Comparison of puncture methods in patients with hemodialysis: A randomized controlled trial.

INTRODUCTION: Arteriovenous fistula or arteriovenous graft is essential to long-term survival and quality of life in patients receiving hemodialysis. To date, no research has examined the clinical impacts of different puncture methods. This study compared the rope ladder and area puncture techniques in terms of vascular patency, pain, and quality of life among patients receiving hemodialysis. METHODS: A prospective longitudinal study was performed with 6-month follow-up. A total of 98 participants recruited from a hemodialysis center in Taiwan were randomly assigned to receive the rope ladder technique (experimental group) or the area puncture technique (control group). Vascular patency was assessed by examining access flow and percutaneous transluminal angioplasty rate. Pain and quality of life were measured using the Numerical Pain Rating Scale (NPRS) and Kidney Disease Quality of Life Instrument (KDQOL-36™), respectively. All outcome variables were measured repeatedly and analyzed using a generalized estimating equation. RESULTS: Overall, quality of life was significantly better for the experimental group than for the control group (ß = 47.23, p < 0.001). The percutaneous transluminal angioplasty rate was lower for the experimental group than for the control group (12.0% vs. 18.8%). However, no significant differences were found in access flow and pain level between the two groups over time. CONCLUSION: Hemodialysis patients who received the rope ladder puncture technique had a lower percutaneous angioplasty rate and better quality of life than patients who received the area puncture technique, suggesting that the rope ladder technique could be implemented as a routine cannulation method in hemodialysis clinics.

[Applying Problem Behavior Theory to Investigate the Factors Affecting Tobacco Products Use by Students at Eight Universities in the Greater Taipei Area].

BACKGROUND: There is growing concern related to the recent rise in consumption of cigarettes, electronic cigarettes, and heated tobacco products. The government should pay more attention to the use of various tobacco products by university students. PURPOSE: Problem behavior theory was used in this study to explore the factors influencing the use of various tobacco products by university students in the Greater Taipei area. METHODS: In this cross-sectional study, convenience sampling was used to select eight institutions of higher education in the Greater Taipei area. Eight departments recognized by the Ministry of Education were then listed on a table for use in randomizing the selection of third- and fourth-year undergraduate students. A total of 115 participants filled out the questionnaires included in the self-administered online survey. Data analysis was conducted using logistic regression. RESULTS: The prevalence of tobacco-product use in the sample was 5.22%. Logistic regression analysis revealed having parents who smoked (adjusted odds ratio, AOR = 2.05), holding a positive attitude toward their parents' smoking (AOR = 4.23), having peers who smoked (AOR = 4.33), engaging in deviant behavior (AOR = 90.44), and having peers involved in deviant behavior (AOR = 103.99) to be associated with a higher likelihood of engaging in tobacco-product use. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Family, peers and delinquency significantly influence the usage behavior of university students with regard to tobacco products. The government should allocate greater resources for tobacco harm prevention education aimed at the parents of university students. In addition, integrating tobacco harm education into campus curricula, utilizing social media for online digital education, and providing students with counseling and support measures are strategies that may help reduce the tobacco-product use among this vulnerable population.

Prevalence of heated tobacco product use among adolescents in Taiwan.

OBJECTIVE: To determine the penetration of heated tobacco products (HTPs) into the youth market in Taiwan, with a particular focus on the correlation between IQOS use and the usage of other tobacco products. METHODS: Data from the 2018 Global Youth Tobacco Survey were used to assess previous experience with and current use (within 30 days prior to survey completion) of IQOS products by Taiwanese students aged 12-18 years. Independent variables included the usage patterns of conventional cigarettes and e-cigarettes. The control variables included background information (gender, grade, monthly income/allowance, household educational level, smoking status at home and among close friends), access to free cigarettes, as well as exposure to cigarette advertisements and anti-tobacco courses. Logistic regression was used to identify tobacco usage patterns correlated with IQOS use. RESULTS: In 2018, 2.33% of Taiwan's adolescents were currently using IQOS and 4.17% had tried IQOS. The use of conventional cigarettes and e-cigarettes (individually and together) were associated with an elevated risk of the ever use and current use of IQOS. CONCLUSION: Despite the fact that HTP products are not sold legally in Taiwan, the use of IQOS products by young people is far from negligible. We recommend amending the "Tobacco Hazards Prevention Act" to include regulations pertaining to the sale and marketing of HTPs.

Comparing the Characteristics of Cigarette Smoking and e-Cigarette and IQOS Use among Adolescents in Taiwan.

Objectives: Our objective in this study was to identify the risk factors for cigarette, e-cigarette, and IQOS use among adolescents in Taiwan, with a particular focus on socioeconomic status, smoking status of parents and peers, cigarette promotions, and anti-tobacco campaigns. Methods: Data were obtained from the 2018 version of the annual cross-sectional Taiwan Global Youth Tobacco Survey, which is used to monitor tobacco use among Taiwanese adolescents in junior and senior high schools. The dependent variables in the study were "current cigarette smoking," "current use of e-cigarettes," and "current use of IQOS devices" (i.e., during the 30 days prior to survey completion). Independent variables included gender, school grade, monthly income/allowance, educational level of parents, smoking status of parents, smoking status of close friends, access to free cigarettes, exposure to cigarette advertisements, and attendance at anti-tobacco courses. Logistic regression was used in the identification of factors correlated with the current use of cigarettes, e-cigarettes, or IQOS. Results: We determined that 5.65% of the adolescents in the study were currently using cigarettes, 2.74% were currently using e-cigarettes, and 2.33% were currently using IQOS. Our analysis revealed a number of factors that have a bearing on smoking behavior, including gender, monthly allowance, educational level of parents, smoking status of parents and close friends, access to free cigarettes, and exposure to cigarette advertisements. Conclusions: The tobacco product that was most widely used by adolescents was cigarettes, followed by e-cigarettes and IQOS. The socioeconomic status, smoking status of parents/close friends, and access to cigarettes were all identified as important factors related to the current use of cigarettes, e-cigarettes, and IQOS by adolescents.

Dual Use of E-Cigarettes and Traditional Cigarettes Among Adolescents in Taiwan, 2014-2016.

Introduction: We investigated the use of electronic cigarettes (e-cigarettes) with traditional cigarettes among adolescents during 2014 to 2016 to identify risk factors for using e-cigarettes only, traditional cigarettes only, or both products. Methods: We used cross-sectional data from the Taiwan Global Youth Tobacco Survey, (conducted over a 3-year period by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan), which is representative of tobacco use among adolescents aged 12-18 years. The outcome variable was smoking behavior. Dependent variables included gender, grade, monthly income/allowance, parents' educational level, parents' smoking status, close friends' smoking status, use of other tobacco products, contact with cigarette/e-cigarette advertisements, and access to free cigarettes/e-cigarettes. Multinomial regression identify factors influencing the smoking behaviors of adolescents, as manifested in the use of traditional cigarettes only, e-cigarettes only, e-cigarettes with traditional cigarettes, and nonsmoking. Results: When weighted to the population, the sample included 1723150 adolescents in 2014, 1691568 adolescents in 2015, and 1627216 adolescents in 2016. The rates averaged over three years were as follows: nonsmoking (91.6%), traditional cigarettes only (5.4%), e-cigarettes only (1.5%), and dual usage (1.6%). Among adolescents in Taiwan, the following were risk factors for dual use: male, older, high monthly allowance, smoking parents, smoking friends, use of other tobacco products, contact with cigarette advertisements, and access to free cigarettes. Conclusions: Our results revealed an increase in the number of adolescents using e-cigarettes with traditional cigarettes. We recommend that the government continue smoking cessation programs while maintaining control over advertisements and promotions for tobacco products. Implications: This is the first study to examine the dual use of e-cigarettes and traditional cigarettes among adolescents in Taiwan. This study identified the risk factors of using traditional cigarettes only, using e-cigarettes only, and the dual use of e-cigarettes and traditional cigarettes, with nonsmokers used as a reference group. This study examined the relationship between exposure to cigarette promotions and the use of various tobacco products including the dual use of e-cigarettes and traditional cigarettes, both of which have been disregarded in previous studies.

Electronic Cigarette Use and Attempts to Quit Smoking Cigarettes Among Adolescents in Taiwan.

PURPOSE: This study assessed the relationship between electronic cigarette (e-cigarette) use and attempts to quit smoking cigarettes by adolescent smokers in Taiwan. METHODS: Data were obtained from the cross-sectional Taiwan Global Youth Tobacco Survey conducted annually between 2014 and 2016, which included adolescents aged 12-18 years. The independent variable was e-cigarette use in the previous 30 days. The outcome variable was attempts to quit cigarette smoking during the previous 12 months. We controlled for the following variables: year of survey, gender, grade, monthly income/allowance, numbers of cigarettes per day, smoking status of parents and friends, use of other tobacco products, access to free tobacco products, assistance in quitting smoking, and exposure to anti-tobacco campaigns. RESULTS: Among cigarettes smokers, the prevalence of current e-cigarette use (in the previous 30 days) increased from 9.82% (2014) to 27.46% (2016), whereas attempts to quit smoking cigarettes decreased slightly from 71.31% (2014) to 70.59% (2016). Current e-cigarette use (OR = 1.21) was positively associated with attempts to quit cigarette smoking. Smokers who observed anti-tobacco media messages (OR = 1.12), attended antismoking classes (OR = 1.17), were influenced by warnings on cigarette packages (OR = 3.32), or received help to quit (OR = 3.11) were more likely to have attempted to quit cigarettes. CONCLUSIONS: We identified factors correlated with attempts to quit smoking, and recommend that the government continue monitoring electronic cigarette use, combat smoking in the media, provide antismoking classes, and expand health warnings on cigarette packages.

Induction of cyclooxygenase-2 gene by Candida albicans through EGFR, ERK, and p38 pathways in human urinary epithelium.

In the present data, we found that Candida albicans (C. albicans) caused bladder epithelial cell morphology alteration, cell damage, and inflammatory responses, including cyclooxygenase-2 (COX-2) gene and protein expression as well as prostaglandin E2 accumulation. In addition, the molecular pathway underlying C. albicans-induced urothelial COX-2 gene expression was examined. Among MAPK pathways, phosphorylation of ERK1/2, p38, and JNK each increased following C. albicans infection for 12 h. However, C. albicans-induced COX-2 protein expression was inhibited by specific inhibitors of ERK and p38 (U0126 and SB203580) but not by JNK inhibitor SP600125. Additional evidence came from the increased amount of phosphorylated RSK that is the mutual downstream molecule of ERK1/2 and p38. Furthermore, phosphorylation of RSK protein was reduced by the ERK and p38 inhibitor, suggesting that the urothelial COX-2 gene was induced majorly though the ERK/p38-RSK pathway by C. albicans infection. We also found transcription factor CREB-1 showed increased binding to the COX-2 gene promoter by chromatin immunoprecipitation assay. Next, we used receptor inhibitors including Toll-like receptor (TLR)-Myd88 inhibitor ST2825, Dectin-Syk inhibitor Syk inhibitor, and epidermal growth factor receptor (EGFR) inhibitor PD168393 to identify which one was the main target associated with C. albicans binding. The results revealed that it was EGFR, recognized by C. albicans, that mostly mediated the ERK/p38-RSK pathway activation to induce COX-2 gene expression, but this was not the case for TLRs and Dectin receptors. In summary, these results demonstrated the EGFR-ERK/p38-RSK-CREB-1 pathway was involved significantly in the C. albicans-induced COX-2 expression in human urothelium.

Associative memory and underlying brain correlates in older adults with mild cognitive impairment.

This study investigated associative recognition memory by using unique features of the Chinese language and the underlying neuroanatomical correlates. The study participants were 22 Chinese speakers with mild cognitive impairment (MCI) and 25 cognitively normal (CN) Chinese speakers. The results revealed that the MCI group demonstrated impaired associative memory performance, despite exhibiting item memory performance comparable with that of the CN group, and that associative memory performance in older adults was associated with gray matter integrity in the medial temporal regions as well as executive function. An abnormal elevation was also observed in false-positive errors related to features unique to Chinese characters, namely orthographical errors, in addition to rearranged and semantic errors in the MCI group relative to the CN group, and the three error subtypes were differentially associated with gray matter integrity in the hippocampus or lateral prefrontal regions. Overall, these results demonstrate the value of evaluating associative memory in people with prodromal Alzheimer's disease (AD), and further elucidate the underlying neural substrates related to associative recognition memory in older adults.

The relationship between smoking status and health-related quality of life among smokers who participated in a 1-year smoking cessation programme in Taiwan: a cohort study using the EQ-5D.

OBJECTIVE: To assess the relationship between smoking status and health-related quality of life 1 year after participation in a smoking cessation programme in Taiwan. DESIGN: A cohort study of smokers who voluntarily participated in a smoking cessation programme with two follow-up assessments of smoking status via telephone interview, conducted 6 months and 1 year after finishing the smoking cessation programme. SETTING: Hospitals and clinics providing smoking cessation services. PARTICIPANTS: A total of 3514 participants completed both telephone interviews, which represents a response rate of 64%. After the interviews, participants were divided into four groups according to their smoking status: (1) long-term quitters: participants who had quit tobacco use for 1 year; (2) short-term quitters: participants who had been smoking for at least 6 months and then quit tobacco for 6 months after participating in the programme; (3) relapsed smokers: participants who relapsed into tobacco use after ceasing tobacco use for 6 months; and (4) continuing smokers: participants who failed to quit smoking for at least 1 year, despite participating in the programme. INTERVENTIONS: The Outpatient Smoking Cessation Service of Taiwan provides counselling and pharmacotherapy to individuals seeking to quit smoking. PRIMARY OUTCOMES: The health-related quality of life of the participants was measured using an approved Chinese version of the EuroQol-5D-3L (EQ-5D-3L) descriptive system. RESULTS: After controlling for sex, age, education, marital status, job status, monthly income and disease status at baseline, our results revealed that long-term (OR=0.61 (0.48 to 0.77)) and short-term (OR=0.65 (0.54 to 0.79)) quitters experienced less anxiety and depression than did continuing smokers. CONCLUSIONS: Our study provides evidence to support claims that all quitters, regardless of whether they stop smoking for 6 months or 1 year, have better quality of life with regard to anxiety or depression.

Socioeconomic disparities in preventable hospitalization among adults with diabetes in Taiwan: a multilevel modelling approach.

INTRODUCTION: Literature shows socioeconomic disparities are related to various aspects of diabetes care. However, few studies have explored the relationship between socioeconomics and healthcare outcomes, particularly with regard to preventable hospitalization. This cohort study employed hierarchical modelling to evaluate the role of socioeconomics at both the individual and regional levels in order to examine disparities associated with the preventable hospitalization of diabetes patients in Taiwan. METHODS: This study employed the Longitudinal Health Insurance Database 2010, which provided a representative cohort comprising one million people enrolled in Taiwan's National Health Insurance in 2010. All diabetes patients aged 18 and older who received regular care in 2010 were included in this study. The outcome examined in this study was diabetes-related preventable hospitalization during the period of 2010 to 2011. Socioeconomic status at the individual level was measured according to income and at the regional level according to level of urbanization and the proportion of residents who had completed college education. Control variables included age, gender, comorbidities, time of diabetes diagnosis, participated in the pay-for-performance program status, and the characteristics of regular sources of care, including the level of the facility (i.e., medical centre, regional hospital, local hospital, outpatient clinic) and ownership. Statistical analysis was performed using generalized linear mixed models. RESULTS: A total of 57,791 patients from 25 regions diagnosed with type-2 diabetes mellitus were identified in the National Health Insurance claim data for the year 2010. 1040 of these patients (1.8%) had at least one diabetes-related preventable hospitalization event during the period of 2010-2011. After controlling for the characteristics of patients and health care providers, our results show that dependents and patients in low and middle income brackets (OR = 2.48, 2.44, and 2.08 respectively) as well as those living in regions with a low, median, or high education bracket (OR = 1.32, 1.38, and 1.46 respectively) face a higher probability of preventable hospitalization. CONCLUSIONS: Our results demonstrate that the socioeconomic effects of higher education at the regional level as well as income at the individual level are important factors which affect disparities in diabetes-related preventable hospitalization.

Differences in patient reports on the quality of care in a diabetes pay-for-performance program between 1 year enrolled and newly enrolled patients.

OBJECTIVE: This study aimed to assess the quality of care from the perspective of patients who participated in the diabetes pay-for-performance (P4P) program in Taiwan. DESIGN: A cross-sectional telephone interview to measure the quality of care for patients with diabetes mellitus. SETTING: A stratified sampling according to the level and region of the health-care providers in Taiwan. PARTICIPANTS: A total of 1796 patients with diabetes mellitus responded to the telephone survey. INTERVENTIONS: The patients were divided into two groups according to the length of time they had participated in the program: (1) the case group, who had received comprehensive care for at least 1 year and (2) the control group, who were newly enrolled in the diabetes mellitus P4P program for <3 months. MAIN OUTCOME MEASURES: The compliance of diabetes self-care and the level of satisfaction with the quality of care from the perspective of the patients. RESULTS: After controlling for the characteristics of the health-care providers involved, pattern of diabetes treatment, self-reported health status and other patient characteristics, the case group performed better in exercise, had regular medication and better foot care and showed overall compliance with diabetes self-care and perceived better quality of care than the control group. CONCLUSIONS: The patients who had received comprehensive care for 1 year showed better compliance with self-care and were more satisfied with the quality of care they had received. The P4P program appears to be associated with this enhanced care.

A cost-benefit analysis of the outpatient smoking cessation services in Taiwan from a societal viewpoint.

INTRODUCTION: This study applied a cost-benefit analysis from a societal viewpoint to evaluate the Outpatient Smoking Cessation Services (OSCS) program. METHODS: The costs measured in this study include the cost to the health sector, non-health sectors, the patients and their family, as well as the loss of productivity as a result of smoking. The benefits measured the medical costs savings and the earnings due to the increased life expectancy of a person that has stopped smoking for 15 years. Data were obtained from the primary data of a telephone survey, the literatures and reports from the Outpatient Smoking Cessation Management Center and government. Sensitivity analyses were conducted to verify the robustness of the results. RESULTS: There were 169,761 cases that participated in the outpatient smoking cessation program in the years 2007 and 2008, of those cases, 8,282 successfully stopped smoking. The total cost of the OSCS program was 18 million USD. The total benefits of the program were 215 million USD with a 3% discount rate; the net benefit to society was 196 million USD. After conducting sensitivity analyses on the different abstinence, relapse, and discount rates, from a societal perspective, the benefits still far exceeded the costs, while from a health care perspective, there was only a net benefit when the respondent's abstinence rate was used. CONCLUSIONS: From a societal perspective, the OSCS program in Taiwan is cost-beneficial. This study provides partial support for the policy makers to increase the budget and expand the OSCS program.