

Objective: The prevention of infections is crucial in long-term care programs. Investigations of the occurrence and sources of pathogens in long-term care facilities (LTCFs) are still lacking, especially in eastern Taiwan. In this study, we conducted a surveillance of two common pathogens, Acinetobacter baumannii (AB) and methicillin-resistant Staphylococcus aureus (MRSA), in LTCFs in Hualien. Materials and Methods: Pathogenic assays including isolation, identification, and antimicrobial susceptibility tests were conducted for AB and MRSA at LTCFs in Eastern Taiwan. Staphylococcal cassette chromosome mec typing assays were done to understand the relatedness of clonal strains of MRSA. Results: All AB-positive samples in the LTCFs were mainly from water-rich samples and were drug susceptible. Our data indicated that the AB strains from LTCFs were similar to those from Puzi River watersheds in Taiwan, which were not drug resistant to commonly used antibiotics. On the other hand, the drug resistance analysis of MRSA indicated that the genotypes from the LTCFs were similar to those from nearby hospitals. Eight strains of MRSA were isolated from four LTCFs, of which five were identified as hospital-acquired strains according to SSCmed typing assays. Conclusion: These findings suggest that MRSA in LTCFs might propagate from hospitals and could be transmitted between hospitals and LTCFs. Health authorities should be aware of this risk. The long-term follow-up of MRSA is recommended in local medical institutions as well as in LTCFs for correlative analysis. [ABSTRACT FROM AUTHOR]

Highlights • Exercise, smoking, and nutritional status were all associated with cognitive function in adults aged 65 years and over. • Nutritional status predicted the likelihood of subsequent cognitive decline. • Current and consistent exercise and good nutrition should benefit cognitive function and cognitive reserve, and protect against cognitive decline among older adults. • Discontinued exercise, poor nutritional status, and cigarette smoking might be harmful to cognition and increase the risk of cognitive decline. Abstract This study aimed to explore the long-term effects of exercise, smoking, and nutritional status on cognitive reserve and changes in cognitive function among Taiwanese adults aged ≥65 years. Data were obtained from the Taiwan Longitudinal Study of Aging, a national representative population-based cohort study. Results showed that the average baseline scores on the Short Portable Mental Status Questionnaire (SPMSQ) and Mini-Nutritional Assessment (MNA) were 9.07 and 26.01, respectively. The proportions of smoking and exercising at baseline were 24.12% and 58.67%, respectively. A linear regression analysis indicated that old adults who were current and consistent exercisers had better subsequent 4-year SPMSQ scores than those who were not exercisers (P < 0.05). The MNA score was positively associated with subsequent 4- and 8-year SPMSQ scores for the 65–74-year-old adults (P < 0.05). The logistic regression analysis showed that current and consistent exercise was negatively associated with subsequent 4-year cognitive decline (P < 0.05). Previous exercise experience was positively associated with subsequent 8-year cognitive decline for the ≥75-year-old adults (P < 0.05). The MNA score was negatively correlated with subsequent 4- and 8-year cognitive decline among the 65–74-year-old adults. Among the adults aged ≥75 years, consistent smoking was positively associated with cognitive decline over 4 years (P < 0.05). Therefore, current and consistent exercise and good nutritional status benefit cognitive function and reserve, and have protective effects on cognitive decline among old adults, whereas discontinued exercise, poor nutrition, and cigarette smoking are likely to raise the risk of cognitive decline. [ABSTRACT FROM AUTHOR]

Abstract Instant messengers (IM) mediate several types of negative social exchanges that can affect the psychological well-being of their users. Using an instant messenger popular in Taiwan (LINE) as an example, this study examined the relationship between IM communication and well-being. An online survey was conducted and found that negative IM social exchanges in which messages were ignored by their recipients, interfered with other activities, or contained hostility or ridicule were directly related to a global measure of negative social exchange that included face-to-face as well as online interactions. Insensitive IM social exchanges were positively related to loneliness, depression, and fear of missing out (FoMO), and were negatively related to social support. Highlights • Insensitive IM social exchanges were positively related to loneliness and depression. • Insensitive IM social exchanges were positively related to fear of missing out. • Insensitive IM social exchanges were negatively related to social support. • IM hostility was positively related to loneliness and depression. • IM ridicule was positively related to loneliness and depression. [ABSTRACT FROM AUTHOR]

Objective: To compare the healing results between platelet-rich plasma (PRP) and platelet-derived patches versus traditional advanced wound dressings in patients with chronic wounds. Method: Patients with and without diabetes were divided into two groups, each of which received either PRP patch treatments or the advanced wound dressings. All wounds were cleaned, debrided and assessed by physicians. The data were analysed and represented as mean ± standard deviation (SD). Student's t-test was used to calculate the significance of differences between both groups. Values of p<0.05 were considered statistically significant. Results: Patients with and without diabetes receiving PRP patch treatments saw improvement in wound healing in two weeks (p=0.0083). Patients with diabetes who received platelet-derived patch treatment and PRP injection experienced wound size reduction to <25% of the original area by the fourth week of treatment, and >90% of the subjects had wounds of <10% their original size in the last three weeks of the trial. Conversely, the wound area in the control subjects receiving traditional advanced wound dressings remained at 25–50% of their original size from the fourth week of treatment to the end of the trial. The healing process of the PRP patch experimental group was statistically significant compared with the control group (p<0.0001). Conclusion: Combining treatments of PRP injections and platelet-derived patches significantly improved the healing outcomes of patients with chronic wounds, most notably in patients with diabetes, when compared with a traditional treatment of advanced wound dressings. [ABSTRACT FROM AUTHOR]

Although organ transplantation is the definitive treatment for end-stage organ failure, the post-transplant outcomes can be substantially influenced by cardiovascular complications. A national cohort study was performed to estimate risks of cardiovascular diseases in those with heart, lung, kidney, and liver transplantation. This cohort study consisted of 5978 solid organ transplantations identified using the Taiwan National Health Insurance Database. Cardiovascular and mortality risks in transplant recipients were evaluated using standardized incidence ratios, excess absolute risks, and standardized mortality ratios as compared to those in the general population. In heart, kidney, and liver recipients, the standardized incidence ratios of overall cardiovascular diseases were 9.41 (7.75-11.44), 3.32 (2.29-3.77), and 1.4 (1.15-1.7) and the overall standardized mortality ratios were 5.23 (4.54-6.03), 1.48 (1.34-1.63), and 3.95 (3.64-4.28), respectively. Except for heart organ recipients who were at highest risk for coronary artery disease with a standardized incidence ratio of 13.12 (10.57-16.29), kidney and liver organ recipients had a ninefold increased risk in developing deep vein thrombosis post-transplant. In conclusion, solid organ transplant patients are at risk of cardiovascular disease, in particular, deep vein thrombosis, which may warrant early identification of high-risk patients in addition to prompt and adequate thromboprophylaxis perioperatively. [ABSTRACT FROM AUTHOR]

Despite the evidence that some commonly used Chinese medications (CMs) have antiplatelet/anticoagulant effects, many patients still used antiplatelets combined with CMs. We conducted a nested case-crossover study to examine the associations between the concomitant use of antiplatelets and CMs and major bleeding using population-based health database in Taiwan. Among the cohort of 79,463 outpatients prescribed antiplatelets (e.g., aspirin and clopidogrel) continuously, 1,209 patients hospitalized with new occurring bleeding in 2012 and 2013 were included. Those recruited patients served as their own controls to compare different times of exposure to prespecified CMs (e.g., Asian ginseng and dong quai) and antiplatelet agents. The periods of case, control 1, and control 2 were defined as 1–4 weeks, 6–9 weeks, and 13–16 weeks before hospitalization, respectively. Conditional logistic regression analyses found that concurrent use of antiplatelet drugs with any of the prespecified CMs in the case period might not significantly increase the risks of bleeding over that in the control periods (OR = 1.00, 95% CI 0.51 to 1.95 and OR = 1.13, 95% CI 0.65 to 1.97). The study showed no strong relationships between hospitalization for major bleeding events and concurrent use of antiplatelet drugs with the prespecified CMs. [ABSTRACT FROM AUTHOR]

Human adenoviruses (HAdVs) are DNA viruses found in recreational water, such as water parks and swimming pools. Human adenovirus 41 (HAdV-41) is the most common serotype detected and is a leading cause of acute diarrheal disease. The focus of this study is to determine the prevalence of HAdVs in hot springs. Of 57 samples collected from four different geological sites, 16 samples have shown evidence of HAdVs (28.1%). HAdV-41 and porcine adenovirus 5 (PAdV-5) were the two types isolated, with a greater frequency of HAdV-41, which in other settings has been associated with acute diarrhea. The highest occurrence was found in private hot tubs/Yuya (37.5%), followed by an outlet of hot springs (30.8%); public pools and foot pools shared the same detection rate of 21.4% (3/14). However, there was no evidence supporting a link between water quality indicators and HAdV detection rate. From a phylogenic analysis and BLAST against the NCBI database, it was concluded that HAdV-41 obtained from hot spring areas are closely related to global environmental genotypes. [ABSTRACT FROM AUTHOR]

Aim The present study aimed to examine the associations between dietary patterns and depressive symptoms in a Taiwanese population aged 53 years and over, and evaluate the longitudinal impacts of dietary patterns on depressive symptoms. Methods Data were from the Taiwan Longitudinal Study of Aging. Result Depressive symptoms were identified in 23% of adults aged ≥53 years. Multivariate logistic regression analysis showed that a Western dietary pattern, which was characterized by frequent consumption of meat/poultry and eggs, with infrequent consumption of fish, beans/legumes, vegetables and fruit, was cross-sectionally associated with a high risk of depressive symptoms ( P < 0.05). A traditional dietary pattern, which was characterized by frequent consumption of meat/poultry and eggs with infrequent consumption of fish, increased by 60% the risk of depressive symptoms during the subsequent 8 years ( P < 0.05). A healthy dietary pattern, which was characterized by frequent consumption of fish, vegetables and fruits, was not significantly associated with subsequent depressive symptoms. Conclusions Dietary patterns correlate with depressive symptoms in a Taiwanese population aged 53 years and over. The Western and traditional dietary patterns, characterized by frequent consumption of meat/poultry and eggs, and infrequent consumption of fish, increased the risk of current and subsequent depressive symptoms. Geriatr Gerontol Int 2016; 16: 1289-1295. [ABSTRACT FROM AUTHOR]

Mud volcanoes are the most dynamic and unstable sedimentary structures in the areas of tectonic compression like the subduction zones. In this study, we comprehensively analyzed the distribution of minerals as well as diversity, abundance and metabolic potential of the microbial communities of major mud volcanic groups across Taiwan namely Chu-kou Fault (CKF), Gu-ting-keng Anticline (GTKA), Chi-shan Fault (CSF), and Longitudinal Valley Fault (LVF). The mud volcano fluids recorded relatively higher Na and Cl contents than the other elements, particularly in the CKF and GTKA groups. The highest microbial diversity and richness were observed in the CSF group, followed by the GTKA group, whereas the lowest microbial diversity was observed in the CKF and LVF groups. Proteobacteria were common in all the sampling sites, except WST-7 and WST-H (Wu-Shan-Ting) of the CSF group, which were abundant in Chloroflexi. The halophilic genus Alterococcus was abundant in the Na-and Cl-rich CL-A sites of the CKF group. Sulfurovum was dominant in the CLHS (Chung-Lun hot spring) site of the CKF group and was positively correlated with sulfur/thiosulfate respiration, which might have resulted in a higher expression of these pathways in the respective group. Aerobic methane-oxidizing microbial communities, such as Methylobacter , Methylomicrobium , Methylomonas , and Methylosoma , constituted a dominant part of the LVF and CSF groups, except for the YNH-A and YNH–B (Yang-Nyu-Hu) sites. The WST-7 and JS sites were abundant in both methane-producing and methane-oxidizing microbial communities. The LGH-F1 (Lei-Gong-Huo) site was dominated by both methanotrophic and methylotrophic genera, such as Methylomicrobium and Methylophaga , respectively. Methylotrophy, methanotrophs, and hydrocarbon-degrading pathways were more abundant in the LVF and CSF groups but not in the remaining groups. The results of this study extend our knowledge of the diversity, abundance, and metabolic functions of prokaryotes in major terrestrial mud volcanoes in Taiwan. [ABSTRACT FROM AUTHOR]

This study was aimed to evaluate the cross-sectional and longitudinal associations between various perceived-stress and depressive symptoms in old Taiwanese men and women aged 50 years and over. Data were derived from the Taiwan Longitudinal Study on Aging. Stress for health, finance, and family members’ related issues were all cross-sectionally associated with concurrent depressive symptoms for men and women (all P < 0.05). Increased/constant-high health stress was positively associated with subsequent depressive symptoms in both genders (all P < 0.05). Constantly high job stress and increased stress over family members’ problems were associated with higher likelihood of subsequent depressive symptoms in men ( P < 0.05). Constantly high/increased financial stress and relationship strain with family members were positively associated with subsequent depressive symptoms in women (all P < 0.05). The results suggest that stress for health, job, finance, and family members-related issues are unequally associated with depressive symptoms among Taiwanese men and women aged 50 years and over. Changes of health stress even reduced are significantly associated with subsequent depressive symptoms. Long-term job stress and increased stress over family members’ problems increase occurrences of men’s depressive symptoms, while increased/long-term financial stress and relationship-strain with family members increase occurrences of women’s depressive symptoms. Long-term high health stress has more impacts on men’s depressive symptoms than women’s, while long-term high relationship strain with family members has more impacts on women’s depressive symptoms than men’s. [ABSTRACT FROM AUTHOR]

For better traceability of seafood products in Taiwan, we need to effectively test product quality during the processes of identification of seafood species. The aim of this study was to analyse gene diversity and the methods of identification of high-value seafood, ivory shell ( Babylonia areolata ), on the Penghu Island in Taiwan using molecular marker technology and to build a relevant molecular database. Thirty-three samples of B. areolata and the samples of 5 other Babylonia species, including Babylonia feicheni , Babylonia spirata spirata , Babylonia perforata and Babylonia formosae formosae , from cultivation and from the wild were tested using the inter-simple sequence repeat ( ISSR ) method, mitochondrial DNA analysis, PCR-single-strand conformation polymorphism (PCR-SSCP) and PCR-denaturing gradient gel electrophoresis (PCR-DGGE). The results showed that the primers ISSR3, ISSR7 and ISSR13 of the ISSR method and cytochrome C oxidase subunit 1 ( coxI ) gene analysis have a good discriminatory power in inter-species and intra-species tests. In conclusion, ISSR, PCR-DGGE and PCR-SSCP with coxI analysis can be used for the screening and identification of B. areolata species. Furthermore, these molecular methods could be useful for the identification of other types of seafood. [ABSTRACT FROM AUTHOR]

• AdV pollution in fishing ports was associated with nearby polluted river water. • HAdV 41 and PAdV 5 were the dominant serotypes in the waters of the fishing ports. • The seasonal distributions of HAdV and PAdV differed significantly. • The AdV detection rate significantly differed according to regional distribution. • The presence of AdV was associated with total plate count, pH, and salinity. Adenoviruses (AdVs) are a major cause of clinical infections and have been proposed as indicators of water quality. However, quantitative data on the environmental prevalence of AdVs is lacking. We investigated the prevalence, distribution, seasonal occurrence, quantity, and genotype of AdVs in 13 fishing harbours in Taiwan. AdVs in the water samples were isolated by membrane filtration and the AdV DNA was extracted. Next, AdVs were detected using nested polymerase chain reaction. Genotyping and phylogenetic analysis were performed to identify various AdV genotypes present in the water samples. The F species human AdV (HAdV) serotype 41 (63.6%) and C species porcine AdV (PAdV) serotype 5 (33.3%) were more prevalent than the other serotypes. The prevalence of AdVs was highest in the fall, followed by in the spring and summer. Among the fishing harbours, the highest detection rate of AdVs was observed in Yenpudongang in all seasons. However, Puoziliao was the only site at which AdVs were not detected during the study period. AdV detection at sampling sites may be correlated with sewage and livestock wastewater discharge via outflow of nearby rivers to fishing ports. Statistical analysis (Mann–Whitney U test) based on data from water quality indicators revealed that the presence of AdVs was significantly associated with the heterotrophic plate count, pH, and salinity. Human and swine population data from nearby local townships and river/drainage basins were collected from the Taiwan Central Government's website. The data were analyzed using Spearman's rank correlation coefficient to determine the relationship between the prevalence of AdVs, HAdVs, and PAdVs in fishing harbours, and microbial water quality indicators. Statistical evidence indicated that the detection levels of HAdVs and PAdVs in fishing harbours were mainly associated with human and swine populations in the corresponding river/drainage basin, respectively. Additionally, the swine population in the river/drainage basin was positively correlated with microbial water quality indicators. [Display omitted] [ABSTRACT FROM AUTHOR]

The microbial characteristics of water bodies located in the outflow of hot springs may affect the water quality parameters of the associated river ecosystem. Using 16S rRNA amplicon sequencing, we investigated the bacterial diversity and functional profiles of the Huang Gang (HG) Creek, located in the trace metal-rich, acid-sulfate thermal springs zone of the Tatun Volcano Group (TVG). Biofilms and water samples were collected from the upstream, midstream, and geothermal valleys and downstream of the creek. The results showed that the biofilm and water samples had distinct bacterial diversity and abundance profiles. Acidophilic sulfur-oxidizing bacteria were found to be more abundant in water samples, whereas aquatic photosynthetic bacterial communities were dominant in biofilms. The water samples were contaminated with Legionella and Chlamydiae , which could contaminate the nearby river and cause clinical infections in humans. The upstream samples were highly unique and displayed higher diversity than the other sites. Moderate thermo-acidophiles were dominant in the upstream and midstream regions, whereas the geothermal valley and downstream samples were abundant in thermo-acidophiles. In addition, functional profiling revealed higher expression of sulfur, arsenic, and iron-related functions in water and lead-related functions in the biofilms of the creek. As described in previous studies, the hydrochemical properties of the HG Creek were influenced by the TVG hot springs. Our findings indicated that the hydrochemical properties of the HG Creek were highly correlated with the bacterial diversity and functional potential of running water as compared to biofilms. [Display omitted] • Bacterial characteristics of water were associated with hydro-chemical properties. • Proteo- and Cyano-bacteria are dominant phyla in water and biofilm, respectively. • Infectious potential Legionella and Chlamydiae genera have been found in the water. • Sulfur, arsenic, and iron functional bacteria were abundant in water than biofilms. • Acidophilic thermophiles were abundant in the geothermal valley associated samples. [ABSTRACT FROM AUTHOR]

Aim: This study evaluated the cross-sectional and longitudinal associations of functional and health status with institutional care, and examined determinants of institutional care use over time. Methods: Data of this study were obtained from the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET), which was launched in 1989 and involved a nationally representative sample of nearly-old and old Taiwanese. The baseline data in this present study were collected in 1999, and followed in 2003 and 2007. Results: Participants with institutional care use had a higher activities of daily living (ADL) score, more self-reported diseases and poorer self-reported health status than participants without institutional care use (all P < 0.05). Cross-sectional analysis showed that a higher ADL score, having heart diseases and having a stroke were positively associated with institutional care use ( P < 0.05); whereas the number of self-reported diseases and poor self-reported health status were not associated with institutional care use. Longitudinal analysis showed that increased ADL scores and the number of self-reported diseases over 4- and 8 years were associated with an increased likelihood of subsequent institutional care use (all P < 0.05). Worsening health status over 4 years was associated with an increased likelihood of subsequent institutional care use, but this association did not exist over 8 years. Conclusions: Only ADL and ADL deterioration over time are cross-sectionally and longitudinally associated with increased institutional care use. Declining functional status is a major determinant of institutional care use for Taiwanese aged over 53 years. Geriatr Gerontol Int 2013; 13: 597-606. [ABSTRACT FROM AUTHOR]

Purpose: We examined the extent of concurrent use of antiplatelets, anticoagulants, or digoxin with Chinese medications (CMs) and identified its associated factors. Methods: A retrospective cohort study was conducted using one million random samples from the Longitudinal Health Insurance Database 2005 in Taiwan. High-risk Western medications (HRWMs) focused on in this study were antiplatelets (aspirin, clopidogrel, dipyridamole, ticlopidine), anticoagulants (heparin, warfarin), and digoxin. Concurrent use was described as having an overlapping use period of HRWM with CMs any time in 2005. Baseline demographics, comorbidities, and health service utilizations between patients with and without concurrent HRWM-CM use were compared. Logistic regression analyses were performed to identify factors associated with incident concurrent use. Results: Of the 70,698 eligible HRWM users, 13.2 % used CMs concurrently for an average duration of 26.7 ± 43 days. The incidence of concurrent HRWM-CM use, which excluded prior CM use within 6 months preceding the first CM use, was 6.3 %. Warfarin or ticlopidine users were more likely to be prescribed with CMs than were the other HRWM users. Factors associated with an increasing incidence of concurrent HRWM-CM use included female sex, age 45-54 years, middle monthly income, higher number of outpatient visits or distinct prescribed medications, and a previous diagnosis of heart diseases, stroke, or hypertension. In contrast, age ≥65 years and higher medical expenditure were associated with a lower incidence of concurrent use. Conclusions: In the Taiwanese population, approximately one in eight HRWM users were concomitantly prescribed CMs. Whether such concurrent use is associated with adverse clinical outcomes warrants further investigations. [ABSTRACT FROM AUTHOR]

Abstract: In order to investigate the influences of the city scale, usage, topography, and climate on surface heat balance, the authors compared the surface heat balance for three urban areas in Taiwan, namely, Kaohsiung City, Taichung City, and Tainan City, estimated using ASTER and Formosat-2 data. The net radiation was in a similar range in all three study areas because the cities are in close proximity to each other. Tainan City released 60–70% of the sensible heat flux of the other cities because of its smaller size. Taichung City, which is located in a basin, exhibited the largest sensible heat flux, due to the radiation cooling during the night before the observation. Anthropogenic heat discharge clearly decreased the storage heat flux in certain industrial areas in Kaohsiung City and Taichung City, while the small scale urban functions moderated the variation of storage heat flux in Tainan City. These results imply that the terrain around a given city as well as the scale of urban activity significantly affect the heat balance in the cities. [Copyright &y& Elsevier]

Aims: Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is a promising alternative to ablative surgery in treatment of refractory obsessive-compulsive disorder (OCD). A pilot study was conducted to assess 15-month outcomes of DBS in patients with refractory OCD in Taiwan. Methods: Four adult patients with a 3-year or more history of refractory OCD (Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] score of at least 28) met the criteria for DBS surgery. DBS electrodes were implanted bilaterally in the VC/VS. Stimulation was adjusted for therapeutic benefit and absence of adverse effects. Psychiatric evaluation was conducted preoperatively, postoperatively, and at follow up at every 3 months for 15 months. Primary outcome measure was Y-BOCS. Secondary outcomes included the Hamilton Depression Rating Scale (HAM-D), and the Global Assessment of Function Scale. Results: Mean severity of OCD was a Y-BOCS score of 36.3 ± 2.1. At the end of 15 months' follow up, there was a 33.06% decrease in OCD severity ( P = 0.001). Similar findings were seen for HAM-D (32.51% reduction, P = 0.005), and Global Assessment of Function Scale (31.03% increase, P = 0.026). In terms of adverse effects, two patients suffered from hypomania episodes after several weeks of DBS stimulation, and one had transient hypomania-like syndrome during DBS initial programming. One patient (Case 1) had an allergic reaction to implantation of the pulse generator in the chest, and another patient (Case 3) exhibited vertigo. Conclusions: We confirm that DBS of the VC/VS appears to be beneficial for improvements in function and mood among patients with treatment-resistant OCD. Compared to previous studies examining the therapeutic effects of DBS, no serious adverse effects were observed. [ABSTRACT FROM AUTHOR]

Seven species of cultivated and edible seaweeds found in Southern Taiwan—including Enteromorpha intestinalis, Monostorma nitidum, Ulva lactuca, Dictyopteris undulata, Sargassum hemiphyllum var. chinense, Laurencia intermedia, and Porphyra dentate—were used to determine their antioxidant activity by different extraction methods. All seaweeds were extracted using water at 90°C, sterilization at 121°C, homogenization, or enzymatic hydrolysis. Extracts were evaluated for their free radical-scavenging capacity using 1,1-diphenyl-2-pricrylhydrazyl (DPPH), their reducing power, and their superoxide anion scavenging activity. The DPPH-scavenging capacity of S. hemiphyllum var. chinense extracts produced by sterilization (98.59%), homogenization (94.72%), and carbohydrate-degrading enzyme treatment was higher than that of protease extracts, except for U. lactuca. The reducing power of S. hemiphyllum var. chinense water extracts and M. nitidum Viscozyme extracts was better than that of a commercial antioxidant. S. hemiphyllum var. chinense exhibited higher superoxide anion scavenging activity than the other species. The results demonstrate that different extracts of some of the seaweeds showed remarkable antioxidant activity in different assays. The results also provide important information for the marine food industry and suggest that seaweed might be a valuable source of natural antioxidants. [ABSTRACT FROM PUBLISHER]

This case introduces an online learning adoption in a local hospital for improving employee training through a technology platform. In the third year after adoption, use of the online system had declined dramatically after initial enthusiasm by hospital staff. The learning technology seemed to be working as well as it always had. Incentives for training were still in place and there had been no significant changes to the organization in terms of growth or competitive and financial pressures. This phenomenon disappoints the implementers, and they want to know what had gone wrong and to decide the next step of action. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Mini-Nutritional Assessment (MNA) and Subjective Global Assessment (SGA) are two frequently used tools in nutritional assessment. Objectives: This study aimed to evaluate the feasibility of applying the MNA with population-specific anthropometric modifications and to compare the predictive ability of MNA with that of the SGA in patients with hemodialysis. Design: Purposive sampling. Methods: This study was conducted in the Hemodialysis Unit of E-Da Hospital in Kaohsiung, Taiwan. A total of 192 patients with hemodialysis were evaluated their nutritional status concomitantly with the SGA and the MNA in two versions-MNA Taiwan version-I adopted population-specific anthropometric cut points, and MNA Taiwan version-II had body mass index (BMI) omitted. Results: The SGA graded 1% malnourished and 51% at risk of malnutrition for patients with hemodialysis; MNA Taiwan version-I graded 3% and 41%, respectively, whereas MNA Taiwan version-II graded 5% and 36%, respectively. There were significant differences between patterns of nutritional status predicted with the SGA and the MNA versions (P <0.05). The scores predicted with both tools correlated positively with appetite, serum albumin and creatinine levels, BMI, and mid-arm and calf circumferences, and negatively with number of emergency visits. However, only MNA versions negatively correlated with length of hospital stay (all P <0.05). Linear regression analysis revealed that the MNA Taiwan version-I, -II and SGA scores were positively associated with BMI and serum albumin level, and negatively associated with number of emergency visits after adjusting for confounders (all P <0.05). However, only MNA Taiwan version-I and -II were negatively associated with C-reactive protein (CRP) level (P<0.05). The associations of MNA Taiwan version-II with albumin and CRP levels were stronger than those obtained using MNA Taiwan version-I and SGA. Conclusions: The present study suggests that both the modified MNA versions can evaluate nutritional risk of patients with hemodialysis in Taiwan. The MNA Taiwan version-II which adopted population-specific anthropometric cut values without BMI is better able to assess nutritional status and reflect health status of patients with hemodialysis than MNA Taiwan version-I and SGA. [Copyright &y& Elsevier]

Ethnicity and age play important roles in the epidemiology of idiopathic nephrotic syndrome (INS) in children. The purposes of this study were to compare the clinical features, renal histopathology, steroid response, and long-term prognosis in Chinese children between different age groups. This is a retrospective cohort study of children aged between 2 and 18 years old with INS. Patients were divided into two groups according to age. Group I consisted of children between 2 and 8 years old (n = 49). Group II consisted of the remaining patients (n = 50). The clinical biochemical parameters, response to steroid treatment, renal histology, and long-term outcomes were analyzed. The biochemical parameters at the onset were similar in the two groups. Group II had a significantly higher frequency of microscopic hematuria (P = 0.011). Of the 67 children biopsied, minimal change disease was the most common histopathology for both groups. There was a higher frequency with focal and segmental glomerulosclerosis in group II (24% vs. 6.1%), but the difference between the two groups was not significant. During follow-up, the frequency of hypertension was significantly higher in group II (P = 0.006). Two cases in group I developed chronic kidney disease (CKD) vs. eight cases in group II. The frequency of progression to CKD is significantly higher (P = 0.042) in Group II. In conclusion, children beyond 8 years of age with INS have a higher incidence of microscopic hematuria, higher risk of hypertension and progression to CKD in long-term follow-up. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association of body fatness and sedentary status with asthma and respiratory symptoms in schoolchildren in Kaohsiung, Taiwan. A questionnaire study elicited episodes of respiratory symptoms and data on lifestyle and anthropometric parameters in 1329 5th grade schoolchildren. Results showed that 12.4% of boys and 9.5% of girls had physician-diagnosed asthma, whereas 15.1% of boys and 12.4% of girls had suspected asthma. Significantly greater proportions of boys had non-exercise-induced respiratory symptoms than girls (p < 0.05). The number of respiratory symptoms was positively correlated with TV-watching time per day and self-reported sedentary time per weekend-day in girls (p < 0.05). Underweight was positively associated with one of the seven respiratory symptoms in girls (p < 0.05). At risk of overweight was positively associated with two of the seven respiratory symptoms in boys and one of the seven respiratory symptoms in girls (all p < 0.05). The risk of having physician-diagnosed asthma and suspected asthma increased 93% and 72%, respectively, in schoolchildren at risk of overweight (p < 0.05). Overweight was associated with a 78% increase in physician-diagnosed asthma (adjusted odd ratio (aOR) = 1.78, 95% CI = 1.08-2.91, p < 0.05). Higher sedentary time was significantly associated with more occurrences of one of the seven respiratory symptoms in girls (aOR = 1.05, 95% CI = 1.00-1.11, p < 0.05). Higher body mass index (BMI) was significantly correlated with longer TV-watching time per day in girls and longer self-reported sedentary time per weekday in boys (p < 0.05). In summary, schoolchildren who are at risk of overweight or overweight and/or have more sedentary time have increased risk of respiratory symptoms and asthma. Weight and sedentary statuses of schoolchildren can affect their respiratory health. [ABSTRACT FROM AUTHOR]

C-reactive protein (CRP), a plasma inflammation marker, has been known to play a role in the development of cardiovascular diseases. This study aims to evaluate the association of CRP with anthropometric and plasma lipid parameters in elderly Taiwanese 65 years or older. Data from the Elderly Nutrition and Health Survey in Taiwan (1999-2000), a national probability sampling study conducted to gain an understanding of the dietary pattern, and nutritional and health status of elderly Taiwanese were analyzed. Results showed that in men, CRP was positively correlated with age and waist-to-hip ratio (WHR) (both p<0.05) whereas in women, CRP was positively correlated with waist and WHR but negatively correlated with HDL-C (all p<0.05). Linear regression analysis showed that log CRP was positively associated with WHR in both genders (p<0.05) after adjusting for confounders. The correlation of CRP with WHR was stronger than that with both waist circumference and body mass index (BMI). Log CRP was inversely associated with HDL-C in women, but not men. The study suggests that among the anthropometric parameters examined, WHR is a stronger predictor for elevated CRP in elderly Taiwanese men and women. Whereas low HDL-C is a predictor among the plasma lipid parameters for elevated plasma CRP, at least in women. Gender differences exist in the association of CRP with anthropometric and lipid parameters. indices [ABSTRACT FROM AUTHOR]

Background: Liver transplantation is a challenging procedure that is associated with perioperative morbidity and mortality, so it is justifiable to perform such a procedure in high-volume procedure centers. Organ shortage remains a major issue in Taiwan. Due to the difficulty in establishing a high-volume procedure center, it is important to review the overall outcome of patients undergoing liver transplantation at a small-volume procedure center to determine if performing such a procedure is justified. Methods: Between April 2001 and May 2005, 26 adults underwent deceased donor liver transplantation at Taipei Veterans General Hospital. The overall outcomes were reviewed in terms of 90-day mortality, 1-year and 3-year survival rates. In addition, the patients were divided into a hepatocellular carcinoma (HCC) group (n =12) and a benign end-stage liver disease (ESLD) group (n =14). The clinical demographics, 90-day mortality, 1-year and 3-year survival rates were reviewed and compared between the 2 groups. Results: The 90-day mortality was 15.3% in the whole series, 8.3% in the HCC group and 18.7% in the ESLD group. The overall 1-year and 3-year survival rates were 76.9% and 63.5%, respectively, for the whole series. For the 2 groups, the respective 1-year and 3-year survival rates were 83.3% and 71.4% in the HCC group, and 71.4% and 57.1% in the ESLD group. The survival difference was not significant (p =0.319) between the 2 groups. In the HCC group, the 1-year and 3-year disease-free survival rates were 88.9% and 71.1%, respectively. Conclusion: The survival rates between ESLD and HCC patients undergoing liver transplantation at a small-volume procedure center were comparable. The results of the whole series were not satisfactory, but the results for the HCC group were acceptable. [J Chin Med Assoc 2008;71(4):186–190] [Copyright &y& Elsevier]

The average global annual growth rate of digital content products has grown exponentially. This is because of the technology advancement, cost reduction, and availability of the enabling technologies, e.g., digital processing, digital storage, and digital telecommunications. The development of the digital content industry (DCI) requires a strong cultural background, creative ideas, respect of intellectual property rights, and telecommunications infrastructure, which are all dependent on government supportive policies. This study summarizes the government policies, progress, and obstacles in the development of Taiwan's DCI and compares these subjects with other countries, including the United States, EU countries, Japan, and Korea. In this paper, Taiwan's DCI opportunities and challenges will be discussed, and strategies and recommendations will be provided, based on Taiwan's unique resources and competitive advantages. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the association of diet with respiratory symptoms and asthma in schoolchildren in Taipei, Taiwan. An in-class interview survey elicited experiences of asthma and respiratory symptoms and consumption frequencies of the major food categories in 2290 fifth graders. Respiratory symptoms surveyed included persistent cough, chest tightness, wheezing with cold, wheezing without cold, dyspnea-associated wheezing, and exercise-induced cough or wheezing. Results showed that the consumption of sweetened beverages had the strongest association with respiratory symptoms and was positively associated with six of the seven respiratory symptoms (all p < 0.05). The adjusted odds ratios (aOR) ranged from 1.05 (95% confidence interval (CI = 1.01-1.09) for exercise-induced cough to 1.09 (95% CI = 1.03-1.16) for wheezing without cold. Egg consumption was associated with 5 of the 7 respiratory symptoms. Consumptions of seafood, soy products, and fruits were each negatively associated with one of the seven respiratory symptoms (all p < 0.05). Consumption of seafood was negatively associated with physician-diagnosed asthma and consumptions of sweetened beverages and eggs were positively associated with suspected asthma (p < 0.05). In conclusion, the study suggests that diet is associated with the respiratory symptoms in schoolchildren in Taipei. Consumptions of sweetened beverages and eggs are associated with increased risk of respiratory symptoms and asthma whereas consumptions of soy products and fruits are associated with reduced risk of respiratory symptoms. [ABSTRACT FROM AUTHOR]

The study evaluated the associations of body fatness, TV-watching time, and physical activity with the occurrences of asthma and respiratory symptoms in schoolchildren in Taipei, Taiwan. A questionnaire survey was conducted to elicit episodes of respiratory symptoms and data on lifestyle and anthropometric factors in 2290 5th-grade schoolchildren. Results show that overweight was positively associated with 5 of the 7 respiratory symptoms. The risk of having respiratory symptoms increased 47%-94% in overweight schoolchildren. Watching TV ≥ 3 hrs/day was associated with more occurrences of respiratory symptoms (aOR = 1.42-1.90). Physical activity ≥3 times/week was associated with fewer occurrences of respiratory symptoms (aOR = 0.66-0.73). Overweight was positively associated with an increased risk of suspected asthma in boys (aOR = 1.56, 95% CI = 1.07-2.29), but not in girls. In summary, overweight and greater TV-watching time increase the risk of respiratory symptoms, while habitual physical activity decreases the risk of respiratory symptoms. Weight status, sedentary life, and frequency of physical exercise are the factors that can impact on the respiratory health of schoolchildren. [ABSTRACT FROM AUTHOR]

This study examined the association of residential environmental factors with respiratory symptoms and asthma in 2,290 fifth graders in Taipei, Taiwan. A self-report survey questionnaire elicited experiences of respiratory symptoms, disease history, and characteristics of residential environmental factors from schoolchildren. The proportion of schoolchildren having physician-diagnosed asthma was 9.8% and suspected asthma was 16.1%. The proportions of having respiratory symptoms in the past 12 months ranged from 9.8% for wheezing without a cold to 40.5% for exercise-induced cough. Higher proportions of boys had non-exercise-induced respiratory symptoms, physician-diagnosed asthma, and suspected asthma than girls ( p [ABSTRACT FROM AUTHOR]