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Heat warning systems represent a critical health adaptation strategy under global boiling. This study evaluates the appropriateness of the existing criteria of heat warning categories, which were established based on climatology. The objectives were (1) to evaluate the association of the daily maximum temperature (Tmax) and multiple health outcomes (including emergency visits, hospitalization cases, and mortality of heat-related illness (HRI), cardiovascular, respiratory, diabetes, and renal diseases) considering both the lag and cumulative effects, and (2) to identify vulnerable groups (considering their demographic, occupation, geographic, and health status) and areas of heat-health impacts. Weather and health records in Taiwan from May to October from 2000 to 2019 were analyzed using generalized additive models. The results show that HRI was the most sensitive health outcome, and the relative risk (RR) was 1.81 (confidence interval (CI): 1.51 – 2.18) and 2.99 (CI: 1.99 – 4.49) for emergency visits and hospitalizations, respectively, when Tmax was ≥ 34 °C. The corresponding RRs were 2.00 (CI: 1.67 – 2.39) and 2.39 (CI: 1.44 – 3.95) when Tmax was ≥ 32 and ≥ 31 °C for three consecutive days, respectively. The morbidity risks of cardiovascular, respiratory, diabetes, and renal diseases all increased at different temperature thresholds. Significant associations between Tmax and health outcomes occurred at thresholds lower than the current warning thresholds, indicating the need for revision. Both lag and cumulative effects need to be considered in heat-health warning systems. People with hypertension, hyperglycemia, or hyperlipidemia were found to be more vulnerable, as they had higher RRs for pneumonia, COPD, and stroke than the general population. Among different occupations, farmers were found to be most vulnerable. This study demonstrates a methodology considering both lag and cumulative effects that can be applied in other countries to assist in the establishment of evidence-based heat-health warning systems.
The recent emergence of azithromycin-resistant extensively drug-resistant (AziR-XDR) Salmonella enterica serovar Typhimurium (S. Typhimurium) in Taiwan poses a significant public health concern. To investigate the genetic basis and the evolutionary dynamics, we analyzed 60 isolates collected between 2007 and 2024, comprising multidrug-resistant (MDR, n = 45) and AziR-XDR (n = 15) isolates from human and animal sources. Whole-genome sequencing analysis revealed that 36 of 45 MDR isolates and all AziR-XDR isolates belonged to the HC50_13 subclone (differing by ≤ 50 core genes) and clustered within the HC20_152604 cluster (differing by ≤ 20 core genes) and the SNP cluster PDS000042202. All HC50_13 MDR isolates and AziR-XDR isolates carried core resistance genes including aac(3)-IId, aph(3'')-Ib, aph(6)-Id, blaTEM-1, floR, sul2, tet(A) on type 2 IncC plasmids, and AziR-XDR isolates carried additional antimicrobial resistance genes (ARGs) on the plasmids, including blaDHA-1, dfrA17, mph(A), qnrB, and sul1, conferring additional resistance to azithromycin, trimethoprim, third-generation cephalosporins, and fluoroquinolones. AziR-XDR S. Typhimurium strains belonging to the HC50_13 subclone were initially identified in 2016 and have notably increased in Taiwan since 2021. The subclone was likely evolved from MDR ancestor strains by multiple IS26-mediated acquisitions of additional resistance cassettes. Our findings demonstrate how MDR S. Typhimurium can evolve locally into highly resistant strains. This underscores the need for genomic surveillance and coordinated antimicrobial stewardship in Taiwan and globally to prevent further dissemination of the highly resistant HC20_152604 clade.
Population-based screen-and-treat of Helicobacter pylori infection, a well-established cause of gastric cancer, is emerging as an effective strategy to reduce gastric cancer incidence and mortality, in line with recommendations from the working group convened by the International Agency for Research on Cancer. This report reviews the development of the population-based H. pylori screen-and-treat strategy as a healthcare policy for gastric cancer prevention in Taiwan from 2004 to 2025, tracing its evolution from localized pilot programs to regional initiatives and, ultimately, to full population-wide implementation. To support systematic implementation at the population level, Taiwan adopted a three-tiered foundation that includes: (1) a centralized planning committee; (2) screening service delivery through primary care providers, guided by clinical guidelines established by medical societies; and (3) community engagement to raise awareness of stomach health and promote participation in screen-and-treat programs through social media campaigns. Program execution strictly follows the principles of organized screening, supported by standardized quality indicators, integrated digital tracking systems, structured audit mechanisms, and both effectiveness and cost-effectiveness assessments. Strategies are tailored to local contexts: in the Matsu Islands, mass screening using the 13C urea breath test and subsequent eradication treatment led to reductions in H. pylori prevalence and gastric cancer incidence and mortality; in Changhua County, a pragmatic randomized clinical trial showed that stool sample-based screening using H. pylori stool antigen and fecal immunochemical testing improved participation and reduced gastric cancer incidence; and in indigenous communities, household-based approaches utilizing the 13C urea breath test could enhance H. pylori detection rate and reduce the intrafamilial transmission. In addition to the continuous assessment of its effectiveness in preventing both gastric cancer and peptic ulcer disease, it is also essential to evaluate the potential impacts on antibiotic resistance and gut microbial succession after mass H. pylori eradication. All these programs consistently maintain high standards of quality and equity, ensuring accessibility for diverse populations with varying socioeconomic positions. Collectively, it demonstrates how robust scientific evaluations, when combined with organized screening principles and systematic performance monitoring, can be effectively translated into sustainable, evidence-based programs for population-wide gastric cancer prevention.
Taiwan's declining fertility rate is reshaping the pediatric care landscape. The demands of child health care encompass acute and critical care, chronic disease management, complex diagnostic conditions, as well as developmental and mental health support. In response, the Ministry of Health and Welfare's Program for Excellence in Child Health Care and the Project of Holistic Physicians for Young Children represent a strategic transition toward proactive, community-anchored child health stewardship. By integrating preventive services, developmental surveillance, case management, and cross-sector coordination, these initiatives strengthen early detection and timely intervention while redefining pediatricians as key actors within the social safety net. Embedding prevention-oriented competencies into undergraduate medical education and pediatric subspecialty training will further empower pediatricians to influence population-level child health outcomes. This forward-looking transformation positions pediatrics to sustain high-value impact amid demographic headwinds, ensuring equitable and continuous health support for every child.
