Different traditional Chinese medicine constitution is associated with dietary and lifestyle behaviors among adults in Taiwan.

The World Health Organization states prevention of chronic diseases should be based on good lifestyle behaviors and healthy diets as they can reduce the risk of chronic diseases by 80%. The theory of traditional Chinese medicine constitution (TCMC) emphasizes the congenital differences of TCMC stem from the genes of parents, while acquired differences in TCMC are caused by factors as living environments, lifestyle behaviors, and dietary habits. From the perspective of preventive medicine, this study explores the correlation between dietary habits and lifestyle behaviors as potential risk factors for different types of TCMC-balanced constitution, Yang deficiency, Yin deficiency, and Phlegm stasis. Research data were collected from 2760 subjects aged 30 to 70 years participating in a survey conducted by Taiwan Biobank in 2012 to 2017. The survey included basic demographic characteristics, lifestyle behaviors, and dietary habits along with a Body Constitution Questionnaire. Compared to men, women were 3 to 4 times more likely to develop Yang-deficiency, Yin-deficiency, and Phlegm stasis. Variables that affected TCMC were smoking, midnight snack consumption, consumption of gravy-soaked or lard-soaked rice/noodles, deep-fried soybean products, bread spread, pickled vegetables as side dishes for the main course of a meal, and the dietary habit of vegetables or fruits instead of high-fat desserts. Poor dietary habits and lifestyle behaviors are the cause of unbalanced TCMCs. Understanding the specific TCMC of individual can provide useful information and predictions to maintain physical health and achieve early disease prevention to meet the goal of preventive medicine.

Factors influencing terminal cancer patients' autonomous DNR decision: a longitudinal statutory document and clinical database study.

OBJECTIVE: Much of our knowledge of patient autonomy of DNR (do-not-resuscitate) is derived from the cross-sectional questionnaire surveys. Using signatures on statutory documents and medical records, we analyzed longitudinal data to understand the fact of terminal cancer patients' autonomous DNR decision-making in Taiwan. METHODS: Using the medical information system database of one public medical center in Taiwan, we identified hospitalized cancer patients who died between Jan. 2017 and Dec. 2018, collected their demographic and clinical course data and records of their statutory DNR document types, letter of intent (DNR-LOI) signed by the patient personally and the consent form signed by their close relatives. RESULTS: We identified 1,338 signed DNR documents, 754 (56.35%) being DNR-LOI. Many patients had the first DNR order within their last week of life (40.81%). Signing the DNR-LOI was positively associated with being under the care of a family medicine physician prior to death at last hospitalization and having hospice palliative care and negatively associated with patient age ≥ 65 years, no formal education, having ≥ 3 children, having the first DNR order to death ≤ 29 days, and the last admission in an intensive care unit. CONCLUSIONS: A substantial proportion of terminal cancer patients did not sign DNR documents by themselves. It indicates they may not know their actual terminal conditions and lose the last chance to grasp time to express their life values and wishes. Medical staff involving cancer patient care may need further education on the legal and ethical issues revolving around patient autonomy and training on communicating end-of-life options with the patients. We suggest proactively discussing DNR decision issues with terminal cancer patients no later than when their estimated survival is close to 1 month.

Effectiveness of Varenicline Versus Combination Nicotine Replacement Therapy for Smoking Cessation: One-Year Outcomes in a Smoking Cessation Clinic in Taiwan.

INTRODUCTION: Varenicline and combination nicotine replacement treatment (cNRT) have been recommended as the most effective pharmacotherapies, with equal abstinence rate for smoking cessation in a network meta-analysis of randomized trials, but data from real-world long-term follow-up studies are rare. This study aimed to compare the 12-month sustained abstinence rates of smokers using varenicline versus cNRT in their quit attempt. METHODS: A total of 3569 smokers were recruited via the Department of Family Medicine outpatient department at Kaohsiung Veteran General Hospital between June 2013 and March 2019. Participants received counseling from a physician and chose either varenicline (N = 2870) or cNRT (N = 699) for smoking cessation. Both varenicline and cNRT users could receive a free 8-week supply and eight clinic visits over 90 days. Participants were followed-up by telephone at 12, 24, and 52 weeks from first visit. The primary outcome measure of the study was self-reported sustained abstinence up to 52 weeks. RESULTS: Varenicline users had a significantly higher sustained abstinence rate at weeks 12-52, adjusted for baseline variables (15.2% vs 10.3%, p = .001; adjusted odds ratio = 1.47, 95% confidence interval: 1.05-2.05). Other significant predictors of 52 weeks sustained abstinence were being male, having a higher income, attending more clinical visits, and have lower nicotine dependence. CONCLUSION: Varenicline appears to have higher sustained abstinence rates to 52 weeks compared with cNRT, in a smoking cessation clinic where smokers can choose their medication option. IMPLICATIONS: Network meta-analysis of randomized trials suggests that varenicline and cNRT are similarly effective for smoking cessation. This study shows that 1-year sustained abstinence rates were significantly higher among smokers using varenicline, compared with smokers using cNRT, when used as part of a structured smoking cessation program. These findings are highly relevant to policy makers and service providers to help determine provision of smoking cessation treatment.

Body constitution of traditional Chinese medicine caused a significant effect on depression in adult women.

BACKGROUND: and purpose: Depression is a common mental disorder and reduces quality of life. As traditional Chinese medicine constitution (TCMC) has become an increasingly popular complementary and alternative approach for early detection and treatment of disease, this study investigated the relationship of female-related factors and constitution with depression. MATERIALS AND METHODS: This cross-sectional study included 1423 women from the Taiwan Biobank. A questionnaire of 44 items was used covering a variety of factors and the Body Constitution Questionnaire. The constitution types were divided into Yang-deficiency, Yin-deficiency, and Phlegm stasis. RESULTS: Yang (p = 0.022) or Yin (p = 0.017) deficiencies, being single (p = 0.027-0.033), previous use of women's health supplements (p = 0.005-0.008), and smoking (p = 0.033-0.036) were associated with a higher risk of depression. CONCLUSION: Integration of TCMC with Western medicine may be an alternative option towards depression prevention and alleviation.

Characteristics of Hardcore Male Smokers in Taiwan: A Qualitative Study.

Objectives: The purpose of this study was to explore the characteristics of hardcore smokers who were previously hospitalized. Study design: A descriptive qualitative design was used to investigate a sample of 29 male Taiwanese smokers. Methods: Male hardcore smokers were recruited at a hospital in southern Taiwan and their smoking behaviors and attitudes were explored in semistructured interviews. Inclusion criteria were: (1) smoking at least weekly or daily during the past year, (2) 100 cigarettes during the lifetime, (3) persistent smoking, or (4) at least one hospitalization. Audio-recorded interview data were analyzed using content categorization of the responses. Results: Four main themes emerged to describe characteristics of Taiwanese hardcore smokers: (1) physiological and psychological dependence, (2) no motivation to quit despite knowledge of negative health consequences, (3) social interaction and cultural norms, and (4) negative attitudes toward, but compliance with, smoking-free policies. Conclusions: The results can inform public health nurses of characteristics of Taiwanese hardcore smokers, which in turn may develop effective smoking cessation program to increase smoking cessation rate among Taiwanese hardcore smokers.

Long-term smoking cessation rates in elderly versus other adult smokers: A 3-year follow-up study in Taiwan.

INTRODUCTION: Smoking cessation improves life expectancy at any age. There is some evidence that elderly smokers have at least as good a chance of successfully stopping as other smokers but direct comparisons with long-term follow up are rare. This study aimed to compare success rates up to 3 years in smokers aged 65+ versus other adult smokers with and without adjustment for a range of other smoker characteristics. METHODS: This was a prospective study of 1065 smokers who attended a stop-smoking clinic in Taiwan. Participants (896 < 65 years, 169 65+ years) were followed up by telephone 3, 6, 12 and 36 months after the initial quit date. Prolonged abstinence (abstinent at all follow-ups) and point prevalence abstinence (7 days prior to final follow up) were compared between 'elderly' participants aged 65+ years versus 'non-elderly' participants aged <65 years with and without adjustment for a range of baseline smoker characteristics (sex, educational level, previous quit attempts, cigarette dependence score). Non-responders were considered to be smoking. RESULTS: Prolonged 36-month abstinence rates were 20.1% (N = 34) and 15.3% (N = 137) in the elderly and non-elderly participants respectively (p = 0.137). Point prevalence 36-month abstinence rates were 37.3% (N = 63) and 26.5% (N = 237) in the elderly and non-elderly participants respectively (p = 0.005). The odds ratios comparing elderly versus non-elderly abstinence rates after adjustment for baseline variables were 1.17 (95%CI = 0.75-1.83) and 1.52 (95%CI = 1.05-2.20) for prolonged abstinence and point prevalence abstinence respectively. CONCLUSIONS: Elderly smokers attending smoker clinics in Taiwan appear to be at least as likely to achieve long-term abstinence as other adult smokers.

Comparative Effectiveness of Smoking Cessation Medications: A National Prospective Cohort From Taiwan.

BACKGROUND AND OBJECTIVE: Relative effectiveness of smoking cessation medications-varenicline, bupropion and nicotine replacement therapy (NRT)-remains unclear among smokers in real-world settings. Evidence in females and smokers with light/moderate nicotine dependence is particularly insufficient. This study compared the effectiveness of varenicline, bupropion or NRT gum relative to NRT patch, in achieving abstinence among recent quitters. METHODS: In a national smoking cessation program in Taiwan (2012-2015), a cohort of 11,968 participants received varenicline (n = 5,052), bupropion (n = 823), NRT gum (n = 1944) or NRT patch (n = 4,149). The 7-day, 1-month or 6-month point-prevalence was calculated based on self-reported last smoking event via telephone interview after 6 months. Logistic regression modellings estimated odds ratios (OR) and 95% confidence intervals (CI) for achieving abstinence using different modalities (NRT patch as referent). Models included age, sex, education, marital status, geographic region, smoke-years, nicotine-dependence level, medical institution, number of clinic visits and medication use duration. Analyses were further stratified by sex and dependence severity. RESULTS: Participants were predominantly male (83%) with a mean age of 43.7±12.6 years. Varenicline users were more likely than NRT patch users to achieve abstinence, based on 7-day point-prevalence (OR = 1.30, CI: 1.19-1.44), 1-month point-prevalence (OR = 1.36, CI: 1.24-1.50) or 6-month point-prevalence (OR = 1.30, CI: 1.14-1.47). Compared with NRT patch, varenicline was associated with greater odds of being abstinent in women (OR = 1.29, CI: 1.01-1.65), men (OR = 1.31, CI: 1.18-1.46), those with light/moderate dependence (OR = 1.42, CI: 1.24-1.63) or smokers with severe dependence (OR = 1.19, CI: 1.04-1.37), based on 7-day point-prevalence. Differences in effectiveness were not observed between users of bupropion, NRT gum and NRT patch. CONCLUSIONS: In smoking cessation clinics in Taiwan, varenicline users reported higher abstinence rates than NRT patch users after 6 months. Women and smokers with light/moderate nicotine dependence may also benefit from varenicline in actual clinical practice.

Gender Differences in Outcome of an Attempt to Stop Smoking Among Smokers Attending a Smoking Cessation Clinic in Taiwan: 3-Year Follow-Up Study.

Studies that have examined gender differences in smoking cessation have produced mixed results. The purpose of the study was to examine whether there are gender differences in long-term smoking abstinence rates in smokers treated with nicotine patches at a smoking cessation clinic in Taiwan, where 39% of men and 5% of women smoke. This study included 1,065 smokers, comprising of 940 men and 125 women. Smokers were invited to attend the clinic every 1-2 weeks for a maximum of eight visits over 90 days, where they received prescriptions for nicotine patches, counseling, and educational materials. Participants were contacted by telephone at 1 and 3 years after the first visit and were asked whether they had smoked at all over the past 7 days. The results showed that women were significantly less likely than men to be abstinent at 1 year (adjusted odds ratio [aOR] = 0.64; 95% CI [confidence interval] = [0.41, 0.99]; p = .044) and 3 years (aOR = 0.44; 95% CI = [0.27, 0.74]; p = .02). More effective ways are needed to help female smokers quit in societies where smoking in women is rare and may be associated with social stigma.

Psychometric Evaluation of the Cigarette Withdrawal Scale (Chinese Version) in Male Smokers in Taiwan.

BACKGROUND: Symptoms of smoking withdrawal are a central feature of nicotine dependence. A valid and reliable measure of these symptoms is important to better understand nicotine dependence and to develop effective interventions. PURPOSE: The objective of this study was to examine the validity and reliability of the Chinese version of the Cigarette Withdrawal Scale (CWS-C). METHODS: This study conducted cross-sectional surveys in two phases. In the first phase, exploratory factor analysis was used to test the underlying factor structure, the criterion validity, and the reliability of the CWS-C. A reliability test was conducted to assess the internal consistency and stability of the instrument. In the second phase, confirmatory factor analysis validated the factor model that had been proposed in earlier empirical research. The total sample size used in analysis was 497. RESULTS: The CWS-C achieved a level of efficacy that was similar to the English version. Exploratory factor analysis showed that the six factors of the instrument accounted for 80.3% of the variance. The full scale and all of the subscale items, with the exception of the appetite-weight gain subscale (r = .12, p = .09), were significantly associated with the Fagerstrom Test for Nicotine Dependence (r = .25-.50, p < .05). The Cronbach's alpha of the full scale was .93, with retest coefficient of .84. Confirmatory factor analysis confirmed that the CWS-C had six correlated factors. Field testing showed that the CWS-C is a reliable and valid Chinese-language instrument for assessing the symptoms of cigarette withdrawal. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The CWS-C performed well in terms of reliability and validity in several tests conducted on male Taiwanese smokers. Accurate measurement is expected to help health professionals better understand smoker quitting patterns and the severity of withdrawal symptoms and to develop improved withdrawal-symptom treatment interventions.

A comparison of the effectiveness of varenicline and transdermal nicotine patch in outpatients following a standardized smoking cessation program in Southern Taiwan.

`Varenicline use has been shown to produce greater long-term smoking cessation rates than bupropion but has no clear differences compared to the transdermal nicotine patch. We performed this study to compare the effectiveness of varenicline with the nicotine patch at 3 and 6 months of follow-up of patients in an outpatient smoking cessation program provided by a hospital in Southern Taiwan. The sample consisted of 463 patients who attended the smoking cessation program at the outpatient family medicine clinic at Kaohsiung Veterans General Hospital between March 2006 and December 2008. All patients were aged ≥18 years and either smoked ≥10 cigarettes per day or scored ≥4 on the Fagerström Test for Nicotine Dependence. Patients were seen by a physician for up to 8 sessions in 90 days. Medication use was guided by patient preference (208 opted for varenicline and 255 for the nicotine patch). The primary outcomes of the study were self-reported 7-day point prevalence abstinence rates at 3 and 6 months from the first clinic visit. Varenicline users had a significantly higher abstinence rate than those using nicotine patch at 3-month (47.1% vs. 30.6%; odds ratio [OR] = 2.02, 95% confidence interval [CI] = [1.38, 2.96]) and 6-month follow-up (41.3% vs. 30.6%; OR = 1.60, 95% CI [1.09, 2.32]). Both groups had similar incidences of adverse events. Varenicline use in a sample of treatment-seeking-dependent smokers was associated with significantly higher abstinence rates than the nicotine patch.

Varenicline versus transdermal nicotine patch: a 3-year follow-up in a smoking cessation clinic in Taiwan.

RATIONALE: A network meta-analysis of randomized trials and real-world comparative studies strongly suggest that varenicline is more effective in aiding smoking cessation than single form nicotine replacement therapy (NRT). Modeling the health benefits attributable to this difference relies on extrapolation to lifetime cessation, but to date, follow-up has only extended to 12 months. Longer term follow-up data are helpful in checking these assumptions. OBJECTIVES: This study aimed to compare the sustained abstinence rates of smokers using varenicline versus nicotine patch in their quit attempt up to 36 months. METHOD: Five hundred eighty-seven smokers were recruited at Kaohsiung Veteran General Hospital between Feb 2006 and Aug 2009. Participants received counseling from a physician and received either varenicline (N=296) or the nicotine patch (N=291) for smoking cessation. Both varenicline and nicotine patch users could receive their medications for a maximum of 8 weeks. Participants were followed up by telephone at 3, 6, 12, and 36 months from the first visit. The primary outcome measure was self-reported sustained abstinence up to 36 months. Measures were also taken of smoking characteristics, cigarette dependence, and sociodemographic characteristics. RESULTS: Multiple logistic regression of 36-month sustained abstinence on to medication adjusting for other baseline variables showed a significant advantage for varenicline, OR=7.94 (95 % CI 1.87-33.74). CONCLUSION: An 8-week course of varenicline appears to yield higher abstinence rate up to 3 years than a similar length course of nicotine transdermal patch in routine clinical practice where behavioral support is available.

Smoking cessation program in outpatient clinics of Family Medicine Department in Taiwan: a longitudinal evaluation.

The Government of Taiwan has imposed a tobacco health tax of NT$5 (US$0.14) per pack of cigarettes since January 2002. The Department of Health has now begun to fund a smoking cessation program that provides nicotine-replacement therapy (NRT) and brief counseling by physicians in outpatient clinics. The purpose of the current study was to evaluate the smoking cessation program with a 3-year follow-up review implemented at outpatient clinics, which were run by the Family Medicine Department in a medical center, with a total of 772 adult participants. The abstinence rates were 99.7%, 49.2%, 37.7%, 30.2%, and 22.7%, at the 1-, 3-, 6-, 12-, and 36-month points, respectively. The frequency of clinic visits is a major factor predicting long-term cessation. The results indicate the need to pursue implementation and evaluation of multidisciplinary interventions in smoking cessation clinics with a longer follow-up, including the promotion of compliance to increase clinic visits and prevent relapse.

Factors related to incomplete flexible sigmoidoscopy among adult Chinese in Taiwan.

BACKGROUND: Sigmoidoscopy is effective in colorectal cancer screening, but incomplete examinations may overlook colonic pathologies and delay diagnosis. This study aimed to explore risk factors for incomplete insertions of flexible sigmoidoscopy among Taiwanese. METHODS: Healthy adults participating in health check-up in a tertiary medical center were invited for study. Subjects were recruited when they had fully consented and agreed to participate. Factors related to incomplete insertions of flexible sigmoidoscopy were evaluated and multivariate logistic regression was used to determine independent risk factors. A predictive model was generated by the risk factors identified. RESULTS: In total, 1,252 subjects (mean age, 53.9 13.1 years; age range, 2187 years; male/female,780/472) were enrolled, and 278 (22.2%) incomplete insertions were recorded. Multivariate analysis showed that female gender (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.562.73; p < 0.001), age >or= 60 years (OR, 1.68; 95% CI, 1.262.23; p < 0.001), inadequate bowel preparation (OR, 1.66; 95% CI, 1.212.16; p = 0.001), history of constipation (OR, 2.43; 95% CI, 1.045.69; p = 0.042), and body mass index (BMI) < 25 kg/m2 (OR, 1.41; 95% CI, 1.051.89; p = 0.024) were all independent risk factors. The probability of incomplete insertion was significantly associated with the sum of the aforementioned risk factors (p < 0.001). Compared with subjects with no risk factors, the risks of incomplete insertions increased significantly among subjects bearing 1 risk factor (OR, 2.57; 95% CI, 1.474.49; p = 0.001), 2 risk factors (OR, 4.41; 95% CI, 2.527.39; p < 0.001), 3 risk factors (OR, 6.40; 95% CI, 3.5611.52; p < 0.001) and >or= 4 risk factors (OR, 10.00; 95% CI, 3.8925.70; p < 0.001). CONCLUSION: Female sex, age >or= 60 years, BMI < 25 kg/m2, history of constipation, and inadequate bowel preparation were independent risk factors for incomplete insertion of flexible sigmoidoscopy. Subjects with multiple risk factors may consider alternative modalities for colonic examination.

A randomized, placebo-controlled trial of varenicline, a selective alpha4beta2 nicotinic acetylcholine receptor partial agonist, as a new therapy for smoking cessation in Asian smokers.

BACKGROUND: Rates of smoking in East Asian men range from >35% to >60%, and are increasing in women and the young. OBJECTIVE: This study evaluated the efficacy and tolerability of 1 mg BID varenicline, a novel alpha4beta2 nicotinic acetylcholine receptor partial agonist, for smoking cessation in smokers in Taiwan and Korea. METHODS: A randomized, double-blind, placebo-controlled, 12-week treatment, 12-week follow-up trial was conducted at 5 sites each in Korea and Taiwan. Eligible subjects, smoking >or=10 cigarettes/d, received brief smoking-cessation counseling and were randomly assigned in a 1:1 ratio to varenicline 1 mg BID (titrated during the first week) or placebo. Smoking status was established by self-report and confirmed at clinic visits by end-expiratory carbon monoxide or= 5% for varenicline were nausea (43.7% for varenicline vs 11.3% placebo), insomnia (15.1% vs 13.7%), increased appetite (7.9% vs 6.5%), constipation (7.1% vs 2.4%), anxiety (5.6% vs 2.4%), and abnormal dreams (5.6% vs 0.8%). Adverse events resulted in <10% treatment discontinuations overall. CONCLUSION: Varenicline was an efficacious and well-tolerated pharmacotherapy for smoking cessation in this group of Asian smokers over a 12-week treatment period, and its effects persisted for a further 12-week follow-up period.