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Previous research has made it clear that older learners are mainly learning for learning's sake. However, few studies have explored the intrinsic aspects of older learners' motivation in detail; also, the factors that influence their learning motivation remain under-researched and under-theorised. To address this gap, this survey-based quantitative study investigated the learning motivations of 816 older learners from an intrinsic-motivation viewpoint, and explored the predictors of these motivations, including institutional as well as personal factors. The results indicated that these older learners rated their intrinsic motivations highly (3.97/5 overall), and that such motivations could be differentiated into cognitive-oriented and social-oriented motivations. The most important predictors of intrinsic motivations for the respondents were institutional variables, especially teacher support and peer support. Importantly, institutional predictor variables were found to diminish the negative impacts of both self-reported poor health and age on these older adults' overall intrinsic motivation to learn. These findings imply that, in Taiwan, providing more teacher- and peer support is likely to increase the intrinsic motivation to learn for vulnerable older adults who are disadvantaged by health problems and old age.

Policy on educational gerontology seems a relatively recent subfield in most countries' social policies. The concept of education for older adults did not appear in Taiwan's political discourse until 1980. The purposes of this paper are to provide an overall introduction to the development of educational gerontology policies and practices in Taiwan and to discuss the challenges and implications for future policy agendas. In this paper, first, we address the development of policies and practices in educational gerontology in Taiwan. Second, we explain the current major legislation and programs of educational gerontology. Lastly, this paper criticizes the current policies and practices and envisions the future policies and practices of educational gerontology in Taiwan. (Contains 1 figure and 1 table.)

The concept of person-centered care has been incorporated through various healthcare interventions to enhance mental health-related outcomes and ensure the quality of care delivered to individuals living with dementia. Reminiscence therapy (RT) is a popular therapeutic intervention for individuals with dementia. The purpose of this study is to evaluate intervention effects of group RT on symptoms of agitation in individuals with dementia. We employed a quasi-experimental repeated measures study design. The participants included 80 older adults with dementia, residing in two long-term care facilities in Taiwan. The participants received a 120-minute group RT session once per week for 10 weeks. Outcomes were measured 1 week pre- and post-intervention. It was observed that participation in group RT significantly improved agitated behavior of individuals with dementia across time periods. The designed RT program showed promising effects regarding improving the agitated behavior of older adults with dementia living in long-term care homes. Incorporating RT activities into clinical social work practice may help long‐term care to evolve in a more diverse and innovative direction. [ABSTRACT FROM AUTHOR]

Genomic changes in Mycoplasma pneumoniae caused by adaptation to environmental or ecologic pressures are poorly understood. We collected M. pneumoniae from children who had confirmed pneumonia in Taiwan during 2017-2020. We used whole-genome sequencing to compare these isolates with a worldwide collection of current and historical clinical strains for characterizing population structures. A phylogenetic tree for 284 strains showed that all sequenced strains consisted of 5 clades: T1-1 (sequence type [ST]1), T1-2 (mainly ST3), T1-3 (ST17), T2-1 (mainly ST2), and T2-2 (mainly ST14). We identified a putative recombination block containing 6 genes (MPN366‒371). Macrolide resistance involving 23S rRNA mutations was detected for each clade. Clonal expansion of macrolide resistance occurred mostly within subtype 1 strains, of which clade T1-2 showed the highest recombination rate and genome diversity. Functional characterization of recombined regions provided clarification of the biologic role of these recombination events in the evolution of M. pneumoniae. [ABSTRACT FROM AUTHOR]

The data on long-term trends and factors of tobacco retailers' compliance in Taiwan are limited. The new regulations of the Tobacco Hazards Prevention Act were established in 2009. Now, the government is planning to raise the minimum legal age (MLA) for purchasing tobacco products from 18 to 20, so the results of this study will be an important reference to promote new regulations in the future. We carried out an observational mystery shopping study design and data were collected from 2009 to 2019. In total, 6320 undercover tests were conducted to investigate selling by tobacco retailers to persons aged less than 18 years by an impartial third party annually. Logistic regression was used to analyze the factors influencing compliance by adjusting test variables and independent variables. The compliance rate increased by 8.4% annually and was better among tests conducted during summer vacation (AOR = 1.324), chain convenience stores (AOR = 3.651), supermarkets or hypermarkets (AOR = 1.973), and verifications with age (AOR = 15.345). It is the first study to explore long-term and national tobacco retailers' enforcement effects by an impartial third party in Asia. The findings suggest that local health agencies should enhance enforcement on those stores which were tested during non-summer holidays and weekends, betel nut stands, and grocery stores. [ABSTRACT FROM AUTHOR]

Background: Follicular thyroid cancer (FTC) is the second most common malignancy of thyroid. About 7%–23% of patients with FTC have distant metastasis. The aim of this study was to investigate the risk factors associated with distant metastasis and the impact of distant metastasis on survival in FTC patients. Methods: Patients with FTC were analyzed using a prospectively maintained dataset of thyroid cancer registered at a tertiary hospital in Taiwan between December 1976 and May 2020. Results: A total of 190 patients with a mean follow-up of 7.7 years were included in this study, including 29 with distant metastasis at diagnosis, 14 who developed metastasis during follow-up, and 147 without metastasis. Multivariate analysis adjusted for age, gender, tumor stage, and extrathyroidal invasion revealed old age (≥ 55 years) (adjusted odds ratio, 27.6; 95% confidence interval [CI], 8.75–86.8; P < 0.001) and extrathyroidal invasion (odds ratio, 24.1; 95% CI, 3.50–166.5; P = 0.001) were significantly associated with an increased risk of distant metastasis. Metastasis was correlated with higher cancer-specific mortality (adjusted hazard ratio, 35.5; 95% CI, 6.1–206.1; P < 0.001). In addition, patients with metastatic FTC diagnosed on initial presentation had the lowest 10-year cancer-specific survival rate (26.0%), followed by those who developed metastatic disease after initial treatment (76.6%), while patients without metastasis were all alive (100%) (P ≤ 0.002 for all comparisons). Conclusions: Age and extrathyroidal invasion are significant risk factors for distant metastasis of FTC. Patients with metastatic FTC, especially when diagnosed on initial presentation, have dismal survival outcomes. [ABSTRACT FROM AUTHOR]

Incidence of invasive pneumococcal disease caused by antimicrobial-resistant Streptococcus pneumoniae types not included in pneumococcal conjugate vaccines has increased, including a penicillin- and meropenem-resistant serotype 15A-ST63 clone in Japan. During 2013-2017, we collected 206 invasive pneumococcal isolates in Taiwan for penicillin and meropenem susceptibility testing. We found serotypes 15B/C-ST83 and 15A-ST63 were the most prevalent penicillin- and meropenem-resistant clones. A transformation study confirmed that penicillin-binding protein (PBP) 2b was the primary meropenem resistance determinant, and PBP1a was essential for high-level resistance. The rate of serotype 15B/C-ST83 increased during the study. All 15B/C-ST83 isolates showed an ermB macrolide resistance genotype. Prediction analysis of recombination sites revealed 12 recombination regions in 15B/C-ST83 compared with the S. pneumoniae Spain23F-ST81 genome. Pneumococcal clones rapidly recombine to acquire survival advantages and undergo local expansion under the selective pressure exerted by vaccines and antimicrobial drugs. The spread of 15B/C-ST83 is alarming for countries with high antimicrobial pressure. [ABSTRACT FROM AUTHOR]

Previous research has made it clear that older learners are mainly learning for learning's sake. However, few studies have explored the intrinsic aspects of older learners' motivation in detail; also, the factors that influence their learning motivation remain under-researched and under-theorised. To address this gap, this survey-based quantitative study investigated the learning motivations of 816 older learners from an intrinsic-motivation viewpoint, and explored the predictors of these motivations, including institutional as well as personal factors. The results indicated that these older learners rated their intrinsic motivations highly (3.97/5 overall), and that such motivations could be differentiated into cognitive-oriented and social-oriented motivations. The most important predictors of intrinsic motivations for the respondents were institutional variables, especially teacher support and peer support. Importantly, institutional predictor variables were found to diminish the negative impacts of both self-reported poor health and age on these older adults' overall intrinsic motivation to learn. These findings imply that, in Taiwan, providing more teacher- and peer support is likely to increase the intrinsic motivation to learn for vulnerable older adults who are disadvantaged by health problems and old age. [ABSTRACT FROM AUTHOR]

Background: Early antiretroviral therapy (ART) is recommended as an intervention for HIV by the World Health Organization. However, the association between the CD4 count at ART initiation and the risk of adverse drug reactions (ADRs) remains unclear. Purpose: This study aimed to describe the trends related to symptom number and intensity among patients newly diagnosed with HIV in three different CD4-count-based groups and then to investigate the ADR trends for these three groups at different points in time. Methods: This multi-center cohort study recruited newly diagnosed HIV/AIDS patients who had not previously used ART from AIDS-designated hospitals in Taiwan from March 2015 to December 2016. Study measures were assessed at the time of case enrollment (T0) and during the 1st month (T1), 4-6th month (T2), and 7-9th month (T3) of ART treatment. Patients were stratified into three groups according to initial CD4 count: ≤ 350 cells/mm³, > 350-500 cells/ mm³ and >500 cells/mm³. Repeated measures ANOVA and generalized estimating equations were used to estimate the relationships between the level of initial CD4 count and ADRs. Results: A total of 207 patients completed the study. Mean symptom numbers and symptom intensities decreased significantly over time in all three groups (p < .01). The largest mean reduction in both symptom number and intensity was achieved by the CD4 count > 500 cells/mm3 group. Overall, at least one ADR was reported by 85.7% of the participants at the first month of ART use, and the incidence of ADR had decreased by an average of 22% at the 7--9th month assessment (p < .001). ARDs decreased significantly over time in the CD4 count > 500 cells/mm³ group, with the degrees of ADRs in systematic side effect most significantly decreased in this group (p = .03). Conclusions/ Implications for Practice: Number and intensity of symptoms significantly improved over time in all three CD4 count groups. The percentage of systematic side effects was most reduced in the CD4 count >500 cells/mm3 group. The results of this study may be referenced by HIV care providers when discussing with patients the initiation of ART and the potential risks of experiencing ADRs. [ABSTRACT FROM AUTHOR]

Background: In Taiwan, the causes of death and related factors in the oldest old people with Alzheimer disease (AD) are not well characterized. We investigated the factors associated with mortality in the oldest old patients with newly diagnosed AD admitted to a long-stay residential facility. Methods: We performed a prospective study of newly diagnosed AD patients at a veterans' home between 2012 and 2016. At admission, all eligible participants received a comprehensive geriatric assessment, including demographic variables, lifestyle habits, cognitive evaluations, medical conditions (comorbidities, Age-Adjusted Charlson Comorbidity Index score, and polypharmacy), nutritional status evaluated by the Mini Nutritional Assessment-Short Form and body mass index (BMI), and global functional status. A Cox proportional hazards model was used to evaluate the predictive values of clinical parameters for all-cause mortality. Results: The cohort comprised 84 newly diagnosed AD patients (mean age 86.6 ± 3.9 years) with a mean follow-up period of 2.1 ± 1.2 years. The overall median survival was 3.5 years from the time of AD diagnosis (95% confidence interval, 3.1–3.9 years). BMI was significantly lower in the deceased group than in the alive group (20.7 ± 2.9 vs. 22.6 ± 3.4, p = 0.023). Logistic regression demonstrated that the clinical parameters significantly associated with mortality were high global comorbidity, low nutritional status (malnutrition and underweight), and impaired physical function at the time of AD diagnosis. Conclusion: Comorbidity burden, nutritional status, and physical functional status at the time of dementia diagnosis are important contributors to poor outcome in the oldest old. Efforts to control concurrent chronic disorders, nutritional interventions, and physical independency as a long-term care strategy for dementia may provide survival benefit. [ABSTRACT FROM AUTHOR]

Background: Small agarics are poorly documented in Taiwan, with previously reported species either rudimentarily described or lacking a description or diagnosis in most cases. A survey on small agarics in a lowland forest of Taiwan revealed two species previously unrecorded. Results: One agaric, which is characterized mainly by white hairs overlying the pileus, a conspicuous cup-shaped basal disc surrounding the stipe, and inamyloid basidiospores, fits the genus Mycena and appears undescribed. It readily produced abundant basidiomata in culture in three weeks. The other agaric is Gloiocephala epiphylla, being characterized by its reduced hymenium and conspicuous pileogloeocystidia. ITS sequences from the two agarics further corroborated the identifications. Their macroscopic and microscopic features and culture morphology are described. A dichotomous key is provided to the species of Mycena reported in Taiwan. Conclusion: The Mycena species is newly described as M. albopilosa herein. Gloiocephala epiphylla is new to Taiwan, being the only species of the genus known on the island. [ABSTRACT FROM AUTHOR]

Taiwan's accelerated rate of aging is more than twice that of European countries and United States. Although demographic aging was not a major concern in Taiwan until 1993, when it became an aging society, aging issues now have become an imperative topic both in policy and in practice in the country. As this article demonstrates, in response to the challenge of the rapidly growing older population and the inspiration of cultural values of filial obligation and respect to elders, the concepts of active aging and aging in place are leading the policies and practices of gerontology to meet the diverse needs of the aging population in Taiwan. However, challenges remain, including the question of how to promote systematic endeavors, both in policies or research on aging, and how to encourage greater involvement of nongovernment organizations in the aging issue. In addition, some emerging issues about aging are addressed in this article including inadequate resources for older rural adults, building an age-friendly environment, and the increasing number of people with dementia. [ABSTRACT FROM AUTHOR]

Background: Disclosure of mental distress to physicians is important for mental illness identification, early referrals and proper treatment to prevent suicide. Little is known about what affects mental health communication in the clinical settings in the Chinese societies. Aims: The study aimed to identify the demographic, psychosocial and medical factors related to people with non-disclosure of their mental distress. Methods: We interviewed a series of consecutive inpatients from two medical wards of a general hospital in northern Taiwan. We collected depressive symptoms (the Patient Health Questionnaire, PHQ-9), living arrangement, threatening life events, suicide risks (i.e. past self-harm history, lifetime suicide ideas and hopelessness) and recent experience of mental distress disclosure. Furthermore, we explored the reasons of non-disclosure. Results: A total of 230 medical inpatients agreed to participate (53.5% males). The results indicated that only 5.7% actually communicated their mental health concerns, and that 12.3% were willing to talk about their mental health problems. Among the 69 (30%) depressed participants (PHQ-9 score ≥ 10 points), the disclosure rate was low (8.7%) and the wish to talk about mental distress was also low (10.3%). After adjustment, living alone (OR = 7.58, 95% CI = 1.56–36.91) and having stressful life events (OR = 3.68, 95% CI = 1.09–12.46) remained significant in predicting disclosure of mental distress. The 109 participants attributed their refusal of communicating mental distress as medical-related attributes, subjective perceptions or sociocultural factors. Conclusion: Communication of mental distress in medical settings was uncommon due to medical or psychosocial barriers in Taiwan. Skill training to facilitate disclosure in medical education and public campaigns to improve knowledge of depression and enhance help-seeking deserve more attention, particularly under the influence of stigma in the Chinese societies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to the use of antiretroviral treatment for curing HIV virus diseases, in the previous issue.

Few empirical studies have evaluated the mediating effects of quality of life (QoL) among people living with HIV/AIDS (PLWHA). The purposes of this study were to identify the predictors of QoL and to test the mediating effects of social support on depression and QoL among patients enrolled in an HIV case-management program in Taiwan. A cross-sectional, descriptive correlation design collected data from 108 HIV-infected individuals. Individuals were assessed using the Beck Depression Inventory II, the short version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF), and the Multidimensional Scale of Perceived Social Support between September 2007 and April 2010. After adjusting for sociodemographic characteristics (including age, gender, and mode of transmission) and clinical information (including CD4 count and time since diagnosis with HIV), the study findings showed that QoL was significantly and positively correlated with both social support and the initiation of highly active antiretroviral therapy (HAART), and was negatively correlated with depression and time since diagnosis with HIV. The strongest predictors for QoL were depression followed by the initiation of HAART and social support, with anR2of 0.40. Social support partially mediated the relationship between depression and QoL. Health professionals should enhance HIV-infected individuals' social support to alleviate the level of depression and further increase the QoL among PLWHA. [ABSTRACT FROM AUTHOR]

Background: Monitoring the quality of human immunodeficiency virus (HIV) care and evaluating the effectiveness of HIV case management programs (CMPs) as approaches to raising the rate of HIV care retention and to improving the efficacy of viral suppression after the initiation of highly active antiretroviral therapy (HAART) are important focuses of research worldwide. Purpose: This study describes the trends and evaluates the influence of CMPs on retention in care and viral suppression among patients in Taiwan diagnosed with HIV from 2008 to 2010. Methods: This retrospective study enrolled 1,302 HIV-positive individuals who had visited at least one outpatient clinic between 2008 and 2012. Of these patients, 715 (54.9%) were enrolled in an HIV CMP. Trend analysis and logistic regression were applied to investigate longitudinal trends and the impact of CMPs on the quality of HIV care. Results: Retention in care improved substantially from 44.5% in 2008 to 57.3% in 2012. The percentage of viral suppression within 12 months of the initiation of HAART increased from 88.4% in 2008 to 93.5% in 2012. Of the patients who were in HIV CMPs, 73.6% were retained in care, which was significantly higher than the 31.7% among those who were not enrolled in CMPs (p < .001). Among the patients who received HAART for more than 180 days, those who achieved viral suppression within 12 months were significantly more likely to be retained in care (adjusted odds ratio = 5.36, 95% CI = 2.6-10.9, p < .001). Conclusions and Implications for Practice: Nurse-led case management programs play a role in improving HIV-related health outcomes. HIV CMPs are beneficial to HIV-infected patients by improving retention in care and are indirectly associated with successful viral suppression. [ABSTRACT FROM AUTHOR]

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Abstract: Background: Long-term retention of patients in care is emerging as an important factor for the mortality among persons with human immunodeficiency virus (HIV) infection. Objectives: The study was to determine the impact of the case management with retention in care on mortality among HIV infected patients. Design and settings: A longitudinal prospective cohort study was conducted at a tertiary referral HIV-designated hospital in Taiwan. Participants: Charts from 1040 patients who had made at least one visit for HIV care at the HIV Clinic in the study hospital in 2009 were abstracted. Methods: A computerized data collection form was used to retrospectively retrieve the electronic demographic and clinical data generated during each clinic visit. Follow-up ended at death or at the last clinic visit as of December 31, 2009. Results: Less than half (44.2%) of 961 HIV-infected patients were retained for follow-up from 2005 to 2009. Patients who received case management were 4.78 times more likely to remain consistently in care than those who did not receive case management, after controlling for other confounding variables. In the Cox proportional hazard analysis, higher hazards of death were independently associated with older age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.026–1.055), entering care before 2005 (HR: 1.73; 95% CI: 1.035–2.885), low baseline CD4 cell count (HR: 0.997; 95% CI: 0.995–0.998), without antiretroviral therapy (HR: 0.55; 95% CI: 0.334–0.909), irregular attendance of HIV care or loss to follow-up (HR: 0.058; 95% CI: 0.023–0.148), acquisition of HIV infection through sexual contact (HR: 2.95; 95% CI: 1.517–5.746), and irregular attendance or lost to follow-up and did not enrolled in the case management program (HR: 3.76; 95% CI: 1.015–14.777). Conclusion: Retention in care is independently predictive of survival, and case management is a mediator affecting retention on survival. Case managers need to identify high risk patients for irregular attendance and to retain them in HIV care in order to maximize their health outcomes. [Copyright &y& Elsevier]

For many years, the understanding of gastrointestinal stromal tumors (GISTs), which are the most common mesenchymal tumors of the gastrointestinal tract, has been very limited. However, it is now possible to provide a more precise definition through the use of pathology classification and molecular techniques. Coupled with the advancement of clinical practice, especially the development of targeted therapy, there is now a much better insight into its treatment. At present, organizations such as the National Comprehensive Cancer Network in the USA and the European Society for Medical Oncology in Europe have established a consensus and drawn up guidelines for the diagnosis, treatment, and follow-up of GISTs. With experts coming from various districts in Taiwan and combining the most recent clinical data and experiences, the Taiwan Surgical Society of Gastroenterology drafted the first national GIST treatment guidelines after a consensus meeting in 2007. Following subsequent advances in GIST diagnosis and treatment, further revisions and modifications have been made to the original guidelines. We present here the updated consensus and recommendations of the Taiwan Surgical Society of Gastroenterology for the diagnosis and treatment of GIST. We hope these guidelines can help enhance the quality of diagnosis, treatment, and care of patients with GIST in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Pancreatic adenocarcinoma (PCA) is one of the most lethal human malignancies, and radical surgery remains the cornerstone of treatment. After resection, the overall 5-year survival rate is only 10% to 29%. At the time of presentation, however, about 40% of patients generally have distant metastases and another 40% are usually diagnosed with locally advanced cancers. The remaining 20% of patients are indicated for surgery on the basis of the results of preoperative imaging studies; however, about half of these patients are found to be unsuitable for resection during surgical exploration. In the current study, we aimed to determine the clinicopathological characteristics that predict the resectability of PCA and to conduct a prognostic analysis of PCA after resection to identify favorable survival factors. Methods: We retrospectively reviewed the medical files of 688 patients (422 men and 266 women) who had undergone surgery for histopathologically proven PCA in the Department of Surgery at Chang Gung Memorial Hospital in Taiwan from 1981 to 2006. We compared the clinical characteristics of patients who underwent resection and patients who did not undergo resection in order to identify the predictive factors for successful resectability of PCA, and we conducted prognostic analysis for PCA after resection. Results: A carbohydrate antigen 19-9 (CA 19-9) level of 37 U/ml or greater and a tumor size of 3 cm or more independently predicted resectability of PCA. In terms of survival after resection, PCA patients with better nutritional status (measured as having an albumin level greater than 3.5 g/dl), radical resection, early tumor stage and betterdifferentiated tumors were associated with favorable survival. Conclusions: Besides traditional imaging studies, preoperative CA 19-9 levels and tumor size can also be used to determine the resectability of PCA. Better nutritional status, curative resection, early tumor stage and welldifferentiated tumors predict the favorable prognosis of PCA patients after resection. [ABSTRACT FROM AUTHOR]

Background. Opinions regarding the impact of human epidermal growth factor receptor (HER)-2 overexpression or HER-2 amplification on the prognosis of gastric cancer patients are mixed. The present study attempted to clarify this issue by investigating a large cohort of surgical patients. Methods. We investigated 1,036 gastric cancer patients undergoing curative-intent resection. Their surgical specimens were evaluated for HER-2 expression by immunohistochemistry (IHC), and those with HER-2 expression levels of 2+ were additionally subjected to fluorescence in situ hybridization (FISH). Data on demographic and clinicopathological features and relevant prognostic factors in these patients were analyzed. Results. HER-2 positivity was noted in 64 (6.1%) of 1,036 gastric cancer patients, including 46 patients whose HER-2 expression level was 3+ on IHC and 18 patients whose FISH results were positive. On univariate analysis, HER-2 positivity was more often associated with differentiated histology, intestinal type, and negative resection margins, whereas only differentiated histology was independently associated with HER-2 positivity in a logistic regression model. For stage I-IV gastric cancer, HER-2 was not a prognostic factor. In a subpopulation study, although HER-2 positivity emerged as a favorable prognostic factor for stage III-IV gastric cancer on univariate analysis, it failed to be an independent prognostic factor after multivariate adjustment. Conclusions. The prevalence of HER-2 positivity, determined using standardized assays and scoring criteria in a large cohort of gastric cancer patients after resection, was 6.1%. HER-2 positivity was phenotypically associated with differentiated histology. HER-2 is not an independent prognostic factor for gastric cancer. [ABSTRACT FROM AUTHOR]

longitudinal prospective study was conducted at an AIDS designated hospital in Taiwan. The study aimed to determine the incidence of syphilis and to identify risk factors predicting new onset syphilis and relapse into risky behaviors among 117 patients enrolled in the HIV case management program for 1 year. Having a new episode of syphilis was defined as patients had a fourfold increase of serum rapid plasma reagin titers from baseline to 12-month follow-up. After enrollment, 17% relapsed in unprotected sexual intercourse. New onset syphilis was noted in ten (10.4%) participants, and all were men having sex with men. The incidence of syphilis was 5.8 per 100 person-years. Predictors of a new episode of syphilis were higher CD4 cell counts [hazard ratio (HR), 1.003; 95% confidence interval (CI), 1.00-1.006], and recreational drug use (HR, 18.89; 95% CI, 2.78-128.15). Regular screening for syphilis among patients retaining in HIV care remains necessary. [ABSTRACT FROM AUTHOR]

13 X-chromosomal short tandem repeat (STR) multiplex system (DXS6807, DXS8378, DSX9902, DXS7132, DXS9898, DXS6809, DXS6789, DXS7424, DXS101, GATA172D05, HPRTB, DXS8377, and DXS7423) was tested on 1,037 DNA samples from eight population groups currently living in Taiwan. Different distributions of the allelic frequencies in different populations were presented. DXS8377 and DXS101 were the two most polymorphic loci in these eight populations, whereas DXS7423 was the least informative marker in most of the populations studied. The genetic distances between the populations and the constructed phylogenetic tree revealed a long genetic distance between Asian and Caucasian populations as well as isolation of the Tao population. The phylogenetic tree grouped populations into clusters compatible with their ethnogeographic relationships. This 13 X-chromosomal short tandem repeat multiplex system offers a considerable number of polymorphic patterns in different populations. This system can be useful in forensic identification casework and ethnogeographic research. [ABSTRACT FROM AUTHOR]

The analysis of Y-chromosome short tandem repeat (Y-STR) loci is a powerful tool in forensic casework. The aim of this study was to present the 17 Y-STR loci haplotype distributions of groups of population living in Taiwan and to demonstrate genetic distances between the groups as well as multidimensional scaling plot based on Y-STR genotype data. Five hundred and fifteen DNA samples from unrelated males of seven groups of population, including Taiwanese Han, two groups of indigenous Taiwanese of Taiwan Island, Tao, mainland Chinese, Filipinos, and a group of people with European, Near Eastern, or South Asian ancestry, were analyzed using a commercial kit that co-amplifies 17 Y-STRs. A total of 471 different haplotypes with 440 unique haplotypes were identified. The overall haplotype diversity was 0.9995 ± 0.0002. High haplotype diversity was observed in six groups of population, except the Tao. These Y-STRs revealed a low discrimination capacity in the Tao population (36.84%), which should be considered in forensic practice. The multidimensional scaling plot of these seven groups of population constructed based on the genetic distances according to 17 Y-STR loci presented a clear patrilineal genetic substructure in the area. Partial Y-STRs profiling reduced the discrimination capacity in most groups of population and distorted the multidimensional scaling plot. [ABSTRACT FROM AUTHOR]

Bacillus cereus is a major food-born pathogen in Taiwan and its major syndromes include vomiting, fever and diarrhea. To minimize the possibility of exposing consumers to pathogenic B. cereus, this study develops a rapid and sensitive assay that utilizes immunoliposomal nanovesicles (IMLNs) and immunomagnetic beads (IMBs). In this work, fluorescent dyes (sulforhodamine B)-loaded IMLNs were employed to increase the detection signal; anti- B. cereus antibody-conjugated IMBs were applied to capture B. cereus in samples. Hence in this assay, a sandwich complex was formed as “IMBs- B. cereus-IMLNs”. The optimal IMLNs had a diameter of 300 nm with a conjugated antibody molar percentage (mol%) of 0.25 mol%. The limit of detection (LOD) of this developed assay reaches 10 CFU/mL of B. cereus with the false negative value as zero in 20 parallel assays in milk samples. To evaluate the specificity of this assay, nine Gram positive and negative bacteria were tested and found to cause no significant interference problems. In conclusion, this study elucidates the feasibility of using a novel IMB/IMLN assay for detecting B. cereus and its LOD without pre-enrichment could amount to 10 CFU/mL within 4 h. [ABSTRACT FROM AUTHOR]

This descriptive, cross-sectional survey study illustrates the roles for and motives of being a family visitor to accompany a hospitalized loved one during hospitalization in a Taiwanese hospital. Family visitors were approached by research assistants on a random basis in acute inpatient units. Among the 1,034 participants, 91% were relatives. About 80.0% of them were present to attend to the patient's physical care, 61.0% to offer psychological support, and 63.5% to express their desire to learn more about the patient's medical condition and illness in time. Their primary motives included fulfilling one of their responsibilities, coming to help voluntarily, showing filial piety for their parent, and being afraid that the patient could not obtain appropriate care. The family involvement culture in Taiwan may have placed pressure on family members to be present at the bedside and contributed to families' psychological and financial burden. [ABSTRACT FROM AUTHOR]

This research explores customer''s expectations of service quality in hot spring hotels in Taiwan. Based on the five dimensions of PZB service quality, a specialist questionnaire is utilized to establish a complete service quality evaluation framework for hot spring hotels. In this research, analysis network process (ANP) is applied to find the relative weights among the criteria and to emphasize the interdependent relationships, thus increasing the accuracy of our results. Finally, the service quality evaluation framework and evaluation results can be used as a guide for hot spring hotel proprietors to review, improve, and enhance service planning and service qualities in the future. [Copyright &y& Elsevier]

The article cites a survey of nursing executives concerning the availability of holistic nursing care for hospitalized patients conducted at hospitals in Taiwan. According to the survey, only 40% of hospitals had any facilities for religious service and only 4% employed recruited volunteers to provide religious support. It is determined that only 20% of hospitals offered rooms for special ceremonies frequently used for rituals after patient death.

This study investigated the linkages between patient falls and open visiting hours in an acute care setting in Taiwan. The activities of the accompanying family members/aides when patients fell were analyzed. More than 35% of the family members/aides who were watching patients were ineffective in preventing the falls. [ABSTRACT FROM AUTHOR]

In order to care ethically nurses need to care holistically; holistic care includes religious/spiritual care. This research attempted to answer the question: Do nurses have the resources to offer religious care? This article discusses only one aspect – the provision of religious care within the Taiwanese health care system. It is assumed that, if hospitals do not provide enough religious services, nurses working in these hospitals cannot be fully ethical beings or cannot respect patients' religious needs. The relevant literature was reviewed, followed by a survey study on the provision of religious facilities and services. Aspects considered are: the religions influences in and on Taiwanese society; the religious needs of patients and their families; strategies that patients use to enable them to cope with their health care problems; professional motives for attuning to patients' religious needs; and hospital provision for meeting the religious and spiritual needs of patients. A survey of nursing executives showed differences between religious service provision in hospitals with and without a hospice ward. The practical implications for hospital management and nursing practice are discussed. [ABSTRACT FROM AUTHOR]

This article aims to help readers to learn about health care related cultural and religious beliefs and spiritual needs in Chinese communities. The recall diary of a severe acute respiratory syndrome (SARS)-infected intern working in Hoping Hospital in Taiwan during the 2003 SARS epidemic is presented and used to assist in understanding one patient's spiritual activities when personally confronted with this newly emerging infectious disease. The article also gives an overview of the 2003 SARS epidemic in Taiwan, and discusses people's general perceptions towards infectious diseases, their coping strategies concerning disease, and their spiritual beliefs, the psychological impact of the 2003 SARS outbreak in Chinese communities, Chinese myths about infectious disease, and the religious activities of a SARS-infected intern in Taiwan. Recommendations are given on how to achieve quality holistic nursing care. [ABSTRACT FROM AUTHOR]

Background/Purpose. We analyzed confluence patterns of intrahepatic segmental bile ducts, seeking to relate hepato-lithiasis to anatomic variation. The comparative study was completed patients with hepatolithiasis in Taiwan and Japan. Methods. Direct cholangiography was performed in 103 hepatolithiasis patients in Taiwan and 77 in Japan. Segmental ducts patterns were classified as type I, normal configuration; type II, ?triad? confluence; type III, posterior segmental duct joining left hepatic duct; or type IV, distal confluence of the right posterior segmental duct. Results. Taiwanese patients had only calcium bilirubinate or black stones, and were mostly female. As overall analysis, types I, II, III, and IV were found in 61, 26, 13, and 3 patients, respectively. In Japanese, types I, II, III, and IV were found in 52, 10, 13, and 2, respectively. There was no difference between the two institutes. Since no patients in Taiwan had cholesterol calculi, Japanese patients were reanalyzed including only 58 patients with calcium bilirubinate or black stones. Differences in those populations remained insignificant. Conclusion. Anatomic variations in segmental ducts apparently do not contribute to pathogenesis of hepatolithiasis. [ABSTRACT FROM AUTHOR]

Dissemination of multidrug-resistant, particularly tigecycline-resistant, Acinetobacter baumannii is of critical importance, as tigecycline is considered a last-line antibiotic. Acquisition of tet(X), a tigecycline-inactivating enzyme mostly found in strains of animal origin, imparts tigecycline resistance to A. baumannii. Herein, we investigated the presence of tet(X) variants among 228 tigecycline-non-susceptible A. baumannii isolates from patients at a Taiwanese hospital via polymerase chain reaction using a newly designed universal primer pair. Seven strains (3%) carrying tet(X)-like genes were subjected to whole genome sequencing, revealing high DNA identity. Phylogenetic analysis based on the PFGE profile clustered the seven strains in a clade, which were thus considered outbreak strains. These strains, which were found to co-harbor the chromosome-encoded tet(X6) and the plasmid-encoded blaOXA-72 genes, showed a distinct genotype with an uncommon sequence type (Oxford ST793/Pasteur ST723) and a new capsular type (KL129). In conclusion, we identified an outbreak clone co-carrying tet(X6) and blaOXA-72 among a group of clinical A. baumannii isolates in Taiwan. To the best of our knowledge, this is the first description of tet(X6) in humans and the first report of a tet(X)-like gene in Taiwan. These findings identify the risk for the spread of tet(X6)-carrying tigecycline- and carbapenem-resistant A. baumannii in human healthcare settings. [ABSTRACT FROM AUTHOR]

Simple Summary: This study aims to evaluate overall survival and the risk of cause-specific mortality of thyroid cancer patients. Thyroid cancer patients were obtained from the universal health insurance claims from Taiwan between 2001 and 2017. We compared these patients with control subjects matched for age, gender, and baseline conditions to assess the risk of mortality. Of the 30,778 patients with thyroid cancer, the overall mortality rate was 1.29% and the leading causes of death were thyroid cancer (31.2%), other cancers (29.9%), and cardiovascular disease (CVD) mortality (12.3%), respectively. We found patients with thyroid cancer had excellent overall survival and lower CVD mortality risk. The incidence of thyroid cancer has increased substantially worldwide. However, the overall mortality risk and actual causes of death in thyroid cancer patients have not been extensively evaluated. In this study, patients with thyroid cancer diagnosed between 2001 and 2017 were analyzed from Taiwan's National Health Insurance Research Database. We compared these patients with control subjects matched for age, gender, history of cardiovascular disease (CVD), hyperlipidemia, diabetes mellitus, hypertension, and occupation to assess the risk of overall mortality and cause-specific mortality. Finally, our cohort comprised 30,778 patients with thyroid cancer. Three hundred and ninety-eight deaths (1.29%) occurred during a median follow-up of 60.0 months (range: 30.3 to 117.6 months). The primary cause of death was thyroid cancer mortality (31.2%), followed by other malignancy-related mortality (29.9%) and CVD mortality (12.3%). The overall mortality risk was similar between the thyroid cancer and control groups (unadjusted hazard ratio (HR): 0.98; 95% confidence interval (CI): 0.88–1.10); the adjusted HR was 1.07 (95% CI: 0.95–1.20) after multivariate adjustment for age, gender, history of CVD, hyperlipidemia, diabetes mellitus, hypertension, and occupation. The risk of other malignancy-related mortality was comparable between two groups. CVD mortality risk was lower in the thyroid cancer group, with an unadjusted HR of 0.51 (95% CI: 0.38–0.69) and adjusted HR of 0.56 (95% CI: 0.42–0.76). In conclusion, patients with thyroid cancer had excellent overall survival. Thyroid cancer-specific mortality was the leading cause of death, highlighting the importance of thyroid cancer management. Thyroid cancer patients had lower CVD mortality risk than the general population. [ABSTRACT FROM AUTHOR]

Background: Koelreuteria henryi Dummer is an indigenous plant in Taiwan. The species has been used in traditional folk medicine for the promotion of liver functions and for treating malaria and urethritis. The present study investigated the antioxidant activity of the flower extract of Koelreuteria henryi Dummer. The extraction conditions were optimized by the contents of total phenolic acids and total flavonoids, and antioxidant activity assays. Moreover, an in vitro study for investigating antioxidant activity of K. henryi flower extract was demonstrated by hydrogen peroxide (H2O2)-induced apoptosis. Results: K. henryi flower extracted for 150 min showed high contents of total phenolic acids and total flavonoids. In an in vitro model, L929 cells were pretreated with K. henryi flower extract, and then treated with H2O2 to induce oxidative damage. Results demonstrated that H2O2-induced apoptosis was inhibited by the treatment of 200 µg/ml K. henryi flower extract through the mitochondria-mediated pathway and mitogen-activated protein kinase (MAPK) pathway. The caspase 8/9 activity and expression of p-p38 and pERK were repressed by K. henryi flower extract. In addition, the prevention of H2O2-induced apoptosis by K. henryi flower extract activated the nuclear factor-erythroid 2-related factor (Nrf2) stress response pathway to transcript heme oxygenase 1 (HO-1). Also, K. henryi flower extract prevented H2O2-induced apoptosis through HO-1 production, as evident by the use of HO-1 inhibitor. Conclusions: The present study demonstrated that K. henryi flower extract could inhibit the H2O2-induced apoptosis in L929 cells through the activation of the Nrf2/HO-1 pathway. [ABSTRACT FROM AUTHOR]

Mycoplasma pneumoniae is currently the most commonly detected bacterial cause of childhood community-acquired pneumonia in several countries. Of note, clonal expansion of macrolide-resistant ST3 occurred in Japan and South Korea. An alarming surge in macrolide resistance complicates the treatment of pneumonia. We aimed to evaluate the clinical manifestation and clonal relatedness of M. pneumoniae circulating among children in Taiwan. We prospectively enrolled 626 children with radiologically confirmed pneumonia between 2017 and 2019. An M. pneumoniae infection was suspected on clinical grounds, and tested by real-time PCR and oropharyngeal swab cultures. We used multilocus sequence typing and whole-genome sequencing to characterize the genetic features of M. pneumoniae. A total of 226 children with M. pneumoniae pneumonia were enrolled. Macrolide resistance was found in 77% (174/226) of patients. Multi-locus sequence typing revealed that ST3 (n = 93) and its single-locus variant ST17 (n = 84) were the predominant clones among macrolide-resistant strains. ST17 presented clinical characteristics comparable to its ancestor ST3. On multivariate analysis, macrolide resistance (OR 3.5; 95% CI 1.4–8.5; p 0.007) was independently associated with fever >72 hours after macrolide treatment. By whole-genome sequencing, prediction analysis of recombination sites revealed one recombination site in ST3 and ST17 compared with M29 (a macrolide-sensitive ST3 strain isolated from China in 2005) containing cytadhesin MgpC-like protein, RepMP4 and RepMP5. ST17 had another recombination site containing an adhesin and RepMP2/3. In addition to macrolide resistance, ST3 and its ST17 variant might evolve through recombination between repetitive sequences and non-P1 cytadhesins for persistent circulation in Taiwan. [ABSTRACT FROM AUTHOR]

Accumulating evidence has indicated that Vibrio parahaemolyticus stains resistant to multiple drugs may pose a serious threat to public health and could lead to global economic. Phage therapy is an alternative and eco-friendly biocontrol strategy for the prevention and control of diseases in the aquatic systems. Therefore, this study was oriented to isolate and characterize the applicability of phages for V. parahaemolyticus (VP) lysis in aquaculture. Here, twenty-two lytic bacteriophages (BP1–22) were isolated from sewage collected in a local shrimp farming area and from the tissue of AHPND-infected shrimp and oysters collected in Taiwan. Among these, phage BP14 could effectively lyse V. parahaemolyticus , this bacterium causes acute hepatopancreatic necrosis disease (AHPND), resulting in severe mortality in Litopenaeus vannamei and Penaeus monodon , two marine shrimp species that are commonly grown in aquaculture farms. Characterization of the morphology of the virion particle via electron microscopy revealed that the virus belonged to the family Inoviridae , as suggested by its filamentous shape. The genome of phage BP14 was composed of 9071 bp with a 43.85% GC content and was inserted into a chromosome depending on the occurrence of Xer site-specific recombination. Furthermore, phage BP14 established a chronic productive infection, thus continuously releasing virions from infected cells. A viral load of approximately 12 plaque-forming units (PFUs) per cell was determined for phage BP14 under laboratory growth conditions. Western blotting and ELISA analyses revealed that phage BP14 decreased the levels of toxin-PirB and PirA protein by approximately 40%–60% compared to the wild-type VP. Collectively, our findings demonstrated the potential applicability of phage BP14 for the biological control of VP AHPND. • A total of 22 phages lysis the V. parahaemolyticus (VP) were collected in Taiwan. • Phage BP14 can infect a broad range of VPs including VP AHPND PD2 in Taiwan and 3HP in Thailand. • Phage BP14 belongs to the family Inoviridae. • Phage BP14 establishes a chronic productive infection, thus continuously releasing virions from infected cells. • Phage BP14 decreased the production of toxin-proteins, demonstrating its potential as a biological agent against VP AHPND. [ABSTRACT FROM AUTHOR]

• First report of bla NDM-1 / bla NDM-4 and bla OXA-181 co-harbouring strains in Taiwan • Discovery of a novel bla NDM-1 + bla OXA-181 hybrid plasmid • An outbreak of bla NDM-4 + bla OXA-181 co-carriage with enhanced carbapenem resistance • The emergence of KL51 carbapenem-resistant Klebsiella pneumoniae The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) is related to the transmission of carbapenemase genes. Strains carrying more than one carbapenemase with a broadened spectrum of antibiotic resistance have been detected, which is concerning. Although bla KPC -encoding ST11-KL47/KL64 strains are dominant, other clones are emerging. This study investigated 137 CRKP from patients' blood samples in Taiwan. Polymerase chain reaction (PCR) was used to identify carbapenemase genes and capsular (KL) types. Most strains (56%, 77/137) possessed bla KPC alone; however, 12% (17/137) carried bla NDM + bla OXA-48-like and these strains showed high resistance to imipenem and meropenem. Strains carrying bla NDM + bla OXA-48-like predominantly belonged to KL51 (n =15), followed by KL64 (n =1) and KL47 (n =1). Whole-genome sequencing of one KL51 strain indicated that bla NDM-4 and bla OXA-181 are carried on two different plasmids. PCR was performed using specific primers located in these plasmids, and all bla NDM + bla OXA-48-like -encoding strains except the KL64 strain were considered to carry the two abovementioned plasmids. Genome analysis for the KL64 strain revealed that bla NDM-1 and bla OXA-181 are encoded in one plasmid. Notably, the KL51 bla OXA-181 plasmid shared high sequence similarity with the KL64 bla NDM-1 + bla OXA-181 plasmid, except the KL64 plasmid comprised a 15,040-bp insertion encoding bla NDM-1. The data revealed KL51 as a predominant KL type carrying bla NDM-4 + bla OXA-181 , and identified a novel plasmid carrying bla NDM-1 + bla OXA-181 , highlighting the spread of specific plasmids and clones of CRKP in Taiwan. [ABSTRACT FROM AUTHOR]

Acinetobacter baumannii is the main cause of nosocomial infections, which are increasingly difficult to treat due to the emergence of carbapenem resistance. This study focused on major carbapenemase genes and explored the association between carbapenemase genes, sequence types (ST types), and capsular types (K types). A total of 98 carbapenem-resistant A. baumannii (CRAB) strains were collected from two hospitals, the Chang Gung Memorial Hospital-Lin Kou branch (LCGMH) in northern Taiwan and the CGMH-Kaohsiung branch (KCGMH) in southern Taiwan, from 2015 to 2017. Major carbapenemase genes of class A, B, and D β-lactamases were detected by polymerase chain reaction. All strains except 1 were positive for bla OXA-51-like , 76 strains (77.6%) carried bla OXA-23-like , and 25 strains (25.5%) carried bla OXA-24-like. The regional distribution showed that bla OXA-23-like was more common than bla OXA-24-like in both hospitals (85.3% and 60% in LCGMH and KCGMH, respectively); however, the percentage of bla OXA-24-like was much higher in KCGMH (46.7%) than in LCGMH (16.2%). Oxford multilocus sequence typing and global optimal eBURST analysis were conducted for 59 strains. The results of this study showed the association between bla OXA gene patterns, ST types, and K types and demonstrated that four major K types, KL2, KL10, KL22, and KL52, which were associated with specific ST types, were mainly clustered into clonal complexes CC208 and CC549 (a unique clonal complex found in Taiwan). These findings provide important information for monitoring the epidemiology and dissemination of this pathogen. [ABSTRACT FROM AUTHOR]

• The full-bloomed inflorescence has the highest ornamental value. • Application of ethylene action inhibitors extends the longevity by four days. • White crane orchid has the potential for cut flower production. White crane orchid (Calanthe triplicata) is one of the native orchids in Taiwan. It features pure white flowers, a unique flowering pattern, an elegant inflorescence, and it is of high ornamental value. In order to evaluate the feasibility of white crane orchid for cut flower production, we characterized the growing and blooming of the white crane orchid inflorescence during its vase life in deionized water. Up to 30 florets on each rachis bloomed from the bottom to the top on the raceme of the white crane orchid. The floret at the lowest position began to wilt after more than 20 florets bloomed. The early senescence symptoms of a floret were the yellowing labellum and blackening anther cap. To investigate the flower longevity and the overall ornamental value of inflorescences, they were harvested when bearing 0, 11, and 20 opened florets. The inflorescences in the three developmental stages had a vase life of 22 days, 9 days and 6 days, respectively, in deionized water at 25 °C. Although they have the longest vase life, inflorescences that were harvested in the budding period (0 opened florets) had a relatively low ornamental value; conversely, the ornamental value of the inflorescences harvested in the blooming period (20 opened florets) was the highest, followed by that at the stage with 11 florets. The application of ethylene action inhibitors, such as 1-methylcyclopropene (1-MCP) or silver thiosulfate (STS), to the inflorescences harvested in the blooming period (20 opened florets) has extended their vase life from 6 days to 8 days and to 10 days, respectively. [ABSTRACT FROM AUTHOR]

Background: Long COVID, an emerging public health issue, is characterized by persistent symptoms following SARS-CoV-2 infection. This study aims to explore the relationship between post-COVID-19 symptomatology and patient distress employing Latent Class Analysis to uncover symptom co-occurrence patterns and their association with distress., Methods: A cross-sectional study was conducted using an online survey among 240 participants from a university and affiliated hospital of southern Taiwan. The survey quantified distress due to persistent symptoms and assessed the prevalence of Long COVID, symptom co-occurrence, and latent symptom classes. Latent Class Analysis (LCA) identified distinct symptom patterns, and multiple regression models evaluated associations between symptom patterns, distress, and demographic factors., Results: The study found that 80 % of participants experienced Long COVID, with symptoms persisting for over three months. Individuals with multiple COVID-19 infections showed a significant increase in general (β = 1.79), cardiovascular (β = 0.61), and neuropsychological symptoms (β = 2.18), and higher total distress scores (β = 6.35). Three distinct symptomatology classes were identified: "Diverse", "Mild", and "Severe" symptomatology. The "Mild Symptomatology" class was associated with lower distress (-10.61), while the "Severe Symptomatology" class showed a significantly higher distress due to symptoms (13.32)., Conclusion: The study highlights the significant impact of Long COVID on individuals, with distinct patterns of symptomatology and associated distress. It emphasizes the cumulative effect of multiple COVID-19 infections on symptom severity and the importance of tailored care strategies., Competing Interests: Declaration of Competing Interest The authors have no competing interest to declare., (Copyright © 2024. Published by Elsevier Ltd.)

Objectives: To evaluate the process and the comprehensiveness of advance care planning (ACP), we designed a national ACP-OSCE (Objective Structured Clinical Examination) program., Methods: The program was designed as a 40-minute OSCE test. Participants were categorized as different ACP team members to illustrate realistic scenarios. Preceptors were asked to observe ACP professionals' actions, responses, and communication skills during ACP with standardized patients (SP) through a one-way mirror. Participants' communication skills, medical expertise, legal knowledge, empathetic response and problem-solving skills of ACP were also self-evaluated before and after OSCE. Thematic analysis was used for qualitative analysis., Results: In Nov 2019, a total of 18 ACP teams with 38 ACP professionals completed the ACP-OSCE program, including 15 physicians, 15 nurses, 5 social workers, and 3 psychologists. After the ACP-OSCE program, the average score of communication skills, medical expertise, legal knowledge, empathetic response, ACP problem-solving all increased. Nurses felt improved in medical expertise, legal knowledge, and problem-solving skills, psychologists and social workers felt improved in legal knowledge, while physicians felt no improved in all domain, statistically. Thematic analysis showed professional skills, doctoral-patient communication, benefit and difficulties of ACP were the topics which participants care about. Meanwhile, most participants agreed that ACP-OSCE program is an appropriate educational tool., Conclusion: This is the first national ACP-OSCE program in Asia. We believe that this ACP-OSCE program could be applied in other countries to improve the ACP process and quality., (© 2024. The Author(s).)

From 2008 to 2020, the Taiwan National Notifiable Disease Surveillance System database demonstrated that the incidence of non-vaccine serotype 23A invasive pneumococcal disease (IPD) approximately doubled. In this study, 276 non-repetitive pneumococcal clinical isolates were collected from two medical centers in Taiwan between 2019 and 2021. Of these 267 pneumococci, 60 were serotype 23A. Among them, 50 (83%) of serotype 23A isolates belonged to the sequence type (ST) 166 variant of the Spain 9V -3 clone. Pneumococcal 23A-ST166 isolates were collected to assess their evolutionary relationships using whole-genome sequencing. All 23A-ST166 isolates were resistant to amoxicillin and meropenem, and 96% harbored a novel combination of penicillin-binding proteins (PBPs) (1a:2b:2x):15:11:299, the newly identified PBP2x-299 in Taiwan. Transformation of the pbp1a , pbp2b , and pbp2x alleles into the β-lactam-susceptible R6 strain revealed that PBP2x-299 and PBP2b-11 increased the MIC of ceftriaxone and meropenem by 16-fold, respectively. Prediction analysis of recombination sites in PMEN3 descendants (23A-ST166 in Taiwan, 35B-ST156 in the United States, and 11A-ST838/ST6521 in Europe) showed that adaptive evolution involved repeated, selectively favored convergent recombination in the capsular polysaccharide synthesis region, PBPs, murM , and folP genome sites. In the late 13-valent pneumococcal conjugate vaccine era, PMEN3 continuously displayed an evolutionary capacity for global dissemination and persistence, increasing IPD incidence, leading to an offset in the decrease of pneumococcal conjugate vaccine serotype-related diseases, and contributing to high antibiotic resistance. A clonal shift with a highly β-lactam-resistant non-vaccine serotype 23A, from ST338 to ST166, increased in Taiwan. ST166 is a single-locus variant of the Spain 9V -3 clone, which is also called the PMEN3 lineage. All 23A-ST166 isolates, in this study, were resistant to amoxicillin and meropenem, and 96% harbored a novel combination of penicillin-binding proteins (PBPs) (1a:2b:2x):15:11:299. PBP2x-299 and PBP2b-11 contributed to the increasing MIC of ceftriaxone and meropenem, respectively. Prediction analysis of recombination sites in PMEN3 descendants showed that adaptive evolution involved repeated, selectively favored convergent recombination in the capsular polysaccharide synthesis region, PBPs, murM , and folP genome sites. In the late 13-valent pneumococcal conjugate vaccine era, PMEN3 continuously displays the evolutionary capacity for dissemination, leading to an offset in the decrease of pneumococcal conjugate vaccine serotype-related diseases and contributing to high antibiotic resistance., Competing Interests: The authors declare no conflict of interest.

An outbreak of respiratory syncytial virus (RSV) has been observed in Taiwan since August 2020. We reviewed a central laboratory-based surveillance network established over 20 years by Taiwan Centres for Disease Control for respiratory viral pathogens between 2010 and 2020.A retrospective study of children <5 years old hospitalized with RSV infection at Chang Gung Memorial Hospital between 2018 and 2020 was conducted, and samples positive for RSV-A were sequenced. Clinical data were obtained and stratified by genotype and year.Data from 2020 showed an approximately 4-fold surge in RSV cases compared to 2010 in Taiwan, surpassing previous years during which ON1 was prevalent. Phylogenetic analysis of G protein showed that novel ON1 variants were clustered separately from those of 2018 and 2019 seasons and ON1 reference strains. The variant G protein carried six amino acid changes that emerged gradually in 2019; high consistency was observed in 2020. A unique substitution, E257K, was observed in 2020 exclusively. The F protein of the variant carried T12I and H514N substitutions, which weren't at antigenic sites. In terms of multivariate analysis, age (OR: 0.97; 95% CI: 0.94-0.99; p  = 0.02) and 2020 ON1 variant (OR:2.52; 95% CI:1.13-5.63; p  = 0.025) were independently associated with oxygen saturation <94% during hospitalization.The 2020 ON1 variant didn't show higher replication or virulence compared with those in 2018 in our study. The unprecedented 2020 RSV epidemic may attribute to antigenic changes and lack of interferon-stimulated immunity induced by seasonal circulating virus under non-pharmaceutical intervention.

Acinetobacter baumannii emerged as one of the most important pathogens that causes nosocomial infections due to its increased multidrug resistance. Identifying capsular epidemiology in A. baumannii can aid in the development of effective treatments and preventive measures against this emerging pathogen. Here we established a wzc -based method, and combined it with wzy -PCR to determine capsular types of A. baumannii causing nosocomial bacteraemia collected at two medical centres in Taiwan from 2015 to 2017. Among the 237 patients with A. baumannii bacteraemia, 98 (41.4%) isolates were resistant to carbapenems. Four prevalent capsular types (KL2, KL10, KL22, and KL52) accounted for 84.7% of carbapenem-resistant A. baumannii (CRAB) and 12.2% of non-CRAB. The rate of pneumonia, intensive care unit admission, APACHE II score, and Pitt bacteraemia score were higher in patients with KL2/10/22/52 infection than in those with non-KL2/10/22/52 infection. Patients with KL2/10/22/52 infection and patients with CRAB infection have a higher cumulative incidence of attributable and all-cause in-hospital 30-day mortality. On multivariate analysis, appropriate empirical antimicrobial therapy within 24 h was associated with a lower risk of 30-day attributable mortality in the KL2/10/22/52 isolates (odds ratio = 0.19, 95% CI: 0.06-0.66, p  = 0.008) but not in non-KL2/10/22/52 isolates. Early recognition of carbapenem resistance-associated capsular types may help clinicians to promptly implement appropriate antimicrobial therapy for improving the outcomes in patients with CRAB bacteraemia.

The ongoing coronavirus disease-2019 (COVID-19) epidemic continues to have a global impact. This article describes the author's experience providing nursing care to a female patient who was diagnosed with COVID-19 after returning to Taiwan from overseas. During the patient's period of isolation (February 5th to February 29th, 2020), the author used Roy's adaptation model to perform first-level holistic physical, psychological, and social nursing assessments and collected health-problem information using face-to-face interviews, telephone interviews, and observations via a remote monitoring system. A second level of assessment confirmed that the problems faced by the patient included (1) existing infections related to COVID-19 and (2) anxiety related to uncertainties about disease prognosis, forgiveness from the family, and potential violations of personal privacy by the media. Due to the special nature of the isolation ward, the author used a remote physiological monitoring system to monitor the vital signs, fever, and shortness of breath status of the patient to quickly decrease her physical discomfort and to improve her self-care ability during hospitalization. Environmental cleanliness was strictly maintained to reduce the risk of cross-infection and ensure patient safety. To alleviate patient anxiety, the author established a good therapeutic interpersonal relationship with the patient by making 10-60 minutes of caring calls to her each day, by providing individual care measures, and by using the Internet to play audio and video to teach mindfulness meditation. Caring for COVID-19 cases is a completely new experience. The author hopes that this experience may be used as a reference for caregivers.

Incidence of invasive pneumococcal disease caused by antimicrobial-resistant Streptococcus pneumoniae types not included in pneumococcal conjugate vaccines has increased, including a penicillin- and meropenem-resistant serotype 15A-ST63 clone in Japan. During 2013-2017, we collected 206 invasive pneumococcal isolates in Taiwan for penicillin and meropenem susceptibility testing. We found serotypes 15B/C-ST83 and 15A-ST63 were the most prevalent penicillin- and meropenem-resistant clones. A transformation study confirmed that penicillin-binding protein (PBP) 2b was the primary meropenem resistance determinant, and PBP1a was essential for high-level resistance. The rate of serotype 15B/C-ST83 increased during the study. All 15B/C-ST83 isolates showed an ermB macrolide resistance genotype. Prediction analysis of recombination sites revealed 12 recombination regions in 15B/C-ST83 compared with the S. pneumoniae Spain 23F -ST81 genome. Pneumococcal clones rapidly recombine to acquire survival advantages and undergo local expansion under the selective pressure exerted by vaccines and antimicrobial drugs. The spread of 15B/C-ST83 is alarming for countries with high antimicrobial pressure.

Background: Early antiretroviral therapy (ART) is recommended as an intervention for HIV by the World Health Organization. However, the association between the CD4 count at ART initiation and the risk of adverse drug reactions (ADRs) remains unclear., Purpose: This study aimed to describe the trends related to symptom number and intensity among patients newly diagnosed with HIV in three different CD4-count-based groups and then to investigate the ADR trends for these three groups at different points in time., Methods: This multi-center cohort study recruited newly diagnosed HIV/AIDS patients who had not previously used ART from AIDS-designated hospitals in Taiwan from March 2015 to December 2016. Study measures were assessed at the time of case enrollment (T0) and during the 1st month (T1), 4-6th month (T2), and 7-9th month (T3) of ART treatment. Patients were stratified into three groups according to initial CD4 count: ≤ 350 cells/mm 3 , >350-500 cells/mm 3 and >500 cells/mm 3 . Repeated measures ANOVA and generalized estimating equations were used to estimate the relationships between the level of initial CD4 count and ADRs., Results: A total of 207 patients completed the study. Mean symptom numbers and symptom intensities decreased significantly over time in all three groups (p < .01). The largest mean reduction in both symptom number and intensity was achieved by the CD4 count >500 cells/mm 3 group. Overall, at least one ADR was reported by 85.7% of the participants at the first month of ART use, and the incidence of ADR had decreased by an average of 22% at the 7-9th month assessment (p < .001). ARDs decreased significantly over time in the CD4 count > 500 cells/mm 3 group, with the degrees of ADRs in systematic side effect most significantly decreased in this group (p = .03)., Conclusions / Implications for Practice: Number and intensity of symptoms significantly improved over time in all three CD4 count groups. The percentage of systematic side effects was most reduced in the CD4 count > 500 cells/mm 3 group. The results of this study may be referenced by HIV care providers when discussing with patients the initiation of ART and the potential risks of experiencing ADRs.

Background/purpose: Early detection of suicide risk is a challenge in suicide prevention. A comprehensive yet efficient tool providing timely identification of key risk factors allows healthcare providers to initiate interventions. The study aims to validate the 9-item Concise Mental Health Checklist (CMHC-9)., Methods: A series of cross-sectional surveys were conducted in 3982 participants from psychiatric outpatient (n = 931), medical outpatient (n = 931) and community (n = 2120) populations. The factor analysis with internal consistency coefficients (Cronbach's α) and receiver operating characteristic (ROC) analysis were performed to evaluate the scale's reliability and validity., Results: The internal consistency of the CMHC-9 was satisfactory based on Cronbach's α values for the total sample (α = 0.79) and the three sub-samples (i.e., α = 0.76 for psychiatric subjects; 0.67 for community subjects; and 0.69 for medical outpatient subjects). Hierarchical exploratory factor analysis revealed that the CMHC-9 was a single-dimensional scale with two-factor structure of psychopathology and suicidality. The two-factor solution was confirmed by confirmatory factor analysis. The optimal cut-off of 3/4 obtained from the ROC analysis represented a satisfactory sensitivity (92%) and specificity (82%) in identifying recent suicide ideation., Conclusion: This large-scale study confirmed the CMHC-9 as a brief and effective tool for suicide risk detection. It is recommended that CMHC-9 can be used for care engagement and risk identification in both medical and community settings among people at risk for suicide., (Copyright © 2019 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)