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Background: Enterobius vermicularis (pinworm) is a common parasitic intestinal infection in children. A gradual decrease in prevalence of pinworm infection has been noted in resource-rich settings, such as Taiwan. However, the influence of socio-demographic factors on the temporal trend in pinworm infection rates in children under the current pinworm infection prevention policy in Taiwan is not well characterized. This study aimed to evaluate the trend of pinworm infection prevalence and the associated socio-demographic risk factors among children in Hualien County, Taiwan.Methodology: This retrospective longitudinal study included school-aged children in Hualien during 2009–2018. Children were screened for pinworm infection using adhesive cellophane perianal swabs while they were in grades 1 and 4 in school. The factors associated with pinworm infection were analyzed. Trend analysis of pinworm infection rate stratified by sex and residential setting (urban, suburban, and rural) were also performed.Results: A total of 90,730 school-aged children from grades 1 and 4 during 2009–2018 were included. Young age and male sex were risk factors for pinworm infection (P < 0.001). Negative correlation between body mass index (BMI) and enterobiasis was observed and decreased pinworm infection was noted during the study reference period. Children in suburban and rural areas had higher odds ratio for pinworm infection than those in urban areas (suburban: 1.45; rural: 5.27; P < 0.001 for both). Trend analysis revealed a significant decrease in the overall pinworm prevalence rate during 2009–2018 (P for trend: P = 0.953), and it was higher than that in urban and suburban areas.Conclusions: Risk factors for pinworm infection included young age, male, and BMI. High pinworm infection among school-age children in rural areas of Hualien is still an important issue.

ObjectiveScreening and eradication ofHelicobacter pylorihelp reduce disparities in the incidence of gastric cancer. We aimed to evaluate its acceptability and feasibility in the indigenous communities and develop a family index-case method to roll out this programme.DesignWe enrolled residents aged 20–60 years from Taiwanese indigenous communities to receive a course of test, treat, retest and re-treat initial treatment failures with the13C-urea breath tests and four-drug antibiotic treatments. We also invited the family members of a participant (constituting an index case) to join the programme and evaluated whether the infection rate would be higher in the positive index cases.ResultsBetween 24 September 2018 and 31 December 2021, 15 057 participants (8852 indigenous and 6205 non-indigenous) were enrolled, with a participation rate of 80.0% (15 057 of 18 821 invitees). The positivity rate was 44.1% (95% CI 43.3% to 44.9%). In the proof-of-concept study with 72 indigenous families (258 participants), family members of a positive index case had 1.98 times (95% CI 1.03 to 3.80) higher prevalence ofH. pylorithan those of a negative index case. The results were replicated in the mass screening setting (1.95 times, 95% CI 1.61 to 2.36) when 1115 indigenous and 555 non-indigenous families were included (4157 participants). Of the 6643 testing positive, 5493 (82.6%) received treatment. According to intention-to-treat and per-protocol analyses, the eradication rates were 91.7% (89.1% to 94.3%) and 92.1% (89.2% to 95.0%), respectively, after one to two courses of treatment. The rate of adverse effects leading to treatment discontinuation was low at 1.2% (0.9% to 1.5%).ConclusionA high participation rate, a high eradication rate ofH. pyloriand an efficient rollout method indicate that a primary prevention strategy is acceptable and feasible in indigenous communities.Trial registration numberNCT03900910.

This study examined the differences in factors affecting mortality between urban and rural areas in Taiwan. A retrospective study design was adopted by using the older adult health examination data during 2013-2019 from Hualien, Taiwan. The overall mortality risk in rural areas was significantly higher than urban areas. However, there was no significant difference in the mortality risk between the urban and rural older adults with unhealthy behaviors. Betel nut chewing was a significant risk factor of mortality among the rural older adults, while alcohol consumption was a protective factor; smoking, hepatitis C, and mental illness were significant risk factors among the urban older adults. The rural older adults had a higher rate of death from heart disease and lower rate of death from sepsis than the urban older adults. This study highlights the importance of individualized health promotion strategies for urban and rural areas for reducing mortality from disease.

Background: To identify the gastric cancer burden in Indigenous Taiwanese peoples and conduct a project to evaluate how to reduce the disparities most effectively in Indigenous communities. Methods: First, we quantified the gastric cancer burden for Indigenous peoples using data from Taiwan Cancer and Mortality Registries. Risk factor analyses were carried out based on literature review and data from ongoing mass screening for other cancers. Second, we identified parameters that might be associated with Helicobacter pylori infection or help identify a good eradication strategy. Findings: Gastric cancer incidence (24·4 vs. 12·3 per 100,000 person-years) and mortality rates (15·8 vs. 6·8 per 100,000 person-years) were higher in Indigenous peoples than in non-Indigenous, with 2·19-fold (95% Confidence Interval [CI]: 2·06-2·33) and 2·47-fold (2·28-2·67) increased risk, respectively. Despite similar cancer stage at diagnosis, the survival rate in Indigenous peoples was 9·6% (0·1-20·1%) lower. Helicobacter pylori infection is a well-documented risk factor and smoking for >10 years increased the risk by 26·3% (7·9-47·8%). In Indigenous communities, both H. pylori infection (56·1%, 95% CI: 53·6-58·6%) and smoking (28·4%, 95% CI: 25·7-31·0%) were prevalent. Program eradication rates using clarithromycin-based triple therapy were suboptimal (73·7%, 95% CI: 70·0-77·4%); the habits of smoking (1·49-fold, 95% CI: 1·10-2·02) and betel nut chewing (1·40-fold, 95% CI: 1·03-1·89) were associated with the higher risk of treatment failure. Interpretation: Gastric cancer burden is higher in Indigenous Taiwanese than in their non-Indigenous counterparts. Eliminating risk factors, including H. pylori eradication and smoking cessation, is a top priority to reduce this health disparity. Funding: Health Promotion Administration, Ministry of Health and Welfare, Taiwan. Declaration of Interest: The authors report no conflicts of interest. Ethical Approval: The Research Ethics Committee of National Taiwan University Hospital (201804108RINB) and the Council of Indigenous Peoples in Taiwan (1070056368) approved the protocol for this program. The informed consent has been obtained from each participant.

Background The current consensus does not support the use of booster dose because of its anamnestic response in almost all children 15 years after universal infant hepatitis B virus (HBV) vaccination. However, in our clinical setting, numerous concerned parents request a booster administration for their children. We aimed to provide the possible predictors of booster response in adolescents before this booster administration. Methods This study comprised a series of cross-sectional serological surveys of HBV markers in 15-year-old individuals between 2008 and 2012. Data on serum hepatitis B surface antigen, hepatitis B surface antibody (anti-HBs), and liver-function biomarkers in a total of 887 senior high-school students were collected. There were two parts to this study: HBV seroepidemiology and booster-response analysis to identify the possible response predictors and decay factors after the HBV booster administration. Results The overall anti-HBs and hepatitis B surface antigen seropositivity rates were 34.7% and 0.7%, respectively, and the median anti-HBs titer was 3.3 mIU/mL. Six weeks after one dose of recombinant HBV vaccine, the overall booster-response rate in the double-seronegative recipients was 94% (471/501). Among the participants whose initial anti-HBs titers were undetectable or low, 72.4% (247/341) and 95.6% (153/160), respectively, reactivated their anti-HBs titers ≥ 100 mIU/mL about 6 weeks after the booster administration. The likelihood of postbooster anti-HBs titer reaching an adequate protective level increased with the prebooster titer. The female participants had stronger anamnestic responses compared to the male participants. Conclusion We found that the female participants and prebooster anti-HBs titers above the detection limit of the immunoassay were good predictors of HBV booster response.

A 1-year-10-month-old boy was admitted to our pediatric intensive care unit due to near drowning with pulmonary edema. A conventional ventilator with 100% oxygen supplementation was used initially, but was shifted to high frequency oscillatory ventilation as his oxygen saturation was around 84–88%. Therapeutic hypothermia was applied due to hypoxic ischemic encephalopathy with severe acidosis. His respiratory condition improved and he was extubated successfully on the 6th hospital day. The patient had no obvious neurological defects and he was discharged in a stable condition after 17 days of hospitalization. Our case report demonstrates the advantages of therapeutic hypothermia on survival and neurological outcomes in treating pediatric near drowning patients.

Background: Pediatric hematuria/proteinuria is a risk factor for chronic kidney disease in later life, and school urinary screening can detect asymptomatic glomerulonephritis in the early stage. This study aimed to evaluate the prevalence of hematuria/proteinuria and its association with different socio-demographic factors among school children in 2013 in Hualien, Taiwan. Methods: A cross-sectional study was conducted among first, fourth, and seventh graders. Health examination results and urinalysis data were analyzed. Logistic regression models were used to the simultaneously analyze the association between the prevalence of hematuria/proteinuria and socio-demographic factors. Results: A total of 9544 students were included. The overall prevalence of hematuria and proteinuria was 4.1% and 5.7%, respectively. Students who were females, of a high grade level, of aboriginal ethnicity, and living in rural areas had higher hematuria risk (all P

The incidence of hepatocellular carcinoma (HCC) increases with age, but protective antibody responses decrease with time after infants are immunized against hepatitis B virus (HBV). We investigated whether immunization of infants against HBV prevents their developing HCC as adults. We also searched for strategies to maximize the cancer-preventive effects.We collected data from 2 Taiwan HCC registry systems on 1509 patients (6-26 years old) diagnosed with HCC from 1983 through 2011. Data on history of HBV immunization and prenatal maternal levels of HBV antigens of all HCC patients born after July 1984 were retrieved from the HBV immunization data bank of the Taiwan Center for Disease Control. We collected data on birth cohort-specific populations (6-26 years old) of Taiwan using the National Household Registry System. Rates of HCC incidence per 10(5) person-years were derived by dividing the number of patients with HCC by the person-years of the general population. Relative risks (RR) for HCC were estimated by Poisson regression analysis in vaccinated vs unvaccinated birth cohorts. We stratified patients by age group to evaluate the association of birth cohorts and HCC risks.Of the 1509 patients with HCC, 1343 were born before, and 166 were born after, the HBV vaccination program began. HCC incidence per 10(5) person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. The RRs for HCC in patients 6-9 years old, 10-14 years old, 15-19 years old, and 20-26 years old who were vaccinated vs unvaccinated were 0.26 (95% confidence interval [CI], 0.17-0.40), 0.34 (95% CI, 0.25-0.48), 0.37 (95% CI, 0.25-0.51), and 0.42 (95% CI, 0.32-0.56), respectively. The RR for HCC in 6- to 26-year-olds was lower in the later vs the earlier cohorts (born in 1992-2005 vs 1986-1992; P.001 and 1986-1992 vs 1984-1986; P .002). Transmission of HBV from highly infectious mothers and incomplete immunization were associated with development of HCC.Based on an analysis of 1509 patients with HCC in Taiwan, immunization of infants against HBV reduces their risk of developing HCC as children and young adults. Improving HBV vaccination strategies and overcoming risk factors could reduce the incidence of liver cancer.