[Care Strategies and Trends in Taiwan During the COVID-19 Pandemic].

The ongoing COVID-19 pandemic has currently spread to over 100 countries, infecting over thirty million people and causing nearly one million deaths. The COVID-19 pandemic is the most serious pandemic crisis faced by the world medical system for at least a century. To address the impacts of pandemic prevention and control measures and of societal concerns regarding risks of contraction in healthcare environments, related policies and management must be adopted to provide effective care and future prevention. The author introduces the prevention policies implemented during the pandemic under coordinated medical systems, the National Health Insurance program, pandemic management, and national and international governmental organizations to provide readers with a reference for the current situation of the pandemic in Taiwan and the world.

Low Levels of IgM and IgA Recognizing Acetylated C1-Inhibitor Peptides Are Associated with Systemic Lupus Erythematosus in Taiwanese Women.

The objective of this study was to identify novel acetylation (Ac) modifications of the C1-inhibitor (C1-INH) and explain the association of the levels of autoantibodies against acetylated C1-INH peptides with the risk of developing systemic lupus erythematosus (SLE). Ac modifications of the C1-INH were identified and validated through in-gel digestion, nano-liquid chromatography-tandem mass spectrometry, immunoprecipitation, and Western blotting by using serum protein samples obtained from patients with SLE and age-matched healthy controls (HCs). In addition, the levels of serum C1-INH, Ac-protein adducts, and autoantibodies against unmodified and acetylated C1-INH peptides were measured. C1-INH levels in patients with SLE were significantly lower than those in HCs by 1.53-fold (p = 0.0008); however, Ac-protein adduct concentrations in patients with SLE were significantly higher than those in HCs by 1.35-fold (p = 0.0009). Moreover, immunoglobulin M (IgM) anti-C1-INH367-385 Ac and IgA anti-C1-INH367-385 Ac levels in patients with SLE were significantly lower than those in HCs. The low levels of IgM anti-C1-INH367-385 (odds ratio [OR] = 4.725, p < 0.001), IgM anti-C1-INH367-385 Ac (OR = 4.089, p = 0.001), and IgA anti-C1-INH367-385 Ac (OR = 5.566, p < 0.001) indicated increased risks for the development of SLE compared with HCs.

[Health Without Boundaries].

'Sow in spring, grow through the summer, harvest in autumn, store in winter' reflects the ancient wisdom of the Chinese people, passed down for thousands of years. As this year comes to a close, this journal would like to pause to recognize that Taiwan's national health insurance system has been looking after and caring for the health of Taiwan's people for more than 20 years. What can we do to better follow global care trends and to perform better for public health in Taiwan? Many thanks to Director Wang of the Health Promotion Administration for introducing to readers the concept of 'health without boundaries' and examining Taiwan's future healthcare blueprint from a global perspective. In addition, under the influence of fast-changing medical technologies and rising life expectancies, the increase in the population with chronic diseases prompted Health Promotion Administration's Chronic Disease Division Chief Jia Shuli to provide a comprehensive description of his division's work, from developing chronic disease self-care regimens to developing follow-up control protocols. Professor Lin, with years of diabetes prevention, treatment and innovative experience, has also written an article for this issue that explains why health professionals should go beyond dealing with diseases in order to listen, cooperate with, and interact with patients in order to expand the adoption and effectiveness of diabetes self-management programs. Finally, Professor Guo's article stresses the importance of promoting a healthy environment by going beyond focusing on one's health to address the improvement of the overall environment in order to shape the urban health landscape and achieve A+ health quality. In these cold winter days, brew a pot of hot tea and let us taste together these rare journeys of wisdom.

[Bracing in Adolescent Idiopathic Scoliosis].

Scoliosis is a common medical problem, with an incidence of between 0.47% and 5.2% in the general population globally. Adolescent idiopathic scoliosis (AIS) accounts for nearly 80% of all scoliosis. Young people with AIS often experience negative social consequences in association with their condition. Without proper and timely treatment, the potential resulting disabilities range from trunk deformity, pain, and neurological complications to compromised cardiopulmonary function, all of which may cause lifelong suffering. Scoliosis may be treated either conservatively or surgically, based on the severity of the disease. Bracing is the most widely adopted method of conservative treatment. However, the main goal of bracing is to inhibit the progression of the spinal curvature rather than to cure scoliosis. The clinical effectiveness of bracing in Taiwan has often been underutilized as a result of financial or other factors such as the availability of the treatment. The purpose of the present review is to clarify the effectiveness of bracing for AIS by elucidating the pathophysiology of scoliosis and examining the recent clinical evidence. The importance of preventative care and the unique contribution of nursing care to treatment has to date been under-recognized. The positive support that nurses provide to the families of the patients during the early phases of treatment as well as to the patients themselves, including helping them exercise appropriately and wear the brace correctly, is an essential component of effective treatment. Learning how to work with and to adapt to the brace being part of the body is an important part of the treatment as well as a way to avoid pain. Nurses are in an ideal position to facilitate this learning process and, overall, to provide health education.

[A Long Way Home: The Current State of Care Provided by Family Caregivers and Public Health Nurses to Persons With Mental Illness in the Community].

According to Taiwan's Health and Welfare Ministry statistics, Taiwan had a total of 122,538 people who were officially registered as mentally disabled at the end of December 2013. Worldwide, schizophrenia ranks as the sixth most burdensome disease in terms of total expenditures. The present paper uses the two actual care stories of the families of mental illness patients and compares and contrasts these with the community mental illness care models used in other countries. The hospital-based psychiatric and community-based mental illness care that is practiced in Taiwan presents dilemmas and has long focused on "disease-orientated care" rather than holistic care. The gap between institutional and community mental rehabilitation services in Taiwan are examined. We recommend that policy makers create an open space for mental illness family caregivers and public health nurses to engage in dialogue in order to effectively integrate the care resources available to community mental illness patients and to break down the care barriers that currently separate community mental illness patients, family caregivers, and public health nurses.

Characteristics of unplanned hospital admissions due to drug-related problems in cancer patients.

BACKGROUND: Studies have examined drug-related problems (DRPs) that have led to hospital admissions in the general population. However, there is a lack of information on the characteristics of DRPs in the cancer population. OBJECTIVE: The objective of this study was to investigate the type, causality, severity, and preventability of DRPs that result in unplanned hospitalizations among cancer patients. METHODS: This was a prospective, cohort study conducted in two oncology wards between July and December 2012. All patients who were diagnosed with solid tumor or lymphoma and required unplanned hospitalization were included. The incidence of DRPs among hospital admissions was captured, and the nature of the DRPs (causality, severity, and preventability) was characterized. RESULTS: There were 1,299 admissions and 1,275 were eligible for analysis. Among the 1,275 eligible admissions, 158 (12.4%) were considered to be associated with a DRP. In the 158 admissions associated with DRPs, 164 DRPs were found. The majority of the DRP-related admissions were adverse drug reactions (ADRs) (n=155/164, 94.5%), probable (n=98, 59.8%), moderately severe (n=155, 94.5%), and probably or definitely preventable (n=86, 52.4%). Most patients with DRPs recovered and were discharged. Febrile neutropenia was the most common adverse drug reaction, and drug combinations involving antihypertensives and long-term corticosteroids raised the risks for potential drug-drug interactions among patients with cancer. CONCLUSION: The incidence of DRP-induced unplanned hospital admissions was 12.4% among cancer patients. Approximately half of these were preventable events.

[Comprehensive cross-cultural care: an exploration of the immigrant care barriers and cross-cultural care competency of community nurses].

Advanced information technologies and increasingly convenient transportation links have drawn countries forward into the current era of globalization, while growing transnational migration has encouraged multicultural trends. The difficulties new immigrants have in adapting to their adopted culture is an issue to which healthcare must be sensitive and responsive. Information on approaches to cross-cultural healthcare is sparse in the Taiwan literature. In this paper, the author reviews relevant domestic and overseas articles to assess historical and government policy trends as well as cross-cultural care competency development. As different ethnic populations increase, each should be provided with proper health education supported by medical volunteers from their own ethnicities. In terms of policy, healthcare personnel should understand their own culture and develop sensitivity to the needs and concerns of others. As part of their training, healthcare staff should gain a second language competency in order to enhance cultural literacy and enhance cross-cultural sensitivity and overall sensitivity within the healthcare system to the needs of the global community.

An acpXL mutant of Rhizobium leguminosarum bv. phaseoli lacks 27-hydroxyoctacosanoic acid in its lipid A and is developmentally delayed during symbiotic infection of the determinate nodulating host plant Phaseolus vulgaris.

Rhizobium leguminosarum is a Gram-negative bacterium that forms nitrogen-fixing symbioses with compatible leguminous plants via intracellular invasion and establishes a persistent infection within host membrane-derived subcellular compartments. Notably, an unusual very-long-chain fatty acid (VLCFA) is found in the lipid A of R. leguminosarum as well as in the lipid A of the medically relevant pathogens Brucella abortus, Brucella melitensis, Bartonella henselae, and Legionella pneumophila, which are also able to persist within intracellular host-derived membranes. These bacterial symbionts and pathogens each contain a homologous gene region necessary for the synthesis and transfer of the VLCFA to the lipid A. Within this region lies a gene that encodes the specialized acyl carrier protein AcpXL, on which the VLCFA is built. This study describes the biochemical and infection phenotypes of an acpXL mutant which lacks the VLCFA. The mutation was created in R. leguminosarum bv. phaseoli strain 8002, which forms symbiosis with Phaseolus vulgaris, a determinate nodulating legume. Structural analysis using gas chromatography and mass spectrometry revealed that the mutant lipid A lacked the VLCFA. Compared to the parent strain, the mutant was more sensitive to the detergents deoxycholate and dodecyl sulfate and the antimicrobial peptide polymyxin B, suggesting a compromise to membrane stability. In addition, the mutant was more sensitive to higher salt concentrations. Passage through the plant restored salt tolerance. Electron microscopic examination showed that the mutant was developmentally delayed during symbiotic infection of the host plant Phaseolus vulgaris and produced abnormal symbiosome structures.

Erythropoietin suppresses the formation of macrophage foam cells: role of liver X receptor alpha.

BACKGROUND: In addition to the hematopoietic effect of erythropoietin, increasing evidence suggests that erythropoietin also exerts protective effects for cardiovascular diseases. However, the role of erythropoietin and its underlying mechanism in macrophage foam cell formation are poorly understood. METHODS AND RESULTS: Compared with wild-type specimens, erythropoietin was increased in atherosclerotic aortas of apolipoprotein E-deficient (apoE(-/-)) mice, mainly in the macrophage foam cells of the lesions. Erythropoietin levels in culture medium and macrophages were significantly elevated in response to oxidized low-density lipoprotein in a dose-dependent manner. Furthermore, erythropoietin markedly attenuated lipid accumulation in oxidized low-density lipoprotein-treated macrophages, a result that was due to an increase in cholesterol efflux. Erythropoietin treatment significantly increased ATP-binding cassette transporters (ABC) A1 and ABCG1 mRNA and protein levels without affecting protein expression of scavenger receptors, including scavenger receptor-A, CD36, and scavenger receptor-BI. The upregulation of ABCA1 and ABCG1 by erythropoietin resulted from liver X receptor alpha activation, which was confirmed by its prevention on expression of ABCA1 and ABCG1 after pharmacological or small interfering RNA inhibition of liver X receptor alpha. Moreover, the erythropoietin-mediated attenuation on lipid accumulation was abolished by such inhibition. Finally, reduced lipid accumulation and marked increase in ABCA1 and ABCG1 were demonstrated in erythropoietin-overexpressed macrophages. CONCLUSIONS: Our data suggest that erythropoietin suppresses foam cell formation via the liver X receptor alpha-dependent upregulation of ABCA1 and ABCG1.

[Empowering the family-center health model: the toy library as a health promotion platform].

Facing the lowest birth rates in its history, Taiwan is increasingly recognizing the centrality of children's healthcare needs to effective family care. The World Health Organization's goal of health for all emphasizes health promotion. However, little research attention has been given to how families actively promote personal health in everyday life. This article considers 'family-centric' healthcare, with a particular emphasis on children's health and well-being and the mother health promotion model. Authors employ a 'toy library' as the health promotion platform to build community interaction and empower the health enhancement process. Results suggested the following: 1. The fixed-point type toy library may be an effective tool in a health promotion strategy; 2. A model may be developed for rural institution agencies; 3. Cooperation may be facilitated using a medical service vehicle; 4. The love bag program can serve extended purposes. The authors found that the empowerment and growth of tribal mothers is a key element to facilitate the successful development of their children. Based on findings, the implementation of a toy library as the platform to build community-based health promotion model is suggested.

Alleviative Effect of Ruellia tuberosa L. on Insulin Resistance and Abnormal Lipid Accumulation in TNF-α-Treated FL83B Mouse Hepatocytes.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease, and most patients with T2DM develop nonalcoholic fatty liver disease (NAFLD). Both diseases are closely linked to insulin resistance (IR). Our previous studies demonstrated that Ruellia tuberosa L. (RTL) extract significantly enhanced glucose uptake in the skeletal muscles and ameliorated hyperglycemia and IR in T2DM rats. We proposed that RTL might be via enhancing hepatic antioxidant capacity. However, the potent RTL bioactivity remains unidentified. In this study, we investigated the effects of RTL on glucose uptake, IR, and lipid accumulation in vitro to mimic the T2DM accompanied by the NAFLD paradigm. FL83B mouse hepatocytes were treated with tumor necrosis factor-α (TNF-α) to induce IR, coincubated with oleic acid (OA) to induce lipid accumulation, and then, treated with RTL fractions, fractionated with n-hexane or ethyl acetate (EA), from column chromatography, and analyzed by thin-layer chromatography. Our results showed that the ethyl acetate fraction (EAf2) from RTL significantly increased glucose uptake and suppressed lipid accumulation in TNF-α plus OA-treated FL83B cells. Western blot analysis showed that EAf2 from RTL ameliorated IR by upregulating the expression of insulin-signaling-related proteins, including protein kinase B, glucose transporter-2, and peroxisome proliferator-activated receptor alpha in TNF-α plus OA-treated FL83B cells. The results of this study suggest that EAf2 from RTL may improve hepatic glucose uptake and alleviate lipid accumulation by ameliorating and suppressing the hepatic insulin signaling and lipogenesis pathways, respectively, in hepatocytes.

Measuring professional competency of public health nurses: development of a scale and psychometric evaluation.

AIMS AND OBJECTIVES: To develop an instrument to measure public health nurse competencies in Taiwan and to test its psychometric properties. BACKGROUND: Core competencies for public health nursing practice have been established in the USA and elsewhere but no equivalent studies have been undertaken in Taiwan. DESIGN: Postal survey of self-administered questionnaire to 1534 full-time public health nurses (response rate 67.3%). METHODS: The Public Health Nurse Professional Competency Scale was based on a literature review, the six key competencies identified by the Taiwan Nurses Association and the 'typical' tasks reported by nursing researchers. The scale comprised four domains and 38 items using a four-point Likert scale. Validity and reliability of the scale were determined by a seven-member professional panel and the content validity calculated for each domain. Discriminatory power and the item-total correlation index were used to analyse and eliminate items. Convergent and discriminant validity were assessed and factor analysis to test the dimensions of the scale--stability was determined by interscale correlations, internal and test-retest reliability. RESULTS: The mean age of respondents was 40.6 years (SD 8.54) with the majority holding an associate degree (67.0%). Participants had worked for an average of 11.7 years (SD 9.20) and 74.4% held a registered nurse license. The scale had strong content validity (Indices > 0.8) and good test-retest reliability (Cronbach's α = 0.93-0.97). Nine items were excluded during factor analysis and three factors accounted for 46-82% of the total variance: (1) basic-care, (2) community health management and (3) combined teaching and self-development competencies. The scale had high discriminant validity. CONCLUSIONS: A Public Health Nurse Professional Competency Scale has been developed and shown to have good reliability and validity. RELEVANCE TO CLINICAL PRACTICE: The scale can be used to assess the competencies of Public Health Nurses in Taiwan and improve the quality of clinical services provided.

[Nurses deliver quality care in the community nurses deliver quality care in the community].

In Taiwan, responsibility for administering healthcare services is being gradually moved out of hospitals and into the community. As such, nurses are increasingly required to address new problems and meet the specific healthcare needs of important subgroups such as Taiwan's growing elderly population and young adult immigrants. Because policies have lagged behind such developments, nurses are expected to provide leadership in addressing these new challenges. Their status within the medical system, however, continues to reflect earlier, more 'traditional' stereotypes and gives inadequate credit for current responsibilities, which include providing long term healthcare and public health nursing, in addition to homecare responsibilities. In the face of these challenges, Taiwan community nurses have continued to develop new ways to provide care and demonstrated innovation, commitment and flexibility in their roles. If nurses are to continue to take a leading role in developing community healthcare services, they require professional recognition as well as appropriate policy support from regulatory and local government authorities.

Regulation of LH receptor and PGF2alpha receptor signaling by the regulator of G protein signaling 2 (RGS2) in human and mouse granulosa cells.

Regulators of G protein signaling (RGS) proteins bind the G protein Galpha subunit in its active GTP-bound state and accelerate its GTPase activity, thus halting Galpha activity. Induction of RGS2 expression has been previously shown in the rat ovary in response to ovulatory stimulation; however, the significance of RGS2 in the ovary has not been established. This study reports the potential role of RGS2 in the signaling of two G protein-coupled receptors, the LH and PGF2alpha (FP) receptors, in the human and the mouse granulosa cell lines, KGN and NT-1. The RGS2 mRNA concentration was rapidly and transiently elevated by human chorionic gonadotropin (hCG) or PGF2alpha analogue cloprostenol and this was followed by a decline to basal level at 24 h. Expression of the downstream critical target gene of the LH and FP receptor signaling pathways, namely, cyclooxygenase 2 (COX2), was induced by hCG but was inhibited by cloprostenol. Overexpression of RGS2 attenuated hCG-induced COX2 transcription. However, this augmented cloprostenol-mediated suppression of COX2 transcription. Confocal microscopy and immunoblot analysis were adopted to monitor the intracellular localization of RGS2 in COS-7 cells carrying the FP receptor and expressing RGS2-GFP or FLAG-RGS2. RGS2 was initially located predominantly in the nucleus and activation of the FP receptor resulted in RGS2 translocation from nucleus to the cell membrane. Thus, RGS2 expression was upregulated by LH receptor and FP receptor activation and modulation of partner receptor signaling by RGS2 may require RGS2 translocation from the nucleus to the plasma membrane.

Postnatal depression and the experience of South Asian marriage migrant women in Taiwan: survey and semi-structured interview study.

OBJECTIVES: To investigate the experience of South Asian marriage migrant women in Taiwan by (1) determining their experiences and health beliefs during the postnatal period and their uptake of health care and determining the number of women with positive screening scores for postnatal depression during this period. METHODS: South Asian marriage migrant women were recruited using the following criteria: (1) Vietnamese and Indonesian women living in Taiwan for more than 1 year; (2) 6 months post-uncomplicated delivery; (3) conversational ability in Taiwanese and/or Mandarin Chinese and (4) a semi-structured interview and translated versions of the Edinburgh Postnatal Depression Scale (EPDS) investigated their experiences and health beliefs and identified the women with positive screens for postnatal depression. RESULTS: A total of 106 migrant women agreed to take part. Ninety-two women were from Vietnam (86.7%) and 14 from Indonesia (13.3%). More than half (56.6%) were aged between 19 and 24 (66% primigravida). The husbands of the women were mainly unskilled workers (80%). The frequency of a positive screen for postnatal depression was 25.5% (EPDS score >13). There was a statistically significant association between a score of 13 or more on the EPDS and self-reported 'emotional distress' following birth (p<0.01 ANOVA). Thematic analysis derived four key themes related to their experience and health beliefs: (1) Self-reported health: Although the main concern of the migrant women was the health of their baby and their families, some of them found their new families were unsupportive when they themselves were unwell. (2) Health beliefs: Dietary beliefs were important with a number of issues arising from a difference in health beliefs between themselves and their new families. (3) Access to health care: Communication problems and difficulties arising from their relationships with their new families affected 1/3 of women's access to health care and available health information. (4) Adaptation to a new environment: Many of the women described how difficult it was to adapt to their new environment and how they coped with the difficulties. CONCLUSIONS: South Asian migrant women in Taiwan face considerable challenges. If the health needs of these women are to be met, interventions which are "culturally competent" at the level of the individual, family and organisation need to be developed.

[The sound of gong: the relationship between music and nursing care].

Nurses focus on individual care in order to create the beauty of unique caring arts. But music therapy can also play an essential role to fill the gap between patients' care needs and individual wants. When nurses use music therapy as an intervention tool, they consider the process of progress, analyzing the data to show the outcome. How to apply music to the care process, improving the patients' care quality may, therefore, become an important task in future nursing training. However, due to the lack of specific and accurate measurements for music therapy, suggestions should be made for further investigation in three directions: 1. To develop a suitable Taiwanese style of music therapy. 2. To understand the mechanism of music therapy's physical and emotional effects on humans. 3. Quality assurance of music therapy in nursing care.

Effects of nano-TiO2 on the agronomically-relevant Rhizobium-legume symbiosis.

The impact of nano-TiO2 on Rhizobium-legume symbiosis was studied using garden peas and the compatible bacterial partner Rhizobium leguminosarum bv. viciae 3841. Exposure to nano-TiO2 did not affect the germination of peas grown aseptically, nor did it impact the gross root structure. However, nano-TiO2 exposure did impact plant development by decreasing the number of secondary lateral roots. Cultured R. leguminosarum bv. viciae 3841 was also impacted by exposure to nano-TiO2, resulting in morphological changes to the bacterial cells. Moreover, the interaction between these two organisms was disrupted by nano-TiO2 exposure, such that root nodule development and the subsequent onset of nitrogen fixation were delayed. Further, the polysaccharide composition of the walls of infected cells of nodules was altered, suggesting that the exposure induced a systemic response in host plants. Therefore, nano-TiO2 contamination in the environment is potentially hazardous to the Rhizobium-legume symbiosis system.

Effects of nano-ZnO on the agronomically relevant Rhizobium-legume symbiosis.

The impact of nano-ZnO (nZnO) on Rhizobium-legume symbiosis was studied with garden pea and its compatible bacterial partner Rhizobium leguminosarum bv. viciae 3841. Exposure of peas to nZnO had no impact on germination, but significantly affected root length. Chronic exposure of plant to nZnO impacted its development by decreasing the number of the first- and the second-order lateral roots, stem length, leaf surface area, and transpiration. The effect of nZnO dissolution on phytotoxicity was also examined. Results showed that Zn(2+) had negative impact on plant development. Exposure of R. leguminosarum bv. viciae 3841 to nZnO brought about morphological changes by rendering the microbial cells toward round shape and damaging the bacterial surface. Furthermore, the presence of nZnO in the rhizosphere affected root nodulation, delayed the onset of nitrogen fixation, and caused early senescence of nodules. Attachment of nanoparticles on the root surface and dissolution of Zn(2+) are important factors affecting the phytotocity of nZnO. Hence, the presence of nZnO in the environment is potentially hazardous to the Rhizobium-legume symbiosis system.

Costs and length of stay of drug-related hospital admissions in cancer patients.

BACKGROUND: Most previous studies of the incidence and economic impact of drug-related hospital admissions were not cancer specific, despite the fact that drug-related problems (DRPs) are of particular concern in oncology. OBJECTIVE: The goals of this study were to assess the economic impact, particularly the length of stay (LOS) and direct medical costs (DMC), of drug-related hospital admissions and the associated factors in cancer patients in Singapore. METHODS: A prospective study was conducted over a 5-month period in 2 oncology wards at the largest acute tertiary hospital in Singapore. Drug-related admissions were identified from all oncology admissions to these wards, and the demographic, clinical, and cost data of these drug-related admissions were collected. The association between LOS and DMC as well as their associations with age, severity, and preventability of DRPs were examined. A nationwide estimation was made to determine the overall DMC of drug-related hospital admissions among cancer patients. RESULTS: A total of 151 drug-related admissions that occurred among 137 cancer patients were identified. The mean DMC (in Singapore dollars [SGD]) and LOS per drug-related admission were SGD $4747 and 6.1 days, respectively. A nationwide extrapolation estimated an annual total DMC of SGD $16.2 million. Longer LOS was found to be correlated with higher DMC (rs = 0.86, P < 0.001) and preventable DRPs (P = 0.02). CONCLUSIONS: Drug-related hospitalization among cancer patients is costly; therefore, more attention is warranted to develop and improve strategies for preventing drug-related morbidity and mortality in cancer patients.