Taiwan Society Research Articles

Discourses on Non‐conforming Marriages: Love in Taiwan

In contemporary Taiwan, arranged marriage seems a remote legend. However, the mainstream ideology of romantic love and marriage is a recent phenomenon that started only half a century ago. The debate on love and marriage that took place a hundred years ago has been reopened in current Taiwanese society on transnational marriage and same‐sex marriage debates, which are regarded as non‐conforming marriages in a specific historical period. We argue that the hegemonic ideology of romantic love has produced a powerful exclusionary effect on cross‐border marriages based on ethnic and class discrimination, but also an inclusive effect on same‐sex marriage in present Taiwan society, which underscores the power of the discourse of love in modern Taiwanese social life. The love discourse can be progressive in a specific historical conjuncture, but it can also be regressive by excluding other forms of intimacy.

One-Year Outcomes of Acute Decompensated Systolic Heart Failure in Taiwan: Lessons from TSOC-HFrEF Registry.

Heart failure (HF) is a global health problem. The Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry was a multicenter, observational survey of patients admitted with HFrEF in Taiwan. The aim of this study was to report the one-year outcome in this large-cohort of hospitalized patients presenting with acute decompensated HFrEF. Patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan. A total of 1509 patients were enrolled into the registry by the end of October 2014. Clinical status, readmission rates and dispensed medications were collected and analyzed 1 year after patient index hospitalization. Our study indicated that re-hospitalization rates after HFrEF were 31.9% and 38.5% at 6 and 12 months after index hospitalization, respectively. Of these patients, 9.7% of them were readmitted more than once. At 6 and 12 months after hospital discharge, all-cause mortality rates were 9.5% and 15.9%, respectively, and cardiovascular mortality rates were 6.8% and 10.5%, respectively. Twenty-three patients (1.5%) underwent heart transplantation. During a follow-up period of 1 year, 46.4% of patients were free from mortality, HF re-hospitalization, left ventricular assist device use and heart transplantation. At the conclusion of follow-up, 57.5% of patients were prescribed either with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers; also, 66.3% were prescribed with beta-blockers and 40.8% were prescribed with mineralocorticoid receptor antagonists. The TSOC-HFrEF registry showed evidence of suboptimal practice of guideline-directed medical therapy and high HF re-hospitalization rate in Taiwan. The one-year mortality rate of the TSOC-HFrEF registry remained high. Ultimately, our data indicated a need for further improvement in HF care.

A Special Issue for The 13th Annual Conference of the Taiwan Society for Mass Spectrometry.

A Special Issue for The 13th Annual Conference of the Taiwan Society for Mass Spectrometry.

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.

Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.

Outcomes of limited period of adalimumab treatment in moderate to severe Crohn's disease patients: Taiwan Society of Inflammatory Bowel Disease Study.

Background/AimsIn Taiwan, due to budget limitations, the National Health Insurance only allows for a limited period of biologics use in treating moderate to severe Crohn's disease (CD). We aimed to access the outcomes of CD patients following a limited period use of biologics, specifically focusing on the relapse rate and remission duration; also the response rate to second use when applicable.MethodsThis was a multicenter, retrospective, observational study and we enrolled CD patients who had been treated with adalimumab (ADA) according to the insurance guidelines from 2009 to 2015.ResultsA total of 54 CD patients, with follow-up of more than 6 months after the withdrawal of ADA, were enrolled. The average period of treatment with ADA was 16.7±9.7 months. After discontinuing ADA, 59.3% patients suffered a clinical relapse. In the univariate analysis, the reason for withdrawal was a risk factor for relapse (P=0.042). In the multivariate analysis, current smoker became an important risk factor for relapse (OR, 3.9; 95% CI, 1.2−14.8; P=0.044) and male sex was another risk factor (OR, 2.9; 95% CI, 1.1−8.6; P=0.049). For those 48 patients who received a second round of biologics, the clinical response was seen in 60.4%, and 1 anaphylaxis occurred.ConclusionsFifty-nine percent of patients experienced a relapse after discontinuing the limited period of ADA treatment, and most of them occurred within 1 year following cessation. Male sex and current smoker were risk factors for relapse. Though 60.4% of the relapse patients responded to ADA again.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.

The Ethical Impact on Confucian Society by Individualism : With Taiwan Society as an Example

The Ethical Impact on Confucian Society by Individualism : With Taiwan Society as an Example

2016 Guidelines of the Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology for the management of atrial fibrillation.

Atrial fibrillation (AF) is the most common sustained arrhythmia. Both the incidence and prevalence of AF are increasing, and the burden of AF is becoming huge. Many innovative advances have emerged in the past decade for the diagnosis and management of AF, including a new scoring system for the prediction of stroke and bleeding events, the introduction of non-vitamin K antagonist oral anticoagulants and their special benefits in Asians, new rhythm- and rate-control concepts, optimal endpoints of rate control, upstream therapy, life-style modification to prevent AF recurrence, and new ablation techniques. The Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology aimed to update the information and have appointed a jointed writing committee for new AF guidelines. The writing committee members comprehensively reviewed and summarized the literature, and completed the 2016 Guidelines of the Taiwan Heart Rhythm Society and the Taiwan Society of Cardiology for the Management of Atrial Fibrillation. This guideline presents the details of the updated recommendations, along with their background and rationale, focusing on data unique for Asians. The guidelines are not mandatory, and members of the writing committee fully realize that treatment of AF should be individualized. The physician's decision remains most important in AF management.

Cultural Competence in Taiwan Health Care and Society: Rationale for and State of the Science

Cultural Competence in Taiwan Health Care and Society: Rationale for and State of the Science

Elderly Adults with Late-Onset Ulcerative Colitis Tend to Have Atypical, Milder Initial Clinical Presentations but Higher Surgical Rates and Mortality: A Taiwan Society of Inflammatory Bowel Disease Study

Elderly Adults with Late-Onset Ulcerative Colitis Tend to Have Atypical, Milder Initial Clinical Presentations but Higher Surgical Rates and Mortality: A Taiwan Society of Inflammatory Bowel Disease Study

Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.

The Effect of Ecological Elasticity in Taiwan’s Carbon Reduction Policies: The STIRPAT Model

<p>The challenges from the climate change and the global warming have become one of the most important issues to solve in the world. Under the Kyoto Protocol, countries which have signed the Kyoto Protocol have faced the pressure of reducing greenhouse gas emissions. The two main policies for reducing carbon dioxide are “carbon tax” and “carbon trading”. This research explores which policy will be more suitable for the society and economic environment of Taiwan. This research uses EIA database, the statistical data from the Taiwan Bureau of Energy, Ministry of Economic Affairs, and the data from AREMOS database from 1982 to 2010. The dependent variable is the emission of carbon dioxide, and the independent variables are premium diesel oil price index, population, GDP per capita and the squared term of GDP per capita. The research method is based on the Ordinary Least Squares to estimate the ecological elasticity in the STIRPAT model by analyzing the influence of the change of energy price to the change of the emission of carbon dioxide. From the empirical result, it was discovered that though the energy price and the emission of carbon dioxide was negatively correlated, the ecological elasticity was inelastic. As a result, carbon trading seems a more suitable policy for Taiwan.</p>

Serum Vascular Adhesion Protein-1 Predicts End-Stage Renal Disease in Patients with Type 2 Diabetes.

BackgroundDiabetes is the leading cause of end-stage renal disease (ESRD) worldwide. Vascular adhesion protein-1 (VAP-1) participates in inflammation and catalyzes the deamination of primary amines into aldehydes, hydrogen peroxide, and ammonia, both of which are involved in the pathogenesis of diabetic complications. We have shown that serum VAP-1 is higher in patients with diabetes and in patients with chronic kidney disease (CKD), and can predict cardiovascular mortality in subjects with diabetes. In this study, we investigated if serum VAP-1 can predict ESRD in diabetic subjects.MethodsIn this prospective cohort study, a total of 604 type 2 diabetic subjects were enrolled between 1996 to 2003 at National Taiwan University Hospital, Taiwan, and were followed for a median of 12.36 years. The development of ESRD was ascertained by linking our database with the nationally comprehensive Taiwan Society Nephrology registry. Serum VAP-1 concentrations at enrollment were measured by time-resolved immunofluorometric assay.ResultsSubjects with serum VAP-1 in the highest tertile had the highest incidence of ESRD (p<0.001). Every 1-SD increase in serum VAP-1 was associated with a hazard ratio of 1.55 (95%CI 1.12–2.14, p<0.01) for the risk of ESRD, adjusted for smoking, history of cardiovascular disease, body mass index, hypertension, HbA1c, duration of diabetes, total cholesterol, use of statins, ankle-brachial index, estimated GFR, and proteinuria. We developed a risk score comprising serum VAP-1, HbA1c, estimated GFR, and proteinuria, which could predict ESRD with good performance (area under the ROC curve = 0.9406, 95%CI 0.8871–0.9941, sensitivity = 77.3%, and specificity = 92.8%). We also developed an algorithm based on the stage of CKD and a risk score including serum VAP-1, which can stratify these subjects into 3 categories with an ESRD risk of 0.101%/year, 0.131%/year, and 2.427%/year, respectively.ConclusionsIn conclusion, serum VAP-1 can predict ESRD and is a useful biomarker to improve risk stratification in type 2 diabetic subjects.

A large symptomatic jejunal subepithelial tumor treated with endoloop-assisted polypectomy using spiral enteroscopy.

Jen-Wei Chou, Ken-Sheng Cheng, Ching-Pin Lin Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, College of Medicine, China Medical University, Taichung, Taiwan, ROC, Division of Gastroenterology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC, Taiwan Society of Inflammatory Bowel Disease, Taiwan Association for the Study of Small Intestinal Diseases

A retrospective analysis of 20-year data of the surgical management of ulcerative colitis patients in Taiwan: a study of Taiwan Society of Inflammatory Bowel Disease.

Background/AimsWith the recent progress in medical treatment, surgery still plays a necessary and important role in treating ulcerative colitis (UC) patients. In this study, we analyzed the surgical results and outcomes of UC in Taiwan in the recent 20 years, via a multi-center study through the collaboration of Taiwan Society of IBD.MethodsA retrospective analysis of surgery data of UC patients from January 1, 1995, through December 31, 2014, in 6 Taiwan major medical centers was conducted. The patients' demographic data, indications for surgery, and outcome details were recorded and analyzed.ResultsThe data of 87 UC patients who received surgical treatment were recorded. The median post-operative follow-up duration was 51.1 months and ranged from 0.4 to 300 months. The mean age at UC diagnosis was 45.3±16.0 years and that at operation was 48.5±15.2 years. The 3 leading indications for surgical intervention were uncontrolled bleeding (16.1%), perforation (13.8%), and intractability (12.6%). In total, 27.6% of surgeries were performed in an emergency setting. Total or subtotal colectomy with rectal preservation (41.4%) was the most common operation. There were 6 mortalities, all due to sepsis. Emergency operation and low pre-operative albumin level were significantly associated with poor survival (P=0.013 and 0.034, respectively).ConclusionsIn the past 20 years, there was no significant change in the indications for surgery in UC patients. Emergency surgeries and low pre-operative albumin level were associated with poor survival. Therefore, an optimal timing of elective surgery for people with poorly controlled UC is paramount.

A new start for 'Intestinal Research' as an official journal of AOCC.

On behalf of the Asian Organization for Crohn's and Colitis (AOCC), I am honored to announce that Intestinal Research (Intest Res) becomes the official journal of AOCC and joint publication of the Chinese Society of IBD (CSIBD), the Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Disease (KASID), and the Taiwan Society of IBD (TSIBD). AOCC was founded in 2013 through the collaboration of China, Korea, and Japan to improve the care of patients with IBD in Asia. Since then, AOCC has been constructing a platform to conduct collaborative research in IBD in Asia. I believe that Intest Res will strengthen the network and collaborating research among Asian countries in this field. In this point, publication of Intest Res as the official journal of AOCC is a great milestone for the Asian IBD community. The incidence and prevalence of IBD has been rapidly increasing in Asia during the last several decades, although the incidence in Asia is still lower than western countries. One of the reasons for the lower incidence may be the difference of genetic background. Changes of environmental factors such as diet, microbes or smoking might have led to the increase of the patients. Studies of clinical aspects such as diagnosis and treatment are now in progress. We now realize that there are some similarity and difference in clinical characteristics and response to treatment in Asian patients compared with Westerns'. There remain many challenges in this region regarding diagnosis, treatment, and research of IBD, because there are various kinds of region-specific issues including lifestyle, healthcare system, genetics, and epidemiology. We need to share our information and experience on the care of IBD patients with the rest of world. To meet those demands, Intest Res will provide an excellent platform for Asian doctors to transmit their research to the world. I sincerely believe that Intest Res will play an important role in our collaboration and evolution of AOCC and provide the chance of IBD specialist to hold their tight cooperation for future research of IBD. The advancement of Intest Res is the key to success of IBD research in Asia. I strongly encourage Asian doctors and investigators to actively contribute to our official journal, Intest Res, by submitting original articles and reviews.

2014 Lush Public Awareness Prize Winner: Taiwan Society for the Prevention of Cruelty to Animals (TSPCA), Taiwan

2014 Lush Public Awareness Prize Winner: Taiwan Society for the Prevention of Cruelty to Animals (TSPCA), Taiwan

Cultural Mobilization in Reinvigorating the Rural Society in Taiwan: The Case of the Wanbao Community

Cultural mobilization matters in the process of reinvigorating rural development. Its effectiveness can be well promoted, as the public participation in the locality is included. This paper discuss...

A trend analysis of ergonomic research themes in Taiwan

This paper examines the development of ergonomics in Taiwan by analysing 1404 scientific articles published by 113 permanent members of the Ergonomics Society of Taiwan (EST). Each article was classified by key words and abstract content. Each article was also coded by period of publication (1971–1992 (first period), 1993–1997 (second period), 1998–2002 (third period), 2003–2007 (fourth period), and 2008–2012 (fifth period), and against 13 topic categories. The results show that rate of publication has increased by approximately 100 articles every five years since 1993.The most popular topic was ergonomics assessment and analysis techniques in the first period, force exertion-related research in the second period, product design and evaluation in the third period, occupational safety and health in the fourth period and human–computer interface in the fifth period. Each of these is highly relevant to current contemporary issues around the world. Finally, potential areas for future ergonomics research in Taiwan are discussed.

A Cross-Cultural Study of Perceived Marital Problems in Taiwan and the United States

Research has consistently found an association between marital distress and poor mental and physical health of couples, as well as the impact on maladaptive child outcomes. Several studies have examined the problems that couples experience in the United States, while only one study has in Taiwan. However, there is no cross-cultural research on marital problems between the West and the East to examine how cultures influence couples’ perceived marital problems. This cross-cultural study of marital problems is important because couples in Taiwan and other collectivistic societies might have marital priorities that are unique to their cultural characteristics. Thus, the common marital problems in Western culture might not apply to Eastern culture. In this study, perceptions of marital problems by 213 married couples living in urban Taiwan and 715 couples in the United States were examined. Results indicated the US couples reported significantly more marital problems than did the Taiwan couples in five out of six areas: communication, intimacy/sexual relations, financial matters, division of labor, and power. On the other hand, rearing children was the biggest problem among Taiwan couples, while it was the least commonly reported problem among the US sample. Implications of these findings are discussed for increasing cultural sensitivity in the MFT field.