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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.

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

Biliary atresia is the most common cause of death from liver disease in children. Although the Kasai operation before 60 days of age can significantly improve prognosis, delay in referral and surgery remains a formidable problem worldwide because of difficulties in differentiating it from benign prolonged neonatal jaundice. We established a universal screening system using an infant stool color card to promote the early diagnosis and treatment of biliary atresia. After a pilot regional study in 2002–2003, a national stool color screening system was established by integrating the infant stool color card into the child health booklet given to every neonate in Taiwan since 2004. Within 24 hours of the discovery of an abnormal stool color, this event is reported to the registry center. The annual incidence of biliary atresia per 10,000 live births in 2004 and 2005 was 1.85 (40/216,419) and 1.70 (35/205,854), respectively. The sensitivity of detecting biliary atresia using stool cards before 60 days of age was 72.5% in 2004, which improved to 97.1% in 2005. The national rate of the Kasai operation before 60 days of age increased from 60% in 2004 to 74.3% in 2005. The jaundice-free rate (

Background Current consensus does not support the use of a universal booster of hepatitis B virus (HBV) vaccine because there is an anamnestic response in almost all children 15 years after universal infant HBV vaccination. We aimed to provide a booster strategy among adolescents as a result of their changes in lifestyle and sexual activity. Methods This study comprised a series of cross-sectional serological surveys of HBV markers in four age groups between 2004 and 2012. The seropositivity rates of hepatitis B surface antigen (HBsAg) and its reciprocal antibody (anti-HBs) for each age group were collected. There were two parts to this study; age-specific HBV seroepidemiology and subgroup analysis, including effects of different vaccine types, booster response for immunogenicity at 15 years of age, and longitudinal follow-up to identify possible additional protection by HBV booster. Results Within the study period, data on serum anti-HBs and HBsAg in a total of 6950 students from four age groups were collected. The overall anti-HBs and HBsAg seropositivity rates were 44.3% and 1.2%, respectively. The anti-HBs seropositivity rate in the plasma-derived subgroup was significantly higher in both 15- and 18-year age groups. Overall response rate in the double-seronegative recipients at 15 years of age was 92.5% at 6 weeks following one recombinant HBV booster dose. Among the 24 recipients showing anti-HBs seroconversion at 6 weeks after booster, seven subjects (29.2%) had lost their anti-HBs seropositivity again within 3 years. Increased seropositivity rates and titers of anti-HBs did not provide additional protective effects among subjects comprehensively vaccinated against HBV in infancy. Conclusions HBV booster strategy at 15 years of age was the main contributor to the unique age-related phenomenon of anti-HBs seropositivity rate and titer. No increase in HBsAg seropositivity rates within different age groups was observed. Vaccination with plasma-derived HBV vaccines in infancy provided higher anti-HBs seropositivity at 15–18 years of age. Overall booster response rate was 92.5% and indicated that intact immunogenicity persisted at least 15 years after primary HBV vaccination in infancy. Booster vaccination of HBV did not confer additional protection against HBsAg carriage in our study.

Objective To study the etiology of short stature in children in eastern Taiwan. Materials and Methods This retrospective study included patients referred to Hualien Buddhist Tzu Chi General Hospital for evaluation of short stature from 2002 to 2008. Data were collected from medical records, and included body height and weight by percentile, maternal history, birth history, past medical history, relevant hematological and biochemical investigations, urinalysis, levels of growth and thyroid hormones, bone age, and genetic study. Results A total of 139 children were enrolled. Sixty (43.2%) were classified as having idiopathic short stature, 48 (34.5%) were attributed to underlying disease such as gastrointestinal disorder or chronic illness, 14 (10.1%) had been small for gestational age at birth and their growth had not caught up with that of their peers, 11 (7.9%) were diagnosed with familial short stature, and 6 (4.3%) were diagnosed with growth hormone deficiency. Conclusion Idiopathic short stature was the most common etiology of short stature in children in eastern Taiwan. The incidence of short stature attributed to underlying disease seems to be higher than in other areas of Taiwan. The percentage of small-for-gestational-age children without catch-up growth was also higher in eastern Taiwan than in other areas.

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.

Effects of histamine on the twitch tension, intracellular Na+ activity (aiNa), and action potential were simultaneously and continuously measured in the isolated cardiac papillary muscle of guinea pigs. In the driven fiber at 60 beats/ min, histamine induced a concentration-dependent positive inotropic effect, and apparently increased the amplitude of the action potential and shortened the duration at 3 microM, and significantly decreased aiNa by 6.7% from the control value of 4.5 +/- 0.1 mM (n = 6, p < 0.05) at 0.3 microM. Cimetidine at 10 microM did not produce any significant effect but partially antagonized the action of histamine. The respective concentrations of 1 and 3 microM histamine significantly decreased aiNa by 5.4 and 14.3% from the control 5.6 +/- 0.1 mM (n = 6, p < 0.05) in the presence of 10 microM cimetidine. Chlorpheniramine at 10 microM significantly reduced the twitch tension and aiNa, and prolonged the action potential duration. Histamine at 1 microM increased the twitch tension and decreased aiNa from 4.5 +/- 0.1 to 4.1 +/- 0.1 mM (n = 5, p < 0.05) in the presence of 10 microM chlorpheniramine. The combined application of 10 microM cimetidine and 10 microM chlorpheniramine reduced the twitch tension and abolished most effects of histamine. In high potassium solution (16.2 mM), 1 microM histamine significantly decreased aiNa by 12.9% from the control of 3.1 +/- 0.2 mM (n = 5, p < 0.05). The treatment of 0.5 or 1 microM ouabain increased the tension development and aiNa, and abolished the decrease in aiNa produced by the effect of histamine. The results suggest that histamine can directly stimulate Na-K pump in sarcolemma through means of the activation of both H1- and H2-receptors.

Systemic lupus erythematosus presenting as acute pancreatitis is rare. We report a case of a 12-year-old girl with a 1-year history of systemic lupus erythematosus who developed active pancreatitis. The pancreatitis was first manifested by nausea, vomiting, fever, and abdominal pain. Elevated serum amylase (578 U/L) and lipase levels (5588 U/L), and pancreatic enlargement on ultrasound and computerized tomography confirmed the diagnosis. She responded well to high-dose corticosteroid. The high titer of antinuclear antibodies (1:1280) and low level of complement components (C3, 42.9 mg/dL; C4, 2.3 mg/dL) during the pancreatitis attack suggested that the pancreatitis may have been due to systemic lupus erythematosus exacerbation and not related to drug therapy.

Mother-to-infant transmission is the major cause of hepatitis B virus (HBV) infection among immunized children. There has been much debate about screening pregnant women and administering hepatitis B immunoglobulin (HBIG) to newborns. We analyzed the rate of HBV infection among children born to hepatitis B surface antigen (HBsAg)-positive mothers and whether HBIG administration reduces transmission.We analyzed data from 2356 children born to HBsAg-positive mothers, identified through prenatal maternal screens. In addition to HBV vaccines, HBIG was given to all 583 children with hepatitis B e antigen (HBeAg)-positive mothers and to 723 of 1773 children with HBeAg-negative mothers. Serology tests for HBV were performed from 2007 to 2009, when children were 0.5-10 years old.A significantly greater percentage of children with HBeAg-positive mothers tested positive for antibodies against the hepatitis B core protein (16.76%) and HBsAg (9.26%) than children with HBeAg-negative mothers (1.58% and 0.29%, respectively; P.0001 and.001). Among the HBV-infected children, the rate of chronicity also was higher among children with HBeAg-positive mothers than children with HBeAg-negative mothers (54% vs 17%; P = .002). Similar rates of antibodies against the hepatitis B core protein (0.99% and 1.88%; P = .19) and HBsAg (0.14% and 0.29%; P = .65) were noted in children born to HBeAg-negative mothers who were or were not given HBIG. Infantile fulminant hepatitis developed in 1 of 1050 children who did not receive HBIG (.095%).Children born to HBeAg-positive mothers are at greatest risk for chronic HBV infection (9.26%), despite immunization. Administration of HBIG to infants born to HBeAg-negative mothers did not appear to reduce the rate of chronic HBV infection, but might prevent infantile fulminant hepatitis. Screening pregnant women for HBsAg and HBeAg might control mother-to-infant transmission of HBV.

Background To assess the prevalence of obesity and major physical examination items including dental caries, myopia, pinworm, hematuria, and proteinuria among school children in Hualien, Taiwan. In addition, the health status differences between gender, grader, levels of residence urbanization, and body mass index (BMI) were examined. Methods Cross-sectional studies with a total of 11,080 students (age, 7–14 years) in grades 1, 4, and 7 were evaluated for weight, height, routine physical examination, and urine analysis during the 2010 Student Health Examination in Hualien. Frequencies, Chi-square test, and logistic regression were conducted using SPSS. Results Of the 11,080 students evaluated, 1357 (12.2%) were overweight, and 1421 (12.8%) were obese. There were significant differences in overweight/obese prevalence by gender, by grader, and by levels of residence urbanization. Dental caries, myopia, and obesity were the most prevalent health problems among these students (75.6%, 33.0%, and 12.8%, respectively). In crude and adjusted analyses, research results showed that there were significant differences in the prevalence of major physical examination items between different gender, grader, levels of residence urbanization, and BMI groups. Girls had a higher prevalence of dental caries, myopia, and hematuria than boys (all p Conclusion Routine health examination provides an important way to detect students’ health problems. Our study elucidated major health problems among school children in Hualien, Taiwan. In addition, the results also indicated that the prevalence of health problems had a significant relationship with gender, grader, levels of residence urbanization, and BMI. It is suggested that school health interventions should consider students’ health profiles along with their risk factors status in planning.