Taiwan's Health Research Articles

Abstract Su705: Predictive Model and Factors for Out-of-Hospital Cardiac Arrest in Geriatric Patients with insomnia: A Longitudinal Study

Background: Previous studies have shown that geriatric insomnia can impact the quality of life and lead to various health risks and comorbidities, which may further result in out-of-hospital cardiac arrest (OHCA). Therefore, assessing the risk of OHCA in elderly patients with insomnia is crucial. Hypothesis: We hypothesized that a predictive model incorporating demographic, clinical, and treatment adherence factors can effectively estimate the risk of OHCA among geriatric patients with insomnia. Aim: This study aimed to develop and validate a predictive model for OHCA in geriatric patients with insomnia using a large-scale population-based analysis. Method: A retrospective cohort study was conducted using data from Taiwan's Health and Welfare Data Science Center spanning from 2011 to 2020. The study included elderly patients diagnosed with insomnia who received medication. Predictors of OHCA, such as age, sex, comorbidities, medication adherence, and psychotherapy, were analyzed using multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC) with both internal and temporal validation. Results: Among 438,147 eligible elderly patients with insomnia, 7,666 experienced OHCA. Using data from 2011 to 2018 for model development, the AUROC for predicting OHCA within 7 days, 30 days, and 90 days ranged from 0.749 to 0.762 in the training set and 0.768 to 0.784 in the validation set. Key predictors included older age, male sex, prior medical resource use, hemodialysis, pre-existing comorbidities, medication possession ratio, medication changes, and recent psychotherapy (Figure 1). The model was also tested in 2019 and 2020 dataset (began of the COVID-19 in Taiwan), respectively, demonstrating consistent predictive performance (Figure 2). Specifically, the 7-day model in 2019 showed a sensitivity of 0.776, specificity of 0.632, and accuracy of 0.632, with a positive likelihood ratio (PLR) of 2.11, and negative likelihood ratio (NLR) of 0.36. In 2020, it achieved a sensitivity of 0.739, specificity of 0.661, accuracy of 0.661, PLR of 2.18, NLR of 0.40. Conclusion: The study developed a reliable predictive model for OHCA in geriatric patients with insomnia, highlighting significant predictors such as age, comorbidities, medication adherence, and recent psychotherapy. This model can aid clinicians in identifying high-risk patients and improving preventative care strategies.

Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial.

Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date. This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS. The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan. A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference -0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference -0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05). The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients' physical functions and spinal flexibility.

The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study.

In Taiwan's public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. This study aimed to investigate (1) Taiwanese pharmacists' knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19-related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual's KAP and corresponding perspectives toward the NBRS. A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists' KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument's internal consistency reliability was ascertained using Cronbach α (0.819), and its content validity was verified by field experts. Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58% (201/343) and 39% (136/343) held positive and neutral attitudes toward COVID-19-related policies, respectively; and 77% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19-testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan's COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises.

Diurnal temperature range and cardiopulmonary health in Taiwan: Evaluating impacts, thresholds, and vulnerable groups

The health impacts of the diurnal temperature range (DTR), which may be affected by climate change, have received little attention. The objectives of this study were (1) to evaluate the association of DTR and cardiopulmonary outcomes, (2) to select the proper thresholds for a DTR warning system, and (3) to identify vulnerable groups. The weather and health records in Taiwan from 2000 to 2019, with a maximum DTR of 12.8 °C, were analyzed using generalized additive models. The health outcomes included cardiovascular (CVD) and respiratory disease (RD) categories and several sub-categories, such as ischemic heart disease, stroke, pneumonia, asthma, and chronic obstructive pulmonary disease. The results showed that the associations of DTR and cardiopulmonary outcomes were as significant as, and sometimes even stronger than, those of the daily maximum temperature and daily minimum apparent temperature in the warm and cold seasons, respectively. The significant association began at DTR of 6 °C, lower than previously reported. The identified DTR warning thresholds were 8.5 and 11 °C for the warm and cold seasons, respectively. DTR is statistically significantly associated with a 5–36% and a 9–20% increase in cardiopulmonary emergency and hospitalized cases in the warm season with a 1 °C increase above 8.5 °C, respectively. In the cold season, DTR is significantly associated with 7–41%, 4–30%, and 36–100% increases in cardiopulmonary emergency, hospitalized, and mortality with a 1 °C increase above 11 °C, respectively. People with hypertension, hyperglycemia, and hyperlipidemia had even higher risks. Vulnerable age and sex groups were identified if they had a lower DTR–health threshold than the general population, which can be integrated into a warning system. In conclusion, DTR may be increased on a local or city scale under climate change; a DTR warning system and vulnerable group identification may be warranted in most countries for health risk reduction.

The lifestyle of new middle-aged and older adults in Taiwan described by wearable device: age and gender differences.

Studies of lifestyle through comprehensive objective and subjective measurements of health outcomes are lacking. An examination of lifestyle factors in middle-aged and older adults in terms of age, gender, and the interaction effect of age and gender from physiological and psychological perspectives are imperative. Recent advances in technology such as actigraphy have facilitated objective measurements. This exploratory study contributes to research on age and gender interactions on circadian rhythm, physical activity, sleep, and psychological variables by employing wrist accelerometers to measure behavioral circadian rhythm objectively and by using questionnaires to assess psychological status subjectively. The data were drawn from 218 participants aged 50 and older from the "Middle-aged and older adults Chinese Health and Actigraphy in Taiwan (MOCHA-T)". The results: (1) older adult group is associated with declined physical activity (MVPA time 79.9min VS. 107.9min, p = .002), worse sleep efficiency (78.1% VS. 81.9%, p = .008), and earlier lifestyle (Acrophase 14.19h VS. 14.69h, p = .01) comparing to middle-aged group. (2) Women have a more regular lifestyle (Interdaily stability 0.6 VS. 051, p < 0.001), higher physical activity (MVPA time 105.7min VS. 79.3min, p = .004), and better sleep efficiency (81.6% VS. 77.8%, p = .011) than men. (3) Significant age-by-gender interactions existed in life satisfaction (p = .025), relative amplitude (p = .016), and total wake time (p = .038). Furthermore, aging was associated with significant increases in life satisfaction among men as well as significant decreases in relative amplitude and reductions in the total wake time among women. In conclusion, aging exerted differential effects on life satisfaction in men as well as relative amplitude and the total wake time in women. This result highlights disparities in lifestyle arising from interconnected social and biological challenges.

Influenza Infection During Pregnancy and Risk of Seizures in Offspring

Seizure is a common neurological problem among infants and children up to age 6 years. Prenatal exposure to maternal influenza infection has been reported to be associated with childhood seizures. To evaluate the association between maternal influenza infection and risk of childhood seizures. This cohort study identified mother-offspring pairs from January 1, 2004, to December 31, 2013, using records in Taiwan's Maternal and Child Health Database. Mothers who had influenza infection during pregnancy and their first offspring were identified and assigned to the influenza group. Mothers in the control group were those without influenza during pregnancy and were matched 1:4 with mothers in the influenza group by maternal age, offspring sex, and date of delivery. Offspring were followed up until December 31, 2020. Data were analyzed between March 2023 and July 2024. Diagnosis of influenza infection during pregnancy defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes 487.0, 487.1, and 487.8, or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes J09, J10, and J11. The primary outcome was the association between maternal influenza infection during pregnancy and risk of any type of seizures during childhood, including both epilepsy and febrile seizures. Adjusted hazard ratios (AHRs) and 95% CIs were estimated using Cox proportional hazards regression models. Pregnancy-related complications were collected as covariates. A total of 1 316 107 mother-offspring pairs were enrolled, of whom 75 835 mothers (predominant maternal age, 25-29 years; 39 324 male offspring [51.9%]) were assigned to the influenza group and 1 240 272 were matched and assigned to the control group (n = 303 340; predominant maternal age, 30-34 years; 157 296 male offspring [51.9%]). In the influenza group, there was a slightly higher prevalence of placenta previa or abruption compared with the control group (1.6% [1241] vs 1.4% [4350]; P < .001). The cumulative risk of seizures was higher among offspring whose mothers had influenza infection. After controlling for potential confounders, the AHRs were 1.09 (95% CI, 1.05-1.14) for seizures, 1.11 (95% CI, 1.06-1.17) for febrile convulsions, and 1.04 (95% CI, 0.97-1.13) for epilepsy. In the subgroup analysis, no statistically significant differences were observed between the trimesters regarding the timing of influenza infection. Results of this cohort study suggest that maternal influenza infection during pregnancy was associated with an increased risk of childhood seizures, especially febrile seizures, but not epilepsy. Further studies are needed to elucidate the mechanisms underlying childhood neurological development.

Experiences of Male Indonesian Migrant Workers During the COVID-19 Pandemic to Post-Pandemic Period in Taiwan: A Phenomenological Study.

The challenges faced by male migrant workers during the pandemic have not been fully understood. This study aimed to explore the experiences of male Indonesian migrant workers during the COVID-19 pandemic in Taiwan. This study used an interpretive phenomenological design. Twenty male Indonesian migrant workers in southern Taiwan were individually interviewed. Data were analyzed using reflective thematic analysis. The migrant workers had conflicting emotions during the pandemic, faced challenges during self-quarantine, lived on board ships, and experienced restrictions on social and religious activities. The workers prioritized maintaining their health to ensure that they would not be easily infected while working. COVID-19 vaccines were made available to migrant workers in Taiwan. The workers had many hopes that they would achieve a better and more prosperous life by working in Taiwan than in their home country. Although the 3-year COVID-19 period was difficult for Indonesian migrant workers in Taiwan, Taiwan's policies provided hope for them to endure the pandemic. The results have implications for Taiwan's health care system, labor development, and transcultural health care.

Association between methylphenidate use and long-term cardiovascular risk in paediatric patients with attention deficit and hyperactivity disorder

BackgroundThere have been concerns about the potential cardiovascular (CV) adverse effects associated with methylphenidate (MTH) use. However, only limited evidence exists on the long-term safety of MTH.ObjectiveTo evaluate whether MTH...

Ethics and Governance of Artificial Intelligence for Health and Current Situation in Taiwan

&lt;p&gt;現代人工智慧(artificial intelligence，以下簡稱為AI)從數據中學習後並將演算法整合到系統與工具中，使其能夠自動執行任務，讓人類不須再對每一個步驟進行明確的編寫程式。生成式AI為一類AI技術，其演算法被訓練能生成具有原創性的內容，例如文章、圖像或影片等等。世界衛生組織(WHO)首次在2021年6月底公布了一份全面指南：「人工智慧於健康領域之倫理與治理」(Ethics and governance of artificial intelligence for health)。WHO諮詢了20位AI領域頂尖專家並指出了在醫療保健中使用AI的潛在好處和風險，並提出了六項經過共識達成的原則供政府、研究者與醫療提供者在使用AI時參考。這些原則包括：(1)保護人類自主權；(2)促進人類福祉、安全、和公共利益；(3)確保透明度、可解釋性、和可理解性；(4)確立責任歸屬和問責制；(5)確保包容性和公平性；(6)促進具適應性及可持續之人工智慧。&lt;/p&gt; &lt;p&gt;WHO於2024年1月再次更新本指南並探討了生成式AI，即大型多模態模型(Large Multimodal Models, LMMs)，其能接受多種類型的數據輸入並生成多樣的輸出。有研究預測稱LMMs將在醫療保健、科學研究、公共衛生和藥物開發中得到廣泛應用、亦被稱為「通用目的基礎模型」。儘管尚未證明LMMs是否能夠勝任各種程度的工作，不可否認的是其被廣泛應用的速度比歷史上任何工具都更快。LMMs的吸引力在於其透過模仿人類溝通的方式促進了「人機互動」，並在詢問或數據輸入後生成「看似人類」或甚至「權威般」的回應。由於其快速地被大眾接受並使用，以及其潛在顛覆傳統社會服務模式的能力，許多政府機關及企業政府均積極投入發展生成式AI。&lt;/p&gt; &lt;p&gt;WHO發布這份指南，旨在幫助評估使用LMMs在醫療保健方面的權益和挑戰，並制定相對應的政策。本文將簡介這篇指南中關於在醫療領域使用AI的建議與利弊，並討論現今歐盟、美國及台灣在AI領域相關法令以及發展。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Modern AI (artificial intelligence) learns from data and automates tasks, while generative AI creates original content like articles, images, or videos. WHO’s comprehensive guideline &amp;ldquo;Ethics and Governance of Artificial Intelligence for Health&amp;rdquo; released in June 2021 outlines six principles for AI applications in healthcare, including protecting human autonomy and promoting transparency. The principles aim to guide governments, researchers, and healthcare providers in utilizing AI responsibly. &lt;/p&gt; &lt;p&gt; In January 2024, WHO updated its guidelines, focusing on generative AI, particularly Large Multimodal Models (LMMs), which is capable of producing diverse outputs from various data inputs. Despite uncertainties regarding their capabilities, research suggests that LMMs will have broad applications in healthcare and beyond, known as &amp;ldquo;general-purpose baseline models.&amp;rdquo; Their rapid adoption is attributed to their ability to mimic human interaction, potentially disrupting traditional social services, leading to significant investments from governments and enterprises. &lt;/p&gt; &lt;p&gt; WHO releases this guideline to assist in assessing the benefits and challenges of using LMMs in healthcare and to formulate corresponding policies. This article provides an overview of the recommendations and the pros and cons of using AI in the medical field outlined in this guideline, as well as discuss the current EU, US, and Taiwan regulations and developments in the field of AI.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Integrating traditional Chinese Medicine reduced the risk of hip fracture in patients with dementia

Background/purposeThe high incidence of hip fracture is an important problem among dementia patients because of their higher risk of falls and balance deficits due to a lack of physical activity. The aim of this study was to investigate whether traditional Chinese medicine (TCM) therapy could reduce the risk of hip fracture in dementia patients. MethodsWe identified 38,071 patients who were first diagnosed with dementia from January 1, 2000, to December 31, 2017, from the database of the 2000 Longitudinal Generation Tracking Database (LGTD 2000) provided by the Health and Welfare Data Science Center (HWDC) in Taiwan. Patients who received TCM treatment after the initial diagnosis of dementia were assigned to the TCM group, and patients who never received TCM treatment were assigned to the non-TCM group. After performing 1:1 propensity score matching (1:1) based on age, sex, comorbidities and medication between the TCM and non-TCM groups, there were 902 patients in each group. Patients were followed up to December 31, 2018, and incidences of hip fracture after the initial diagnosis of dementia between the two groups were compared with Cox regression analysis. ResultsNinety-four patients in the non-TCM group (10.42%) and 58 patients in the TCM group (6.43%) suffered from hip fracture during the follow-up period. Patients in the TCM group had a lower incidence of hip fracture than those in the non-TCM group (adjusted hazard ratio = 0.54, 95% confidence interval = 0.38–0.76). ConclusionsIntegrating TCM health care for dementia patients might reduce the risk of hip fracture.

Indonesian Students' Mental Health in Taiwan: A Comparison of School-Age Students' and Indonesian Migrant Workers' Mental Health

Spirituality and empathy significantly impact many Indonesian migrant laborers in Taiwan are experiencing mental health issues, highlighting the importance of focusing on this aspect. Non-formal education provides both migrant workers and Indonesian children in Taiwan with suitable educational opportunities. Indonesian students studying in Taiwan: their mental health is analyzed and compared in this research. The study differentiates between students of school age and adult migrant workers studying in Taiwan. Utilizing a case study approach, the research involved seven student participants. The findings indicate that school-age students exhibit good mental health. Conversely, Indonesian migrant workers who are students face numerous challenges in non-formal education. They experience higher levels of stress, struggle to adhere to the learning schedule, frequently miss classes, and consequently, do not achieve optimal learning outcomes. The study also identified some students with autism who receive a specialized curriculum to ensure equal educational opportunities (Selvaprabu et al., 2024). These autistic students appear more disciplined and achieve their learning objectives, although at a slower pace. The research suggests implementing counseling strategies to motivate Indonesian migrant workers to pursue education and achieve equal learning opportunities. Additionally, there is a need for Taiwanese students to have access to their autonomous curriculum

Association between parental well-being and preschooler stress measured as hair cortisol concentration: A prospective cohort study.

Hair cortisol concentration (HCC) is a valuable biomarker for evaluating chronic stress in preschoolers. However, few studies have explored early life HCC and its associated factors. This prospective cohort study analysed the HCC in children aged 6-48months and its associations with parental HCC as well as positive and negative parental mental health outcomes. We used data from the ongoing Longitudinal Examination Across Prenatal and Postpartum Health in Taiwan (LEAPP-HIT) project, conducted in Taipei between 2020 and 2024. Hair samples were collected from both parents and children in 177 families (91 samples obtained during pregnancy and 86 during the postpartum period). The parents also completed self-reported questionnaires. Multiple linear regression was conducted to analyse the data. We observed a significant positive correlation between parents' and preschoolers' HCC. Furthermore, maternal depression (adjusted beta coefficient [aβ]=0.09, 95% confidence interval [CI]=0.02, 0.16) and perceived stress (aβ=0.15, 95% CI=0.02, 0.26) were positively associated with preschoolers' HCC. By contrast, higher maternal eudaimonia was associated with lower HCC in preschoolers (aβ=-0.11, 95% CI=-0.20, -0.01). For parents, maternal depression, anxiety, and perceived stress were independently associated with an increased HCC during the postnatal period, whereas maternal eudaimonia was negatively associated with HCC. Our results indicate that both mothers and fathers affect children's responses to stress. Assessment of cortisol stress hormone concentrations through hair samples can be a key means of detecting preschoolers' stress levels and enabling early intervention.

Characteristics and Prevalence of Vancomycin-variable Enterococcus faecium bacteremia in southern Taiwan

BackgroundVancomycin-variable enterococci (VVE) are vanA-carrying Enterococcus faecium that are phenotypically susceptible to vancomycin and can only be detected using molecular methods, leading to the possibility of treatment failure and posing threats to infection control. This study aimed to determine the prevalence of VVE and its associated clinical risk factors. MethodsThis retrospective study was conducted in two hospitals in southern Taiwan. Patients with phenotypically vancomycin-susceptible E. faecium bacteremia were enrolled between 2017 and 2021. VVEs were defined as isolates harboring the vanA gene that were phenotypically susceptible to vancomycin. Vancomycin-susceptible E. faecium (VSE) isolates were phenotypically susceptible to vancomycin and lacked vanA or vanB genes. ResultsOf the 142 enrolled patients, 121 (85.2%) had VSE and 21 (14.8%) had VVE. Resistance rates to penicillin, tetracycline, and fosfomycin were higher in VVE isolates. Malignancy (adjusted odds ratio [aOR] = 4.87; 95% confidence interval [CI] 1.54–15.41, p = 0.007) and central venous catheter usage (aOR = 4.69; 95% CI 1.49–14.78, p = 0.008) were the independent risk factors associated with VVE bacteremia. Being male (aOR = 0.12, CI 0.03–0.44, p = 0.002) was less likely to be associated with VVE bacteremia. Although VVE was not associated with 30-day mortality (38.1% [VVE] vs. 35.5% [VSE], p = 0.822), one case of subsequent vancomycin-resistant enterococci infection in the VVE group with vancomycin treatment (4.8%, 1/21) was identified, which led to subsequent mortality. ConclusionsThe prevalence of VVE was high among E. faecium isolates with vancomycin-susceptible phenotypes in southern Taiwan. Although the current study revealed that VVE bacteremia was not associated with poor clinical outcome, further multicenter surveillance survey is recommended to evaluate the possible impact of VVE on public health in Taiwan.

Challenges and Strategies of Developing Certified Anesthetist Nurse Practitioners in the Post-Pandemic Era in Taiwan

&lt;p&gt;臺灣的麻醉護理在專業定位、執業範圍、證照考試和標準化訓練制度等方面面臨著諸多挑戰，尤其2020 年衛生福利部雖將麻醉護理師正式納入專科護理師之制度內，但後續所推行之標準化課程也衍生出更多待解決之難題，如：未導入核心能力架構及評量機制、欠缺思考成人學習理論、龐大的訓練課程時數、麻醉專師之師資量能不足及欠缺系統性師資培育等窘境。本文提出二項教育改革的因應策略，首先是建構以勝任能力導向的麻醉專科護理教育架構並發展麻醉訓練專師之系統性評量工具，即「可信賴專業活動」，未來則需建立共創教學和共享資源文化，以促進教師之間的協作和知識分享，期能提高教學品質，並為教師和學員帶來更豐富、多元化的學習體驗。本文呼籲麻醉專師訓練應即刻進行課程再造，打破傳統以知識和時間為本的教學框架，改以混成授課、自主學習作為課程規劃與執行之原則，積極接軌「勝任能力導向教育」的全球發展趨勢，朝向共創、共享之目標邁進。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Anesthetist nurse practitioners in Taiwan encountered several challenges, particularly in terms of professional identity, scope of practice, certification, and standardized training programs. In 2020, the Ministry of Health and Welfare in Taiwan recognized anesthetist nurse practitioner as one of the advanced practice nurses and included them under the regulation of the nurse practitioner system. However, the implementation of the nationwide standardized training program had faced some unre-solved issues and challenges including that the lack of alignment with competency frameworks or pro-grammatic assessments, the extensive increase of training courses, neglects of adult learning theories, shortage of nurse anesthetists instructors, and lack of faculty development system for nurse anesthetist instructors. This article proposes two initiatives as responses to educational reform: 1. constructing a competency-based framework and developing programmatic assessments for training Student Reg-istered Nurse Anesthetist Nurse Practitioner (SRNANP) ; 2. establishing a culture of collaborative teaching and resource sharing. The new culture enhances teaching quality and provides a richer, more diverse learning experience for both trainers and trainees. The article emphasizes the need for im-mediate curriculum transformation in SRNANP training. It emphasizes on the removal of traditional knowledge-centric and time-centric teaching frameworks and focused on adopting blended learning and self-directed learning principles. By aligning with the global trend of competency-based educa-tion, we can actively move toward the goal of co-creation and resource sharing&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Prevalence, trends, and specialized palliative care utilization in Taiwanese children and young adults with life-limiting conditions between 2008 and 2017: a nationwide population-based study

BackgroundPrevious studies have shown a growing need for pediatric palliative care, but there is a lack of knowledge in many countries concerning prevalence of service use among children and young adults with life-limiting conditions. This study aimed to estimate (1) the annual prevalence of children and young adults with a life-limiting condition, and (2) their specialized palliative care and other healthcare utilization.MethodsData from the Health and Welfare Data Science Center in Taiwan were used. All children and young adults aged 0–25 years recorded in inpatient or outpatient data, and infants aged < 1 year in death data with a life-limiting condition diagnostic code from 2008 to 2017 were recruited. Poisson regression was used to estimate the crude and adjusted relative risk of prevalence of life-limiting conditions with 95% confidence intervals, adjusted for age and sex, and to evaluate the trend in prevalence of each life-limiting diagnostic groups, in specialized palliative care and other service use.ResultsData contained 236,250 individuals with a life-limiting condition, of which oncological and congenital abnormalities were the most common. There was an annualized increase over 10 years in the prevalence of life-limiting conditions of 36.4%, from 45,311 cases (59.4 per 10,000 population) to 52,226 cases (81.0 per 10,000 population), with the highest prevalence in individuals aged 21–25 years. All diagnostic groups showed significant increases in prevalence (p < .001) with the exception of oncology, circulatory, and “other” group. Specialized palliative care services, including family consultation, shared care, home visits have increased in use over time (p < .001), while inpatient hospice has slightly decreased. The highest prevalence of healthcare use was for traditional Chinese medicine (237.1 per 1,000 population in 2017), but this decreased over time (p < .001).ConclusionsDue to a growing trend towards multidisciplinary care, healthcare professionals and policymakers must engage and take action to expand specialized palliative care and integrate delivery of other healthcare services. Traditional Chinese medicine having a decreasing slope, yet still the highest prevalence of use, needs further attention.

Concomitant use of antidepressants and benzodiazepines during pregnancy and associated risk of congenital malformations: a population-based cohort study in Taiwan

Despite the frequent co-administration of antidepressants and benzodiazepines, the association between such concomitant use during pregnancy and the risk of congenital malformations remains inadequately explored. This study aims to examine the association between concomitant use of antidepressants and benzodiazepines during the first trimester and organ-specific congenital malformations. We conducted a population-based cohort study using Taiwan's National Birth Certificate Application database, the Maternal and Child Health database, and Taiwan's National Health Insurance database. Pregnant people aged 15-50 years with singleton births between Jan 1, 2004, and Dec 31, 2018, were included. Use of antidepressants and benzodiazepines was defined as at least one prescription during the first trimester, and concomitant use was defined as the overlapping prescription of both drugs with an overlapping prescription period. The primary outcomes were overall congenital malformations and eight organ-specific malformations, consisting of the nervous system, heart, respiratory system, oral cleft, digestive system, urinary system, genital system, and limb malformations. Logistic regression models with propensity score fine stratification weighting approach were used to control for measured confounders. Analyses controlling for confounding by indication and sibling comparison analyses were done to address unmeasured confounders. No individuals with lived experience participated in the research or writing process. The cohort included 2 634 021 singleton pregnancies, and 8599 (0·3%) individuals were concomitant users of antidepressants and benzodiazepines during the first trimester (mean age at delivery was 31·8 years [SD 5·2] for pregnancies with exposure to antidepressants and benzodiazepines vs 30·7 years [SD 4·9] for pregnancies without exposure). All study participants were female, and information about ethnicity was not available. Absolute risk of overall malformations was 3·81 per 100 pregnancies with exposure, compared with 2·87 per 100 pregnancies without exposure. The propensity score-weighted odds ratios (weighted ORs) did not suggest an increased risk for overall malformations (weighted OR 1·10, 95% CI 0·94-1·28), heart defects (1·01, 0·83-1·23), or any of the other organ-specific malformations, except for digestive system malformations, for which the weighted OR remained statistically significant after adjustment (1·63, 1·06-2·51). The absence of an increased risk for overall congenital malformations associated with concomitant use of antidepressants and benzodiazepines was supported by the analyses controlling for confounding by indication and sibling-matched comparisons. The findings of this study suggest that the concomitant use of antidepressants and benzodiazepines during the first trimester is not associated with a substantial increase in risk for most malformation subtypes. However, considering other potential adverse effects of using both medications concomitantly, a thorough assessment of the risks and benefits is crucial for clinical decision making. National Science and Technology Council.

Nationwide Big Data Analysis of Statin Use and Intracerebral Hemorrhage Risk in Acute Ischemic Stroke Patients in Taiwan.

Background and Objectives: Although statins are recommended for secondary prevention of acute ischemic stroke, some population-based studies and clinical evidence suggest that they might be used with an increased risk of intracranial hemorrhage. In this nested case-control study, we used Taiwan's nationwide universal health insurance database to investigate the possible association between statin therapy prescribed to acute ischemic stroke patients and their risk of subsequent intracerebral hemorrhage and all-cause mortality in Taiwan. Materials and Methods: All data were retrospectively obtained from Taiwan's National Health Insurance Research Database. Acute ischemic stroke patients were divided into a cohort receiving statin pharmacotherapy and a control cohort not receiving statin pharmacotherapy. A 1:1 matching for age, gender, and index day, and propensity score matching was conducted, producing 39,366 cases and 39,366 controls. The primary outcomes were long-term subsequent intracerebral hemorrhage and all-cause mortality. The competing risk between subsequent intracerebral hemorrhage and all-cause mortality was estimated using the Fine and Gray regression hazards model. Results: Patients receiving statin pharmacotherapy after an acute ischemic stroke had a significantly lower risk of subsequent intracerebral hemorrhage (p < 0.0001) and lower all-cause mortality rates (p < 0.0001). Low, moderate, and high dosages of statin were associated with significantly decreased risks for subsequent intracerebral hemorrhage (adjusted sHRs 0.82, 0.74, 0.53) and all-cause mortality (adjusted sHRs 0.75, 0.74, 0.74), respectively. Conclusions: Statin pharmacotherapy was found to safely and effectively reduce the risk of subsequent intracerebral hemorrhage and all-cause mortality in acute ischemic stroke patients in Taiwan.

Genetic predisposition to bone mineral density and their health conditions in East Asians.

Osteoporosis, a condition defined by low BMD (typically < -2.5 SD), causes a higher fracture risk and leads to significant economic, social, and clinical impacts. Genome-wide studies mainly in Caucasians have found many genetic links to osteoporosis, fractures, and BMD, with limited research in East Asians (EAS). We investigated the genetic aspects of BMD in 86 716 individuals from the Taiwan Biobank and their causal links to health conditions within EAS. A genome-wide association study (GWAS) was conducted, followed by observational studies, polygenic risk score assessments, and genetic correlation analyses to identify associated health conditions linked to BMD. GWAS and gene-based GWAS studies identified 78 significant SNPs and 75 genes related to BMD, highlighting pathways like Hedgehog, WNT-mediated, and TGF-β. Our cross-trait linkage disequilibrium score regression analyses for BMD and osteoporosis consistently validated their genetic correlations with BMI and type 2 diabetes (T2D) in EAS. Higher BMD was linked to lower osteoporosis risk but increased BMI and T2D, whereas osteoporosis linked to lower BMI, waist circumference, hemoglobinA1c, and reduced T2D risk. Bidirectional Mendelian randomization analyses revealed that a higher BMI causally increases BMD in EAS. However, no direct causal relationships were found between BMD and T2D, or between osteoporosis and either BMI or T2D. This study identified key genetic factors for bone health in Taiwan, and revealed significant health conditions in EAS, particularly highlighting the genetic interplay between bone health and metabolic traits like T2D and BMI.

Health-related inequalities in out-of-pocket expenditure under universal health coverage in Taiwan: A cross-sectional decomposition analysis.

Studies have investigated income-related inequality in out-of-pocket expenditure (OOPE) on health care but less is known about health-related inequality of OOPE distribution. This study analysed the relationship between health-related inequality and OOPE and the factors contributing to OOPE inequality in Taiwan. We developed a household OOPE questionnaire and conducted a nationally representative cross-sectional survey of households in Taiwan between January and August 2022, using two-stage probability proportional-to-size sampling based on a national address registry in Taiwan. We calculated a concentration index to determine OOPE inequality in health. We then identified factors contributing to OOPE inequality in health distribution by performing a decomposition analysis. A total of 657 people responded to the survey (81.4% response rate). The two largest categories of OOPE were spending on curative care and on medical goods and pharmaceuticals, with concentration indices of -0.265 (p < .001), -0.272 (p = .006) and -0.227 (p = .003), respectively, indicating that the OOPE burden fell disproportionately on people with poor health. Socioeconomic status explained significant proportions of inequality in total, curative and medical goods and pharmaceuticals OOPE. Utilisation of health care increased the OOPE burden among people with poor health while having private health insurance worked in the opposite direction. In Taiwan, people in poor health faced a disproportionately high OOPE burden, indicating that the National Health Insurance scheme may not meet their needs for health care. There is a need for policies to take account of the different factors affecting health inequalities in OOPE in order to enhance equity in Taiwan's universal health system.

Abstract PO1-10-09: The Performance Of Mobile Units Versus Hospital Units In National Breast Cancer Screening Program In Taiwan, 2010-2020

Abstract Purpose After the implementation of mobile units, the screened population increased from 3.9% to 40% of all women from 2004 to 2019 in Taiwan’s Breast Cancer Screening Program. There are limited studies comparing mobile units to hospital units. This study evaluated and compared the performance of the biennial mammography breast cancer screening in mobile units to hospital units in Taiwan over the past decade. Methods A cohort of 3 062 190 women aged 40 to 69 years who underwent biennial breast cancer mammography screenings from 2010 to 2020 was conducted, and data were obtained from the Health Promotion Administration, Ministry of Health and Welfare of Taiwan. Comparing participation of screened women mobile units and hospital units across national screening. Performance measures were determined as percentages and 95% confidence intervals (CIs) using the Wald asymptotic method. Results Among 3 062 190 women who underwent 7 444 450 examinations in the study population, the screened population by mobile units accounted for approximately 45.45 % of total examinations. The volume of screening mammograms performed in the mobile unit increased the number of people reached by this program. Since 2015, screenings performed in the mobile units have outnumbered those performed at brick-and-mortar hospitals: they comprised 480 456 of the 859 221 examinations (55.9%) performed in 2019. During the 10-year periods, the screen-detected cancers were 12 000 and 18 370 for mobile units and hospital units, respectively. Young women preferred screening in hospitals, resulting in a greater proportion of screen-detected cancers among those attending hospitals (49.4%) compared to the mobile unit (34.3%). The mean recall rate was higher in the hospitals at 8.95% (95% CI, 8.93%-8.99%) than in the mobile units at 7.27% (95% CI, 7.25%-7.32%). Conclusion Implementing mobile units increased the coverage of the screening program across the population. Hospital units had a younger patient population and higher recall rate than those mobile units. We can enhance mammography screening rates and follow-up among these groups by identifying these features, which can use to develop programs and materials fitting populations' specific requirements. Summary statement In Taiwan, the development of breast cancer screening has shown beneficial outcomes, especially with the deployment of mobile unit services to increase screened women. Our results could serve as an informative reference for other nations. Keywords: Breast cancer; screening; mobile units; hospital units. Table 1. Clinical Demographics for Mammographic Screening Examinations Table 2. Performance Measures of Digital Mammographic Screenings for Breast Cancer Citation Format: Vy Vu, Amy Ming-Fang Yen, Melissa Min-Szu Yao, Wing P. Chan. The Performance Of Mobile Units Versus Hospital Units In National Breast Cancer Screening Program In Taiwan, 2010-2020 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-09.