The success of controlling the coronavirus disease 2019 (COVID-19) pandemic during 2020–2021 in Taiwan can be attributed to the legal authority of the government and timely public health policy. Further, digital technology through established government infrastructure and public-private partnerships enabled the efficient and effective implementation of public health policy. Digital technology can assist with these interventions through monitoring and surveillance, contact tracing, screening, risk communication, and resource allocation. The response time for controlling highly contagious infectious diseases, such as SARS-CoV-2, was shortened due to digital adoption. The primary benefits of introducing digital technology to disease control are enhancing efficiency, prioritizing resource allocation, promoting residents' compliance, and reducing social anxiety from active risk communication. Many digital technologies have been used to cope with the COVID-19 pandemic in Taiwan. This study lists the purposes and mechanisms of these technologies to control the COVID-19 pandemic in Taiwan. Citizens' trust in digital governance and high adherence to policies are also fundamental to disease control. Furthermore, this chapter discusses the underlying digital infrastructure and supporting framework for facilitating the rapid dissemination of digital applications. Public health policies and appropriate digital technology can efficiently enhance resource allocation and facilitate precise pandemic control.

Understanding the causes of noise annoyance requires recognition of the factors that affect soundscape perceptions. This study aims to explore multilevel factors of acoustic comfort and the perceived health effects of sound exposure, including personal traits, sound characteristics, and spatiotemporal features of the surrounding environment. We designed the Soundmap chatbot to collect data from the participants during May 16-July 16, 2022. The participants completed two tasks including sound recording and questionnaires. Sound feature extraction and identification were computed. Two soundscape perception variables were used as outcome variables and measured, and cumulative link mixed models were applied for statistical analysis. Results showed that for female participants, lower acoustic comfort was associated with sound exposure at night, at the land use of transportation and built-up areas, as well as the sounds of machines, vehicles, and airplanes. Low-frequency sound exposure and sounds of nature, silence, music, and human activity were associated with higher acoustic comfort, and these exposures were also associated with positive perceptions of health in rural areas and on weekends. Individuals with extraversion had a higher tolerance to sound; those with high noise sensitivity had a lower tolerance to sound. Understanding sound perception is crucial in maintaining a sustainable urban acoustic environment.

IntroductionDuring the COVID-19 pandemic, many employees were encouraged to temporarily work from home as an attempt to decrease social contact with others. However, the employees' quality of life (QoL) may have been threatened by this mode of working. This study, therefore, aims to explore the employees' QoL given the new mode of working from home (WFH) as a result of the pandemic vs. working in the office (WIO), the amount of social contact that they were exposed to, and the ratio of face-to-face contact that they had.MethodsA total of 803 WFH employees and 588 WIO employees' QoL was assessed during the same time period using the WHOQOL-BREF, which contains four domains: physical health, psychological health, social relationship, and the environment. We then divided the participants into 16 groups in accordance with the levels of work mode, social contact quantity, and face-to-face contact ratio–forming a case-control study. A differential item functioning (DIF) analysis was used to analyze the responses on the WHOQOL-BREF under the 4-dimensional rating scale model fitting.ResultsThe results indicated that WFH employees' QoL was superior to that of WIO employees. The relationship between the WFH mode and the employees' QoL was specifically moderated by the amount of social contact and the ratio of face-to-face contact that was experienced. The results further demonstrated that the increased amount of non-face-to-face contact was better for WFH employees' QoL than that of WIO employees.DiscussionIn conclusion, the WFH mode was practical during the COVID-19 pandemic, as our findings indicated that WFH employees' QoL was better than WIO employees' QoL. However, maintaining social connections is equally important as this allows employees to perform better at their jobs and maintain such performance. The employees with a higher number of social support had a better QoL. Additionally, the facets detected as DIF items provided implications for the QoL with regard to the research methodology and insight into factors affecting the employees' QoL.

Introduction The detrimental effects of air pollution on the brain are well established. However, few studies have examined the effect of air pollution on traumatic brain injury (TBI). This pilot study evaluated the association between short-term air pollution exposure and traumatic intracranial hemorrhage (TIH). Methods Hospital data of patients with TBI following road traffic accidents were retrospectively collected from the electronic medical records at five trauma centers in Taiwan between 1 January and 31 December 2017. TIH was employed as an outcome measure. All road accident locations were geocoded, and air quality data were collected from the nearest monitoring stations. Air pollutants were entered into five multivariable models. A sensitivity analysis was performed on patients who are vulnerable to suffering TBI after road accidents, including motorcyclists, bicyclists, and pedestrians. Results Among 730 patients with TBI, 327 had TIH. The ages of ≥65 [odds ratio (OR), 3.24; 95% confidence interval (CI), 1.85–5.70], 45–64 (OR, 2.61; 95% CI, 1.64–4.15), and 25–44 (OR, 1.79; 95% CI, 1.13–2.84) years were identified as significant risk factors in the multivariable analysis. In the best-fit multivariable model, exposure to higher concentrations of particulate matter ≤ 2.5 μm in aerodynamic diameter (PM 2.5 ) was associated with an elevated TIH risk (OR, 1.50; 95% CI, 1.17–1.94). The concentration of nitrogen oxides (NO X ) did not increase the risk of TIH (OR, 0.45; 95% CI, 0.32–0.61). After categorizing the air pollution concentration according to quartile, the trend tests in the multivariate model showed that the concentrations of PM 2.5 and NO X were significant ( p = 0.017 and p < 0.001, respectively). There was a negative borderline significant association between temperature and TIH risk (OR, 0.75; 95% CI, 0.56–1.00, p = 0.05). Notably, the single-vehicle crash was a significant risk factor (OR, 2.11; 95% CI, 1.30–3.42) for TIH. Discussion High PM 2.5 concentrations and low temperatures are risk factors for TIH in patients with TBI. High NO X concentrations are associated with a lower TIH risk.

Background Autosomal-dominant polycystic kidney disease (ADPKD) is the most prevalent hereditary kidney disease and the fourth leading cause of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). Nevertheless, there is a paucity of epidemiological research examining the risk factors and survival on RRT for ADPKD. Thus, we aimed to investigate the cumulative effects of cardiometabolic comorbidities, including hypertension (HTN), type 2 diabetes mellitus (DM), and dyslipidemia (DLP) to clinical outcomes in ADPKD. Methods We identified 6,142 patients with ADPKD aged ≥ 20 years from 2000 to 2015 using a nationwide population-based database. HTN, DM, and DLP diagnoses before or at the time of ADPKD diagnosis and different combinations of the three diagnoses were used as the predictors for the outcomes. Survival analyses were used to estimate the adjusted mortality risk from cardiometabolic comorbidities and the risk for renal survival. Results Patients with ADPKD who developed ESRD had the higher all-cause mortality (HR, 5.14; [95% CI: 3.88–6.80]). Patients with all three of the diseases had a significantly higher risk of entering ESRD (HR:4.15, [95% CI:3.27–5.27]), followed by those with HTN and DM (HR:3.62, [95% CI:2.82–4.65]), HTN and DLP (HR:3.54, [95% CI:2.91–4.31]), and HTN alone (HR:3.10, [95% CI:2.62–3.66]) compared with those without any three cardiometabolic comorbidities. Conclusions Our study discovered the cumulative effect of HTN, DM, and DLP on the risk of developing ESRD, which reinforces the urgency of proactive prevention of cardiometabolic comorbidities to improve renal outcomes and overall survival in ADPKD patients.

Background Oral health could influence cognitive function by stimulating brain activity and blood flow. The quantified oral status from oral inflammation, frailty and masticatory performance were rarely applied to the cognitive function screening. We aimed to adopt non-invasive digital biomarkers to quantify oral health and employ machine learning algorithms to detect cognitive decline in the community. Methods We conducted a prospective case-control study to recruit 196 participants between 50 and 80 years old from Puzi Hospital (Chiayi County, Taiwan) between December 01, 2021, and December 31, 2022, including 163 with normal cognitive function and 33 with cognitive decline. Demographics, daily interactions, electronically stored medical records, masticatory ability, plaque index, oral diadochokinesis (ODK), periodontal status, and digital oral health indicators were collected. Cognitive function was classified, and confirmed mild cognitive impairment diagnoses were used for sensitivity analysis. Results The cognitive decline group significantly differed in ODK rate ( P = 0.003) and acidity from SILL-Ha ( P = 0.04). Younger age, increased social interactions, fewer cariogenic bacteria, high leukocytes, and high buffering capacity led to lower risk of cognitive decline. Patients with slow ODK, high plaque index, variance of hue (VOH) from bicolor chewing gum, and acidity had increased risk of cognitive decline. The prediction model area under the curve was 0.86 and was 0.99 for the sensitivity analysis. Conclusions A digital oral health biomarker approach is feasible for tracing cognitive function. When maintaining oral hygiene and oral health, cognitive status can be assessed simultaneously and early monitoring of cognitive status can prevent disease burden in the future.

BackgroundKidney function is associated with clinical outcomes in patients with cancer. ObjectivesThis study aimed to assess the association between kidney function decline and cancer-related mortality among community-dwelling elderly individuals. DesignThis was a retrospective longitudinal cohort study. ParticipantsThe 61,988 participants were from an elderly health examination database in Taipei City from 2005 to 2012. MeasurementsMultivariable logistic regression was used to assess the association between baseline covariates and rapidly deteriorating estimated glomerular filtration rate (eGFR). In addition, Cox proportional hazards model and the Fine-Gray model were used to quantify the effects of covariates on total cancer mortality and six specific cancer mortalities. ResultsDuring the follow-up period, 1482 participants died of cancer. Their baseline average eGFR was 73.8 +/- 19.9 mL/min/1.73 m(2), and 18.3% had rapid renal function decline (>= 5 mL/min/1.73 m(2) per year). Rapid renal function decline was positively related to age, baseline eGFR, proteinuria, hypertension, waist circumferences, high log triglyceride levels, and diabetes mellitus (DM) history. In Cox proportional hazard models, participants with rapid eGFR decline had an increased risk of cancer mortality [hazard ratio (95% CI): 1.97 (1.73, 2.24); p < 0.001] compared to those without rapid eGFR decline. In the analysis of site-specific cancer mortality risk, rapid eGFR decline was associated with six site-specific cancer mortality, namely gastrointestinal tract, hepatobiliary, lung, prostate, urinary tract, and hematological malignancies. ConclusionsElderly individuals with rapid kidney function decline had higher cancer mortality risks. Serial assessments of dynamic changes in eGFR might provide information relevant for cancer prognosis.

Respiratory infectious diseases are closely related to meteorological conditions and pollutants, and the changes of their epidemiological characteristics rarely explored in recent 10 years. We aimed to assess the incidence and mortality trends for respiratory infectious diseases from 2004 to 2018, and examine the associations between air pollution (PM2.5, PM10, SO2, NO2, O3 and CO exposure and meteorological conditions [mean temperature, relative humidity, air pressure, precipitation, wind speed, and sunlight hours] and respiratory infectious diseases. Data were collected from China’s notifiable infectious disease report database. Joinpoint regression models were used to examine changes in incidence and mortality for each respiratory infectious disease and to estimate average annual percentage changes (AAPCs). We used Pearson’s correlation coefficient to examine the associations between air pollution exposure and meteorological conditions. A Distributed Lag Non-Linear Model (DLNM) with relative risk was applied to analyze the impact of meteorological conditions and air pollutants on respiratory infectious diseases. We also applied a time-series decomposition approach based on LOESS (locally weighted regression) to present the seasonality of seven respiratory infectious diseases. A total of 23,444,640 cases and 45,291 deaths caused by seven respiratory infectious diseases were recorded in China, and the national mean age-standardized incidence and mortality were 115.87/100,000 and 0.23/100,000, respectively. The AAPC of age-adjusted incidence was 0.23 but was -2.11 for age-adjusted mortality; change of incidence and mortality differed by age groups. SO2 and PM10 in air pollutants and relative humidity and air pressure in climatic factors had significant effects on most respiratory diseases in this study. Based on DLNM results, meteorological factors had a stronger impact on respiratory infectious diseases with an acute and short-term lag effect compared with air pollutants.

Intro: Severe outbreaks in Taiwan during 1987-2015 had always started from failure in detecting early dengue cases. However, the extreme low numbers of indigenous dengue cases in southern Taiwan during 2016-2022 have been succeeded with early efforts through integrated surveillance systems, including, free charge NS1 screening of virological surveillance for patients with dengue-like illness, fever surveillance at the airport and entomological surveillance looking for mosquito breeding sites. Recently, we used machine learning models to assist in finding lab.-confirmed dengue cases and predicting severe dengue cases in the elderly. Methods: We investigated factors that were associated with severe dengue outbreaks in southern Taiwan and used geographical information system (GIS) to plot spatial distribution of laboratory-confirmed dengue cases. Findings: Six epidemiological findings can direct prevention and control policies. (1) The onset of epidemics begins with imported dengue cases and appropriate weather conditions (high temperature, low humidity) enlightening to educate the symptoms/signs of dengue for travelers is important. (2) DENV-2, had resulted in most severe epidemics. (3) Once DENV- 2/DENV-3 circulates too long or severe cases occur, fatal dengue cases will increase alongside the prolongation of epidemic wave. (4) In areas with high population densities, either longer epidemic wave or higher transmission intensity can result in greater percentage of severe dengue cases. However, in areas with low population densities, both conditions can lead to greater percentage of severe dengue cases Therefore., interrupting DENV transmission efficiently can reduce severe/fatal cases. (5) Severe dengue cases frequently occur in tempo-spatial dengue clusters implying the importance to find out the sources of infection. The overlapping areas between high mosquito indices and dengue clusters facilitate transmission persistence. (6) Source reduction is more effective than insecticide-spraying. Conclusion: integrated surveillance systems, immediate interrupting transmission, and identifying mosquito breeding sites all together can reduce epidemic severity and thus promoting global health.

Background Using a 10 week nationwide online survey performed during a time period containing the time ahead, the start, and the peak of a COVID-19 outbreak in Taiwan, we investigated aspects that could affect participants’ vaccination intentions. Methods From March to May 2021, we surveyed 1,773 people in Taiwan, aged from 20 to 75 years, to determine potential acceptance rates and factors influencing the acceptance of a COVID-19 vaccine. We used an ordinal logistic regression with a backward selection method to identify factors that affected vaccination intention. Results Several factors could increase individuals’ vaccination intentions including: being male, older, with an openness personality, having a better quality of life in the physical health domain, having better knowledge and personal health behavior, having more trust in the government, and being worried about misinformation. Perceived risks played a crucial role in the vaccine decision-making process. When the pandemic intensified, people’s vaccination intentions increased significantly. Conclusion The findings of the present study could highlight individuals’ vaccination attitudes and provide governments with an empirical and dynamic base to design tailored strategies to increase vaccination rates.

Abstract Background Osteoporosis is an important public health issue in aging societies because of its associated morbidity, mortality, and decreased quality of life. The study aims to identify the association of low bone mineral density, including osteoporosis and osteopenia, with environmental and personal factors. Methods The data of participants aged ≥ 20 years with multiple visits were obtained from a health check-up database in Taiwan from 2008 to 2016. Multivariable logistic regressions were performed to identify the selected factors associated with low bone mineral density for multiple visit data. Results A total of 194,910 participants with 359,943 visits were included in this study. The prevalence of low bone mineral density (BMD) in the study population was 10.6% (n = 20.615). Older women, ever and current smokers (odds ratio (OR) = 1.04 [95% confidence interval (CI) = 1.01, 1.08]), or participants who were underweight (OR = 1.72 [1.64, 1.81]), consumed a vegetarian diet (OR = 1.32 [1.25, 1.39]), or had higher triglyceride levels (OR = 1.04 [1.01, 1.06]) were significantly associated with a higher risk of low BMD. Participants who had higher educational years (OR = 0.43 [0.41, 0.46]), higher physical activity (OR = 0.93 [0.89, 0.97]), appropriate sleep duration and better quality (OR = 0.98 [0.97, 0.99]), dairy intake (≥ 1 slice of yogurt or cheese/week, OR = 0.97 [0.95, 0.99]), higher uric acid (OR = 0.93 [0.91, 0.95]), higher walkability (OR = 0.997 [0.995,0.999]), and higher solar radiation exposure (OR = 0.997 [0.97,0.99]) were significantly associated with a lower risk of low BMD. Conclusion Interventions in different directions, such as having better health behaviors, increasing sun exposure, and residing in a highly walkable environment, are beneficial for reducing the risk of low BMD.

Abstract Background This study aims to explore issues, such as (i) whether there is a difference in quality of life (QoL) among subgroups of the work mode (working from home (WFH) vs. working in the office (WIO)), social contact quantity, and face contact ratio; (ii) whether employees' QoL is moderated by the social contact quantity and face contact ratio given their work mode; (iii) whether the three-way interaction effect of work mode, social contact quantity, and face contact ratio on employee's QoL is significant; and (iv) whether the WHOQOL-BREF invariantly measures for the subgroups of the work mode, social contact quantity, and face contact ratio. Methods We assessed the QoL of 803 WFH employees and 588 WIO employees during the same time period and divided them into sixteen groups resulting from the levels of work mode, social contact quantity, and face contact ratio, forming a case-control study. A differential item functioning (DIF) analysis was used for analyzing the responses on the WHOQOL-BREF under the 4-dimensional rating scale model fitting. Results Our results indicated that WFH employees’ QoL was superior to that of WIO employees [χ2(1) = 8.52, p = 0.0035]. However, since the work mode was moderated by the social contact quantity [χ2(3) = 10.89, p = .012] and face contact ratio [χ2(1) = 11.39, p < .001], WFH employees’ QoL was worse than that of WIO employees if their amount of social contact was low and if most social contacts were not face-to-face. Moreover, WFH employees’ QoL was better than WIF employees’ QoL when most contacts were not face-to-face and the number of social contacts was high [χ2(3) = 9.07, p = .028]. Besides, the WHOQOL-BREF measured employees’ QoL biasedly as many facets of the WHOQOL-BREF were found to diverge among subgroups of the work mode and social contact quantity.Conclusions The WFH mode was practical in the COVID-19 pandemic. However, maintaining social connections is equally important so that employees can maintain good performance in jobs. The facets detected as DIF items provided implications for QoL research methodology and insight into factors affecting employees' QoL.

OBJECTIVES:To evaluate class suspension and mass vaccination implemented among Taipei schoolchildren during the 2009 influenza pandemic and investigate factors affecting antibody responses. METHODS:We conducted 2 cohort studies on: (1) 972 schoolchildren from November 2009-March 2010 to evaluate pandemic policies and (2) 935 schoolchildren from November 2011-March 2012 to verify factors in antibody waning. Anti-influenza H1N1pdm09 hemagglutination inhibition antibodies (HI-Ab) were measured from serum samples collected before vaccination, and at 1 and 4 months after vaccination. Factors affecting HI-Ab responses were investigated through logistic regression and generalized estimating equation. RESULTS:Seroprevalence of H1N1pdm09 before vaccination was significantly higher among schoolchildren who experienced class suspensions than those who did not (59.6% vs 47.5%, p<0.05). Participating in after-school activities (adjusted odds ratio [aOR]=2.47, p=0.047) and having ≥3 hours per week of exercise (aOR=2.86, p=0.019) were significantly correlated with H1N1pdm09 infection. Two doses of the H1N1pdm09 vaccine demonstrated significantly better antibody persistence than 1 dose (HI-Ab geometric mean titer: 132.5 vs 88.6, p=0.047). Vaccine effectiveness after controlling for preexisting immunity was 86% (32%-97%). Exercise ≥3 hours per week and preexisting immunity were significantly associated with antibody waning/maintenance. CONCLUSIONS:This study is the first to show that exercise and preexisting immunity may affect antibody waning. Further investigation is needed to identify immune correlates of protection.

BACKGROUND:The COVID-19 outbreak has not only changed the lifestyles of people globally but has also resulted in other challenges, such as the requirement of self-isolation and distance learning. Moreover, people are unable to venture out to exercise, leading to reduced movement, and therefore, the demand for exercise at home has increased.OBJECTIVE:We intended to investigate the relationships between a Nintendo Ring Fit Adventure (RFA) intervention and improvements in running time, cardiac force index (CFI), sleep quality (Chinese version of the Pittsburgh Sleep Quality Index score), and mood disorders (5-item Brief Symptom Rating Scale score).METHODS:This was a randomized prospective study and included 80 students who were required to complete a 1600-meter outdoor run before and after the intervention, the completion times of which were recorded in seconds. They were also required to fill out a lifestyle questionnaire. During the study, 40 participants (16 males and 24 females, with an average age of 23.75 years) were assigned to the RFA group and were required to exercise for 30 minutes 3 times per week (in the adventure mode) over 4 weeks. The exercise intensity was set according to the instructions given by the virtual coach during the first game. The remaining 40 participants (30 males and 10 females, with an average age of 22.65 years) were assigned to the control group and maintained their regular habits during the study period.RESULTS:The study was completed by 80 participants aged 20 to 36 years (mean 23.20, SD 2.96 years). The results showed that the running time in the RFA group was significantly reduced. After 4 weeks of physical training, it took females in the RFA group 19.79 seconds (P=.03) and males 22.56 seconds (P=.03) less than the baseline to complete the 1600-meter run. In contrast, there were no significant differences in the performance of the control group in the run before and after the fourth week of intervention. In terms of mood disorders, the average score of the RFA group increased from 1.81 to 3.31 for males (difference=1.50, P=.04) and from 3.17 to 4.54 for females (difference=1.38, P=.06). In addition, no significant differences between the RFA and control groups were observed for the CFI peak acceleration (CFIPA)_walk, CFIPA_run, or sleep quality.CONCLUSIONS:RFA could either maintain or improve an individual's physical fitness, thereby providing a good solution for people involved in distance learning or those who have not exercised for an extended period.TRIAL REGISTRATION:ClinicalTrials.gov NCT05227040; https://clinicaltrials.gov/ct2/show/NCT05227040.

Strict and repeated lockdowns have caused public fatigue regarding policy compliance and had a large impact on several countries’ economies. We aimed to evaluate the effectiveness of a soft lockdown policy and the strategy of active community screening for controlling COVID-19 in Taiwan. We used village-based daily confirmed COVID-19 statistics in Taipei City and New Taipei City, between May 2, 2021, and July 17, 2021. The temporal Gi* statistic was used to compute the spatiotemporal hotspots. Simple linear regression was used to evaluate the trend of the epidemic, positivity rate from community screening, and mobility changes in COVID-19 cases and incidence before and after a level three alert in both cities. We used a Bayesian hierarchical zero-inflated Poisson model to estimate the daily infection risk. The cities accounted for 11,403 (81.17%) of 14,048 locally confirmed cases. The mean effective reproduction number (Re) surged before the level three alert and peaked on May 16, 2021, the day after the level three alert in Taipei City (Re = 3.66) and New Taipei City (Re = 3.37). Mobility reduction and a lower positive rate were positively associated with a lower number of cases and incidence. In the spatiotemporal view, seven major districts were identified with a radial spreading pattern from one hard-hit district. Villages with a higher inflow degree centrality among people aged ≥ 60 years, having confirmed cases, specific land-use types, and with a higher aging index had higher infection risks than other villages. Early soft lockdown policy and detection of infected patients showed an effective strategy to control COVID-19 in Taiwan.

UNSTRUCTURED This study aims to explore issues, such as (i) whether there is a difference in quality of life (QoL) among subgroups of the work mode (working from home (WFH) vs. working in the office (WIO)), social contact quantity, and face contact ratio; (ii) whether employees' QoL is moderated by the social contact quantity and face contact ratio given their work mode; (iii) whether the three-way interaction effect of work mode, social contact quantity, and face contact ratio on employee's QoL is significant; and (iv) whether the WHOQOL-BREF invariantly measures for the subgroups of the work mode, social contact quantity, and face contact ratio. We assessed the QoL of 803 WFH employees and 588 WIO employees during the same time period and divided them into sixteen groups resulting from the levels of work mode, social contact quantity, and face contact ratio, forming a case-control study. A differential item functioning (DIF) analysis was used for analyzing the responses on the WHOQOL-BREF under the 4-dimensional rating scale model fitting. Our results indicated that WFH employees' QoL was superior to that of WIO employees. However, since the work mode was moderated by the social contact quantity and face contact ratio, WFH employees' QoL was worse than that of WIO employees if their amount of social contact was low and if most social contacts were not face-to-face. Moreover, WFH employees' QoL was better than WIF employees' QoL when most contacts were not face-to-face and the number of social contacts was high. Besides, the WHOQOL-BREF measured employees' QoL biasedly as many facets of the WHOQOL-BREF were found to diverge among subgroups of the work mode and social contact quantity. The WFH mode was practical in the COVID-19 pandemic. However, maintaining social connections is equally important so that employees can maintain good performance in jobs. The facets detected as DIF items provided implications for QoL research methodology and insight into factors affecting employees' QoL.

BackgroundTo assess the incidence and mortality trends for respiratory infectious diseases from 2004 to 2018, and examine the associations between long-term air pollution exposure, meteorological conditions and respiratory infectious diseases.MethodsThe data from the notifiable infectious disease report database of China. Joinpoint regression models were used to examine changes in incidence and mortality for each respiratory infectious disease and to estimate average annual percentage changes (AAPCs). A Distributed Lag Non-Linear Model (DLNM) with relative risk was applied to analyze the impact of meteorological conditions and air pollutants on respiratory infectious diseases. We also applied a time-series decomposition approach based on Loess to present the seasonality of seven respiratory infectious diseases.FindingsA total of 23,444,640 cases and 45,291 deaths caused by seven respiratory infectious diseases were recorded in China, and the mean age-standardized incidence and mortality of 115.87/100,000 and 0.23/100,000 nationally. The annual percentage change (APC) of age-adjusted incidence was 0.23; however, the APC of age-adjusted mortality was -2.11. Incidence and mortality differed by age. Pulmonary tuberculosis was most closely related to weather conditions, followed by measles, meningococcal meningitis, rubella, mumps, influenza, and pertussis. Except measles and mumps, other five respiratory infectious diseases were strongly related to air pollutants. Meningococcal meningitis and rubella had strongest correlations with PM10; influenza had significant associations between influenza incidence and NO2, O3, and CO.InterpretationThe incidence and mortality of seven respiratory infectious diseases were large different among Chinese provinces in 2004-2018, and the influence of environmental factors and pollutants on respiratory infectious diseases cannot be ignored.

Geographical inequalities in premature mortality and the role of neighbourhood social determinants of health (SDOH) have been less explored. This study aims to assess the geographical inequalities in premature mortality in Taiwan and how neighbourhood SDOH contribute to them and to examine the place-specific associations between neighbourhood SDOH and premature mortality. We used township-level nationwide data for the years 2015 to 2019, including age-standardized premature mortality rates and three upstream SDOH (ethnicity, education, and income). Space-time scan statistics were used to assess the geographical inequality in premature mortality. A geographical and temporal weighted regression was applied to assess spatial heterogeneity and how neighbourhood SDOH contribute to geographic variation in premature mortality. We found geographical inequality in premature mortality to be clearly clustered around mountainous rural and indigenous areas. The association between neighbourhood SDOH and premature mortality was shown to be area-specific. Ethnicity and education could explain nearly 84% variation in premature mortality. After adjusting for neighbourhood SDOH, only a handful of hotspots for premature mortality remained, mainly consisting of rural and indigenous areas in the central-south region of Taiwan. These findings provide empirical evidence for developing locally tailored public health programs for geographical priority areas.

BackgroundCOVID-19 was declared a public health emergency by the World Health Organization (WHO) in January 2020. Various physical distancing interventions were introduced to flatten the epidemic curve and reduce the disease burden. We evaluated the impacts of policy stringency and residents' compliance on time-varying reproduction number in 17 countries.MethodsData were from WHO reports of local transmission (February 28 to April 8, 2020) in Australia, Canada, Finland, France, Germany, Greece, Italy, Spain, Sweden, Thailand, the UK, US and Vietnam. Earlier local transmission data where available from press releases were added for Japan, South Korea, Singapore and Taiwan starting January 28, 2020. COVID-19 policy responses were from the Oxford Covid-19 Government Response Tracker with 17 indicators. Changes in people's behaviors were from Google's COVID-19 community mobility reports and Apple Maps' mobility trends reports. We estimated the daily time-varying reproduction number (Rt) by country. 0-, 7- and 14-day lagged effects of non-pharmaceutical interventions and changes in human mobility on Rt were estimated by linear mixed-effects models.ResultsRt initially surged rapidly, then declined gradually depending on policy stringency. The highest mean policy stringency scores were for Italy (69.97) and South Korea (61.00). Variations in stringency scores were higher in Europe, the US and Australia than in Asia. The human mobility reduction was greater in countries with strict policies (median stringency score > = 50). In terms of immediate (0-day lag) effects, Rt reductions were found for workplace-closure, limited-gathering, and stay-at-home policies. At a 7-day lag, Rt reductions were found for workplace closure, restrictions on gatherings, stay-at-home requirements, international travel controls, contact tracing and reducing walking around. At a 14-day lag, Rt reductions were found for restrictions on gatherings, less visiting and staying in parks, and reduced walking around.ConclusionThe findings show physical distancing policies and residents' compliance can slow transmission, with the lag-to-effect time varying by policy.