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Sio-Ian Tou,1 Cheng-Li Lin,2,3 Chia-Yu Huang,4,5,&ast; Hung-Rong Yen5– 9,&ast; 1Department of Pediatrics, Chung Kang Branch, Cheng-Ching General Hospital, Taichung, Taiwan; 2Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 3College of Medicine, China Medical University, Taichung, Taiwan; 4Department of Family Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; 5Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 6International Master Program in Acupuncture, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 7Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan; 8Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; 9Chinese Medicine Research Center, China Medical University, Taichung, Taiwan&ast;These authors contributed equally to this workCorrespondence: Hung-Rong Yen, China Medical University, 91 Hsueh-Shih Road, North District, Taichung, 404, Taiwan, Tel +886-4-22053366 ext. 3313, Fax +886-4-22365141, Email hungrongyen@gmail.com Chia-Yu Huang, Taichung Tzu Chi Hospital, 88, Sec 1, Fengxing Road, Tanzi Dist, Taichung, 427, Taiwan, Tel +886-4-36060666, Fax +886-4- 36026656, Email dochuangcharlie@gmail.comPurpose: Coprescription means that patients use different prescription medications at the same time, which can lead to polypharmacy and subsequent complications. In Taiwan, prescriptions can be ordered by Western physicians, traditional Chinese physicians and dentists. It is essential to disclose the trends in coprescription to prevent possible polypharmacy among children.Patients and Methods: We used the Longitudinal Health Insurance Database 2000 in Taiwan. Children < 18 years old who had coprescription from 2002 to 2012 are included. The odds ratio and 95% confidence interval are estimated by a logistic regression model to evaluate the correlation between basic characteristics and coprescription.Results: A total of 44,801 children are included in the analysis. The numbers of children with coprescription and the numbers of coprescriptions ordered for children increased with calendar years. Children aged 3– 5 year and 6– 8 years constituted the majority of coprescriptions, while those aged < 3 years constituted the minority of coprescriptions. Compared to those in the Western medication-alone group, aged 3– 5 years and children who lived in central and southern Taiwan are more likely to have coprescription.Conclusion: Coprescription among Taiwanese children is not uncommon. Healthcare providers, policymakers and parents should be aware of the real coprescription situation among the children.Keywords: pediatrics, Chinese herbal medicine, polypharmacy, big-data analysis

ABSTRACT Given the scant literature of corporate social responsibility (CSR) reporting on mainland China, especially in the Western academia, the present paper aims at providing an overview of the CSR reporting requirements in that country. A comparison with major reporting trends such as the adoption of GRI-G3 is made to further understand the development of CSR in China. A literature review of prior studies is also conducted concerning CSR in China, especially those which are available only in the Chinese language. In summary, the overview indicates that CSR reporting in China is at a very preliminary stage and more empirical research in this area is urgently called for. Copyright © 2012 John Wiley & Sons, Ltd and ERP Environment. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to determine whether different maturity levels and birth weights could change the risk of long-term ophthalmological complications in preterm infants., Design: This was a cohort study., Setting: This was a nationwide population-based study., Participants: Newborns born between 2009 and 2012 were identified; newborns with congenital deformities, newborns with missing data on urban area, sex, gestational week at birth or birth weight and newborns who died before the age of 8 years were excluded., Interventions: Infants were divided into full-term, preterm and preterm with retinopathy of prematurity (ROP) cohorts based on their basic characteristics at birth., Primary Outcome Measures: The primary outcomes were ophthalmological complications, including strabismus, refractive error, amblyopia, cataracts and glaucoma., Results: Ultimately, 735 702 infants were included in the analysis. There were 727 403, 7165 and 1134 newborns in the full term, preterm without ROP and preterm with ROP cohorts, respectively. Premature infants, whether without ROP or with ROP, had an elevated risk of various ophthalmic complications, with adjusted ORs (aORs) ranging from 1.48 to 2.74 and 1.90 to 10.34, respectively. Extremely low birth weight contributes to an increased risk of various ophthalmic complications, with aORs ranging from 2.21 to 6.55. Moreover, a higher number of negative variables, such as preterm birth or low body weight, increased the risk of various ophthalmological complications, with the aOR falling within the range of 1.03-23.86., Conclusions: Immaturity and low body weight were risk factors for ophthalmological complications in preterm infants. The presence of both of these two risk factors increased the risk of ophthalmological complications. Our results are essential for caregivers and health policy-makers to design comprehensive follow-up plans for preterm infants., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

To evaluate the effect of acupoint stimulation compared to other interventions on pain control in neonates who underwent heel lance, we searched for randomized controlled trials across six databases (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, and Web of Science) published up to January 2023. Studies comparing acupoint stimulation and other interventions for controlling heel lance pain in neonates were included. These reports measured at least one of the following variables: pain score, crying time, oxygenation saturation, heart rate, respiration rate, and duration of the procedure. The data were independently extracted by two authors, and the PRISMA guidelines for study selection were followed. A total of 79 articles were screened, and 10 studies, with results on 813 neonates, were included in the final selection. The pain scores recorded during the heel lance procedure were not significantly different between the acupoint stimulation cohort and the control cohort (SMD of -0.26, 95% confidence interval (CI) from -0.52 to 0.01; p = 0.06; I 2 = 68%). After processing the subgroup analyses, significant differences were found in the comparisons of acupuncture vs. usual care (SMD of -1.25, 95% CI from -2.23 to 0.27) and acupressure vs. usual care (SMD of -0.62, 95% CI from -0.96 to -0.28); nonsignificant differences were found in other comparisons. Our results demonstrate that acupoint stimulation may improve pain score during the heel lance procedure.

Objective: The aim of this study is to investigate the association between acupuncture therapy and the risk of fracture in patient with osteoarthritis (OA). Design: The authors performed a 1:1 propensity score-matched cohort study to analyze patient with OA between January 1, 1997 and December 31, 2010 through the Taiwanese National Health Insurance Research Database. Patients who received acupuncture therapy from the initial date of diagnosis of OA to December 31, 2010 were included in the acupuncture cohort. Patients who did not receive acupuncture during the same follow-up period were defined as the no-acupuncture cohort. A Cox regression model was used to adjust for sex, age, comorbidities, prescription, and surgical experiences. Hazard ratios (HRs) were compared between the two cohorts. Results: A total of 3416 patients were identified after 1:1 propensity score matching. The patients had similar basic characteristics. In the final analysis, 292 patients in the acupuncture cohort (30.06 per 1000 person-years) and 431 patients in the no-acupuncture cohort (56.08 per 1000 person-years) developed fractures (adjusted HRs 0.57, 95% confidence interval 0.49-0.67). A reduced cumulative incidence of fracture was found in the acupuncture cohort (log-rank test, p  < 0.001). The association between acupuncture and reducing the fracture incidence was independent of sex, comorbidities, drugs use, and surgical experiences. Conclusion: Their results revealed the association between acupuncture therapies and a reduced incidence of fracture development in patients with OA. This finding provides noteworthy ideas for further research.

Vaccination is the most effective intervention to prevent infection and subsequent complications from SARS-CoV-2. Because of their multiple comorbidities, the elderly population experienced the highest number of deaths from the COVID-19 pandemic. Although in most countries, older people have top priority for COVID-19 vaccines, their actual willingness and attitudes regarding vaccination are still unclear. Thus, we conducted a cross-sectional study to investigate their willingness, attitudes, awareness, and knowledge of COVID-19 through a web-based questionnaire after the first local outbreak of COVID-19 in Taiwan. A total of 957 questionnaires were completed, and 74.9% of elderly individuals were likely to receive COVID-19 vaccines. The results from a multiple logistic regression demonstrated that older people who need to visit the outpatient department and have a high level of concern about the safety of COVID-19 vaccines are prone to having a negative willingness to accept COVID-19 vaccines. The following items related to awareness of the COVID-19 pandemic were attributed to the acceptance of COVID-19 vaccines: "understanding the risk of being infected by SARS-CoV-2", "understanding the effectiveness of COVID-19 vaccines", "willingness to accept the COVID-19 vaccine for protecting others", and "safety of COVID-19 vaccines is a key factor for you to accept them". Furthermore, a positive association between COVID-19 vaccination and attitudes toward accepting booster doses of the COVID-19 vaccine was observed. Our results show that these factors could affect the willingness of older people to accept COVID-19 vaccines and that they are important for policymakers and medical staff to develop vaccination plans during the COVID-19 pandemic.

Objective: Chinese herbal medicine (CHM) is quite popular in Asia. The purpose of this study is to investigate the benefits of decreasing the risk of cirrhosis in patients with non-alcoholic fatty liver disease (NAFLD) by using CHM. Design: We performed a 1:3 propensity score-matched cohort study to analyze patients with NAFLD diagnosed between January 1, 1997 and December 31, 2011 through the Taiwanese National Health Insurance Research Database. Patients who received CHM therapy from the initial date of diagnosis of NAFLD to December 31, 2011 were included in the CHM group. Patients who were not treated with CHM during the same interval were categorized in the non-CHM group. Cox regression model was used to adjust for sex, age, comorbidities, and drug use. Hazard ratios were also compared between the two groups. Results: A total of 13,072 patients were identified after 1:3 propensity score matching. The patients had similar basic characteristics. A lower cumulative incidence of cirrhosis was found in the CHM cohort (log-rank test, p  < 0.0001). Finally, 176 patients in the CHM cohort (4.66 per 1000 person-years) and 582 patients in the non-CHM cohort (7.92 per 1000 person-years) developed cirrhosis (adjusted hazard ratios 0.63, 95% confidence interval 0.53-0.75). The effect of CHM to lower cirrhosis incidence was independent of sex, drug use, and comorbidities, including diabetes mellitus, hypertension, and cardiovascular diseases. Patients older than 40 years of age and without comorbidities such as chronic obstructive pulmonary disease, hyperlipidemia, alcoholism, tobacco use, or obesity also benefited from CHM. Conclusions: Our study is the first large-scale investigation in Taiwan that shows the association between patients with NAFLD and cirrhosis prevention after CHM intervention. The results may be useful for treatment and for decision making for patients and clinical doctors. Further restricted trials are needed to support our findings.

Purpose: We share our strategies for preventing the COVID-19 outbreak in a nursing home in Taiwan., Methods: We compared the number of outpatient department visits, the days of prescription from the outpatient department, the number of emergency department visits of the nursing home residents and staff, the number of admissions, and the days of admission of the residents for respiratory tract infection treatment between 2019 and 2020 to examine the effect of our preventive measures in the nursing home. Residents and staff who continuously lived and worked in the nursing home from 2019 to 2020 were included. The differences in outcomes between 2019 and 2020 were examined using paired sample t tests. The multivariate analyses were presented through generalized estimating equation analysis., Results: A cohort of 183 residents and 127 staff was included and their electronic medical documentation was analyzed in two periods: January-September 2019 and January-September 2020. These residents had lower numbers of outpatient department visits (P < 0.001), days of prescription from the outpatient department (P < 0.001), number of emergency department visits (P < 0.001), number of admissions (P < 0.001), and days of admission (P < 0.001) to treat respiratory tract infections from January-September 2020 than January-September 2019. These staff members had lower numbers of outpatient department visits (P = 0.015) and days of prescription from the outpatient department (P = 0.009) to treat respiratory tract infections from January-September 2020 than January-September 2019., Conclusion: The association between our preventive measures and decreasing the risk of respiratory tract infection in nursing home residents and staff could be found. Sharing these experiences is valuable, as they provide important insights related to clinical practice during the COVID-19 pandemic.

Background: We investigated whether the availability of a tap water supply system is associated with lowering the admission rate 30 days after burn injury., Methods: We analysed data from the Longitudinal Health Insurance Database 2000 from the National Health Research Institutes. It contains a random sample of 1,000,000 subjects out of 22 million beneficiaries of the National Health Insurance of Taiwan from 1996 to 2010. The included patients were diagnosed twice with burn injuries in local medical departments. The odds ratios and 95% confidence intervals were estimated by logistic regression model to evaluate the correlations of baseline characteristics and comorbidities., Results: A total of 5,996 patients were identified after 1:1 propensity score matching. They had similar basic characteristics. Ultimately, 96 patients in the case cohort (1.10 per 1,000 person-years) and 58 patients in the control cohort (0.66 per 1,000 person-years) were admitted 30 days after a burn injury (adjusted hazard ratio 1.67, 95% confidence interval 1.21-2.32). A lower incidence of admission because of burn injury was found in the control cohort (log-rank test, p = 0.019). The advantageous effect of a well-equipped tap water system on a lower admission rate in burn patients was independent of comorbidities., Conclusions: The results of this study demonstrated the association between lowering the admission rate at 30 days in burn patients in Taiwan and using a well-equipped tap water system. It also could offer important information to the government for enhancing the availability of tap water system in those areas lack adequate tap water supply which is useful to protect burn patients from following admission., (Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.)

Aim of the Study: The purpose of this study is to demonstrate that Chinese herbal medicine is beneficial for survival improvement in patients with multiple myeloma., Materials and Methods: We performed a 1:1 propensity score-matched cohort study to analyze patients with multiple myeloma diagnosed between January 1, 2002, and December 31, 2012, through the Taiwanese National Health Insurance Research Database. Patients who received Chinese herbal medicine therapy from the initial date of diagnosis of multiple myeloma to December 31, 2012, were included in the Chinese herbal medicine group. Patients who were not treated with Chinese herbal medicine during the same interval were categorized in the non-Chinese herbal medicine group. A Cox regression model was used to adjust for sex, age, comorbidities, and drug use. Hazard ratios were also compared between the 2 groups., Results: A total of 312 patients were identified after 1:1 propensity score matching. The patients had similar basic characteristics. A better survival status was found in the Chinese herbal medicine cohort (log-rank test, P < .0001). Finally, 49 patients in the Chinese herbal medicine cohort and 96 patients in the non-Chinese herbal medicine cohort died (adjusted hazard ratio = 0.35, 95% confidence interval = 0.24-0.51). The effect of survival improvement from Chinese herbal medicine in patients with multiple myeloma could be observed when prescriptions had the duration of ≥30 days., Conclusions: Our results showed that patients with multiple myeloma could benefit from Chinese herbal medicine treatment, which could improve the survival rate in Taiwan. The findings offer important ideas for further study.

Aim: To evaluate the impact of the national 'Be Clear on Cancer' bowel cancer reminder campaign on service and diagnosis at a single UK institution. Secondly, to evaluate the socio-economic background of patients referred before and after the reminder campaign compared with the regional demographic., Method: Suspected cancer 2-week wait patients in the 3 months precampaign, postcampaign and after the reminder campaign were included. Demographics, investigations and diagnosis were recorded. The postcode was used to allocate a National Readership Survey social grade., Results: Three hundred and eighty-three referrals were received in the 3 months precampaign, 550 postcampaign and 470 postreminder campaign. There were significant increases in the monthly referral rates following the campaign (P < 0.001 in both the post- and postreminder periods). Significantly more patients from social grades AB and C1C2 than expected from regional demographics were referred precampaign and after the reminder campaign (P < 0.001 in each case). There were no significant differences between the proportions of patients diagnosed with colorectal cancer in the three study periods (P = 0.710)., Conclusion: The 'Be Clear on Cancer' bowel cancer campaign has had a significant sustained impact on resources. It has failed to increase referrals among lower socio-economic grades, leading to an increase in 'worried well' referrals and no change in numbers, or the stage, of colorectal cancers diagnosed., (Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.)

Background: Extra-levator abdominoperineal excision of the rectum (ELAPER) for low rectal cancer is used to avoid the adverse oncological outcomes of inadvertent perforation and a positive circumferential resection margin associated with the conventional APER technique. This wider excision creates a large defect requiring pelvic floor reconstruction, and there is still controversy regarding the best method of closure. The aim of this study is to present outcomes of biological mesh pelvic floor reconstruction following ELAPER., Methods: Prospective data on consecutive patients having ELAPER for low rectal cancer at a single UK institution between October 2008 and March 2013 were collected. The perineum was reconstructed using a biological mesh and the short-term outcomes were evaluated, focusing particularly on perineal wound complications and perineal hernias., Results: Thirty-four patients were included [median age 62 years, range 40-72 years, 27 males (79 %)]. The median operative time was 248 min (range 120-340 min). The median length of hospital stay was 9 days (range 4-20 days). There were three perineal complications (9 %) requiring surgical intervention, but no meshes were removed. There were no perineal hernias. The median length of follow-up was 21 months (range 1-54 months). The overall mortality was 9 % from distant metastases., Conclusions: Our series adds to the increasing evidence that good outcomes can be achieved for pelvic floor reconstruction with biological mesh following ELAPER without the additional use of myocutaneous flaps. The low serious complication rate, good outcomes in perineal wound healing and the absence of perineal hernias demonstrates that this is a safe and feasible procedure.

Aim: A literature review was performed to elucidate whether long-course preoperative radiotherapy for patients with rectal cancer affects lymph node yield, and whether this influences prognosis., Method: Cochrane Database, PubMed/MEDLINE, Scopus, Web of Knowledge, Embase and CINAHL databases and reference lists from published journal articles published between 1 January 1990 and 30 June 2011 were searched. Studies examining lymph node yield and prognosis were selected for review., Results: One thousand and twenty-nine articles were found, of which 11 met the inclusion criteria. None was a randomized controlled trial and all were cohort studies. Four studies showed that long-course preoperative radiotherapy reduced lymph node yield; however only one demonstrated a statistically significant survival benefit in patients with higher lymph node yields. Five-year survival was 48% in patients with fewer than and 69% in those with more than 11 lymph nodes identified in the operative specimen (P = 0.04)., Conclusion: Whilst long-course preoperative radiotherapy appears to reduce lymph node yield in patients with rectal cancer, no causal relationship between lymph node yield and survival can be established in this group of patients., (© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.)

Background and Objectives: Colorectal cancers (CRC) with high-level micro-satellite instability (MSI-H) show reduced metastatic potential and better prognosis compared to stage-matched stable (MSS) cancers. Angiogenesis/lymphangiogenesis, central to tumour growth and spread, is mediated by vascular endothelial growth factor (VEGF) cytokines, but little is known of their relationship to MSI., Methods: In this study, 67 sporadic CRC with identified MSI status, and 8 samples of normal colon were analysed for VEGF-A soluble isoforms (VEGF-121/VEGF-165) and VEGF-C gene transcription (by RT-PCR and scanning densitometry), and blood vessel density (BVD; measuring angiogenesis) and VEGF-C protein expression (measuring lymphangiogenesis)., Results: Compared to normal colon, VEGF-165 transcription was reduced (P < 0.05), but VEGF-121 transcription was higher in MSS (P < 0.06) and MSI-L (P < 0.01) cancers (but similar in MSI-H). VEGF-165 transcription was unrelated to MSI, but VEGF-121 transcription was elevated in MSI-L (P < 0.06). There was a weak inverse correlation with VEGF-121 transcription and Dukes stage (P < 0.09), and with BVD and MSI (P < 0.09). With a singular di-nucleotide loci mutation (MSI-L), VEGF-121 (P < 0.03) and VEGF-C (P < 0.04) transcription was elevated., Conclusions: MSI-H cancers have reduced angiogenic/lymphangiogenic potential, and transcription of VEGF-121 may be important in early growth and spread of CRC. Elevated VEGF-121 and VEGF-C transcription with singular di-nucleotide mutations may aid in the identification of distinct MSI-L cancers., (2005 Wiley-Liss, Inc.)

Micro-satellite instability (MSI) is relevant in the management of colorectal cancers (CRC) and relies on analysis of gene mutations, or production of the proteins involved in DNA mismatch repair (e.g. MLH1, MSH2). p53 mutation is also relevant in MSI, but high-level CRC (MSI-H) demonstrate fewer mutations than low-level (MSI-L) or stable (MSS) cancers. Recently, the importance of gene activity (transcription) in MSI has been identified, where rather than being mutated genes have been downregulated. In this study, 67 sporadic CRC and eight samples of normal bowel were analysed for MSI status (by SSCP) and levels of MLH1, MSH2 and p53 gene transcription (by RT-PCR and scanning densitometry). Micro-satellite instability correlated with gender and site, with more MSI-H CRC in females (P<0.02) and in the right colon (P<0.04). In MSI-H, p53 transcription was markedly reduced (P<0.003). Compared to normal bowel, MLH1 transcription was elevated in all cancers (P<0.01), while MSH2 transcription was elevated only in MSI-H (P<0.04). There was a direct correlation between MLH1 and MSH2 transcription (P<0.001). Although fewer mutations are reported in MSI-H than MSI-L/MSS, these results suggest that reduced p53 transcription might account for decreased tumour suppression in MSI-H. The direct correlation between MLH1 and MSH2 transcription suggests that control of these genes might be coordinated.