Objectives To identify and characterize space-time clusters of road traffic collisions (RTCs) involving older adults in Taiwan, with emphasis on spatial and temporal features that may inform targeted prevention strategies. Methods We analyzed nationwide RTC data from Taiwan’s Police Traffic Accident Report (PTAR) registry from 2014 to 2023, including 145,450 older adult victims aged ≥65 years. Six variables, including three spatial (urbanization level, crash location, and type of traffic signal) and three temporals (monsoon season, day of the week, and time of day), were selected to perform latent class analysis (LCA) for identifying distinct spatiotemporal crash clusters. Model fit indices (AIC, BIC, CAIC, ABIC, and entropy) guided the selection of the optimal number of clusters. Demographic and road user characteristics across clusters were compared using bivariate analyses. Results Three distinct clusters were identified: (1) urban intersection crashes, (2) intersection crashes in medium- and low-urbanized areas, and (3) crashes on unsignalized road segments. Collisions were more likely to occur at intersections (n=85,247, 58.6%) and in highly urbanized areas, (n=61,432, 42.2%). Most incidents took place on weekdays (n=103,441, 71.1%) and during morning hours (n=70,382, 48.4%). Significant differences across clusters were found in age, sex, road user role, and vehicle type (all p < 0.001). Conclusion This study demonstrates the heterogeneity in spatiotemporal patterns of RTCs involving older adults in Taiwan. These findings highlight areas where further investigation into context-specific traffic safety measures could inform efforts to enhance mobility and reduce injury risk among older adults.

With the global rise in the aging population, ensuring safe mobility for older adults is an urgent public health concern. In Taiwan, scooters are widely used by older individuals, yet the impact of air pollution, particularly fine particulate matter (PM2.5), on their traffic safety remains poorly understood. This study investigated the short-term association between PM2.5 exposure and the risk of scooter collisions among older adults. We conducted a nationwide time-series analysis using Taiwan’s Police-Reported Traffic Accident Registry and air quality monitoring data from 2023. The study included 58,181 scooter riders aged ≥ 65 years involved in collisions. Daily PM2.5 concentrations were derived from over 70 monitoring stations. We applied distributed lag non-linear models (DLNM) with a negative binomial distribution to estimate the association between PM2.5 exposure and daily scooter collision counts, adjusting for meteorological variables, co-pollutants (NO₂ and SO₂), and temporal variables. The models accounted for both same-day exposure and cumulative effect of exposure across lag periods of up to 14 days. We found that 159 older adults were involved in scooter collisions per day on average, with a mean PM2.5 level of 13.4 µg/m³. A non-linear exposure-response relationship was observed, with rate ratios increased at PM2.5 levels ≥ 20 µg/m³, particularly over longer lag periods. The highest risk estimate was observed for 15-day cumulative exposure at 31 µg/m³ (rate ratio = 2.357; 95

Objective: Whether pregnancy is associated with severe injuries from motor vehicle crashes (MVCs) remains unclear. This study aimed to investigate the potential relationship between pregnancy and severity of injuries from MVCs. Methods: We identified a total of 23,559 pregnant women victims who encountered MVCs during pregnancy as well as 94,236 age- and calendar year-at MVC matched non-pregnant women victims that are also involved in MVCs. Injury severity was assessed using the Maximum Abbreviated Injury Scale (MAIS) based on the diagnosis of medical claims after MVCs. Multinomial logistic regression models were used to estimate the odds ratio and corresponding 95 % CI of injury severity levels associated with pregnancy. Results: Pregnant women had a significantly higher risk of both severe (adjusted odds ratio, aOR = 1.79, 95 % CI = 1.54-2.08) and mild injuries (aOR = 8.63, 95 % CI = 8.21-9.07) following MVCs as compared to non-pregnant women victims. Particularly, pregnant women who were riding scooters had an increased risk of severe injury (aOR = 4.25, 95 % CI = 3.58-5.04). In addition, pregnant women who experienced MVC but without any injury were more likely to visit a clinic than non-pregnant MVC victims. Conclusion: Pregnant women victims, particularly those who were riding scooters involved in MVCs suffered from a higher risk of severe injury as compared to their non-pregnant counterparts. Our findings suggest that women should consider avoiding riding a scooter and must use restrictive devices during pregnancy, which would help reduce the severity of injuries sustained following an MVC.

BackgroundHeart attacks including acute ST-segment elevation myocardial infarction (STEMI) and acute decompensated heart failure (ADHF) caused from the particulate matter (PM) and air pollutant exposures are positively associated with regional air pollution severity and individual exposure. The exceptional coronavirus disease epidemic of 2019 (COVID-19) may enhance the air conditions in areas under COVID-19 pandemic. We sought to study the impact of COVID-19 pandemic on air particulate matter (PM) exposure and heart attacks in Taiwan.MethodsThis retrospective cohort study was conducted in one teaching hospital in Taichung, Taiwan. We examined emergency patients diagnosed with acute STEMI and ADHF from January 1, 2017, to March 31, 2020, (i.e., before the COVID-19 pandemic) and from April 1, 2020, to December 31, 2021, (after the COVID-19 pandemic). The effects of particulate matter with a diameter of less than 2.5 micrometers (PM2.5) and PM10 as well as temperature and humidity on environmental air pollutants were recorded. The analysis was performed with a unidirectional case-crossover research design and a conditional logistic regression model.ResultsBoth PM2.5 and PM10 levels had a positive association with the risk of acute STEMI before the COVID-19 pandemic (PM2.5 adjusted odds ratio (OR): 1.016, 95% confidence interval (CI): 1.003–1.032 and PM10 adjusted OR: 1.009, 95% CI: 1.001–1.018) and ADHF (PM2.5 adjusted OR: 1.046, 95% CI: 1.034–1.067 and PM10 adjusted OR: 1.023, 95% CI: 1.027–1.047). Moreover, the results demonstrated that PM2.5 and PM10 were not associated with the risk of acute STEMI or ADHF after the COVID-19 pandemic. Reduction in PM2.5 and PM10 levels after the COVID-19 pandemic were noted. Hospital admissions for acute STEMI (7.4 and 5.8/per month) and ADHF (9.7 and 8.2/per month) also decreased (21.6 and 15.5%) after the COVID-19 pandemic.ConclusionIn Taiwan, paradoxical reductions in PM2.5 and PM10 levels during the COVID-19 pandemic may decrease the number of hospital admissions for acute STEMI and ADHF. As the COVID-19 pandemic eases, the condition of air pollution may gradually become worse again. The governments should formulate better policies to improve the health of the public and the quality of the air.

Background Stroke and traumatic intracranial hemorrhage (tICH) are major causes of disability worldwide, with stroke exerting significant negative effects on the brain, potentially elevating tICH risk. In this study, we investigated tICH risk in stroke survivors. Methods and Results Using relevant data (2017–2019) from Taiwan's National Health Insurance Research Database, we conducted a population‐based retrospective cohort study. Patients were categorized into stroke and nonstroke groups, and tICH risk was compared using a Cox proportional‐hazards model. Among 164 628 patients with stroke, 1004 experienced tICH. Patients with stroke had a higher tICH risk than nonstroke counterparts (adjusted hazard ratio [HR], 3.49 [95% CI, 3.17–3.84]). Subgroup analysis by stroke type revealed higher tICH risk in hemorrhagic stroke survivors compared with ischemic stroke survivors (HR, 5.64 [95% CI, 4.97–6.39] versus 2.87 [95% CI, 2.58–3.18], respectively). Older patients (≥45 years) with stroke had a higher tICH risk compared with their younger counterparts (<45 years), in contrast to younger patients without stroke (HR, 7.89 [95% CI, 6.41–9.70] versus 4.44 [95% CI, 2.99–6.59], respectively). Dementia and Parkinson disease emerged as significant tICH risk factors (HR, 1.69 [95% CI, 1.44–2.00] versus 2.17 [95% CI, 1.71–2.75], respectively). In the stroke group, the highest tICH incidence density occurred 3 months after stroke, particularly in patients aged >65 years. Conclusions Stroke survivors, particularly those with hemorrhagic stroke and those aged ≥45 years, face elevated tICH risk. Interventions targeting the high‐risk period are vital, with fall injuries potentially contributing to tICH incidence.

BackgroundTo evaluate the association between maternal MVCs during pregnancy and neurodevelopmental disorders (NDDs, including intellectual disability, ADHD, ASD, and infantile cerebral palsy) in children.MethodsThis population-based cohort of live births in Taiwan was analyzed, comparing children born to mothers involved in MVCs during pregnancy with those without such exposure. Children were linked to the insurance database to identify the possible diagnosis of NDDs. The Cox proportional hazards regression model was used to estimate the relative hazards.ResultsA total of 19,277 children with maternal MVCs and 76,015 children without exposure were included. Children exposed to maternal MVCs during the first two trimesters or whose mothers sustained mild to severe injuries showed a higher risk of intellectual disability. Severe maternal injuries also increased the risk of infantile cerebral palsy (aHR = 3.86; 1.27-11.78). MVCs in the third trimester, or mild maternal injuries, were associated with a higher risk of ASD (third trimester: aHR = 1.40; 1.04-1.87; mild injuries: aHR = 1.38; 1.09-1.74).ConclusionChildren exposed to maternal MVCs with severe injuries had a higher risk of intellectual disability and cerebral palsy. Third-trimester exposure may increase the risk of ASD. However, these findings should be interpreted cautiously as genetic factors may contribute to the observed association.ImpactThere is some evidence linking maternal MVCs during pregnancy to the development of neurodevelopmental disorders in children.Children of mothers with severely injured were more likely to suffer from infantile cerebral palsy and intellectual disability.The risk of autism spectrum disorder is higher in children whose mothers are involved in MVCs during the late stage of pregnancy, and there is also an increased risk of intellectual disability during the first two trimesters.

Abstract Background Understanding demographic profiles is essential to the assessment of health burden imposed by motor vehicle crashes (MVCs) on pregnant women. However, Asian studies that have examined it are lacking. The study aimed to describe the demographic characteristics and prevalence of MVCs involving pregnant women in Taiwan. Methods A cross-sectional study conducted by the Taiwan Birth Notification dataset from 2008 to 2017 was linked with the police-reported traffic collision registry to identify pregnant women involved in MVCs. The pregnant women were categorized according to their gestational age, age at delivery, the role of road user (driver, passenger, or pedestrian), and vehicle types (car, two-wheeled motor vehicle, or others). A chi-square test was performed for the significance test. Results A total of 22,134 (1.13%) pregnant women were involved in MVCs in the study period. Two-wheeled motor vehicle (47.9%) and driver (81.4%) were the mainly reported vehicle type and road user at the crash scenes, respectively. The majority of MVCs occurred in pregnant women aged 28–34 years. The number of MVCs rapidly declined after 37 weeks of gestation, especially two-wheeled motor vehicle or car crashes. However, the number of pedestrian victims climbed up during the third trimester. Conclusion Pregnant women are susceptible to MVCs regardless of their gestational age, role of a road user, or type of vehicle. The findings of this study emphasize the need for increased awareness of traffic collision prevention among pregnant women aged 28–34. In addition, improving pedestrian safety is essential for the reduction of pregnant victims.

Background: Changes in risk of motor vehicle crashes (MVCs) during pregnancy are less known, and very few studies have assessed this issue by using unselected population-based datasets and adopting a before-and-during design. The study aimed to address the risk of MVC events in association with pregnancy using a national pregnant women cohort in Taiwan.Methods: We conducted a self-matched design in which each woman served as a driver before and during pregnancy. A total of 1,372,664 pregnant women with live birth(s) at 18-50 years of age between 2008 and 2017 were identified from the Birth Notification dataset. MVC events as a driver were ascertained from the Police -reported Traffic Accident Registry dataset. We calculated the rate ratio (RR) with a 95 % confidence interval (CI) using the conditional Poisson regression model to compare the MVC event rates between pre-pregnancy and pregnancy periods.Results: The overall rate of MVC events was significantly reduced during pregnancy (RR = 0.69, 95 % confidence interval (CI) = 0.68-0.71). Mothers with alcoholism during pregnancy were associated with an increased RR at 2.00 but with a very wide CI. Reduction in RR was primarily attributed to the reduced MVC event rate involving scooter crashes (0.60, 95 % CI = 0.58-0.62).Conclusion: Although MVC event rates decreased during women became pregnant, many women drivers were still involved in MVCs during pregnancy. Their potential maternal and perinatal conditions along with their off-spring's health outcomes need further investigations.

BACKGROUNDAdverse events in fetuses are well researched but studies on the follow-up health outcomes of infants exposed to maternal motor vehicle crashes (MVCs) during pregnancy have yielded inconsistent results. This study aimed to investigate the association of maternal exposure to MVCs during pregnancy with the risk of adverse neonatal outcomes.METHODSThis population-based cohort study used data from birth notifications in Taiwan. A total of 19 277 offspring with maternal exposure to MVCs during pregnancy and 76 015 randomly selected comparison offspring without such exposure were selected. Neonatal adverse outcomes were identified from National Health Insurance medical claims data. Conditional logistic regression was used to estimate the unadjusted and adjusted odds ratios (aORs) of neonatal adverse outcomes.RESULTSOffspring exposed to maternal MVCs during pregnancy had a higher risk of birth defects (aOR, 1.21; 95% CI, 1.04-1.41) than offspring without such exposure. This positive association was sustained with exposure to an MVC during the first or second trimester. A dose-response relationship (P = 0.0023) was observed between the level of injury severity and the risk of birth defects.CONCLUSIONSIn the early stages of pregnancy, maternal exposure to MVCs may entail a risk of birth defects in the offspring. The potential mechanisms for the associations of maternal exposure to MVCs with birth defects need further investigation.

BACKGROUND:Limited studies have assessed the association of motor vehicle crashes (MVCs) during pregnancy with adverse maternal outcomes using a population-based nationwide dataset that covers all MVCs. METHODS:A total of 20 844 births from women who had been involved in MVCs during pregnancy were obtained from the National Birth Notification (BN) Database in Taiwan. We randomly selected 83 274 control births from women in the BN matched on age, gestational age and crash date. All study subjects were linked to medical claims and the Death Registry to identify the maternal outcomes after crashes. Conditional logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% CI of adverse outcomes associated with MVCs during pregnancy. RESULTS:Pregnant women involved in MVCs had significantly higher risks of placental abruption (aOR=1.51, 95% CI 1.30 to 1.74), prolonged uterine contractions (aOR=1.31, 95% CI 1.11 to 1.53), antepartum haemorrhage (aOR=1.19, 95% CI 1.12 to 1.26) and caesarean delivery (aOR=1.05, 95% CI 1.02 to 1.09) than the controls. Such elevated risks tended to be higher in the MVCs with greater severity. Scooter riders had higher ORs of various adverse maternal outcomes than car drivers. CONCLUSIONS:Women involved in MVCs during pregnancy were at increased risk of various adverse maternal outcomes, especially in those with severe MVCs and riding scooters at MVCs. These findings suggest that clinicians should be aware of these effects, and educational materials that include the above information should be provided as part of prenatal care.

One of the chronic diseases whose diagnosis and treatment involve many psychological problems is breast cancer. Considering the nature of this disease, it seems necessary to use psychological treatment. The purpose of the current study was to investigate the effectiveness of compassion-based treatment in improving the performance of women with breast cancer. This study is a semi-experimental type and was done with a post-test and pre-test design and with two experimental and control groups. The

Although past studies have identified predictors related to child injuries with developmental disorders, national-level research in Asia is limited. The objective of this study was to explore the risk factors for child injuries with developmental disorders in Taiwan using a national-level integrated database for the period between 2004–2015 (The Maternal and Child Health Database, National Health Insurance Research Database, Census Registry, and Indigenous Household Registration). Children younger than 12 years old who had records of visiting the ER or being hospitalized due to injury or without injury were included in this study. A 1:1 nested case-control study (injury vs. noninjury) to examine the risk factors for child injury with developmental disorder was performed. A total of 2,167,930 children were enrolled. The risk factors were associated with repeated ER visits or hospitalization: being indigenous (adjusted odds ratio [AOR]: 1.51; CI: 1.45–1.57); having a developmental disorder (AOR: 1.74; CI: 1.70–1.78); and having parents with illicit drug use (AOR: 1.48; CI: 1.32–1.66), alcohol abuse (AOR: 1.21; CI: 1.07–1.37), or a history of mental illness (AOR: 1.43; CI: 1.41–1.46). Being indigenous, having developmental disorders, and having parents with history of illicit drug use, alcohol abuse, or mental illness were predictors related to injuries in children.

Abstract Background Most studies have focused on injuries sustained by intoxicated drivers themselves, but few have examined the effect of drunk driving on injury outcomes among VRUs (vulnerable road users) in developing countries. This study aims to evaluate the effect of drunk driving on fatal injuries among VRUs (pedestrians, cyclists, or motorcyclists). Methods The data were extracted from the National Taiwan Traffic Crash Dataset from January 1, 2011, to December 31, 2019. Crashes involving one motorized vehicle and one VRU were considered. This study examines the effect of drunk driving by estimating multivariate logistic regression models of fatal injuries among VRUs after controlling for other variables. Results Among 1,416,168 casualties, the fatality rate of VRUs involved in drunk driving was higher than that of general road users (2.1% vs. 0.6%). Drunk driving was a significant risk factor for fatal injuries among VRUs. Other risk factors for fatal injuries among VRUs included VRU age ≥ 65 years (adjusted odds ratio [AOR]: 5.24, 95% confidence interval [CI]: 5.53–6.07), a nighttime accident (AOR: 4.52, 95% CI: 4.22–4.84), and being hit by a heavy-duty vehicle (AOR: 2.83, 95% CI: 2.26–3.55). Subgroup analyses revealed a linear relationship between driver blood alcohol concentration (BAC) and the risk of fatal injury among motorcyclists. Motorcyclists exhibited the highest fatality rate when they had a BAC ≤ 0.03% (AOR: 3.54, 95% CI: 3.08–4.08). Conclusion Drunk driving was associated with a higher risk of fatality for all VRUs. The risk of fatal injury among motorcyclists was linearly related to the BAC of the drunk drivers. Injuries were more severe for intoxicated motorcyclists, even those with BAC ≤ 0.03%, which is within the legal limit.

The aim of the study was to provide a systematic review and meta-analysis of studies examining the association between mortality risk and motor vehicle crashes (MVCs) in pregnant women compared with nonpregnant women. We used relevant MeSH terms to identify epidemiological studies of mortality risk in relation to MVCs from PubMed, Embase, and MEDLINE databases. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. For comparison of mortality from MVCs between pregnant and nonpregnant women, the pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. The eight studies selected met all inclusion criteria. These studies included 14,120 injured victims who were pregnant at the time of the incident and 207,935 victims who were not pregnant. Compared with nonpregnant women, pregnant women had a moderate but insignificant decrease in mortality risk (pooled OR = 0.68, 95% CI = 0.38–1.22, I2 = 88.71%). Subgroup analysis revealed that the pooled OR significantly increased at 1.64 (95% CI = 1.16–2.33, I2 < 0.01%) for two studies with a similar difference in the mean injury severity score (ISS) between pregnant and nonpregnant women. Future studies should further explore the risk factors associated with MVCs in pregnant women to reduce maternal mortality.

Long-term exposure to high concentrations of air pollution is known to lead to increased cardiovascular disease, but it remains unclear whether short-term exposure increases the incidence of acute myocardial infarction (AMI) and acute heart failure (AHF). A time-stratified case-crossover design was used, including data from the 2-year period (January 1, 2017 to December 31, 2018), from the National Health Insurance Academic Research Database of Taiwan. Air pollution data were obtained from the Air Quality Monitoring Station of the Environmental Protection Agency of the Executive Yuan. A generalized linear model was used for statistical analysis. In areas with a long-term moderate severity of air pollution, a 10 μg/m3 increase in fine particulate matter (PM2.5) and particulate matter (PM10) exposure in a short period of time coincided with an increase in AMI by 6.5% to 6.7% and 0.9% to 1.1%, respectively, and AHF by 6.1% to 6.4% and 0.9% to 1.0%, respectively. A long-term high severity of air pollution (PM2.5 and PM10) coincided with an increase in AMI by 7.9% to 8.8% and 4.4% to 4.9%, respectively, and AHF by 7.6% to 8.4% and 4.3% to 4.8%, respectively. In areas with a long-term moderate or high severity of air pollution, short-term exposure to high concentrations of PM2.5 and PM10 pollution is positively correlated with AMI and AHF.

Long-term exposure to air pollution results in a high incidence of cardiovascular disease. Many studies have found that short-term exposure to air pollution can trigger acute myocardial infarction. This study aims to determine whether results in areas with different levels of severity of air pollution are similar. The study design is a time-stratified case-crossover analysis. This was a retrospective study based on hospital medical records. The study period was since 1 January 2017 to 31 December 2018. Research data were collected from Taoyuan Hospital, located in an area with low severity of pollution, and Taichung Hospital, located in an area with high severity of pollution. The correlation between short-term air pollution exposure and acute myocardial infarction was analyzed. The correlation between short-term exposure to ambient air pollutants and acute myocardial infarction was not significant for the cases collected from Taoyuan Hospital (PM2.5 OR: 1.006 and 95% CI: 0.995-1.017; PM10 OR: 0.996 and 95% CI: 0.988-1.003). However, for the cases collected from Taichung Hospital, short-term exposure to ambient PM2.5 (odds ratio: 1.021; 95% confidence interval: 1.002-1.040) and PM10 (odds ratio: 1.010; 95% confidence interval: 1.001-1.020) resulted in high incidence of acute myocardial infarction. Short-term pollutant exposure will increase the incidence of acute myocardial infarction based on the severity of regional air pollution. In addition to addressing traditional cardiovascular disease risk factors, the government must formulate relevant policies for reducing air pollution and the resulting hazards to citizens' health.

Background: Research suggests that drivers tend to engage in risk-taking behaviours on public holidays. Studies that examined the association between holidays (or other special days) and fatal injuries are inconsistent. This study used UK STATS19 data to investigate the associations of nine public holidays on road crash casualties. Methods: This retrospective study assessed UK STATS19 crash data for 1990–2017. All casualties from two vehicle crashes were initially considered; subsequently, casualties with missing data were excluded. Multiple logistic regression was estimated to explore the associations of potential risk factors with the likelihood of killed or seriously injured (KSI) casualties and to calculate adjusted odds ratios (AORs). Results: In total, 3,751,998 casualties from traffic accidents in the United Kingdom during 1990–2017 were included in the final data set; among these, 410,299 (10.9%) were KSI casualties, and 3,341,699 (89.1%) were slight injuries. Crashes on public holidays were 16% (AOR = 1.16; 95% confidence interval [CI] = 1.13–1.19) more likely to involve KSI casualties than were crashes on non-holidays. With other factors controlled for, crashes during the Queen’s 2002 Golden Jubilee and on New Year’s Day were 48% (AOR = 1.48; 95% CI = 1.06–2.07) and 36% (AOR = 1.36; 1.26–1.48) more likely to lead to KSIs, respectively. Conclusions: The proportion of crashes resulting in KSI casualties on public holidays was higher than that on non-holidays. Furthermore, crashes during the Queen’s 2002 Golden Jubilee had the highest risk of KSI casualties followed by New Year’s Day.