Background: Previous studies have shown inconsistent results regarding the impact of traffic pollution on the prevalence of chronic obstructive pulmonary disease (COPD). Therefore, using frequency matching and propensity scores, we explored the association between traffic pollution and COPD in a cohort of 8284 residents in a major agricultural county in Taiwan. Methods: All subjects completed a structured questionnaire interview and health checkups. Subjects with COPD were identified using Taiwan National Health Insurance Research Databases. A hybrid kriging/LUR model was used to identify levels of traffic-related air pollutants (PM_2.5 and O₃). Multiple logistic regression models were used to calculate the prevalence ratios (PRs) of COPD and evaluate the role played by traffic-related indices between air pollutants and COPD. The distributed lag nonlinear model was applied in the analysis; we excluded current or ever smokers to perform the sensitivity analysis. Results: Increased PRs of COPD per SD increment of PM_2.5 were 1.10 (95% CI 1.05–1.15) and 1.25 (95% CI 1.13–1.40) in the population with age and sex matching as well as propensity-score matching, respectively. The results of the sensitivity analysis were similar between the single and two pollutant models. PM_2.5 concentrations were significantly associated with traffic flow including sedans, buses, and trucks (p < 0.01). The higher road area and the higher PM_2.5 concentrations near the subject’s residence correlated with a greater risk of developing COPD (p for interaction < 0.01). Conclusions: Our results suggest that long-term exposure to traffic-related air pollution may be positively associated with the prevalence of COPD. Graphical

In order to compare the transmissibility of the 2009 pH1N1 pandemic during successive waves of infections in summer and fall/winter in the Northern Hemisphere, and to assess the temporal changes during the course of the outbreak in relation to the intervention measures implemented, we analyze the epidemiological patterns of the epidemic in Taiwan during July 2009-March 2010.

Introduction. Previous studies have examined the association between specific mental disorders, particularly mood and anxiety disorders, and substance-related disorders; but the temporal link between them remains unclear. This study aimed to examine whether individuals with specific mental disorders, including affective psychoses, neurotic disorders, schizophrenia, personality disorders, and adjustment reaction, have higher risks for subsequently developing substance-related disorders compared to those without. Methods. A large-scale study with longitudinal data was conducted using the Taiwan National Health Insurance Research Database (NHIRD) consisting of 2,000,118 patients’ medical records from 2000 to 2009. A total of 124,423 people diagnosed with selected mental disorders and the same number of people without the diagnoses of the selected disorders were identified between January 1, 2001, and December 31, 2006, and followed up for the diagnoses of substance-related disorders till the end of 2009. We estimated the risk for subsequently developing substance-related disorders among patients with the selected mental disorders compared to those without by using Cox proportional hazard models. The cumulative incidence of substance-related disorders was calculated using the Kaplan-Meier method. Results. The risk for developing substance-related disorders in patients with selected mental disorders is about 5 times (HR=5.09, 95% CI: 4.74-5.48) higher than those without after adjusting for potential confounding variables. From the multivariate analyses of subsamples stratified by age, sex, and urban and income levels, we found all adjusted hazard ratios were significantly higher than 1.0, ranging from 2.12 (95% CI: 1.72-2.62) to 14.55 (95% CI: 7.89-26.83). For children and adolescents aged 10-19 years, those with specific mental disorders had 14.55-fold higher risk for developing substance-related disorders in later life compared to their counterparts. Furthermore, patients with personality disorders had the highest risk (HR=25.05). Conclusions. The earlier onset of the selected mental disorders is a potential risk for developing substance-related disorders in later life, particularly for personality disorders. Health professionals should pay more attention to this at-risk population, especially to adolescents with mental disorders.

Background. Archery exercise exerts a rehabilitative effect on patients with paraplegia and might potentially serve as complementary physiotherapy for patients with Parkinsons disease. Objective. This study aimed to examine the rehabilitative effects of an archery intervention. Methods. A randomized controlled trial of a 12-week intervention was performed in patients with idiopathic Parkinsons disease. Thirty-one of the 39 eligible patients recruited from a medical center in Taiwan participated in the trial, of whom 16 were in the experimental group practicing archery exercises and 15 were in the control group at the beginning; twenty-nine completed the whole process. The Purdue pegboard test (PPT), the Unified Parkinsons Disease Rating Scale I to III (UPDRS I to III), physical fitness test, and timed up and go test (TUG) were used to assess the intervention effects of archery exercise. Results. Compared to the control group, the outcome differences between the posthoc and baseline tests in PPT, UPDRS I to III, lower extremity muscular strength, and TUG in the experimental group (between-group difference in differences mean: 2.07, 1.59, 1.36, 2.25, 3.81, 9.10, 3.57, and 1.51, respectively) did show positive changes and their effect sizes examined from MannWhitney U tests (η: 0.631, 0.544, 0.555, 0.372, 0.411, 0.470, 0.601, and 0.381, respectively; Ps<0.05) were medium to large, indicating that the archery intervention exerted promising effects on improving hand flexibility and finger dexterity, activity functions in motor movement, lower extremity muscular strength, and gait and balance ability. Conclusions. Traditional archery exercise was suggested to have a rehabilitative effect for mild to moderate Parkinsons disease and could be a form of physiotherapy. Nevertheless, studies with larger sample sizes and extended intervention periods are needed to ascertain the long-term effects of archery exercise.

Background: In the current study, we surveyed the trend of breast cancer operations in the past two decades and compared mastectomy alone or with immediate breast reconstruction (IBR) with the measurement of the outcome reported by patients and oncologic safety evaluation. Methods: A retrospective study surveyed the trends in breast cancer surgery methods at a single institution between January 2000 and December 2021. Clinical manifestations, outcomes, patient-reported outcome measures, and oncologic safety evaluations between mastectomy alone or with IBR were analyzed, with and without propensity score matching (PSM). Results: The trend of breast cancer operations showed that breast-conserving surgery (BCS) and mastectomy with IBR were increasing while mastectomy alone was decreasing. Among the 3759 patients who underwent mastectomies, 1091 (29%) patients had mastectomy with IBR while 2668 (71%) received mastectomy alone. In multivariate analysis, age less than 45 years, breast magnetic resonance imaging before surgery, luminal A subtype, nipple-sparing mastectomy, oncoplastic reconstructive breast surgeon, and high-volume surgeon were important independent factors for mastectomy with IBR. Mastectomy with IBR was associated with better patient-reported cosmetic results than mastectomy alone and comparable to BCS. After PSM and a median follow-up of 106.1 months, there was no difference in Kaplan-Meier survival curve analysis between patients who underwent mastectomy alone or mastectomy with IBR in terms of locoregional recurrence, distant metastasis or overall survival. Conclusions: Mastectomy with IBR demonstrated better reported cosmetic outcomes and comparable oncologic safety compared to mastectomy alone. Independent factors promoting IBR were identified, which could help increase the breast reconstruction rate. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266