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Kawasaki disease (KD) is an inflammatory vasculitis disorder of unknown etiology. It is a rare but fatal disease and the leading cause of acquired coronary heart disease in children under the age of 5 years. We examined the association of KD with the demographics of family members, parents' characteristics, and perinatal factors in Taiwanese children. This nested case-control study used data from Taiwan's Health and Welfare Data Science Center and initially included children born in Taiwan between January 1, 2006, and December 31, 2015 (n = 1,939,449); the children were observed for KD development before the age of 5 years (n = 7870). The control group consisted of children without KD who were matched with each KD case by sex and birth date at a ratio of 8:1. The odds ratio (ORs) of the aforementioned associations were estimated using conditional logistic regression. The risk of KD decreased in children with younger parents [<25 years; younger maternal age, OR = 0.72, 95% confidence interval (CI), 0.66-0.79; younger paternal age, OR = 0.68, 95% CI, 0.59-0.78], lower socioeconomic status, more than 2 siblings (OR = 0.80, 95% CI, 0.73-0.89), and siblings with a history of KD (OR = 4.39, 95% CI, 3.29-5.86). Children living in suburban (OR = 0.95, 95% CI, 0.90-1.00) and rural (OR = 0.81, 95%CI, 0.74-0.90) areas exhibited a lower risk of KD than children living in urban areas. In conclusion, a higher incidence rate of KD was observed in children aged <5 years who had an urban lifestyle, had siblings with KD, were born to older mothers, and belonged to high-income and smaller families. Parental allergic or autoimmune diseases were not associated with the risk of KD., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tseng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aim: This study aimed to explore the association between multimorbidity patterns with/without frailty and future mortality among Taiwanese middle-aged and older adults through a population-based cohort study design., Methods: Data were collected from the Taiwan Longitudinal Study on Aging. The data were obtained from Wave 3, with the multimorbidity patterns in the years of 1996 being analyzed through latent class analysis. Frailty was defined using the modified Fried criteria. The association between each disease group with/without frailty and mortality was examined using logistic regression, with the reference group as the Relatively healthy group without frailty. Survival analysis was performed using Cox regression, and the follow-up period of mortality was from 1 January 1996 to 31 December 2012., Results: A total of 4748 middle-aged and older adults with an average age of 66.3 years (SD: 9.07 years) were included. Four disease patterns were identified in 1996, namely the Cardiometabolic (21.0%), Arthritis-cataract (11.9%), Relatively healthy (61.6%), and Multimorbidity (5.5%) groups. After adjusting for all covariates, the Relatively healthy group with frailty showed the highest risk for mortality (odds ratio: 3.66, 95% confidence interval [95% CI]: 2.24-5.95), followed by the Cardiometabolic group with frailty (odds ratio: 3.58, 95% CI: 1.96-6.54), Multimorbidity group with frailty (odds ratio: 2.28, 95% CI: 1.17-4.44), Multimorbidity group without frailty (odds ratio: 1.44, 95% CI: 1.01-2.04), and the Cardiometabolic group without frailty (odds ratio: 1.24, 95% CI: 1.04-1.49)., Conclusions: Frailty plays an important role in mortality among middle-aged and older adults with distinct multimorbidity patterns. Middle-aged and older adults with a relatively healthy multimorbidity pattern or a cardiometabolic multimorbidity pattern with frailty encountered dismal outcomes. Geriatr Gerontol Int 2023; 23: 684-691., (© 2023 Japan Geriatrics Society.)

Background: Depression can affect the development of cognitive functions, and there are many people with depressive symptoms and cognitive decline in the aging population. The role of mediators between depressive symptoms and the subsequent cognitive decline remains unclear. We aimed to investigate whether depressive symptoms can slow down cognitive decline through a mediator., Methods: A total of 3,135 samples were collected in 2003, 2007, and 2011. This study used the CES-D10 and SPMSQ (Short Portable Mental State Questionnaire) to measure depression and cognitive functions. The effect of depression trajectory on the subsequent cognitive dysfunction was analyzed using multivariable logistic regression, and the mediating effect was analyzed using the Sobel test., Results: The results of the multivariable linear regression analysis showed that after including different variables in each model, such as leisure activities and mobility in 2003 and 2007, women had a higher percentage of depressive symptoms in each model, compared to men. The effect of depression in 2003 on cognitive decline in 2011 was mediated by intellectual leisure activities in 2007 in men (Z=-2.01) and physical activity limitation in 2007 in women (Z=-3.02)., Conclusions: The mediation effect of this study shows that people with depressive symptoms will reduce their participation in leisure activities, which will lead to the degeneration of cognitive function. We suggest that if depressive symptoms are addressed as early as possible, people will have the ability and motivation to delay the decline of cognitive function through participation in leisure activities., (© 2023. The Author(s).)

Background: Previous research has found different multimorbidity patterns that negatively affects health outcomes of older adults. However, there is scarce evidence, especially on the role of social participation in the association between multimorbidity patterns and depression. Our study aimed to explore the relationship between multimorbidity patterns and depression among older adults in Taiwan, including the social participation effect on the different multimorbidity patterns., Methods: Data were retracted from the Taiwan longitudinal study on ageing (TLSA) for this population-based cohort study. 1,975 older adults (age > 50) were included and were followed up from 1996 to 2011. We used latent class analysis to determine participants' multimorbidity patterns in 1996, whereas their incident depression was determined in 2011 by CES-D. Multivariable logistic regression was used to analyse the relationship between multimorbidity patterns and depression., Results: The participants' average age was 62.1 years in 1996. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 93), (2) Arthritis-cataract group (n = 105), (3) Multimorbidity group (n = 128) and (4) Relatively healthy group (n = 1649). Greater risk of incident depression was found among participants in the Multimorbidity group (OR: 1.62; 95% CI: 1.02-2.58) than the Relatively healthy group after the multivariable analysis. Compare to participants in the relatively healthy group with social participation, participants in the arthritis-cataract group without social participation (OR: 2.22, 95% CI: 1.03-4.78) and the multimorbidity group without social participation (OR: 2.21, 95% CI: 1.14-4.30) had significantly increased risk of having depression., Conclusion: Distinct multimorbidity patterns among older adults in Taiwan are linked with the incident depression during later life, and social participation functioned as a protective factor., (© 2023. The Author(s).)

This study examined the association between socioeconomic position (SEP) trajectories and frailty in the elderly population in Taiwan. We used data from people aged 53 years and over (n = 1284) collected from wave two of the Social Environment and Biomarkers of Aging Study. Frailty was identified using the modified Fried criteria, with the scores combined to use to categorize participants as frail (score = 3-5), prefrail (score = 1 or 2) and robust (score = 0). We applied a group-based person-centered trajectory model to identify four types of SEP trajectories (low-low, 19.2%; high-low 12.5%; low-high, 35.4%; and high-high, 32.9%) to describe the social mobility patterns in the participants' lives from childhood to older age. The mean age of the study population was 65.30 ± 8.94 years, and 47.39% of the participants were women. The prevalence of frailty was 18.39%. The low-low, high-low, low-high, and high-high SEP trajectory groups were represented by 37.92%, 24.93%, 15.43%, and 7.91%, respectively, of the study population. We used multinomial logistic regression models to evaluate the association between SEP and the risk of frailty. Compared with the low-low SEP trajectory group, the high-high SEP trajectory group was significantly associated with a lower prevalence of frail and pre-frail (odds ratios 0.17 and 0.36; 95% confidence interval 0.08-0.34 and 0.21-0.61). Our results suggest that a disadvantaged life-course SEP is associated with increased risks of frailty in older age. Avoiding that unfavourable SEP trajectories over the life course translate into an increased probability of frailty is key to reducing health inequalities in elderly populations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier B.V.)

Background: Visual impairment (VI) was associated with cognitive impairment. However, different visual trajectories might contribute to different risks of cognitive decline in the elderly., Aims: This study aimed to evaluate the association between visual trajectories and cognitive impairment., Methods: Four thousand two hundred eight community-dwelling elder adults were identified from Waves IV-VII (1999-2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive function was determined using the Short Portable Mental Status Questionnaire (SPMSQ) scores. Visual impairment was self-reported and visual trajectories were assessed in at least two waves of the survey. Ordinal logistic regression was performed to estimate adjusted odds ratios (adjORs) and 95% confidence intervals (CIs)., Results: Participants with visual trajectory from no VI to VI had significantly higher risk of cognitive impairment with an adjOR of 1.69 (95% CI 1.12-2.57) than participants without VI. Compared to participants without VI, participants with persistent VI (adjOR 1.32; 95% CI 0.89-1.96) and with visual trajectory from VI to no VI (adjOR 1.25; 95% CI 0.83-1.88) were not associated with cognitive impairment. A protective association between eyeglasses use and cognitive impairment (adjOR 0.69; 95% CI 0.55-0.87) was found in this study. Importantly, cataract was associated with higher risk of cognitive impairment (adjOR 1.34; 95% CI 1.10-1.62). However, nonsurgical cataract treatment did not show protective effect on cognitive impairment in patients with cataract., Conclusions and Discussion: Visual trajectory from no VI to VI is a significant risk factor for cognitive impairment that physicians should pay special attention during community screening., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Multimorbidity has negative impacts on the health outcomes of older adults. Previous research has discovered different patterns of multimorbidity. However, evidence is scarce for associations between multimorbidity patterns and disability/frailty, especially evidence from longitudinal studies. This study aimed to explore the relationship between multimorbidity patterns and disability/frailty among older adults in Taiwan., Methods: This population-based cohort study used data from the Taiwan Longitudinal Study on Aging. It included 2,194 older adults (age >50 years) who were followed from 1996 to 2011. The participants' multimorbidity patterns in 1996 were determined by latent class analysis; their incident disability and frailty were ascertained in 2011. Multivariate logistic regression was used to analyze the relationship between multimorbidity patterns and disability/frailty., Results: In 1996, the participants' average age was 62 years. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 222), (2) Arthritis-cataract group (n = 112), (3) Multimorbidity group (n = 189), and (4) Relatively healthy group (n = 1671). After adjusting for age, sex, social participation, alcohol consumption, self-rated health, admission in the past year, and depression, participants in the Cardiometabolic group had a greater risk of incident disability (odds ratio: 1.78; 95% confidence interval: 1.26-2.52), compared with the Relatively healthy group. No statistically significant relationships were found between multimorbidity patterns and frailty. Subgroup analysis showed that females in the Cardiometabolic and Multimorbidity groups had greater risks of developing disability., Conclusion: This 16-year, population-based cohort study showed that distinct multimorbidity patterns among older adults in Taiwan were associated with incident disability during later life but were not related to frailty., (Copyright © 2022 Elsevier B.V. All rights reserved.)

In middle-aged and older adults, attitude toward aging (ATA) exerts significant influences on their current and future health. For health promotion to be successful, participants' ATA requires health care providers' attention. Knowing the factors associated with ATA can facilitate future studies to investigate effective interventions. The aim of this study was to identify the factors associated with ATA in middle-aged and older adults. This cross-sectional study analyzed data of a nationally representative sample of adults aged 58 years and older collected in a population-based longitudinal study: the Taiwan Longitudinal Study on Aging (TLSA). To identify the factors associated with ATA, we investigated demographic factors (age, gender, education, marital and cohabitation status, and financial satisfaction status) and health-related factors (number of co-morbidities, depression, physical function dependency) with bivariate analysis and multiple regression analysis. To identify the activities beneficial to ATA over and above demographic and health-related factors, various activities (exercise, volunteer service, and leisure activities) were each examined individually by multiple regression analysis. The factors detrimental to ATA were advanced age, a higher number of co-morbidities, living alone, depression, and dependence on physical function. Those beneficial to ATA were higher education, financial satisfaction, physical exercise, volunteer service, and six leisure activities.

Identification of alloantibodies and achieving a reduction in the rate of red blood cell (RBC) alloimmunization are important issues to prevent transfusion complications. The aim of this study was to identify the antigen and alloantibodies in our patients and to study the association of alloimmunization with previous transfusion. Transfusion records from the blood bank of Kaohsiung Medical University Hospital between 2015 and 2017 were retrospectively enrolled in the study. Antigen and antibody identification was performed using routine blood bank methods. In total, 56,422 transfusion records from 2015 to 2017 were included in the study. Among them, 1858 alloantibody episodes were found in the pre-transfusion survey, and anti-Mia, anti-E, and cold antibodies were the most common alloantibodies, with a prevalence of 3.29% (1858/56,422). Among them, 130 episodes involved newly found alloantibodies with no alloantibodies found in the previous transfusion survey. Tracing back to these newly transfusion-induced alloantibodies, the antibody was found with a mean of 10.8 ± 7.8 units of packed RBC transfusion, a mean of 66.3 ± 52.8 days, and with a mean of 4.3 ± 2.7 times of transfusion from the first transfusion therapy. An antibody survey revealed that Rh-ee (62.1%) was the most common phenotype in these newly identified antibodies. In summary, this hospital-based study revealed that RBC alloantibody rates were present at rates of 3.29%, with anti-Mia, anti-E, and cold antibodies being the most common alloantibodies. Among them, anti-E was the most commonly developed alloantibody. Given that the Rh-ee group is the most common phenotype in our population, the strategy of using Rh-ee blood for Rh-ee recipients is reasonable for transfusion safety., (© 2021 The Authors. The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical University.)

It has been considered that widowed persons have a higher risk of death. This study intended to explore whether social participation could improve this trend. A longitudinal study database was constructed to explore the trend of survival and its change with social participation in widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007, and 2011 was linked with the National Death Registry from 1999 through 2012. In total, there were 1417 widowed persons and 4500 nonwidowed persons included in this study, excluding divorced and never-married people. The survival trend analysis was carried out with social participation as the main predictive factor stratified for comparative analysis. Our results showed that the widowed were older than the nonwidowed, were female-dominant, had a lower education level, were more economically stressed, and were less likely to engage in regular exercise, and thus showed generally poorer health; for example, being more vulnerable to having chronic diseases, disability with the Activities of Daily Living (ADL), cognitive impairment with the Short Portable Mental State Questionnaire (SPMSQ), and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed was significantly higher than that of the nonwidowed, but the death trend for those with social participation was significantly lower than that of their counterparts in both the widowed and nonwidowed. After matching with gender and age for widowed persons, the widowed with social participation had a significantly lower risk of death (adjusted hazard ratio (HR), 0.83; 95% confidence interval (CI), 0.71-0.98) compared to the widowed without social participation. It was concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons.

This study examined the association between dietary patterns and the development of frailty during 4-, 8-, 12-year follow-up periods in the population-based Taiwan Study. We used the data of an elderly population aged 53 years and over ( n = 3486) from four waves of the Taiwan Longitudinal Study on Aging. Frailty was identified by using the modified Fried criteria and the values were summed to derive a frailty score. We applied reduced rank regression to determine dietary patterns, which were divided into tertiles (healthy, general, and unhealthy dietary pattern). We used multinomial logistic regression models to assess the association between dietary patterns and the risk of frailty. The healthy dietary pattern was characterized by a higher intake of antioxidant drinks (tea), energy-rich foods (carbohydrates, e.g., rice, noodles), protein-rich foods (fish, meat, seafood, and eggs), and phytonutrient-rich foods (fruit and dark green vegetables). Compared with the healthy pattern, the unhealthy dietary pattern showed significant cross-sectional, short-term, medium-term, and long-term associations with a higher prevalence of frailty (odds ratios (OR) 2.74; 95% confidence interval (CI) 1.94-3.87, OR 2.55; 95% CI 1.67-3.88, OR 1.66; 95% CI 1.07-2.57, and OR 2.35; 95% CI 1.27-4.34, respectively). Our findings support recommendations to increase the intake of antioxidant drinks, energy-rich foods, protein-rich foods, and phytonutrient-rich foods, which were associated with a non-frail status. This healthy dietary pattern can help prevent frailty over time in elderly people.

Objectives: Self-rated health (SRH) is an assessment and predictor of health based on an individual's general condition; however, evidence of the value of SRH for predicting frailty remains scarce for older Asian adults. This study aimed to evaluate the relationship between SRH score trajectory and frailty among older individuals in Taiwan., Design: An 8-year retrospective cohort study., Setting: Data were retrieved from the Taiwan Longitudinal Study on Aging from 1999 to 2007., Participants: Respondents aged 53-69 years old who were not frail or disabled in 1999 (n=1956)., Primary and Secondary Outcome Measures: Frailty was defined using the Fried criteria. The group-based trajectory modelling technique was used to estimate SRH trajectories. Logistic regression analysis was used to examine the associations between changes in SRH and frailty., Results: Four SRH trajectory classes were identified across the 8-year follow-up: 232 participants (11.9%) were classified into the constantly poor SRH group, 1123 (57.4%) into the constantly fair SRH group, 335 (17.1%) into the constantly good SRH group and 266 (13.6%) into the good-to-fair SRH group. After adjusting for gender, age, level of education, income, social participation, health behaviours and major comorbidities, it was found that age, poor income satisfaction, without job and constantly poor SRH were associated with increased risk of frailty, while constantly good SRH (OR 0.04, 95% CI (0.01 to 0.32)) and good-to-fair SRH (OR 0.19, 95% CI (0.06 to 0.63)) were associated with reduced risks of frailty., Conclusions: Constantly poor SRH was associated with an increased risk of frailty in older age. SRH in older adults should be recognised as a predictive tool for future frailty. Diet and exercise interventions may help to prevent frailty among high-risk older individuals with constantly low SRH., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Patients with gout have an increased risk of urolithiasis and usually need urate-lowering therapy (ULT) for the prevention of disease progression. However, there is a paucity of clinical data regarding the risk of future urolithiasis in ULT users., Methods: This nested case-control study was performed using the Taiwan National Health Insurance Research Database. The aim of this study was to examine whether ULT (xanthine oxidase inhibitors [XOIs] or uricosuric agents) is associated with risk of future urolithiasis in patients with gout. Data were collected from January 2000 to December 2012., Results: This study included 2307 case patients and 2307 matched controls. Case patients had gout that developed into urolithiasis, and control patients had gout but were not diagnosed with urolithiasis during the study period. Patients had a mean age of 56.3 years at diagnosis of gout, and 83.2% were male patients. No association was detected between use of XOIs or uricosuric agents and risk of future urolithiasis. Furthermore, there was no significant difference in the risk of future urolithiasis in patients exposed to various cumulative days of XOI or uricosuric prescriptions., Conclusion: The present study provides evidence that neither XOIs nor uricosuric agents are associated with risk of future urolithiasis in patients with gout. Before the availability of more clinical evidence, ensuring high fluid intake and prospective monitoring of urolithiasis development are still important for uricosuric agent users., (© 2021 John Wiley & Sons Ltd.)

Background: The prevalence of diabetes mellitus (DM) during pregnancy and childhood obesity is increasing worldwide. Factors affecting the growth of children with overweight whose mothers had DM are complicated and inconclusive. Few longitudinal studies have focused on the growth of infants with macrosomia born to mothers with DM and the factors influencing their overweight. This study explored risk factors for childhood overweight/obesity (OWOB) among children of mothers with DM. Perinatal, maternal socio-demographic, infant care, and maternal body weight characteristics as well as child growth until age 3 years were analyzed using a longitudinal design., Methods: In total, 24,200 pairs of mothers and their children from the Taiwan Birth Cohort Study were included. Combined Taiwan Children Growth Curve report classifications were analyzed for infant growth at birth and at 6, 12, 18, 24, and 36 months old (m/o). A multiple logistic regression analysis with different model settings was used to assess factors affecting the growth of high birth weight children of mothers with diabetic mellitus (HODM)., Results: Children in the HODM group had a higher average body weight than did those in the non-DM group at different age stages. Relative to the non-DM group, weight gain in the HODM group was slower before 18 m/o but faster from 18 to 36 m/o, particularly after 24 m/o. Maternal DM was a major risk factor for childhood OWOB (odds ratio [OR]: 3.25-3.95). After adjustment for related confounders, the OR was 2.19-3.17. Maternal overweight or obesity and higher gestational weight gain were greater risk factors for childhood OWOB at 3 years old after adjusted maternal DM and other selected confounders (OR: 1.45 and 1.23, respectively). Breastfeeding until 6 m/o was a protective factor against childhood OWOB (OR: 0.95). The HODM and non-DM groups did not differ significantly in perinatal, maternal socio-demographic, or infant care characteristics., Conclusions: Maternal DM is a major factor of childhood OWOB. Maternal body weight before and after pregnancy affects childhood OWOB, and this effect increases with the child's age.

Hidradenitis suppurativa (HS), also called acne inversa, is an inflammatory skin disease, which causes HS patients to suffer from recurrent symptoms and severe comorbidities. The aim of this article was to provide evidence on the epidemiology of HS in Taiwan through a retrospective population-based cohort study. The patients with International Classification of Diseases, Ninth Revision, Clinical Modification code 705.83 and Anatomical Therapeutic Chemical codes for HS treatments from 2000 to 2013 in the National Health Insurance Research Database, which covers 99.9% Taiwanese residents, were enrolled in this 14-year nationwide population-based cohort study. The age- and sex-standardized prevalence, incidence, and the prescription pattern for HS were analyzed. The annual percent change (APC) was used to estimate the trend of prevalence and incidence of HS from 2000 to 2013. During 2000-2013 in Taiwan, the 14-year period prevalence rate was 185.6/100 000 (95% confidence interval [CI], 177.3-194.3) with an APC of -2.96% (95% CI, -1.73 to -4.17) and the mean annual adjusted incidence rate from 2001 to 2013 was 11.8/100 000 (95% CI, 11.2-12.5) with an APC of -4.65% (95% CI, -3.32 to -5.95). Female : male ratio was 0.92 and the most common onset age was 15-24 years. Major treatments were systemic corticosteroids, systemic antihistamines, systemic antibiotics, and topical antibiotics. An increasing tendency of using systemic antibiotics was noted. In Taiwan, decreasing incidence and prevalence of HS was shown during 2000-2013. Relatively lower incidence and prevalence were noted compared to Western countries. Male predominance was revealed, and the use of systemic antibiotics became the mainstream in treatment for HS., (© 2021 Japanese Dermatological Association.)

Aim: To evaluate whether late-career unemployment is associated with increased physical frailty among older adults in Taiwan by the design of a population-based cohort study., Methods: Data were retrieved from the Taiwan Longitudinal Study on Aging. The study examined data from the period 1999 to 2007. A total of 652 subjects were included in the final analysis, and they were categorized as normally employed or unemployed depending on their employment status in 1999. Frailty was defined using the Fried criteria. Multiple confounding factors were adjusted in a multilevel analysis., Results: The average age of the participants in 1999 was 59.0 years. A total of 491 participants were normally employed, and 161 participants were unemployed. After adjustment for gender, age, level of education, income, marital status, and number of chronic diseases, late-career unemployment was associated with increased frailty [odds ratio (OR) = 1.61; 95% confidence interval (CI) = 1.00-2.59]. The risk of developing frailty was higher for participants who were unemployed during late career and had poor self-rated health [OR = 3.54; 95% CI = 1.37-9.20]., Conclusions: Late-career unemployment is associated with increased frailty, especially for those who also have poor self-rated health. Older adults should be encouraged to maintain normal employment during the later stages of their career before retirement. Employers should apply strategies to prevent possible late-career unemployment, and the government should provide resources and help to unemployed older workers so that they can minimize poor health outcomes in late life. Geriatr Gerontol Int 2021; 21: 353-358., (© 2021 Japan Geriatrics Society.)

Objectives: Few studies have focused on weight change and frailty, especially in Asia. This research aimed to evaluate midlife body mass index (BMI) trajectory and assess its relationship with frailty 8 years later in Taiwan., Design: A prospective cohort study., Setting and Participants: Data were retrieved from the Taiwan Longitudinal Study on Aging conducted from 1999 to 2007. The analysis was restricted to respondents aged between 50 to 69 years old, who were not frail in 1999 and were alive in 2007 (n=1609)., Measurements: Frailty was defined using the Fried criteria. The group-based model of trajectory was used to estimate BMI trajectories among elderly participants. Logistic regression analysis was used to examine the association between BMI change and frailty., Results: Four trajectory classes were identified and each remained stable during the 8-year follow-up. There were 316 participants (20.3%) in the low-normal weight group (baseline BMI=20.38 kg/m2), 737 participants (44.7%) in the high-normal weight group (baseline BMI=23.22 kg/m2), 449 participants (28.4%) in the overweight group (baseline BMI=26.24 kg/m2), and 107 participants (6.6%) in the obesity group (baseline BMI=30.65 kg/m2). After adjustment for confounding factors, the low-normal weight group and obesity group were associated with increased frailty compared with the high-normal weight group., Conclusion: Our results showed that the BMI trajectories of midlife individuals tended to be constant and those in both the low-normal weight group and obesity group had an increased risk of developing frailty in later life. Therefore, an optimal weight-targeting strategy should be considered for Asian elderly individuals., Competing Interests: There are no conflicts of interest to declare

Background: Little is known about how the frequency of physical activity in adults influences the occurrence of metabolic syndrome (MetS), and whether there are gender differences within these effects., Methods: In this study, 3368 residents from the established "Landseed Cohort" underwent three waves of health examinations, and those who did not have MetS at baseline were selected and analyzed using a multiple Poisson regression model. By calculating the adjusted relative risk (ARR), the linear and nonlinear relationships between the frequency of physical activity and risk of developing MetS were examined for male and female participants., Results: The prevalence of MetS was fairly stable across the three waves (ranging from 16.24% to 16.82%), but the incidence dropped from 7.11% to 4.52%. The risk of MetS in women was 10 times higher than that in men (ARR = 10.06; 95% CI = 6.60-15.33), and frequent exercise was shown to help prevent it. The frequency of exercise had a linear dose-response effect in females and an exponential protective effect in males on the occurrence of MetS. Exercising more than four times a week for females and twice or more a week for males effectively reduced the risk of developing MetS., Conclusions: The frequency of physical activity in adults was negatively related to the risk of developing MetS, and this relationship differed based on gender. The protective effect of physical activity on MetS was linear in females and exponential in males.

Background: The prognostic impact of perineural invasion (PNI) in patients with esophageal cancer who receive neoadjuvant chemoradiotherapy (nCRT) remains unclear., Methods: A thorough pathological review of PNI was performed on post-nCRT esophagectomy specimens obtained from non-ypT0 patients with esophageal squamous cell carcinoma (ESCC). When PNI was identified, it was classified according to the presence or absence of penetration through the nerve sheath (i.e., PNI surrounding the nerve sheath [PNI-SS] versus PNI penetrating through the nerve sheath [PNI-TS]). The impact of PNI on overall survival (OS) was assessed in combination with clinical and pathological risk factors., Results: A total of 177 eligible patients were identified between 1998 and 2008. PNI was identified in 43.5% (77/177) of participants. Of them, 33 and 44 had PNI-SS and PNI-TS, respectively. The 5-year OS rate of patients with PNI-TS was significantly lower (6.7%) than that observed in those without PNI (30.6%, P < 0.001). However, the 5-year OS observed in the latter group did not differ significantly from that of patients with PNI-SS (26%, P = 0.68). Multivariate analysis identified PNI-TS (hazard ratio [HR] = 1.965, P = 0.02), LVI (HR = 1.514, P = 0.048), and ypN2 stage (HR = 2.39, P = 0.007) as independent adverse prognostic factors for OS., Conclusions: The presence of PNI-TS after nCRT is associated with poor survival. A thorough assessment of distinct PNI patterns (i.e., PNI-TS versus PNI-SS) should be part of the routine post-nCRT histopathological work-up of ESCC patients., (Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Objective: The present study investigates the relationship between BMI and all-cause mortality among middle-aged and older adults with or without pre-existing diseases., Design: A population-based cohort study., Setting: The Taiwan Longitudinal Study on Aging is a nationwide prospective cohort study comprising a representative random sample of middle-aged and older adults. The study period was 1996-2007., Subjects: We followed 4145 middle-aged and older adults, totalling 42,353 person-years., Results: Overweight and mildly obese participants showed a 16% and 30% decrease in the risk of death, respectively, compared with those of normal weight after adjusting for potential covariates (e.g. demographic characteristics, health behaviour, co-morbidities and physical function). Underweight adults showed a 1.36-fold increased adjusted hazard ratio of death compared with normal-weight adults. Adults with a BMI of 27.0-28.0 kg/m(2) showed a significantly lower adjusted hazard ratio of all-cause mortality rate compared with adults who had normal BMI values when they had coexisting hypertension or diabetes (adjusted hazard ratio = 0.50; 95% CI 0.30, 0.81 for hypertension and adjusted hazard ratio=0.41; 95% CI 0.18, 0.89 for diabetes)., Conclusions: The study demonstrates that underweight people have a higher risk of death, and overweight and mildly obese people have a lower risk of death, compared with people of normal weight among middle-aged and older adults. An optimal BMI may be based on the individual, who exhibits pre-existing diseases or not.

We evaluated the role of statins in delaying insulin use and diabetes-related diseases in Asian patients with type 2 diabetes mellitus (T2DM) because statins can cause new-onset diabetes.We used data from the Longitudinal Health Insurance Database in this retrospective cohort study. The 12,470 T2DM patients were categorized into 2 cohorts: a statin cohort comprising 2545 patients who received statin therapy for at least 6 months (180 days) before the index date and a nonstatin cohort comprising 9925 patients who did not receive statin therapy. The control-to-case ratio was set at approximately 4:1. Univariable and multivariable Cox proportional hazards regression analyses were performed to evaluate the risk of diabetes-related events and insulin use on receiving statin treatment.Patients in the statin cohort had a 48% lower risk of diabetes-related coma than those in the nonstatin cohort (95% confidence interval = 0.29-0.92). Patients with >730 days of statin therapy had a significantly lower risk of insulin use, diabetes-related disorders of the eye and neurons, and peripheral circulatory disorders. Compared with patients in the nonstatin cohort, the risk of insulin use, diabetes-related coma, and diabetes-related disorders of the eye and neurons was lower in patients on a cumulative defined daily dose (cDDD) of statins for >475 days.These results suggest that longer duration of statin use and higher cDDD of statins can delay insulin use in Asian patients with T2DM.

The authors aimed to investigate whether a change in depressive status was associated with a change in the risk of mortality in the elderly during a four-year follow-up period. Data came from the Survey of Health and Living Status of the Elderly in Taiwan. A cohort of 1784 men and women in Taiwan aged 65 or older who were assessed on two occasions in 1999 and 2003, and subsequently followed up until 2007. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). The mortality risk of different depressive statuses was computed after adjustment for a variety of covariates. The data were further analyzed by gender and cause of death. Overall, chronic depression was associated with all-cause mortality (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.18-2.32) after 4 years of follow-up and controlling for covariates. When analyzing by gender, incident depression was associated with mortality in males only (HR=1.54; 95% CI=1.04-2.27). In females, only chronic depression was associated with a higher risk of mortality (HR=1.77; 95% CI=1.08-2.88). The increased risk of mortality with incident depression in males and chronic depression in females was attributed to non-cardiovascular disease (non-CVD) causes more than to CVD causes. In males, chronic depression predicted a higher incidence of CVD deaths. While chronic depression confers a greater risk of mortality in older women, incident depression predicts increased mortality in older men. The link between changing depressive status, gender, ethnicity and mortality warrants further investigation., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: Depressive symptoms have been associated with increased mortality risk in previous cohort studies, but there is a paucity of research on Asian elderly in recent years. The authors investigated the depression-mortality link using data from a representative national cohort., Methods: Data came from the Survey of Health and Living Status of the Elderly in Taiwan. A cohort of 2416 men and women in Taiwan aged 65 or older were followed up for eight years from 1999 to 2007. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale. The mortality risk of depression was computed after adjustment for a variety of covariates. Data on the presence or absence of chronic diseases were further analyzed., Results: Overall, depressive symptoms were associated with all-cause mortality (hazard ratio (HR), 1.21; 95% confidence interval (CI), 1.03-1.42) after eight years follow-up, but this mortality risk was detected in men only (HR, 1.27; 95% CI, 1.03-1.56), not in women (HR, 1.1; 95% CI, 0.86-1.4). Further analyses showed that in the group without chronic diseases (without diabetes mellitus, stroke, lung disease, cancer, or cognitive impairment), depressive symptoms were associated with mortality (HR, 1.40; 95% CI, 1.12-1.76) after eight years follow-up; however, there was no association between depressive symptoms and mortality in participants with chronic diseases (HR, 1.02; 95% CI, 0.82-1.26)., Conclusion: Depressive symptoms are an independent risk factor for mortality in the elderly. Elderly depressive men and elderly without chronic diseases seemed to have a greater mortality risk.

Few national longitudinal studies have investigated the predictors of a better depression outcome in geriatric depression. This study examined the predictors of improvement in case-level depressive symptoms in the elderly. In this prospective cohort and population-based study in Taiwan, 206 non-demented and case-level depressed subjects aged 65 and older were interviewed at baseline in 2003 and follow-up in 2007. The independent variables included demographics, chronic medical diseases, and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms, assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CESD-10) assessed at follow-up. Multivariate analyses were used to identify the predictors of improvement in depression. The independent predictors of improvement in depression over a 4-year follow-up period are more social support and fewer mobility limitations at baseline. With regards to practical health-related behaviors, the 2 items of social support most associated with improvement in depression were willingness of significant others to talk with you and satisfaction with dependence upon significant others; the 2 items of mobility limitations most associated with non-improvement of depression were difficulty in carrying things and squatting. These findings suggested that health-related behaviors were important to the depression outcome in the elderly; moreover, interventions to improve depression should include practical health-related behaviors aimed at these modifiable risk factors., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The association between polymorphisms in vascular endothelial growth factor (VEGF) +936C>T and cyclin D1 (CCND1) +870A>G genes, oral cancer risk, and disease-free survival remains controversial. We found no association between polymorphisms in the CCND1 and VEGF genes and oral cancer development using multivariate logistic regression analysis. Clinical data indicated that the VEGF +936C>T polymorphisms were associated with larger tumor size and advanced cancer stage, but the χ(2) test did not show that CCND1 polymorphisms were associated with larger tumor size and advanced cancer stage. However, Cox proportional hazards model analysis showed no correlation between the VEGF +936C>T polymorphisms and poor disease-free survival. The CCND1 +870A>G polymorphisms (hazard ratio (HR)=1.62, 95% CI=1.10-2.46; adjusted HR=1.63, 95% CI=1.08-2.54) and larger tumor size were associated with poor 5-year disease-free survival by the log rank test and multivariate Cox proportional hazards model analysis. We hypothesized that polymorphisms in CCND1 +870A>G and VEGF +936C>T genes are not correlated with the development of oral cancer. We found the CCND1 +870G allele to be an independent risk factor for poor 5-year disease-free survival in oral cancer patients. VEGF +936C>T polymorphisms were not directly correlated with poor survival, but they might be associated with increased tumor size, which affected our disease-free survival results., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Few national longitudinal studies have investigated the modifiable risk factors for depression in the elderly. This study investigated the risk factors and health-related behaviors associated with depressive symptoms using a national survey of Taiwanese elderly with a 4-year follow-up period. In this prospective cohort study, 1481 non-demented population-based elderly were interviewed at baseline in 2003 and at follow-up in 2007. The independent variables included demographics, chronic medical diseases and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms assessed at follow-up. Reduced rank regression was applied to characterize independent factors related to depressive symptoms. The prevalence of depressive symptoms at follow-up was 21.1%. The results of multivariate analyses revealed three independent risk factors for depressive symptoms: fewer leisure activities (odds ratio, OR=0.56, 95% confidence interval, CI=0.38-0.83, p=0.0034), more mobility limitations (OR=1.93, 95% CI=1.30-2.86, p=0.0011) and higher stress levels (OR=2.43, 95% CI=1.68-3.50, p<0.0001). The leisure activities least associated with depression were reading newspapers/books and doing outdoor building projects; the two mobility limitations most associated with depression were difficulty in lifting things and in climbing stairs. The two stresses most associated with depression were perceived health stress and financial stress. These results indicated that interventions to prevent or reduce depression in older adults should include practical strategies aimed at these modifiable risk factors., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Understanding the hierarchy of higher-level physical functions to infer disability level (mild, moderate or severe) is essential for the precise targeting of preventive interventions and has been examined previously in a cross-sectional study. Based on longitudinal data, this study evaluated the hierarchy of higher-level physical functions., Methods: Data from a cohort of 2729 community-dwelling persons aged over 50 with no initial disability were drawn from the "Survey of Health and Living Status of the Elderly in Taiwan" from 1996 through 2007. The three-level hierarchy of eight chosen activities was examined by the median ages to disability onset with survival analyses and by Cox regressions, which examined the effects of sex and age on the development of this hierarchy., Results: The progression of incident disability was as follows: mild level-running, carrying weight, and squatting; moderate level-climbing stairs, walking, and standing; and severe level-grasping and raising arms up. Women and older persons were at greater risk of developing more severe levels of disability. Another Cox regression with one index activity from each hierarchical level revealed similar results., Conclusions: The three-level hierarchy of higher-level physical functions has been validated longitudinally, suggesting rich research and clinical implications.

The atopic march hypothesis suggests that allergy diseases often progress from atopic dermatitis to allergic asthma, and allergic rhinitis. How often can the classic progression of allergic diseases be observed in the pediatric patient population? This study aimed to observe the pattern of allergic diseases progression, onset age, disease intervals, and frequency of the allergic march. Data from the National Health Insurance Research Database in the period 1996-2008 were used to obtain a cohort of children with allergic disease. Physician's diagnosis was used to confirm the allergic disease based on the international disease coding. The age of disease onset was compared. There were 10,729 children aged <5 years enrolled from the 200,000 individuals randomly sampled in 2000. Of these, 5866 (54.7%) had been diagnosed with at least one allergic disease. The rate of only one of three diseases diagnosed was 29.8% (3195 patients), whereas 18.8% had two allergic diseases and 6.1% had all three allergic diseases. Only 4.2% of cases matched the allergic march. Patients with more than one disease had earlier onset age than those who had only one disease (4.17 versus 2.79 and 2.32 years old; p < 0.05). The allergic march accounts for only 4.2% in this study. A patient with only one allergic disease after the age of 4.17 years will not have another allergic disease until the age of 12 years. However, a patient with an allergic disease before 2.79 years old will probably have another allergic disease in 1.96-2.5 years.

Objectives: Deficiency and/or decreased activity of methyltetrahydrofolate reductase (MTHFR) resulted from MTHFR variants are associated with hyperhomocysteinemia, an independent risk factor for vasculopathies in diabetic patients. The aim of this study was to examine MTHFR genotypes between healthy and type 2 diabetes mellitus (T2DM) subjects., Design and Methods: MTHFR C677T and A1298C genotypes were analyzed in 56 T2DM and 62 healthy subjects by PCR-RFLP. Association between MTHFR genotypes and T2DM as well as the lipid/glucose metabolic indexes among T2DM subjects was statistically analyzed., Results: No significance in the distribution of MTHFR genotypes between healthy and T2DM subjects is found. Besides, no significant associations between lipid/glucose metabolic indexes with MTHFR genotypes among diabetic patients are observed., Conclusions: These data indicate the previous observation that MTHFR polymorphisms may play some roles in the pathogenesis and complications of T2DM in Caucasians are unlikely to be applied in Taiwanese patients., (Copyright © 2011 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.)

Aim: To examine the effect of regular ongoing exercise lifestyle on mental and physical health in a group of independent community-dwelling Taiwanese older adults over a 2-year period., Methods: 197 older adults (mean age 72.5 years; 106 men and 91 women) who were independent in walking, instrumental and basic activities of daily living completed the baseline and a 2-year follow-up assessment. Older adults regularly performing exercises during the 2-year study period were grouped into regular exercise group; otherwise in the irregular exercise group. Baseline and follow-up assessments included a face-to-face interview and a battery of performance tests., Results: The regular exercise group showed significantly less depression (P = 0.03) and tended to regress less on the performance tests (P = 0.025-0.410) across 2 years compared to the irregular exercise group., Conclusion: Regular exercise is important for maintaining or even improving mental and functional health, even for independent community-dwelling older adults., (© 2010 The Authors. Australasian Journal on Ageing © 2010 ACOTA.)

Fresh frozen plasma (FFP) transfusion remains a significant issue for blood banks because of a lack of consensus regarding its appropriate use. To study the factors influencing physician compliance, we evaluated FFP transfusion episodes in the year 2008, using a computerized transfusion decision support system. A total of 10,926 episodes were reviewed. The demographic data, physician compliance, and therapeutic efficacy were investigated. The physician noncompliance rate was 46.5%. The highest number was ordered by the hepatobiliary division, which might be due to the high incidence of liver cirrhosis and hepatoma in Taiwan. Excluding the cases for plasma exchange and emergency surgery, 31.2% of episodes had abnormal coagulation results before transfusions. The therapeutic efficacy is statistically significant in patients with abnormal pretransfusion coagulation tests (P < .001). Computerization may be a favorable trend in medical management systems, but it should be more functional to improve medical quality.

The Nutrition and Health Survey in Taiwan (NAHSIT) 2005-2008 was funded by the Department of Health to provide continued assessment of health and nutrition of the people in Taiwan. This household survey collected data from children aged less than 6 years and adults aged 19 years and above, and adopted a three-stage stratified, clustered sampling scheme similar to that used in the NAHSIT 1993-1996. Four samples were produced. One sample with five geographical strata was selected for inference to the whole of Taiwan, while the other three samples, including Hakka, Penghu and mountainous areas were produced for inference to each cultural stratum. A total of 6,189 household interviews and 3,670 health examinations were completed. Interview data included household information, socio-demographics, 24-hour dietary recall, food frequency and habits, dietary and nutritional knowledge, attitudes and behaviors, physical activity, medical history and bone health. Health exam data included anthropometry, blood pressure, physical fitness, bone density, as well as blood and urine collection. Response rate for the household interview was 65%. Of these household interviews, 59% participated in the health exam. Only in a few age subgroups were there significant differences in sex, age, education, or ethnicity distribution between respondents and non-respondents. For the health exam, certain significant differences between participants and non-participants were mostly observed in those aged 19-64 years. The results of this survey will be of benefit to researchers, policy makers and the public to understand and improve the nutrition and health status of pre-school children and adults in Taiwan.

This study aimed to identify the risk factors for cognitive impairment among the elderly population in Taiwan. Data were drawn from three waves of the "Survey of Health and Living Status of the Elderly in Taiwan", a national longitudinal study started in 1989. We included respondents without dementia or cognitive impairment at baseline in 1993 and followed them over a 10-year period. Cognitive function was measured by the nine-item Short Portable Mental Status Questionnaire in 1993, 1999, and 2003. Independent variables, including age, sex, marital status, education, ethnicity, ADLs, IADLs, physical function, social participation, chronic diseases, smoking, and alcohol drinking, were collected at baseline in 1993. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regression was used to evaluate the predictive factors for cognitive impairment. Of the eligible 1,626 respondents, 72 (4.43%) and 484 (29.77%) individuals did not complete follow-up in 1999 and 2003, respectively, mostly due to death. Our results showed that older age (OR = 2.60, 95% CI = 1.79-3.78), being female, lower educational level, IADL disability (OR = 2.06, 95% CI = 1.38-3.09), and having a history of diabetes (OR = 1.70, 95% CI = 1.06-2.74) or stroke (OR = 2.36, 95% CI = 1.06-5.26) were independent predictors for cognitive impairment in Taiwan., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Purpose: Professional bus drivers are at increased risk for cardiovascular disease, but the underlying causes are unclear. Professional bus drivers often follow shift schedules. Especially, an association between shift work and early manifestations of cardiovascular disease has not been elucidated. Thus we investigated the links between shift work and arteriosclerosis risk in professional bus drivers., Methods: Questionnaires were administered to 184 bus drivers on demographic characteristics, lifestyle, and occupational history from 5 transportation companies in Taiwan. Brachial-ankle pulse wave velocity (baPWV) was measured using a volume-plethysmographic apparatus. Body mass index, waist circumference, biochemical variables, and blood pressure were also measured., Results: Arteriosclerotic risk factors (age, weekly driving hours, systolic blood pressure, diastolic blood pressure, and insulin level) differed in part among different groups of drivers. Long-term shift drivers had higher baPWV compared to regular drivers and short-term shift drivers (1594 cm/s vs. 1497 and 1432, p<0.01). Our multiple regression model showed that age (p<0.01) and diastolic blood pressure (p<0.01) were positively associated with baPWV in our professional drivers. After adjusting for all covariates, we observed that baPWV increased by 3.6 cm/s for per 1-year increment in years of shift driving., Conclusions: Long-term shift work could increase the risk of arteriosclerosis in professional bus drivers. Larger studies would be necessary to provide further evidence regarding this finding.

For the past few years, a large number of diesel vehicles carrying gravel and sand have shuttled back and forth every day on the main route (Tai-16 and Tai-21 highways) from Shuili to Shinyi in Nantou County, Taiwan, in support of a river-dredging project. Five stations along Tai-16 and three stations along Tai-21 were selected as the exposure sites. Two very small villages located about 9 and 12 kilometers, respectively, away from the diesel transport routes were selected as the control sites. In this study, five exposure pathways, i.e., ingestion from drinking water, household dust, rice, non-rice dishes, and inhalation from airborne particles, were considered. The daily intake doses of metals varied significantly among the five exposure pathways. There was a significant difference between the exposure and control sites regarding the doses of metals obtained from the exposure pathways of household dust and aerosols. However, regarding the exposure pathways of rice, non-rice dishes, and drinking water, no significant difference between the exposure and the control sites was observed for most metals. Residents who lived within 30 meters of diesel transport roads at the exposure sites were selected as the exposure groups for urine sampling, while residents of the control sites were selected as the control groups. The metal concentrations in the urine of the exposure groups were all higher than those of the control groups. With regards to the urinary metals Fe, Pb, Cu, Ni, and Mo, the levels of urinary metals in residents and the daily intakes of metals from the five exposure pathways showed that the exposure pathways from environmental media (i.e., drinking water, aerosols, and household dust) were a greater factor than food pathways (i.e., rice and non-rice dishes) in the resulting comparative differences between urinary concentration levels of Fe, Pb, Cu, and Mo in exposure groups and control groups. However, the food exposure pathways, rather than the environmental pathways, led to greater comparative differences between the urinary concentration levels of Mn within the two groups.

Molecular genotyping of the ABO alleles has been widely used in ABO subgroups analysis and has been able to solve the rare ABO blood grouping discrepancies. The genotypes of sixty-one A2B phenotype donors recruited from the middle and south of Taiwan were analyzed by means of molecular methods. The A2B phenotype was initially identified by serological test. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to screen the ABO alleles at nucleotides (nt) 261 and 703 based on the nt differences found in the ABO alleles. The subgroups of the A2 allele were determined by the PCR-RFLP and direct sequencing methods. The discrepancies between the phenotype and genotype of the A2B were then studied by subcloning and nucleotide sequence analysis. Our results show that 55 of the 61 A2B donors (90%) are A205/B allele and two are A201/B allele. Four cases were heterozygotes of the cis-AB/O or B alleles. Two were cis-AB04/O allele, one was cis-AB01/O allele and the other was cis-AB02/B allele. In conclusion, most A2B genotypes belong to the A205/B allele in Taiwan. In this study, we report for the first time the presence of the A205, A201, and cis-AB02 alleles in Taiwan.

The "Nutrition and Health Survey of Taiwan's Elementary School Children (2001-2002)" was to investigate the nutritional status, influential dietary and non-dietary factors, health and development, and school performance, as well as the inter-relationships among these factors. The survey adopted a two-staged stratified, clustered probability sampling scheme. Towns and districts in Taiwan with particular ethnic and geographical characteristics were designated into 13 strata including Hakka areas, mountain areas, eastern Taiwan, the Penghu Islands, 3 northern regions, 3 central regions and 3 southern regions. Eight schools were selected from each stratum using the probabilities proportional to sizes method. Twenty-four pupils were randomly selected within each school. The survey included face-to-face interviews and health examinations. Taking seasonal effects into consideration, the face-to-face interviews were evenly allocated into each of the two semesters. A total of 2,419 face-to-face interviews and 2,475 health examinations were completed. Interview data included household information, socio-demographics, 24-hour dietary recall, food frequency, dietary and nutritional knowledge, attitudes and behaviors, physical activity, medical history, oral health, pubertal development, and bone health. Health exam data included anthropometry, blood pressure, physical fitness, bone density, dental health, and blood and urine collection. SUDAAN was used to adjust sampling design effect. There were no significant differences in sibling rank and parental characteristics between respondents and non-respondents, which indicates that our survey is representative and unbiased. The results of this survey will increase our understanding on the nutrition and health status of schoolchildren and can be used to shape public health policy in Taiwan.

Background: Body mass index (BMI) and waist circumference are highly correlated. One or the other predicts the metabolic syndromes better, depending on characteristic of the population studied, such as age, gender, and ethnicity. We examined the impact of isolated central obesity, isolated BMI elevation, and the combined type of obesity on metabolic disorders, in order to shed lights on the strategy of obesity screening., Methods: The study subjects were Chinese aged 20 or above residing in Taiwan. Their data were derived from two large-scale studies: the Nutrition and Health Survey in Taiwan (NAHSIT 1993-1996) and the Cardiovascular Disease Risk Factor Two-township Study (CVDFACTS, 1994-1997). In evaluating the relations between obesity and health risks, the cut-points of BMI (> or =24 kg/m(2) for overweight) and waist circumference (> or =80 cm for women and > or =90 cm for men) recommended by Department of Health in Taiwan for Taiwanese people were used to define various types of obesity., Results: We found that there was a small but nontrivial proportion (1.7% for men and 4.0% for women) of Taiwanese people for whom BMI was in the normal range but their waist circumferences were above normal. These people were at a higher risk of developing metabolic syndromes than those with isolated BMI elevation. Their risks were close to that of the combined type., Conclusions: In order to screen out high-risk obese individuals, isolated centrally obese subjects should not be overlooked. Therefore, we recommend to assess waist circumference in parallel to, not just sequential to the measurement of BMI in Chinese.

Background: Recommendations based on scanty data have been made to lower the body mass index (BMI; in kg/m(2)) cutoff for obesity in Asians., Objective: The goal was to compare relations between BMI and metabolic comorbidity among Asians and US whites and blacks., Methods: We compared the prevalence rate, sensitivity, specificity, predictive values, and impact fraction of comorbidities at each BMI level and the BMI-comorbidity relations across ethnic groups by using data from the third National Health and Nutrition Examination Survey and the Nutrition and Health Survey in Taiwan (1993-1996)., Results: For most BMI values, the prevalences of hypertension, diabetes, and hyperuricemia were higher for Taiwanese than for US whites. In addition, increments of BMI corresponded to higher odds ratios in Taiwanese than in US whites for hypertriglyceridemia (P = 0.01) and hypertension (P = 0.075). BMI-comorbidity relations were stronger in Taiwanese than in US blacks for all comorbidities studied. BMIs of 22.5, 26, and 27.5 were the cutoffs with the highest sum of positive and negative predictive value for Taiwanese, US white, and US black men, respectively. The same order was observed for women. For BMIs >27, >85% of Taiwanese, 66% of whites, and 55% of blacks had at least one of the studied comorbidities. However, a cutoff close to the median of the studied population was often found by maximizing sensitivity and specificity. Reducing BMI from >25 to <25 in persons in the United States could eliminate 13% of the obesity comorbidity studied. The corresponding cutoff in Taiwan is slightly <24., Conclusion: These data suggest a possible need to set lower BMI cutoffs for Asians, but where to draw the line is a complex issue.

The Bureau of Controlled Drugs at Ministry of Health, Executive Yuan in Taiwan announced, on 1 April 2000, the schedules of controlled drugs with abuse potential and implemented a policy on 1 October 2000 to control them. Flunitrazepam (FM2), along with other two benzodiazepines (triazolam and brotizolam), is placed on Schedule III. The aim of the present study was to analyze the pattern of flunitrazepam prescriptions across all medical subspecialty departments at Taipei Medical University-Wan Fang Hospital (TMU-WFH), Taiwan. We analyzed 1170 prescriptions over 12 month period from 1 July 2000 to 31 May 2001. All prescription data were divided into three 4 month periods: period I was when the flunitrazepam prescription was not controlled, period II represented the time when flunitrazepam was placed on Schedule III and when physicians were required to use a special duplicated prescription form and period III was when the TMU-WFH started to set a stricter control for the prescription of flunitrazepam. The results indicated that the number of flunitrazepam prescriptions during period III had decreased significantly compared with period I (P < or = 0.05). Eventually, 45.7% of flunitrazepam-medicated patients were followed up monthly with a restriction of their flunitrazepam supply to no more than 14 days, 22.9% of patients were followed up fortnightly at clinics with a 14 day supply of flunitrazepam, 15.7% were followed up fortnightly with a 14 day restriction of flunitrazepam plus a non-flunitrazepan benzodiazepine supplement, 10.7% were referred to clinics within the Department of Psychiatry and 5% were switched from flunitrazepam to other drugs.

Interdependent self-construal, collective self-esteem, age, and gender were used to predict attitudes toward seeking professional psychological help among a sample of junior high, high school, and college students in Taiwan (N = 594). Self-construal, collective self-esteem, and help-seeking attitudes were measured by the Self-Construal Scale (T. M. Singelis, 1994), the Collective Self-Esteem Scale Revised (R. Luhtanen & J. Crocker, 1992), and the Attitudes Towards Seeking Professional Psychological Help Scale (E. H. Fischer & J. L. Turner, 1970), respectively. By using stepwise regression, each of the independent factors with the exception of age significantly predicted the dependent variable, professional psychological help-seeking attitudes. Implications for counseling and future research are addressed.

Background and Purpose: The significance of isolated systolic hypertension (ISH) has been well documented, particularly in the elderly. However, isolated diastolic hypertension (IDH) has not been formally recognized as a unique hypertension entity. This study compared the ages of onset and characteristics of ISH and IDH., Methods: The Cardiovascular Disease Risk Factors Two-Township Study (CVDFACTS) is an ongoing longitudinal study of the risk factors for and pathogenesis of cardiovascular disease in two Taiwanese townships, Chu-Dung (a Hakka community) and Pu-Tzu (a Fukienese community); participating patients were included in our study. Among the 3,357 subjects who were aged at least 20 years, free of hypertension, and had complete data at baseline, 2,374 subjects were followed. The average duration of follow-up was 3.23 years and the follow-up rate was 71%. Data regarding smoking, alcohol consumption, health and socioeconomic background, blood pressure, and body mass index were collected. Clinical and hemostatic profiles were assessed., Results: ISH (systolic blood pressure, SBP > or = 140 mmHg and diastolic blood pressure, DBP < or = 90 mmHg) incidence increased with age in general (men: 0 per 1,000 person-years at age 20-34 yr, 1.9 at age 35-49, 14.3 at age 50-64, 40.9 at age 65-74, and 73.3 at age 75+ yr; women: 0 per 1,000 person-yr at age 20-34 yr, 3.6 at age 35-49, 17.8 at age 50-64, 64.9 9 at age 65-74, and 33.5 at age 75+ yr), but peak incidence of IDH (DBP > or = 90 mmHg and SBP < or = 140 mmHg) occurred between 35 and 49 years (men: 8.9 per 1,000 person-yr at age 20-34 yr, 14.5 at age 35-49, 12.3 at age 50-64, 2.7 at age 65-74, and 0 at age 75+ yr; women: 1.7 per 1,000 person-yr at age 20-34, 4.2 at age 35-49, 3.7 at age 50-64, 0 at age 65-74, and 0 at age 75+ yr). Significant predictors for ISH were older age (men: hazard ratio, HR = 8.25 at 45-64 yr and HR = 22.91 at 65+ yr; women: HR = 34.11 at 45-64 yr and HR = 97.98 at 65+ yr), diabetes (HR = 2.57) and elevated fibrinogen (HR = 1.49) in men, and shorter clotting time in women (HR = 1.23). Significant predictors for IDH were elevated body mass index (men: HR = 4.03; women: HR = 7.4), and higher glucose (HR = 1.46) and uric acid concentrations (HR = 1.94) in men., Conclusions: The results of this study indicate that ISH and IDH have different age incidence patterns and predictors, and suggest that the pathogenesis of ISH and IDH may be different.

The Cardiovascular Disease (CVD) Risk Factor Two-Township Study is a longitudinal cardiovascular epidemiologic study of two suburban towns in Taiwan. Analyzing baseline data from 1,080 men and 1,510 women aged 18 and above, this paper focuses on the relationship of several hemostatic factors to CVD correlates: blood lipids, apolipoproteins, glucose, and uric acid, and blood pressure. Information on these relationships can shed light on whether hemostatic factors contribute to the pathogenesis of CVD independently or through known mechanisms. Pearson correlation and multiple regression analysis were used to analyze the data. In the population studied, cholesterol, and apolipoprotein B had the strongest correlations with all hemostatic factors tested. Triglyceride was also strongly associated with factor VIIc. Factor VIIIc, factor VIIc, and fibrinogen, ordered by the strength of the correlation, were positively and significantly correlated with glucose, uric acid, and blood pressure levels. The associations of apolipoprotein B and cholesterol with fibrinogen (p = 0.14-0.20) were not as strong as those with factors VIIc (p = 0.28-0.37) and VIIIc (p = 0.15-0.30). Factors VIIc and VIIIc were independently associated with most clinical variables studied, including the levels of cholesterol components, triglyceride, glucose, uric acid, and diastolic blood pressure. These finding indicate that states of coagulating factors correlated, to varied degrees, with levels of blood lipid parameters, uric acid, and blood pressure in the population studied.

Seasonal influence on mortality from cardiovascular and cerebrovascular diseases is well documented. Understanding the seasonal variations in cardiovascular risk factors can shed light on this phenomenon. Elevation of coagulation factors during cold weather may in part explain the higher mortality from myocardial infarction and stroke in winter. The Cardiovascular Disease Risk Factors Community Study (CVDFACTS) included subjects belonging to 2 cohorts located in northern and southern Taiwan. This study included 2877 subjects aged 18 and above whose blood levels were examined for various coagulating factors. Besides measuring conventional cardiovascular risk factors including: blood pressure, body mass index and total cholesterol, values for blood fibrinogen, factor VII activity, factor VIII activity, plasminogen, antithrombin III, prothrombin time and activated partial thromboplastin time were determined for all subjects. Of these hemostatic parameters, levels of all, except prothrombin time, were statistically different between days with mean temperature > 20 degrees C and days with temperature < or = 20 degrees C (P < 0.01). In cold weather, a greater tendency to clot in circulatory system was demonstrated in this study, indicating seasonal variations may be demonstrated in this subtropical region.

The role of hemostatic factors in the pathogenesis of cardiovascular disease has gained much attention recently. Information about hemostatic factors, and their age patterns is sparse for orientals. With the data collected in the Cardiovascular Disease Risk Factor Two-township Study in Taiwan, this study shows that, in general, the older the age, the stronger the tendency toward thrombosis. With advancing age, prothrombin time, activated partial thromboplastin time, and antithrombin-III level decreased steadily; but mean values of fibrinogen, factor VIIc, and factor VIIIc increased. Gender differences in the age patterns of the above factors are carefully described. Curvilinear relations between hemostatic factors and age were demonstrated for adults aged 18 and above for all hemostatic factors studied. This curvilinearity should be taken into consideration when adjusting for the effect of age in data analysis to avoid residual confounding, particularly when the age range of the study subjects is wide.