Study and thinking of training system of obstetrics and gynecology residents in Taiwan region of China / 中华医学教育探索杂志

This paper introduces the historical development, training contents, the inspection mechanism and management regulations of obstetrics and gynecology residents training in Taiwan region, China. Drawing lessons from the experience and ideas of the standardized residency training system of obstetrics and gynecology in Taiwan region, combined with the present situation and deficiencies of the training system in the mainland China, this paper puts forward constructive suggestions for the standardized residency training of obstetrics and gynecology, so as to obtain more efficient and satisfactory training results and provide ideas for cultivating excellent obstetrics and gynecology specialists in mainland China.

Manejo de la infección por SARS-CoV-2 en Taiwán: una experiencia exitosa

El manejo de la infección por SARS-CoV-2 en Taiwán ha sido catalogado como uno de los más eficientes del mundo. Tiene una población que es casi equivalente a la del Perú, pero el número de infectados fue menor de seiscientos y la mortalidad ha sido sumamente baja: solo siete pacientes han fallecido hasta el mes de diciembre. A pesar de su cercanía geográfica a la ciudad de Wuhan, esta región afrontó la pandemia con éxito, ya que contaba con la experiencia previa de la epidemia del SARS en el 2003, y también porque la población tiene una mayor conciencia ciudadana que las de otros países. Las acciones que han convertido a Taiwán en un ejemplo de cómo puede desarrollarse una política de salud pública eficiente para controlar la diseminación del SARS-CoV-2 son las siguientes: la utilización de recursos electrónicos e informáticos, el empleo correcto de la información, el desarrollo de pruebas de laboratorio propias y, por último, el manejo cuidadoso y efectivo de los casos sospechosos, los contactos y los pacientes hospitalizados. Esta experiencia es un ejemplo importante para nuestro país.

The management of the SARS-CoV-2 infection in Taiwan has been listed as one of the most efficient in the world. Its population size is almost equivalent to that of Peru, but the rate of infections has been less than 600 and the mortality rate has been extremely low: only seven patients died until December. Despite its geographical proximity to the city of Wuhan, Taiwan successfully faced the pandemic because of its previous experience with the SARS epidemic in 2003 and its greater public awareness compared to that in other countries. The actions that have made of Taiwan an example of how to develop an efficient public health policy to control the spread of SARS-CoV-2 are the following: the use of electronic and computer resources; the appropriate use of information; the development of its own laboratory tests; and, finally, the careful and effective management of suspected cases, contacts and hospitalized patients. This experience is an important example for our country.

Comparative study on the quality of life and mental health of teenagers in Zhengzhou and HongKong and Taiwan / 中国学校卫生

Objective@#To explore the quality of life and mental health status of adolescents in Zhengzhou, and to compare with HongKong and Taiwan.@*Methods@#A total of 6 401 students from 12 primary and secondary schools in Zhengzhou City. A total of 3 642 students from HongKong and 1 547 students from Taiwan were selected by cluster sampling. And Padiatric Quality of Life Inventory Version 4.0, Self-Esteem Scale, General Self-efficacy Scale, Depression Anxiety Stress Scale and self-made general situation questionnaire were used to conduct questionnaire survey.@*Results@#The total score of quality of life and the scores of each dimension in Zhengzhou were significantly higher than those in HongKong, while self-esteem and anxiety were lower than those of Taiwan adolescents（P<0.05). In addition to self-esteem, anxiety and stress, the scores of quality of life and mental health of adolescents of different grades and genders in Zhengzhou were statistically different(t=13.53，20.71，10.92，20.26，14.68，-16.03，21.26；6.16，3.81，-2.22，-0.33，8.76，4.16，2.71，P<0.01). The quality of life of adolescents in HongKong and Taiwan in different grades and genders were basically the same as those in Zhengzhou, and the differences of depression and stress scores in grades were the same as those in Zhengzhou.@*Conclusion@#The overall quality of life and mental health of adolescents in Zhengzhou is better than that in Hong Kong and Taiwan. It is necessary to explore the relationship between the quality of life and mental health of adolescents in order to improve their quality of life.

The protective ability and cellular mechanism of Koelreuteria henryi Dummer flower extract against hydrogen peroxide-induced cellular oxidative damage

BACKGROUND: Koelreuteria henryi Dummer is an indigenous plant in Taiwan. The species has been used in traditional folk medicine for the promotion of liver functions and for treating malaria and urethritis. The present study investigated the antioxidant activity of the flower extract of Koelreuteria henryi Dummer. The extraction conditions were optimized by the contents of total phenolic acids and total flavonoids, and antioxidant activity assays. Moreover, an in vitro study for investigating antioxidant activity of K. henryi flower extract was demonstrated by hydrogen peroxide (H2O2)-induced apoptosis. RESULTS: K. henryi flower extracted for 150 min showed high contents of total phenolic acids and total flavonoids. In an in vitro model, L929 cells were pretreated with K. henryi flower extract, and then treated with H2O2 to induce oxidative damage. Results demonstrated that H2O2-induced apoptosis was inhibited by the treatment of 200 µg/ml K. henryi flower extract through the mitochondria-mediated pathway and mitogen-activated protein kinase (MAPK) pathway. The caspase 8/9 activity and expression of p-p38 and pERK were repressed by K. henryi flower extract. In addition, the prevention of H2O2-induced apoptosis by K. henryi flower extract activated the nuclear factor-erythroid 2-related factor (Nrf2) stress response pathway to transcript heme oxygenase 1 (HO-1). Also, K. henryi flower extract prevented H2O2-induced apoptosis through HO-1 production, as evident by the use of HO-1 inhibitor. CONCLUSIONS: The present study demonstrated that K. henryi flower extract could inhibit the H2O2-induced apoptosis in L929 cells through the activation of the Nrf2/HO-1 pathway.

Physical Therapy Development in Taiwan, China / 中国康复理论与实践

The development of physical therapy, as well as the education and certification for physiotherapist, and human resources, practice, and future development in Taiwan were introduced.

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

Frequent loss of CD10 expression in follicular lymphoma with leukaemic presentation

@# Follicular lymphoma (FL) is usually a nodal lymphoma expressing CD10, rarely with leukaemic presentation (FL-LP). Materials and Methods: We searched for FL-LP in our institution from 2000 to 2018 and characterised the neoplastic cells by flow cytometry, immunohistochemistry and fluorescence in situ hybridization. Thirteen (6.1%) of 212 FL cases were FL-LP, all de novo neoplasms. The leukaemic cells were small in 12 cases and large in one. All had concurrent FL, mostly (92%; 12/13) low-grade. The single case with large leukaemic cells had a concurrent primary splenic low-grade FL and a double-hit large B-cell lymphoma in the marrow. Results: CD10 was expressed in the leukaemic cells in 38% (5/13) cases by flow cytometry and in 77% (10/13) cases in tumours (p= 0.0471). IGH/BCL2 reciprocal translocation was identified in 85% (11/13) cases. Most patients were treated with chemotherapy. In a median follow-up time of 36 months, nine patients were in complete remission. The 2- and 5-year survival rates were at 100% and 83%, respectively. In this study, we characterised a series of de novo FL-LP in Taiwan. All patients had concurrent nodal and/or tissue tumours, which might suggest that these patients seek medical help too late. Conclusion: The lower CD10 expression rate by flow cytometry than by immunohistochemistry might be due to different epitopes for these assays. Alternatively, loss of CD10 expression might play a role in the pathogenesis of leukaemic change. The clinical course of FL-LP could be aggressive, but a significant proportion of the patients obtained complete remission with chemotherapy.

Glycemic control in tuberculosis: Lessons learned from Taiwan

The global epidemic of diabetes and tuberculosis poses challenges to the control of both diseases. Patients with tuberculosis and diabetes experience worse clinical manifestations, increased risk of treatment failure, recurrence, and death. Diabetes is also associated with risk for latent tuberculosis infection. Management of hyperglycemia reduces the risk and improves the outcome of tuberculosis in diabetic patients. Recent epidemiological studies from Taiwan have provided new and important information on the benefits of metformin in tuberculosis. When addressing the issue of multidrug-resistant tuberculosis, a shortened anti-tuberculous therapeutic regime seems a feasible approach for better cure rates, with less loss-to-follow.

Discovery of Eurytrema Eggs in Sediment from a Colonial Period Latrine in Taiwan

In this study we take a closer look at the diseases that afflicted Japanese police officers who were stationed in a remote mountainous region of Taiwan from 1921 to 1944. Samples were taken from the latrine at the Huabanuo police outpost, and analyzed for the eggs of intestinal parasites, using microscopy and ELISA. The eggs of Eurytrema sp., (possibly E. pancreaticum), whipworm and roundworm were shown to be present. True infection with Eurytrema would indicate that the policemen ate uncooked grasshoppers and crickets infected with the parasite. However, false parasitism might also occur if the policemen ate the uncooked intestines of infected cattle, and the Eurytrema eggs passed through the human intestines. These findings provide an insight into the diet and health of the Japanese colonists in Taiwan nearly a century ago.

Glycemic control in tuberculosis: Lessons learned from Taiwan

The global epidemic of diabetes and tuberculosis poses challenges to the control of both diseases. Patients with tuberculosis and diabetes experience worse clinical manifestations, increased risk of treatment failure, recurrence, and death. Diabetes is also associated with risk for latent tuberculosis infection. Management of hyperglycemia reduces the risk and improves the outcome of tuberculosis in diabetic patients. Recent epidemiological studies from Taiwan have provided new and important information on the benefits of metformin in tuberculosis. When addressing the issue of multidrug-resistant tuberculosis, a shortened anti-tuberculous therapeutic regime seems a feasible approach for better cure rates, with less loss-to-follow.

Comparison and reflections on the training of rehabilitation physicians in Taiwan and Mainland China / 中华医学教育探索杂志

Rehabilitation physician training is an important part of the development of rehabilitation medicine.Rehabilitation physician education in Taiwan has a complete and standardized training system,and rehabilitation physician training in mainland China is mainly achieved through standardized residency training.This article compares the differences in training processes for rehabilitation physicians in education in medical colleges and universities,residency training,and specialist training between Taiwan and mainland China.The results show that rehabilitation physician training in Taiwan is rigorous and orderly,with reasonable contents,clear objectives,strong specialty,and standardized assessment,while in mainland China,rehabilitation physicians in mainland China have insufficient training time,and there is a lack of detailed training plan and unified assessment standards.Rehabilitation physician training in mainland China needs to learn from advanced experience,further reform the training process,improve the operability of the overall education program,and perfect the training system of rehabilitation physicians.

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.

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.

Demonstration and reference of DRGs case management in a medical center in Taiwan of China / 中华医院管理杂志

Since the first edition of Tw-DRGs was developed in Taiwan in 2002, the system introduction of the hospital management level has been successfully completed. This paper detailed the organizational structure of DRGs case management in local hospitals ( DRGs promotion group, front-end medical care, ICD end, and the medical expenses reporting). It also introduced the operation process of identifying, locking and adjusting process of the pre-hospital, in-hospital and post-hospital aspects of inpatients, and provides in the end useful experiences for the promotion of DRGs case management in China′s mainland hospitals.

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.

Study on the Management System of OTC Drug in Taiwan Are a of China Based on Consumer Guidance Perspective / 中国药房

OBJECTIVE： To provide reference for the improvement of OTC drug management system in mainland China. METHODS： By analyzing the classification， registration management， conversion procedures and supporting measures， instructions and packaging management of OTC drugs in Taiwan area of China， and considering the current situation and problems of OTC drug management in mainland China， suggestions for improving OTC drug management system in mainland China were put forward. RESULTS & CONCLUSIONS： OTC drugs of Taiwan area could be divided into drugs instructed by physicians and pharmacists （hereinafter referred to as “instructed drugs”） as well as patent drugs. The registration management of instructed drugs was implemented in accordance with the Criteria for the Review of Instructed Drugs. The criteria not only regulated the active ingredients， dosage forms， indications， usage and dosage， side effects， matters needing attention and warnings of instructed drugs， but also stipulated the requirements for labeling， instructions and outer-of-the-box printing of instructed drugs. Taiwan area had also established a mechanism for evaluating drug conversion to expand the variety range of prescription drugs converted to OTC drugs， and had equipped a series of supporting measures to reduce the safety risks arising from drug conversion. In 2016， Taiwan area also formulated the Format and Relevant Standards for Outer-of-the-Box of Generic Western OCT Drug， and revised the drug instructions and the outer-of-the-box. The format was more standardized and the terminology was easier to understand， which made it easier for the public to read. It is suggested that mainland China should refer to the experience of Taiwan area， set up special registration channels for OTC drugs and simplify the requirements for examination and approval， pay attention to and improve the matching measures for the conversion of prescription drugs to OTC drugs， encourage brand building and improve intelligibility of OTC drug instructions， so as to build an effective OTC drug management system.

Dengue outbreaks in Taiwan, 1998-2017: Importation, serotype and temporal pattern

Objective: To ascertain the role of imported cases and serotypes on dengue outbreaks in Taiwan which have been sporadic yet highly volatile during the past two decades, exhibiting record-breaking magnitude in recent years. Methods: Confirmed case and serotype data from Taiwan Centers for Disease Control during 1998-2017 were fully examined, with fitting of weekly and daily case data of each city/county to a mathematical model to pinpoint the waves of cases and their locations. Moreover, we quantify the timing of turning point and transmission potential of each wave and determine its circulating serotype, to ascertain any pattern or connection between the variations in circulating serotypes and the magnitude/transmissibility of outbreak. Results: While the number of imported case increased steadily during past two decades, the yearly number of indigenous cases fluctuated wildly. Moreover, while yearly percentages of serotypes for imported cases remains steady, that of indigenous cases does not exhibit any clear pattern. There was at least one wave of reported cases somewhere in Taiwan every year from 1998 to 2015, except in 2016-2017. The effective reproduction number R for all waves in all locations ranged from 1.14 to 2.87, with the exception of two Tainan waves, in 2010 (3.95) and 2015 (6.84). Four major outbreaks of over 2000 cases reveal circulation of one dominant serotype. Conclusions: Correlation between imported cases and indigenous outbreak prove to be difficult to ascertain, even with the availability of serotype data. However, although there had been occasional co-circulation of serotypes in one location, and for some years with different serotypes circulating in different locations, all major outbreaks of over 2 000 cases during the past two decades are due to circulation of mainly a single serotype, perhaps indicating greater transmission potential with one dominating serotype.

Data resource profile: the National Health Insurance Research Database (NHIRD) / 한국역학회지

Electronic health records (EHRs) can provide researchers with extraordinary opportunities for population-based research. The National Health Insurance system of Taiwan was established in 1995 and covers more than 99.6% of the Taiwanese population; this system's claims data are released as the National Health Insurance Research Database (NHIRD). All data from primary outpatient departments and inpatient hospital care settings after 2000 are included in this database. After a change and update in 2016, the NHIRD is maintained and regulated by the Data Science Centre of the Ministry of Health and Welfare of Taiwan. Datasets for approved research are released in three forms: sampling datasets comprising 2 million subjects, disease-specific databases, and full population datasets. These datasets are de-identified and contain basic demographic information, disease diagnoses, prescriptions, operations, and investigations. Data can be linked to government surveys or other research datasets. While only a small number of validation studies with small sample sizes have been undertaken, they have generally reported positive predictive values of over 70% for various diagnoses. Currently, patients cannot opt out of inclusion in the database, although this requirement is under review. In conclusion, the NHIRD is a large, powerful data source for biomedical research.

Data resource profile: the National Health Insurance Research Database (NHIRD) / 한국역학회지

Electronic health records (EHRs) can provide researchers with extraordinary opportunities for population-based research. The National Health Insurance system of Taiwan was established in 1995 and covers more than 99.6% of the Taiwanese population; this system's claims data are released as the National Health Insurance Research Database (NHIRD). All data from primary outpatient departments and inpatient hospital care settings after 2000 are included in this database. After a change and update in 2016, the NHIRD is maintained and regulated by the Data Science Centre of the Ministry of Health and Welfare of Taiwan. Datasets for approved research are released in three forms: sampling datasets comprising 2 million subjects, disease-specific databases, and full population datasets. These datasets are de-identified and contain basic demographic information, disease diagnoses, prescriptions, operations, and investigations. Data can be linked to government surveys or other research datasets. While only a small number of validation studies with small sample sizes have been undertaken, they have generally reported positive predictive values of over 70% for various diagnoses. Currently, patients cannot opt out of inclusion in the database, although this requirement is under review. In conclusion, the NHIRD is a large, powerful data source for biomedical research.

Preliminary investigation of acaroid mites breeding in commercial food in Hsinchu City,Taiwan Province,China / 中国血吸虫病防治杂志

Objective To investigate the breeding of acaroid mites in the stored food in Taiwan Province,China.Methods The breeding mites from samples selected from the markets in Hsinchu City,Taiwan Province were separated under a micro-scope.The isolations were used for slide preparation,then observed and identified under a microscope.Results Among the 39 species samples,13 species of acaroid mites were isolated from the samples.They belonged to 11 genera of 6 families.They were Acarus siro,Tyrophagus putrescentiae,Tyrophagus longior,Aleuroglyphus ovatus,Caloglyphus berlesei,Suidasia nesbitti,Lar-doglyphus konoi,Lepidoglyphus destructor,Dermatophagoides pteronyssinus,Chortoglyphus arcuatus,Carpoglyphus lactis,Der-matophagoides farina and Gohieria fuscus.Conclusions There are acaroid mites breeding in the commercial food in Hsinchu City,Taiwan Province,China.Therefore,relevant measures should be taken to control the breeding of acaroid mites.