Taiwan's Health Research Articles

Prenatal antidepressant use and the implication of hypertensive disorders during pregnancy

Evidence for the association between prenatal antidepressant use and the development of hypertensive disorders of pregnancy is inconsistent. Previous studies have reported that antidepressant use during pregnancy increases the risk for gestational hypertension and preeclampsia, but the results of these studies are potentially confounded by important methodologic limitations. Furthermore, it remains unknown whether a higher cumulative dose of antidepressant increases the risk for hypertensive disorders of pregnancy. This study aimed to investigate the association between prenatal antidepressant use and the risk for hypertensive disorders of pregnancy and the potential effect of a higher cumulative antidepressant dose. This retrospective cohort study used data from the Health and Welfare Database in Taiwan. Pregnant women with depression aged 18 to 49 years were enrolled as part of the study population. Prenatal antidepressant use was defined as at least 1 dispensing record of an antidepressant between the conception date and 20 weeks of gestation. Antidepressant users were further divided into groups according to the cumulative defined daily dose based on whether they took the defined daily dose for ≤10 weeks (low cumulative dose group ≤70 cumulative defined daily dose) or for >10 weeks (high cumulative dose group >70 cumulative defined daily dose). The primary outcome was hypertensive disorders of pregnancy defined as the diagnosis of either gestational hypertension or preeclampsia during the period from 20 weeks of gestation to delivery. Propensity score matching and stabilized inverse probability of treatment weighting were used to balance the confounders between the comparison groups. A robust Cox regression model was used to evaluate the association between exposure and outcome. A total of 5664 pregnant women with depression were included in the study (2832 antidepressant users matched to 2832 antidepressant nonusers). Prenatal antidepressant use was not associated with an increased risk for hypertensive disorders of pregnancy (adjusted hazard ratio, 0.89; 95% confidence interval, 0.67-1.18). However, among antidepressant users, the risk for hypertensive disorders of pregnancy was higher among women with a higher cumulative defined daily dose than among women with a lower cumulative defined daily dose (adjusted hazard ratio, 2.46; 95% confidence interval, 1.05-5.74). No association was found between antidepressant use and the development of hypertensive disorders of pregnancy. However, women taking higher cumulative doses of antidepressants were at greater risk. More frequent or regular monitoring of blood pressure may be warranted in women on high cumulative doses of antidepressants.

Obese People Do Not Have a Higher Chance of Adherence to Recommended Daily Intake for the Most Nutrients

ObjectivesThere is a myth that obesity equals overnutrition. We conducted a study to examine whether obese people had a higher chance of adherence to recommended daily intake. MethodsA retrospective cross-sectional study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2014–2016. NAHSIT is a nationwide representative survey aimed to investigate and monitor the nutritional status of Taiwanese people. Fourteen nutrient intakes, including vitamin A, C, D, E, B1, B2, B3, B6, B12, Fe, Mg, Zn, Ca, and P, were evaluated using 24-hour dietary recall. Logistic regression models will be used to determine whether obesity was related to the higher chance of adherence to recommended daily intakes. Stratified analyses were conducted by sex. Obese (body mass index (BMI) ≥ 27 kg/m2) and normal-weight (18.5 kg/m2 ≤ BMI < 24 kg/m2) people were defined according to the criteria of the Ministry of Health and Welfare in Taiwan. ResultsA total of 3075 participants (51% of females) aged 19 and above were included in the final analysis. After adjusting for age, body mass index, education level, marital status, and family income, as expected, we found that obese men have a higher chance of adherence to recommended daily intake of vitamin B3 (odds ratio (OR) = 1.70, 95% confidence interval (CI) = 1.29–2.23), Fe (OR = 1.46, 95% CI = 1.06–2.00), and Zn (OR = 1.41, 95% CI = 1.07–1.85), compared with normal-weight men. However, obese women have a lower chance of adherence to recommended daily intake of vitamin C (OR = 0.73, 95% CI = 0.56–0.95) and Mg (OR = 0.72, 95% CI = 0.54–0.95), compared with normal-weight women. For the most nutrient intakes, we found no difference between obese and normal-weight people in the chance of adherence to recommended daily intake. ConclusionsIn general, we found that obesity did not equal overnutrition. Obese women have insufficient intakes of some nutrients compared with normal-weight women. Our finding indicated that obese people might have more nutritional imbalance. Funding SourcesThis study was supported by China Medical University.

Social Media Mining for an Analysis of Nutrition and Dietary Health in Taiwan.

Dining is an essential part of human life. In order to pursue a healthier self, more and more people enjoy homemade cuisines. Consequently, the amount of recipe websites has increased significantly. These online recipes represent different cultures and cooking methods from various regions, and provide important indications on nutritional content. In recent years, the development of data science made data mining a popular research area. However, only a few researches in Taiwan have applied data mining in the studies of recipes and nutrients. Therefore, this work aims at utilizing machine learning models to discover health-related insights from recipes on social media. First, we collected over 15,000 Chinese recipes from the largest recipe website in Taiwan to build a recipe database. We then extracted information from this dataset through natural language processing methodologies so as to better understand the characteristics of various cuisines and ingredients. Thus, we can establish a classification model for the automatic categorization of recipes. We further performed cluster analysis for grouping nutrients to recognize the nutritional differences for each cluster and each cuisine type. The results showed that using the support vector machine (SVM) model can successfully classify recipes with an average F-score of 82%. We also analyzed the nutritional value of different cuisine categories and the possible health effects they may bring to the consumers. Our methods and findings can assist future work on extracting essential nutritional information from recipes and promoting healthier diets.

Correlation Between Malpractice Litigation and Legislation Reform in Taiwan Over a 30-Year Period.

BackgroundThe annual medical litigation rate has increased yearly since 1987 in Taiwan. Policy makers keep going medical legislation reforms. The effectiveness of legislation reforms to reduce malpractice litigation risk is uncertain.ObjectiveTo determine whether medical legislation reform helps reduce the risk of medical litigation.Design, Setting, and ParticipantsThis retrospective study used national data obtained from Ministry of Health and Welfare in Taiwan. The period analyzed was from 1987 to 2018. The annual medical litigation rate was determined, types of medical negligence litigation were compared, medical appraisal results were summarized, and the importance of medical legislation was identified.InterventionsAfter legislation reform vs before legislation reform.MeasurementsThe main outcome showed trends in medical dispute assessments over time by adjusting for the general population (per 1, 000, 000 people). We established 2004 and 2012 as the 2 cut-points for further analysis of medical appraisal results due to legislation reform.ResultsWith legislation reforms, the annual medical litigation rate decreased from 26.68 cases per million people in 2012 to 16.41 cases per million people in 2018. The annual medical litigation rate declined by approximately 38% from 2012 to 2018. Medical appraisal results were malpractice cases in 22.1% before Medical Care Act (2004 Reform) compared with 18.8% from 2004 to 2012 (odds ratio [OR], 0.82; 95% CI, 0.727–0.924; p=0.001), and 6.4% after mediation system introduced in 2012 (odds ratio [OR], 0.243; 95% CI, 0.205–0.288; p<0.001).ConclusionMedical legislation reform has reduced the risk of malpractice litigation over time.

Gender- and age-related differences of statin use on incident dementia in patients with rheumatoid arthritis: a Nationwide population-based cohort study

BackgroundSome observational studies have found a significant association between the use of statin and a reduced risk of dementia. However, the results of these studies are unclear in patients with rheumatoid arthritis (RA). This study is to determine the association between the use of statins and the incidence of dementia according to sex and age-related differences in patients with RA.MethodsWe conducted a nationwide retrospective cohort study using the Taiwan Health Insurance Review and Assessment Service database (2003–2016). The primary outcome assessed was the risk of dementia by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was used to estimate the adjusted hazard ratio of new-onset dementia. Subgroup analysis was also conducted.ResultsAmong the 264,036 eligible patients with RA aged > 40 years, statin users were compared with non-statin users by propensity score matching at a ratio of 1:1 (25,764 in each group). However, no association was found between the use of statins and the risk of new-onset dementia (NOD) in patients with RA (HR: 1.01; 95% CI: 0.97–1.06). The subgroup analysis identified the use of statin as having a protective effect against developing NOD in male and older patients.ConclusionNo association was observed between the use of a statin and the risk of NOD in patients with RA, including patients of both genders and aged 40–60 years, but these parameters were affected by gender and age. The decreased risk of NOD in patients with RA was greater among older male patients. Use of a statin in older male (> 60 years) patients with RA may be needed in clinical practice to prevent dementia.

Atmospheric pollutants sources, health risk assessment study at a commercial, urban and traffic site

Ambient air pollutants have detrimental effects on human health and ambient air quality in central Taiwan is worsening. The aims of this study are as follows: (1) Measure the ambient air concentrations and dry deposition fluxes of particulates at a mixed commercial, urban and traffic sampling site in Luliao. (2) Identify the metallic elements that are attached to the particulates at this mixed sampling site. (3) Discuss the effects of ambient air pollutants (metallic elements that are attached to the particulates) on the health of local people using contamination factors and degrees of contamination [Ghosh et al. (2018). Source and chemical species characterization of PM10 and human health risk assessment of semi-urban, urban and industrial areas of West Bengal, India. Chemosphere 207:626–636]. The mean total suspended particulate concentrations were highest in the winter and lowest in the summer. The deposition fluxes were highest in the autumn and lowest in the summer. ANOVA results revealed no significant seasonal variation in the concentrations or dry depositions of particulates and metallic elements (Al, Cd, Cr, Mn, Ni, Pb and Zn) at the sampling site. Cu was the only exception, as its concentration varied seasonally. Degrees of contamination and contamination factor values for metallic elements Cd, Cr, Cu, Mn, Ni, Pb and Zn were low. Most of the metallic elements – Zn, Cr, Ni, Cd, Pb and Al – were locally emitted. Local residents close to the site faced no immediate carcinogenic or other health-related risk. Taichung World Flora Exposition was held in Taichung city and lasted as long as six months, and traffic flow increased significantly during this period. Hence, high density traffic flow during the Taichung World Flora Exposition might have been responsible for the high concentration and seasonal variations concentrations of metallic elements Cu and Mn at this time.

Inequality in Health: The Correlation between Poverty and Injury-A Comprehensive Analysis Based on Income Level in Taiwan: A Cross-Sectional Study.

Is income still an obstacle that influences health in Taiwan, the National Health Insurance system was instituted in 1995? After collecting injured inpatient data from the health insurance information of nearly the whole population, we categorized the cases as either low-income or nonlow-income and tried to determine the correlation between poverty and injury. Chi-square tests, Fisher’s exact tests, an independent-samples t-test, and percentages were used to identify differences in demographics, causes for hospitalization, and other hospital care variables. Between 1998 and 2015, there were 74,337 inpatients with low-income injuries, which represented 1.6% of all inpatients with injury events. The hospitalization mortality rate for the low-income group was 1.9 times higher than that of the nonlow-income group. Furthermore, the average length of hospital stay (9.9 days), average medical expenses (1681 USD), and mortality rate (3.6%) values for the low-income inpatients were higher than those of the nonlow-income group (7.6 days, 1573 USD, and 2.1%, respectively). Among the injury causes, the percentages of “fall,” “suicide,” and “homicide” incidences were higher for the low-income group than for the nonlow-income group. These findings support our hypothesis that there is a correlation between poverty and injury level, which results in health inequality. Achieving healthcare equality may require collaboration between the government and private and nonprofit organizations to increase the awareness of this phenomenon.

Forecasting of the Prevalence of Dementia Using the LSTM Neural Network in Taiwan

The World Health Organization has urged countries to prioritize dementia in their public health policies. Dementia poses a tremendous socioeconomic burden, and the accurate prediction of the annual increase in prevalence is essential for establishing strategies to cope with its effects. The present study established a model based on the architecture of the long short-term memory (LSTM) neural network for predicting the number of dementia cases in Taiwan, which considers the effects of age and sex on the prevalence of dementia. The LSTM network is a variant of recurrent neural networks (RNNs), which possesses a special gate structure and avoids the problems in RNNs of gradient explosion, gradient vanishing, and long-term memory failure. A number of patients diagnosed as having dementia from 1997 to 2017 was collected in annual units from a data set extracted from the Health Insurance Database of the Ministry of Health and Welfare in Taiwan. To further verify the validity of the proposed model, the LSTM network was compared with three types of models: statistical models (exponential smoothing (ETS), autoregressive integrated moving average model (ARIMA), trigonometric seasonality, Box–Cox transformation, autoregressive moving average errors, and trend seasonal components model (TBATS)), hybrid models (support vector regression (SVR), particle swarm optimization–based support vector regression (PSOSVR)), and deep learning model (artificial neural networks (ANN)). The mean absolute percentage error (MAPE), root-mean-square error (RMSE), mean absolute error (MAE), and R-squared (R2) were used to evaluate the model performances. The results indicated that the LSTM network has higher prediction accuracy than the three types of models for forecasting the prevalence of dementia in Taiwan.

Effectiveness and healthcare costs of eribulin versus capecitabine among metastatic breast cancer patients in Taiwan

ObjectiveTo compare the real-world effectiveness and costs of eribulin to those of capecitabine in patients with metastatic breast cancer (MBC) pretreated with anthracyclines and taxanes. MethodsThis study extracted data from the Health and Welfare Database in Taiwan to identify MBC patients, and then eribulin and capecitabine users were matched at a 1:1 ratio by age, residential region, Charlson Comorbidity Index score, and molecular subtype of BC cell. The overall survival (OS) and time-to-treatment discontinuation (TTD) curves were plotted using the Kaplan–Meier method. Healthcare utilization and costs between the two groups were compared. ResultsA total of 24,550 MBC patients were identified, and 298 patients were enrolled in each group after matching. The median OS was 11.8 months for eribulin (95%CI: 11.5–13.5 months) and 15.2 months for capecitabine (95%CI: 15.3–17.9 months; HR = 1.7, p < 0.0001). The median TTD was 4.0 months for eribulin and 6.6 months for capecitabine (HR = 1.6; p < 0.0001). No significant difference was found between the two groups in patients with >4 prior chemotherapy agents (OS: HR 1.1, 95%CI 0.8–1.5; TTD: HR 1.2, 95%CI 0.9–1.7). The total healthcare costs per patient during the treatment period were NT$580,523.8 for eribulin versus NT$497,223.8 for capecitabine (p < 0.0001), and total medication costs were NT$438,335.8 and NT$348,438.4 (p < 0.0001), respectively. ConclusionAlthough eribulin showed an attenuated effect in the real-world setting in Taiwan, it may serve as an alternative for capecitabine in a heavy pretreated population. The total healthcare and medication costs were found to be higher with eribulin treatment.

Evaluation of US and Taiwan Health System Performance: A Review of the Literature

The delivery and coverage of healthcare vary drastically from country to country. The United States (U.S.) and Taiwan present a case of contrasting healthcare systems from the roots up as one relies on a single-payer system and the other utilizes a multi-payer system. Along with other differences including health status, cost of care, and utilization of care, there are also notable similarities among the two systems. This paper will analyze the similarities and major differences between the two systems. A literature review was conducted to identify the major characteristics of the two systems and report health statuses for the two countries to compare the level of care provided under varying delivery models. Both qualitative and quantitative data was used to draw conclusions regarding the similarities and difference between the U.S. multi-payer system and the Taiwan single-payer national health insurance system. It was concluded that while there are few similarities, especially when comparing the U.S. Medicare and Medicaid programs to the Taiwan National Health Insurance system, there are mainly differences present between the two systems.

Nursing manpower forecast for cancer patients

Background and objectivesThis paper presents a dynamic model aimed at predicting nursing manpower requirements for cancer care over the next ten years. The proposed model, based on the Taiwan Health Insurance Database (2000 to 2010), is meant to serve as a reference in establishing policy for government health units. MethodsThe proposed prediction model uses fuzzy sets to replace definite values with interval values in order to account for uncertainties in real-world data and enhance the flexibility of prediction results. ResultsOur results suggest that the demand for nursing manpower for cancer care will grow steadily in the foreseeable future. The gap between the demand for nursing staff and the supply is expected to peak in 2027. By then, the number of oncologists is expected to reach 7,083 (54.32% of the total number of in-hospital physicians), but the number of oncology nurses will be less than 26,297 (56.5% of the total healthcare manpower). It is also expected that there will be fewer than 1,613 outpatient physicians (71.81% of the total number of physicians) and fewer than 4,967 outpatient nurses (68.46% of the total nursing manpower). ConclusionsThis paper provides a valuable reference for government agencies involved in the nursing manpower planning to improve the quality of nursing care.

The Association Between the Use of Cholinesterase Inhibitors and Cardiovascular Events Among Older Patients With Alzheimer Disease

ObjectiveTo evaluate the association between the use of cholinesterase inhibitors (ChEIs) and incident cardiovascular events (CVEs) among older patients with Alzheimer disease (AD). Patients and MethodsThis retrospective cohort study was conducted with a new-user design and active-comparator design. The data source was the 2005–2014 Full Population file from the Health and Welfare Database in Taiwan. Patients were included if they were aged 50 years or older and had been diagnosed with AD between January 1, 2006, and December 31, 2010. The association between ChEI use and the risk of CVEs was investigated in patients with AD. Among the ChEI users, the risk of CVEs was further compared between patients with different cumulative doses and different ChEI treatment strategies. The propensity score method, which included matching and inverse probability of treatment weighting, was used to balance the potential confounders. A Cox proportional hazards model with competing risks was used to estimate the hazard ratio of CVEs. ResultsThe study included 6070 patients with AD. After covariate adjustment, ChEI users had a significantly lower risk of CVEs than nonusers (hazard ratio, 0.57; 95% CI, 0.51 to 0.62). Among ChEI users, patients with a high cumulative dose had a significantly lower risk of CVEs than those with a low cumulative dose (hazard ratio, 0.82; 95% CI, 0.70 to 0.96). ConclusionThe use of ChEIs was associated with a decreased risk of incident CVEs among patients with AD. The cardioprotective effect of ChEIs showed a dose-response relationship.

Relationships between health literacy and quality of life among survivors with breast cancer.

During the survival period of breast cancer patients, an understanding of and ability to implement health knowledge may be important for survivors' physical and mental quality of life (QOL). This study aims to investigate the health literacy and predictors of QOL for survivors of breast cancer. A cross-sectional design was used, and convenience sampling was performed. Eighty-six survivors with breast cancer were recruited from a general hospital in northern Taiwan from February to August 2017. Taiwan's health literacy scale and SF-12 questionnaire were used for data collection. The average health literacy score was 3.28. Education level and breast cancer stage were significant factors for the health literacy of survivors with breast cancer. Age, body mass index and health literacy were predictors of physical health-related QOL. Health literacy also was a predictor of mental health-related QOL. The results provide the factors associated health literacy as well as health-related QOL. Nurses should understand the health literacy among survivors with breast cancer and improve health literacy to optimize their quality of life.

A Nationwide Population-Based Study on the Incidence of Parapharyngeal and Retropharyngeal Abscess-A 10-Year Study.

This study aimed to investigate the annual incidence of parapharyngeal and retropharyngeal abscess (PRPA) based on 10-year population-based data. Patients with PRPA were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of over two million enrollees of the National Health Insurance system that covers over 99% of Taiwan’s citizens. During 2007–2016, 5779 patients received a diagnosis of PRPA. We calculated the population-wide incidence rates of PRPA by sex and age group (20–44, 45–64, and >64) as well as in-hospital mortality. The annual incidence rate of PRPA was 2.64 per 100,000 people. The gender-specific incidence rates per 100,000 people were 3.34 for males and 1.94 for females with a male:female gender ratio of 1.72. A slight increase in incidence rates among both genders over the study period was noted. Age-specific rates were lowest in the 20–44 age group with a mean annual incidence of 2.00 per 100,000 people, and the highest rates were noted in the age groups of 45–64 and >64 years with mean annual incidences of 3.21 and 3.20, respectively. We found that PRPA is common in Taiwan, males and older individuals are more susceptible to it, and incidence has increased in recent years.

Use and Cost-Effectiveness of a Telehealth Service at a Centralized COVID-19 Quarantine Center in Taiwan: Cohort Study.

BackgroundTelehealth is a recommended method for monitoring the progression of nonsevere infections in patients with COVID-19. However, telehealth has not been widely implemented to monitor SARS-CoV-2 infection in quarantined individuals. Moreover, studies on the cost-effectiveness of quarantine measures during the COVID-19 pandemic are scarce.ObjectiveIn this cohort study, we aimed to use telehealth to monitor COVID-19 infections in 217 quarantined Taiwanese travelers and to analyze the cost-effectiveness of the quarantine program.MethodsTravelers were quarantined for 14 days at the Taiwan Yangmingshan quarantine center and monitored until they were discharged. The travelers’ clinical symptoms were evaluated twice daily. A multidisciplinary medical team used the telehealth system to provide timely assistance for ill travelers. The cost of the mandatory quarantine was calculated according to data from the Ministry of Health and Welfare of Taiwan.ResultsAll 217 quarantined travelers tested negative for SARS-CoV-2 upon admission to the quarantine center. During the quarantine, 28/217 travelers (12.9%) became ill and were evaluated via telehealth. Three travelers with fever were hospitalized after telehealth assessment, and subsequent tests for COVID-19 were negative for all three patients. The total cost incurred during the quarantine was US $193,938, which equated to US $894 per individual.ConclusionsTelehealth is an effective instrument for monitoring COVID-19 infection in quarantined travelers and could help provide timely disease management for people who are ill. It is imperative to screen and quarantine international travelers for SARS-CoV-2 infection to reduce the nationwide spread of COVID-19.

Increased risk of subsequent benign prostatic hyperplasia in non-Helicobacter pylori-infected peptic ulcer patients: a population-based cohort study

The vagus nerve plays an essential role in homeostasis and inflammation. Clinically, peptic ulcer patients without helicobacter pylori (HP) infection may provide a population for studying the effect of vagal hyperactivity. There were interests in the association of gastrointestinal disease and urogenital disorders. Herein, we try to investigate subsequent risk of benign prostatic hyperplasia (BPH) in non-HP infected peptic ulcer patients. We identified 17,672 peptic ulcer admission male patients newly diagnosed in 1998–2007 from Taiwan Health Insurance Database, and 17,672 male comparison without peptic ulcer, frequency matched by age, and index-year. We assessed subsequent incidence of BPH in each cohort by the end of 2013, and then compared the risk of developing BPH between individuals with and without peptic ulcer. In addition, peptic ulcer patients underwent surgery were also examined. There were 2954 peptic ulcer patients and 2291 comparisons noted with the occurrence of BPH (25.35 and 16.70 per 1000 person-years, respectively). Compared to comparisons, peptic ulcer patients had a 1.45- and 1.26-fold BPH risk in multivariable Cox model and Fine and Gray model (95% CI 1.37–1.54 and 1.19–1.34). In age-stratified analysis, the highest risk of BPH was in 45–59 years (interaction p < 0.05). Regarding surgery types, peptic ulcer patients who underwent simple suture surgery (i.e.: with integrated vagus nerve) had a significant higher BPH risk than comparison (HR 1.50 and 95% CI 1.33–1.74; SHR 1.26 and 95% CI 1.07–1.48), while patients underwent truncal vagotomy/pyloroplasty showed a lower incidence of BPH. In this study, non-HP-infected male peptic ulcer patients were found to have an increased risk of subsequent BPH. Indicating that there might be a role of vagus nerve. Based on the limitations of retrospective nature, further studies are required.

Air pollutants and daily outpatient visits for cardiovascular and cerebrovascular diseases in central Taiwan

Background: This study aimed to evaluate the health impacts of air pollutants and meteorological factors (fog, haze, and low cloud) under megacity conditions in central Taiwan. In addition, we used the Kriging interpolation and land use regression for more accurate exposure assessment. Material and Method: We retrieved daily records of outpatient department (OPD) visits from the Health and Welfare Data Science Center of the Ministry of Health and Welfare of Taiwan and included those for ischemic heart and cerebrovascular diseases (ICD-9 codes 410 to 414 and 430 to 438; ICD-10 codes: I20 to 25 and I60 to I69) in 2016. We combined the air pollution data on the level of fine aerosol and chemical components obtained from the air quality monitoring stations established by the Environmental Protection Administration in the Taichung and Nantou areas with the meteorological data obtained from the Central Weather Bureau to assess their associations with the OPD visits. Autoregressive integrated moving average and classification and regression trees models were constructed to evaluate and describe the effects of air pollutants and meteorological factors on the OPD isits for ischemic heart and cerebrovascular diseases. Results: The PM2.5 measured at station in Nantou and Changhua were significantly higher than those measured at stations in Taichung. The OPD visits for cardiovascular and cerebrovascular diseases by residents nearby the station in Nantou and Changhua were also significantly more than those paid by residents nearby the stations in Taichung. OPD visits for ischemic heart and cerebrovascular diseases had positive association with PM2.5 concentration on the same day and the day before. Conclusions: The level of PM2.5 was associated with OPD visits for ischemic heart and cerebrovascular diseases on the same day and the next day. Further studies are needed to identify the susceptible populations and evaluate the impacts.

Does physical activity exacerbate the air pollution risk of mortality? A longitudinal cohort study

BackgroundPhysical inactivity and air pollution are two major public health challenges worldwide. Given that physical activity (PA) increases ventilation rate, the increased intake of air pollutants may exacerbate the adverse health effects of air pollution. We investigated the combined effects of long-term exposure to fine particle matter (PM2.5) and PA on mortality in Taiwan.Methods We included 384,130 adults (≥18 years) with 842,394 medical measurements from 2001 to 2016. The participants were then followed up until May 31, 2019. The vital data was from the National Death Registry maintained by the Ministry of Health and Welfare in Taiwan. Ambient PM2.5 exposure was estimated using a satellite-based spatiotemporal model. We used Cox regression model with time-dependent covariates to investigate the main and combined effects of PM2.5 and PA on all-natural cause mortality.ResultsWe observed that the risk of death decreased 11% [hazard risk (HR) is 0.89 with a 95% confidence interval (CI) of 0.88−0.91] for each 10 MET-h increase in PA, while the risk increased 20% [HR (95%CI): 1.20 (1.15−1.25)] for each 10 µg/m3 increase in PM2.5. We found that active participants had a slightly higher risk of death due to PM2.5, although the overall combined effects of PA and PM2.5 were not significant [HR (95%CI) is 1.00 (0.98−1.02)].ConclusionsPA was associated with lower risk of mortality, whilst PM2.5 was associated with a higher risk. PA may amplify detrimental effects of PM2.5 during exercise. We suggest that people could exercise in highly polluted regions, but they should reduce air pollution exposure during exercise to minimise PM2.5 effects.

Public attitudes towards e-cigarette regulations and policies in Taiwan.

Background: There are various approaches to e-cigarette regulation globally. In Taiwan, the term “e-cigarette” is not found in existing regulations, but health authorities apply explanatory notes derived from standing laws to e-cigarette. Taiwan health authority is in the process of regulative reform to include “e-cigarette” in standing tobacco law. Our objective was to investigate the public’s attitudes towards potential policy options for e-cigarette regulations in Taiwan.Design and Methods: We conduct an anonymous online survey in the general public. A questionnaire in Mandarin was posted on the website Stop-tabac.ch between July and November 2017.Results: Participants (n=236) were mostly male, young, highly educated, employed, and smoked or had smoked cigarettes in the past. Half were e-cigarette users. Four measures banning ecigarettes, labelling content and nicotine level and establishing a maximum-allowable nicotine level were supported by more than 70% of participants. Vaping status was strongly associated with support for most measures after controlling for other factors in multivariate models.Conclusion: We documented attitudes of a self-selected sample of the general public in Taiwan regarding e-cigarette regulations and policies. These results may be useful to design studies in more representative samples and to inform e-cigarette regulations, policies and education campaigns.Significance for public healthThere are various approaches to e-cigarette regulation globally. The term “e-cigarette” is not found in existing regulations, but Taiwanese health authorities apply explanatory notes derived from standing laws to regulate e-cigarette. In Taiwan, there is no e-cigarette approved, but used. The Taiwanese health authorities face the challenge of how to best regulate it. Little is known about public attitudes toward current e-cigarette legislation. In addition, no literature is available about public attitudes to e-cigarette control measures that either applied already in other countries for e-cigarette or in Taiwan for tobacco control. This is the first study to examine the public attitudes towards e-cigarette legislations in Taiwan. Our findings on specific policy issues are useful in terms of identifying the need for information and education among policy makers, health professionals and the public, in Taiwan particularly, and in international community.

&lt;p&gt;Relationship Between Gallstone Disease and Cardiometabolic Risk Factors in Elderly People with Non-Alcoholic Fatty Liver Disease&lt;/p&gt;

BackgroundThe prevalence of gallstone disease (GSD) increases with age, and the elderly have a much higher mortality risk and incidence of surgical comorbidities. The aim of this study was to explore the relationship between GSD and cardiometabolic risk factors in elderly people with non-alcoholic fatty liver disease (NAFLD).MethodsIn this cross-sectional study, we analyzed the data of elderly people who underwent annual health check-ups at a Northern Taiwan health examination center. These data were collected from physical examination, blood tests, abdominal ultrasonography, and medical histories. We excluded those with hepatitis B or C infections, heavy alcohol consumption, or cholecystectomy.ResultsThe analysis included 3,037 participants with a mean age of 73.6±6.0 years. Over 70% were overweight or obese, and the overall prevalence of GSD was 17.7%. In our univariate analysis, GSD was positively correlated with age, body mass index, metabolic syndrome, diabetes mellitus (DM), hypertension (HTN), and various metabolic factors (fasting plasma glucose [FPG], triglyceride, uric acid, and high-density lipoprotein cholesterol [HDL-C] levels). After adjustment for age, gender, and body mass index, metabolic syndrome showed a positive association with GSD (odds ratio [OR] 1.31 [95% confidence interval [CI], 1.05–1.64]; P=0.020). Specific components of metabolic syndrome that increased the risk for GSD in NAFLD elderly include lower levels of HDL-C (OR 1.35 [95% CI, 1.10–1.66]; P<0.001) and elevated FPG (OR 1.36 [95% CI, 1.10–1.69]; P<0.001).ConclusionOur study concluded that GSD is significantly associated with metabolic syndrome in elderly people with NAFLD. Reduced HDL-C and elevated FPG both heighten the risk of developing GSD. Therefore, to lower the risk of GSD in NAFLD patients, their FPG levels and HDL-C levels must be regularly followed-up, and these patients should be educated about the symptoms of GSD if they meet the criteria for metabolic syndrome.