Asia University

This article compares disabled and non-disabled people in terms of the impact of the COVID-19 outbreak on their levels of anxiety and mental well-being and their satisfaction with the government’s responses. Taiwanese disabled ( N = 324) and non-disabled ( N = 1985) citizens aged 20 or older completed a cross-sectional online survey in April 2020. During the pandemic, Taiwanese disabled citizens were more likely than their non-disabled counterparts to show lower levels of anxiety and less satisfaction with the government’s measures against the pandemic, including those related to disabled people. Regression analyses revealed that disability status, income, health and levels of satisfaction with the government’s responses were significantly associated with levels of anxiety. The findings indicate that disabled people are inured to restrictions in mobility and exclusion from society. The government’s measures against the pandemic were not exceptional but reflect a general neglect of the needs and well-being of this population.

Objectives Systemic immune-inflammation index (SII) is a biomarker of inflammatory conditions; however, no scoring system has been evaluated for predicting mortality in patients with renal failure in intensive care unit (ICU). This study aimed to determine associations between SII level and mortality in patients with renal failure. Design Using the Medical Information Mart for Intensive Care IV (V.2.0) database (USA), this retrospective study included 837 patients who were admitted to ICU with end-stage renal disease (ESRD), between 2008 and 2019. Primary and secondary outcome measures Cox proportional-hazards models were used to evaluate correlations between SII and outcomes, expressing results as hazard ratios (HRs) with 95% confidence intervals (95% CIs). Regression analysis was used to determine associations between variables and SII. Results In total, 837 adult patients from a total of 76 943 patients admitted to ICU were included, comprising 59.60% males with mean age 62.27±14.9 years and mean BMI 28.36±7.43 Kg/m ² . Using median SII (1628 X 10 ⁹ /L) as cut-off value, high (≥ 1628X10 ⁹ /L) SII was also associated with an increased risk of ICU mortality (HR 1.97 (95% CI 1.15 to 3.35), p=0.034), in-hospital mortality (HR 1.95 (95% CI 1.23 to 3.09), p=0.017) and total mortality (HR 1.30 (95% CI 1.07 to 1.58), p=0.024). Conclusions SII may predict mortality in critically ill patients admitted to ICU with ESRD. SII ≥ 1628×10 ⁹ /L correlates significantly with increased ICU mortality, in-hospital mortality and total mortality.

Background Placental weight (PW) is a crucial factor in fetal development, influencing various health outcomes throughout life. This study investigates whether there is a causal relationship between PW and the risk of developing migraine. Methods Genetic variants associated with PW were obtained from the Early Growth Genetics Consortium, including fetal, maternal, and paternal genomes. Migraine data were derived from a 2022 genome‐wide association study meta‐analysis by the International Headache Genetics Consortium. Significant single nucleotide polymorphisms (SNPs) associated with PW were selected and analyzed to assess causality. Results Out of 11 PW phenotypes, six PW phenotypes with at least two SNPs each were included for Mendelian randomization analysis. The analysis revealed that PW (fetal effect, conditional on maternal and paternal genotype) was significantly associated with a reduced risk of migraine (odds ratio 0.81, 95% confidence interval 0.71–0.93; p = 0.003, false discovery rate adjusted p = 0.018). Sensitivity analyses confirmed the robustness of the findings, showing no evidence of heterogeneity or pleiotropy. Conclusion Our findings suggest a potential causal relationship between fetal genetically predicted increased PW and a reduced risk of migraine in the offspring. Further research into the mechanisms underlying this association and its implications for migraine prevention is warranted.

Aims Age‐related macular degeneration (AMD) is a leading cause of vision loss worldwide among older adults. Although some studies propose that statins could reduce AMD risk and progression, others report conflicting findings. This study aimed to evaluate the impact of statin use on the incidence of AMD. Methods This study used Taiwan's National Health Insurance Research Database (2000–2021) with the LGTD2000 cohort. Participants were categorized into statin users (≥6 months, 2001–2020) and nonusers. AMD incidence was analysed using Cox regression and Kaplan–Meier methods, with propensity score matching applied to report adjusted hazard ratios (AHRs) and confidence intervals (CIs). Results After adjusting for confounding factors, statin use for over 2 years was associated with a significantly lower risk of AMD compared to nonstatin users (AHR = 0.79, 95% CI: 0.69–0.91). Subgroup analyses demonstrated that long‐term statin use (≥730 days) showed protective associations across most sex and age groups. Specifically, risk reduction was observed for both non‐neovascular AMD (AHR = 0.84, 95% CI: 0.70–1.02) and neovascular AMD (AHR = 0.72, 95% CI: 0.59–0.88). Furthermore, dose–response analysis revealed that higher cumulative statin exposure was associated with a decreased AMD risk, while lower cumulative exposure was associated with an increased risk. Conclusion This study indicated that prolonged statin use exceeding 2 years was associated with a significantly decreased risk of developing both non‐neovascular and neovascular AMD.

Aim This study develops the Cognitive Load of Activity Participation scale (CLAPs) and establishes its expert validity. CLAPs is designed to evaluate the perceived cognitive load and participation frequency of activities of daily life in older adults. Methods Items of the preliminary version of CLAPs were compiled based on extensive literature reviews and field feedback from face‐to‐face focus groups with 40 older adults of diverse demographic backgrounds. The modified Delphi technique was then employed to modify and trim items through two rounds of inputs from a selected panel of experts. The panel ( n = 16) was formed by experts from diverse healthcare professions. Results The preliminary version of CLAPs consisted of 47 items covering five categories of activities: daily and housework activities, leisure and entertainment activities, social participation activities, productive activities, and learning activities. After modification, the first version of CLAPs retained 28 items, with a content validity index of 0.96, achieving a high consensus. Conclusions CLAPs is the first self‐report questionnaire that offers insights into the daily cognitive activity engagement of older adults and may provide clinicians with a basis for tailored lifestyle recommendations. Further psychometric evaluation with a large sample size is necessary. Geriatr Gerontol Int 2025; ••: ••–•• .

Introduction Tuberculosis (TB) is a globally prevalent chronic infectious disease. The World Health Organization estimates that mental illnesses will become the leading cause of global disease burden in 2030. The inability to detect and provide proper treatment for TB in mental illness patients is an epidemic prevention blind spot. The objective of this study was to retrospectively compare the incidence of TB between the general public and mental illness patients. Methods This study used data across Taiwan from 2002 to 2013. The National Health Insurance Research Database, Registry for Catastrophic Illness Patients, Tuberculosis Database, and Household Registration Records of Taiwan were analyzed. Propensity score matching was used to reduce basic characteristic differences between mental illness patients and the general public. The conditional Cox proportional hazards model and cumulative risk curve were used to compare their risk of developing TB. Results It was shown that TB incidence was 87 and 71 per 100 000 person‐years in mental illness patients and the general public, respectively. The risk of developing TB in mental illness patients was 1.48 times (95% CI: 1.38–1.59) that of the general public. Conclusion Mental illness patients are a high‐risk population for TB and should be listed as key subjects for TB prevention and control.

Background Kidney transplantation is the preferred treatment for end-stage kidney disease (ESKD) in the United States, yet access and outcomes vary by insurance type, race, and socioeconomic status. This systematic review synthesizes U.S.-based evidence on how insurance coverage influences transplant waitlisting, access, and outcomes. AI-assisted analysis was used to quantify disparities and propose policy recommendations. Methods A systematic review of MEDLINE, EMBASE, and the Cochrane Database (through November 2024) was conducted to identify studies on insurance-related disparities in U.S. kidney transplantation (PROSPERO: CRD42023484733). AI-assisted synthesis using o3-mini-high (2025) was employed to identify patterns and guide policy development. Results Among 2,163 records, 14 studies met inclusion criteria. Patients with Medicare or Medicaid—particularly racial and ethnic minorities—had lower referral rates and higher transplant waitlist rejection compared to those with private insurance. Socioeconomic barriers such as low income and limited education further impaired access and worsened post-transplant outcomes. Publicly insured recipients had higher post-transplant mortality and graft failure rates. Loss of Medicare after 36 months was associated with reduced immunosuppressant adherence and increased rejection. Disparities were amplified by Medicaid expansion variability and inconsistent transplant center policies. AI-assisted analysis confirmed these disparities and generated policy proposals including standardized referral guidelines, lifelong immunosuppressant coverage, targeted financial aid, equity-linked incentives for transplant centers, and scalable digital health solutions. Conclusion Insurance type, race, and socioeconomic status significantly influence kidney transplant access and outcomes. AI-assisted analysis identified structural inequities and informed targeted policy strategies to advance transplant equity and support broader healthcare reform.

Background Although binaural beat therapy (BBT) has been demonstrated to alleviate symptoms of anxiety and depression, but the effects of BBT of different frequencies on college students have not been thoroughly explored. This study explored the effects of BBT with different frequencies on autonomic nervous system regulation (i.e., anxiety reduction) among college students. Methods This was a quasiexperimental study. Participants were recruited from a university in southern Taiwan. Each of the participants received interventions with different frequencies (theta frequency, 6 Hz; alpha frequency, 10 Hz; and beta frequency, 25 Hz). For each intervention, participants were subjected to 20 min of natural sounds embedded with binaural beats of a specific frequency. A pretest and posttest were conducted to measure blood pressure (BP) and heart rate variability. Results A total of 65 participants were recruited. The mean age of participants was 20.15 years. Heart rate and systolic and diastolic BP were significantly lower after intervention with theta-frequency binaural beats (p < 0.05). Systolic BP was significantly lower after intervention with alpha-frequency binaural beats (p < 0.05). Heart rate, systolic BP, and nLF were significantly lower and nHF was significantly higher after intervention with beta-frequency binaural beats (p < 0.01). No significant differences were observed between the effects of the three interventions on ANS regulation among the participants. Conclusion BBT, in which participants were subjected to theta-frequency, alpha-frequency, and beta-frequency binaural beats for 20 min, contributed to reducing anxiety. No significant differences were observed between the effects of each frequency.

Background: The present study investigated the 1‐month, 2‐month, and 3‐month prospective associations of Google search terms with suicide in Taiwan from 2012 to 2022. Methods: We analyzed daily suicide data from Taiwan’s Cause of Death Statistics between January 1, 2012, and December 31, 2022. Data on Google search volumes for 37 terms related to suicide‐related, socioeconomic status, familial problems, and physical and psychiatric problems were extracted from Google Trends. Cross‐correlation coefficients between monthly Google search term volumes and monthly suicide were calculated at lags of 3 months (lag‐3), 2 months (lag‐2), and 1 month (lag‐1). Results: The monthly Google search volumes of two terms, “pain” and “Taiwan economy”, positively predicted monthly suicide in the total population. The search term “hypnotic” lag‐3 negatively correlated with monthly suicide in the population aged ≥65. The search term “allergy” lag‐1 positively correlated with monthly suicide in the population aged ≥65. Conclusions: The monthly Google search terms of “pain” and “Taiwan economy” positively correlated with monthly suicide. The search terms “hypnotic” and “allergy” negatively and positively correlated with monthly suicide in the population aged ≥65, respectively. These terms may enable more accurate forecasting of future suicides.

We addressed the underrepresentation of non-European populations in genome-wide association studies (GWASs) by building HiGenome, a large-scale genetic resource for the Taiwanese Han population. Using a custom genotyping array, we integrated deidentified electronic medical records (2003 to 2021) with genomic data to enable GWASs, phenome-wide association studies, and polygenic risk score (PRS) analysis. Among 413,000 participants, 323,397 passed ancestry and quality control filtering. GWASs covered 1085 traits, focusing on diseases prevalent in Taiwan such as type 2 diabetes, chronic kidney disease, gout, and alcoholic liver damage. PRSs were calculated for 238 traits, with the strongest associations observed in musculoskeletal disorders. Incorporating PRS into clinical practice supports early risk prediction and personalized prevention. To further expand translational value, we also conducted pharmacogenomic analysis and human leukocyte antigen typing. HiGenome offers a large-scale genetic and clinical dataset from the Taiwanese Han population, supporting population-specific analyses and precision medicine development in East Asia. The hospital-based design enables continuous follow-up and longitudinal data expansion.

Background: Psychiatric patients with Type 2 diabetes often experience suboptimal care and poor health outcomes. Aims: This study is aimed at investigating the impact of a diabetes pay‐for‐performance (P4P) program on glycemic control in psychiatric patients with diabetes by comparing two regional psychiatric hospitals, one with the P4P program and one without. Methods: We conducted a retrospective quasiexperimental study. A total of 149 psychiatric outpatients with Type 2 diabetes were enrolled in the P4P group, and 129 patients were in the non‐P4P group. Hemoglobin A1c (HbA1c) values in the fourth quarter of 2018 served as baseline (before P4P implementation in either hospital). Follow‐up HbA1c levels were collected at 3, 6, 9, and 12 months in 2019. Propensity score matching was performed based on baseline HbA1c to create comparable groups. Changes in HbA1c over 1 year were analyzed using paired and independent t ‐tests and a generalized estimating equation (GEE) model. Result: The mean HbA1c level in the P4P group decreased progressively over 12 months (from 6.97% at baseline to 6.60%), whereas the non‐P4P group showed an increase (from 7.00% to 7.12%). By the fourth quarter, the P4P group had a significantly lower mean HbA1c than the non‐P4P group ( p < 0.05). Subgroup analysis showed a greater HbA1c reduction in P4P participants who were male or had schizophrenia ( p = 0.01 and p = 0.04, respectively). Conclusions: The P4P program was associated with significantly improved glycemic control in psychiatric patients with diabetes compared to usual care. This integrated care model may be an effective strategy to improve diabetes outcomes in psychiatric populations.

Path Planning is a key problem in autonomous navigation requiring efficient, safe traversal, and real-time responses. This paper introduces a new method of realizing and implementing skeletonization based on wave propagation using the Grassfire Algorithm. The Grassfire Algorithm uses the traditional method of skeletonization and enhances it by taking the most optimized path, which prioritizes the longest common points, to find an optimized path of travel that exhibits navigation methods. In the absence of any common points at distance, the algorithm limits degradation by using the synchronization, repetition rules, or fallback of wave propagation. Our proposed algorithm can support adaptable responses from the system that allows for the cancellation of path offset, and simultaneous response to changes in the environment, while maintaining skeleton shape even in cluttered or dynamic environments. The experimental results of the proposed algorithm on various grid maps demonstrate the proposed method's ability to generate collision-free, geometrically-related paths appropriate for complex, real-world applications, such as UAV, or multi-agent systems. The Grassfire Method, then, is both a light-weight, topological method with potential for improving real-time robotic path planning in autonomous systems.

Importance Compares the responses of four AI models to common nephrology-related questions encountered in clinical settings. Objective To evaluate generative AI models in enhancing nephrology patient communication and education. Design Generative AI in Nephrology Setting In a study conducted from December 8–12, 2023, and October 21–23, 2024, IT engineers evaluated GPT-4, GPT-4o, Gemini 1.0 Ultra, and PaLM 2 for nephrology patient communication and education, querying each with 21 nephrology questions and three renal biopsy reports, repeated for consistency. Intervention(s) (for clinical trials) or Exposure(s) (for observational studies) None. Main Outcome(s) and Measure(s) Fifteen nephrologists and one nephrology researcher assessed responses for Appropriateness, Helpfulness, Consistency, and human-like empathy, with rating scale (1–4). Using Shapiro–Wilk and Mann–Whitney U tests with Holm correction, along with TF-IDF, BertScore, and ROUGE were used. The study compared the performance of GPT-4, GPT-4o, Gemini 1.0 Ultra, and PaLM 2 across 24 nephrology-related questions. Results GPT-4o consistently achieved high scores in Appropriateness (3.39 ± 0.7) and Helpfulness (3.24 ± 0.73), while PaLM 2 demonstrated the highest consistency score (3.0 ± 0.86). In empathy, GPT-4 achieved the highest overall score (80.73%), excelling in patient-centric scenarios, followed by GPT-4o (76.56%). PaLM 2 showed competitive empathy in specific cases, despite scoring lower in consistency and Appropriateness. For Kidney-Related Queries, GPT-4o excelled in relevance metrics, achieving the highest BertScore (0.57) and ROUGE for one-word metrics (0.54). Gemini 1.0 Ultra led in generating coherent responses for Renal Biopsy Reports with the highest TF-IDF (0.56) and ROUGE for longest similar sentences (0.47). All 101 references provided by GPT-4 were 100% accurate. Conclusions and Relevance GPT-4o emerged as the most accurate and consistent model across most evaluation categories, while GPT-4 demonstrated superior empathy and balanced performance. PaLM 2 and Gemini 1.0 Ultra showed strengths in specific areas, highlighting the potential for tailored applications of generative AI in nephrology clinical practice.

Type 2 diabetes mellitus remains a critical global health challenge, driving the pursuit of novel therapeutic strategies. This study investigated the anti-diabetic efficacy of the peptide 1CBR, derived from sodium caseinate hydrolysate, administered orally at 25 mg/kg/day to db/db mice over a 4-week period. Glucose tolerance was evaluated via oral glucose tolerance tests (OGTT), while plasma dipeptidyl peptidase-IV (DPP-IV) activity, glucagon-like peptide-1 (GLP-1), and insulin concentrations were quantified using enzyme-linked immunosorbent assays (ELISA). Two bioactive peptides, GPFPLPD and APDSGNFR, were isolated and characterized, exhibiting half-maximal inhibitory concentrations (IC50) of 99.12 µM and 73.07 µM for DPP-IV inhibition, respectively, and both significantly stimulated GLP-1 secretion in enteroendocrine cells in vitro. Pharmacokinetic analysis in Sprague–Dawley rats demonstrated oral bioavailability of 11.28% and 19.12% for these peptides, surpassing typical expectations for peptide-based agents. Collectively, these results provide compelling evidence that 1CBR-derived peptides exert glucose-lowering effects through the dual mechanisms of DPP-IV inhibition and GLP-1 stimulation, combined with favorable oral absorption profiles. These findings underscore the potential of 1CBR peptides as promising candidates for development into nutraceuticals or pharmaceutical agents for diabetes management.

Aim: The aim of this study was to estimate the prevalence and determinants of aging in place (AIP) willingness among persons 60 years and older in a national cross-sectional community-based study in Thailand in 2022. Methods: Information was taken from the 2022 Health, Aging, and Retirement in Thailand survey. Only community-dwelling individuals aged 60 and above were included in the sample (analytic sample: n = 3648). AIP willingness was measured using established metrics. The factors influencing AIP willingness were evaluated using logistic regression. Results: The prevalence of AIP willingness was 88.3%. Logistic regressions showed that predisposing factors (increasing age, being retired, and female sex), enabling factors (satisfactory support from children), need factors (multimorbidity, fewer depressive symptoms, and fewer pain sites), and psychosocial factors (not agreeing on an elderly home, higher subjective life expectancy, and current non-smoking) were associated with AIP willingness. Conclusions: Our knowledge of the factors influencing AIP willingness in community-living people 60 years of age and older is improved by this national study. Health and welfare strategies to increase enabling factors (satisfactory support from children), decrease need factors (depression and multisite pain), and increase psychosocial factors (positive attitudes towards AIP and smoking cessation) may help in increasing AIP willingness.

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide, contributing to metabolic dysfunction and increased healthcare costs. The green Mediterranean diet reduces intrahepatic fat and elevates the plasma levels of 2,5-dihydroxybenzoic acid (2,5-DHBA), suggesting a mechanistic role for 2,5-DHBA in hepatic lipid metabolism. This study aimed to evaluate the therapeutic potential of 2,5-DHBA in MASLD and elucidate its molecular mechanism. Methods: Lipid accumulation was assessed in oleic acid-treated HepG2 cells and a high-fat diet (HFD)-induced MASLD mouse model. RNA sequencing, molecular docking, and immunohistochemical staining were performed to investigate the molecular mechanisms, focusing on the chemokine (C-C motif) ligand 2 (CCL2)–CCL2 receptor (CCR2) axis. Results: 2,5-DHBA significantly reduced hepatic lipid accumulation in both HepG2 cells and HFD-fed mice in a dose-dependent manner. RNA sequencing revealed the marked downregulation of CCL2, a key proinflammatory mediator in MASLD pathogenesis. Molecular docking predicted that 2,5-DHBA competed with CCL2 for binding at the CCR2 axis. Immunohistochemistry further confirmed that 2,5-DHBA treatment lowered hepatic CCL2 expression, suppressed nuclear factor-κB activation, and reduced inflammatory cell infiltration. These findings suggest that 2,5-DHBA exerted anti-steatotic effects by modulating the CCL2-CCR2 signaling pathway. Conclusions: This is the first study to demonstrate that 2,5-DHBA attenuates hepatic steatosis via targeting the CCL2-CCR2 axis. These findings highlight its potential as a novel nutraceutical strategy for MASLD treatment.

Background Work stress presents significant challenges to employee well-being and productivity. Physical activity interventions in the workplace have been associated with occupational stress reduction; however, further investigation with meticulous planning and comprehensive descriptions of the interventions is necessary. Objective This study aimed to synthesize the effects of physical activity interventions on work stress among employees based on studies published from 2019 to 2024. Methods This comprehensive review examines the effects of physical activity interventions on work stress outcomes, synthesizing studies published between 2019 and 2024. The study followed the PRISMA guidelines and was registered in PROSPERO (CRD42024611620). Quality assessment was performed using Cochrane's Risk of Bias tools, and meta-analysis was conducted using Comprehensive Meta-Analysis software. Results The review analyzed interventions such as aerobic training, resistance training, holistic movement practices, and sports activities. This study revealed a small negative correlation between physical activity and stress (d = −0.24, 95% CI [−0.83, 0.35]). Substantial heterogeneity (I² = 98%, p < 0.001) indicated variation across populations and intervention types. Conclusions Despite modest effects, results highlight the potential of tailored, sustainable physical activity programs to improve employee resilience and workplace well-being. This study emphasizes incorporating physical activity into wellness strategies and encourages future research to optimize intervention design and implementation for maximum impact.

Background The study’s objective was to assess adult Mozambicans’ past 12-month suicidal behavior (PSB), major depressive disorder (MDD), and generalized anxiety disorder (GAD). Methods Data from 10,074 women (aged 20–49 years) and 3,941 men (aged 20–54 years) that participated in the 2022 to 2023 Mozambique Demographic and health Survey were analyzed. Results The prevalence of PSB among women (attempt 1.0%, plan 1.8%, and ideation 4.2%) was 4.6% and among men (attempt 0.6%, plan 1.6%, and ideation 3.1%) was 3.4%. Among women and men, the prevalence of MDD was 10.6% and 2.3%, respectively, and the prevalence of GAD was 11.9% and 2.3%, respectively. In adjusted logistic regression analysis, among women and men, MDD was positively and being married or cohabiting was negatively associated with PSB, while among women being HIV positive and among men history of sexually transmitted infection (STI) were positively associated with PSB. Among women and men, having a history of STI was positively, and currently working was negatively associated with MDD. In addition, among women, low dietary diversity and ‘big problem to get money for medical treatment’ were positively, and among men, having hypertension, lung disease, and early sexual debut were associated with MDD. Among women, having a history of STI, low dietary diversity, ‘big problem to get money for medical treatment’, and the use of solid cooking fuel were positively, and currently working and early sexual debut were negatively associated with GAD. Among men, having hypertension and having been diagnosed with lung disease were positively associated with GAD. Conclusion Almost 4% of participants had PSB, among women more than 10% had MDD and GAD, respectively, and among men more than 2% had MDD and GAD, respectively. Public health interventions can be guided by a number of associated factors that have been identified.