Delayed sustained lung inflation for preterm neonates in neonatal intensive care unit: a randomized controlled trial.

INTRODUCTION: Sustained lung inflation (SLI) right after birth to decrease the use of mechanical ventilation of preterm infants is controversial because of potential harm. This randomized controlled trial was conducted to evaluate the effectiveness and safety of delayed SLI in neonatal intensive care unit (NICU). METHODS: Preterm neonates requiring continuous positive airway pressure after birth were eligible for enrollment. In the experimental group, SLI with 20 cm H2O for 15 s was conducted by experienced staff in the NICU between 30 min and 24 h after birth. RESULTS: A total of 45 neonates were enrolled into this study, including 24 in the experimental group and 21 in the control group. There was no significant difference in the birth condition between the experimental and control groups, including gestational age (p = 0.151), birth weight (p = 0.692), and Apgar score at 1 min (p = 0.410) and 5 min (p = 0.518). The results showed the duration of respiratory support was shorter in the experimental group than the control group (p = 0.044). In addition, there was no significant difference in the other outcomes, such as pneumothorax, patent ductus arteriosus, and bronchopulmonary dysplasia. CONCLUSION: Our findings indicate that sustained inflation conducted by experienced staff in the NICU is safe. The data suggest that SLI conducted by experienced staff in the NICU after stabilization could serve as an alternative management for preterm infants with respiratory distress. However, the reduction in use of respiratory support should be interpreted cautiously as a result of limited sample size. TRIAL REGISTRATION: University hospital Medical Information Network (UMIN) Clinical Trials Registry: UMIN000052797 (retrospectively registered).

Association between fine particulate air pollution and the risk of death from lung cancer in Taiwan.

Airborne fine particulate matter (PM2.5) has been classified as a Group I carcinogen leading to lung cancer in humans by the International Agency for Research on Cancer (IARC). In Taiwan, where there is a growing incidence of this disease, lung cancer is currently the leading cause of cancer-associated deaths in women and second leading cause of deaths in men. Because tobacco use is rare in Taiwan, especially amongst women, the high incidence of this type of cancer was suggested to be attributed to the other external contaminants, including airborne PM2 pollution. In this ecologic study, a possible association between ambient air PM2.5 exposure and likelihood of death attributed to lung cancer was examined in Taiwan in 66 municipalities. Annual PM2.5 levels and age-standardized lung cancer mortality rates for male and female residents were calculated for years 2010 to 2019. Weighted-multiple regression was applied to analyze our data, adjusting for level of urbanization and physician density. For males, the adjusted risk ratios (RRs) for lung cancer mortality were 1.01 for municipalities with PM2.5 levels 21.85-28.21 ug/m3 and 1.07 for municipalities with 28.22-31.23 ug/m3, compared to those with the lowest PM2.5 levels. For females, these adjusted RRs were 0.99 and 1.06, respectively. Data demonstrated an association between chronic exposure to high levels of PM2.5 and increased likelihood of death attributed to lung cancer for both men and women in Taiwan. Further studies are needed to explore the relationship between PM2.5 air pollution exposure and risk of lung cancer histologic subtype.

Relationship between fine particulate air pollution and hospital admissions for depression: a case-crossover study in Taipei.

There are few apparent studies regarding the association between fine particulate matter (PM2.5) air pollution and development of depression. Data obtained from epidemiological studies are inconsistent and controversial. The aim of this case-crossover study was to examine the association between short-term exposure to PM2.5 alone and in combination with other pollutants and frequency of hospitalizations for depression from 2009 to 2013 in Taipei, Taiwan. In the single pollutant model without adjustment for other pollutants, 17% and 4% increase in admissions attributed to depression correlated with interquartile range (IQR) rise in PM2.5 levels was noted on warm and cool days, respectively. Data were also analyzed using two-pollutant models and it was found that on warm days, the association continued to be significant after including one of the following pollutants: sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) or carbon monoxide (CO). On cool days, the significance was lost. In conclusion, the relationship between ambient outdoor PM2.5 exposure and rates of hospitalization for depression appeared to be temperature dependent in Taipei. Further research is needed to verify these observations as well as to distinguish the relative contributions of PM2.5 and temperature to development for hospital admissions for depression.

Association between ozone air pollution levels and hospitalizations for depression in Taipei: a time-stratified case-crossover study.

Epidemiologic studies reported an association between exposure to ambient air pollutants and increased mortality rate attributed to suicide and suicide attempts. The investigation sought to determine whether there is an association between short-term ambient ozone (O3) level exposure and daily hospital admissions for depression in Taipei from 2009 to 2013 using a time-stratified case-crossover design. In our single-pollutant model (with no adjustment for other pollutants), the % increase in daily hospital admissions for depression was 12% on warm days and 30% on cool days, per interquartile range (IQR) rise in O3 levels, respectively. Ozone levels were significantly correlated with daily number of depression admissions both on warm and cool days. In our two-pollutant models, O3 levels remained significant after adjusting for other air pollutants, including particulate matter (PM10, PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) both on warm and cool days. Although O3 levels tended to be higher on warm days, admissions for depression were higher on cool days, suggesting that the relationship between O3 concentrations and depression may be affected by temperature. Further study is needed to better understand these findings.

Relationship between ozone air pollution and daily suicide mortality: a time-stratified case-crossover study in Taipei.

Several studies suggested short-term exposure to air pollution might be associated with suicide mortality, although results have been inconsistent and vary depending upon the type of air contaminants. While seasonal variation associated with suicide was reported to occur and that in the spring and early summer there are peaks in ozone (O3) distribution, the relationship between these two parameters is not known. The aim of this study was to examine the potential association between O3 levels and daily mortality rate related to suicide in Taipei for the period 2004-2008 using a time-stratified case-crossover analysis. In our single pollutant model without adjustment for other pollutants, the risk of suicide increased by 11% on warm days and 15% on cool days for each interquartile range (IQR) rise in O3 concentration, respectively. The relationship was positive but did not reach significance. In our two-pollutant models, O3 remained non-significant on warm days after inclusion of one of any other ambient air contaminants into the model. However, on cool days, a significant association was found between O3 levels and enhanced risk of mortality due to suicide after nitrogen dioxide (NO2) or carbon monoxide (CO) were included. The overall positive but not significant findings of elevated risk of mortality frequently attributed to suicide on days with higher O3 levels suggest that outdoor exposures to this gaseous contaminant may contribute to increases in daily mortality rate related to suicide.

Aerosol therapy in relation to retinopathy of prematurity in mechanically ventilated preterm infants.

BACKGROUND: Aerosol administration is increasingly being used as a therapeutic intervention for mechanically ventilated preterm infants. However, the effects of inhalation therapy on retinopathy of prematurity (ROP) have not yet been explored. METHODS: A retrospective cohort study was conducted in a tertiary level neonatal intensive care unit (NICU) from 2011 to 2013. All preterm infants with a gestational age (GA) of 24~29 weeks receiving invasive intubation for more than 1 week in the NICU were included. Infants with severe congenital anomalies were excluded. ROP was defined as stage II or greater according to medical records by ophthalmologists. A multivariate logistic regression model was used to estimate the risk of ROP in relation to inhalation therapy after adjusting for confounders. RESULTS: In total, 205 infants were enrolled in this study, including 154 with inhalation therapy and 51 without inhalation therapy. Univariate analyses showed an association of inhalation with the following characteristics: sex (p = 0.047), GA (p = 0.029), sepsis (p = 0.047), bronchopulmonary dysplasia (BPD) (p < 0.001), and ROP (p = 0.001). Furthermore, logistic regression analysis indicated that inhalation therapy was an independent risk factor for ROP (odds ratio (OR) = 2.639; 95% confidence interval (CI) = 1.050~6.615). In addition, infants with a GA of 24~25 weeks (OR = 6.063; 95% CI = 2.482~14.81) and 26~27 weeks (OR = 3.825; 95% CI = 1.694~8.638) were at higher risk of ROP than those with a GA of 28~29 weeks. Other factors - including sex, sepsis, BPD, and delivery mode - did not carry significant risk. CONCLUSION: Aerosol therapy with pure oxygen delivery is associated with ROP. Clinicians should exercise great caution when conducting aerosol therapy with excess oxygen in mechanically ventilated preterm infants.

Farming and mortality rates attributed to non-Hodgkin's lymphoma in Taiwan.

Previous studies suggested an elevated risk of non-Hodgkin's lymphoma (NHL) among farmers. To date, no apparent study examined the association between farming and NHL in Asian countries. The aim of this study was to investigate whether farmers in Taiwan exhibited an increased risk of mortality attributed to NHL. To this end, a mortality odds ratio (MOR) study was conducted to estimate the relative risk of mortality attributed to NHL for farmers in Taiwan. Data on the decedents enrolled in this investigation were derived from the death certificate database for the period 1997-2009. The study group comprised individuals who died from NHL and who were 50 years or older. The control group consisted of subjects who died from all other causes, excluding cancers, in the corresponding age group. Multiple logistic regression analysis was performed to compute the MOR, with adjustments for gender, age at death, year of death, marital status, and urbanizational levels. Among 32,456 deceased farmers, 205 died due to NHL. Farmers were found to have a nonsignificantly higher MOR than nonfarmers. This risk estimate is similar to estimates in previous meta-analyses. The MOR for NHL was higher among farmers who died 65 years or older than among those who died at younger ages. The findings indicate that farming in Taiwan may increase the risk of death attributed to NHL. Exposure to pesticides might be an influential factor contributing to high risk of mortality attributed to NHL among farmers and therefore needs to be further investigated.

Short-term effects of ozone air pollution on hospital admissions for myocardial infarction: A time-stratified case-crossover study in Taipei.

This study was undertaken to determine whether there was a correlation between ambient ozone (O3) levels and number of hospital admissions for myocardial infarction (MI) in Taipei, Taiwan. Hospital admissions for MI and ambient air pollution data for Taipei were obtained for the period from 2006 to 2010. The relative risk (RR) of hospital admissions for MI was estimated using a time-stratified case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased RR for a number of MI admissions was significantly associated with higher O3 levels both on warm days (>23°C) and on cool days (<23°C). This observation was accompanied by an interquartile range elevation correlated with a 7% (95% CI = 2%-12%) and 17% (95% CI = 11%-25%) rise in number of MI admissions, respectively. In the two-pollutant models, no significant associations between ambient O3 concentrations and number of MI admissions were observed on warm days. However, on cool days, correlation between ambient O3 after inclusion of each of the other five pollutants, particulate matter (PM10 or PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2) or carbon monoxide (CO), and number of MI admissions remained significant. This study provides evidence that higher levels of ambient O3 increase the RR of number of hospital admissions for MI.

Perceived risk of tuberculosis infection among healthcare workers in Swaziland.

BACKGROUND: The incidence of tuberculosis (TB) in the Kingdom of Swaziland is extremely high. How healthcare workers (HCWs) in Swaziland perceive infection control (IC) measures for preventing TB transmission is unclear. This study aimed to determine perceived risk of TB infection in relation to IC measures among HCWs in three institutions of Swaziland. METHODS: A cross-sectional questionnaire survey was conducted in 2014. Demographic data and IC measures were collected from main and allied HCWs. RESULTS: In total, 186 HCWs (19 doctors, 99 nurses, and 68 allied HCWs) were enrolled. The multivariate logistic regression analyses revealed that nurses (OR = 39.87, 95% CI = 2.721-584.3) and other HCWs (OR =99.34, 95% CI = 7.469-1321) perceived a higher TB infection risk than did doctors. Moreover, HCWs working for <4 years at the TB department perceived a lower TB infection risk (OR = 0.099, 95% CI = 0.022-0.453). Availability of N95 respirator masks (OR = 0.055, 95% CI = 0.005-0.586) and a designated sputum collection area (OR = 0.142, 95% CI = 0.037-0.545) also carried lower TB infection risks. CONCLUSION: This study depicts the current status of IC measures for TB infection in a high prevalence country. The results suggest that HCWs perceived a greater TB infection risk at inadequate environmental IC measures.

Risk assessment of gene variants for neonatal hyperbilirubinemia in Taiwan.

BACKGROUND: Hyperbilirubinemia is a common disorder during neonatal period in Taiwan. Gene variants may play an important role in the development of neonatal hyperbilirubinemia. The current study investigated the association between neonatal hyperbilirubinemia and common gene variants involving the production and metabolism of bilirubin. METHODS: This prospective study enrolled 444 healthy infants born in the Chang Gung Memorial Hospital at Taipei from 2013-2015. Hyperbilirubinemia was defined as a total bilirubin ≥ 15 mg/dL. A log-binomial model was used to assess the risk of gene variants. RESULTS: The most common genetic variant was short heme oxygenase (HO)-1 promoter GT-allele (<24 repeats) (39.4 %), followed by GA at nt388 in hepatic solute carrier organic anion transporter 1B1 (SLCO1B1) (31.1 %), GA at nt211 in UDP-glucuronosyltransferase 1A1 (UGT1A1) (29.3 %), ABO incompatibility (16.2 %), alpha thalassemia (5.0 %), and G6PD deficiency (3.2 %). The log-binomial analysis demonstrated greater risks of hyperbilirubinemia in infants with GA at nt211 in UGT1A1 (RR = 1.548; 95 % CI = 1.096-2.187), short HO-1 promoter GT-repeat (RR = 2.185; 95 % CI = 1.527-3.125), and G6PD deficiency (RR = 1.985; 95 % CI = 1.010-3.901). The other gene variants - including blood type, alpha thalassemia, and SLCO1B1 - carried no significant risk. CONCLUSIONS: G6PD deficiency, short HO-1 promoter GT-repeat and GA at nt211 in UGT1A1 are risk factors of neonatal hyperbilirubinemia. The data provide clinical evidence to explain the high incidence of neonatal hyperbilirubinemia in Taiwan.

Short-Term Effect of Coarse Particles on Daily Mortality Rate in A Tropical City, Kaohsiung, Taiwan.

Many studies examined the short-term effects of air pollution on frequency of daily mortality over the past two decades. However, information on the relationship between exposure to levels of coarse particles (PM(2.5-10)) and daily mortality rate is relatively sparse due to limited availability of monitoring data and findings are inconsistent. This study was undertaken to determine whether an association exists between PM(2.5-10) levels and rate of daily mortality in Kaohsiung, Taiwan, a large industrial city with a tropical climate. Daily mortality rate, air pollution parameters, and weather data for Kaohsiung were obtained for the period 2006-2008. The relative risk (RR) of daily mortality occurrence was estimated using a time-stratified case-crossover approach, controlling for (1) weather variables, (2) day of the week, (3) seasonality, and (4) long-term time trends. For the single-pollutant model without adjustment for other pollutants, PM(2.5-10) exposure levels showed significant correlation with total mortality rate both on warm and cool days, with an interquartile range increase associated with a 14% (95% CI = 5-23%) and 12% (95% CI = 5-20%) rise in number of total deaths, respectively. In two-pollutant models, PM(2.5-10) exerted significant influence on total mortality frequency after inclusion of sulfur dioxide (SO(2)) on warm days. On cool days, PM(2.5-10) induced significant elevation in total mortality rate when SO(2) or ozone (O(3)) was added in the regression model. There was no apparent indication of an association between PM(2.5-10) exposure and deaths attributed to respiratory and circulatory diseases. This study provided evidence of correlation between short-term exposure to PM(2.5-10) and increased risk of death for all causes.

Short-Term Effects of Coarse Particulate Matter on Hospital Admissions for Cardiovascular Diseases: A Case-Crossover Study in a Tropical City.

This study was undertaken to determine whether there was an association between coarse particles (PM2.5-10) levels and frequency of hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD, including ischemic heart disease (IHD), stroke, congestive heart failure (CHF), and arrhythmias, and ambient air pollution data levels for Kaohsiung were obtained for the period 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased rates of admissions for CVD were significantly associated with higher coarse PM levels only on cool days (< 25°C), with a 10-µg/m(3) elevation in PM2.5-10 concentrations associated with a 3% (95% CI = 2-4%) rise in IHD admissions, 5% (95% CI = 4-6%) increase in stroke admissions, 3% (95% CI = 1-6%) elevation in CHF admissions, and 3% (95% CI = 0-6%) rise in arrhythmias admissions. No significant associations were found between coarse particle levels and number of hospital admissions for CVD on warm days. In the two-pollutant models, PM2.5-10 levels remained significantly correlated with higher rate of CVD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. Compared to the effect estimate associated with a 10-µg/m(3) increase in PM2.5 levels, effect estimates of frequency of CVD-related admissions associated with a 10-µg/m(3) rise in coarse PM levels were weaker. This study provides evidence that higher levels of PM2.5-10 enhance the risk of hospital admissions for CVD.

Survey of patient perceptions towards short-term mobile medical aid for those living in a medically underserved area of Swaziland.

BACKGROUND: An increasing number of short-term medical missions (STMMs) are being dispatched to provide humanitarian healthcare; however, extensive investigations on how recipient patients perceive STMMs are lacking. The current study evaluated the perceptions of patients toward medical services provided by a Taiwanese STMM in a resource-poor area of Swaziland. METHODS: A structured questionnaire survey was completed by patients who had received medical services from the medical mission of Taipei Medical University in Swaziland in July 2014. RESULTS: In total, 349 questionnaires were valid for the analysis. More respondents were female than male (69.6% vs 30.4%). The most common chief complaint was musculoskeletal problems (45.8%), followed by respiratory symptoms (35.0%). Most of the patients stated that their overall experience with the medical services was excellent (91.4%). Universal patients would like to see the service provided in the future (99.7%). Nearly 90% of the patients were aware of how to take care of the medical problem they were diagnosed with. A majority of the patients comprehended what their medical providers said. Only a few patients did not understand what physicians said (5.2%). CONCLUSION: Medical services provided by the STMM were helpful in resolving patients' problems. The data have crucial implications for evaluating overseas mobile medical aid from the viewpoint of patients.

Implementation of evidence-based practice in relation to a clinical nursing ladder system: a national survey in Taiwan.

BACKGROUND: Although evidence-based practice (EBP) has been widely investigated, few studies have investigated its correlation with a clinical nursing ladder system. The current national study evaluates whether EBP implementation has been incorporated into the clinical ladder system. METHODS: A cross-sectional questionnaire survey was conducted nationwide of registered nurses among regional hospitals of Taiwan in January to April 2011. Subjects were categorized into beginning nurses (N1 and N2) and advanced nurses (N3 and N4) by the clinical ladder system. Multivariate logistic regression model was used to adjust for possible confounding demographic factors. RESULTS: Valid postal questionnaires were collected from 4,206 nurses, including 2,028 N1, 1,595 N2, 412 N3, and 171 N4 nurses. Advanced nurses were more aware of EBP than beginning nurses (p < 0.001; 90.7% vs. 78.0%). In addition, advanced nurses were more likely to hold positive beliefs about and attitudes toward EBP (p < 0.001) and possessed more sufficient knowledge of and skills in EBP (p < 0.001). Furthermore, they more often implemented EBP principles (p < 0.001) and accessed online evidence-based retrieval databases (p < 0.001). The most common motivation for using online databases was self-learning for advanced nurses and positional promotion for beginning nurses. Multivariate logistic regression analyses showed advanced nurses were more aware of EBP, had higher knowledge and skills of EBP, and more often implemented EBP than beginning nurses. LINKING EVIDENCE TO ACTION: The awareness of, beliefs in, attitudes toward, knowledge of, skills in, and behaviors of EBP among advanced nurses were better than those among beginning nurses. The data indicate that a clinical ladder system can serve as a useful means to enhance EBP implementation.

Cytokine responses of TNF-α, IL-6, and IL-10 in G6PD-deficient infants.

G6PD-deficient adults are reported to be susceptible to severe infection, and decreased cytokine responses have been postulated as the underlying mechanism. However, investigating the association of G6PD deficiency and cytokine responses during infancy is lacking. The current study aims to determine whether cytokine responses of tumor necrosis factor ()-α, interleukins (IL)-6, and IL-10 are impaired in the G6PD-deficient infants. Upon agreements with informed consents, peripheral blood mononuclear cells (PBMCs) of enrolled infants were collected twice at 1 month and 1 year of age. PBMCs were then stimulated with toll-like receptor (TLR) agonists-including PAM3csk4 for TLR1-2, poly (I:C) for TLR3, and lipopolysaccharide for TLR4-to analyze the expression of TNF-α, IL-6, and IL-10. Males (P = .004) and phototherapy during neonatal period (P = .008) were more common among G6PD-deficient infants than G6PD-normal subjects. After the stimulation of TLR agonists, there was no significant difference in the expression of TNF-α, IL-6, and IL-10 between PBMCs of G6PD-deficient and -normal infants at both 1 month and 1 year of age. In conclusion, the clinical characteristics of G6PD-deficient infants are different from those of G6PD-normal subjects. The data suggest that the innate immune responses to TLR agonists in G6PD-deficient infants are not different from those of G6PD-normal infants.

Increasing utilization of Internet-based resources following efforts to promote evidence-based medicine: a national study in Taiwan.

BACKGROUND: Since the beginning of 2007, the National Health Research Institutes has been promoting the dissemination of evidence-based medicine (EBM). The current study examined longitudinal trends of behaviors in how hospital-based physicians and nurses have searched for medical information during the spread of EBM. METHODS: Cross-sectional postal questionnaire surveys were conducted in nationally representative regional hospitals of Taiwan thrice in 2007, 2009, and 2011. Demographic data were gathered concerning gender, age, working experience, teaching appointment, academic degree, and administrative position. Linear and logistic regression models were used to examine predictors and changes over time. RESULTS: Data from physicians and nurses were collected in 2007 (n = 1156), 2009 (n = 2975), and 2011 (n = 3999). There were significant increases in the use of four Internet-based resources - Web portals, online databases, electronic journals, and electronic books - across the three survey years among physicians and nurses (p < 0.001). Access to textbooks and printed journals, however, did not change over the 4-year study period. In addition, there were significant relationships between the usage of Internet-based resources and users' characteristics. Age and faculty position were important predictors in relation to the usage among physicians and nurses, while academic degree served as a critical factor among nurses only. CONCLUSIONS: Physicians and nurses used a variety of sources to look for medical information. There was a steady increase in use of Internet-based resources during the diffusion period of EBM. The findings highlight the importance of the Internet as a prominent source of medical information for main healthcare professionals.

Effectiveness of national evidence-based medicine competition in Taiwan.

BACKGROUND: Competition and education are intimately related and can be combined in many ways. The role of competition in medical education of evidence-based medicine (EBM) has not been investigated. In order to enhance the dissemination and implementation of EBM in Taiwan, EBM competitions have been established among healthcare professionals. This study was to evaluate the impact of competition in EBM learning. METHODS: The EBM competition used PICO (patient, intervention, comparison, and outcome) queries to examine participants' skills in framing an answerable question, literature search, critical appraisal and clinical application among interdisciplinary teams. A structured questionnaire survey was conducted to investigate EBM among participants in the years of 2009 and 2011. Participants completed a baseline questionnaire survey at three months prior to the competition and finished the same questionnaire right after the competition. RESULTS: Valid questionnaires were collected from 358 participants, included 162 physicians, 71 nurses, 101 pharmacists, and 24 other allied healthcare professionals. There were significant increases in participants' knowledge of and skills in EBM (p<0.001). Their barriers to literature searching and forming answerable questions significantly decreased (p<0.01). Furthermore, there were significant increases in their access to the evidence-based retrieval databases, including the Cochrane Library (p<0.001), MD Consult (p<0.001), ProQuest (p<0.001), UpToDate (p=0.001), CINAHL (p=0.001), and MicroMedex (p=0.024). CONCLUSIONS: The current study demonstrates a method that successfully enhanced the knowledge of, skills in, and behavior of EBM. The data suggest competition using PICO queries may serve as an effective way to facilitate the learning of EBM.

Perceptions of COVID-19 during and after the Omicron outbreak among healthcare personnel in Indonesia.

Introduction: The COVID-19 pandemic occurred in several waves with different levels of seriousness. Healthcare personnel (HCP) constituted a high-risk population for COVID-19, necessitating monitoring of their knowledge, attitudes, and practices (KAP) status and level of psychological distress. This study investigated differences in the impacts of COVID-19 during and after the Omicron outbreak among HCP in Indonesia. Methods: An online structured questionnaire survey was distributed twice in selected hospitals of Indonesia: the first survey was between December 2021 and February 2022 (Omicron era) and the second between August and October 2022 (post-Omicron era). A multiple logistic regression model was used to determine the differences in KAP and psychological distress among HCP toward COVID-19 with demographic characteristics adjusted for. Results: This study included 402 (Omicron era) and 584 (post-Omicron era) HCP members. Positive attitudes were more common in the Omicron era than in the post-Omicron era (p = 0.001). The availability of face shields and protective eyewear significantly decreased from 62.7 to 55.6% (p = 0.028). However, psychological distress among HCP significantly increased after the Omicron outbreak (p = 0.024). Multiple logistic regression analyses revealed a decrease of positive attitudes (OR = 0.626; 95% CI = 0.476-0.823) in the post-Omicron era. Conclusion: Our data indicated a significant increase in psychological distress among HCP in the post-Omicron era. These findings suggest a need for greater focus on psychological distress among HCP in Indonesia.

Perceptions towards the COVID-19 Pandemic during Different Lockdown Levels among International Students in Taiwan.

International students face many impediments under the COVID-19 pandemic. The objectives of this study are to assess the association between the perceptions of international students and the lockdown policy for COVID-19. In 2021, three different levels of lockdown policy were enforced, including level I from January to April, level III from May to July, and level II from August to December. We conducted three surveys for international graduate students using a validated questionnaire during the different lockdown levels. We collected 185, 119, and 83 valid questionnaires in level I, II, and III, respectively. There were linear trends in the correlations of lockdown policy with the knowledge (p = 0.052), attitudes (p = 0.002), and practices (p < 0.001) of COVID-19. In brief, the stricter the lockdown policy, the better the students adhered to sufficient knowledge, positive attitudes, and healthy practices. Furthermore, there were significant linear correlations of lockdown policy with the transportation, school study, leisure, family life, and diet behavior. In conclusion, lockdown policy had important impacts on the knowledge, attitudes, practices, and daily lives of international students. The findings indicated that the lockdown system and its corresponding measures appear to affect perceptions in a positive way.

Breast milk jaundice and maternal diet with chinese herbal medicines.

Our objective was to identify the association between maternal diet with Chinese herbal medicines and prolonged jaundice of breast-fed infants. Healthy infants at 25 to 45 days of age were eligible for enrollment into this prospective study. Jaundice was defined as a transcutaneous bilirubin (TcB) value ≥ 5 mg/dL. A questionnaire survey asking feeding type, stool pattern, and maternal diet was conducted at the time of TcB measurement. A total of 1148 infants were enrolled, including 151 formula-fed, 436 combination-fed, and 561 breast-fed infants. The incidences of jaundice were 4.0% in formula-fed infants, 15.1% in combination-fed infants, and 39.8% in breast-fed infants (P < 0.001). In addition, jaundice was noted in 37.1% of preterm infants and 25.0% of term infants (P < 0.001). Furthermore, jaundice was more common in breast-fed infants whose mothers did not consume the traditional Chinese herbal medicines than in breast-fed infants whose mothers did consume such medicines (P < 0.001). In conclusion, this cohort study has identified late-preterm birth and breast feeding as the contributory factors for prolonged jaundice of apparently well infants. The data indicate that postpartum diet with Chinese herbal medicines is associated with breast milk jaundice.