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Many educational strategies have been proposed to improve students' learning motivation and outcomes. This paper reports the student learning outcome results of a three-year study centered on the Electronics course at the Department of Physics of National Taiwan University. In the first year, peer instruction (PI) with in-class lectures was implemented. In the second year, in-class lectures were replaced with online lectures in a flipped classroom (FC) approach, and PI in class was maintained. In the third year, PI-based conceptual questions (CQs) were scored as part of in-class homework to enhance motivation for online lecture preview. Learning performance was evaluated based on cumulative percentage of correct answers to CQs and summative assessment. The results revealed improved student performance on summative assessment with PI and FC approaches combined. Furthermore, when CQs were scored, overall learning outcomes were significantly enhanced. In addition, an advantage of using a PI plus FC approach over using PI alone is that more course materials can be covered in online videos, which prevents a loss of lecture content to the time-consuming, in-class discussions involved in PI. Our study indicates that when students' motivations to prepare before class are reinforced using graded CQs, the learning outcome enhancement of PI plus FC is even more significant.

Background. Reversed condition is rarely found in most flatfishes in natural environment, except for some certain species. The mechanism controlling the reversals in flatfishes has been studied in some cultivated species, whereas some have only few cases for the entire family and remain unclear. Here, we report the first record of a dextral (reversed) specimen of Parabothus taiwanensis Amaoka & Shen, 1993 collected off southwestern Taiwan recently. It represents the second reversed case ever recorded in Bothidae. We aim to provide a detailed description of this dextral specimen and compared to the sinistral (normal) specimens collected from the vicinity. Methods. Specimens were fixed in 4% formaldehyde and transferred to 70% ethanol for preservation. Meristic and morphometric characters were examined for both dextral and sinistral specimens. Dissections were made on specimens to confirm the position of internal organs. Lastly, X-radiographs were taken to elucidate the osteological features. Results. As a result, no differences of both meristic and morphometric characters were observed between the dextral and sinistral specimens. Nevertheless, situs inversus viscerum is discovered in the dextral specimen for the first time in Bothidae and the sixth record within flatfishes. [ABSTRACT FROM AUTHOR]

In massive bleaching events (losing symbiotic algae from corals), more sensitive corals are bleached earlier than other corals. To perform a comparison of bleaching susceptibility within and across coral species, a simple quantitative method is required. Accordingly, we present a laboratory-based method for comparing the bleaching susceptibility of various coral species by using a standardized image analysis protocol. Coral fragments were sampled from the colonies of five species selected from Kenting, southern Taiwan, and maintained in the same aquarium tank with circulating seawater; 2 seawater temperature regimes were used (i.e., fast-heating program (FHP), with a heating rate of 1 °C per day; and slow-heating program (SHP), with a heating rate of 1 °C per 3 days). Each coral fragment was photographed periodically, and the colored images were subsequently converted to grayscale images and then digitally analyzed to determine the standardized grayscale values (G0) by comparing with that of standard color strip. The G0 of a sample at each time of photographing during bleaching was divided by the difference of G0 between the acclimating and the same but completely bleached fragment to derive the relative grayscale (RG%) at a particular stage of bleaching; this is done for each coral fragment of a colony. The smaller the RG% of a coral fragment the closer it is approaching completely bleached condition. The level of decrease in RG% within a time series of images in each heating regime was used to establish a bleaching time index (BTI). The lower the BTI, the sooner to reach a defined bleaching level (e.g., 30%), this indicates the coral is more sensitive to thermal bleaching. In the experiment, we compared the bleaching susceptibility of the five species. Based on the proposed BTI, the five species were ranked in terms of bleaching susceptibility, and the rankings were identical between the two temperature regimes; three species in Pocilloporidae had lower BTI, whereas the hydrocoral Millepora species had the highest BTI. Within each heating regime, the BTI of different species were ranked and used to indicate susceptibility. In the FHP, the three Pocilloporidae species could be divided into two groups in terms of bleaching susceptibility. FHP not only displayed a higher differentiating capability on coal bleaching susceptibility than SHP, but also had a faster completion time, thus reducing the likelihood of unforeseen complications during the tank experiments. Our color-based method is easier and less effort-intensive than methods involving the assessment of zooxanthellae densities. Moreover, it requires much fewer replicates and all samples in one large tank (e.g., 300 L) for the studies considering multiple species comparisons. This method opens opportunities for studying the effects of species types, acclimatization (e.g., seasons), and environmental factors other than temperature on coral bleaching. [ABSTRACT FROM AUTHOR]

Background: In aging societies, residents of residential long-term care facilities (RLTCF) are a population that can significantly influence the success of efforts to promote hospice care and to achieve societal goals of domestic aging in place and good death. Multidisciplinary healthcare providers in RLTCF play vital roles in assessing, coordinating, and implementing the "five whole concepts" of hospice care. Purpose: To explore multidisciplinary healthcare providers' experiences with implementing hospice care in RLTCF. Study results may be referenced for future research into hospice care in RLTCF. Methods: In this qualitative study, one-on-one interviews were conducted with 14 multidisciplinary healthcare providers working for three hospital-affiliated RLTCFs in Northern Taiwan from April to July 2019. Each interview lasted between 40 and 68 minutes. Data were transcribed and then analyzed using the content analysis technique. Results: The emergent themes derived from participant experiences were "lack of hospice care literacy and multidisciplinary communication", "insufficient resources for hospice care implementation", "a dilemma between reasonability and sensibility", "quandary about and bearing from facing family dying", and "expectation of mental and physical well-being for family and residents". Conclusions/Implications for Practice: The experiences of the participants illuminate the importance of strengthening hospice care training for multidisciplinary RLTCF healthcare providers; establishing standard operating procedures; and increasing the manpower, environmental, and equipment resources available for implementing hospice care in RLTCF. [ABSTRACT FROM AUTHOR]

Background: The Taiwanese government increased financial subsidies for smoking cessation services in 2012. We aimed to evaluate the effects of this new policy on smoking cessation services from the physician's perspective.Methods: This was a cross-sectional nationwide survey. Physicians who provided smoking cessation services for more than ten patient encounters in the preceding year of the new policy (February 2011 to March 2012) were recruited. The questionnaire was developed by two experts and was validated by a committee consisting of 11 delegates.Results: We sent a total of 1,319 questionnaires. The response rate was 45.9 %. The majority of respondents were male (88.4 %), middle-aged (65.3 %), and worked as family physicians (56.1 %). Most physicians agreed that the new policy had increased the number of patients seeking smoking cessation, increased patients' willingness to adopt pharmacotherapy, helped physicians to prescribe medications, improved patients' adherence to medications, and improved quality of care. These changes were most prominent in medical centers. Changes in the practice of the 5As (ask, advise, assess, assist, arrange) were moderate. Among different medical settings, the most significant change was an increase in the expenditure on smoking cessation medications.Conclusions: The new subsidization policy in Taiwan has improved smoking cessation services. Overall, physicians reported positive effects of the new policy. Further study is warranted to evaluate the long-term influence of the policy. [ABSTRACT FROM AUTHOR]

Background: The European Organisation for Research and Treatment of Cancer (EORTC) Group has developed a new multidimensional instrument measuring cancer-related fatigue to be used in conjunction with the quality of life core questionnaire (EORTC QLQ-C30). The module EORTC QLQ-FA13 assesses physical, cognitive, and emotional aspects of cancer-related fatigue.Methods: The methodology follows the EORTC guidelines for phase IV validation of modules. This paper focuses on the results of the psychometric validation of the factorial structure of the module. For validation and cross-validation confirmatory factor analysis (maximum likelihood estimation), intraclass correlation and Cronbach alpha for internal consistency were employed. The study involved an international multicenter collaboration of 11 European and non-European countries.Results: A total of 946 patients with various tumor diagnoses were enrolled. Based on the confirmatory factor analysis, we could approve the three-dimensional structure of the module. Removing one item and reassigning the factorial mapping of another item resulted in the EORTC QLQ-FA12. For the revised scale, we found evidence supporting good local (indicator reliability ≥ 0.60, factor reliability ≥ 0.82) and global model fit (GFI t1|t2 = 0.965/0.957, CFI t1|t2 = 0.976/0.972, RMSEA t1|t2 = 0.060/0.069) for both measurement points. For each scale, test-retest reliability proved to be very good (intraclass correlation: R t1-t2 = 0.905-0.921) and internal consistency proved to be good to high (Cronbach alpha = .79-.90).Conclusion: Based on the former phase III module, the multidimensional structure was revised as a phase IV module (EORTC FA12) with an improved scale structure. For a comprehensive validation of the EORTC FA12, further aspects of convergent and divergent validity as well as sensitivity to change should be determined. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the conceptual structure of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30 (EORTC QLQ-C30) by analyzing data collected from patients with major cancers in Taiwan. The conceptual structure underlying QLQ-C30, including higher-order factors, was explored by structural equation modeling (SEM). Methods: The Taiwan Chinese version of the EORTC QLQ-C30 was used as the measuring instrument. Higher-order models, including mental health/physical health, mental function/physical burden, symptom burden/function, single latent health-related quality of life, formative symptom burden/function, and formative health-related quality of life, were tested. Results: Study subjects included 283 patients with breast, lung, and nasopharyngeal cancers. The original QLQ-C30 multi-factorial structure demonstrated poor composite reliability of the cognitive function subscale. The formative symptom/burden model was favored by model fit indices, further supporting causal-indicator duality, but was compromised by unexpected associations between symptomatic subscales and latent factors. The formative health-related quality of life was proposed with a single second-order latent factor where symptomatic subscales remained formative. Two additional symptom measures from the formal cognitive function subscale with the formative health-related quality-of-life model were proposed as the alterative conceptual structure for the Taiwan Chinese QLQ-C30. Conclusions: Results of the current study represent the complete SEM approach for the EORTC QLQ-C30. The formative health-related quality-of-life model with elimination of cognitive function enhances the conceptual structure of the Taiwan Chinese version with parsimonious fit and interpretability. [ABSTRACT FROM AUTHOR]

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

Objective Informational needs among cancer patients are similar, but the degree of information disclosure in different cultural areas varies. In this paper, we present the results of a cross-cultural study on information received. Methods The EORTC information questionnaire, EORTC QLQ-INFO25, was administered during the treatment process. This questionnaire evaluates the information that patients report they have received. Cross-cultural differences in information have been evaluated using statistical tests such as Kruskall-Wallis and multivariate models with covariates to account for differences in clinical and demographic characteristics across areas. Results Four hundred and fifty-one patients from three cultural areas, North-Middle Europe, South Europe, and Taiwan, were included in the study. Significant differences among the three cultural areas appeared in eight QLQ-INFO25 dimensions: information about the disease; medical tests; places of care; written information; information on CD/tape/video; satisfaction; wish for more information; and information helpfulness. North-Middle Europe patients received more written information (mean = 67.2 (North) and 33.8 (South)) and South Europe patients received more information on different places of care (mean = 24.7 (North) and 35.0 (South)). Patients from North-Middle Europe and South Europe received more information than patients from Taiwan about the disease (mean = 57.9, 60.6, and 47.1, respectively) and medical tests (70.9, 70.4, and 54.5), showed more satisfaction (64.8, 70.2, and 35.0), and considered the information more helpful (71.9, 73.9, and 50.4). These results were confirmed when adjusting for age, education, and disease stage. Conclusion There are cross-cultural differences in information received. Some of these differences are based on the characteristics of each culture. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the actual situations that young female sex workers must face in order to provide policy advice for the prevention and control of sexually transmitted infections. Methods: We conducted tape-recorded in-depth interviews with female sex workers under 30 years of age by snowball sampling. The main content of the interviews included working conditions and the actual use of condoms. We spent about 90 to 120 minutes for the first interview, and extended to second or third interviews if necessary. We analyzed the tape recordings to summarize the common experiences of the participants. Results: A total of 19 young female sex workers participated in this study. We found that the participants had little ability to avoid sexually transmitted infections. They had inadequate socialization skills and minimal knowledge obtained from school; therefore, they had little ability to negotiate with their customers. Incorrect measures of self-protection further increased their opportunity to get infected. Conclusions: We recommend a preventive strategy of harm reduction by establishing a peer-consultation model to deliver correct knowledge and bargaining skills, combined with passive, comprehensive screening to help young sex workers prevent and detect sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the reliability and validity, and the application of the Taiwan Chinese Version of the EORTC QLQ-OES18. Methods: The authors translated the questionnaire according to the guideline of the EORTC. Ninety-five patients with oesophageal cancer in National Taiwan University Hospital were interviewed using the questionnaire and the EORTC QLQ-C30 between October 2002 and September 2007. Answer distribution and psychometric properties of the EORTC QLQ-OES18 were examined. Results: The mean age of the patients was 60 years (SD 12 years). Most of the patients were in advanced stages of disease, with two-thirds off-treatment. The Cronbach's alpha coefficients were satisfactory (0.77-0.82) or near-satisfactory (pain: 0.67). The item-to-own and item-to-other scale correlations showed satisfactory results. Patients who were on-treatment versus off-treatment had significantly poorer quality of life scores in dysphagia, dry mouth, and taste, and a borderline poorer score in cough. Opposite situations were seen in the scales of reflux and choking. Conclusions: The EORTC QLQ-OES18 is a valid instrument to assess quality of life issues in patients with oesophageal cancer in Taiwan. [ABSTRACT FROM AUTHOR]

This study evaluated the associations between economic, social, psychological factors, and health-related quality of life of hemodialysis patients. Cross-sectional study design was used. End-stage renal disease patients who had received maintenance hemodialysis for more than 2 months at 14 centers in northern Taiwan were invited to participate. Demographic, economic, and psychosocial data of patients were collected. Depression was assessed by the Beck Depression Inventory. Health-related quality of life was measured by the Medical Outcomes Study Short-Form 36. Multivariable linear regression analyses were performed. Eight hundred sixty-one patients (373 males, mean age 59.4 ± 13.2 years) completed the study. Higher monthly income was positively associated with role emotional and mental health ( P < 0.05), and so was increased frequency of social activities with social functioning ( P < 0.05). The more worries, the stronger the inverse associations with social functioning ( P < 0.05) and mental health ( P < 0.01). Higher depression scores were associated with lower scores of all Short-Form 36 dimensions ( P < 0.01). Higher monthly income and increased social activities are associated with better health-related quality of life, whereas more worries and higher depression scores are associated with worse health-related quality of life of hemodialysis patients. [ABSTRACT FROM AUTHOR]

The relatively high incidence of gastric cancer in Taiwan warranted the need of a disease-specific quality of life (QOL) instrument. We translated the EORTC QLQ-C30 and QLQ-STO22 according to the guidelines from the EORTC. A total of 100 patients were interviewed. Convergent and discriminant validity, Cronbach's alpha coefficient and known-groups comparisons were used to examine the reliability and validity. We found good reliability for multi-item subscales of the QLQ-C30 and QLQ-STO22 (Cronbach's alpha coefficient: 0.70–0.94) except cognitive functioning of the QLQ-C30 and eating restriction of the QLQ-STO22. Patients in the active treatment group experienced compromised functional status and worse treatment-associated symptoms than those in the follow-up group. Similar results were found in comparisons based on Eastern Cooperative Oncology Group (ECOG) Performance Status and dysphagia grades. The study has ascertained the cross-cultural validity, reliability and clinical applicability of the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-STO22. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study compared the health-related quality of life (HRQOL) of mothers using different infant feeding methods. We used the Medical Outcomes Study 36-item Short-Form (SF-36) to measure the HRQOL of 1,747 mothers and used the scores to look for associations with infant feeding methods (not breastfeeding, breastfeeding for <1 month, breastfeeding 1–5 months, and still breastfeeding at the 6th month). The mothers were chosen via a stratified sampling from the Taiwan national birth registration data between November and December 2003. HRQOL and breastfeeding duration were positively associated. Of the eight unadjusted domain scores of the SF-36, general health perception and mental health were significantly different among these four different infant feeding groups ( P < 0.05). After controlling for potential confounding factors, mothers who breastfed for 6 months or longer had a higher HRQOL score than the other mothers. In addition, their physical functioning, general health perception and mental health scores were higher than those of mothers who did not breastfeed ( P < 0.05). Mother’s family income and parity and child’s health status were also associated with mother’s quality of life. Compared to the other mothers, mothers who breastfed for six moths or longer had better HRQOL. However, the limitation that this study was cross-sectional in design should be considered and further studies are needed. [ABSTRACT FROM AUTHOR]

Background: In recent years, the creation of supportive environments for encouraging mothers to breastfeed their children has emerged as a key health issue for women and children. The provision of lactation rooms and breast pumping breaks have helped mothers to continue breastfeeding after returning to work, but their effectiveness is uncertain. The aim of this study was to assess the effects of worksite breastfeeding-friendly policies and work-related factors on the behaviour of working mothers. Methods: This study was conducted at a large Taiwanese semiconductor manufacturer in August-September 2003. Questionnaires were used to collect data on female employees' breastfeeding behaviour, child rearing and work status when raising their most recently born child. A total of 998 valid questionnaires were collected, giving a response rate of 75.3%. Results: The results showed that 66.9% of survey respondents breastfed initially during their maternity leave, which averaged 56 days. Despite the provision of lactation rooms and breast pumping breaks, only 10.6% mothers continued to breastfeed after returning to work, primarily office workers and those who were aware of their company's breastfeeding-friendly policies. Conclusion: In conclusion, breastfeeding-friendly policies can significantly affect breastfeeding behaviour. However, an unfavourable working environment, especially for fab workers, can make it difficult to implement breastfeeding measures. With health professionals emphasizing that the importance of breastfeeding for infant health, and as only females can perform lactation, it is vital that women's work "productive role" and family "reproductive role" be respected and accommodated by society. [ABSTRACT FROM AUTHOR]

Aim: Comprehensive periodic health examination of elderly people is popular in Taiwan. The purpose of this study is to identify predictors of mortality of the elderly from the findings of their periodic health examination. Methods: From the period 1996-1999, 4794 elderly people aged 65 and older underwent periodic health examination in our institution. The status of survival of these 4794 subjects up to 31 December, 2000 was ascertained. Cox proportional hazard regression was performed to estimate the hazard ratio of mortality of the findings in the health examination. Results: The median follow-up time was 34 months. In the multivariate model, significant findings associated with increased mortality included: smoking daily (hazard ratio [HR]: 1.401; 95% CI = 1.000-1.963); intake less than three dishes of vegetables and two fruits per day (HR: 1.434; 95% CI = 1.049-1.960); urine protein > 0.3 g/L (HR: 2.184; 95% CI = 1.399-3.411); low hemoglobin (HR: 1.924; 95% CI = 1.423-2.602); serum albumin < 40 g/L (HR: 2.108; 95% CI = 1.514-2.935); globulin > 35 g/L (HR: 1.421; 95% CI = 1.034-1.952); serum aspartate transaminase level > 40 IU/L (HR:2.468, 95% CI = 1.571-3.878); and blood urea nitrogen level > 7.8 mmol/L (HR: 1.427; 95% CI = 1.025-1.988). Conclusions: Lifestyle, dietary habit and some findings of the blood and urine tests done in the periodic health examination were found to be significantly associated with the mortality of people aged 65 years or older in Taiwan. [ABSTRACT FROM AUTHOR]

The objective of this study was to test the reliability and validity of the Taiwan Chinese version of the EORTC QLQ-C30 (version 3) and EORTC QLQ-BR23. The authors followed the guidelines of translation and pilot testing of the questionnaires. The questionnaires were given to 35 breast cancer patients under active treatment and 54 under follow-up at the National Taiwan University Hospital from November 2000 to October 2001. A retest was conducted one to two weeks after the first interview/form completion for the follow-up group. The intraclass correlation coefficients of the two questionnaires were moderate to high in the follow-up group. The Cronbach's α coefficients of most scales of the two questionnaires were ≥ 0.70 except that of physical functioning (0.68), cognitive functioning (0.53), and arm symptoms (0.59). Correlations of scales measuring similar dimensions of the EORTC QLQ-C30 and the SF-36 were moderate. Patients in the active treatment group had more serious QOL problems due to disease and treatment. Results of this study showed that the Taiwan Chinese version of the two questionnaires had good test/retest reliability, high internal consistency in most scales, and could show the expected differences between patients in active chemotherapy and follow-up group. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the quality of life (QOL) impact of urinary incontinence (UI) and to examine its relationship with treatment seeking in adult Taiwanese women. We conducted a cross-section in-person questionnaire interview of 1608 adult women living in the Taipei area. The characteristics and incontinence status were recorded. A short form incontinence impact questionnaire (IIQ-7) was used to evaluate the QOL impact of UI. Multiple logistic regression analysis was used to assess the determinative factors for treatment seeking. The mean IIQ-7 score of the 205 (12.7%) women who reported urinary leakage more than once per month in the preceding 12 months was 5.0 (range: 0–19), which showed a significant correlation with the severity of incontinence (r = 0.59, p < 0.001). Women with mixed type UI had a higher IIQ-7 score compared to those with stress or urge UI. Fifty-five (26.8%) incontinent women had sought medical help. Treatment seeking was highly related to IIQ-7 scores as 75% of incontinent women with an IIQ-7 score > 10 in contrast to 5% of those with an IIQ-7 score &les; (p < 0.001) had sought medical care. On multiple logistic regression analysis, perceiving UI as a disease and a higher IIQ-7 score were independent factors predicting treatment seeking. We concluded that UI is a common problem that brings substantial QOL impact to Taiwanese women. The IIQ-7 questionnaire may provide a useful measurement to quantitate the degree of QOL impact, which is largely affected by the severity and type of incontinence. Women who perceive UI as a disease and those with a higher degree of QOL impact are more likely to seek medical help. Furthermore, treatment seeking in Taiwanese women with significant UI may be more common than thought as a great majority of women with higher IIQ-7 scores had sought medical help. [ABSTRACT FROM AUTHOR]

Abstract: There was no existing scale in Mandarin Chinese to specifically measure QOL in old age. We aimed to validate a Chinese Taiwan version of the CASP-19 (control, autonomy, self-realization, pleasure), a QOL questionnaire, in Taiwan. The existing CASP-19 Cantonese version was modified into Chinese Taiwan version and pilot tested. Data were then gathered from 699 older people. Score distribution, exploratory and confirmatory factor structure, reliability and clinical validity of the CASP-19 and its shortened version, the CASP-12, were examined. The mean age of the participants was 75.5 (standard deviation (SD) 6.5), and half (49.5%) were female. The mean CASP-19 score was 38.2 (range 11–56; SD 7.1), lower than that of Western countries. Exploratory factor analysis revealed an additional factor, ‘participation’ (CASPP-19). There was satisfactory internal consistency (Cronbach's α 0.63–0.85) for the subscales, except for the control domain. For the 19-item scale, the first order five-domain model (CASPP-19) yielded the best fit. For the CASP-12, first and second order original CASP-12 models performed equally well. There was an inverse relationship between the CASP total scores and frailty, chronic diseases, depressive disorders, living alone and fall events in the past 12months, supporting good clinical validity for all versions of the CASP scale (CASP-19, CASPP-19, original and new CASP-12). The original CASP-12 may be presently the best choice for use in China, Taiwan or other Mandarin-speaking populations due to its conciseness and model parsimony. [Copyright &y& Elsevier]

This study seeks to examine whether being listed as a particular type of share (H share, red-chip stock, Taiwan-based stock, or Hong Kong local stock) on the main board of the Hong Kong Exchange will affect the idiosyncratic risks and market risks. The findings are as follows: (1) different political connections mainly affect idiosyncratic risk, (2) the hypothesis of big size with high market risk is supported, (3) the idiosyncratic risks of all the companies in each category taken by category are negatively correlated with expected short-run returns. These results mean that investors should hold the stocks with previous low idiosyncratic risk to earn high expected returns. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To examine the prevalence rate and predictors of alcohol use problems among patients undergoing methadone maintenance treatment (MMT). Design: This was a prospective follow-up study. Participants: Study population included 438 patients who underwent more than 6 months of MMT. Measurements: Demographic and clinical characteristics were collected for each patient prior to treatment, and treatment-related variables were collected during treatment process. Hazardous drinking, alcohol abuse, and dependence were measured using a Chinese version of the Alcohol Use Disorders Identification Test (AUDIT) and by measuring breath alcohol concentration. Findings: The prevalence rates of alcohol use problems, indicated by hazardous drinking are 31.4%. The protective predictors of alcohol use problems among MMT patients include an attendance rate of more than 90% (odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.30–0.97) and being older than 36 years (OR = 0.48, 95% CI = 0.27–0.86), and alcohol drinking problem at intake of study is a risk factor (OR = 5.30, 95% CI = 2.87–9.76). Conclusions: High attendance rate, which is regarded as a component of clinical policy and a key component of therapeutic context, should be incorporated with brief interventions to lower alcohol use problems among MMT patients. [Copyright &y& Elsevier]

Background/purpose: Breast cancer is the most common female malignancy in Taiwan; however, quality of life (QOL) following breast cancer therapy remains rarely studied. The aim of the present study was to evaluate QOL among Taiwanese breast cancer patients with and without breast-conserving therapy.Methods: A total of 130 women with breast cancer (37 with breast-conserving therapy and 93 with modified radical mastectomy) were enrolled between August, 2004 and December, 2007 in a single center. Patients who underwent breast-conserving therapy were younger, less likely to be married, had a higher educational level, and were at an earlier clinical stage than those who underwent modified radical mastectomy. The traditional Chinese version of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 questionnaires were used as measuring instruments. Structural equation modeling with mean structural analysis, which evaluates configuration invariance and compares groups for latent functional/symptomatic factors, was constructed using a multi-indicators approach.Results: Patients with breast-conserving therapy reported worse global QOL status and role function scores and higher symptomatic scores for fatigue, pain, dyspnea, insomnia, appetite loss, breast and arm problem subscales than those without conserving therapy. In addition, age, marital status, hormone manipulation and postoperative adjuvant therapy were significant confounders for QOL. Measurement invariance was ascertained and the same QOL construct could be applied to Taiwanese subjects with and without breast-conserving therapy.Conclusion: Our study suggests that breast-conserving therapy might be associated with worse perceived QOL for Taiwanese breast cancer survivors. [ABSTRACT FROM AUTHOR]

Background Despite a growing body of literature reporting eating disorders (EDs) in non-Western countries in recent years, most of these studies are limited to questionnaire-based surveys or case-series studies. This study aimed to investigate the prevalence and correlates of EDs in Taiwanese high-school students.Methods The study subjects consisted of all the female high-school students enrolled in the gifted dance class in 2003 in Taiwan (n=655) and non-dance female students randomly chosen from the same school (n=1251). All the participants were asked to complete self-report questionnaires, including the 26-item Eating Attitudes Test (EAT-26) and the Bulimic Investigatory Test Edinburgh (BITE). All the screen positives and an approximate 10% random sample of the screen negatives were then interviewed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Version (SCID-I/P).Results The prevalence of individual EDs was much higher in the dance [0·7% for anorexia nervosa (AN), 2·5% for bulimia nervosa (BN) and 4·8% for EDs, not otherwise specified (EDNOS)] than in the non-dance (0·1, 1·0 and 0·7% respectively) students. Multivariate logistic regression analyses revealed that being in the dance class, higher concern about body shape and lower family support were correlates of EDs for all students, whereas lower parental education level was associated with EDs only for non-dance students.Conclusion EDs were more prevalent in the weight-concerned subpopulation. Although AN is still rare, BN has emerged as a comparable prevalent disorder in Taiwan, as in Western countries. [ABSTRACT FROM AUTHOR]

Background Type 2 diabetes is becoming more prevalent and its successful management relies on patients' self-care behaviours. Measures focusing on patients' perceptions can be effective behavioural interventions. Aim To gain insight into the perceptions of patients with diabetes, especially ideas of the illness course and perceived severity, and their impacts on self-care behaviour. Design of study Qualitative approach with in-depth patient interviews (n = 22) and seven focus groups (n = 53). Setting A rural town in Taiwan. Method The interview protocol was mainly derived from Kleinman's explanatory model. Purposive sampling strategies of maximum variation were used. The transcript of the interviews was analysed with editing and immersion/crystallisation styles. Results Diabetes is regarded as an incurable, inevitably deteriorating disorder of sugar metabolism with many chronic complications. Patients thought that renal injury, followed by blindness, leg amputation, and poor peripheral circulation, were the most frequent complications. They also assessed their perceived severity of the disease at specific points in time through different indicators in their daily lives, such as sugar level, presence of complications, and medications used. Patients felt that these aspects progressed concurrently and that the illness course followed a unidimensional process. The ever-increasing doses of medication was considered by these patients to be a side-effect of the drugs taken. Conclusion Physicians should clarify with their patients that the risks of uraemia, blindness, and leg amputation are less prevalent than expected and that patients should pay more attention to cardiovascular complications. Certain oral hypoglycaemic agents may not cause a vicious cycle of ever-increasing doses of medication and the drugs that need to be taken should not be seen as indicators of severity but, rather, measures taken to prevent the diabetes becoming severe in the future. [ABSTRACT FROM AUTHOR]

Mycoplasma pneumonia (MP) infection might be pathogenically closely related to urticaria. This study is a nationwide population-based cohort study from 1997 to 2013, which investigated the association between MP infection and urticaria in Taiwan. A total of 1,175 patients were included for the study group, and 2,350 for the control group. Multivariate Cox regression analysis was performed to estimate the adjusted hazard ratio (aHR) for urticaria. Result showed that 254 patients with new-onset urticaria were involved in the study group and 465 incident cases in the control group. The incidence rates (per 100,000 person-months) of urticaria were 37.2 and 32.5 in the study and control groups, respectively. The relative risk is 1.1 (95% CI = 1.0–1.3) indicating no significant correlation between MP and urticaria. The multivariate analysis revealed that the risk of urticaria with MP infection (aHR = 1.1, P = 0.1058) had no statistically significance difference compared to the control group. However, the risk of urticaria in MP-infected patients aged between 20 and 59 years old was found to have increased (aHR = 1.6, 95% CI = 1.1–2.2) prior to a diagnosis. [ABSTRACT FROM AUTHOR]

Background: The increasing incidence of colorectal cancer in Taiwan has generated a need for a disease-specific quality-of-life measuring instrument. We aimed to validate the Taiwan Chinese version of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29.Methods: A total of 108 patients were interviewed. Convergent and discriminant validity, Cronbach's alpha coefficient, test-retest reliability, and known-groups comparisons were used to examine the reliability and validity.Results: We found good internal consistency reliability for multi-item scales of the QLQ-C30 and QLQ-CR29, except for the cognitive function and pain scale of the QLQ-C30. Patients in the active treatment group reported compromised functional scale scores (global health status/quality of life, QLQ-C30) and worse symptoms (blood and mucus in stool, QLQ-CR29) than those in the follow-up group. Similar results were found in comparisons based on Eastern Cooperative Oncology Group (ECOG) Performance Status and Bristol Stool Scale: higher physical function/sexual interest, less fatigue/urine frequency symptoms for patients with the lowest ECOG Performance Status (Grade 0), and borderline worse stool frequency scores from Types 5 and 6 patients on the Bristol Stool Scale.Conclusion: The study validated the Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-CR29. The clinical applicability warrants further studies with greater number of participants. [ABSTRACT FROM AUTHOR]

Background: The human leukocyte antigen (HLA) genes, exhibiting significant genetic diversity, are associated with susceptibility to various clinical diseases and diverse in drug responses. High costs of HLA sequencing and the population-specific architecture of this genetic region necessitate the establishment of a population-specific HLA imputation reference panel. Moreover, there is a lack of understanding about the genetic and phenotypic landscape of HLA variations within the Taiwanese population. Methods: We created models for a Taiwanese-specific HLA imputation reference panel. These models were trained with the array genotype data and HLA sequencing data from 845 Taiwanese subjects. HLA imputation was applied for 59,448 Taiwanese subjects to characterize the HLA allele and haplotype frequencies. Additionally, a phenome-wide association study (PheWAS) was conducted to identify the phenotypes associated with HLA variations. The association of the biallelic HLA variants with the binary and quantitative traits were evaluated with additive logistic and linear regression models, respectively. Furthermore, an omnibus test with likelihood-ratio test was applied for each HLA amino acid position in the multiallelic HLA amino acid polymorphisms to compare the difference between a fitted model and a null model following a χ2 distribution of n-1 degree of freedom at a position with n residues. Finally, we estimated the prevalence of adverse drug reactions (ADR)-related HLA alleles in the Taiwanese population. Results: In this study, the reference panel models displayed remarkable accuracy, with averages of 99.3%, 98.9%, and 99.1% for 2-, 4-, 6-digit alleles of the eight classical HLA genes, respectively. For PheWAS, a total of 18,136 significant associations with HLA variants across 26 phenotypes are identified (p < 5×10-8), highlighting the pleiotropy feature of the HLA region. Among the independent signals, 15 are novel, including the association of HLA-B pos 138 variation with ankylosing spondylitis (AS), and rs9266290 and rs9266292 with allergy. Through an analysis spanning the entire HLA region, we identified clusters of phenotype correlations. Finally, the carriers of pharmacogenomic related HLA alleles, including HLA-C*01:02 (35.86%), HLA-B*58:01 (20.9%), and HLA-B*15:02 (8.38%), were characterized in the Taiwanese general population. Conclusions: We successfully delivered the HLA imputation for 59,448 Taiwanese subjects and characterized the genetic and phenotypic landscapes of the HLA variations. In addition, we quantified the estimated prevalence of the ADR-related HLA alleles in the Taiwanese population. The developed HLA imputation reference panel could be used for estimation of population HLA allele frequencies, which can facilitate further studies in the role of HLA variants in a wider range of phenotypes in the population. [ABSTRACT FROM AUTHOR]

Evidence that smoking area restrictions and raising cigarette taxes affect smokers’ behavior of seeking help in cessation is limited. The authors conducted a case-control study of 200 participants in Taipei City, Taiwan, from December 2008 to June 2009 to evaluate the association between knowledge on legislation and the behavior of seeking help in smoking cessation. They compared smokers who sought assistance in clinics/classes and smokers who did not, matching for age, gender, and recruitment time. In a univariate model, both banning smoking and increasing prices had positive effects on smokers’ behavior, but the effect size of the latter was larger (P = .021). A better knowledge of the regulations was associated with cessation effort (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.44-5.23), as were being more influenced by increased prices (OR = 2.44; 95% CI = 1.38-4.34) and by smoking bans (OR = 2.32; 95% CI = 1.29-4.16). Increased knowledge of the regulations is associated with seeking help for smoking. [ABSTRACT FROM PUBLISHER]

For a long time, Taiwan was confined to being an object of the EU's China policy, but the EU increasingly treats Taiwan as a partner in its own right. EU-Taiwan relations are in their most dynamic stage since the EU opened its representative office in Taipei in 2003. But the 'One China policy' still constrains EU-Taiwan relations, as the EU only recognizes the People's Republic of China as a sovereign state and not Taiwan. The article analyzes EU-Taiwan relations through the lens of Normative Power Europe. Taiwan has gained more attention and support in the EU, because Taiwan is Asia's most liberal democracy. Furthermore, Taiwan also fits well into the EU's geo-economic strategy of de-risking. China's increasingly aggressive policy towards Taiwan and strong support from the United States for Taiwan strengthen the EU's support for Taiwan, too. [ABSTRACT FROM AUTHOR]

This article examines Zhang Wojun (1902–1955) and the memory of his 'collaboration' with Japan during the Second World War. A Taiwanese-born writer and educator who lived in Beijing for 25 years, his drifting identity was full of ambiguities. Although he was one of the key intellectuals behind Taiwan's New-Old Literatures Debate and responsible for introducing many May Fourth ideas to Taiwan, he also played an important role in bringing Japanese literature and thought into Chinese discourse during the 1920s, 1930s, and 1940s. During the war, he continued to teach in Beijing and travelled to Japan to attend the Greater East Asia Writers' conferences. Some of his works from this period call for the Chinese people to support the empire and eradicate Western culture and literature from Asia, but many of his writings also indicate a strong sense of Chinese nationalism. This article considers the memories of Zhang, his various intellectual contributions, and his oeuvre, arguing that his collaboration must be understood and contextualized within his intellectual landscape through a research methodology that examines continuities and change across decades of his life and work. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is a well-established risk factor for active tuberculosis (TB) infection. Despite the worldwide rapid increase in the prevalence of prediabetes, its impact on the risk of active TB remains largely unknown. This study aimed to investigate the relationship between prediabetes and risk of active TB in a large cohort study.Methods: A total of 119 352 participants were screened from a community-based health screening programme in Northern Taiwan. Diabetes mellitus and prediabetes were defined by baseline fasting plasma glucose (FPG) and prescription of anti-diabetic drugs. Incident cases of active TB were identified from the National Tuberculosis Registry. Kaplan-Meier curves and Cox regression analysis were employed to estimate the hazard ratios for prediabetes and DM compared with normoglycaemia. Spline regression was performed to investigate the dose-response relationship between FPG level and risk of TB disease.Results: At baseline, 27 404 (22.96%) participants had prediabetes and 10 943 (9.17%) participants had DM. After an average follow-up of 7.2 years, 322 TB cases occurred. The adjusted hazard ratio of developing active TB disease was 0.73 [95% confidence interval (CI) 0.55-0.97] for prediabetic and 1.48 (95% CI 1.11-1.98) for diabetic participants compared with normoglycaemic individuals. Spline regression revealed a U-shaped association between FPG level and risk of active TB disease, with the lowest risk at FPG around110 mg/dl. Sensitivity analyses were conducted to exclude factors such as potential confounders (including body mass index), misclassification of glycaemic level, and selection bias, and results showed that those factors could not explain the lower risk of active TB.Conclusions: Prediabetes was associated with a 27% reduced risk of active TB disease compared with normoglycaemia. The biological mechanism of this inverse association and its implication for global nutrition transition and TB control should be further investigated. [ABSTRACT FROM AUTHOR]

This study investigates age-specific prostate-specific antigen (PSA) distributions in Taiwanese men and recommends reference ranges for this population after comparison with other studies. From January 1999 to December 2016, a total of 213,986 Taiwanese men aged above 19 years old without history of prostate cancer, urinary tract infection, or prostate infection were recruited from the Taiwan MJ cohort, an ongoing prospective cohort of health examinations conducted by the MJ Health Screening Center in Taiwan. Participants were divided into seven age groups. Simple descriptive statistical analyses were carried out and quartiles and 95th percentiles were calculated for each group as reference ranges for serum PSA in screening for prostate cancer in Taiwanese men. Serum PSA concentration correlated with age (r = 0.274, p<0.001). The median serum PSA concentration (5th to 95th percentile) ranged from 0.7 ng/ml (0.3 to 1.8) for men 20–29 years old (n = 6,382) to 1.6 ng/ml (0.4 to 8.4) for men over 79 years old (n = 504). The age-specific PSA reference ranges are as follows: 20–29 years, 1.80 ng/ml; 30–39 years, 1.80 ng/ml; 40–49 years, 2.0 ng/ml; 50–59 years, 3.20 ng/ml; 60–69 years, 5.60 ng/ml; 70–79 years, 7.40 ng/ml; over 80 years, 8.40 ng/ml. Almost no change occurred in the median serum PSA value in men 50 years old or younger, while a gradual increase was observed in men over 50. Taiwanese men aged 60 years above showed higher 95th percentile serum PSA values compared to Caucasian men and men in other Asian countries but were closer to those of Asian American and African American men. Results indicate significantly different PSA levels correlating to different ethnicities, suggesting that Oesterling's age-specific PSA reference ranges might not be appropriate for Taiwanese men. Our results should be further studied to validate the age-specific PSA reference ranges for Taiwanese men presented in this study. [ABSTRACT FROM AUTHOR]

The evolution of the Taiwan orogen, an active arc–continent collision zone between the North Luzon Arc (NLA) and the Eurasian continent, is recorded in arc volcanic and sedimentary rocks from the Taiyuan retro‐foredeep basin of the Coastal Range, eastern Taiwan. Arc volcanism in the northern NLA experienced a magmatic culmination at 9–7 Ma and a cessation at 5.3–4.3 Ma, based on new U‐Pb zircon ages. Young zircon U‐Pb ages (1.74, 1.58, and <1.2 Ma) and low Hf isotope signatures also indicate that three biotite‐bearing lapilli tuff layers deposited in the retro‐foredeep basin are associated with eruptions of the Lutao volcano in the southern NLA. NLA volcanism terminated progressively from ∼5.3 to <1.2 Ma in response to a southward‐propagating collision zone that followed the uplift of the orogenic wedge by <3 myr. The detrital zircon U‐Pb age spectra suggest no significant shift in provenance during the Plio‐Pleistocene period and indicate that the synorogenic sediments in the Taiyuan Basin were mainly derived from the Yuli Belt, a Miocene accretionary complex in the eastern Taiwan orogen. The accumulation rate of synorogenic deposits varies from 0.53 to 5.14 km/myr, with an abrupt increase at ∼2 Ma. This new rate is higher than the previously proposed rates and that of the pro‐foreland basin to the west, suggesting asymmetric and rapid uplift of the Taiwan orogen. Plain Language Summary: Taiwan was formed by the northwestward convergence of the North Luzon Arc (NLA) with the Eurasian continental margin. Most of the uppermost parts of the arc volcanoes and orogens have been intensely eroded; nevertheless, their detritus is well preserved in the Taiyuan Basin in the southern Coastal Range, eastern Taiwan. In this study, zircons separated from remnant arc volcanic and sedimentary sequences are dated by an in situ U‐Pb method to offer temporal constraints and provide insight into the arc‐continental collision evolution in Taiwan. The latest ages from the NLA volcanoes reveal a southward cessation of magmatism from ∼5.3 to <1.2 Ma, which is consistent with an oblique collision. Detritus from the Yuli Belt, a Miocene accretionary prism in the eastern Taiwan orogen, started to fill the Taiyuan Basin beginning at <4.3 Ma. Meanwhile, three embedded tuff layers dated at 1.74, 1.58, and <1.2 Ma indicate eruptions associated with Lutao, an offshore NLA volcanic islet, and suggest an abrupt increase in the deposition rate at ∼2 Ma, corresponding to rapid and extensive exhumation of the Taiwan orogen. Key Points: New zircon U‐Pb ages confirm the history of the volcanic arc and retro‐foredeep sediments and their linkages to the nearby Taiwan orogenThe previously proposed shift in clastic composition of the retro‐foredeep sediments is interpreted as an unroofing record of the Yuli BeltOur zircon ages confirm the abrupt increase in the deposition rate of retro‐foredeep basin infilling from 0.53 to 5.14 km/myr at ∼2 Ma [ABSTRACT FROM AUTHOR]

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]

This paper presents results of a case study on cliff recession mechanism and progressive development of talus deposits around Xiangshan of the Sishou Hills in the southeast of the Taipei Basin. Based on photogrammetric analysis and physical modeling, the geomorphologic changes of talus deposits are carefully examined and the cliff recession rates from 1904 to 2005 are thus measured and tabulated. Our study identified the fundamental control factors on mechanisms of cliff recession and proposed a possible scenario of cliff recession and progressive development of talus deposits around the Xiangshan region from 1904 to 2005. [ABSTRACT FROM AUTHOR]

Milkfish, Chanos chanos, is often cultured with white shrimp, Penaeus indicus, to maintain ecological stability and increase profits. This study uses the outputs and cost data of 169 milkfish farmers in Taiwan for the years 2018 and 2019 and applies translog cost function modeling to analyze the production scale economy and input–input demand combinations of two stocking densities (<10,000, ≥10,000 fry/ha) and two fry stocking sizes (2–3 in. and ≥4 in.). The study found that high‐density stocking (≥10,000 fry/ha) of small or large milkfish fry has economies of scale overall. Thus, the average culture cost may be reduced by expanding the scale of milkfish production. High‐density stocking of small fry exhibits a comparatively higher own‐price elasticity of fry. As such, farmers are sensitive to fry price variations. The study also found that labor and capital exhibit the highest substitutability. Capital inputs may thus be increased to mitigate the effects of wage increments. In terms of production, the four observed clusters do not exhibit cost complementarity. Moreover, the survival rate of white shrimp in high‐density stocking milkfish polycultures is relatively low. It is thus recommended to strictly control the stocking density of white shrimp and to minimize the risk of excessively high stocking densities by stocking white shrimp in batches. [ABSTRACT FROM AUTHOR]

Overweight and obese are risk factors for various diseases. In Taiwan, the combined prevalence of overweight and obesity has increased dramatically. Here, we conducted a genome-wide association study (GWAS) on four adiposity traits, including body-mass index (BMI), body fat percentage (BF%), waist circumference (WC), and waist-hip ratio (WHR), using the data for more than 21,000 subjects in Taiwan Biobank. Associations were evaluated between 6,546,460 single-nucleotide polymorphisms (SNPs) and adiposity traits, yielding 13 genome-wide significant (GWS) adiposity-associated trait-loci pairs. A known gene, FTO, as well as two BF%-associated loci (GNPDA2-GABRG1 [4p12] and RNU6-2-PIAS1 [15q23]) were identified as pleiotropic effects. Moreover, RALGAPA1 was found as a specific genetic predisposing factor to high BMI in a Taiwanese population. Compared to other populations, a slightly lower heritability of the four adiposity traits was found in our cohort. Surprisingly, we uncovered the importance of neural pathways that might influence BF%, WC and WHR in the Taiwanese (East Asian) population. Additionally, a moderate genetic correlation between the WHR and BMI (γg = 0.52; p = 2.37×10−9) was detected, suggesting different genetic determinants exist for abdominal adiposity and overall adiposity. In conclusion, the obesity-related genetic loci identified here provide new insights into the genetic underpinnings of adiposity in the Taiwanese population. Author summary: Overweight and obese individuals are at risk for various medical conditions in Taiwan. Thus, we performed a genome-wide association study (GWAS) on four adiposity traits, including body-mass index (BMI), body fat percentage (BF%), waist circumference (WC), and waist-hip ratio (WHR), using information for more than 21,000 subjects from the Taiwan Biobank. We identified in total 13 genome-wide significant (GWS) adiposity-associated loci, which including well known genetic loci that associated with BMI, such as FTO. Additionally, we found RALGAPA1 as plausible specific susceptibility loci for BMI in Taiwanese. Surprisingly, pathway analysis revealing neuronal implication to BF%, WC and WHR in this population. [ABSTRACT FROM AUTHOR]

Background: The treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients in the 1990s in Taiwan was not satisfactory. To strengthen programmatic management of drug-resistant tuberculosis (PMDT), Taiwan MDR-TB Consortium (TMTC) was established in 2007. We assess the performance and epidemiologic impact of TMTC. Methodology/Principle findings: We analyzed the trends of proportion of TB cases with drug susceptibility testing, enrollment of MDR-TB patients into TMTC and outcomes of treatment of all MDR-TB patients in Taiwan from 2007–2016. We computed the trends of both incidence and prevalence of MDR-TB from 2007–2016. We assessed the trends of MDR-TB among both new and recurrent TB cases. The proportion of TB cases with drug susceptibility testing results increased from 24.2% in 2007 to 97.9% in 2016. Of the 1,452 MDR-TB patients who were eligible for TMTC care, 1,197 (82.4%) were enrolled in TMTC, in whom 82.9% had treatment success. MDR-TB incidence was 9.0 cases per million in 2007, which declined to 4.6 cases per million in 2016 (p<0.0001). MDR-TB prevalence decreased from 19.4 cases per million in 2007 to 8.4 cases per million in 2016 (p<0.0001). The proportion of MDR-TB among new TB cases decreased from 1.4% in 2010 to 1.0% in 2016 (p = 0.039); and that among recurrent TB cases from 9.0% in 2010 to 1.8% in 2016 (p<0.0001). Conclusions: We concluded that effective PMDT have had a significant impact on the epidemic of drug-resistant TB in Taiwan. [ABSTRACT FROM AUTHOR]

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

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

Abstract: Objective: The study investigates the association between area-level socioeconomic status (SES) and children''s lung function. Methods: Participants were 3994 seventh grade students from the Taiwan Children Health Study living in 14 communities in Taiwan and were recruited in 2007. Area-level SES predictors were population size, occupation type, income and education level. Hierarchical linear models (HLM) were used to examine the effects of area-level SES on lung function, after accounting for area air pollution and individual SES (parental education and family income). Results: Areas with high income were independently associated with lower child lung function. The coefficients for log transformation of area tax per person in HLM were −47.8 (95% confidence interval (CI): −80.9, −14.8) in FEV1, −43.8 (95% CI: −75.2, −12.5) in FVC, −93.4 (95% CI: −179.3, −7.5) in FEF25-75 and −203.2 (95% CI: −349.1, −57.2) in PEF. All SES predictors influenced in the same direction and affected males more. The interaction of area tax per person with parental educational level was significant on PEF, suggesting significant association of greater parental education with lower lung function in children. Conclusion: High area SES was inversely associated with lung function in Taiwanese children. [Copyright &y& Elsevier]

Colorectal cancer (CRC) is the third most common cancer worldwide. The incidence and mortality rates of CRC are significantly higher in Taiwan than in other developed countries. Genes involved in CRC tumorigenesis differ depending on whether the tumor occurs on the left or right side of the colon, and genomic analysis is a keystone in the study and treatment of CRC subtypes. However, few studies have focused on the genetic landscape of Taiwanese patients with CRC. This study comprehensively analyzed the genomes of 141 Taiwanese patients with CRC through whole-exome sequencing. Significant genomic differences related to the site of CRC development were observed. Blood metabolomic profiling and polygenic risk score analysis were performed to identify potential biomarkers for the early identification and prevention of CRC in the Taiwanese population. Our findings provide vital clues for establishing population-specific treatments and health policies for CRC prevention in Taiwan. [ABSTRACT FROM AUTHOR]

Simple Summary: In recent years, studies have found that coral infectious diseases are gradually spreading. Ciliate disease poses a serious threat to corals, and infected corals will fester and die within a short period of time. Clove is a traditional Chinese medicine. In this study, Clove extract was used to evaluate the treatment of ciliate diseases to achieve safety and to reduce the stress response of corals. Studies have shown that 1500 ppm clove extract can effectively treat ciliate parasitism, and does not affect coral zooxanthellae, chlorophyll a, or stress response. This extract has been successfully applied to a Taiwan coral king coral farm, which will have great significance for large-scale coral aquaculture. In recent years, ciliate infections have caused serious casualties to corals in the ocean. Infected corals die within a short period of time, which not only poses a threat to wild coral reefs, but also has a major impact on large scale aquaculture of coral. Clove is a kind of Chinese medicine with antifungal, antibacterial, antiviral, insecticidal, and other functions. Clove is a natural product. If it can be used in the treatment of coral ciliates, it will reduce this threat to the environment. The clove extract was diluted with sterile seawater to 500 ppm, 1500 ppm, 2500 ppm, 5000 ppm, 7500 ppm, and 10,000 ppm to carry out virulence test on ciliates. The results show that the LC50 value is 1500 ppm, which can cause the death of ciliates in 10 min without causing significant changes in G. columna SOD, CAT, chlorophyll a, and zooxanthellae. In addition, observation of tissue slices revealed that no ciliates and vacuum were found in the G. columna tissue after 10 min of medicated bathing. In summary, 1500 ppm of clove extract can be used for the treatment of coral ciliates. [ABSTRACT FROM AUTHOR]

International capital mobility and economic restructuring have brought training and skills acquisition to the forefront of policy dialogues. Taiwan has gone beyond most countries in promoting vocational education and setting strict quotas for schooling. Although the education plans do not have separate targets for men and women, they have gendered outcomes. Estimates of earnings premiums using ordinary least squares and quantile regression techniques indicate that only men have gained consistently higher premiums from vocational school compared to general schooling. Women who were denied access to the university system have forgone college premiums that exceed those of men. Also, the commerce track, in which women cluster, yields an earnings penalty compared to general schooling, while the technical track, in which men predominate, yields an earnings premium. Policy reforms based on relaxing education quotas and enforcing equal opportunity legislation would provide women with more rewarding education and career options. [ABSTRACT FROM AUTHOR]

Type 2 diabetes is becoming more prevalent in Taiwan. Growing evidence suggests a patient-centred approach is more effective in facilitating self-management than a professional-centred one. The aim of this qualitative study was to investigate Chinese diabetic patients’ perceptions about their illness and treatment strategies to facilitate patient-centred, culture-sensitive clinical skills.We used in-depth interviews to collect perspectives from 22 participants recruited from a rural Taiwan community. All interviews were audio-taped and the transcripts were analysed by editing and immersion/crystallization. Emerging themes were compared with current medical knowledge to determine their clinical significance.Generally, Chinese diabetic patients had variable perceptions about different treatment strategies. All agreed that dietary restriction and exercise were beneficial. The former, mainly understood as reducing carbohydrate intake, was thought to be most important; exercise, to the point of sweating, was seen as a way to eliminate pharmaceutical toxins. Taking medicine was regarded with ambivalent attitudes due to concerns about adverse effects (especially renal injury).Patients regarded all treatment strategies as integrative and intertwined in daily life. There are three misconceptions which we found should be clarified during medical consultations: (i) focusing on sugar-control only; (ii) benefit of sweating to eliminate toxins; (iii) fear of renal toxicity of hypoglycaemic agents. The renaming of diabetes, to such as‘metabolic syndrome’, may bring new, acceptable insight to Chinese diabetic patients.Diabet. Med. (2004) [ABSTRACT FROM AUTHOR]

Measurement of quality of life (QoL) in hepatocellular carcinoma (HCC) requires assessment of factors related to chronic liver disease, as well as issues related to the primary tumour and its treatment. This study describes the development of a questionnaire module in patients from Europe, as well as Taiwan and Hong Kong. The questionnaire was developed according to the European Organisation for Research and Treatment of Cancer (EORTC) QoL Group guidelines. Twenty nine QoL issues were identified from a literature search. Semi-structured interviews with patients (n=32) and health-care professionals (n=10) reduced the issues to 22 items forming a provisional questionnaire. This was tested in 158 patients from three countries. Descriptive statistics and clinical judgement reduced the module to 18 items conceptualised as containing six scales and two single item. This study recommends the EORTC QLQ-HCC18 to accompany the QLQ-C30 to measure QoL in clinical trials in HCC. [Copyright &y& Elsevier]

Abstract Background: GB Virus C (GBV-C)/hepatitis G virus (HGV) was identified in 1995–1996 as a transfusion-transmissible virus. The diagnosis of GBV-C/HGV infection is based on the detection of GBV-C/HGV-RNA by using polymerase chain reaction. Recently, an enzyme immunoassay detecting the antibodies to the viral protein, E2 envelope protein (anti-envelope) of GBV-C/HGV, has been developed. Methods: Serum GBV-C/HGV-RNA and anti-envelope antibody were determined in 76 cases of intravenous drug users (IVDU), 76 patients with regular hemodialysis and in 80 prostitutes to evaluate the GBV-C/HGV infection rate among high-risk populations in Taiwan. Seventy-six healthy blood donors were randomly selected and were used as a control group. Results: The prevalence of GBV-C/HGV-RNA in high-risk populations was 33% for IVDU, 16% for patients with hemodialysis and 13% for prostitutes, which was significantly higher than the 3% obtained in the control group (P < 0.05 for all groups). The prevalence of anti-envelope antibody was 13% for IVDU, 21% for patients with hemodialysis and 23% for prostitutes, which was not significantly different from the control group (11%). Among the 99 subjects who had positive GBV-C/HGV markers, 97 were tested for exclusive positivity for either GBV-C/HGV-RNA or anti-envelope antibody. Conclusions: The presence of serum anti-envelope antibody usually indicates the clearance of serum GBV-C/HGV-RNA in patients infected with GBV-C/HGV. GB Virus-C/HGV infection in high-risk populations, determined by the presence of serum GBV-C/HGV-RNA, may underestimate the true level of past and present infection. [ABSTRACT FROM AUTHOR]

Reports on a Taiwanese study which described growth before and after menarche. Height, weight and body mass index of school girls; Growth velocity of height and weight. INSET: Subjects and methods..