Associations of hyperglycemic emergency and severe hypoglycemia incidences with seasonality and ambient temperature among pregnant women with diabetes: a nested case-control study in Taiwan

BACKGROUND@#Associations of acute glycemic complications with season and ambient temperature have been reported in general population with diabetes. However, little is known about the risks of acute glycemic complications in relation to season and ambient temperature in pregnant women, who are likely to be even more vulnerable. This work aimed to investigate the associations of season and ambient temperature with pregnancies complicated with hyperglycemia emergency or severe hypoglycemia.@*METHODS@#Two separate case-control studies were nested within 150,153 pregnancies by women with type 1, type 2, or gestational diabetes between 2009 and 2014 in Taiwan. Hyperglycemia emergency (mainly diabetic ketoacidosis and hyperosmolar hyperglycemic state) and severe hypoglycemia occurred in 77 and 153 diabetic pregnancies (cases), respectively. Ten control pregnancies were randomly selected for each case by matching each case pregnancy on type of diabetes (i.e., T1DM, T2DM, or GDM), maternal age on the date of acute glycemic complication occurrence (i.e., index date), and "length of gestation at risk" (i.e., period between conception and index date). Meteorological parameters were retrieved from 542 meteorological monitoring stations across Taiwan during 2008-2014. Conditional logistic regression analysis with generalized estimation equation was separately performed to estimate the covariate adjusted odds ratios (ORs) of each of the two acute glycemic complications in association with season and ambient temperature within 30 days prior to the index date.@*RESULTS@#Compared to summer, winter season was associated with a significantly elevated risk of severe hypoglycemia with an OR of 1.74 (95% confidence interval (CI) 1.08-2.79). The OR of hyperglycemic emergency was also elevated in winter season at OR of 1.88, but the significance is only marginal (95% CI 0.97-3.64, p = 0.0598). Subgroup analyses further noted that such seasonal variation was also observed in pregnancies with pre-pregnancy type 1 diabetes and gestational diabetes. On the other hand, ambient temperature was not significantly associated with the two acute glycemic complications.@*CONCLUSIONS@#A moderately but significantly elevated risk of severe hypoglycemia was found in pregnant women with diabetes during winter season, and such increased risk was more evident in pregnancies with T1DM.

Unity and separation of lifting-thrusting and twirling reinforcing-reducing manipulation / 中国针灸

To analyze the collaborative use and separation reasons of lifting-thrusting and twirling reinforcing and reducing manipulation. Lifting-thrusting manipulation and twirling manipulation are two important contents of acupuncture methods. In traditional acupuncture and moxibustion, the two methods were used in reinforcing and reducing concert, which was mainly related to the therapeutic thought guided by the

Health literacy and depression in women with type 2 diabetes mellitus

OBJECTIVES: The prevalence of diabetes mellitus has recently increased in Taiwan, and depression is common among these patients. Moreover, a lack of health literacy may lead to depression. In this study, we explored the correlation between health literacy and depression in diabetic women. METHODS: In this cross-sectional study, 152 women with type 2 diabetes mellitus were recruited from the outpatient clinic of a regional teaching hospital in Taiwan. The data were collected through medical records and a self-reported structured questionnaire, which included items on basic attributes, self-rated health status, the Center for Epidemiologic Studies Depression Scale (CES-D), and Chinese Health Literacy Scale for Diabetes (CHLSD). The results were analyzed using descriptive statistical analyses, bivariate correlation tests, and linear regression analyses. RESULTS: One hundred thirty-five valid questionnaires were obtained. Approximately 20% of the participants had a higher tendency toward depression as per their CES-D score, and the CHLSD results showed that 13.33% had poor health literacy. There was a negative correlation between health literacy and depressive tendencies after adjusting for self-rated health status, economic satisfaction status, employment status, and education level using multivariate linear regression analyses. For each 1-point rise in the CHLSD score, the CES-D score decreased by 0.17 points (z=−2.05, p=0.042). CONCLUSIONS: A negative correlation was identified between health literacy and depression. Self-rated health status, economic satisfaction, employment status, and higher education level are factors that also affect depressive tendency among diabetic women.

PM

BACKGROUND@#Particulate matter (PM) < 2.5 μm (PM@*METHODS@#We obtained DNA methylation and exercise data of 496 participants (aged between 30 and 70 years) from the Taiwan Biobank (TWB) database. We also extracted PM@*RESULTS@#DLEC1 methylation and PM@*CONCLUSIONS@#We found significant positive associations between PM

Discussion on the needling technique with filiform needle in acupuncture-moxibustion teaching materials in the Republic of China / 中国针灸

Through collecting the literature data of the needling technique with filiform needle in 20 acupuncture-moxibustion teaching materials in the Republic of China， the manipulation techniques with filiform needle were analyzed, such as the technique of needle insertion, the technique of reinforcing and reducing, and the management of acupuncture abnormal conditions, as well as manual techniques and analgesics methods. It is found that the era of the Republic of China was the transition period of traditional acupuncture techniques to the modern ones in acupuncture-moxibustion teaching materials, in which, the twirling technique was predominated in the technique of needle insertion. In that period, the insertion technique of tube needle had been introduced and simplified, the theory and method of the new-style technique of reinforcing and reducing were emerged and the types of acupuncture abnormal conditions recorded in the teaching materials were different from those at present. Additionally, the applicable manipulation had not been specified nationally. There were the highly influential teaching materials, i.e. , and . The acupuncture-moxibustion teaching materials in the Republic of China has been influenced by the transition of acupuncture-moxibustion education modes, the introduction of Chinese-translation version of Japanese acupuncture-moxibustion books, the academic thoughts of acupuncture masters and the manufacturing process of needle devices.

Reducing the consumption of personal protective equipment by setting up a multifunctional sampling station in the emergency department to screen for COVID-19 infection in Taiwan

In Taiwan, high-risk patients have been identified and tested for preventing community spread of COVID-19. Most sample collection was performed in emergency departments (EDs). Traditional sample collection requires substantial personal protective equipment (PPE), healthcare professionals, sanitation workers, and isolation space. To solve this problem, we established a multifunctional sample collection station (MSCS) for COVID-19 testing in front of our ED. The station is composed of a thick and clear acrylic board (2 cm), which completely separates the patient and medical personnel. Three pairs of gloves (length, 45 cm) are attached and fixed on the outside wall of the MSCS. The gloves are used to conduct sampling of throat/nasal swabs, sputum, and blood from patients. The gap between the board and the building is only 0.2 cm (sealed with silicone sealant). ED personnel communicate with patients using a small two-way broadcast system. Medical waste is put in specific trashcans installed in the table outside the MSCS. With full physical protection, the personnel conducting the sampling procedure need to wear only their N95 mask and gloves. After we activated the station, our PPE, sampling time, and sanitization resources were considerably conserved during the 4-week observation period. The MSCS obviously saved time and PPE. It elevated the efficiency and capacity of the ED for handling potential community infections of COVID-19.

The Third Asian Radiology Forum: Screening Programs in Asia

Bibliometrics of Vietnam Publications in the Science Citation Index: general trends and comparison with other tropical countries / Bibliometría de las publicaciones de Vietnam en el Science Citation Index: tendencias generales y comparación con otros países tropicales

Introduction: The economy of Vietnam, a highly populated tropical country with a per capita gross domestic product of $ 8 000, is growing rapidly, but there are few recent studies of general scope about its scientific productivity and how it compares with other tropical countries. Objective: To identify trends in Vietnamese science and compare them with trends in other tropical countries. Methods: We extracted data about scientific papers, in all disciplines that had Vietnam as country in the Science Citation Index Expanded for the period 1991 to 2018, focusing on type of publication, language, subject, authorship, collaboration, and citations. Results: Vietnam publishes more document types than other tropical countries, and those in this particular database are mostly in English, albeit most Vietnamese science is published in Vietnamese and not covered by the index. The primary categories were multidisciplinary materials science, mathematics, and applied mathematics. Most collaboration was done with the USA, Japan, South Korea, and France. A large number of articles were published by the Vietnam Academy of Science and Technology, and the most frequent foreign collaboration was with the University of Oxford. Conclusion: The tropical countries of Latin America, Africa, and Asia studied in our project have some similarities but also crucial differences. Science is developing rapidly in Vietnam and the production of articles in Vietnamese, which represent the vast majority of research in the country but is not included in this database, should also be studied.

Introducción: La economía de Vietnam, un país tropical muy poblado con un producto interno bruto per cápita de $ 8000, está creciendo rápidamente, pero hay pocos estudios recientes y de enfoque general sobre su productividad científica y cómo se compara con la de otros países tropicales. Objetivo: Identificar tendencias en la ciencia vietnamita y compararlas con las tendencias en otros países tropicales. Métodos: Extrajimos datos sobre artículos científicos, en todas las disciplinas que tenían a Vietnam como "país" en el Science Citation Index Expanded para el período 1991 a 2018, centrándonos en el tipo de publicación, idioma, tema, autoría, colaboración y citas. Resultados: Vietnam publica más tipos de documentos que otros países tropicales, y los de esta base de datos en particular están principalmente en inglés, aunque la mayoría de la ciencia vietnamita se publica en vietnamita y no está cubierta por el índice. Las categorías principales fueron ciencia de materiales (estudios multidisciplinarios), matemáticas y matemáticas aplicadas. La mayor parte de la colaboración se realizó con EE. UU., Japón, Corea del Sur y Francia. La Academia de Ciencia y Tecnología de Vietnam publicó una proporción importante de estos artículos, y la colaboración extranjera más frecuente fue con la Universidad de Oxford. Conclusión: los países tropicales de América Latina, África y Asia estudiados en nuestro proyecto tienen tanto similitudes como diferencias importantes con Vietnam. La ciencia en Vietnam está en una etapa de crecimiento y convendría estudiar los artículos que se publican en vietnamita, los cuales representan la amplia mayoría de la ciencia del país, pero no se incluyen en esta base de datos.

Relationships of homophobic bullying during childhood and adolescence with problematic internet and smartphone use in early adulthood among sexual minority men in Taiwan

Abstract Background Mental health disparity in sexual minorities is a crucial clinical and public health issue worldwide. A total of 500 homosexual or bisexual men aged between 20 and 25 years participated in this study. Objectives The aims of the study were to examine the relationships of victimization of traditional and cyber homophobic bullying during childhood and adolescence with problematic internet and smartphone use and activities during early adulthood among sexual minority men in Taiwan. Methods The seveirities of problematic internet and smartphone use and activities in early adulthood were compared between victims and non-victims of bullying. The severities of problematic internet and smartphone use were also compared among the groups of various types of bullying as well as among the groups of various persistence durations of being bullied. Results Victims of traditional and cyber homophobic bullying had more severe problematic internet and smartphone use than non-victims. Victims of multi-type bullying had more severe problematic internet use than victims of single-type bullying. Prolonged victimization was significantly associated with problematic internet and smartphone use. Discussion: Victimization of traditional and cyber homophobic bullying during childhood and adolescence predicts problematic internet and smartphone use during early adulthood among sexual minority men.

Prior uterine myoma and risk of ovarian cancer: a population-based case-control study / 부인종양

OBJECTIVE: Uterine myoma which results in the magnitude of ovarian cancer remains uncertain. This study aimed to assess the association between women with previous uterine myoma and the risk of ovarian cancer. METHODS: This population-based case-control study was conducted using the Taiwan National Health Insurance Research Database between 2006 and 2010. We identified 4,088 adult women with newly diagnosed ovarian cancer with 16,348 women without ovarian cancer matched for age, urbanization level, income and initial diagnosis date. Logistic regression analyses were used to evaluate the variables associated with ovarian cancer. In addition, the effect of surgical interventions on the risk of ovarian cancer was also evaluated. RESULTS: Women with previous uterine myoma were more likely than those who did not to have ovarian cancer (adjusted odds ratio [aOR]=2.26; 95% confidence interval [CI]=2.06−2.49). Patients with uterine myoma who either received (aOR=1.79; 95% CI=1.51−2.13) or did not receive hormone replacement therapy (aOR=2.51; 95% CI=2.24−2.82) experienced a significantly higher risk of ovarian cancer than those without uterine myoma, respectively. However, patients with uterine myoma who underwent either myomectomy (aOR=0.55; 95% CI=0.39−0.77) or hysterectomy (aOR=0.33; 95% CI=0.26−0.42) had a significantly lower risk of ovarian cancer. CONCLUSION: The results revealed that a significantly higher risk of ovarian cancer in women with previous uterine myoma, through an indirect mechanism. Furthermore, a lower risk of ovarian cancer was observed in women who underwent surgical removal of the uterine myoma.

Impact of socio-demographic factors, lifestyle and health status on nutritional status among the elderly in Taiwan

BACKGROUND/OBJECTIVES: Aging is an imperative problem for many countries in this century, and presents several challenges for the maintenance of good nutritional status. This study aims to assess the impact of socio-demographic factors, lifestyle and health status on the nutritional status among the elderly in Taiwan. SUBJECTS/METHODS: A cross-sectional study was carried out in Taiwan. Data were obtained from the Mei Jau Health Management Institution, which is a private health evaluation provider with multiple health screening centers in Taiwan and Asia. This study included 7947 adults aged 65 years or above. The data were extracted between 2001 to 2010. Nutritional status was assessed using anthropometric data, biochemical data and dietary intake information. RESULTS: Among the 7947 participants with mean age of 70.1 (SD = 4.5) years, 20.2%, 6.6%, 10.5% and 52.5% experienced underweight, protein malnutrition, anemia and inadequate dietary intake in the past month, respectively. Age was negatively correlated with body weight (r = −0.19, P = 0.02), body mass index (r = −0.41, P < 0.001), albumin level (r = −0.93, P < 0.001) and hemoglobin level (r = −0.30, P = 0.008). Age above 70 years, gender, unmarried status, retirement, lack of education, low family income, smoking, alcohol drinking, sleep duration of 6-8 hours, vegetarian diet, multiple medications, comorbidity and dysphagia were positively associated with malnutrition in older adults. CONCLUSIONS: Underweight and inadequate dietary intake are prevalent among the elderly in Taiwan. Vegetarian diet, multiple medications, comorbidity, dysphagia and lifestyle factors such as smoking, alcohol drinking and sleep duration of 6–8 hours are risk factors for undernutrition in older adults.

A Cross-sectional Study of Cancer Knowledge and Beliefs Among Faith-based Chinese in the USA Versus Taiwan / 예방의학회지

OBJECTIVES: This study examined cancer knowledge, beliefs, and practice among faith-based Chinese in the USA versus Taiwan to gain better understandings on how environment and culture might play a role for tailored cancer education programs. METHODS: A self-administered survey included a validated 10-item Cancer Screening Belief Scale (CSBS), an 8-item Cancer Screening Knowledge Test (CSKT), and a 14-item cancer Warning Signs Test (CWST) was administered. Participants were recruited from 9 Chinese churches (5 in the USA and 4 in Taiwan). RESULTS: A total of 372 Chinese participated, 50% lived in the USA and 50% in Taiwan. Mean age was 44.31 (standard deviation, 14.74), 60% males, and majority had college education (85%). Taiwan participants scored higher on both CSKT (6.13 vs. 5.52; p < 0.001) and CWST (6.80 vs. 5.38; p < 0.001). Although perceived screening benefits and barriers were similar, Taiwan participants endorsed higher on screening norms (11.67 vs. 10.82; p < 0.001). Taiwan participants also indicated more doctor recommending cancer screenings (42.1% vs. 29.6%; p=0.015), USA participants were more likely to have had annual health exams (65.4% vs. 48.9%; p=0.002). Regression results showed that those resided in the USA were 2.38 times more likely to report annual health exams. Married status (odds ratio [OR], 2.85), college education (OR, 2.38), doctor’s recommendation (OR, 2.87), no family cancer history (OR, 2.47), and those with lower barriers were significant factors on annual health exams. CONCLUSIONS: Taiwan participants scored higher on cancer knowledge and screening norms, while more USA participants reported annual health exams. Taiwan’s universal healthcare might play a role on the different healthcare seeking patterns.

Reality of Kawasaki disease epidemiology / 소아과

Epidemiologic studies of Kawasaki disease (KD) have shown a new pattern or change of its occurrence suggestive of its pathophysiology or risk factors from the first patient with KD reported in 1961. The incidence of KD in Northeast Asian countries including Japan, South Korea, China, and Taiwan is 10–30 times higher than that in the United States and Europe. Knowing the true epidemiology of KD in each country and the availability of publications of KD epidemiology also could benefit general health care providers and general population. This would enable the early detection and treatment of KD, ultimately reducing the incidence of coronary artery complications and mortality. Therefore, efforts to investigate the true epidemiology of KD should be continued in every country using a questionnaire survey, National Health Insurance system data, or combined methods depending on each country’s medical environment to ensure high-quality care of patients with KD.

Development of an oligonucleotide microarray for simultaneous detection of two canine MDR1 genotypes and association between genotypes and chemotherapy side effects

Canine MDR1 gene mutations produce translated P-glycoprotein, an active drug efflux transporter, resulting in dysfunction or over-expression. The 4-base deletion at exon 4 of MDR1 at nucleotide position 230 (nt230[del4]) in exon 4 makes P-glycoprotein lose function, leading to drug accumulation and toxicity. The G allele of the c.-6-180T>G variation in intron 1 of MDR1 (single nucleotide polymorphism [SNP] 180) causes P-glycoprotein over-expression, making epileptic dogs resistant to phenobarbital treatment. Both of these mutations are reported to be common in collies. This study develops a more efficient method to detect these two mutations simultaneously, and clarifies the genotype association with the side effects of chemotherapy. Genotype distribution in Taiwan was also investigated. An oligonucleotide microarray was successfully developed for the detection of both genotypes and was applied to clinical samples. No 4-base deletion mutant allele was detected in dogs in Taiwan. However, the G allele variation of SNP 180 was spread across all dog breeds, not only in collies. The chemotherapy adverse effect percentages of the SNP 180 T/T, T/G, and G/G genotypes were 16.7%, 6.3%, and 0%, respectively. This study describes an efficient way for MDR1 gene mutation detection, clarifying genotype distribution, and the association with chemotherapy.

Novel application of Influenza A virus-inoculated chorioallantoic membrane to characterize a NP-specific monoclonal antibody for immunohistochemistry assaying

Monoclonal antibodies (MAbs) are widely applied in disease diagnoses. Herein, we report a MAb, WF-4, against Influenza A virus nucleoprotein (NP), its broad response with Influenza A virus, and its application in an immunohistochemistry (IHC) assay. WF-4 was screened by immunofluorescence assay (IFA). The results showed that its reactivity with baculovirus-expressed full-length recombinant NP (rNP) in Western blot (WB), indicating its IHC applicability. Fifteen Influenza A virus (reference subtypes H1 to H15) infected chicken embryonated chorioallantoic membranes (CAM), fixed by formalin, were all detectable in the WF-4-based IHC assay. Also, the reactivity of the IHC test with NP from experimentally inoculated H6N1 and from all recent outbreaks of H5 subtype avian Influenza A virus (AIV) field cases in Taiwan showed positive results. Our data indicate that CAM, a by-product of Influenza A virus preparation, is helpful for Influenza A virus-specific MAb characterization, and that the WF-4 MAb recognizes conserved and linear epitopes of Influenza A virus NP. Therefore, WF-4 is capable of detecting NP antigens via IHC and may be suitable for developing various tests for diagnosis of Influenza A virus and, especially, AIV infection.

Systematic Review on Research Status of Workplace Violence / 이화의대지

OBJECTIVES: Research on workplace violence has been conducted, but rarely has been organized systematically. In this study, we summarize the definition and classification of workplace violence studies and review the literature on workplace violence. METHODS: Using academic search engines PubMed, Google Scholar and DBpia, we found 856 papers including “workplace violence” and “adverse social behavior” AND workplace in the title published until December 2018, and 208 papers were selected. The selected papers were classified by continent and country, year of publication, occupation, classification criteria of workplace violence, and research topic. RESULTS: By country, the number of articles in the United States was the most with 40 (19.2%), followed by China 27 (13%), Korea 16 (7.7%), and Taiwan and Australia 15 (7.2%). By job category, healthcare workers accounted for the largest portion with 162 (79.0%) of the total, and 80 of them were conducted on nurses. Other occupations included civil servants, manufacturing workers, toll collectors and wageworkers. Among the classification methods of workplace violence, 147 (67.4%) articles were classified as type and there was a difference in the type of violence defined for each article. In the research topic, 114 (44.2%) articles analyzed the effects of workplace violence, and 105 (40.7%) articles describe the prevalence and characteristics of workplace violence, and 23 (8.9%) articles analyzing the causes of violence. CONCLUSION: The research topic is biased toward the field of healthcare, so it is necessary to expand to include various occupations or other specified occupations. It is also necessary to prepare appropriate measures against workplace violence.

Foreign Systems of Education for Gastrointestinal Fellows / 대한소화기학회지

There is a growing interest in gastroenterology and hepatology fellowship training in Korea and other countries. The Korean Society of Gastroenterology held an international symposium for gastroenterology and hepatology fellowship training, titled, “GI Fellow Training in Asia-Pacific Countries” on April 14, 2018. The Japanese education system was different for each hospital. The American societies for gastroenterology set up their education system together and have continued with frequent modification. The Taiwan and Singapore education systems are well organized and localized. We need a well-organized and sustainable education system for gastroenterology and hepatology fellowship training suitable for Korea.

An expert-led and artificial intelligence system-assisted tutoring course to improve the confidence of Chinese medical interns in suturing and ligature skills: a prospective pilot study / 보건의료교육평가

PURPOSE: Lack of confidence in suturing/ligature skills due to insufficient practice and assessments is common among novice Chinese medical interns. This study aimed to improve the skill acquisition of medical interns through a new intervention program. METHODS: In addition to regular clinical training, expert-led or expert-led plus artificial intelligence (AI) system tutoring courses were implemented during the first 2 weeks of the surgical block. Interns could voluntarily join the regular (no additional tutoring), expert-led tutoring, or expert-led+AI tutoring groups freely. In the regular group, interns (n=25) did not receive additional tutoring. The expert-led group received 3-hour expert-led tutoring and in-training formative assessments after 2 practice sessions. After a similar expert-led course, the expert-led+AI group (n=23) practiced and assessed their skills on an AI system. Through a comparison with the internal standard, the system automatically recorded and evaluated every intern's suturing/ligature skills. In the expert-led+AI group, performance and confidence were compared between interns who participated in 1, 2, or 3 AI practice sessions. RESULTS: The end-of-surgical block objective structured clinical examination (OSCE) performance and self-assessed confidence in suturing/ligature skills were highest in the expert-led+AI group. In comparison with the expert-led group, the expert-led+AI group showed similar performance in the in-training assessment and greater improvement in the end-of-surgical block OSCE. In the expert-led+AI group, the best performance and highest post-OSCE confidence were noted in those who engaged in 3 AI practice sessions. CONCLUSION: This pilot study demonstrated the potential value of incorporating an additional expert-led+AI system–assisted tutoring course into the regular surgical curriculum.

Self-management Experience of Middle-aged and Older Adults With Type 2 Diabetes: A Qualitative Study

PURPOSE: Diabetes mellitus has been either the fourth or fifth leading cause of death among Taiwanese adults during 1995–2015. Older adults with diabetes are at higher risk of developing diabetic macrovascular and micro-vascular complications. The purpose of this study explored the self-management experiences of middle-aged and older adults with diabetes through a focus group. METHODS: Purposive sampling was used to recruit patients with diabetes from the metabolic outpatient clinics of medical centers and regional hospitals in Taiwan. Two focus groups, comprising a total of 23 participants, were employed to collect data, and group discussions were held a total of four times in an education room that was distant from clinical areas. RESULTS: Three themes were generated from analysis of the collected data: (1) “listening to the voice of the body and observing physical changes,” (2) “re-recognizing diabetes and challenges,” and (3) “self-management implementation dilemmas.” This study provided new insights into the experiences of middle-aged and older adults in Taiwan regarding their self-management of diabetes. CONCLUSION: Healthcare teams should be involved in the self-management education of patients with diabetes as early as possible to reduce patients' anxiety and to develop more patient-centered, culture-sensitive clinical skills. In addition to monitoring patients' self-management, healthcare professor should pay more attention to patients' successful adaptation to and coexistence with the disease.