PurposeThe aim of this study was to identify the combination of patients with dementia and their caregivers' characteristics associated with long-term care (LTC) services usage.Patients and methodsA cross-sectional study was conducted with 475 patients with mild, moderate, and severe dementia at Changhua Christian Hospital, Taiwan. Eleven types of variables from patients with dementia, nine types of variables from patients' caregivers, and 15 types of LTC services were used for this study. The Apriori algorithm was employed to identify the attributes from the patients and their caregivers who used a particular LTC service from a comprehensive viewpoint.ResultsA total of 75 rules were generated by the Apriori algorithm with support of 2%, confidence of 80%, and lift >1. Among these rules, 25 rules belonged to home personal care services which were summarized further into four general rules for home personal care services. On the other hand, 50 rules belonged to assistive devices that were summarized further into 21 general rules based on their similarities. Patient's walking ability, patient's emotional liability, unemployed or retired caregivers, caregivers' feelings with either helplessness or hopelessness, and caregivers who cared for patients with dementia solely were found to be the critical variables to use home personal care services. In contrast, patient's walking ability, age, and severity as well as caregivers' age, mood, marital status, caregiving burden, and the patient being cared for mainly by a foreign care helper were found to be the critical variables to use assistive devices.ConclusionThis study showed preliminary results on the LTC service usage from patients with dementia and their caregivers residing in the community. Understanding the patient–caregiver dyad's profile leads the service providers, policymakers, and the referral team to tailor service provisions better to meet the needs and identify the potential target groups. The findings in this study serve as references to reduce caregivers' burden as well as to improve the quality of care for patients with dementia.

Introduction:Inguinal hernia repair is one of the most common surgeries worldwide. However, there is limited information on its underlying genetic mechanism. Studies on the genetic factors related to inguinal hernia in Han Chinese are lacking. Therefore, we aimed to conduct a hospital-based study to assess the genetic factors and comorbidities underlying inguinal hernia in Taiwan. Materials and Methods: This was a retrospective case-control study. Utilizing data from the Taiwan Precision Medicine Initiative, we identified 1000 patients with inguinal hernia and 10,021 matched controls without inguinal hernia between June 2019 and June 2020. Four susceptibility loci (rs2009262, rs13091322, rs6991952, and rs3809060) associated with inguinal hernia were genotyped by the Taiwan Biobank version 2 (TWBv2) array. Inguinal hernia, surgery types, and comorbidities were obtained from the electronic health records of Taichung Veterans General Hospital. Results: Adult-onset inguinal hernia was associated with WT1 rs3809060 GT/TT genotype in males and EFEMP1 rs2009262 TC/CC genotype in females. In addition, we identified sex-specific risk factors associated with inguinal hernia; benign prostatic hyperplasia in males (OR: 3.19, 95% CI: 2.73 -3.73, p< 0.001), chronic obstructive pulmonary disease in females (OR: 2.34, 95% CI: 1.33 -4.11, p = 0.003) and overweight, defined by body mass index ≧24 kg/m 2 (OR: 0.75, 95% CI: 0.65 -0.86, p<0.001 in males, and OR: 0.60, 95% CI:0.37 -0.98, p = 0.042 in females), were inversely associated with inguinal hernia. After stratifying BMI, overweight males with EFEMP1 rs2009262 TC/CC genotype exhibited a higher risk of inguinal hernia (OR: 1.31, 95% CI: 1.07 -1.61, p = 0.01). Additionally, rs3809060 was specifically associated with male patients with direct-type inguinal hernia (OR: 1.62, 95% CI: 1.19 -2.22, p = 0.002). Conclusion: Genetic susceptibility appears to participate in the pathogenesis of inguinal hernia in the Taiwanese population in a sex-specific manner. Future studies are needed to illuminate the complex interplay between heredity and comorbidities.

Importance: Polygenic risk score (PRS) is effective in predict benign prostatic hyperplasia (BPH) incidence, prognosis and risk of operation in Han Chinese. Objective: The aim of our study is to investigate the role of PRS for BPH incidence and treatment outcome through hospital-based genome-wide association study (GWAS). Design, setting, and participants: The Affymetrix Genome-Wide TWB 2.0 SNP Array genotyped 6,237 male participants with benign prostatic hyperplasia (BPH) and 17,170 non-BPH controls from the Taiwan Precision Medicine Initiative (TPMI). PRS was determined using PGS001865, which included 1,712 single nucleotide polymorphisms. PRS scores were categorized into quartiles (Q1-Q4) and their association with outcomes in BPH patients was analyzed using logistic regression models. Main outcomes and measures: We investigated the PRS association with BPH incidence, adjusting for age and PSA levels. We explored PSA's relationship with prostate volume and assessed 5ARI treatment response via percentage reduction in prostate volume per patient. Additionally, we studied the PRS association with TURP risk. Results: In a cohort of 23,407 men, 6,237 were diagnosed with BPH. Risk of BPH was higher in the fourth quartile (Q4) than the first quartile (Q1) (OR=1.34, 95% CI=1.24-1.46, p<0.0001), even after adjusting for age (OR=1.39, 95% CI=1.27-1.52, p<0.0001). The Q4 group had larger prostate volume (43.1 ± 25.0 ml) than Q1 (34.6 ± 19.0 ml) (p<0.001), and less volume reduction after 5ARI treatment (Q1: 29.9 ± 16.6 ml, Q4: 25.0 ± 18.6 ml, p=0.011). Q1 had lower cumulative TURP probability at 3, 5, and 10 years compared to Q4 (p=0.045, p=0.009, p<0.001, respectively). PRS Q4 was an independent TURP risk in multivariate COX hazard regression (HR=1.45, 95% CI=1.09-1.92, p=0.012). Conclusions and relevance: In this hospital-based cohort, a higher PRS was associated with the susceptibility to BPH in male Han Chinese. In patients with BPH, a higher PRS was associated higher PSA level, larger prostate volume, inferior response of 5ARI and higher risk of TURP. Age, PSA and prostate volume were also independent risk of TURP. Prospective large-scale study with longer follow-up would be needed to validate our result.