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Pressure ulcers are a common problem among individuals who, for medical reasons, must spend most of their day in bed. Manually turning a person's body is labor intensive and can easily cause occupational injuries.To compare the effectiveness of a new assisted turning mattress in pressure management with that of a conventional air mattress.This is a single-session crossover trial study. Twenty-four participants confined to bed were transferred onto the selected mattress (assisted turning or conventional air mattresses) in the selected position. Average interface pressures of bony prominences were measured after the participants laid on the mattress in different positions. After the data collection, they were transferred to the second mattress, and the process was repeated. Subjective feedback from participants and caregivers was also acquired immediately following a one-week trial period of assisted turning mattresses.The mean interface pressures were comparable for most body parts between two mattresses. Subjective feedback showed that assisted turning mattresses could relieve caregivers' workload but at the cost of patients' decreased feelings of safety.Assisted turning mattresses are equal to conventional air mattresses in pressure distribution. Proper pressure management through scheduled positional changes is required in assisted turning mattresses.

ObjectiveScreening and eradication ofHelicobacter pylorihelp reduce disparities in the incidence of gastric cancer. We aimed to evaluate its acceptability and feasibility in the indigenous communities and develop a family index-case method to roll out this programme.DesignWe enrolled residents aged 20–60 years from Taiwanese indigenous communities to receive a course of test, treat, retest and re-treat initial treatment failures with the13C-urea breath tests and four-drug antibiotic treatments. We also invited the family members of a participant (constituting an index case) to join the programme and evaluated whether the infection rate would be higher in the positive index cases.ResultsBetween 24 September 2018 and 31 December 2021, 15 057 participants (8852 indigenous and 6205 non-indigenous) were enrolled, with a participation rate of 80.0% (15 057 of 18 821 invitees). The positivity rate was 44.1% (95% CI 43.3% to 44.9%). In the proof-of-concept study with 72 indigenous families (258 participants), family members of a positive index case had 1.98 times (95% CI 1.03 to 3.80) higher prevalence ofH. pylorithan those of a negative index case. The results were replicated in the mass screening setting (1.95 times, 95% CI 1.61 to 2.36) when 1115 indigenous and 555 non-indigenous families were included (4157 participants). Of the 6643 testing positive, 5493 (82.6%) received treatment. According to intention-to-treat and per-protocol analyses, the eradication rates were 91.7% (89.1% to 94.3%) and 92.1% (89.2% to 95.0%), respectively, after one to two courses of treatment. The rate of adverse effects leading to treatment discontinuation was low at 1.2% (0.9% to 1.5%).ConclusionA high participation rate, a high eradication rate ofH. pyloriand an efficient rollout method indicate that a primary prevention strategy is acceptable and feasible in indigenous communities.Trial registration numberNCT03900910.

Background: Few studies have examined the mental profiles and academic status of collegiate triathletes during training/competitive periods. We evaluated the changes in sleep quality, physical fatigue, emotional state, and academic stress among collegiate triathletes across training periods. Methods: Thirteen collegiate triathletes (19–26 years old) were recruited in this study. Mood state, sleep quality, degree of daytime sleepiness, subjective fatigue, and academic learning states were measured during the following five training periods: before national competitions for 3 months (3M-Pre Comp), 2 months (2M-Pre Comp), 1 month (1M-Pre Comp), 2 weeks (2wk-Pre Comp), and national competition (Comp) according to their academic/training schedule. Results: The academic stress index in 1M-Pre Comp (Final exam) was significantly higher than that in 3M-Pre Comp in these triathletes. No markedly significant differences were observed in overall mood state, sleep quality, individual degree of sleepiness, and fatigue among these five periods. However, the profiles mood state scale (POMS)-fatigue and -anger were lower in 2wk-Pre Comp than that in 1M-Pre com. The POMS-tension score in Comp was significantly higher than that in 3M-Pre Comp and 2M-Pre Comp. POMS-depression in Comp was lower than that in 1M-Pre Comp. Conclusion: We found that training volume was highest one month before a competition, and the academic stress is greatest during their final term exam period (1M-Pre Comp). After comprehensive assessment through analyzing POMS, PSQI, ESS, and personal fatigue (CIS), we found that the collegiate triathletes exhibited healthy emotional and sleep states (PSQI score < 5) across each training period, and our results suggest that these elite collegiate triathletes had proficient self-discipline, time management, and mental adjustment skills.

The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive individuals than in the general population. The magnitude of the colonoscopy-related complication rate in FIT-positive individuals remains unknown. This study aimed to elucidate the colonoscopy-related complication rate after a positive FIT result and compare it with the rate when colonoscopy was performed for other purposes.Information regarding colonoscopy-related severe complications after a positive FIT result (FIT-colonoscopy) and ordinary colonoscopy during 2010-2014 was collected from the Taiwanese Colorectal Cancer Screening Program Database and National Health Insurance Research Database. Severe complications included significant bleeding, perforation, and cardiopulmonary events ≤ 14 days after colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications associated with FIT-colonoscopy compared with ordinary colonoscopy.319 114 FIT-colonoscopies (214 955 patients) were identified, 51 242 (16.1 %) of which included biopsy and 94 172 (29.5 %) included polypectomy. Overall, 2125 significant bleedings (6.7 ‰) and 277 perforations (0.9 ‰) occurred ≤ 14 days after FIT-colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications (adjusted odds ratio [aOR] 4.41, 95 % confidence interval [CI] 4.05-4.81); aOR 1.35, 95 %CI 1.12-1.53; aOR 1.88, 95 %CI 0.61-5.84, respectively). Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding (aOR 3.10, 95 %CI 2.90-3.32).FIT-colonoscopy was associated with a more than two-fold risk of significant bleeding, especially when polypectomy was performed.The likelihood of advanced or synchronous neoplasms is significantly higher in fecal immunochemical test (FIT)-positive individuals than in the general population. The magnitude of the colonoscopy-related complication rate in FIT-positive individuals remains unknown. This study aimed to elucidate the colonoscopy-related complication rate after a positive FIT result and compare it with the rate when colonoscopy was performed for other purposes.Information regarding colonoscopy-related severe complications after a positive FIT result (FIT-colonoscopy) and ordinary colonoscopy during 2010–2014 was collected from the Taiwanese Colorectal Cancer Screening Program Database and National Health Insurance Research Database. Severe complications included significant bleeding, perforation, and cardiopulmonary events ≤ 14 days after colonoscopy. The number of events per 1000 procedures was used to quantify complication rates. Multivariate analysis was conducted to assess the association of various factors with severe complications associated with FIT-colonoscopy compared with ordinary colonoscopy.319 114 FIT-colonoscopies (214 955 patients) were identified, 51 242 (16.1 %) of which included biopsy and 94 172 (29.5 %) included polypectomy. Overall, 2125 significant bleedings (6.7 ‰) and 277 perforations (0.9 ‰) occurred ≤ 14 days after FIT-colonoscopy. Polypectomy, antiplatelet use, and anticoagulant use were associated with higher risk of complications (adjusted odds ratio [aOR] 4.41, 95 % confidence interval [CI] 4.05–4.81); aOR 1.35, 95 %CI 1.12–1.53; aOR 1.88, 95 %CI 0.61–5.84, respectively). Compared with ordinary colonoscopy, FIT-colonoscopy involved significantly higher risk of significant bleeding (aOR 3.10, 95 %CI 2.90–3.32).FIT-colonoscopy was associated with a more than two-fold risk of significant bleeding, especially when polypectomy was performed.

ObjectiveSubjects with a positive faecal immunochemical test (FIT) have a much higher likelihood of advanced neoplasms than the general population. Whether FIT-positive subjects with negative colonoscopy should receive subsequent FIT screening remain unclear.DesignSubjects with a negative colonoscopy after positive FIT in the first screening in the Taiwanese Colorectal Cancer (CRC) Screening Program 2004–2009 were followed until the end of 2014. CRC incidence was compared between those who did and did not receive subsequent FIT screening. Cox regression analysis was conducted, adjusting for major confounders to investigate whether subsequent FIT was associated with lower risk of incident CRC.ResultsThe study cohort was comprised of 9179 subjects who had negative diagnostic colonoscopy after positive FIT in 2004–2009, of whom 6195 received subsequent FIT during the study period. The CRC incidence (per 1000 person years) was 1.34 in those who received subsequent FIT and 2.69 in those who did not, with corresponding adjusted HR (aHR) of 0.47 (95% CI 0.31 to 0.71). Lower adenoma detection rate of diagnostic colonoscopy was associated with higher risk of incident CRC but became non-significant in multivariable analysis after adjustment for subsequent FIT. Higher baseline faecal haemoglobin concentration (FHbC, μg haemoglobin/g faeces) was associated with increased risk of incident CRC (reference: FHbC=20–39; aHR=1.93 (1.04–3.56), 0.95 (0.45–2.00), 2.26 (1.16–4.43) and 2.44 (1.44–4.12) for FHbC=40–59, 60–99, 100–149 and ≥150, respectively).ConclusionSubsequent FIT should be scheduled after negative colonoscopy to detect missed neoplasms and reduce the risk of incident CRC in a national FIT screening programme.

Anopheles anthropophagus (Xu and Feng 1975) is the major vector of malaria in Eastern and Southern China. The species An. anthropophagus is considered a synonym of An. lesteri (Baisas & Hu, 1936), although they differ in several key biological characteristics. Here, we report the complete mitochondrial genome of An. anthropophagus for the first time. The mitogenome of An. anthropophagus is a typical circular, double-stranded molecule with a total length of 15,413 base pairs, and contains 13 protein-coding genes, 22 transfer RNA genes, two ribosomal RNA genes, and an AT-rich control region. A phylogenetic analysis of the complete mitogenomes of 16 species of Anopheles (Culicidae) revealed that An. anthropophagus is closely related to An. sinensis (Wiedemann 1828), in the family Culicidae. The An. anthropophagus mitogenome provides new data for further taxonomic and phylogenetic studies of the genus Anopheles.

Background In response to the emergence of the aging society, the vocational high school education system in Taiwan has established the care service department since 2018. The purpose of this study was to develop core competencies and a professional curriculum for the care service department in vocational high schools. Methods This qualitative study enrolled experts and scholars in the field of long-term care as subjects. First, this study invited 20 experts and scholars to take part in a focus group to collect suggestions as the basis for the development of core competencies and a curriculum. Second, this study invited 10 experts and scholars to participate in three rounds of a Delphi survey to evaluate the planning for the development of core competencies and a curriculum that meet educational needs. Results In this study, we identified eight core competency constructs (interpersonal communication, care, creativity and execution, professional care, patient safety and care, resource connection and application, problem-solving and improvisation, and adherence to a professional code of conduct and ethics) and 15 indicators across two dimensions (general competencies and professional competencies) relating to the care services taught in vocational high schools. We then designed 26 professional subjects according to the core competencies. Conclusions In the past, the core competencies required for providing long-term care could only be cultivated in universities. In response, the Taiwanese government has promoted the cultivation of caregivers in high school, encouraging vocational high schools to establish care service departments and learning pathways to meet long-term care demands in Taiwan, overturn the stereotype that long-term care is an unspecialized profession, and enhance the willingness of young adults to work in the long-term care industry. To foster students’ professional competencies, we identified the core competencies for long-term care service education and devised a professional curriculum to foster the skills and knowledge among students that are required for successfully meeting the care needs of a rapidly aging society through work in the long-term care industry after graduation.

Oral cancer is the fourth most common cancer among men in Taiwan. The age-standardized incidence rate of oral cancer among men in Taiwan has increased since 1980 and became six times greater in 2014. To enable effective public health planning for oral cancer, research on the projection of oral cancer burden is essential. We conducted an age-period-cohort analysis on the incidence of oral cancer among men in Taiwan from 1997 to 2017 and extrapolated the trend to 2025. We found that the period trends for young adults aged between 25 and 44 have already peaked before 2017; the younger, the earlier, and then the trends declined. The cohort trends have peaked roughly at the 1972 birth cohort and then declined for all ages. Despite the increasing trend in the age-standardized incidence rate for oral cancer among men in Taiwan from 1997 to 2017, we forecast a peak attained, an imminent decline after 2017, and a decrease of 8.4% in age-standardized incidence rate from 2017 to 2025. The findings of this study contribute to developing efficient and comprehensive strategies for oral cancer prevention and control.

The purpose of this study is to construct Taiwan’s Active Aging Index (TAAI) based on the Active Aging Index (AAI) of the European Union (EU) and with consideration of the cultural and specific characteristics in Taiwan and to compare the result with the AAI status in the EU-28 countries. The first draft of TAAI was developed; 25 experts from the aging industry, government representatives, and academics were invited to participate in the modified Delphi method or an expert group meeting. Older adults were invited to collect opinions from the perspective of older people. The weights of the TAAI indicators were assessed by an analytical hierarchical method based on the Delphi method questionnaire. The indicators collected by a survey questionnaire were designed, pretested and modified, and then, the data were collected from a sample across four regions of Taiwan (n = 738). The TAAI indicator scores were calculated accordingly. The AAI performance of Taiwan was also compared with the performance of the EU-28 countries. The original 4 AAI domains were maintained in the framework. In TAAI, 11 indicators were added to the existing four domains and, in total, 33 indicators were suggested. The TAAI indicators showed acceptable reliability and predictive validity in self-rated health. The indicators regarding health and capacity for active aging in Taiwan were good, and social participation and economic security could be improved. The TAAI framework and indicators are suggested to be applied in the monitoring and policy making of active aging and in future research.

Background: Survival of colorectal cancer detected within a screening program may largely affect the effectiveness of the screening program. Long-term outcomes of interval cancers after a fecal immunochemical test (FIT) and colonoscopy (interval type post-colonoscopy colorectal cancer; PCCRCi) within a FIT screening program are, however, rarely reported. Methods: The interval cancers occurring within a Taiwan Colorectal Cancer Screening Program in 2004-2012 comprised the study cohort and were followed until 2016. The incidence of FIT interval cancers and PCCRCi was calculated, and PCCRCi were stratified by adenoma detection rate (ADR) levels [ 42% (high)]. The survival status of those with FIT interval cancers and different PCCRCi categories were compared. Findings: In total, 2,746,478 subjects received at least one FIT screening with 1,825 (86·4%) FIT interval cancers and 288 (13·6%) PCCRCis developing during the study period. Hospitals with low ADR levels had a significantly higher incidence of PCCRCi (0·93 per 1000 person-years) than those with middle and high ADR levels (0·70 and 0·58 per 1000 person-years, respectively) (p

AIM The purpose of this study is to investigate the relationship among knowledge, self-efficacy, and self-management of patients with early-stage chronic kidney disease (ESCKD). METHODS This is a cross-sectional correlational study design. This study used purposive sampling to enroll a total of 130 patients with ESCKD. The research instruments included Chronic Kidney Disease Self-Care Knowledge Scale, Chronic Kidney Disease Self-Efficacy Instrument, Chronic Kidney Disease Self-Management Scale, and so on. This study used the statistical software SPSS 20.0 to perform statistical analyses, such as descriptive statistical analysis, independent samples t test, one-way analysis of variance, Pearson product-moment correlation coefficient analysis, and multiple hierarchical regression analysis. RESULTS The knowledge of patients with early kidney disease was moderate (55.10%), self-efficacy was moderate (54.44%), and self-management was moderate (61.11%). The disease knowledge and self-efficacy (r = .59, p < .01) were significantly positively correlated with self-management (r = .50, p < .01); the intervening effect of self-efficacy on self-management (z = 4.58, p < .001) reached statistically significant difference. Self-efficacy was the most significant predictor for self-management and explained 49% of the total variance. CONCLUSIONS This study suggested that self-efficacy was a mediator and predictor for self-management. The research results may serve as reference for related administrative authorities or medical personnel to develop self-efficacy strategies with theoretical basis, as well as appropriate self-efficacy improvement schemes, to transform the methods for enhancing disease knowledge to improve the intervention with self-efficacy language or method and increase patients' disease self-management.

SCN2A mutations have been identified in various encephalopathy phenotypes, ranging from benign familial neonatal-infantile seizure (BFNIS) to more severe forms of epileptic encephalopathy such as Ohtahara syndrome or epilepsy of infancy with migrating focal seizure (EIMFS). Thus far, no particularly effective treatment is available for severe epileptic encephalopathy caused by SCN2A mutations in children. We present the case of a boy who developed seizures on the third day of life and received a diagnosis of EIMFS based on his clinical presentations and electroencephalography reports. Antiepileptic drugs, namely oxcarbazepine, phenytoin, valproate, levetiracetam, and clonazepam, as well as adrenocorticotropic hormone therapy failed to reduce the severity of the seizures. Seizure pattern changed to infantile spasm with extensor thrust since 5 months of age. A ketogenic diet consisting of a medium-chain triglyceride recipe was introduced at 8 months of age and the seizures were resolved in the following 10 months. A de novo mutation in SCN2A (c.573G > T; p.W191C) was proven through next-generation sequencing.

Febrile seizure (FS) is the most common type of convulsion in infants and young children. The occurrence of FS in a subset of children with febrile illness suggested genetic factors may have an important effect on the predisposition of the disease. Using targeted next generation sequencing (NGS), a novel splicing variation (NM_198903.2:c.1249-1G>T) was identified in the γ-aminobutyric acid type A (GABA-A) receptor γ2 subunit (GABRG2) gene of a FS patient. To investigate possible association of FS with single nucleotide polymorphisms (SNPs) in prostaglandin-endoperoxide synthase-2 (prostaglandin G/H synthase-2; PTGS2/cyclooxygenase-2; COX2) gene involving in thermoregulatory pathway, eight SNPs, rs689465, rs689466, rs20417, rs13306038, rs201931599, rs689470, rs4648306 and rs4648308, along with 2 previously reported variations in IL1RN (86-bp VNTR) and IL10 (rs1900872) were genotyped and utilized for case-control association studies on 35 FS and 31 non-FS controls. A single SNP (rs689466) localized at 5'-1192 of the PTGS2 gene exhibited significant association with FS (p=0.045) based on case-control allelic association analyses. A significant decrease in the frequency of the G allele in FS (0.357) was observed compared to that in controls (0.536) with an estimated odds ratio (OR) of 0.48 (95% CI, 0.23-0.99) for the G versus A allele. Using case-control genotypic association analysis, the -1192 A allele is most likely to confer susceptibility to FS by a recessive action model (p=0.045, pointwise empirical p value (EMP1)=0.049). The association of SNPs in PTGS2, in addition to IL6, IL-6 receptor (IL6R) and prostaglandin E receptor 3 (PTGER3) in prior reports, with FS suggests their possible action in concert to modulate phenotypes in FS as well as the involvement of thermoregulatory pathway in pathogenesis of FS.

To analyze the results of samples testing of Jiangsu Provincial Malaria Diagnostic Reference Laboratory in 2017, so as to provide the evidence for improving the malaria diagnostic performance in this province.The samples of reported malaria cases in Jiangsu were collected by the provincial reference laboratory (PRL) in 2017. The microscopy and nucleic acid test were performed to confirm the infection ofTotally 242 malaria cases were reported and the samples were collected by PRL in 2017. A total of 239 cases were confirmedIn 2017, the malaria diagnostic quality of medical technicians is generally high in Jiangsu Province. However, the diagnostic capacity is slightly different among different regions, and the ability to identify non-[

Since Taiwan&rsquo, s age-friendly city (AFC) program was launched in 2012, the central government has provided various resources to the country&rsquo, s 22 local authorities, including budgetary support, policy advocacy, and consultation from a team of experts. This study examines stakeholder perspectives on the process, performance, and outcome of the AFC program. A 53-item questionnaire was developed based on the World Health Organization (WHO) guideline, including mechanisms and processes (20 items), outcome evaluations (23 items), and resource integration (10 items). There was a &ldquo, great difference&rdquo, found among scores between facilitators and experts for &ldquo, inter-exchange experience with local and international cities&rdquo, (40%) and &ldquo, monitor and revise indicators&rdquo, (37%) in mechanisms and processes, &ldquo, evaluate performance of indicators and action plans&rdquo, (37%) in outcome evaluations, and &ldquo, interaction between government and community&rdquo, (46%) and &ldquo, interaction between civil organization and senior society&rdquo, (39%) in resource integration. Clearly, facilitators showed overly optimistic assessments in AFC mechanisms and processes, outcome evaluation, and resource integration. The results showed disconnect between experts&rsquo, expectations versus actual practice conducted by facilitators. Implications of these findings are to integrate top down expectations with the realities of bottom up practice to design more realistic evaluations, continue to educate stakeholders about design, implementation and evaluation, and further integrate resources from government, civil organizations, and community.

Aims and objectives This study was to investigate: (1) the important factors in the self-care of chronic kidney disease (CKD) patients and (2) the mediating effects of self-efficacy on knowledge and self-care. Background Chronic kidney disease has become a major global health issue and is one of the top 10 leading causes of death in Taiwan where the dialysis population ranks first in the world. The number of patients with poor self-care behaviours continues to rise despite ongoing health education. Knowledge and self-efficacy are important factors that influence self-care behaviour; however, very few articles have examined the relationships among them. Design Cross-sectional and correlational design. Methods Subject recruitment was conducted by purposive sampling in the renal outpatient clinics and dialysis centres of two teaching hospitals in northern Taiwan. A total of 247 patients with chronic kidney disease (stages 1–5) were enrolled. Results (1) Knowledge was positively correlated with self-efficacy (r = 0·41, p

Objectives This panel study examined the trajectories of depression and social support during the first year postpartum among marriage-based immigrant mothers in Taiwan, and the effect of social support on depression. Methods This panel study recruited South-Asia immigrant mothers (mean age: 27 years) to complete structured questionnaire at 1 month, 6 month, and 1 year postpartum. A total of 203 immigrant mothers completed structured questionnaires at 1 and 6 months, and 163 completed the questionnaires at 1 year postpartum. Postpartum depression was measured using the Edinburgh Postpartum Depression Scale. Social support was composed of 3 subscales, emotional, instrumental, and informational support. Hierarchical linear modeling was used to examine the relationships between trajectories and factors associated with depression. Results Depression and instrumental support followed downward curvilinear trajectories, while emotional and informational support followed upward curvilinear trajectories. Depression was highest at 1 month, decreased sharply until 6 months, and then leveled off between 6 and 12 months. Emotional and instrumental support negatively covaried with postpartum depression over time. When the three-dimensional supports were considered together, only emotional support retained its significance. Conclusions Our results demonstrated that depression was highest at 1 month, then decreased, and then leveled off during 1 year postpartum, though further study may be needed to confirm the trajectory. The 3 types of social support differed in postpartum trajectory, suggesting the needs to consider them separately in future studies. To decrease postpartum depression among immigrant mothers, strategies should be developed to increase emotional and instrumental support during postpartum period.

Dynamic water solvation is crucial to protein conformational reorganization and hence to protein structure and functionality. We report here the characterization of water dynamics on the L-asparaginase structural homology isozymes L-asparaginases I (AnsA) and II (AnsB), which are shown via fluorescence spectroscopy and dynamics in combination with molecular dynamics simulation to have distinct catalytic activity. By use of the tryptophan (Trp) analog probe 2,7-diaza-tryptophan ((2,7-aza)Trp), which exhibits unique water-catalyzed proton-transfer properties, AnsA and AnsB are shown to have drastically different local water environments surrounding the single Trp. In AnsA, (2,7-aza)Trp exhibits prominent green N(7)-H emission resulting from water-catalyzed excited-state proton transfer. In stark contrast, the N(7)-H emission is virtually absent in AnsB, which supports a water-accessible and a water-scant environment in the proximity of Trp for AnsA and AnsB, respectively. In addition, careful analysis of the emission spectra and corresponding relaxation dynamics, together with the results of molecular dynamics simulations, led us to propose two structural states associated with the rearrangement of the hydrogen-bond network in the vicinity of Trp for the two Ans. The water molecules revealed in the proximity of the Trp residue have semiquantitative correlation with the observed emission spectral variations of (2,7-aza)Trp between AnsA and AnsB. Titration of aspartate, a competitive inhibitor of Ans, revealed an increase in N(7)-H emission intensity in AnsA but no obvious spectral changes in AnsB. The changes in the emission profiles reflect the modulation of structural states by locally confined environment and trapped-water collective motions.

Printed circuit boards (PCBs) are very important materials in consumer electronic products. The process of making PCBs usually uses chemicals, and large quantities of water are needed. PCB manufacturers are devoted to improving the process in order to conform to environmental protection rules and regulations. However, evaluating the performance of environmental protection strategies by quantitative methods is very difficult. Therefore, this study attempts to evaluate the environmental protection strategy of a PCB manufacturer using the novel weakest t-norm (Tw) fuzzy importance-performance analysis with Google Trends (TFIPA-Google). The TFIPA-Google methodology obtain advantages of Tw operations, IPA, and Google Trends, which can handle uncertainty based on a fuzzy matrix of IPA, reduce fuzzy accumulation using the Tw operators, and analyze social media viewpoints using Google Trends. This empirical example based on the TFIPA-Google method shows that the recovered waste material management system should be a priority for PCB manufacturers. Moreover, the TFIPA-Google method can provide more creditable information, based on Tw operations and volume of Google Trends for decision-makers, than a conventional importance-performance analysis (IPA) model.