Community-based multiple screening for metabolic syndrome by innovative theory: A longitudinal study.

The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population.

The Effect and Dose-Response of Functional Electrical Stimulation Cycling Training on Spasticity in Individuals With Spinal Cord Injury: A Systematic Review With Meta-Analysis.

Background: To investigate the effect and dose-response of functional electrical stimulation cycling (FES-cycling) training on spasticity in the individuals with spinal cord injury (SCI). Method: Five electronic databases [PubMed, Scopus, Medline (Proquest), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)] were searched before September 2021. The human trials and studies of English language were only included. Two authors independently reviewed and extracted the searched studies. The primary outcome measure was spasticity assessed by Modified Ashworth Scale or Ashworth Scale for lower limbs. The secondary outcome measures were walking abilities, such as 6 Min Walk Test (6MWT), Timed Up and Go (TUG), and lower limbs muscle strength (LEMS). A subgroup analysis was performed to investigate the efficacious threshold number of training sessions. A meta-regression analysis was used to examine the linear relationship between the training sessions and the effect on spasticity. Results: A total of 764 studies were identified. After screening, 12 selected studies were used for the qualitative synthesis, in which eight of them were quantitatively analyzed. Eight studies included ninety-nine subjects in total with SCI (male: female = 83:16). The time since injury was from less than 4 weeks to 17 years. The age ranged from 20 to 67 years. American Spinal Injury Association (ASIA) impairment level of the number of participants was 59 for ASIA A, 11 for ASIA B, 18 for ASIA C, and 11 for ASIA D. There were 43 subjects with tetraplegia and 56 subjects with paraplegia. Spasticity decreased significantly (95% CI = - 1.538 to - 0.182, p = 0.013) in favor of FES-cycling training. The walking ability and LEMS also improved significantly in favor of FES-cycling training. The subgroup analysis showed that spasticity decreased significantly only in more than 20 training sessions (95% CI = - 1.749 to - 0.149, p = 0.020). The meta-regression analysis showed training sessions and spasticity were not significantly associated (coefficient = - 0.0025, SE = 0.0129, p = 0.849, R 2 analog = 0.37). Conclusion: Functional electrical stimulation-cycling training can improve spasticity, walking ability, and the strength of the lower limbs in the individuals with SCI. The number of training sessions is not linearly related to the decrease of spasticity. Twenty sessions of FES-cycling training are required to obtain the efficacy to decrease spasticity.

Social media (Facebook) improper use and the influence of sleeping quality in Taiwan's university students.

This study examines the relationship between Facebook (FB) usage and addiction level, and sleep quality of university students. A Google Forms questionnaire was prepared and disseminated via the authors' FB profile for university students to fill out. A total of 277, including two studying overseas, took part in this research. Among the survey respondents, over 60% (n = 144) were medical students (p = 0.000); over 30% (n = 84) were always logged into FB; the average and daily usage time of most was 5 to 60 min at a time (p = 0.009), and 3 to 5 h a day (p = 0.040), respectively. The respondents' average sleep time was 7.11 h, but over 61% categorized their sleep quality as poor. It was also found that students from financial and management school were 4.23 times more at risk of FB addiction than the medical counterparts and were likely to be already addicted to FB as well as have a sleep disorder. Based on these results, it is suggested that university students, who fall in the high-risk category, be screened early to prevent them from developing social media addiction and sleep disorders. For improving youths' health and sleep quality, future research should attach the importance to early screening for sleep disturbances caused by the internet and social media addiction.

Impact of tobacco-related chronic obstructive pulmonary disease on developmental trajectories of comorbidities in the Taiwan population.

Comorbidities adversely affect the quality of life and survival of patients with chronic obstructive pulmonary disease (COPD), and timely identification and management of comorbidities are important in caring for COPD patients. This study aimed to investigate the impact of COPD on long-term developmental trajectories of its comorbidities. From 2010 to 2013, all spirometry-confirmed COPD patients with a 5-year follow-up period were identified as the cases. The prevalence of comorbidities and their trajectories in COPD cases were obtained and compared with those in non-COPD controls matched for age, sex, smoking status and Charlson comorbidity index (CCI). Over the study period, a total of 682 patients, 341 each in COPD and control groups were included, with a mean age of 69.1 years and 89% male. The baseline mean CCI was 1.9 for both groups of patients and significantly increased to 3.4 and 2.7 in COPD and control groups after 5 years, respectively (both P < 0.001). Through the 5-year follow-up, a significant increase in the prevalence of all comorbidities of interest was observed in the COPD cohort and the incidence was remarkably higher for hypertension [incidence rate ratio (IRR) 1.495; 95% confidence interval (CI) 1.017-2.198], malignancy (IRR 2.397; 95% CI 1.408-4.081), diabetes mellitus (IRR 2.927; 95% CI 1.612-5.318), heart failure (IRR 2.531; 95% CI 1.502-4.265) and peptic ulcer disease (IRR 2.073; 95% CI 1.176-3.654) as compared to the non-COPD matched controls. In conclusion, our findings suggest that the presence of COPD may be considered a pathogenic factor involved in the development of certain comorbidities.

Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis.

BACKGROUND: To investigate the effects of robot-assisted gait training (RAGT) on spasticity and pain in people with spinal cord injury (SCI). Material and methods. Four electronic databases (PubMed, Scopus, Medline, and Cochrane Central Register of Controlled Trials) were searched for studies published up to November 2019. Only human trials and of English language were included. The searched studies were reviewed and extracted independently by two authors. Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses. Primary outcome measures included spasticity assessed by Ashworth scale (AS) or modified Ashworth scale (MAS) and pain assessed by VAS. Secondary outcome measures included lower extremity motor score (LEMS) and walking ability (i.e., 6-minute walk test, 10-meter walk test). RESULTS: A total of 225 studies were identified. Eighteen studies (7 RCTs and 11 non-RCTs) including 301 subjects met inclusion criteria. The outcome measure of spasticity significantly improved in favor of RAGT group in non-RCTs (AS: 95%CI = -0.202 to -0.068, p ≤ 0.001; MAS: 95%CI = -2.886 to -1.412, p ≤ 0.001). The results on pain did not show significant change after RAGT in either RCTs or non-RCTs. LEMS and walking ability significantly increased in favor of RAGT. CONCLUSIONS: RAGT can improve spasticity and walking ability in people with SCI. The probable reason for no significant change in pain after RAGT is floor effect. RAGT is beneficial for normalizing muscle tone and for improving lower extremity function in people with SCI without causing extra pain.

Commentary on the effects of receptor activator of nuclear factor-B ligand inhibition on bone mass and muscle strength.

The pathophysiology of osteoporosis and sarcopenia.

Metformin use mitigates the adverse prognostic effect of diabetes mellitus in chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVE: Among patients with chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) is a common comorbidity and is probably associated with increased systemic inflammation and worse prognosis. Metformin, with its pleiotropic anti-inflammatory and antioxidant actions, may offer theoretical benefits in COPD patients with DM. Thus, this study aimed to investigate the effects of DM and metformin use on mortality in the clinical trajectory of COPD. METHODS: This was a retrospective cohort study comprising patients with spirometry-confirmed COPD and an age of ≥40 years from 2008 to 2014. The primary outcome of interest was all-cause mortality. We evaluated the effects of DM on mortality through the clinical course of COPD and we also assessed the impact of metformin use on survival of the COPD population. RESULTS: Among 4231 COPD patients, 556 (13%) had DM, and these patients had 1.62 times higher hazards of 2-year mortality than those without DM (95% confidence interval [CI], 1.15-2.28) after adjusting for age, gender, COPD stage, comorbidities and prior COPD hospitalization. Over a 2-year period, metformin users had a significantly lower risk of death (hazard ratio, 0.46; 95% CI, 0.23-0.92) compared with non-metformin users in patients with coexistent COPD and DM. Moreover, metformin users had similar survival to COPD patients without DM. CONCLUSIONS: This study shows that DM is associated with an increased risk of death in COPD patients and metformin use seems to mitigate the hazard. Our findings suggest a potential role of metformin in the management of DM in COPD.

A Randomized Clinical Efficacy Trial of Red Yeast Rice (Monascus pilosus) Against Hyperlipidemia.

Red yeast rice (RYR) has been used as an alternative treatment for hyperlipidemia. According to the previous studies, other compounds, besides monacolin K in RYR, may also reduce the serum lipid level. This study aims at examining the efficacy of monacolin K-rich and Gamma-Aminobutyric Acid (GABA)-rich RYR (Monascus pilosus) with regards to treating hyperlipidemia in a randomized control, double-blind clinical trial. In the research, we assigned 50 eligible subjects to monacolin K-rich RYR, GABA-rich RYR and placebo groups ( n=16 , 17, 17, respectively). The concentrations of TC, LDL-C, HDL, TG and blood biochemical data were evaluated at different phases: before applying (visit 1), after 1-month (visit 2), 2-month (visit 3), 3-month (visit 4) of providing the intervention and 1-month after ending the test food (visit 5) among three groups. During the 3-month intervention, the serum TC and LDL-C levels decreased significantly in the monacolin K group compared to the baseline and the other two groups. The Serum TG level declined steadily but was not statistically significant. Meanwhile, no marked differences in the serum HDL level were revealed among the three groups. Most safety assessment data had minor variation except two subjects (in monacolin K and GABA group separately) reported elevated liver enzymes. Monacolin K-rich RYR can reduce cholesterol as expected, while the GABA-rich RYR performed non-significant reduction on serum triglyceride. The research results demonstrate that using different concentrations and ratios between monacolin K and GABA could be beneficial for antihyperlipidemia.

Diabetes related fatigue sarcopenia, frailty.

The rationale of diabetes related fatigue syndrome and interventions.

Adolescent Perceptions of Peer Responses to Diabetes Self-Management: A Qualitative Study.

BACKGROUND: Type 1 diabetes (T1D) is more prevalent in adolescents than in adults, and the self-management of insulin-dependent diabetes is complex. T1D requires injections of insulin, self-management of blood testing, regular physical activity, and diet monitoring, which are challenging for growing and developing adolescents. Adolescents are often more concerned with how they are perceived by their peers than how they perceive themselves. Positive peer responses influence the self-care management of adolescents with T1D in school settings. By contrast, negative peer responses and avoidance behaviors threaten to negatively affect the health outcomes of adolescents with T1D. Evidence indicates that peer influence is crucial to the successful self-management of diabetes in adolescents. However, very few studies have investigated the effect of peer influence on adolescents with T1D. PURPOSE: This article describes how adolescents with T1D perceive the responses of their peers to their diabetes self-management in school settings. METHODS: Ten 12- to 17-year-old adolescents with diabetes were recruited from a pediatric endocrinology clinic at a university hospital in Taiwan. Audio-recorded interview data were transcribed verbatim and reviewed for accuracy. A thematic analysis approach was used to analyze the narrative content of semistructured interviews with participants. The rigor of the data collection and analysis was emphasized. RESULTS: Analysis of peer responses to the diabetes care practices of the participants revealed six themes: knowledge seeking, curiosity, enthusiasm, empathy, fearfulness, and isolation and bullying. Subthemes were categorized to illustrate how adolescents with T1D balance the challenge of diabetes self-care regimens and normal peer interactions. They were coping with the requirements of their T1D regimen and hoping to determine the perceptions of their peers toward this regimen and themselves. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Understanding the perception of peer identity for adolescents with T1D provides information for diabetes education and assists school nurses to facilitate successful T1D management in adolescents.

A Systematic Review and Meta-Analysis of the Effect of Lifestyle Modification on Metabolic Control in Overweight Children.

Childhood obesity is associated with type 2 diabetes mellitus. We aimed to determine the effects of lifestyle modification programs on fasting plasma glucose (FPG) levels in overweight children. We queried six relevant electronic databases and manually searched for studies published before December 2016. Overweight/obese children who underwent a lifestyle modification for more than 6 months were included. A total of 3923 children from eight randomized controlled trials (RCTs) were included. Compared with the control group, the lifestyle modification group had significantly lower FPG levels by 1.3 mg/dL. The mean differences were significantly decreased for both secondary outcomes; BMI z-score decreased by 0.16 units and insulin levels decreased by 2.4 mU/L. The metaregression showed that the follow-up duration was associated with FPG levels and BMI and insulin levels and half year is a suitable follow-up duration for this population. This study showed that lifestyle modification programs may be effective in reducing the FPG levels of overweight/obese children. Further high-quality RCTs with longer follow-up periods are needed to evaluate the long-term effect of this complementary approach for diabetes mellitus prevention on overweight/obese children.

Integrative traditional Chinese medicine therapy reduces the risk of diabetic ketoacidosis in patients with type 1 diabetes mellitus.

ETHNOPHARMACOLOGICAL RELEVANCE: Life-long insulin is the standard treatment for type 1 diabetes mellitus (T1DM). The role of traditional Chinese medicine (TCM) in T1DM is still not clear. The aim of this study is to explore the prescription pattern of TCM and its impact on the risk of diabetic ketoacidosis (DKA) in patients with T1DM. MATERIALS AND METHODS: We retrieved samples from the registry for catastrophic illness patients from the National Health Insurance Research Database (NHIRD). Based on a frequency (1:4) matched case-control design, patients with T1DM in 2000-2011 were designated as cases (TCM users) and controls (non-TCM users). TCM treatment for patients with T1DM was analyzed. The incidence of DKA and the annual costs of emergency visits and hospitalizations were evaluated for all causes. RESULTS: Overall, 416 subjects were TCM users, whereas a total of 1608 matched subjects were classified as non-TCM users. The most common Chinese herbal formula and single herb is Liu-wei-di-huang-wan (Six-ingredient pill of Rehmannia) and Huang-qi (Radix Astragali; Astragalus membranaceus (Fisch.) Bunge, Astragalus membranaceus var. mongholicus (Bunge) P.K.Hsiao), respectively. Compared with non-TCM users, we found a 33% reduction in DKA incidence for all TCM users (aHR 0.67, 95% CI 0.56-0.81, p <0.000) and a 40% reduction for users receiving TCM treatment for more than 180 days (aHR 0.58, 95% CI 0.41-0.82, p <0.01). There were no significant differences between TCM users and non-users in the frequency and medical costs of emergency visits and hospitalizations. CONCLUSIONS: Integrative TCM use may reduce the risk of DKA in patients with T1DM. Our results suggest that TCM may have a substantial positive impact on the management of TIDM.

Transformation of Sexual Expression in Taiwanese Women After Treatment for Gynecological Cancer.

BACKGROUND: Understanding the sexual experience of women after gynecological cancer is important for nurses caring for this population. Sexual experience should be studied within women's sociocultural context because it influences the construction of sex. However, the sexual experience of Chinese women after gynecological cancer has not been examined qualitatively. OBJECTIVE: The aim of this study is to explore the sexual experience of Taiwanese women after treatment for gynecological cancer. METHODS: Data for this phenomenological study were collected during in-depth, semistructured interviews with 11 women purposively recruited from outpatients of the gynecological clinic of a medical center in northern Taiwan. Interview data were analyzed using the Colaizzi method. RESULTS: Data analysis yielded 4 themes: (1) suffering from sexual changes and difficulties, (2) judgments and uncertainty about the appropriateness of sexual behavior, (3) maintenance and transformation of sexual expression, and (4) reinterpretation and reaffirmation of feminine value. CONCLUSIONS: This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate Chinese and Asian clients about women's sexual expression during and after cancer treatment. IMPLICATIONS FOR PRACTICE: This woman-centered view of the sexual experience of Taiwanese gynecological cancer survivors can help healthcare professionals understand and educate women about possible alternative ways of sexual expression during and after cancer treatment.

Aerosol distribution during open suctioning and long-term surveillance of air quality in a respiratory care center within a medical center.

BACKGROUND: The investigation of hospital air quality has been conducted in wards, ICUs, operating theaters, and public areas. Few studies have assessed air quality in respiratory care centers (RCCs), especially in mechanically ventilated patients with open suctioning. METHODS: The RCC air quality indices (temperature, relative humidity, levels of CO2, total volatile organic compounds, particulate matter [PM], bacteria, and fungi) were monitored over 1 y. The air around the patient's head was sampled during open suctioning to examine the probability of bioaerosol exposure affecting health-care workers. RESULTS: This investigation found that the levels of indoor air pollutants (CO2, PM, bacteria, and fungi) were below the indoor air quality standard set by the Taiwan Environmental Protection Agency. Meanwhile, the levels of total volatile organic compounds sometimes exceeded the indoor air quality standard, particularly in August. The identified bacterial genera included Micrococcus species, Corynebacterium species, and Staphylococcus species, and the predominant fungal genera included yeast, Aspergillus species, Scopulariopsis species, and Trichoderma species. Additionally, airborne PM2.5, PM1, and bacteria were clearly raised during open suctioning in mechanically ventilated patients. This phenomenon demonstrated that open suctioning may increase the bacterial exposure risk of health-care workers. CONCLUSIONS: RCC air quality deserves long-term monitoring and evaluation. Health-care workers must implement self-protection strategies during open suctioning to ensure their occupational health and safety in health-care settings.

A nationwide population-based study of traditional Chinese medicine usage in children in Taiwan.

OBJECTIVES: To characterize the application of traditional Chinese medicine (TCM) among pediatric patients. DESIGN AND SETTING: This study examined data sets from the National Health Insurance Research Database in Taiwan. Two cohorts, each with one million patients who were randomly sampled from the beneficiaries of the National Health Insurance Program from January 1 to December 31 in 2005 or 2010, were chosen for analysis. Children had at least one TCM outpatient clinical record were defined as TCM users, whereas children who had no TCM outpatient records were defined as non-TCM users. MAIN OUTCOME MEASURES: The demographic data, treatment modalities and the disease distributions of the pediatric TCM users were analyzed from two randomly sampled cohorts. RESULTS: Overall, 22% and 22.5% of the children used TCM in 2005 and 2010, respectively. The utilization rate of TCM increased with age. Herbal remedies were the most commonly used therapeutic approach, followed by manipulative therapy and acupuncture. There was an increasing trend of using herbal remedies (increased from 65.6% to 74.4%) and acupuncture (increase from 7.5% to 11.4%), but there was a markedly decreased use of manipulative therapies from 25.6% to 12.3% from 2005 to 2010. There is an obvious increasing use of TCM due to diseases of the digestive system, skin/subcutaneous tissue and genitourinary system from 2005 to 2010. A further comparison of the prevalence rates between TCM and non-TCM visits indicated that allergic rhinitis, dyspepsia, injury and musculoskeletal diseases, as well as menstrual disorders, were the main diseases that children tended to visit TCM clinics in Taiwan. CONCLUSIONS: Our nationwide population-based study revealed the high prevalence and specific usage patterns of TCM in the pediatric population in Taiwan. The results of this study should provide valuable information for physicians, parents and the government concerning pediatric healthcare.

Traditional Chinese medicine for idiopathic precocious puberty: A hospital-based retrospective observational study.

OBJECTIVES: To characterize the application of traditional Chinese medicine (TCM) among children with idiopathic precocious puberty (IPP). DESIGN AND SETTING: This study examined data sets from patients diagnosed with IPP at Chang Gung Memorial Hospital between 2010 and 2012. The patients were allocated into three groups according their voluntary choice of treatment modalities: TCM users (received TCM treatment only), Western medicine (WM) users (received WM treatment only), and "no treatment" group (received no medical treatment at all). MAIN OUTCOME MEASURES: The demographic data of children with IPP were characterized. The prescription patterns and frequencies of TCM for IPP patients were analyzed. The patients' bone maturation rates and the change of predicted height after different approaches were measured as outcomes. RESULTS: There were 3390 patients enrolled in the study. Zhi-Bai-Di-Huang-Wan (70.62%) was the most common herbal formula and Mai-Ya (Hordei Fructus Germinatus) (51.58%) was the most common single herb prescribed for IPP in all of the 2784 prescriptions. The bone maturation rates of TCM users (0.95±0.20) and WM users (0.69±0.05) were both decelerated but the "no treatment" group had an accelerated bone maturation rate of 1.33±0.04. TCM and WM users also had higher predicted height after treatment (1.15±1.19cm versus 1.73±0.29cm), while the "no treatment" group had a decreased predicted height (-0.52±0.23cm). CONCLUSIONS: Our study revealed a comprehensive list of TCM prescriptions for IPP patients. Future well-designed, randomized, double-blinded, and placebo-controlled clinical trials are warranted to evaluate the efficacy and safety of TCM for precocity.

Characteristics and prescription patterns of traditional Chinese medicine in atopic dermatitis patients: ten-year experiences at a medical center in Taiwan.

OBJECTIVES: Complementary and alternative therapies in treating atopic dermatitis are not uncommon. However, substantial evidence and consensus on treating atopic dermatitis is lacking. The aim of this study is to investigate the characteristics and utilization of traditional Chinese medicine in patients with atopic dermatitis. DESIGN: We retrospectively collected patients with atopic dermatitis at the Chang Gung Memorial Hospital in Taiwan between 2002 and 2011. Patients' demographic data, duration and frequency of treatment, serum total immunoglobulin E levels, and traditional Chinese medicine treatment principles and prescription were analyzed. RESULTS: There were 4145 patients (8.8%) received traditional Chinese medicine therapy between 2002 and 2011. Among them, 2841 (68.54%) chose TCM only and 1304 (31.46%) chose to combine TCM and WM therapies. Those who chose combination therapy were younger, and needed more times of visit and longer duration of treatment. The most frequent comorbid conditions accompany atopic dermatitis were allergic rhinitis (46.06%) and asthma (21.46%). Among the 87,573 prescriptions written for Chinese medicine, the most frequently prescribed herbal formula and single herb were Xiao-Feng-San (Eliminate Wind Powder) (16.98%) and Bai-Xian-Pi (Cortex Dictamni) (12.68%), respectively. The most commonly used therapeutic principles of herbal formulas and single herbs were releasing exterior (20.23%) and clearing heat (41.93%), respectively. CONCLUSION: Our hospital-based study characterized the utilization patterns of traditional Chinese medicine in atopic dermatitis patients. This information could be used as references for clinical application and provide valuable information for future clinical trials.

[Effectiveness evaluation of healthy lifestyle interventions in childhood obesity prevention: a systematic review].

BACKGROUND: There is significant reporting on evidence-based research in the literature regarding lifestyle modification programs. There is a need to review and synthesize results in order to develop childhood obesity prevention and intervention strategy recommendations. PURPOSE: Main purposes of the present review were to update the systematic review and critical appraisal of recent evidence in this area and assess the efficacy and quality of published research studies. METHODS: Studies included in this review incorporated the following inclusion criteria: obese children participants 5 to 14 years of age; a face-to-face randomized-controlled study with a 4-week intervention period; and anthropometry, physical activity, sedentary behavior evaluated as primary outcomes after > 6 months. Eleven studies met the 3 inclusion criteria. All were found using the following key word string: RCT or CCT interventional study researches, childhood obesity, overweight, preventive intervention, healthy lifestyle". RESULTS: Evidence from these studies showed that all interventions varied in terms of approach and settings. Most provided a healthy lifestyle program duration of more than 15 minutes per week. Those that included culturally sensitive diet education and 30-60 minutes of moderate-intensity exercise everyday significantly enhanced childhood obesity prevention in terms of both anthropometry and dietary habits and decreased sedentary behavior. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Results suggest that effective healthy lifestyle programs for childhood obesity prevention in Taiwan should provide dietary guidance sensitive to Taiwanese dietary habits, encourage daily physical activities, and decrease sedentary behavior.