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Background On 11 January 2009, Taiwan expanded its smoke-free legislation to all indoor public places and workplaces. This study examined the impact of this policy on secondhand smoke (SHS) exposure in adult non-smokers, across gender and socioeconomic status groups (SES). Methods An annual sample of about 13 000-14 000 non-smokers was drawn from cross-sectional nationwide data of Taiwan Adult Tobacco Behavior Surveys during 2005-2011. Logistic regressions were used to analyse the aggregate data to estimate the association between the 2009 smoke-free legislation and SHS exposures in homes and workplaces. Interaction terms were used to examine the impact of the 2009 smoke-free policy on reducing differences in SHS exposure across gender, education and income groups. Results The 2009 policy reduced the odds of SHS exposure in homes in 2009 (OR=0.76, 95% CI 0.68 to 0.84) and in workplaces (year 2009: OR=0.49, 95% CI 0.39 to 0.62; year 2010: OR=0.79, 95% CI 0.66 to 0.95). The model with interaction terms showed that men were more likely than women to be exposed to workplace SHS (OR=2.02, 95% CI 1.80 to 2.27) but were less likely to be exposed to home SHS (OR=0.79, 95% CI 0.73 to 0.86). SHS exposure in homes was significantly related to lower socioeconomic status, but the 2009 smoke-free policy reduced the difference in SHS exposure across education levels. Conclusions The 2009 smoke-free policy reduced the SHS exposure for non-smokers. However, this impact on home SHS did not persist after 2009, and the effect of protection was unequal across gender and SES groups. Thus, further enforcement of smoking restrictions would be needed to reduce the risk of SHS exposure and improve protection against SHS risk among parts of the population with lower socioeconomic status. [ABSTRACT FROM AUTHOR]

Background: Media guidelines for suicide reporting are available in many countries. However, to what extent the mass media comply with the guidelines is unknown. Few studies are available that investigate systematically whether the mass media reflect the epidemiological reality of suicide deaths in their articles. Methods: Based on the WHO media guidelines, this study investigated the characteristics of newspaper articles of suicides in three Chinese communities, namely Hong Kong, Taiwan and Guangzhou. Epidemiological comparisons were conducted to identify the age and gender differences between the suicide victims as reported in the newspapers and the official records of suicide deaths in all three places. Results: The results found that one media characteristic complied with the WHO media guidelines (ie, only about 2% of the articles were printed on the front page), but there were a number of instances of non-compliance (ie, only 4--14% provided sources for help-seeking and 27--90% printed with photos). The epidemiological comparisons revealed an over-representation of younger suicides and an under-representation of late-life suicides in the newspapers of all three places. Furthermore, female suicides were found to be under-reported in Taiwan and Guangzhou newspapers, but not in Hong Kong papers. Conclusion: Non-compliant suicide articles are prevalent in the newspapers of these three Chinese settings. The observed media misrepresentations may potentially mislead the public and the policy makers about the actual risk for suicide in some demographic groups. [ABSTRACT FROM AUTHOR]

SARS, like HIV, placed healthcare workers at risk and raised issues about the duty to treat. But philosophical accounts of the duty to treat that were developed in the context of HIV did not adequately address some of the ethical issues raised by SARS. Since the next epidemic may be more like SARS than HIV, it is important to illuminate these issues. In this paper, we sketch a general account of the duty to treat that arose in response to HIV. Our purpose is not to defend or criticise this account, but to show that it needs to be developed in order to address three important issues. The first issue concerns how risks should be distributed among healthcare professionals. The second issue concerns the conflicts that arise between professional duties and family duties. The third issue concerns the forms of support that societies owe healthcare workers during epidemics. Our descriptions of these issues are drawn from our experience of the SARS epidemic in Taiwan. [ABSTRACT FROM AUTHOR]

Objective: Since market liberalisation in 1987, the Taiwan Tobacco and Wine Monopoly Bureau (TTWMB) annual statistics indicate that both the demand for imported cigarettes as well as the number of seized smuggled packs have increased with an average revenue loss of NT$4942 million over the past 15 years. The NT$10 average increase in cigarette prices after Taiwan entered the World Trade Organization (WTO) and the implementation of the Tobacco and Alcohol Tax Law in 2002 are forcing policy makers to examine smuggling even more closely. This study evaluates factors that affect an individual smoker's decision to purchase smuggled cigarettes, particularly when faced with higher prices. Design: 437 male smokers of imported cigarettes were drawn from a national interview survey on cigarette consumption, which the Division of Health Policy Research at the National Health Research Institutes conducted during the year 2000. Multiple logistic regression models were used to analyse the behaviour of purchasing smuggled cigarettes with respect to demographic factors, economic factors, smoking behaviour, and other variables. Results: Cigarette price was the driving factor most closely linked to the purchase of smuggled cigarettes—a 1% increase in cigarette price raised the likelihood of purchasing smuggled cigarettes at least 2.60 times (95% confidence interval (CI) 1.08 to 6.26). Smokers who spent more than NT$1000/month on cigarettes were twice as likely to purchase smuggled cigarettes as those who spent less than NT$1000 (odds ratio (OR) 2.34, 95% CI 1.48 to 3.70). Betel nut chewers were more likely to purchase smuggled cigarettes (OR 1.80, 95% CI 1.09 to 2.90). Smokers who opposed cigarette taxation policy were 1.69 times more likely to buy smuggled cigarettes. Personal income was not significantly associated with smuggled cigarettes purchases. Conclusions: This study evaluates what causes smokers to purchase smuggled cigarettes. We have determined that cigarette... INSET: What this paper adds.. [ABSTRACT FROM AUTHOR]

The article presents a study which compared and analyzed the annual prevalence rate of receiving advice to quit smoking from health professionals in Taiwan before and after the increase in funding and the withdrawal of additional funding. Data from the 2004 to 2007 Taiwan Adult Tobacco Survey were analyzed and smoking characteristics were examined. Results showed an increase in rates of receiving quit advice among all smokers during period of increased funding for smoking cessation services.

Objective: This study assesses the effects of a 2005 increase in funding for smoking cessation services on provider participation, patient utilisation of smoking cessation services and cessation outcome at a six-month follow-up. Methods: Analyses are based on existing databases and on a follow-up study among smokers participating in the smoking cessation service. The effect of the policy is evaluated by comparing year 2004 (old policy) with year 2005 (new policy). The generalised estimating equations (GEE) method was conducted to examine the effects of increasing funding for smoking cessation services on monthly smoking cessation services provided per physician and yearly consultations received per patient. Logistic regression was used to examine the effects of increasing funding on smoking cessation outcome. Results: The study found the increased reimbursement rates and medication subsidies for smoking cessation to be positively related to the number of physicians enrolling in the programme (1841 in 2004 vs 3466 in 2005), the number of cessation consultations per month per physician (5.1 vs 14.6) and the number of cessation visits per year per patient (2.0 vs 2.5). Male providers and providers belonging to the private sector were found to offer more cessation consultations. The number of subjects receiving this counselling increased from 22 167 in 2004 to 109 508 in 2005. After adjusting for consumer and provider factors the likelihood of successful quitting among those counselled did not change. Overall, smokers who were older, had attempted to quit in the past year, had lower nicotine dependence, had gone to more smoking cessation service visits, had received consultations in the public sector and were seen by physicians delivering fewer consultations were more likely to have quit smoking at the six-month follow-up. Conclusions: Based on increases in physician enrolment and consultations and the increase in number of subjects receiving counselling and number of visits, the policy of increasing provider incentives and medication subsidies appears to have successfully promoted smoking cessation services. [ABSTRACT FROM AUTHOR]

Objectives: To test the relation between socioeconomic status (SES) and biomarkers of chronic stress, including basal cortisol, and to test whether these biomarkers account for the relation between SES and health outcomes. Design: Cross sectional study using data from the 2000 social and environmental biomarkers of aging study (SEBAS). Setting: Taiwan. Participants: Nationally representative sample of 972 men and women aged 54 and older. Main outcome measures: Highest risk quartiles for 13 biomarkers representing functioning of the neuroendocrine system, immune/inflammatory systems, and the cardiovascular system: cortisol, adrenaline (epinephrine), noradrenaline (norepinephrine), serum dihydroepiandrosterone sulphate (DHEA-S), insulin-like growth factor 1 (IGF1), interleukin 6 (IL6), albumin, systolic blood pressure, diastolic blood pressure, waist-hip ratio, total cholesterol-HDL ratio, HDL cholesterol, and glycosylated haemoglobin; self reported health status (1–5) and self reported mobility difficulties (0–6). Results: Lower SES men have greater odds of falling into the highest risk quartile for only 2 of 13 biomarkers, and show a lower risk for 3 of the 13 biomarkers, with no association between SES and cortisol. Lower SES women have a higher risk for many of the cardiovascular risk factors, but a lower risk for increased basal readings of adrenaline, noradrenaline, and cortisol. Inclusion of all 13 biological markers does not explain the relation between SES and health outcomes in the sample. Conclusions: These data do not support the hypothesis that chronic stress, via sustained activation of stress related autonomic and neuroendocrine responses, is an important mediator in the relation between SES and health outcomes. Most notably, lower SES is not associated with higher basal levels of cortisol in either men or women. These results place an increased burden of proof on researchers who assert that psychosocial stress is an important pathway linking SES and health. [ABSTRACT FROM AUTHOR]

Objectives: Outbreaks of shigellosis among men who have sex with men (MSM) have been reported since the late 1990s. HIV infection is an important risk factor. Since 2014, the global shigellosis epidemic has intensified. Whether chemsex (the use of crystal methamphetamine, γ-hydroxybutyrate or mephedrone to enhance sex) is a new risk factor has not been previously examined.Methods: We conducted a population-based, case-control study in Taiwan. Acute shigellosis cases diagnosed during the 2015 outbreak among MSM living with HIV were compared with those without shigellosis. CD4+ counts, plasma viral load (pVL), gonorrhoea, syphilis and amoebiasis records were obtained from the Notifiable Disease Surveillance System database. We invited cases/controls to provide information on illicit drug use and sexual behaviours, using a structured questionnaire.Results: Seventy-five shigellosis cases were compared with 225 controls. High pVL (>100 000 copies/mL; adjusted OR (aOR): 4.9, 95% CI 1.4 to 16.9), gonorrhoea (aOR: 29.4, 95% CI 2.3 to 340.2) and syphilis (aOR: 4.3, 95% CI 1.6 to 11.6) were independent risk factors of shigellosis. Twenty shigellosis cases and 59 controls completed the questionnaire. Oral-to-anal sex (aOR: 15.5, 95% CI 3.6 to 66.7), chemsex (aOR: 5.6, 95% CI 1.4 to 22.7) and poppers use (aOR: 10.9, 95% CI 1.9 to 64.2) within 12 months were independent behavioural risk factors of shigellosis.Conclusions: Chemsex is a new risk factor for shigellosis among MSM living with HIV, as identified in the 2015-2016 outbreak. Additional risk factors include poppers use, sexual risk behaviours and high pVL. Further studies on chemsex among MSM, which is a rising public health concern, are urgently required. [ABSTRACT FROM AUTHOR]

The article presents a 2015 national prospective cohort study in Taiwan which examined whether screening for the human leukocyte antigen (HLA)-B*58:01 allele before allopurinol treatment is effective in preventing severe cutaneous adverse reactions (SCAR). The study results were compared to the National Health Insurance research database of Taiwan. Based on the results, screening along with alternative drug treatment for carriers is effective in lowering incidence of allopurinol induced SCARs.

Objectives Chronic inflammatory disease may trigger vascular atherosclerosis. This study aimed to determine whether chronic osteomyelitis (COM) is linked to an increased risk of coronary heart disease (CHD). Methods A national insurance claim dataset of more than 23 million enrolees was used to identify 15 054 patients with newly diagnosed COM and 60 216 randomly selected age-matched and gender-matched controls between 2001 and 2009 for comparing the risk and incidence of CHD. The study period was from the entry date to the first date of the following events: the diagnosis of CHD, death, withdrawal from the Taiwan National Health Insurance programme or the end of 2010. The analysis of the CHD risk was performed using Cox proportional hazards regression model. Results During a follow-up period of 67 927 personyears, the overall incidence rate of CHD in COM cohort was 1.95 times higher than non-COM cohort (16.66 vs 8.52 per 1000 person-years). After controlling age, gender and four comorbidities (hypertension, diabetes, hyperlipidaemia and stroke), the risk remained significantly higher in the COM cohort than the control group (adjusted HR=1.65, 95% CI 1.54 to 1.78, p<0.001). In age-stratified analysis, the younger population had a stronger association between COM and CHD risk than the elderly (from HR=3.42, 95% CI 1.60 to 7.32 in age <35 to HR 1.39, 95% CI 1.15 to 1.68 in age ≥ 80). Conclusions This study demonstrates that COM is an independent risk factor for CHD, particularly in the younger population. Further studies are necessary to explore the underlying mechanisms linking COM and CHD. [ABSTRACT FROM AUTHOR]

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of 'DNR' to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. [ABSTRACT FROM AUTHOR]

Objective To evaluate the benefit of mass eradication of Helicobacter pylori infection in reducing premalignant gastric lesions. Design Mass eradication of H pylori infection was started from 2004 for a Taiwanese population with prevalent H pylori infection, who were >30 years of age. Participants positive for the 13C-urea breath test underwent endoscopic screening and 1-week clarithromycin-based triple therapy. For subjects whose initial treatment failed, 10-day levofloxacin-based triple therapy was administered. The main outcome measures were changes in the prevalence of H pylori infection and premalignant gastric lesions, and changes in the incidence of premalignant gastric lesions and gastric cancer before (1995e2003) and after (2004e2008) chemoprevention using various comparators. Results The reduction in H pylori infection was 78.7% (95% CI 76.8% to 80.7%), and the estimated incidence of re-infection/recrudescence was 1% (95% CI 0.6% to 1.4%) per person-year. The effectiveness of reducing the incidence of gastric atrophy resulting from chemoprevention was significant at 77.2% (95% CI 72.3% to 81.2%), while the reduction in intestinal metaplasia was not significant. Compared with the 5-year period before chemoprevention and in the absence of endoscopic screening, the effectiveness in reducing gastric cancer incidence during the chemoprevention period was 25% (rate ratio 0.753, 95% CI 0.372 to 1.524). The reduction in peptic ulcer disease was 67.4% (95% CI 52.2% to 77.8%), while the incidence of oesophagitis was 6% (95% CI 5.1% to 6.9%) after treatment. Conclusions Population-based eradication of H pylori infection has led to a significant reduction in gastric atrophy at the expense of increased oesophagitis. The ultimate benefit in reducing gastric cancer incidence and its mortality should be validated by a further long-term follow-up [ABSTRACT FROM AUTHOR]

Background: Although sons are thought to impose greater physiological costs on mothers than daughters, sons may be advantageous for parental survival in some social contexts. The authors examined the relationship between the sex composition of offspring and parental survival in contemporary China and Taiwan. Because of the importance of sons for the provision of support to elderly parents in these populations, the authors hypothesised that sons would have a beneficial effect on parental survival relative to daughters. Methods: The authors used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the Taiwan Longitudinal Study of Aging (TLSA). The CLHLS sample consisted of 4132 individuals aged 65 years and over in 2002. The TLSA sample comprised two cohorts: 3409 persons aged 60 years and over in 1989 and 2193 persons aged 50-66 years in 1996. These cohorts were followed up for 3, 18 and 11 years, respectively. The Cox proportional hazards model was used to estimate the relationship between the sex composition of offspring and parental mortality. Results: Based on seven measures of sex composition, no protective effect of sons was found in either China or Taiwan. For example, in the 1989 Taiwan sample, the hazard ratio (HR) for maternal mortality associated with having an eldest son was 0.979 (95% CI 0.863 to 1.111). In Taiwan, daughters may have been more beneficial than sons in reducing mortality in recent years. Conclusion: The authors offer several explanations for these findings, including possible benefits associated with emotional and interpersonal forms of support provided by daughters and negative impacts of conflicts arising between parents and resident daughters-in-law. [ABSTRACT FROM AUTHOR]

Background Active ageing is a key to healthy ageing; shopping behaviour is an economically relevant activity of the elderly. Methods Analysis was based on the NAHSIT 1999-2000 dataset. A total of 1841 representative free-living elderly Taiwanese people were selected and information included demographics, socioeconomic status, health behaviours, shopping frequencies, physical function and cognitive function. These data were linked to official death records. Cox proportional hazard models were used to evaluate shopping frequency on death from 1999-2008 with possible covariate adjustment. Results Highly frequent shopping compared to never or rarely predicted survival (HR 0.54, 95% CI 0.43 to 0.67) with adjustment for physical function and cognitive function and other covariates HR was 0.73 (95% CI 0.56 to 0.93). Elderly who shopped every day have 27% less risk of death than the least frequent shoppers. Men benefited more from everyday shopping than women with decreased HR 28% versus 23% compared to the least. Conclusion Shopping behaviour favourably predicts survival. Highly frequent shopping may favour men more than women. Shopping captures several dimensions of personal well-being, health and security as well as contributing to the community's cohesiveness and economy and may represent or actually confer increased longevity. [ABSTRACT FROM AUTHOR]

Objectives: To assess changes in the intensity of suicide news reporting in Taiwan's local newspapers after the arrival of a daily tabloid-type newspaper, Apple Daily (AD), and evaluate the impact of suicide news reporting on actual suicides and possible mutual causation. Methods: A counting process was used to estimate the intensity of daily suicide news items reported in the China Times (CT) and United Daily (UD) before and after the arrival of AD (2002--05). Poisson regression models were used to assess the impact of the intensity of suicide news reporting on the actual number of next day suicides. Granger's causation model was used to assess mutual causation between suicide news reporting and actual suicides. Results: There was a significant increase in reporting intensity of suicide news in the UD soon after the entry of the AD into Taiwan's media market, while a delayed increase of approximately 1 year was observed in the CT. After the arrival of the AD, the reporting intensity in the UD was significantly related to the occurrence of actual suicides (p<0.05), even after controlling for social variables, whereas no significant correlation was previously observed. Mutual causation between suicide news reporting and actual suicides was also observed. Conclusions: The presence of the AD in Taiwan has fuelled competitive reporting of suicide news among traditional newspapers. This increase in the intensity of suicide news reporting has consequently had an impact on the actual number of suicides. This provides further empirical support for improving media reporting as a key element in suicide prevention. [ABSTRACT FROM AUTHOR]

Background Mothers with lower birth weight (LBW) offspring have been found to be associated with cardiovascular disease (CVD) morbidity, which shares many risk factors with diabetes. Aims To investigate the relation between offspring birth weight and maternal risk of mortality from diabetes. Methods A total of 1 400 383 singletons of primigravida registered in Taiwan between 1978 and 1987 were followed to the end of 2006. The offspring birth weight was assessed with and without standardisation for the gestational age of offspring. Cox model was used to estimate the HR of maternal diabetes mortality in relation to offspring birth weights. Results Altogether, 812 (5.8%) mothers died of diabetes. Mothers with LBW (<2500 g) and macrosomia (>4000 g) offspring were both at increased risks of mortality from diabetes with HR 1.76 (95% CI 1.46 to 2.19) and 2.86 (95% CI 2.32 to 3.53), respectively. Similar results were seen while birth weight was standardised for gestational age. Conclusions This cohort study found that mothers with LBW and macrosomia offspring had an increased mortality risk of diabetes. This relationship could be attributable to the possible pathway of intergenerational effects or maternal insulin resistance due to maladaptation to pregnancy. [ABSTRACT FROM AUTHOR]

Background: Human papilloma virus (HPV) has been implicated in the carcinogenesis and prognosis of certain head and neck cancers. Whether it also has a role in the pathogenesis of nasopharyngeal carcinoma (NPC) in Taiwan is unclear. Methods: Detection and genotyping of HPVs were performed in 43 primary NPCs (one WHO-I and 42 WHO-II/III) and 40 nasopharyngeal controls using PCR-based HPV genotyping arrays. Localisation of high-risk HPV and EpsteineBarr virus genomes was performed in another 46 primary NPCs (five WHO-I and 41 WHO-II/III) and seven paired metastatic WHO-II/III NPCs using in situ hybridisation. Results: In the HPV genotyping cohort, oncogenic HPVs were detected equally in WHO-II/III NPCs (31%, 13/42) and nasopharyngeal controls (35%, 14/40). Tumour high-risk HPV status did not correlate with the prognosis of patients with NPC. In the high-risk HPV in situ hybridisation cohort, 14 (88%) of the 16 oncogenic HPV-positive WHO-II/III NPCs showed a unique cytoplasmic/perinuclear staining pattern, which is distinct from the typical dot/punctate nuclear staining pattern indicating HPV genome integration. In addition, oncogenic HPVs were not always retained in NPC cells during the process of metastasis. Conclusions: This study does not support an association between oncogenic HPV and the carcinogenesis or prognosis of WHO-II/III NPCs in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Depression is one of the most commonly encountered mental health problems during older adulthood. This study examines differences in depressive symptom trajectories among older Taiwanese adults across two birth cohorts (1920-1924 and 1925-1929), and explores the relationships between socioeconomic position (SEP) variables and symptom trajectories. Methods: Data from the Taiwan Longitudinal Study on Aging (TLSA) collected between 1989 and 2003 were analysed. The nationally representative sample is composed of community-living adults (n = 2458) in Taiwan aged 60 years and above. Two distinct domains of depressive symptomatology, negative affect and lack of positive affect, assessed by the short form of the Center of Epidemiological Studies-Depression (CES-D) scale were used for all the analyses. Growth curve models were employed to assess the trajectories of depressive symptoms over time. Results: The relationship between ageing and depressive symptoms appeared linear with a minor curvilinear effect. The depressive symptoms in negative affect increased with age (mean linear growth rate = 0.26, p<0.001) but levelled off (mean quadric growth rate = -0.01, p<0.001), while the symptoms in lack of positive affect displayed an opposite trend. The effects of SEP variables also differed by cohort and outcome domain. Conclusions: Remaining active, living with family and having a high level of education are associated with positive affect later in life, while financial strain and poor health are strongly related to negative affect. These results underline the continued role that SEP plays in psychological adjustment over the course of one's life, independently of ageing. [ABSTRACT FROM AUTHOR]

Objective: To estimate the lifetime financial burden on Taiwan's national health insurance (NHI) system, life expectancy and years of life expectancy lost (YLEL) attributable to smoking from major smoking related diseases. Methods: 10 major smoking related diseases (seven cancers, stroke, acute myocardial infarction and chronic obstructive pulmonary disease) were selected for this study. A survival analysis was conducted on linked cohorts from the National Death Registry database and the National Cancer Registry (NCR) and patients at the National Taiwan University Hospital (NTUH). Estimation of the smoking attributable fraction (SAF) for the study diseases was undertaken by combining the relative risks of smokers against non-smokers and the prevalence of smoking in Taiwan. The YLEL attributable to smoking was calculated for the study diseases by combining the survival analysis results, the SAF and the annual incidences of each disease. The lifetime medical expenditure for the study diseases was estimated by integrating the survival curve and the mean annual medical costs calculated from NHI reimbursement records. Results: There were 241 280 incidents of the 10 study diseases in 2001, of which about 53 648 cases (22.2%) were attributable to smoking, with a total YLEL of 191 313 at an average of about 3.6 YLEL per case. For each case, the average survival time was about 10.2 years. Under two different annual discount rates, the total lifetime financial burden on the NHI was estimated at between $291 million (£147 million; €216 million) (3% discount) and $336 million (1% discount) for all diseases attributable to smoking in 2001, accounting for about 24.6% of the total estimated lifetime medical expenditure for all incidents of the 10 study diseases. Conclusions: Smoking places tremendous financial and health burdens upon both society and individuals. A much more stringent tobacco control strategy is needed to curb the damage from smoking. [ABSTRACT FROM AUTHOR]

Background: Acute-disseminated encephalomyelitis (ADEM) is a demyelinating disorder of the central nervous system, whose epidemiology, clinical presentations and functional outcome are incompletely understood in Asian populations. Objective: To assess the clinical presentations, predisposing factors and functional outcome of ADEM in Taiwan. Methods: 50 patients initially diagnosed with ADEM (male, 19; female, 31) were enrolled from 1991 to 2005. Diagnosis of ADEM or multiple sclerosis was established during a follow-up period of 2-120 months. 8 adult patients were noted to have taken the immunomodulatory drug, levamisole, within 3 months before onset of symptoms. The remaining 42 patients (male, 17; female, 25) were categorised by age as children (<16 years, n = 12), young adults (16–49 years, n = 21) and elderly adults (⩾50 years, n = 9). The clinical manifestations, predisposing factors and radiological findings were compared between different age groups and adult patients with or without levamisole use. Functional outcome was compared by a log-rank test. Results: Preceding upper respiratory tract infection was evident in 21 (50%) patients and only one young-adult patient had received Rubella vaccine immunisation. The frequency of fever was higher in children (p = 0.04) and psychiatric symptoms were more prevalent in elderly patients (p = 0.03). Functional recovery was faster in children than in adults (p = 0.002). Initial Expanded Disability Status Scale score (odds ratio (OR) 1.9, p=0.03) and no fever (OR 0.04, p=0.06) were associated with poor outcome (modified Rankin scale ⩾2). After a mean (SD) follow-up of 31.8 (9.9) months, 4 (9.5%) patients developed multiple sclerosis (3 (25%) children, 1 (4.7%) young adult, p=0.03). The neurological disability, radiological and cerebrospinal fluid findings did not differ between patients with and without levamisole use. One elderly adult patient previously receiving levamisole developed multiple sclerosis of relapse-remitting type after a mean follow-up period of 36.9 months. Conclusion: The clinical presentations, functional outcome and risk of developing multiple sclerosis differed between different age groups. Functional recovery was faster in children than in adults. Poor functional outcome was related to initial high Expanded Disability Status Scale score and absence of fever. [ABSTRACT FROM AUTHOR]

Objects: With the advent of genetic technologies, many genetic/metabolic disorders can be detected asymptomatically but might be untreatable, and the benefits and risks of screening for them are not fully known. The purpose of this study is to explore current practice with regard to the parental consent process in newborn screening (NBS). Design: Staff in 23 obstetric clinics/hospitals that conduct NBS in one city of southern Taiwan were interviewed. Using content analysis, 15 interview transcripts, eight completed questionnaires, and other relevant documents from the 23 clinics/hospitals were analysed to reveal the framework of the parental consent process in NBS in southern Taiwan. Main measures: Three categories--informed consent, informed dissent, and no informed/consent--were developed to analyse the parental consent process in NBS. Results: The parental consent procedures in NBS and the quality of the information provided before obtaining consent vary widely. Because the traditional NBS was incorporated into routine paediatric practices in most clinics/hospitals, the most frequently encountered consent model is "informed dissent" (60.9%) and "no informed/consent" (30.4%); while an "informed consent" model (45.5%) is the frequent model for screening rare metabolic/genetic disorders. Conclusions: Specific guidelines to regulate the parental consent process for NBS are essential. Further studies should investigate parental responses to NBS, taking these as the basis on which to establish an informed consent model in Taiwan. [ABSTRACT FROM AUTHOR]

Investigates the role of hydroxytryptamine receptors in the aetiology of bipolar affective disorder in Taiwan. Involvement of genes in serotonin transmission; Indication of findings on the involvement of multiple genetic factors; Analysis of the effect of several genes on one phenotype.

Examines the association between the longest held occupation in a lifetime and risk of disability in activities of daily living (ADL) among elderly people in northern Taiwan. Collection of occupational data through interviews; High risk of ADL disability among unskilled blue collar workers.

Neurological examination of 28 patients, 4 years after serious poisoning by polychlorinated biphenyl contaminated cooking oil, are compared with similar examinations of the same patients two years earlier (in 1980). Clinical peripheral sensory neuropathy was found in 54%, headache in 36% and dizziness in 46% of the patients; these findings did not differ (p greater than 0.1) from those in 1980. Although the mean blood polychlorinated biphenyl concentration (19.2 ppb) in the patients was lower (p less than 0.001) than that in 1980 (35.9 ppb), it was still higher than the normal value (less than 4 ppb). There was no difference in the blood polychlorinated biphenyl concentration of patients with neurological manifestation from those without. Although the mean motor and sensory nerve conduction velocities (MNCV and SNCV) were still slower (p less than 0.06) than the mean normal NCV, the mean MNCV of tibial nerve and SNCV of sural nerve were improved (p less than 0.06) as compared with those in 1980. EEGs were normal except in two cases showing nonspecific slow wave changes. In addition, evoked potentials (somatosensory, visual and brain-stem auditory) were measured in this study and found to be normal in all 12 cases examined. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the cost and determinants of morbidity from work related disabilities.Methods: 114 people who lived in metropolitan Taipei and who had received disability compensation from the Labor Insurance Bureau from March to June, 1991 were randomly selected. There were 77 workers interviewed through a questionnaire that inquired about possible loss of productivity including the duration of morbidity, the ability to return to work, and any change in monthly income upon returning to work.Results: The mean (SD) duration of a stay in hospital was 29 (39) days, median: 15 days. The average duration between discharge from the hospital and returning to work was 111 (146) days, median: 45 days. The main determinants of the duration of the stay in hospital were the number of stays in hospital and the severity of the injury. A multivariate linear analysis showed that old age and the severity of injury determine the durations of morbidity. An ordinal logistic regression analysis showed that the severity of injury, size of the factory, and age determined the magnitude of future productivity loss. Based on these models, it was estimated that the total duration of morbidity (in hospital and at home) due to occupational disability was 660,000 person-days each year. When the percentage of the decrease in income because of permanent disability was converted into a loss of work days, the annual morbidity costs were about 19,000-26,000 person-years between 1985-1990.Conclusion: The morbidity cost was about five times as high as the lump sum payment that a worker usually received for disability compensation. We conclude that morbidity cost should be evaluated carefully in the future for the establishment of accurate and fair disability compensation payments. [ABSTRACT FROM AUTHOR]

The ethics of betel nut use in Taiwan are examined in this article. It first presents scientific facts about the betel quid, its consumption and negative health consequences and then analyses the cultural background and economic factors contributing to its popularity in Asia. Governmental and institutional attempts to curb betel nut cultivation, distribution and sales are also described. Finally, the bioethical implications of this often ignored subject are considered. [ABSTRACT FROM AUTHOR]

The author comments on the study conducted by Huang and colleagues about the practice of terminal care by neonatal doctors and nurses in Taiwan. He outlines the myth in the practice of terminal care involving newborn infants. He calls for the abandonment of the myths to prevent untreated pain and prolonged dying.

The article reports on the introduction of the Camel Dissolvables, identical dissolvable tobacco products by RJ Reynolds (RJR) in three test markets in the U.S. Former RJR chief executive officer (CEO) Susan Ivey states that Camel Dissolvables provide adults with the most convenient and discrete way to enjoy tobacco. It says that RJR wants to market Camel Dissolvables as a reduced-risk product once they receive approval from the U.S. Food and Drug Administration (FDA).

Aims Hepatitis C virus (HCV) is a hepatotropic and lymphotropic RNA virus causally linked to lymphoma with a strong geographic variation. The aim of this study was to investigate the association of HCV and lymphoma in Taiwan, in which HCV is endemic. Methods Patients diagnosed with lymphoma from January 2004 to December 2008 were investigated for serum anti-HCV, and the infection rate was compared with that in healthy controls. Various lymphoma types were investigated for HCV infection. Immunohistochemistry was performed for HCV non-structural (NS)3 protein, and genotyping was performed by reverse transcriptase PCR. Results Thirty-eight (11.0%) of 346 patients with lymphoma were positive for anti-HCV, as compared with 15 (1.8%) of 824 healthy controls (p<0.001, χ² test) with an age-adjusted and sex-adjusted OR of 4.57 (95% CI 2.41 to 8.68). Only nodal (five of eight cases) and splenic (two of two cases) marginal zone lymphomas (MZLs) as a group were significantly associated with HCV, as compared with mucosa-associated lymphoid tissue (MALT) lymphomas (1 of 15; p=0.002, Fisher's exact test). All 26 anti-HCV-positive cases stained for HCV-NS3 were negative. The most common genotypes were 1b (22%) and 2a (56%), with no statistical difference from 203 patients with HCV-related chronic liver disease. Conclusions The incidence of HCV infection among lymphoma patients in Taiwan was significantly higher than that for healthy controls. Furthermore, non-MALT (nodal and splenic) MZL was the only group significantly associated with HCV. A larger national study is warranted to re-confirm our findings and to elucidate if any particular HCV genotypes were related to the pathogenesis of lymphoma. [ABSTRACT FROM AUTHOR]