Cost-effective complete genome sequencing using the MinION platform for identification of recombinant enteroviruses.

IMPORTANCE: By employing a cost-effective approach for complete genome sequencing, the study has enabled the identification of novel enterovirus strains and shed light on the genetic exchange events during outbreaks. The success rate of genome sequencing and the scalability of the protocol demonstrate its practical utility for routine enterovirus surveillance. Moreover, the study's findings of recombinant strains of EVA71 and CVA2 contributing to epidemics in Malaysia and Taiwan emphasize the need for accurate detection and characterization of enteroviruses. The investigation of the whole genome and upstream ORF sequences has provided insights into the evolution and spread of enterovirus subgenogroups. These findings have important implications for the prevention, control, and surveillance of enteroviruses, ultimately contributing to the understanding and management of enterovirus-related illnesses.

The training effectiveness of dental trainees in postgraduate year training program for dentists.

BACKGROUND/PURPOSE: Taiwan's two-year postgraduate year training program for dentists (PGYD) has been implemented since 2010. However, there was no relevant study for confirming the training effectiveness of PGYD trainees. This study evaluated whether different training institution attributes and different training modes for PGYD trainees could result in differences in the achievement of PGYD training purposes. MATERIALS AND METHODS: We adopted the questionnaire survey to collect the views of PGYD trainees on the training effectiveness of PGYD and further evaluated whether different training institution attributes and different training modes for PGYD trainees could result in differences in the achievement of PGYD training purposes. RESULTS: For the "patient-centered" learning environment and the management ability to be a responsible dental clinic owner, the views of PGYD trainees in dental clinics and district hospitals were more positive than those in medical centers. For the clinical professional ability and the management ability to be a responsible dental clinic owner, the views of PGYD trainees in joint group were more positive than those in single hospital. CONCLUSION: We conclude that both hospitals and dental clinics can achieve PGYD training purposes. The smaller training institutions (dental clinics or district hospitals) are better training institution attributes and the joint group is the better training mode to achieve PGYD training purposes. The joint groups with medical centers combining many dental clinics, especially those in remote areas, may be an excellent training mode, because this training mode has the high potential to subsequently balance the distribution of dentists in Taiwan.

Imbalance in the geographical distribution of practicing dentists in postgraduate dental training institutions in Taiwan.

BACKGROUND/PURPOSE: Postgraduate year training program for dentists (PGYD) in Taiwan started since 2010. This study tried to assess the geographical distribution of practicing dentists in postgraduate dental training institutions in Taiwan. MATERIALS AND METHODS: This study utilized the secondary data analysis to measure and compare the numbers of practicing dentists in each type of dental training institution and the numbers of overall practicing dentists among different cities and counties in Taiwan. RESULTS: Our results found that the practicing dentists in each type of dental training institution showed a significantly greater imbalance in geographical distribution than the overall practicing dentists. It meant that the practicing dentists in postgraduate dental training institutions were more concentrated in northern part of Taiwan than in other parts of Taiwan, compared to the number of overall practicing dentists in different cities or counties in Taiwan. However, the disparities in the number of practicing dentists in dental training institutions could be compensated by cross-regional collaborating institutions under the joint training group system. CONCLUSION: Because continuation of the current PGYD system may accelerate the imbalance in geographical distribution of practicing dentists in dental training institutions in Taiwan. To prevent this, further studies on yearly changes in the geographical distribution of dentists in postgraduate dental training institutions by city or county should be taken to monitor whether we should further modify the currently used PGYD system toward a better one to solve the problem of imbalance in the geographical distribution of dentists in postgraduate dental training institutions in Taiwan.

Current practice patterns and training project of oral pathology specialists in Taiwan.

BACKGROUND/PURPOSE: There were 70 oral pathology specialists (OPSs) in Taiwan till 2018. This study reported the current practice patterns and training project of OPSs in Taiwan. MATERIALS AND METHODS: This study exploited the secondary data analysis and interview to survey the current practice patterns and training project of OPSs in Taiwan. RESULTS: Of the 70 OPSs, 8 practiced both anatomical oral pathology (oral histopathological diagnosis) and clinical oral pathology (oral medicine), 8 practiced both general pathology (majorly) and anatomical oral pathology (minorly), 5 practiced oral medicine only, 30 practiced general dentistry or other dental divisions, 11 did teaching or researching, and 8 had retired. There were 9 OPS training hospitals (8 medical centers and one regional hospital) that had 23 OPSs and a training capacity of 11 dentists. Of the 9 OPS training hospitals in Taiwan in 2019, 5 were located in the northern, one in central, two in southern, and one in eastern region. Moreover, we found none of the dentists applying for the OPS training program and the number of OPSs did not increase along with the population and the number of the dentists in recent two years. CONCLUSION: Only 8 OPSs practice both anatomical oral pathology and oral medicine in Taiwan and the manpower of the OPSs in Taiwan faces a severe problem of shortage. We suggest that the government should build a long-term budget to subsidize young OPSs and those dentists who enter the OPS training program to resolve this OPS shortage problem.

Dentist manpower development and geographical distribution of dentists in Taiwan.

BACKGROUND/PURPOSE: The development of dentists in Taiwan has been over a century. This study tried to explore the dentist manpower development and the current status of geographical distribution of dentists in Taiwan. MATERIALS AND METHODS: This study used the secondary data analysis to survey the changes of total dentist number from 1986 to 2018 and the geographic distribution of dentists in different levels of dental institutions in 2019. RESULTS: The total number of dentists increased from 3739 in 1986 to 14,717 in 2018. The total number of hospital dentists increased from 809 in 1986 to 2121 in 2018. However, the proportion of hospital dentists in the total number of dentists decreased from 21.64% in 1986 to 14.41% in 2018. On the contrary, the total number of dental clinic dentists increased from 2930 in 1986 to 12,596 in 2018. The proportion of dental clinic dentists in the total number of dentists increased from 78.36% in 1986 to 85.59% in 2018. The northern region of Taiwan and Taipei City had 52.81% (7829/14,825) and 22.29% (3304/14,825) of the total number of dentists in 2019, respectively. Hospital dentists showed a significantly greater imbalance in geographic distribution than overall dentists. CONCLUSION: Our results indicate that Taiwan has the problems of oversupply of dentists and imbalance in geographical distribution of dentists. Because continuation of the current dentist manpower development may accelerate the oversupply and geographical imbalance of dentists, a mechanism for controlling the total dentist manpower should be implemented to prevent the deterioration of the problems.

Seroprevalence of EV-A71 neutralizing antibodies following the 2011 epidemic in HCMC, Vietnam.

Enterovirus-A71 (EV-A71) cyclically causes hand-foot-mouth disease (HFMD) epidemics in Asian children. An EV-A71 epidemic occurred in Southern Vietnam in 2011, but its scale is not clear. We collected residual sera from non-HFMD Vietnamese inpatients in 2012-2013 to determine seroprevalence of EV-A71 neutralizing antibodies, and measured cross-reactive neutralizing antibody titers against three EV-A71 genogroups. About 23.5% of 1-year-old children in Southern Vietnam has been infected by EV-A71, and the median age of infection was estimated to be 3 years. No significant antigenic variation could be detected among the three EV-A71 genogroups. The high seroprevalence of EV-A71 neutralizing antibody in children living in southern Vietnam indicates the necessity of introducing EV-A71 vaccines in southern Vietnam, particularly for children under 6 months of age. Moreover, it is critical to understand EV-A71 disease burden for formulating national vaccination policy.

Trends of participation of post-graduate year training program for dentists in Taiwan dental training institutions from 2010 to 2018.

BACKGROUND/PURPOSE: The licensed dentists in Taiwan should join the post-graduate year training program for dentists (PGYD) since 2010. This study aimed to analyze the project types and the geographical distribution of the PGYD training institutions in Taiwan from 2010 to 2018. MATERIALS AND METHODS: From 2010 to 2018, 735 hospitals and clinics participated in four types of PGYD project including hospital as the single training institution (project A), clinic as the single training institution (project B), hospital as the main training institution in the joint training group (project C), and clinic as the main training institution in the joint training group (project D). The project types and the geographical distribution of the training institutions were analyzed. RESULTS: The 735 PGYD training projects were proposed by the 735 dental institutions. The project number grew from 119 in 2010 to 195 in 2018. The most common project type was project B (307, 41.8%), followed by the project A (249, 33.9%), the project D (101, 13.7%), and the project C (78, 10.6%). Geographically, these 735 main training institutions were located most commonly in northern region of Taiwan (379, 51.6%), followed by the central region of Taiwan (171, 23.3%), southern region of Taiwan (156, 21.2%), and eastern region of Taiwan (29, 3.9%). CONCLUSION: Hospital or clinic as the single training institution is the two most common PGYD project types in Taiwan from 2010 to 2018. These single or main dental training institutions are mainly located in the northern, central, and southern regions of Taiwan.

Health, healthy lifestyles and health examinations among the older people in Taiwan.

AIM: This aim of this study was to examine the relationship between the utilisation of general health examinations and health and a healthy lifestyle. METHODS: The data were from a 5-wave panel of older Taiwanese people. Health was defined as the absence of chronic diseases and physical function difficulties. A healthy lifestyle included no smoking, no alcohol consumption and engaging in regular exercise. Generalised linear modelling was applied. RESULTS: The individuals with more chronic diseases were more likely to undergo health examinations, but the rate of change declined over time. Having more physical function disabilities may reduce the likelihood of undergoing health examinations. Individuals who engaged in regular exercise were more likely to undergo health examinations. CONCLUSION: Health examination utilisation is related to health and healthy lifestyle among older people.

Happiness and social determinants across age cohorts in Taiwan.

The purpose of this study was to examine happiness and social determinants across age cohorts in Taiwan. The data were obtained from the 2011 Taiwan Social Change Survey (aged 18 +, n = 2,199). The social determinants of happiness included socioeconomic status and social connection. Happiness was not different across the age groups. Receiving less family support, less formal support, more social trust and more control over life were significant for the younger group. Being married and having more social participation were significant for the middle-aged. Receiving less family support and having a higher economic status were significant for the older group.

Geriatric conditions, rather than multimorbidity, as predictors of disability and mortality among octogenarians: A population-based cohort study.

AIM: To examine the impact of geriatric conditions and multimorbidity on the risk of incident disability and mortality among young-old and old-old adults. METHODS: The present study used nationally-representative data from the "Survey of Health and Living Status of the Elderly in Taiwan" for the years 2003 and 2007. Non-disabled older adults were divided into two age groups (65-79 years and ≥80 years). Chronic morbidities and geriatric conditions were assessed in 2003. Incident disability was defined as dependency in one or more activities of daily living in 2007. Vital statistics of the participants was linked to death registration data through 31 December 2007. Multivariable logistic regression and Cox regression were used to determine the effect of multimorbidity and geriatric conditions on health outcomes. RESULTS: Among those aged 65-79 years (n = 1874), the presentation of multimorbidity or two or more geriatric conditions was related to incident disability. Among octogenarians, the presentation of one or more geriatric conditions, but not multimorbidity, was shown to be independently associated with the risk of disability. Multimorbidity was related to a higher adjusted risk of mortality in the young-old group (hazard ratio 1.54; 95% confidence interval 1.1-2.2) but not in the old-old group. Among octogenarians, those with two or more geriatric conditions had a higher adjusted risk of mortality (hazard ratio 1.7; 95% confidence interval 1.2-2.5), compared with those with 0-1 geriatric conditions. CONCLUSIONS: The risk of incident disability and mortality increased in octogenarians with geriatric conditions, but not in cases with multimorbidity.

Identifying factors associated with changes in physical functioning in an older population.

AIM: The present study evaluated the association between changes in physical functioning and a variety of factors in an older population in Taiwan. METHODS: The data of 907 participants were derived from a three-wave cohort study of aging, the Functioning and Aging Study in Taipei, with a study period from 2005 to 2009. Functional status was assessed using activities of daily living, instrumental activities of daily living and mobility tasks, and classified as being normal, with mild disability, moderate disability, and severe disability. All potential factors were allocated into five groups including demography, chronic diseases, geriatric conditions, lifestyle and physical assessments. Generalized estimating equations and generalized linear mixed-effects models were used to identify factors responsible for changes in physical functioning across different waves of data. RESULTS: The proportion of elderly participants with normal function decreased with time throughout the study period. The results of Generalized estimating equations and mixed effects models showed nearly identical sets of factors. These included age, living arrangements, social support, self-rated health, stroke, diabetes, Parkinson's disease, osteoporosis, depression, cognition, vision, history of fracture and falls, incontinence of urine and feces, physical activity, body mass index, and short physical performance battery. CONCLUSIONS: Older persons with stroke, Parkinson's disease, diabetes, osteoporosis, geriatric conditions and poor short physical performance battery score should be considered as the target of prevention against functional decline. Those not living with spouses, with poor self-rated health, with low social support, being underweight or obese and with a sedentary lifestyle might also require major attention.

Trajectories of physical activity and risk factors among Taiwanese older adults.

BACKGROUND: The significance of physical activity has been noticed. However, the dynamic change and the heterogeneity of physical activity patterns among older people are little explored. PURPOSE: This study aimed to identify the trajectory patterns of engaging in physical activity over time and its related factors. METHOD: Nationally representative four-wave panel data from Taiwanese older adults, gathered between 1996 and 2007, were used (n = 4,018). The participants ranged in age from 50 to 96 years old. "Being physically active" was defined as performing physical activity in sports or exercises at least three times per week and lasting for at least 30 min each time. Group-based trajectory analysis was performed for analyzing the data. RESULTS: Four trajectory patterns were identified: inactive (47.83%), decreasing (12.21%), increasing (23.36%), and active (16.60%). Older respondents and those with more education were more likely to be active. Those respondents having more depressive symptoms, having more physical functional limitations, and having jobs were less likely to be physically active in the decreasing, increasing, and active patterns. CONCLUSION: There is heterogeneity among the trajectory patterns of physical activity across time in the older adults. Different strategies of physical activity promotion for the older people should be developed by the group characteristics.

Trajectories of frailty and related factors of the older people in Taiwan.

UNLABELLED: BACKGROUND/STUDY CONTEXT: This study aimed to identify the different trajectories of frailty and factors related to frailty among older adults over time. METHODS: Data were obtained from a five-wave panel composed of older Taiwanese adults from 1993 to 2007 (N = 2306). Frailty was defined as the presence of three or more of the following criteria: shrinking, weakness, exhaustion, slowness, and low physical activity. A group-based model of trajectory analysis was applied with time-dependent and time-independent variables. RESULTS: Three trajectory groups were identified: maintaining nonfrailty, developing frailty, and high risk of frailty. Being female, older, and having a lower level of education were risk factors for being in the developing frailty group or high risk of frailty group. Physical risk factors and psychological factors were associated with frailty within each group. Higher financial satisfaction and social participation were protective factors from frailty for the developing frailty group and high risk of frailty group, respectively. CONCLUSION: Older adults should promote their health physically, psychologically, and socially.

Multidimensional health-transition patterns among a middle-aged and older population.

AIM: Previous studies on health transition have focused on single-dimension outcomes and minimally evaluated heterogeneity. This study aimed to explore heterogeneous and multidimensional health-transition patterns on comorbidity, frailty and disability while examining the factors predicting different patterns of health transition. METHODS: This study drew on data from a nationwide and longitudinally-followed sample of 5131 Taiwanese aged 50 years and older who were interviewed in 1996, 1999, 2003 and 2007. Latent class analysis (LCA) and multinomial logistic regression were applied to identify health-transition patterns and their predictors. RESULTS: We identified six health-transition classes by applying LCA, including "persistently healthy", "well-managed comorbidity", "originally comorbid and gradually deteriorating to disability", "deteriorating gradually and died in late stage of the follow-up period", "deteriorating and died in middle stage of the follow-up period", and "originally comorbid and died in early stage of the follow-up period". Using the "well-managed comorbidity" class as the reference group, men had higher probabilities of being in the categories of dying in the follow-up period, but a lower risk of deteriorating to disability. Younger baseline age, higher education, having social engagement and non-smoking were predictors of "persistently healthy" and were associated with a lower risk of deteriorating to disability and death. Having a spouse and health examinations were associated with a lower risk of death, and also a lower probability of "persistently healthy". CONCLUSIONS: Heterogeneous and multidimensional health-transition patterns exist in middle-aged and older populations. Several factors might have an effect on health-transition patterns.

Joint trajectories of multiple health-related behaviors among the elderly.

OBJECTIVES: The main goal of this study was to identify the multiple trajectories of the following four health behaviors among the elderly by gender: smoking, drinking alcohol, getting regular exercise, and having a health checkup METHODS: Data were from a longitudinal survey conducted among the elderly from 1996 to 2007 in Taiwan. In total, 5,880 respondents were included in the analysis RESULTS: The trajectories of health-related behaviors differed between males and females. Five groups of male elderly were identified: smoking, inactive, healthy lifestyle, smoking and drinking, and quitting. Three groups of female elderly were identified: smoking and drinking, inactive, and healthy lifestyle. Age, education, self-rated health, depressive symptoms, and economic satisfaction at baseline were associated with the health behavior trajectories CONCLUSION: The nature of healthy behaviors and risky behaviors may differ. Thus, multiple trajectories can exhibit patterns that differ from those of single behavior trajectories. Strategies designed to promote health need to consider both gender and behavior patterns which may change over time.

Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study.

BACKGROUND: The economic burden of ventilator-associated pneumonia (VAP) during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term. METHODS: This is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 2004. All subjects underwent endotracheal intubation in the emergency room (ER) on the day of admission or the day before admission, were transferred to the intensive care unit (ICU) and were mechanically ventilated for 48 hours or more. A total of 943 patients who developed VAP were included as the case group, and each was matched with two control patients without VAP by age ( ± 2 years), gender, diagnosis, date of admission ( ± 1 month) and hospital size, resulting in a total of 2,802 patients in the study. Using robust regression and Poisson regression models we examined the effect of VAP on medical utilization including hospitalization expenses, outpatient expenses, total medical expenses, number of ER visits, number of readmissions, number of hospitalization days and number of ICU days, during the index hospitalization and during the following 2-year period. RESULTS: Patients in the VAP group had higher hospitalization expenses, longer length of stay in hospital and in ICU, and a greater number of readmissions than the control group patients. CONCLUSIONS: VAP has a significant impact on medical expenses and utilization, both during the index hospitalization during which VAP developed and in the longer term.