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Alcohol use ranks as one of the most prevalent health-risk behaviors among Taiwanese adolescents. Possible selves--personalized future-oriented cognitions about the self--are significant motivators of one's actions, which may potentially influence adolescent drinking behavior. This study aimed to estimate the content domain-specific possible selves and their associations with drinking behaviors among Taiwanese adolescents. A total of 225 Taiwanese seventh and eighth graders from a public junior high school were recruited. An anonymous self-reported questionnaire was used to collect data during two time-points at six-month intervals. Results showed that having a "physical appearance" related hoped-for possible self and a "friendship" related feared possible self was associated with adolescent alcohol use after six months. Whereas, having the "physical appearance" related hoped-for and feared possible selves were associated with alcohol problems, at both, baseline and six months later. Future studies could clarify the meaning behind "physical appearance" related possible selves.

This study aimed to use a game-based learning (GBL) module with multi-scaffolding and mobile technology for high school students with mild intellectual disabilities (MID) to assist them in learning career education knowledge. This study used a quasi-experimental method to investigate the participants' learning effectiveness, motivation, flow state, game acceptance, and learning behavior patterns (LBP). The differences in the LBP of the high and low learning effectiveness groups and the high and low flow state groups were also investigated. In total, 32 high school students with MID participated in this study. The results show that the GBL module with the multi-scaffolding mechanism could improve their learning effectiveness, motivation, flow state, game acceptance, and LBP and reduce their distraction behavior in the learning activities. The results of the sequential analysis indicated the significance of the behavior of reflection and discussions in the high learning effectiveness group. Additionally, the high-flow state group tended to try multiple strategies to complete the learning tasks. Furthermore, the game mechanism embodied collaborative peer interaction; even when the high-flow group became distracted, they returned to the tasks and continued the discussions with peers.

Students from Asian countries form the largest group of mobile international students in Western anglophone countries. Despite research on the mobility experiences of international students to anglophone and non-anglophone countries, there are limited cross-comparative, mixed-method studies exploring the experiences of host language acquisition and usage and how these impact on academic performance and shapes social connectedness. This study contributes further understanding by exploring language acquisition experiences of international university students in Taiwan and Australia, where the language of instruction is not their native language. In the two universities studied, usage levels (general usage, speaking, reading, listening and writing) differed and depended on situational and contextual needs. Those studying in Australia consistently reported higher mean scores of host language usage across three of the five components: listening, reading and writing. Written communication was perceived to be a challenge for both groups during interviews. Overall, students preferred face-to-face classroom learning and highly valued peer support. Information communication and technology use was common in supporting vocabulary and pronunciation. We discuss how the findings of our study inform the types of academic learning support needed, and how these differed, depending on the host language, and student background.

Public speaking is considered the most anxiety-provoking speaking activity for English as a foreign language (EFL) learner. While traditional lecture-based classrooms hinder EFL learners' constant practice and frequent interaction due to large class sizes and limited time, recent developments in technology, including Artificial Intelligence (AI), Automatic Speech Analysis, and Virtual Reality (VR), may enhance language learning by offering accessible and personalized learning experiences. This study aimed to investigate the effects of technology-enhanced learning on reducing EFL learners' PSA. Thirty-three university students were divided into three groups and received either lecture-based, mobile-assisted, or VR-facilitated instruction for four weeks. The students' perceived PSA levels were reduced in all three groups after their respective instruction, but only the VR-facilitated group reached statistical significance, and there were no differences in the three groups' final oral performances. However, the two technology-enhanced language learning (TELL) groups achieved more convergent performances on the Personal Report of Public Speaking Anxiety scale compared with the non-TELL group, which indicated that the impact of individual differences may have been compensated by technology assistance. The findings suggested that the instructional feedback generated by AI decreased the participants' PSA, although the irreplaceable role of teachers as facilitators was also emphasized, while the potential of using VR in teaching public speaking was evident.

Children always have a natural inclination to play, so the purpose of game-based learning is to establish a way for children to acquire knowledge while playing. This study is to discover the relationship between children's play preferences and learning performances toward a mathematics mobile game we designed. The tablet game we designed, "Lily's Closet", is a mathematics game that guides children aged 3-8 to learn "classification". To explore the preferences and learning performances of the games we designed for the preschool children, we put "Lili's Closet" on a children's tablet named Kizpad with over 200 games. We classify and analyze players' behavior data by Data Mining in our designed game to explore children's play behaviors and preferences. We sampled 6,924 children from Taiwan, aged 3-8 years old. In the results, we found that there is a significant difference in the number of ages and achievements in the game. The maturity of the child's age is positively correlated with the achievement of the game, but it is negatively correlated with the number of times of willing to play. As a result, we suggest that to assist learning, we should give children different levels of games according to their ages. The research hopes to resonate with readers and jointly explore the relationship between mobile games.

The purpose of this study was to investigate the affordances of participatory simulations by comparing students' models of engagement and science learning outcomes in a multi-team participatory simulated game (MPSG) and a single-team participatory simulated game (SPSG). Two versions of a mobile-based game about marine fishery management were created. Participants were 105 seventh-grade students in Taiwan. Research instruments included a Science Game Engagement questionnaire and a Marine Ecosystem and Sustainability Test. Students' interviews and classroom videos were also collected. Students' models of engagement were analyzed by using Partial Least Squares Structural Equation Modeling, and comparisons of subscales of engagement and learning outcomes were made by Analysis of Covariance statistics. The results showed that the students in the MPSG group had a higher level of behavioral engagement and better learning achievement than the students in the SPSG group did. Also, in exploring the interrelationships among the subscales of students' engagement, we found that, in the SPSG group, students' behavioral engagement was positively predicted by their emotional engagement, while in the MPSG group, it was positively predicted by their social engagement. In both groups, behavioral engagement predicted cognitive engagement. This finding was supported by the video data in that more interactions among the group members were observed in the MPSG group. This indicated that the multi-agent, dynamic modeling in the MPSG may have shifted the quality of the learners' social interactions. The affordances of participatory simulated games are discussed, and future research directions are provided.

This study aimed to estimate the population-attributable fraction (PAF) of psychiatric and physical disorders for suicide among older adults, focusing on sex- and age-specific factors. Data from Taiwan's National Health Insurance Research Data and National Death Registry included 9136 cases of suicide in individuals aged 65+, with 89,439 matched controls. Physical and psychiatric disorders were identified through diagnostic records. Conditional logistic regression assessed risk factors, and PAF was calculated using disorder prevalence and adjusted odds ratios. Major suicide risk factors among older adults were depressive disorders, anxiety disorders, and sleep disorders. Physical disorders like hypertension, peptic ulcers, and cancer also showed significant PAF values. The combined PAF of physical disorders equaled that of psychiatric disorders. Psychiatric disorders had a greater impact on women and the youngest-old adults, while physical disorders had a higher contribution among men, middle-old adults, and oldest-old adults. Relying solely on claim data to identify psychiatric and physical disorders may underestimate their prevalence and associations with suicide due to unrecorded cases of individuals not seeking help and the absence of key risk factors like social isolation and family support. This study identifies preventable or treatable risk factors for older adult suicide, emphasizing the need to target specific psychiatric and physical disorders in suicide prevention efforts while taking into account sex- and age-specific considerations. It also underscores the importance of establishing social welfare support systems to address the unique challenges older adults face. • Depressive, anxiety, and sleep disorders are significant suicide risk factors among older adults. • Physical disorders like cancer, hypertension, and peptic ulcers also contribute to suicide risk. • The combined impact of physical and psychiatric disorders on suicide risk is comparable. • Psychiatric disorders are more influential in women and the youngest-old • Physical disorders have a greater impact on men and older adults. [ABSTRACT FROM AUTHOR]

Enabling older adults to age at home is an urgent issue. This study focuses on the attitudes of middle-aged and older people (MAOP) in the capital cities of Taiwan, which are characterised by expensive housing prices and living costs, to examine their preferences for reverse mortgage (RM) schemes. The stated preference method and conditional multinomial logit model are utilised for analysis. The study simulates the total payment duration (TPD) and monthly payment amounts (MPA) to determine the market share of MAOPs' choices regarding terms. The results indicate that MAOPs tend to opt for RM schemes when they have children, partly enhancing the preference toward the long-term alternative (AL). Increasing the MPA has a positive effect on the market share of the AL scheme, but the amount must be increased to 90% to replace the market share of non-participation schemes significantly. The experimental design of this study could serve as a reference for future RM scheme designs. The findings suggest that there should be more alternative funding sources in an ageing society, particularly through revitalising housing assets, to promote ageing in place. [ABSTRACT FROM AUTHOR]

The present study examines the effects of cognitive-based metaphoric mapping instruction (MMI) on English as Foreign Language (EFL) learners' retention and awareness of figurative language at different levels of English proficiency. Ninety-one Taiwanese EFL learners participated in the study, and were separated into a control group that received no instruction in MMI and two experimental groups consisting of high-intermediate and low-intermediate learners, respectively, who did receive instruction in MMI. The results of the pretests and posttests show that MMI significantly increased EFL learners' retention and awareness of figurative language; moreover, high-intermediate learners made greater progress in noticing expressions with more abstract mapping relations. Additionally, MMI assisted learners at a lower proficiency level to acquire more advanced language ability, beyond their current level. These findings support positive claims for a cognitive perspective on second language acquisition as well as the benefits of explicit instruction in the EFL classroom.

In Taiwan, most students with disabilities receive education in an inclusive setting. Literature has documented the effects of interventions in increasing students' positive behaviors in inclusive settings, including students with disabilities in Western countries; however, effectiveness of such interventions in an Asian context remains unclear. The Class-Wide Function-Related Intervention Teams (CW-FIT) is one of the interventions that applies reinforcement-based strategies and provides multi-tiered supports to students with various severity of challenging behaviors. This study investigates the effects of CW-FIT Tier I (i.e. class-wide intervention) and Tier II (i.e. self-management) on the on-task and disruptive behaviors of a student with Autism Spectrum Disorder in an inclusive elementary classroom in Taiwan. Across nine weeks of intervention, the researchers used a reversal single-case design A-B-C-B-C to demonstrate experimental control over five phases. In addition, the researchers administered interviews and questionnaires to collect social validity data from the teacher and peers' perceptions toward the intervention. Findings from this study support that the CW-FIT is an effective intervention in increasing a student's on-task behaviors and decreasing disruptive behaviors in an inclusive classroom in an Asian context. The effect of implementing multiple tiers of CW-FIT was much more effective than implementing solely Tier I (class-wide intervention). The intervention was also well-received by the general education teacher and students.

Alcohol use ranks as one of the most prevalent health-risk behaviors among Taiwanese adolescents. Possible selves—personalized future-oriented cognitions about the self—are significant motivators of one's actions, which may potentially influence adolescent drinking behavior. This study aimed to estimate the content domain-specific possible selves and their associations with drinking behaviors among Taiwanese adolescents. A total of 225 Taiwanese seventh and eighth graders from a public junior high school were recruited. An anonymous self-reported questionnaire was used to collect data during two time-points at six-month intervals. Results showed that having a "physical appearance" related hoped-for possible self and a "friendship" related feared possible self was associated with adolescent alcohol use after six months. Whereas, having the "physical appearance" related hoped-for and feared possible selves were associated with alcohol problems, at both, baseline and six months later. Future studies could clarify the meaning behind "physical appearance" related possible selves. [ABSTRACT FROM AUTHOR]

Idioms have long been regarded as problematic for L2 learners due to the arbitrariness of their meanings and forms. Traditional methods of teaching idioms focus on rote learning and memorization. Recent developments in cognitive linguistics research have considered idioms as analyzable expressions which are motivated by conceptual metaphors and whose meanings can derive from associations between source and target concepts. Believed to be imageable and comprehensive, idioms should be learned through the process of raising L2 learners' awareness of conceptual metaphors behind these expressions. Nevertheless, these methods fail to notice culture entailments embedded in conceptual metaphors. Especially for FL learners who share neither common cultural background nor living environment with the target language users, difficulties resulting from transferability between L1 and L2 idioms owing to cultural similarities and differences may be serious. To bridge the gap between idioms and conceptual metaphors caused by cross-cultural differences, this study suggests a teaching method by incorporating the idea of metaphoric mappings. A case study was conducted in an EFL writing class to investigate the effect of the methods. Essays written by the students before and after the instruction were analyzed. Results showed that the students increased frequencies of using not only common idiomatic expressions but also creative analogies comprising vivid images based on the conceptual metaphors taught. Additionally, they used L2 expressions whose conceptual metaphors also existed in L1 more often then expressions whose conceptual metaphors were exclusive in L2. Such findings affirm the importance of culture and provide valuable insight to EFL teachers in adopting cognitive-oriented method to teach English idioms.

Researchers have indicated that many children from Asian countries have the experience of learning English prior to school at home or at private institutes. The Taiwanese government promotes informal and play-based teaching of English in the home if the parents would like their young children to learn English prior to formal instruction. This study is designed to investigate how Taiwanese mothers attempt to facilitate their children's English development by exploring how they engage their children in English learning at home. We also investigate whether there is a relationship between maternal educational attainment and maternal teaching practices and the use of resources. The sample consists of 647 mothers of preschoolers who responded to a questionnaire which surveyed their practices and resources utilized at home. The results showed that mothers differed in the extent to which they engaged in shared reading and provided toys and computer media for English instruction, and that maternal education is related to the types of strategies and resources provided. The findings provide significant information about what the mothers utilized to assist their young children to learn English language. (Contains 3 tables.)

A commercially significant small coastal forage fish, moonfish (Mene maculata), accounts for almost 98% of Taiwanese purse seine capture, primarily in the southwestern Taiwan region. Research indicates that climate indices affect coastal fish catch and dispersal, while the link between moonfish and climatic variability in this region is still unclear. This study found that the delayed period of Pacific Decadal Oscillation (PDO), North Pacific Oscillation (NPO) and North Pacific Gyre Oscillation (NPGO) affect moonfish distribution and catch rates off southwestern Taiwan. Understudied are the environmental factors connected to these oscillations and their delayed consequences on moonfish catch rates. We focussed on Taiwan purse seiner capture rates (catch per unit effort or CPUE) of moonfish in southwestern Taiwan from 2014 to 2020 and delayed oscillation occurrences up to 5 years to better understand these processes. CPUE demonstrated a 3 to 4‐year positive connection (r > 0.5) with NPGO, NPO and PDO. The region's moonfish catch rates were most affected by NPGO with a 4‐year lag, followed by a 3‐year lag of PDO and lastly a 4‐year lag of NPO, according to the results of generalized additive models (GAMs). All the three oscillations had the greatest impact on moonfish catchability when a lag of >2 years was present. Between 2014 and 2020, moonfish CPUE fluctuated, peaking in 2019. The climatic parameters that affect moonfish in southwestern Taiwan and the Taiwanese purse seine fisheries catches are shown by this study. [ABSTRACT FROM AUTHOR]

COVID-19 has been a significant global concern due to its contagious nature. In May 2021, Taiwan experienced a severe outbreak, leading the government to enforce strict Pandemic Alert Level 3 restrictions in order to curtail its spread. Although previous studies in Taiwan have examined the effects of these measures on air quality, further research is required to compare different time periods and assess the health implications of reducing particulate matter during the Level 3 lockdown. Herein, we analyzed the mass concentrations, chemical compositions, seasonal variations, sources, and potential health risks of PM1.0 and PM2.5 in Central Taiwan before and during the Level 3 lockdown. As a result, coal-fired boilers (47%) and traffic emissions (53%) were identified as the predominant sources of polycyclic aromatic hydrocarbons (PAHs) in PM1.0, while in PM2.5, the dominant sources of PAHs were coal-fired boilers (28%), traffic emissions (50%), and iron and steel sinter plants (22.1%). Before the pandemic, a greater value of 20.9 ± 6.92 μg/m3 was observed for PM2.5, which decreased to 15.3 ± 2.51 μg/m3 during the pandemic due to a reduction in industrial and anthropogenic emissions. Additionally, prior to the pandemic, PM1.0 had a contribution rate of 79% to PM2.5, which changed to 89% during the pandemic. Similarly, BaPeq values in PM2.5 exhibited a comparable trend, with PM1.0 contributing 86% and 65% respectively. In both periods, the OC/EC ratios for PM1.0 and PM2.5 were above 2, due to secondary organic compounds. The incremental lifetime cancer risk (ILCR) of PAHs in PM2.5 decreased by 4.03 × 10-5 during the pandemic, with PM1.0 contributing 73% due to reduced anthropogenic activities. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the association between dietary guideline adherence and overall, outpatient, and emergency medical service utilization in Taiwanese preschoolers. Methods: We selected 614 preschoolers (2–6 years) who had one day of 24-h dietary recall data from the 2013–2016 Nutrition and Health Survey in Taiwan. The Taiwanese Children Healthy Eating Index (TCHEI) was developed on the basis of Taiwanese Food-Based Dietary Guidelines; it assesses dietary adequacy and eating behavior. Data on the participants' outpatient and emergency medical service utilization were obtained for 2013–2018 from the National Health Insurance Research Database. A multivariable generalized linear model was used to evaluate the association between the TCHEI and medical service utilization for all disease and respiratory diseases. Results: After adjustment for confounding factors, children aged 2–3 years in the Tertile (T) 2 and T3 groups of the TCHEI exhibited 25% (95% CI 0.69–0.83) and 16% (95% CI 0.77–0.92) lower overall medical visits, respectively. The same pattern was noted in the outpatient and emergency visits for all diseases and respiratory diseases. The children aged 4–6 years in the T2 group exhibited 15% (95% CI 0.80–0.91) and 11% (95% CI 0.82–0.97) lower overall visits and visits for respiratory diseases, respectively. Moreover, preschoolers in the T2 group exhibited lower overall medical expenditures than did those in the T1 group. Conclusions: TCHEI score was positively correlated with better nutritional status. Optimal dietary intake associated with lower medical service utilization among Taiwan preschoolers. [ABSTRACT FROM AUTHOR]

Background: Most sepsis patients could potentially experience advantageous outcomes from targeted medical intervention, such as fluid resuscitation, antibiotic administration, respiratory support, and nursing care, promptly upon arrival at the emergency department (ED). Several scoring systems have been devised to predict hospital outcomes in sepsis patients, including the Sequential Organ Failure Assessment (SOFA) score. In contrast to prior research, our study introduces the novel approach of utilizing the National Early Warning Score 2 (NEWS2) as a means of assessing treatment efficacy and disease progression during an ED stay for sepsis. Objectives: To evaluate the sepsis prognosis and effectiveness of treatment administered during ED admission in reducing overall hospital mortality rates resulting from sepsis, as measured by the NEWS2. Methods: The present investigation was conducted at a medical center from 1997 to 2020. The NEWS2 was calculated for patients with sepsis who were admitted to the ED in a consecutive manner. The computation was based on the initial and final parameters that were obtained during their stay in the ED. The alteration in the NEWS2 from the initial to the final measurements was utilized to evaluate the benefit of ED management to the hospital outcome of sepsis. Univariate and multivariate Cox regression analyses were performed, encompassing all clinically significant variables, to evaluate the adjusted hazard ratio (HR) for total hospital mortality in sepsis patients with reduced severity, measured by NEWS2 score difference, with a 95% confidence interval (adjusted HR with 95% CI). The study employed Kaplan-Meier analysis with a Log-rank test to assess variations in overall hospital mortality rates between two groups: the "improvement (reduced NEWS2)" and "non-improvement (no change or increased NEWS2)" groups. Results: The present investigation recruited a cohort of 11,011 individuals who experienced the first occurrence of sepsis as the primary diagnosis while hospitalized. The mean age of the improvement and non-improvement groups were 69.57 (± 16.19) and 68.82 (± 16.63) years, respectively. The mean SOFA score of the improvement and non-improvement groups were of no remarkable difference, 9.7 (± 3.39) and 9.8 (± 3.38) years, respectively. The total hospital mortality for sepsis was 42.92% (4,727/11,011). Following treatment by the prevailing guidelines at that time, a total of 5,598 out of 11,011 patients (50.88%) demonstrated improvement in the NEWS2, while the remaining 5,403 patients (49.12%) did not. The improvement group had a total hospital mortality rate of 38.51%, while the non-improvement group had a higher rate of 47.58%. The non-improvement group exhibited a lower prevalence of comorbidities such as congestive heart failure, cerebral vascular disease, and renal disease. The non-improvement group exhibited a lower Charlson comorbidity index score [4.73 (± 3.34)] compared to the improvement group [4.82 (± 3.38)] The group that underwent improvement exhibited a comparatively lower incidence of septic shock development in contrast to the non-improvement group (51.13% versus 54.34%, P < 0.001). The improvement group saw a total of 2,150 patients, which represents 38.41% of the overall sample size of 5,598, transition from the higher-risk to the medium-risk category. A total of 2,741 individuals, representing 48.96% of the sample size of 5,598 patients, exhibited a reduction in severity score only without risk category alteration. Out of the 5,403 patients (the non-improvement group) included in the study, 78.57% (4,245) demonstrated no alteration in the NEWS2. Conversely, 21.43% (1,158) of patients exhibited an escalation in severity score. The Cox regression analysis demonstrated that the implementation of interventions aimed at reducing the NEWS2 during a patient's stay in the ED had a significant positive impact on the outcome, as evidenced by the adjusted HRs of 0.889 (95% CI = 0.808, 0.978) and 0.891 (95% CI = 0.810, 0.981), respectively. The results obtained from the Kaplan-Meier analysis indicated that the survival rate of the improvement group was significantly higher than that of the non-improvement group (P < 0.001) in the hospitalization period. Conclusion: The present study demonstrated that 50.88% of sepsis patients obtained improvement in ED, ascertained by means of the NEWS2 scoring system. The practical dynamics of NEWS2 could be utilized to depict such intricacies clearly. The findings also literally supported the importance of ED management in the comprehensive course of sepsis treatment in reducing the total hospital mortality rate. [ABSTRACT FROM AUTHOR]

Attachment insecurity has been linked to the intense grief of caregivers. However, limited studies have focused on the pre-loss grief and attachment insecurity of caregivers during end-of-life care. In this study, we examined potential correlates of caregivers' pre-loss grief, personal growth, and relationships with the patients, focusing on attachment insecurity and relational closeness. 163 primary caregivers of terminally ill cancer patients were recruited. Sociodemographic, pre-loss grief, personal growth, attachment insecurity, and emotional closeness were assessed from caregivers during the palliative care for patients. The results showed that attachment anxiety, but not attachment avoidance, was significantly associated with pre-loss grief. Emotional closeness during the care of terminal patients, but not before cancer occurrence, was significantly associated with personal growth. The present study highlights the importance of dyadic relational quality between the caregiver and the patient, which is useful in clinical settings to identify at-risk populations for caregivers' pre-loss grief. [ABSTRACT FROM AUTHOR]

Tons of broiler livers are produced yearly in Taiwan but always considered waste. Our team has successfully patented and characterized a chicken‐liver hydrolysate (CLH) with several biofunctions. Chronic alcohol consumption causes hepatosteatosis or even hepatitis, cirrhosis, and cancers. This study was to investigate the hepatoprotection of CLH‐based supplement (GBHP01™) against chronic alcohol consumption. Results showed that GBHP01™ could reduce (p <.05) enlarged liver size, lipid accumulation/steatosis scores, and higher serum AST, ALT, γ‐GT, triglyceride, and cholesterol levels induced by an alcoholic liquid diet. GBHP01™ reduced liver inflammation and apoptosis in alcoholic liquid‐diet‐fed mice via decreasing TBARS, interleukin‐6, interleukin‐1β, and tumor necrosis factor‐α levels, increasing reduced GSH/TEAC levels and activities of SOD, CAT and GPx, as well as downregulating CYP2E1, BAX/BCL2, Cleaved CASPASE‐9/Total CASPASE‐9 and Active CASPASE‐3/Pro‐CASPASE‐3 (p <.05). Furthermore, GBHP01™ elevated hepatic alcohol metabolism (ADH and ALDH activities) (p <.05). In conclusion, this study prove the hepatoprotection of GBHP01™ against alcohol consumption. [ABSTRACT FROM AUTHOR]

Purpose: Continuous advancements in medical diagnostic technology and the growing availability of resources suggest a potential for fluctuations in the incidence rate of retinoblastoma (Rb). This study aimed to analyze incidence data of Rb patients in Taiwan from 1999 to 2018, utilizing the nationwide Taiwan Cancer Registry (TCR) database. Additionally, we investigated the treatment modalities used for these Rb patients and compared them with those observed in other countries. Patients and Methods: We conducted a retrospective cohort study utilizing data from the TCR database. The study cohort comprised individuals who were newly diagnosed with Rb between 1999 and 2018. The incidence of Rb was calculated as the number of patients with Rb per million live births, both for the entire population and for different gender groups and time periods. The trends in Rb incidence from 1999 to 2018 across various age groups and sexes were presented with the linear trend test. Results: From 1999 to 2018, a total of 248 cases of Rb were identified. The overall incidence rate over this 20-year period was 60.20 cases per million live births, corresponding to 1 case per 16,611 live births. Incidence rates for each 5-year period between 1999 and 2018 exhibited no significant differences. The study cohort was predominantly male, with 134 cases (54.03%) being males and 114 cases (45.97%) being females, resulting in an overall male-to-female sex ratio of 1.18. Females had lower relative risk than males (RR: 0.92, 95% CI: 0.72– 1.19). Primary surgical intervention was the preferred treatment modality for over 75% of the cases. Conclusion: This retrospective epidemiology study, using TCR from 1999 to 2018, indicated that no discernible trend of retinoblastoma incidence in Taiwan. Nevertheless, continuous monitoring of incidence rates and exploration of treatment strategies for retinoblastoma within the Taiwanese population are important to address potential changes in developing medical practices. [ABSTRACT FROM AUTHOR]

Aim: Many persons living with dementia (PLWD) reside in the community and are cared for by family members. The aim of this qualitative study was to gain an understanding the enrichment process for family caregivers of PLWD in Taiwan. Design: A grounded theory approach with face‐to‐face semi‐structured interviews was conducted with family caregivers of PLWD in Taiwan. Methods: Interview data from 30 family caregivers of PLWD recruited from dementia clinics or support groups in Taiwan were obtained from the first wave of a larger study conducted from January 2018 to September 2021. Glaser's grounded theory approach with theoretical sampling was used to understand the enrichment process of family caregivers of PLWD. Results: Analysis indicated the core category that characterized the process of enrichment was 'holding together'. Caregivers were able to maintain their connection to the person with dementia through activities that deepened their relationship and strengthened their bond. 'Holding together' included four components: maintaining continuity, creative interactions, interacting with humour and sharing pleasurable activities. Through these components, family caregivers generated positive interactions and relationships with the person living with dementia and sustained their motivation for caregiving. Three modifying elements facilitated or impeded the process of holding together: 'previous daily interactions', 'caregiving beliefs' and 'filial piety'. Conclusion: Through the enrichment process of 'holding together', family caregivers used different strategies to conduct pleasurable and meaningful activities with the person living with dementia to maintain and improve their relationship and enhance their happiness in life. Impact: To facilitate the enrichment process, health care providers should encourage activities between family caregivers and PLWD that promote continuity, increase interactions, provide humour and foster pleasurable activities. Reporting Method: This study adhered to the COREQ guideline checklist. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: To adapt to dramatic changes from physical growth, physical development and the increasing demand of significant others, humor has been found to be an effective coping strategy. However, previous studies have found that adolescents start to express their humor styles with aggressive components which causes negative consequences, such as social anxiety and social loneliness. Therefore, the factors that influence adolescents' humor styles, particularly negative ones, should be of concern. Objective: The purpose of this study was twofold: (1) to investigate the effects of the classroom humor climate and the effects of the personal acceptance of humor messages on adolescents' expressions of humor and (2) to examine how the personal acceptance of humor messages moderates these relationships. Methods: Four types of humor expressions based on the Taiwan Adolescent Humor Instruments were measured: self-deprecating, other-devaluing, body language, and witty response (Chiang et al. in "Psychol Test" 58:179-205, 2011). The current study used a cross-sectional design with data from a nationally representative random sample of 1718 students. The data were analyzed using hierarchical linear modeling. Results: Adolescents' acceptance of humor messages influenced their use of each type of humor, and the classroom climate also modestly influenced their use of humor. When the classroom climate favored self-deprecating/other-devaluing humor, and adolescents more positively accepted self-deprecating/ other-devaluing humor, they engaged in more of that type of humor. Conclusion: Adolescents' acceptance of humor messages should be assessed to identify and reduce maladaptive humor climates and to facilitate a more positive humor style in the classroom by promoting appropriate social norms.

Background: The in-hospital mortality of cardiogenic shock (CS) remains high (28% to 45%). As a result, several studies developed prediction models to assess the mortality risk and provide guidance on treatment, including CardShock and IABP-SHOCK II scores, which performed modestly in external validation studies, reflecting the heterogeneity of the CS populations. Few articles established predictive scores of CS based on Asian people with a higher burden of comorbidities than Caucasians. We aimed to describe the clinical characteristics of a contemporary Asian population with CS, identify risk factors, and develop a predictive scoring model. Methods: A retrospective observational study was conducted between 2014 and 2019 to collect the patients who presented with all-cause CS in the emergency department of a single medical center in Taiwan. We divided patients into subgroups of CS related to acute myocardial infarction (AMI-CS) or heart failure (HF-CS). The outcome was all-cause 30-day mortality. We built the prediction model based on the hazard ratio of significant variables, and the cutoff point of each predictor was determined using the Youden index. We also assessed the discrimination ability of the risk score using the area under a receiver operating characteristic curve. Results: We enrolled 225 patients with CS. One hundred and seven patients (47.6%) were due to AMI-CS, and ninety-eight patients among them received reperfusion therapy. Forty-nine patients (21.8%) eventually died within 30 days. Fifty-three patients (23.55%) presented with platelet counts < 155 × 103/μL, which were negatively associated with a 30-day mortality of CS in the restrictive cubic spline plot, even within the normal range of platelet counts. We identified four predictors: platelet counts < 200 × 103/μL (HR 2.574, 95% CI 1.379–4.805, p = 0.003), left ventricular ejection fraction (LVEF) < 40% (HR 2.613, 95% CI 1.020–6.692, p = 0.045), age > 71 years (HR 2.452, 95% CI 1.327–4.531, p = 0.004), and lactate > 2.7 mmol/L (HR 1.967, 95% CI 1.069–3.620, p = 0.030). The risk score ended with a maximum of 5 points and showed an AUC (95% CI) of 0.774 (0.705–0.843) for all patients, 0.781 (0.678–0.883), and 0.759 (0.662–0.855) for AMI-CS and HF-CS sub-groups, respectively, all p < 0.001. Conclusions: Based on four parameters, platelet counts, LVEF, age, and lactate (PEAL), this model showed a good predictive performance for all-cause mortality at 30 days in the all patients, AMI-CS, and HF-CS subgroups. The restrictive cubic spline plot showed a significantly negative correlation between initial platelet counts and 30-day mortality risk in the AMI-CS and HF-CS subgroups. [ABSTRACT FROM AUTHOR]

Purpose: Epidermal growth factor receptor (EGFR) exon 20 insertions (ex20ins) are associated with poor prognosis and resistance to traditional therapies in patients with non–small cell lung cancer (NSCLC). We aimed to elucidate the characteristics and treatment patterns to improve outcomes among this population in Taiwan. Methods: Patients with advanced or recurrent NSCLC harboring EGFR ex20ins from 2011 to 2021 were reviewed. The treatment groups were classified as platinum-based chemotherapy (PtC), EGFR tyrosine kinase inhibitor (TKI), and others. The response to therapy, objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and factors associated with survival were analyzed. Results: Among the 71 patients, most were never-smoking males with stage IVB adenocarcinoma. The most common first-line (1L) regimen was PtC, followed by TKI. The most common second-line (2L) regimen was TKI. The median PFS of 1L treatment was 5.03 months, and the median OS was 18.43 months. Compared with that of TKI, 1L PtC use was associated with a higher ORR (26.3% vs. 9.1%) and DCR (60.5% vs. 18.2%) and a longer PFS (5.37 vs. 3.13 months, p = 0.044). PFS was also significantly longer in the 2L PtC group than in the 2L TKI group (4.73 vs. 2.25 months, p = 0.047). No patients receiving an immune checkpoint inhibitor–based regimen exhibited a therapeutic response. Conclusion: This study demonstrated the heterogeneous clinical characteristics and treatment pattern of NSCLC patients with EGFR ex20ins, underscoring the need for more effective therapies for this distinct molecular subtype. [ABSTRACT FROM AUTHOR]

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

Taiwan has been an aging society since 2018. As a result, long-term care, end-of-life autonomy, and hospice care have received increasing attention. The government of Taiwan promotes home-based healthcare through the National Health Insurance System to enable the efficient utilization of medical resources and reduce overall medical costs. Taiwan's community hospice and palliative care network is expected to serve as the main care model supplementing partial hospitalization and institutional care. In this article, we review the history of and policies related to hospice and palliative care in Taiwan using a literature review and examining Pingtung County as a case study. The implementation of home-based palliative care is also outlined and policy revisions are proposed. The results are intended to provide a reference for healthcare authorities and medical institutions to promote community hospice and palliative care policies. The integrated care model can enhance the capacity of community-based palliative care, support patients receiving palliative care and their family members and caregivers, and ensure physical and psychological comfort for patients. This model contributes to the realization of older adults' preference for dying at home, which is especially pronounced in cultures where traditional Chinese ideas are deeply rooted. [ABSTRACT FROM AUTHOR]

Foliar diseases caused by Stemphylium and Colletotrichum species are among the major biotic factors limiting Welsh onion production in Taiwan. Owing to concerns about the environment and the development of pathogen resistance to existing fungicides, biological control using endophytes is emerging as an eco-friendly alternative to chemical control. The aim of the present study was to isolate endophytes from healthy Welsh onion leaves and investigate their antagonistic potential against the major phytopathogenic fungi associated with Welsh onion plants in Taiwan. A total of 109 bacterial and 31 fungal strains were isolated from healthy Welsh onion leaves and assigned to 16 bacterial and nine fungal genera using morphological and molecular characterization based on DNA sequence data obtained from nuclear internal transcribed spacer (nrITS) (fungi) and 16S rRNA (bacteria). Evaluation of these endophytic isolates for biocontrol activity against leaf blight pathogens Colletotrichum spaethianum strain SX15-2 and Stemphylium vesicarium strain SX20-2 by dual culture assay and greenhouse experiments resulted in the identification of two bacterial isolates (GFB08 and LFB28) and two fungal isolates (GFF06 and GFF08) as promising antagonists to leaf blight pathogens. Among the four selected isolates, Bacillus strain GFB08 exhibited the highest disease control in the greenhouse study. Therefore, Bacillus strain GFB08 was further evaluated to understand the mechanism underlying its biocontrol efficacy. A phylogenetic analysis based on six genes identified Bacillus strain GFB08 as B. velezensis. The presence of antimicrobial peptide genes (baer, bamC, bmyB, dfnA, fenD, ituC, mlna, and srfAA) and the secretion of several cell wall degrading enzymes (CWDEs), including cellulase and protease, confirmed the antifungal nature of B. velezensis strain GFB08. Leaf blight disease suppression by preventive and curative assays indicated that B. velezensis strain GFB08 has preventive efficacy on C. spaethianum strain SX15-2 and both preventive and curative efficacy on S. vesicarium strain SX20-2. Overall, the current study revealed that healthy Welsh onion leaves harbour diverse bacterial and fungal endophytes, among which the endophytic bacterial strain, B. velezensis strain GFB08, could potentially be used as a biocontrol agent to manage the leaf blight diseases of Welsh onion in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Dentists may be at a higher risk of developing carpal tunnel syndrome (CTS) because of their use of frequent wrist and vibratory instruments at work; however, this issue remains unclear. Therefore, we conducted this study to clarify it. Methods: Taiwan National Health Insurance Research Database was used for this nationwide population-based study. We identified 11,084 dentists, 74,901 non-dentist healthcare professionals (HCPs), and identical number of age- and sex-matched participants from the general population. Participants who had the diagnosis of CTS before 2007 were excluded. Between 2007 and 2011, the risk of developing CTS among dentists, non-dentist HCPs, and the general population was compared by following their medical histories. Results: The cumulative incidence rate of CTS among dentists was 0.5% during the 5-year follow-up period. In dentists, the risk was higher in women (women: 0.7%; men: 0.4%) and older individuals (≥60 years: 1.0%; <60 years: 0.4%). After adjusting for age, sex, and underlying comorbidities, dentists had a lower risk of CTS than the general population (adjusted odds ratio [AOR]: 0.65, 95% confidence interval [CI]: 0.45–0.92). Dentists had a higher risk for CTS compared with non-dentist HCPs, although the difference was not statistically significant (AOR: 1.21; 95% CI: 0.90−1.64). Conclusions: In CTS, dentists had a lower risk than the general population and a trend of higher risk than non-dentist HCPs. The difference between dentists and non-dentist HCPs suggests that we should pay attention to dentists for potential occupational risk of this disease. However, further studies are warranted to better clarify it. [ABSTRACT FROM AUTHOR]

Background/aim: Breast cancer is the most common female malignancy in the world. Nearly ninety percent of screening-detected breast cancers were diagnosed with earlier stages of 0 to II in Taiwan. It's widely acknowledged that mammography screening of breast cancer can achieve the goal of early diagnosis and treatment in terms of preventive task while neglected interval cancers are associated with unfavorable tumor characteristics and worse outcomes. The purpose of this study was to explore the characteristics of screening-detected breast cancers in Taiwan. Materials and methods: Both screening and diagnostic mammography examinations with accompanied BI-RADS (breast imaging-reporting and data system) classification were extracted from the health information system and linked to cancer registry in Taiwan. Enrolled population included those attending their first mammography between 2012 and 2016, excluding subjects with previous breast cancer, or with missing or incomplete data. We compared treatment outcomes between breast cancers with either initial screening or diagnostic mammography (control group), and investigated the compositions of breast cancers detected by screening mammography through direct chart reviews. Results: A total of 84,246 screening and 61,230 diagnostic mammography sessions were performed from 2010 to 2020. More positive results (BI-RADS 0, 3, 4 and 5) were observed for those attending the first diagnostic than the first screening mammography (43.58% versus 16.12%, p < 0.001). Earlier stages (0 and I) distribution (92% versus 81%, p < 0.0001), better survivorship (overall survival: 96.91% versus 92.17%, p = 0.007) and a lower HER2 (human epidermal growth factor receptor II) positive status and lower tumor grade were noted in breast cancers with initial screening rather than diagnostic mammography. Among 26,103 mammography screening invitees between 2012 and 2016, 325 breast cancers were ascertained from cancer registry. Of these, 234 had one, 72 had two and 19 had three episodes of mammography before cancer diagnosis. Extensive chart reviews revealed that women with and without breast symptoms constituted 29.9 and 70.1% of the 325 screening-detected breast cancers, with the latter further divided into false negative results (interval cancer), diagnosed at the first mammography, diagnostic at the secondary or subsequent mammography and those with a delayed biopsy or confirmatory imaging constituted (5.2, 47, 10.5 and 7.4%). Conclusion: Screening-detected breast cancers were a mixture of women with and without symptoms, those with a false negative result, true negative results with cancer detected at subsequent mammography and non-adherers. Despite this, efficacy of mammography screening was ascertained in Taiwan from this study. To further enhance earlier detection and decrease false negativity, the impact of repeated mammography, and additional sonography for symptomatic women, compliance following a positive screening mammography should not be overemphasized. [ABSTRACT FROM AUTHOR]

Most studies about figurative language learning focus on metaphor rather than metonymy; however, the interactions of metonymy and metaphor are so intricate that the boundary forms not a dichotomy but a continuum. Such a continuum and its influences on figurative language learning have not been studied in depth. The present study investigates EFL (English as a Foreign Language) learners' responses to different metonymic and metaphoric expressions. Twenty-eight Taiwanese EFL learners participated in the study, which asked them to rate 40 sentences based on their certainty of figurative language use. The results show that EFL learners were capable of distinguishing between sentences with and without figurative expressions, and were more certain in judging metaphoric expressions than metonymic ones. Moreover, they found it easier to recognise expressions of the emotion "anger" than those of other topics. Their performances indicate that EFL learners are able to use their shared experiences to identify figurative language uses. This study suggests that it may be beneficial to integrate ideas of conceptual metonymy and metaphor to raise learners' awareness of abstract but universal concepts involved in figurative expressions. (Contains 1 note and 6 tables.)

Introduction. Assessment of clinical competence is a significant part of the training for young occupational therapists (OTs). Objective and systematic assessment allows both supervisors and trainees to be aware of the training objectives and monitor the progress. The direct observation of procedural skills (DOPS) is a work-based assessment to evaluate professional knowledge, skills, and attitude in clinical training. This study investigated the perspectives of OT educators and trainees on using DOPS and their discrepancy for OT postgraduate year (PGY) training. Methods. This study used a quantitative online survey. Eighty-six supervisors and 41 trainees of OT PGY training programs from 95 hospitals returned the questionnaire (a 90.5% return rate), and 64 supervisors and 30 trainees who used DOPS were analyzed. Outcomes included the practicality in using the DOPS in clinical settings, the ease of rating the DOPS, and advantages and the disadvantages of the DOPS. Results. Most respondents reported that completing one DOPS required at least 11 minutes for direct observation (11-40 minutes: teacher 92.2%; trainee 80.6%). Most respondents (teacher 96.9%, trainee 96.8%) had feedback after direct observation of DOPS, and about half of the feedback assessments took 5 to 10 minutes (teacher 53.1%, trainee 48.4%). Most OT educators and trainees agreed that clinical resources were sufficient and that DOPS matched with OT training goals, benefited OT competence training, and had a fair, objective, and consistent scoring system. Significantly higher percentages of OT trainees felt stressed in and satisfied with the DOPS assessment than trainers. Differences between teachers and trainees regarding easiness of rating DOPS items were not significant. Conclusion. Most OT educators and trainees agreed that DOPS was a practical and appropriate assessment for OT PGY training. [ABSTRACT FROM AUTHOR]

Rescuing patients with out-of-hospital cardiac arrest (OHCA), especially those with end-stage kidney disease (ESKD), is challenging. This study hypothesizes that OHCA patients with ESKD undergoing maintenance hemodialysis have (1) higher rates of return of spontaneous circulation (ROSC) during cardio-pulmonary resuscitation (CPR) and (2) lower rates of hyperkalemia and less severe acidosis than those without ESKD. OHCA patients who received CPR between 2011 and 2020 were dichotomized into ESKD and non-ESKD groups. The association of ESKD with "any" and "sustained" ROSC were examined using logistic regression analysis. Furthermore, the effect of ESKD on hospital outcomes for OHCA patients who survived to admission was evaluated using Kaplan–Meier analysis. ESKD patients without "any" ROSC displayed lower potassium and higher pH levels than non-ESKD patients. ESKD was positively associated with "any" ROSC (adjusted-OR: 4.82, 95% CI 2.70–5.16, P < 0.01) and "sustained" ROSC (adjusted-OR: 9.45, 95% CI 3.83–24.13, P < 0.01). Kaplan–Meier analysis demonstrated ESKD patients had a non-inferior hospital survival than non-ESKD patients. OHCA patients with ESKD had lower serum potassium level and less severe acidosis compared to the general population in Taiwan; therefore, should not be treated under the stereotypical assumption that hyperkalemia and acidosis always occur. [ABSTRACT FROM AUTHOR]

Objectives: This hospital‐based cohort study evaluated whether ZNF582 and PAX1 methylation levels at baseline can be used as biomarkers to identify lesions with a high potential for malignant transformation in patients with normal mucosa and oral potentially malignant disorders. Patients and methods: We recruited 171 adult patients with normal mucosa and oral potentially malignant disorders in 2012–2014. They were followed until 2017. Outcomes, including advanced histopathological findings and oral cancer occurrence, were obtained from medical charts, the Taiwan Cancer Registry, and cause‐of‐death data. Kaplan–Meier analysis and Cox proportional hazards regression models were used to examine the association of ZNF582 and PAX1 methylation levels at baseline with subsequent outcome occurrences. Results: After 260,192 days of follow‐up, 11 cases of oral cancer and 4 cases of advanced histopathological progression occurred. Patients with higher ZNF582 and PAX1 methylation levels at baseline had a higher incidence of disease progression. After adjustment for all studied factors using Cox proportional hazards regression models, ZNF582m level (adjusted hazard ratio, 11.41; 95% CI, 2.05–63.36; p = 0.005) was the only significant and independent predictor of disease progression. Conclusions: ZNF582 hypermethylation can be an effective and noninvasive biomarker for identifying oral lesions with a high potential for malignant transformation. [ABSTRACT FROM AUTHOR]

As shopping patterns have gradually shifted from offline to online mode, and with recent lockdowns during the coronavirus disease 2019 (COVID-19) pandemic restricting foreign trade and accelerating the growth of the domestic economy, digital transformation has become a major strategy for many retailers to support and expand their businesses. With the pandemic becoming a turning point, the business of major e-commerce companies in Taiwan in the retail of dry goods has grown significantly, and it has driven the online sales of fresh products as well. In this era of fierce competition, it is especially important to find a way that enables consumers to quickly find ideal fresh products on multiple platforms, shortens the time for price comparison, and improves the efficiency of online shopping. This study uses the Python programming language to write a web crawler program that captures product information from fresh food e-commerce platforms, including product introduction, price, origin, and sales volume, and then defines the relevant status of the product, such as product popularity. Accordingly, through Chinese text segmentation and term-frequency calculation, it aims to classify the product names and introductions into frequently occurring words and use them as product-related labels. Finally, the program combines the product information processing results and product-related labels to construct an online fresh food recommendation system. The results of the proposed system show that it reduces the time and energy spent comparing prices. It can also guide consumers to browse products that may be of interest using relevant tags and increase consumption efficiency by helping them find the ideal item when shopping. [ABSTRACT FROM AUTHOR]

Simple Summary: The sulfite contents from bleach in all commercially available mustard pickle products exceeded the allowable limit of food additives (30 ppm), with a failure rate of 100%. Although the samples contained no food pathogens, the high-throughput sequencing results revealed potential environmental contamination in samples. We assessed the microbial and chemical qualities and microbiomes of 14 mustard pickle products coded sequentially from A to N and sold in traditional Taiwanese markets. The results showed that the aerobic plate count and lactic acid bacteria count of commercially available mustard pickle products were 2.18–4.01 and <1.0–3.77 log CFU/g, respectively. Moreover, no coliform bacteria, Escherichia coli, Staphylococcus aureus, Salmonella spp., or Listeria monocytogenes were detected in any of the samples. Analysis of the chemical quality showed that the sulfite content of all samples exceeded 30 ppm, which is the food additive limit in Taiwan. Furthermore, the mean contents of eight biogenic amines in the mustard pickle product samples were below 48.0 mg/kg. The results of high-throughput sequencing showed that the dominant bacterial genera in sample A were Proteus spp. (25%), Vibrio (25%), and Psychrobacter (10%), in sample C they were Weissella (62%) and Lactobacillus (15%), in sample E it was Lactobacillus (97%), and in sample J it was Companilactobacillus (57%). Mustard pickle product samples from different sources contained different microbiomes. The dominant bacterial family was Lactobacillaceae in all samples except for sample A. In contrast, the microbiome of sample A mainly consisted of Morganellaceae and Vibrionaceae, which may have resulted from environmental contamination during storage and sales. The result of this work suggests it may be necessary to monitor sulfite levels and potential sources of bacterial contamination in mustard pickle products, and to take appropriate measures to rule out any public health risks. [ABSTRACT FROM AUTHOR]

Introduction: Both care continuity and coordination are considered essential elements of health care system. However, little is known about the relationship between care continuity and coordination. This study aimed to differentiate the concepts of care continuity and coordination by developing and testing the reliability and validity of the Combined Outpatient Care Continuity and Coordination Assessment (COCCCA) questionnaire under the universal coverage health care system in Taiwan from a patient perspective. Methods: Face-to-face interviews were conducted nationwide with communitydwelling older adults selected via stratified multistage systematic sampling with probability-proportional-to-size process. A total of 2,144 subjects completed the questionnaire, with a response rate of 44.67%. Results: The 16 items of the COCCCA questionnaire were identified via item analysis and principal component analysis (PCA). The PCA generated five dimensions: three continuity-oriented (interpersonal, information sharing and longitudinal between patients and physicians) and two coordination-oriented (information exchange and communication/cooperation among multiple physicians). The second-order confirmatory factor analysis supported the factor structure and indicated that distinct constructs of care continuity and coordination can be identified. Conclusion: The COCCCA instrument can differentiate the concepts of care continuity and care coordination and has been demonstrated to be valid and reliable in outpatient care settings from a patient perspective. [ABSTRACT FROM AUTHOR]

Odontoma is the most common odontogenic tumor. A literature review revealed limited data for odontomas in Taiwan. This study evaluated the radiographic characteristics of odontomas in 1280 patients in the National Taiwan University Children's Hospital (NTUCH). This retrospective study analyzed the odontomas based on examination of mainly panoramic radiographs and related radiographs of 1280 patients in the NTUCH. Chi-square test was used for trend analysis. Among 1280 patients (710 boys and 570 girls), a total of 16 patients with odontomas (10 boys and 6 girls) were identified. There were 14 compound and 2 complex odontomas. The mean age of the patients was 10.38 years with the majority of odontomas occurring in the first (37.5%) and second decade (62.5%) of life. Odontomas had a marked predilection for the mandible (56.25%) and for the anterior region of the jaws (75%), particularly for the anterior maxilla (43.75%). Ten odontomas (62.5%) were associated with the impacted corresponding permanent teeth. The sagittal position of odontomas and vertical relation of odontomas to the corresponding permanent teeth were significantly correlated with the eruption rate of corresponding permanent teeth (P < 0.05). The odontomas occur most commonly in male patients with a male to female ratio of 1.67:1. The incidence of odontomas in our 1280 patients is 1.25%. The age range of patients with odontomas is 6–17 years. The most frequent location of odontomas is the anterior maxillary region. Odontoma is frequently associated with an impacted corresponding permanent tooth. [ABSTRACT FROM AUTHOR]

Purpose: Carbon monoxide (CO) poisoning may damage the pancreas, but the effects of CO poisoning on the development of diabetes and on existing diabetes remain unclear. We conducted a study incorporating data from epidemiologic analyses and animal experiments to clarify these issues. Methods: Using the National Health Insurance Database of Taiwan, we identified CO poisoning patients diagnosed between 2002 and 2016 (CO poisoning cohort) together with references without CO poisoning who were matched by age, sex, and index date at a 1:3 ratio. We followed participants until 2017 and compared the risks of diabetes and hyperglycemic crisis between two cohorts using Cox proportional hazards regressions. In addition, a rat model was used to assess glucose and insulin levels in blood as well as pathological changes in the pancreas and hypothalamus following CO poisoning. Results: Among participants without diabetes history, 29,141 in the CO poisoning cohort had a higher risk for developing diabetes than the 87,423 in the comparison cohort after adjusting for potential confounders (adjusted hazard ratio [AHR]=1.23; 95% confidence interval [CI]: 1.18– 1.28). Among participants with diabetes history, 2302 in the CO poisoning cohort had a higher risk for developing hyperglycemic crisis than the 6906 in participants without CO poisoning (AHR = 2.12; 95% CI: 1.52– 2.96). In the rat model, CO poisoning led to increased glucose and decreased insulin in blood and damages to pancreas and hypothalamus. Conclusion: Our epidemiological study revealed that CO poisoning increased the risks of diabetes and hyperglycemic crisis, which might be attributable to damages in the pancreas and hypothalamus as shown in the animal experiments. [ABSTRACT FROM AUTHOR]

End-stage renal disease (ESRD) patients on long-term hemodialysis (HD) have an elevated risk of sudden cardiac death. This study hypothesizes, for the first time, that these patients have a higher odds of return of spontaneous circulation (ROSC) and subsequent better hospital-outcomes, post out-of-hospital cardiac arrest (OHCA), as opposed to non-ESRD patients. A national database from Taiwan was utilized, in which 101,876 ESRD patients undergoing HD and propensity score-matched non-ESRD patients were used to conduct two analyses: (i) Cox-proportional-hazards-regression for OHCA incidence and (ii) logistic-regression analysis of attaining ROSC after OHCA, both for ESRD patients in comparison to non-ESRD patients. Kaplan-Meier analyses were conducted to determine the difference of survival rates after ROSC between the two cohorts. ESRD patients were found to be at a higher risk of OHCA (adjusted-HR = 2.11, 95% CI: (1.89–2.36), p < 0.001); however, they were at higher odds of attaining ROSC (adjusted-OR = 2.47, 95% CI: 1.90–3.21, p < 0.001), as opposed to non-ESRDs. Further, Kaplan-Meier analysis demonstrated ESRD patients with a better 30-day hospital survival rate than non-ESRD patients. Although ESRD patients had a higher risk of OHCA, they demonstrated higher possibility of ROSC and a better short-term hospital outcome than non-ESRDs. Chronic toxin tolerance and the training of vascular-compliance during regular HD may be possible explanations for better outcomes in ESRD patients. [ABSTRACT FROM AUTHOR]

Background. Patients with influenza-associated acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (vv-ECMO) support have a high mortality rate. Ventilator settings have been known to have a substantial impact on outcomes. However, the optimal settings of mechanical ventilation during vv-ECMO are still unknown. Methods. This multicenter retrospective cohort study was conducted in the intensive care units (ICUs) of three tertiary referral hospitals in Taiwan between July 2009 and December 2019. It aims to describe the effect of ventilator settings during vv-ECMO on patient outcomes. Results. A total of 93 patients with influenza receiving ECMO were screened. Patients were excluded if they: were receiving venoarterial ECMO, died within three days of vv-ECMO initiation, or were transferred to the tertiary referral hospital >24 hours after vv-ECMO initiation. A total of 62 patients were included in the study, and 24 (39%) died within six months. During the first three days of ECMO, there were no differences in tidal volume (5.1 vs. 5.2 mL/kg, p = 0.833), dynamic driving pressure (15 vs. 14 cmH2O, pD0.146), and mechanical power (11.3 vs. 11.8 J/min, p=0.352) between survivors and non-survivors. However, respiratory rates were significantly higher in non-survivors compared with survivors (15 vs. 12 breaths/min, p=0.013). After adjustment for important confounders, a higher mean respiratory rate of >12 breaths/min was still associated with higher mortality (adjusted hazard ratio = 3.31, 95% confidence interval = 1.10-9.97, p=0.034). Conclusions. In patients with influenza-associated ARDS receiving vv-ECMO support, we found that a higher respiratory rate was associated with higher mortality. Respiratory rate might be a modifiable factor to improve outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Background: Few of the interventions currently available for family caregivers (FCGs) of persons with dementia (PWDs) with long-term follow-ups have a grounding in theory and incorporate multicomponent case management formats. Purpose: Based on Pearlin's Caregiving and Stress Process model, this study was developed to examine the effectiveness of a family-centered case management program for PWDs with early to moderate dementia in terms of reducing PWDs behavioral problems and improve FCG outcomes, including distress, self-efficacy, depression, caregiver burden, and health-promoting behaviors. Methods: This randomized, single-blind, parallel-controlled trial included 76 dyads of PWDs and their FCGs. The dyads were recruited from outpatient clinics at dementia centers in three district hospitals in northern Taiwan. The dyads were randomly assigned to the intervention group (IG, n = 39) and control group (CG, n = 37). The dyads in the IG received a four-month intervention with two home or clinic visits and two telephone interviews. The multicomponent interventions provided assessment, education, consultations, support, and referrals to long-term care resources. The CG received routine care and two social phone calls. Data were collected upon enrollment (T0 = baseline) and at 4-,6-, and 12-months post-intervention (T1, T2, and T3, respectively). Generalized estimating equations were conducted to analyze the effects of the intervention. Results: By controlling for the interaction between group and time, we made a comparison between IG and the CG. The results showed significant improvements from baseline measures in behavioral problems in the PWDs for mood, psychosis, and social engagement, and improvements in the FCGs for distress and self-efficacy for obtaining respite as well as for better control of distressing thoughts, feelings of depression, caregiver burden, and overall health promoting behaviors at T1 and T2 (p < 0.5). Significant improvements were also found in the IG for psychomotor regulation among PWDs and the self-efficacy of FCGs in managing the PWDs' disturbing behaviors and health promotion behaviors for nutrition at T1 (p < 0.5). There were no significant improvements in the outcome variables at T3. Conclusions/Implications for Practice: Significant interactions between group and time were found at the 6-month assessment (T2) for improvements in problem behaviors of PWDs and depression, caregiver burden, and distress in the FCGs. Positive effects on self-efficacy and health promotion behaviors among the FCGs were also achieved. The results suggest that a multicomponent case management intervention should be referenced in dementia care policymaking for FCGs and PWDs. [ABSTRACT FROM AUTHOR]

Typhoons in summer and cold snaps during winter in Taiwan often cause huge aquaculture losses. Simultaneously, the lack of human resources is a problem. Therefore, we used wireless transmission technology with various sensors to transmit the temperature, pH value, dissolved oxygen, water level, and life expectancy of the sensor in the fish farm to the server. The integrated data are transmitted to mobile devices through the Internet of Things, enabling administrators to monitor the water quality in a fish farm through mobile devices. Because the current pH sensors cannot be submerged in the liquid for a long time for measurements, human resources and time are required to take the instrument to each fish farm for testing at a fixed time. Therefore, a robotic arm was developed to complete automatic measurement and maintenance actions. We designed this arm with a programmable logic controller, a single chip combined with a wireless transmission module, and an embedded system. This system is divided into control, measurement, server, and mobility. The intelligent measurement equipment designed in this study can work 24 h per day, which effectively reduces the losses caused by personnel, material resources, and data errors. [ABSTRACT FROM AUTHOR]

Well-appearing febrile young children discharged from the emergency department (ED) after medical assessment are still at risk for serious bacterial infections (SBI). The incidence of SBI and the effectiveness of laboratory tests in the pneumococcal conjugate vaccine era remain unknown. We conducted a study using Taiwan's National Health Insurance claims data from 2004 to 2014. Children aged 2–24 months discharged from the ED with a diagnosis compatible with fever without source (FWS) were enrolled. The study identified 431,884 children from the ED with FWS. 13.53% of the children had revisits, 8.62% needed hospitalization and 1.57% developed SBI. Younger children had a higher SBI rate, but a lower revisit rate. The revisit rate was 12.22% for children aged 2–6 months, 13.61% for children aged 7–12 months and 13.77% for children aged 13–24 months (p < 0.0001). The SBI rate was 4.44% for children aged 2–6 months, 1.85% for children aged 2–6 months and 0.96% for children aged 13–24 months (p < 0.0001). Children with hemogram tests, compared to those without, had a higher revisit rate (16.30% vs. 13.15%, p < 0.0001), and a higher SBI rate in the children aged 13–24 months (1.30% vs. 0.92%, p < 0.0001); furthermore, children with urinalysis had a significantly higher revisit rate (14.42% vs. 13.24%, p < 0.0001) and higher SBI rate (2.10% vs. 1.40%, p < 0.0001). Children with FWS aged 2–24 months who were discharged from ED after blood test and urinalysis were still at risk for SBI, especially those aged 2–6 months. [ABSTRACT FROM AUTHOR]

Despite extensive enquiry into the socio-political aspects of environmental impact assessments (EIA), empirical material from east- and south-east Asia remains underrepresented in English-language scholarship. This is notable given increasing infrastructural developments and interest in environmental justice in the region. We contribute to this field by evaluating the Miramar Resort EIA controversy in Taitung County, Taiwan, to assess how a developer and a local government conspired to circumvent an EIA process. Through documentary analysis and stakeholder interviews, we assess the argumentation used by different actors to articulate their support for or opposition to the development. We find that much contention rests on claims to economic benefit and environmental protection that cannot be verified, and on limited participation opportunities. We call for further research into strategies used by proponents to discredit the knowledge and experience of opponents within EIA processes, especially given rising global interest in traditional, local and indigenous knowledge. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To investigate the characteristics and prevalence of demoralisation syndrome among heart transplantation patients in Taiwan. Background: Patients with end‐stage heart failure who have undergone cardiac transplantation are at risk of demoralisation syndrome. Demoralisation syndrome has been studied in cancer populations, but our understanding of the syndrome among heart transplant recipients is limited. Design and Methods: The study adopted a cross‐sectional design and analysed the baseline data from a longitudinal study with cardiac transplant patients at a heart centre in northern Taiwan. A structured questionnaire, namely the Demoralization Scale‐Mandarin Version (DS‐MV), was used to assess demoralisation syndrome. Hierarchical regression was applied to determine the predictors of demoralisation. Reporting was consistent with the STROBE checklist. Results: There were a total of 84 participants with an average age of 51.9 years and a time since heart transplantation of around 4.1 years. Among them, the prevalence of demoralisation syndrome was 35.8%, and 57.1% coped well with stress. In addition, on the DS‐MV, participants tended to choose sentences with positive rather than negative wording. Our data showed that cardiac transplant recipients with stress have higher possibility suffering from demoralisation syndrome; poor renal function and those who cannot relive from stress are predictors for loss of meaning. Conclusions: Chinese individuals tend to hide their weaknesses; nevertheless, demoralisation syndrome among cardiac transplant recipients, as related to stress status and kidney function, is still remarkable. Relevance to clinical practice: Since demoralisation is preventable, further research on this phenomenon in the cardiac transplant population is warranted and needs to be developed. [ABSTRACT FROM AUTHOR]

Background: Patients with diabetes have a relatively high risk of fracture due to osteoporosis. However, the risk of osteoporosis associated with the use of oral hypoglycemic drugs and dipeptidyl peptidase-4 inhibitor (DPP-4i) by patients with diabetes is unclear. This study aimed to explore the effect of DPP-4i on the risk of osteoporosis in Taiwanese patients with type 2 diabetes mellitus (T2DM). Methods: This study enrolled 6339 patients on DPP-4i (DPP-4i group) and 25 356 patients without DPP-4i (non-DPP-4i group). They were matched by 1:4 propensity score matching, using confounding variables including sex, age, comorbidities, medication, and index year. Cox proportional hazards analysis was used to compare hospitalization and mortality during an average follow-up period of 7 years. Results: The mean age of patients in the two groups was 66 years. Men were slightly higher in number (51.79%) than women. At the end of the follow-up period, 113 (0.36%) patients had osteoporosis, of which 15 (0.24%) were in the case group and 98 (0.39%) in the control group. The risk of all-cause osteoporosis was significantly lower in the DPP-4i group than in the non-DPP-4i group (adjusted hazard ratio [HR] 0.616; 95% confidence interval [CI] 0.358--0.961; p = 0.011). Kaplan--Meier analysis showed that the preventive effect on osteoporosis was positively correlated with the cumulative dose of DPP-4i (log-rank, p = 0.039) with the class effect. Conclusion: Compared with not using DPP-4i, the use of DPP-4i in Taiwanese T2DM patients was associated with a lower risk of osteoporosis due to the class effect, and the preventive effect was dose-dependent. However, larger prospective studies are needed to validate this finding and to explore the possible mechanism of the preventive effect of DPP-4i. [ABSTRACT FROM AUTHOR]