Population In Taiwan Research Articles

External validation of the risk prediction model for early diabetic kidney disease in Taiwan population: a retrospective cohort study

ObjectivesThis study aims to independently and externally validate the Risk Prediction Model for Diabetic Kidney Disease (RPM-DKD) in patients with type 2 diabetes mellitus (T2DM).DesignThis is a retrospective cohort study.SettingOutpatient...

Health Awareness and Culturally Appropriate Epidemic Prevention Strategy for COVID-19 in Taiwan's Indigenous Townships

The COVID-19 pandemic has imposed an extremely heavy burden on the medical system in Taiwan. Thus, improving the effectiveness of epidemic prevention efforts and reducing the related burdens on medical staff are critical. Between the initial outbreak of COVID-19 in Taiwan in early 2022 until May of that same year, two townships with high percentages of indigenous (Malayo-Polynesian) residents reported the highest rates of infection nationwide. As the indigenous culture in these and other similar townships differs significantly from Taiwan's mainstream culture, determining how to improve health awareness and provide culturally appropriate treatments during this pandemic in indigenous communities is vital. In the context of Taiwan's indigenous population, this paper addresses the importance of improving health awareness, proposes how to foster a more-friendly health awareness environment, and suggests a strategy for providing effective healthcare under current pandemic conditions. Prevention measures include improving the ability of indigenous citizens to assess the correctness of information provided, improving compliance with epidemic prevention measures, improving knowledge regarding vaccines and rapid screening reagents, and improving the notification process for diagnoses. A culturally appropriate township-based promotion strategy for epidemic prevention should be proposed to increase the effectiveness of epidemic prevention and health promotion to improve health conditions in indigenous communities.

EE381 Cost-Effectiveness Analysis of Atrial Fibrillation Screening in the Elderly Population of Taiwan

Screening for undiagnosed AF can identify patients who could benefit from anticoagulant therapy and reduce the burden of ischemic stroke (IS) through early intervention. The aim of this study was to evaluate whether population screening for AF in Taiwan could be cost-effective from a government perspective.

The genesis of Taiwanese piano art: historical and cultural context

Introduction. The article examines the origins of Taiwanese piano art, its evolution, the influence of national and numerous non-national musical traditions. Until today, no special study devoted to the general panorama of these important processes has been created. The general picture of the formation and development of Taiwanese musical culture in the context of the political, economic and social situation is considered. The purpose of the article is to highlight the origins of Taiwanese piano art, which influenced its evolution, the process of introducing national and numerous non-national elements at the main stages of its formation and development. With the help of analytical, historical, comparative, interdisciplinary methods of research, a number of tasks are solved: the role of Western Christian missionaries in the development of musical education and piano art on the island is determined, the reasons why the Western classical music was accepted by the local society, the questions about the founders of the system of Western of classical music education, the programs and forms of learning in the first music schools in Taiwan, the names of the first Taiwanese composers-pianists are clarified; а periodization of the development of piano art in Taiwan is proposed. Results. The most important historical stages of the formation and development of Taiwanese piano art can be considered: – the period of its creation from the end of the 16th century to 1894; – the period of Japanese colonial rule from 1895 to 1945; – the period of development of national self-awareness, 1946–1986; – the period of reunification with mainland China from 1987. The proposed periodization makes it possible to reveal the entire historical and cultural context of the existence of piano art in Taiwan, to project its genetic settings for further stages of its development. Its basis was national folklore, but since the middle of the 16th century, the island was visited by Spanish, Portuguese, Dutch and Canadian colonists, and the first contacts of Western music with the indigenous population of Taiwan were made thanks to the activities of Western missionaries and were subordinated mainly to religious purposes. The stage of Japanese colonial rule was important for the development of piano art on the island. Due to the influence of Japan, Taiwanese musicians had further opportunities to join the system of Western classical music education, as the Japanese government was helping Taiwanese youth to obtain it. After 1920, Western classical music becomes popular in Taiwan; the formation of composer creativity in the field of piano music also takes place – the activities of such Taiwanese composers and pianists as Chiang Wen-Yeh, Chen Sizhi, Kuo Chih-Yuan, Kao Tzu-Mei and others. In the years 1946–1986, we observe the further development of performing and teaching activities at the island, a bright burst of creativity by such composers as Chang-Hui Hsu, Hsiao Tyzen, Shui-Long Ma and others. After 1987, active musical contacts between China and Taiwan contribute to the further progress of the island’s piano art. The piano works of Taiwanese composers Shih-Hui Chen, Fan-Ling Su, Chien-Yu Huang and others are widely popularized. In recent decades, the performing activities of Taiwanese pianists, represented in the international space by the names of Chien-Yu Huang, Yi Chih Lu, Chiu Tze Lin and many others, have become very active. Today, the piano art of Taiwan is the most important part of not only Chinese, but also world music culture. Conclusions. The study of the origins of the piano art of Taiwan, the periods of its development, ways of refracting different musical traditions will help to understand both the historical-theoretical and aesthetic-pedagogical and artistic significance of this phenomenon in musical art. The most important events in the social and cultural life of Taiwan, since the end of the 16th century, indirectly affected the development of national piano art, which underwent qualitative changes connected with the emergence of new musical forms and means of expression, the methods of using the national and Western compositional techniques. The prospect of further study of the topic consists in a more detailed study of the modern stage of developing piano art in Taiwan and clarifying the influence of its extensive genetic roots on the compositional and performing creativity of representatives of Taiwanese musical culture.

Factors associated with insomnia and suicidal thoughts among outpatients, healthcare workers, and the general population in Taiwan during COVID-19 pandemic: a cross-sectional study

BackgroundInsomnia and suicidal thoughts are two of the negative impacts that have been caused by the COVID-19 pandemic. Identifying the factors that contribute to these psychological problems may help develop strategies to sustain the mental health of the public. The present study examined the psychosocial impacts caused by the COVID-19 pandemic among different populations in Taiwan, and investigated the relationships between these psychosocial variables, insomnia, and suicidal thoughts.MethodsBetween September 2020 and May 2021, online questionnaires including psychometrically validated scales were distributed to a convenience sample of outpatients (n = 205), healthcare workers (HCWs) (n = 500), and individuals in the general population (n = 1200) in Taiwan to collect data regarding their insomnia severity, suicidal thoughts, fear of COVID-19, trust of information, and resilience. Multivariate logistic regression methods were used to identify variables associated with suicidal thoughts and insomnia.ResultsGreater fear of COVID-19 was significantly associated with suicidal thoughts: odds ratios (ORs) with 95% confidence interval (CI) = 1.155 (1.002–1.330) for outpatients; 1.127 (1.035–1.228) for HCWs; and 1.100 (1.130–1.222) for those in the general population. Higher resilience was significantly associated with lower insomnia: OR (95% CI) = 0.819 (0.725–0.926) for outpatients; 0.803 (0.728–0.887), for HCWs; 0.829 (0.785–0.875), and for those in the general population. In addition, there was a statistically significant association between insomnia diagnosis and greater fear of COVID-19 among HCWs (OR [95% CI] = 1.102 [1.062–1.144]) and those in the general population (OR [95% CI] = 1.079 [1.053–1.106]). Among outpatients, there was a statistically significant association between suicidal thoughts and lower trust of information (OR [95% CI] = 0.794 [0.646–0.976]), while among those in the general population there was a statistically significant association between suicidal thoughts and higher insomnia severity (OR [95% CI] = 1.175 [1.13–1.222]). A statistically significant association was also found between insomnia diagnosis and higher suicidal thoughts among those in the general population (OR [95% CI] = 3.455 [2.338–5.106]).ConclusionsTrust of information, fear, and resilience were important factors for suppressing suicidal thoughts and insomnia among the three study populations. Health policies that monitor psychological status and build resiliency of the public are recommended to help develop tailored strategies for different populations affected by the COVID-19 pandemic.

Prognostic Comparison between Oncotype DX® and a 23-Gene Classifier, RecurIndex®, on the Taiwan Breast Cancer Population.

The applicability of the Oncotype DX® (Genomic Health, Inc., Redwood City, CA, USA) recurrence score (RS) in Asian populations is unclear. A 23-gene classifier, RecurIndex® (Amwise Diagnostics, Pte. Ltd., Singapore), has been developed based on the gene expression profiles of early-stage breast cancer patients of ethnic Han Chinese population in Taiwan. This study aimed to compare the performance of the Oncotype DX® RS with the RecurIndex® recurrence index (RI) for predicting relapse-free survival. Therefore, we calculated both the RI and RS for 110 early stage breast cancer patients, with the cut-off value for high-risk recurrence set at 26 and 29 for the RS and the RI, respectively. With relapse-free interval (RFI) as the primary endpoint, the concordance between RS and RI was 78.2% (Kappa value = 0.297). For a median follow-up interval of 27 months, there was a statistically significant difference in RFI between the high- and low-risk groups defined by the RI (p = 0.04) but not between risk groups defined by the RS (p = 0.66). In conclusion, whereas there was high concordance between the RecurIndex® RI and the Oncotype DX RS, the current data showed that the RI had a better discrimination for recurrence risk than the RS. Subsequent studies with larger sample sizes will be needed to confirm the superiority of the RI over the RS in the Asian population.

Surveillance of Rice Blast Resistance Effectiveness and Emerging Virulent Isolates in Taiwan.

Rice blast caused by Magnaporthe oryzae is a dangerous threat to rice production and food security worldwide. Breeding and proper deployment of resistant varieties are effective and environmentally friendly strategies to manage this notorious disease. However, a highly dynamic and quickly evolved rice blast pathogen population in the field has made disease control with resistance germplasms more challenging. Therefore, continued monitoring of pathogen dynamics and application of effective resistance varieties are critical tasks to prolong or sustain field resistance. Here, we report a team project that involved evaluation of rice blast resistance genes and surveillance of M. oryzae field populations in Taiwan. A set of International Rice Research Institute-bred blast-resistant lines (IRBLs) carrying single blast resistance genes was utilized to monitor the field effectiveness of rice blast resistance. Resistance genes such as Ptr (formerly Pita2) and Pi9 exhibited the best and most durable resistance against the rice blast fungus population in Taiwan. Interestingly, line IRBLb-B harboring the Pib gene with good field protection has recently shown susceptible lesions in some locations. To dissect the genotypic features of virulent isolates against the Pib resistance gene, M. oryzae isolates were collected and analyzed. Screening of the AvrPib locus revealed that the majority of field isolates still maintained the wild-type AvrPib status but eight virulent genotypes were found. Pot3 insertion appeared to be a major way to disrupt the AvrPib avirulence function. Interestingly, a novel AvrPib double-allele genotype among virulent isolates was first identified. Pot2 repetitive element-based polymerase chain reaction (rep-PCR) fingerprinting analysis indicated that mutation events may occur independently among different lineages in different geographic locations of Taiwan. This study provides our surveillance experience of rice blast disease and serves as the foundation to sustain rice production.

Healthcare Resource Utilization and Costs Associated with AL Amyloidosis: A Retrospective Matched Cohort Study

Introduction: AL (light-chain) amyloidosis is a chronic, incurable disease caused by the accumulation of misfolded proteins that disrupt cellular activities and impair organ functioning. The annual incidence is 10/million in Western countries and ~8.4/million in Taiwan. The burden of disease is substantial, and cardiac, renal, and liver involvement at diagnosis is common, with adverse effects on survival. The burden of AL amyloidosis on healthcare systems in Asia is not known. Methods: We conducted a population-based study using the Taiwan National Healthcare Insurance Research database (NHIRD) to examine the healthcare resource utilisation (HRU) and costs associated with AL amyloidosis in Taiwan. All patients with confirmed newly diagnosed AL amyloidosis (ICD-10 E85.4, E85.8, E85.9) from 01-Jan-2016 until 31-Dec-2018 were enrolled. Patients without AL amyloidosis (comparators) were randomly selected from the NHIRD database and matched to cases in a 10:1 ratio by age, sex, and calendar year. Costs attributable to AL amyloidosis were obtained by subtracting the all-cause HRU costs incurred by comparators from cases. Patients were followed up until dis-enrolment, death, or study end (31 December 2019), whichever occurred first. Crude mean annual all-cause HRU for 3 years were reported for cases and comparators. Weighted Kaplan-Meier sample average (KMSA) annual costs were calculated to account for loss of follow-up due to death/disenrollment. Results: Data from 645 patients with newly diagnosed AL amyloidosis were matched to 6450 comparators. The median age of all patients was 60.78 years and 59.07% were male. Common co-morbidities were cardiac-related in 27.29% of cases versus 12.11% in comparators, malignancy in 23.41% versus 4.43%, and renal-related in 21.71% versus 3.80%, respectively. Three months after the index date, 8.4% of cases died compared with 0.45% of comparators. This increased to 12.1%/0.9% by 6 months and 18.8%/3.7% by 36 months after the index date. Crude mean annual all-cause HRU in cases exceeded that of comparators. Compared to comparators, cases had 103% more outpatient visits, 177% more emergency room visits, were hospitalised 4-times more frequently, and spent 5.5-times more days in hospital. The difference between cases and comparators decreased in year 2 and year 3, but HRU remained substantially higher in cases than comparators. Cumulative mean annual all-cause costs were significantly higher in cases than comparators over the entire 3-year follow-up period (p<0.0001 for all comparisons) (Table 1). The mean total cost attributable to AL amyloidosis was NT$ 449,643 (SD 36,419) (USD 14,271, SD 1,156) after 3 years, made up of NT$ 259,560 (SD 20,379) (USD 8238, SD 646) for outpatient visits, NT$ 148,207 (SD 20,704) (USD 4704, SD 657) for inpatient episodes, and NT$ 13,242 (SD 4,575) (USD 420, SD 145) for emergency room visits (Table 1). Outpatient care contributed about 62%-64% and inpatient care 34%-36% to the 1-year, 2-year, and 3-year cumulated total costs. Costs incurred during the first year after diagnosis accounted for 55% of the 3-year cumulative cost. The total cost of all-cause healthcare after 3 years was 4-fold higher in cases compared to comparators. Similarly, cumulative mean annual medication and non-medication costs were higher in cases than comparators over the entire 3-year follow-up period (p<0.0001 for all comparisons) (Table 2). Medication costs accounted for 45%-48% of the 1-year, 2-year, and 3-year cumulated total costs. The mean total cost of medications attributable to AL amyloidosis was NT$ 212,606 (SD 27,497) (USD 6,748, SD 872) after 3 years, and the mean non-medication cost was NT$ 257,232 (SD 25,720) (USD 8,164, SD 816). 58% of the AL amyloidosis-attributable medication costs and 52% of the attributable non-medication costs over the 3-year follow-up period were incurred in the first year after diagnosis. Conclusion: This analysis used data from the NHIRD that provides health insurance for the whole population of Taiwan, allowing complete and longitudinal data collection across all treatment settings. Patients with newly diagnosed AL amyloidosis had high levels of co-morbidity and high early mortality. Over a 3-year period after diagnosis, mortality was 5-times higher, and the all-cause total cost was 4-times higher in cases than in comparators. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Decreased trends of using dental amalgam filling for decayed teeth in Taiwan from 1997 to 2013

Background/purposeMercury within dental amalgam has been criticized for the potential toxicity and environmental hazard. Phasing down the use of dental amalgam is the transition for amalgam free dentistry. However, little is known about dental amalgam filling (AMF) in Taiwan. In this study, time trends of AMF were measured by using National Health Insurance Research Database (NHIRD). Materials and methodsA retrospective study was conducted to analyze the AMF data in registered database compiled by Taiwanese NHIRD from 1997 to 2013. The AMF data were further analyzed according to sex, age, and geographic location, respectively. Time trends of dental visits for AMF and medical expenses for AMF were also evaluated. ResultsThe average annual AMF ratio was 8.965% of nationwide population in Taiwan. The prevalence of AMF was significantly decreased both in male and female from 1997 to 2013 (P for trend <0.0001). The decreased pattern of AMF was found by the age stratification (P for trend <0.0001). The significant fall of AMF was also displayed in six districts (P for trend <0.0001). The number of dental visits were ranged from 821,749 in 1997 to 1,313,734 in 2013. However, time trends of dental visits for AMF were significantly decreased (P for trend <0.0001). The medical expenses for AMF were simultaneous significantly decreased from 1997 to 2013 (P for trend <0.0001). ConclusionForm the results of this nationwide population-based database, a significant decrease of AMF in Taiwan was observed during past 17 years.

Association between serum uric acid level and bone mineral density at multiple skeletal sites in middle-aged and elderly men: a cross-sectional study of a healthy population in Taiwan.

Previous studies have reported an association between serum uric acid (sUA) levels and bone mineral density (BMD). However, their findings are controversial and limited to adult men in the general population. This study was aimed at examining the association between sUA levels and BMD at multiple skeletal sites in middle-aged and elderly men. A cross-sectional analysis of BMD at different skeletal sites and sUA levels was conducted on 918 men (age: 50.83 ± 7.95) using data from the Ditmanson Research Database. The participants were categorized into four groups based on quartiles of the sUA level, and BMD were assessed using dual-energy X-ray absorptiometry. Multivariate linear regression models were utilized to investigate the association between sUA levels and BMD. Further, subgroup analyses were performed. After adjusting for potential confounding factors, sUA as a continuous variable was significantly associated with BMD at the femoral neck only (β, 95% confidence interval: 0.007 [0.001-0.013]). However, in the categorical analysis, no significant differences were detected in terms of BMD at different skeletal sites across the different sUA quartile groups. Moreover, if the body mass index (BMI) was < 24kg/m2 for each unit increase in sUA level, the spine, femoral neck, and total hip BMD increased by 0.014, 0.013, and 0.015g/cm2, respectively. The sUA level was not associated with BMD at different skeletal sites in middle-aged and elderly men. Nevertheless, a positive association was only found between sUA levels and BMD at all skeletal sites in the normal weight group.

Screening for Obstructive Sleep Apnea Risk by Using Machine Learning Approaches and Anthropometric Features.

Obstructive sleep apnea (OSA) is a global health concern and is typically diagnosed using in-laboratory polysomnography (PSG). However, PSG is highly time-consuming and labor-intensive. We, therefore, developed machine learning models based on easily accessed anthropometric features to screen for the risk of moderate to severe and severe OSA. We enrolled 3503 patients from Taiwan and determined their PSG parameters and anthropometric features. Subsequently, we compared the mean values among patients with different OSA severity and considered correlations among all participants. We developed models based on the following machine learning approaches: logistic regression, k-nearest neighbors, naïve Bayes, random forest (RF), support vector machine, and XGBoost. Collected data were first independently split into two data sets (training and validation: 80%; testing: 20%). Thereafter, we adopted the model with the highest accuracy in the training and validation stage to predict the testing set. We explored the importance of each feature in the OSA risk screening by calculating the Shapley values of each input variable. The RF model achieved the highest accuracy for moderate to severe (84.74%) and severe (72.61%) OSA. The level of visceral fat was found to be a predominant feature in the risk screening models of OSA with the aforementioned levels of severity. Our machine learning models can be employed to screen for OSA risk in the populations in Taiwan and in those with similar craniofacial structures.

Risk Role of Breast Cancer in Association with Human Papilloma Virus among Female Population in Taiwan: A Nationwide Population-Based Cohort Study.

We analyzed data from the National Health Insurance Research Database (NHIRD) in Taiwan, collected information regarding human papillomavirus (HPV) and breast cancer prevalence, and explored the association between HPV infection and the risk of breast carcinoma. We included the NHIRD data of 30,936 insured patients aged 20 years an older without breast cancer prior to the index date (date of HPV diagnosis) and matched each patient with a reference subject according to age, comorbidities, and index year (1:1 ratio). We calculated the incidence rates of breast cancer in the cohorts, age groups, and comorbidity groups, as well as the relative risk of breast cancer stratified by age and comorbidity in the HPV and non-HPV groups. The patients with and without HPV had incidence rates of 12.5 and 9.81 per 10,000 person years, respectively. The risk of breast cancer for the 50-64 and ≥65 age groups was 1.67 and 1.36 times higher than that in patients younger than 49 years, respectively, and hypertension, chronic obstructive pulmonary disease, and diabetes mellitus were significant risk factors for breast cancer. The HPV group had a higher risk of developing breast cancer than the non-HPV group, regardless of age group and the presence or absence of comorbidities. Patients with HPV in the 50-64 age group were 1.39 times more likely to develop breast cancer than patients of the same age without HPV. Patients older than 49 were more likely to develop breast cancer, and patients with HPV had a higher likelihood of developing breast cancer, regardless of age and the presence or absence of comorbidities. HPV likely plays a causal role in breast cancer.

Cough Characteristics and Healthcare Journeys of Chronic Cough Patients in Community-Based Populations in South Korea and Taiwan

PurposeThis study aimed to understand the cough characteristics and health journeys among community-based chronic cough (CC) patients, and their characteristics associated with healthcare visits.MethodsA population-based cross-sectional study was conducted in 2020, using the South Korea and Taiwan National Health and Wellness Survey (NHWS) and CC surveys. Patients with current CC were defined by daily coughing for > 8 weeks in the past 12 months and currently coughing at the time of survey. The survey items pertained to CC patients’ treatment journey and cough characteristics.ResultsPatients with current CC in South Korea and Taiwan, respectively, had cough duration for 3.45 ± 5.13 years and 5.75 ± 7.28 years and cough severity visual analogue scale (VAS) scores of 4.50 ± 2.15 and 4.46 ± 1.92 out of 0–10 scale, with 70.3% and 57.9% having spoken with a physician about cough. Compared to CC patients who had not visited healthcare professionals for cough, those who visited reported more severe cough (VAS: 3.89 ± 1.71 vs. 4.6 ± 2.02; p = 0.009), worse cough-specific quality of life (Leicester Cough Questionnaire: 16.20 ± 3.23 vs.13.45 ± 2.68, p < 0.001), greater symptom severity (Hull Airway Reflux Questionnaire: 16.73 ± 15.16 vs. 24.57 ± 13.38; p < 0.001), and more urinary incontinence (13.6 vs. 26.5%, p = 0.027). More than 50% of patients perceived cough medication(s) as not or a little useful and 25% felt their physicians did not well understand how CC impacts their life.ConclusionCough is frequently severe and persistent among community-based CC patients. They experience several issues in their health journey, including treatment ineffectiveness and physician’s understanding. Further efforts are warranted to reduce CC burden in the community.

241P P16 IHC stain is an useful marker for predicting outcome of oropharyngeal cancer in Taiwan

Human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV-associated OPSCC) is well known to have a relatively indolent behavior, and it should be staged separately. P16 is a useful surrogate marker for HPV status in OP region. However, the low prevalence of HPV infection in Taiwan (lower than 30%) may cause increased possibility of false positive for p16 staining. This study is aimed to determine the concordance of p16 IHC stain and HPV RNA ISH in Taiwan population.

Analysis of the population genetic structure using microsatellite markers in goat populations in Taiwan

Due to the poor growth rate of the Taiwan black (TB) goat in Taiwan, many exotic breeds were brought into breeding schemes to improve TB goat. However, the excessive cross-breeding of alien species with TB goat has decreased its population numbers, genetic variation and biodiversity. Therefore, TB goat population considered an endemic species in Taiwan that needed to be conservation. The objective of the present study was to analyze the genetic structure and TB goat using genetic markers for genetic improvement and to sustain germplasm conservation and utilization. 15 microsatellite markers, divided into three sets, were used to analyze 690 goats sampled from 10 goat populations. The average number of alleles (Na) and effective alleles (Ne) was 11.87 ± 3.93 and 5.093 ± 1.768, respectively. The average expected heterozygosity (HE) and observed heterozygosity (HO) was 0.780 ± 0.084 and 0.602 ± 0.116, respectively. The average polymorphic information content (PIC) was 0.747 ± 0.103; F IS was 0.058 ± 0.075. All 15 microsatellite markers were highly polymorphic. The genetic distances between individuals were estimated to construct a phylogenetic tree. In present study, the 690 goat samples were divided into 8 clusters. The results indicated that these 15 microsatellite markers successfully clustered goat populations in Taiwan and could assist in the preservation of TB goats.

The genetic variation of a mitochondrial and two behaviour‐related genes in invasive African Sacred Ibis (Threskiornis aethiopicus) populations in Taiwan

The African Sacred Ibis Threskiornis aethiopicus is an invasive bird species in Taiwan and has expanded its distribution range rapidly over the past three decades. There is limited information available on the invasion process of African Sacred Ibises in Taiwan and its genetic consequences. We investigated whether genetic factors reflected the expansion of African Sacred Ibises and determined the extent to which two behaviour‐associated genes may have facilitated invasion. The dopamine receptor gene (DRD4) and the serotonin transporter gene (SERT) have both been found to be associated with novel‐seeking and bold behaviour in birds. We hypothesized that: (1) selection on temperament traits may determine the polymorphisms in these two genes and (2) the likelihood of dispersal of African Sacred Ibis populations can be explained by the intraspecific variation at these two genes. To detect the signals of population expansion and natural selection, we compared intra‐population variation and inter‐population differentiation of DRD4 and SERT with those of a mitochondrial gene (COX1) and an additional intron. We recovered contrasting patterns of nucleotide variation between the mitochondrial and nuclear genes with no single nucleotide polymorphisms detected in COX1 compared with allelic polymorphism in DRD4 and SERT. Populations showed decreasing genetic diversity at DRD4 as their distance to the initial invasive locality increased, consistent with a rapid expansion from one founder population. However, we found little evidence of selection on DRD4 or SERT, suggesting that these behaviour‐related genes are unlikely to have played a significant role in the successful invasion of the African Sacred Ibises in Taiwan. We detected high levels of genetic variation at these two behaviour‐related genes despite the effects of inbreeding in these invasive birds.

The Mutation Hotspots at UGT1A Locus May Be Associated with Gilbert's Syndrome Affecting the Taiwanese Population.

Gilbert’s syndrome is mainly diagnosed through genetic analysis and is primarily detected through a mutation in the promoter region of the UGT1A1 gene. However, most of the research has been conducted on Caucasian populations. In this study, we studied the Han population in Taiwan to investigate the possibility of other mutations that could cause Gilbert’s syndrome. This study comprised a test group of 45 Taiwanese individuals with Gilbert’s syndrome and 180 healthy Taiwanese individuals as a control group. We extracted DNA from the blood samples and then used Axiom Genome-Wide TWB 2.0 array plates for genotyping. Out of 302,771 single nucleotide polymorphisms (SNPs) from 225 subjects, we detected 57 SNPs with the most significant shift in allele frequency; 27 SNPs among them were located in the UGT1A region. Most of the detected SNPs highly correlated with each other and are located near the first exon of UGT1A1, UGT1A3, UGT1A6, and UGT1A7. We used these SNPs as an input for the machine learning algorithms and developed prediction models. Our study reveals a good association between the 27 SNPs detected and Gilbert’s syndrome. Hence, this study provides a reference for diagnosing Gilbert’s syndrome in the Taiwanese population in the future.

Associations between literacy and attitudes toward artificial intelligence–assisted medical consultations: The mediating role of perceived distrust and efficiency of artificial intelligence

Artificial intelligence (AI) is increasingly used in health care. Understanding the factors associated with attitudes toward AI-assisted medical consultations is necessary. This study investigated the associations of health literacy, digital literacy, perceived distrust, and efficiency of AI with attitudes toward AI-assisted medical consultations by using a sample of the general population in Taiwan. Data were collected through an online survey between July and September 2020. A health literacy scale comprising three dimensions (health care, disease prevention, and health promotion) and a digital literacy scale were employed. Path analysis was performed to identify direct and indirect associations between health literacy and digital literacy, perceived distrust, the efficiency of AI, and attitudes toward AI-assisted medical consultations. In total, 1363 respondents completed the questionnaire. Two health literacy dimensions were directly associated with attitudes toward AI-assisted medical consultations, and the association was mediated by perceived distrust and the efficiency of AI. The association between digital literacy and attitudes toward AI-assisted medical consultations was fully mediated by perceived distrust of AI and its efficiency. Emotional perceptions are essential in the association between digital literacy and attitudes toward AI-assisted medical consultations. These results highlight the importance of subjective evaluations of AI used in doctor-patient interactions.

Relationship between obesity-related parameters and chronic kidney disease in middle-aged and elderly populations in Taiwan: A community-based study.

Globally, obesity is a major health problem and can markedly increase the risk of various diseases, including type 2 diabetes mellitus, hypertension (HTN), dyslipidemia, and chronic kidney disease (CKD). The association of obesity-related parameters, such as lipid parameters and their ratio, with CKD in clinical settings is not well understood. This study aimed to investigate the association of obesity-related parameters with CKD in the middle-aged and elderly population in Taiwan. This cross-sectional, community-based study recruited 400 participants (141 males and 259 females) aged 50 years or over from a community health promotion project at the Linkou Chang Gung Memorial Hospital (Guishan District, Taoyuan City) in 2014. Each participant completed a questionnaire including personal information and medical history during a face-to-face interview. Laboratory data were obtained from blood and urine sampling. The data were analyzed using t-test, chi-square test, Pearson's correlation test, multivariate logistic regression, and receiver operating characteristic (ROC) analysis. A total of 81 participants were identified as having CKD [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 or urine albumin/creatinine ratio ≥30 mg/g], and their mean triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio was 3.37 ± 2.72. The mean TG/HDL-C ratio of the 319 participants without CKD was 2.35 ± 1.66. After adjusting for age, TG/HDL-C was significantly positively correlated with blood pressure, body mass index, waist circumference, and fasting plasma glucose but not low-density lipoprotein cholesterol. There was a negative correlation between TG/HDL-C and eGFR. Multiple logistic regression model analysis showed that TG/HDL-C was still significantly associated with CKD (OR: 1.17, 95% CI: 1.01–1.36, p = 0.04) after adjusting for multiple covariates. The cut-off point of TG/HDL-C as a predictor of CKD was 2.54 with an area under the ROC curve of 0.61 (95% CI: 0.53–0.68). There was a significant positive correlation between TG/HDL-C and several cardiovascular disease risk factors, including obesity indices. The TG/HDL-C ratio was significantly associated with the risk of CKD and demonstrated predictive ability for CKD in the middle-aged and elderly population. Further studies on its application in clinical settings are warranted.

Association between socioeconomic position trajectories and frailty among elderly people in Taiwan

This study examined the association between socioeconomic position (SEP) trajectories and frailty in the elderly population in Taiwan. We used data from people aged 53 years and over (n = 1284) collected from wave two of the Social Environment and Biomarkers of Aging Study. Frailty was identified using the modified Fried criteria, with the scores combined to use to categorize participants as frail (score = 3-5), prefrail (score = 1 or 2) and robust (score = 0). We applied a group-based person-centered trajectory model to identify four types of SEP trajectories (low-low, 19.2%; high-low 12.5%; low-high, 35.4%; and high-high, 32.9%) to describe the social mobility patterns in the participants' lives from childhood to older age. The mean age of the study population was 65.30 ± 8.94 years, and 47.39% of the participants were women. The prevalence of frailty was 18.39%. The low-low, high-low, low-high, and high-high SEP trajectory groups were represented by 37.92%, 24.93%, 15.43%, and 7.91%, respectively, of the study population. We used multinomial logistic regression models to evaluate the association between SEP and the risk of frailty. Compared with the low-low SEP trajectory group, the high-high SEP trajectory group was significantly associated with a lower prevalence of frail and pre-frail (odds ratios 0.17 and 0.36; 95% confidence interval 0.08–0.34 and 0.21-0.61). Our results suggest that a disadvantaged life-course SEP is associated with increased risks of frailty in older age. Avoiding that unfavourable SEP trajectories over the life course translate into an increased probability of frailty is key to reducing health inequalities in elderly populations.