The ageing-in-place experiences of widowed mothers caring for adult children with intellectual disabilities remain underexplored in gerontology and long-term care research. This study compares the experiences of widowed mothers aged 80 and over in Taiwan, an East Asian context in which filial piety continues to shape housing and care arrangements, among those with and without adult children with intellectual disabilities. Drawing on Clapham's Housing Pathways framework-personal control, identity, social support, and inequality-we analyse semi-structured interviews with 24 widowed mothers (17 with and 7 without adult children with intellectual disabilities) using an abductive thematic approach. Across both groups, ageing in place was strongly preferred, but this preference carried different meanings. For mothers of children with intellectual disabilities, remaining at home was tied to long-term co-residential caregiving, reciprocal interdependence, and concern for their children's future. For mothers with non-disabled children, it was more closely associated with maintaining independence, supported by family and, in some cases, migrant care workers. Homeownership and community ties fostered stability and belonging, while inequality shaped the extent to which ageing in place could be sustained. These findings show that later-life housing pathways are shaped not only by personal preference but also by caregiving histories, gendered family relations, and culturally embedded expectations of care. The study highlights the need for policies that better support older women with diverse care trajectories in East Asian familialist welfare contexts.

Social work is often framed as an emancipatory, antioppressive and empowering profession. However, disabled people’s own experiences of social work remain underexplored, particularly in Asian contexts where welfare systems, family‐care expectations, cultural meanings of disability and social work professionalisation vary considerably. This study explores how 39 adults with mobility impairments in four major Asian cities—Tokyo, Taipei, Bangkok and Ho Chi Minh City—experienced encounters with formal social work support, limited access to such support, or its absence. Drawing on in‐depth interviews and a cross‐national comparative qualitative design, the study brings critical disability studies and disability rights perspectives into dialogue with emancipatory social work. The findings reveal a paradox of social work institutionalisation: Greater access to formal support can also generate new forms of control and disempowerment. In Japan and Taiwan, where social work was more institutionally visible through hospitals, municipal services, assessments and resource allocation, participants reported both support and disempowerment. Many experienced social workers as gatekeepers of scarce resources who reproduced distrust, paternalism and ableist assumptions rather than promoting autonomy and rights. In Thailand, social work contact was more limited and mainly hospital‐based, while participants often turned to self‐help, peers and informal networks. In Vietnam, participants reported no direct engagement with social workers, making it a case of institutional absence rather than a directly comparable service encounter. The study argues that the presence of social work does not guarantee empowerment, while its absence may leave disabled people without formal advocacy or rights‐based support. Emancipatory social work with disabled people requires disability‐led, rights‐based practice that upholds autonomy and values disabled people’s bodily realities, cultural contexts and lived expertise.

AIMS:This study investigated factors associated with and outcomes of combined loop diuretics with hydrochlorothiazide (HCTZ) for acute decompensated heart failure (ADHF). METHODS:In this retrospective study, adults hospitalized for ADHF and who received intravenous loop diuretics between January 2016 and March 2023 were enrolled. Patients were categorized into two groups based on HCTZ use. Factors associated with combination therapy and clinical outcomes were examined. Effectiveness outcomes included weight change and percentage weight change, while safety outcomes focused on acute kidney injury (AKI) and worsening renal function at discharge. RESULTS:Among 3493 enrolled patients, 329 received combination therapy. Factors associated with combination therapy included use of thiazide diuretics pre-admission (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.25-2.62), pre-admission dose of oral loop diuretics (aOR: 1.28 per defined daily dose; 95% CI: 1.05-1.56), lower estimated glomerular filtration rate (aOR: 0.98 per unit; 95% CI: 0.98-0.99), higher N-terminal pro-B-type natriuretic peptide levels (aOR: 1.02 per 1000 unit; 95% CI: 1.01-1.02), and lower serum albumin (aOR: 0.53 per unit; 95% CI: 0.41-0.68). Compared to loop diuretics monotherapy, weight reduction was greater in combination therapy (adjusted difference -1.2 kg; 95% CI: -1.5 to -0.9) and percentage of weight loss (adjusted difference -1.8%; 95% CI: -2.3 to -1.3), but higher risk of AKI (aOR: 2.7; 95% CI: 2.1-3.5) and worsening renal function at discharge (aOR: 2.4; 95% CI: 1.9-3.1). CONCLUSIONS:Combination therapy enhanced weight reduction in ADHF; however, it might increase the risk of renal dysfunction.

Background: This study aimed to evaluate the effectiveness and safety of fixed-dose combination (FDC) inhaled corticosteroids/long-acting beta 2-agonists (ICS/LABA) in bronchiectasis. Research design and methods: A retrospective cohort study analyzed electronic medical records of bronchiectasis patients initiating ICS/LABA FDC or LAMA between 2007 and 2021. All bronchiectasis diagnoses were made by radiologists using high-resolution computed tomography. Results: Of the 1,736 patients, 1,281 took ICS/LABA FDC and 455 LAMA. Among the 694 propensity score matched patients, ICS/LABA FDC had comparable outcomes to LAMA, with HRs of 1.22 (95% CI 0.81-1.83) for hospitalized respiratory infection, 1.06 (95% CI 0.84-1.33) for acute exacerbation, and 1.06 (95% CI 0.66-1.02) for all-cause hospitalization. Beclomethasone/formoterol (BEC/FOR) or budesonide/formoterol (BUD/FOR) led to a lower risk of acute exacerbation compared to fluticasone/salmeterol (FLU/SAL) (BEC/FOR HR 0.59, 95% CI 0.43-0.81; BUD/FOR HR 0.68, 95% CI 0.50-0.93). BEC/FOR resulted in lower risks of hospitalized respiratory infection (HR 0.48, 95% 0.26-0.86) and all-cause hospitalization (HR 0.55, 95% 0.37-0.80) compared to FLU/SAL. Conclusion: Our findings provide important evidence on the effectiveness and safety of ICS/LABA FDC compared with LAMA for bronchiectasis. BEC/FOR and BUD/FOR were associated with better outcomes than FLU/SAL.

Background and Objectives:This study uses the care poverty framework, focusing on both individuals and structures. In this context, structures are represented by 2 welfare states: Taiwan, an East Asian welfare system and Finland, a Nordic welfare state. This study explores multidimensional care poverty rates and examines 3 realms of individual factors (health status, sociodemographic factors, and care support availability) among older adults in these long-term care (LTC) models. Research Design and Methods:We analyzed data from the 2019 Taiwan Longitudinal Study on Ageing Survey and the 2020 Daily Life and Care in Old Age Survey in Finland to compare the rates and factors of care poverty in these 2 culturally and structurally different countries. Results:Our analysis revealed different rates of care poverty in personal, practical, and socioemotional care needs in the 2 countries. Under a familistic welfare regime, Taiwanese older adults had higher personal care poverty rates than their Finnish counterparts. Those living alone faced more personal and practical care poverty. Conversely, Finnish older adults, under the Nordic welfare model, experienced more practical and socioemotional care poverty. Those with high care needs and disadvantaged social status and support were more likely to experience personal and practical care poverty. Socioemotional care poverty varied with the availability of support and health status in both countries. Discussion and Implications:The study highlights the impact of 2 LTC policies and cultures on older adults' multidimensional care poverty, identifying disadvantaged older adults under different welfare-transforming LTC models. Taiwan's budget-constrained LTC policies and high family reliance contrast with Finland's inadequate attention to the practical and socioemotional needs of its aging population. This study suggests that holistic LTC policies are needed in both countries to improve the well-being of older adults with limited support and health issues.

Geographers have connected the experiences of disabled persons with specific socio-spatial-political phenomena such as disability policies and laws, economic conditions, disability movements, and welfare systems. However, debates over disability theories and accessibility rights have lacked empirical data representing the perspectives of disabled people in Asia. In this study, the first to explore experiences with accessibility in an inter-Asian context, the daily experiences of disabled people in two Southeast Asian countries (Thailand and Vietnam) and two Northeast Asian countries (Japan and Taiwan) were compared. In each country, 10 wheelchair- or crutch-using residents of a large city were invited to be interviewed, of whom 39 participated. Results showed that disabled people's daily experiences are influenced by the cultural and historical contexts in which the concept of disability has been constructed. Attitudinal and cultural barriers to accessibility should be further examined, and Asian contexts should be included in the political geography of disability.

BackgroundTaiwanese patients frequently experience severe hepatotoxicity associated with high-dose methotrexate (HD-MTX) treatment, which interferes with subsequent treatment. Drug-drug interactions occur when MTX is used in combination with proton pump inhibitors (PPIs), trimethoprim-sulfamethoxazole (TMP-SMX), or non-steroidal anti-inflammatory drugs (NSAIDs). In East Asia, real-world analyses on the effects of co-medication and other potential risk factors on the clinical course of HD-MTX-mediated acute hepatotoxicity in patients with osteogenic sarcoma (OGS) are limited.MethodsThis cohort study included patients with newly diagnosed OGS who were treated with HD-MTX between 2009 and 2017 at Taipei Veterans General Hospital. We collected data on the clinical course of HD-MTX-mediated acute hepatotoxicity, co-medications, and other potential risk factors, and analyzed the effects of these factors on the clinical course of HD-MTX-mediated acute hepatotoxicity.ResultsAlmost all patients with OGS treated with HD-MTX developed acute hepatotoxicity with elevated alanine aminotransferase (ALT) levels. Most patients with Grade 3-4 ALT elevation failed to recover to Grade 2 within 7 days. Women and children are high-risk subgroups for HD-MTX-mediated elevation of ALT levels. Age is a factor that contributes to the pharmacokinetic differences of HD-MTX. However, the concurrent use of PPIs, TMP-SMX, or NSAIDs did not affect the elimination of MTX when administered with adequate supportive therapy.ConclusionsCo-administration of PPIs, TMP-SMX, or NSAIDs may have limited effects on acute hepatotoxicity in well-monitored and adequately pre-medicated patients with OGS undergoing chemotherapy with HD-MTX. Clinicians should pay particular attention to ALT levels when prescribing HD-MTX to children and women.

Since 2012, Taiwanese citizens with disabilities have been entitled to personal assistance from local authorities. To explore current features of personal assistance and barriers to its implementation, and distinguish it from homecare services, 33 disabled people and 12 staff members representing 10 local authorities in Taiwan were interviewed. Findings indicate that disabled people prefer personal assistance to homecare and perceive that relationships with their families have improved since the availability of personal assistance. However, many users' needs are unmet due to insufficient hours of service and costly co-payments. Results also show that development of personal assistance has been hindered not only by limited resource allocations but also by a lack of awareness of the concepts of independent living and personal assistance among staff. In the context of East Asian culture, independent living is misinterpreted as self-reliance, leading to the resurrection of the medical model of disability.Points of interestIn Taiwan, personal assistance was launched by a pilot program (2008-2010) run by a disabled people's organization.Since 2012, Taiwanese disabled people have been entitled to receive personal assistance from their local authority, but personal assistance has not been widely recognised by local authorities as an option to support disabled people's independent living.As in Western societies, Taiwanese disabled people prefer personal assistance to homecare. Personal assistance has also promoted positive relationships within families.Limited resources and local authorities' lack of understanding the meaning of independent living and personal assistance are the main barriers to the provision of adequate support.In the East Asian context, independent living has been misunderstood as self-reliance, suggesting no need for assistance or support, which has led to the domination of the medical model and of professionals' and carers' perspectives in the implementation of personal assistance.

The incidence rates and consequences of inappropriate dosing of glucose-lowering drugs remain limited in patients with chronic kidney disease (CKD). A retrospective cohort study was conducted to estimate the frequency of inappropriate dosing of glucose-lowering drugs and to evaluate the subsequent risk of hypoglycemia in outpatients with an estimated glomerular filtration rate (eGFR) of < 50 mL/min/1.73 m 2 . Outpatient visits were divided according to whether the prescription of glucose-lowering drugs included dose adjustment according to eGFR or not. A total of 89,628 outpatient visits were included, 29.3% of which received inappropriate dosing. The incidence rates of the composite of all hypoglycemia were 76.71 and 48.51 events per 10,000 person-months in the inappropriate dosing group and in appropriate dosing group, respectively. After multivariate adjustment, inappropriate dosing was found to lead to an increased risk of composite of all hypoglycemia (hazard ratio 1.52, 95% confidence interval 1.34, 1.73). In the subgroup analysis, there were no significant changes in the risk of hypoglycemia regardless of renal function (eGFR < 30 vs. 30–50 mL/min/1.73 m 2 ). In conclusion, inappropriate dosing of glucose-lowering drugs in patients with CKD is common and associated with a higher risk of hypoglycemia.

Reassessing the continuing need for and choice of antibiotics by using an antibiotic “time out’’ program may reduce unnecessary treatment. This study aimed to explore the effect of an antibiotic stewardship program (ASP) on the antibiotics consumption, incidence of resistant bacterial infections and overall hospital mortality in a tertiary medical center during the study period 2012–2014. An ASP composed of multidisciplinary strategies including pre-prescription approval and post-approval feedback and audit, and a major “time out’’ intervention (shorten the default antibiotic prescription duration) usage was introduced in year 2013. Consumption of antibiotics was quantified by calculating defined daily doses (DDDs). Interrupted time series (ITS) analysis was used to explore the changes of antibiotics consumption before and after intervention, accounting for temporal trends that may be unrelated to intervention. Our results showed that following the intervention, DDDs showed a decreased trend in overall (in particular the major consumed penicillins and cephalosporins), in both intensive care unit (ICU) and non-ICU, and in non-restrictive versus restrictive antibiotics. Importantly, ITS analysis showed a significantly slope change since intervention (slope change p value 0.007), whereas the incidence of carbapenem-resistant and vancomycin-resistant pathogens did not change significantly. Moreover, annual overall mortality rates were 3.0%, 3.1% and 3.1% from 2012 to 2014, respectively. This study indicates that implementing a multi-disciplinary strategy to shorten the default duration of antibiotic prescription can be an effective manner to reduce antibiotic consumption while not compromising resistant infection incidence or mortality rates.

This study contributes to the under-researched area of culture in institutional care for people with intellectual disabilities in an East Asian context. Drawing upon in-depth interviews with 20 women frontline care workers for institutionalized people with intellectual disabilities in Taiwan, we examined culture-specific caring relations such as the fictive kinships of Confucian care ethics (i.e., respect for elders and affection for the young), the charity paradigm, and religious compassion, which can induce attentive and respectful care in institutional spaces but also relegate residents to stigmatized subordination in a hierarchy of caring relations and legitimatize the voluntary exploitation of women workers. In situating the relational nature of care and the dis-enabling potentials of culture at the disability-care-place intersection, we promote an ethics of engagement that values and dignifies both recipients and providers of care.

A novel Tubificidae-reactor with special porous carrier and combined aeration system was designed to investigate the sludge reduction. The influences of change in frequency of high-intensity aeration (FHIA), dissolved oxygen (DO) content, initial sludge concentration (ISC) and sludge retention time (SRT) on the immobilization of Tubificidae and sludge reduction were evaluated. Furthermore, response surface method was applied to optimize the process conditions using the sludge reduction rate and stable immobilization of worms as the target parameters to optimize, and DO as the control factors to be optimized with the fluctuation of influent ISC, while keeping FHIA and SRT at optimum level. Attractive sludge reduction rate (470 mg L−1 d−1) can be obtained using the strategies indicated by the highly correlated model. The optimum conditions were found to be DO of 1.0–1.6 mg/L and ISC of 3000–4000 mg/L respectively, while keeping FHIA at 12 times/d and SRT at 2 d.

Purpose: Applying the concept of care poverty and Andersen's Behavior Model, this study compares the patterns of unmet long-term care needs and investigates the association between unmet needs and the depression and life satisfaction of older adults aged >= 65 in China and Taiwan that belong to the same East Asia welfare model. Methods: Data come from the 2015 China Health and Retirement Longitudinal Survey (N = 6,341) and the 2015 Taiwan Longitudinal Study on Ageing (N = 4,588). Results: Older adults in China and Taiwan differ significantly in terms of demographic and socioeconomic characteristics. The care poverty rate in activities of daily living (ADL) in these two Asian societies was similar and the rate in instrumental activities of daily living (IADL) was lower in Taiwan than in China. Regression analyses showed that unmet care needs were associated with different predisposing and enabling factors between older Chinese (e.g., residential area and marital status) and Taiwanese (e.g., living arrangement and frequency of seeing children) adults, but the association between depressive symptoms and life satisfaction and unmet care needs were highly similar based on comparison of correlation coefficients. Conclusions: Chinese disadvantaged older adults facing a higher risk of unmet care needs were those who were single and lived in rural areas, while Taiwanese were those who lived alone and had no close relationship with children. Additionally, long-term care services should meet the IADL care needs but not be limited to only meeting ADL care needs in both China and Taiwan.

Background: The clinical guidelines suggest that the dosing of cyclosporine (CsA), during combination therapy with paritaprevir/ritonavir–ombitasvir and dasabuvir (PrOD), would be only one-fifth of the pre-PrOD total daily dose to be administered once daily. However, this dosing may not be applicable to all patients depending on their clinical condition. This study focuses on the pharmacokinetic dynamics of PrOD with CsA in Asian organ transplant recipients with severe liver fibrosis or cirrhosis who undergo concurrent treatment with PrOD treatment and CsA. The efficacy and safety of PrOD treatment was also evaluated. Methods: Data from 7 patients obtained between January 2017 and September 2017 were retrospectively analyzed. Determinations of the blood concentrations of CsA were made, whether used as a single treatment or in combination therapy with PrOD. Results: The combination regimen compared with CsA administered alone resulted in a 4.53-fold and 5.52-fold increase in the area under the concentration–time curve from time 0–12 hours (AUC 0–12 h ) of CsA on days 1 and 15, respectively. In addition, the maximal concentration, time to maximum concentration, and terminal phase elimination half-life (t 1/2 ) of CsA were increased during the combined treatment of PrOD and CsA. The authors proposed reducing the CsA dosage during PrOD treatment to one-seventh of that of the pre-PrOD treatment of the total daily dose to maintain target CsA levels. All patients achieved sustained virologic responses at week 12. There were no episodes of serious adverse events or graft rejections observed. Conclusions Although the combination with PrOD significantly affects the pharmacokinetics of CsA, it is effective and safe with regular monitoring of the CsA blood concentrations and appropriate CsA dose adjustment.

AbstractLimited research has been conducted about ageing in place among older parents who co-habit with their ageing offspring with intellectual disability (ID). This study aims to explore which older parents would choose ageing in place together with their ageing offspring with ID instead of moving and what factors are associated with this choice. A face-to-face interview was conducted using the ‘housing pathways’ framework with older parents (⩾60 years) co-habiting with their ageing offspring with ID (⩾40 years) from two local authorities in Taiwan. In total, 237 families completed our census survey between June and September 2015. The results showed that 61.6 per cent of the participants would choose ageing in place with their ageing offspring with ID, while 38.4 per cent of the participants would stay in their previous place without their disabled children, move in with their other children or move to a nursing home. Logistic regression analyses revealed that parents who preferred ageing in place together with their offspring with ID were more likely to own a house (‘personal control’), have higher levels of life satisfaction (‘self-esteem’) and satisfaction with their current community (‘self-identity’), and have a lower level of social support than parents who chose another option. To meet the needs of older parents and their ageing offspring with ID, care and housing transitions should be considered as part of long-term care policy.

Background The efficacy and safety of rituximab (RTX) on hemolytic anemia (HA) is unknown. Therefore we retrospectively analyze the efficacy and safety of RTX in autoimmune hemolytic anemia (AIHA) and microangiopathic hemolytic anemia (MAHA) from the previous literature. Methods Data in clinical trials and observational studies were collected from PubMed, Cochrane, Embase, and Google Scholar until Oct 15, 2018. The efficacy and safety of RTX in patients with AIHA or MAHA were assessed and overall response rates (ORRs), complete response rates (CRRs), adverse events (AEs) and relapse rates (RRs) were extracted if available. A meta-analysis was performed with a random-effects model, estimating mean proportions in all studies, and relative rates in comparative studies. Results After quality assessment, a total of 37 investigations encompassing 1057 patients eligible for meta-analysis were included. Pooled mean proportion of ORR was 0.84 (95% confidence interval [CI] 0.80-0.88), and that of CRR was 0.61 (95% CI 0.49-0.73). Mean AE rate was 0.14 (95% CI 0.10-0.17), and mean RR was 0.21 (95% CI 0.15-0.26). Relative ORR was 1.18 (95% CI 1.02-1.36), and relative CRR was 1.17 (95% CI 0.98-1.39) fold more than the respective non-RTX counter parts. Relative AE rate was 0.77 (95% CI 0.36-1.63), and relative RR was 0.93 (95% CI 0.56-1.55) fold less than the respective non-RTX counter parts. Conclusion RTX is more effective than the treatments without RTX for AIHA and MAHA and is well-tolerated.