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AIM To describe geriatric syndromes and their relationships with quality of life in older adults with diabetes. METHODS Community-dwelling older adults (aged >60 years) with diabetes (n = 316) participated in the present study. Eight geriatric syndromes, including polypharmacy (number of medications), pain (Brief Pain Inventory), urinary incontinence (International Consultation on Incontinence Questionnaire), sleep disturbance (hours of sleep), lower cognitive level (Mini-Mental State Examination), falls, depressive symptoms (Geriatric Depression Scale short form) and functional limitation (Barthel Index and Instrumental Activity of Daily Living), were assessed. The WHOQOL-BREF Taiwan version was used to measure physical, psychological, social and environmental domains of quality of life. RESULTS Polypharmacy was the most common geriatric syndrome (46.6%), followed by pain (41.5%). Participants with any of the geriatric syndromes, except for polypharmacy and sleep disturbance, had significantly poorer quality of life than those without. The Geriatric Depression Scale score was the only common and significant contributor to all four domains of quality of life, explaining 16~29% of the variance. Number of medications, pain level and cognitive level were also significant contributors, although they explained a small amount (

This study explored the gender differences in the relationship between walking activity and sleep disturbances. A cross-sectional study of 201 community-dwelling older adults with diabetes was conducted in southern Taiwan. Using the Taiwanese version of the International Physical Activity Questionnaire, self-administered short version (IPAQ-SS), information on physical activity and sleep disturbance conditions was collected. Among older female adults with diabetes, 54.2% reported sleep disturbance significantly higher than males (38.1%). Logistic regression analysis suggested that for women, in addition to the active group, older adults in the low-active, high-walking group exhibited a significantly lower rate of sleep disturbance than did those who walked less.

CD8(+) memory T (Tm) cells are a significant barrier to transplant tolerance induction in alloantigen-primed recipients, and are insensitive to existing clinical immunosuppressants. Here, we studied the inhibition of CD8(+) Tm cells by arsenic trioxide (As2O3) for the first time. Alloantigen-primed CD8(+) Tm cells were transferred to T cell immunodeficient nude mice. The mice were subjected to heart allotransplantation, and treated with As2O3. The transplant survival time was determined, and the inhibitory effects of As2O3 on CD8(+) Tm cell-mediated immune rejection were assessed through serological studies and inspection of the transplanted heart and lymphoid organs. We found that As2O3 treatment prolonged the mean survival time of the graft and reduced the number of CD8(+) Tm cells in the spleen and lymph nodes. The expression of the genes encoding interleukin (IL)-2, and IFN-γ was reduced, while expression of IL-10 and transforming growth factor-β was increased in the transplant. Our findings show that As2O3 treatment inhibits allograft rejection mediated by alloreactive CD8(+) Tm cells in the mouse heart transplantation model.

Background/PurposeAbnormal alanine aminotransferase level (ALT) levels might be associated with type 2 diabetes, but whether higher ALT levels within the normal range predict the risk is unknown.MethodsWe followed a community-based cohort of 3446 individuals who were ≥35 years old without diabetes and hepatitis B or C in southern Taiwan for 8 years (1997–2004) to study the risk for type 2 diabetes with different normal ALT levels.ResultsAmong the 337 incident diabetes cases, 16.0% were from those with ALT levels

The temporal relation of hepatitis C virus (HCV) infection to the development of type 2 diabetes remains unknown. The authors followed 4,958 persons aged > or =40 years without diabetes (3,486 seronegative, 812 anti-HCV+, 116 with hepatitis B virus/HCV coinfection, and 544 hepatitis B surface antigen (HBsAg)+) from a community-wide cohort in southern Taiwan for 7 years (1997-2003) to study the risk of diabetes associated with HCV infection. A total of 474 participants developed diabetes. The 7-year cumulative incidence was 7.5% for HBsAg+, 8.6% for seronegative, 14.3% for anti-HCV+, and 14.7% for coinfected participants. Compared with HCV- persons, HCV+ persons had a higher cumulative incidence of diabetes (log-rank test, p < 0.0001). A multivariate Cox proportional hazards model showed that anti-HCV+ (hazard ratio = 1.7, 95% confidence interval: 1.3, 2.1), coinfection (hazard ratio = 1.7), overweight, obesity, and increasing age were significantly associated with diabetes (p < 0.05). Gender, educational level, HBsAg+ status, alcohol consumption, and smoking were not significant. After stratification by age and body mass index, the risk ratio for diabetes in anti-HCV+ participants increased when age decreased and body mass index levels increased (p < 0.001). Results show that HCV infection is an independent predictor of diabetes, especially for anti-HCV+ persons who are younger or have a higher body mass index.

The efficacy of influenza vaccination is not well understood for major cause-specific mortality except pneumonia. For 10 months we followed the mortality data of 35,637 vaccinated elderly (>65 years old) in a county with 102,698 elderly in southern Taiwan. A multivariate Cox model showed that vaccination was significantly associated with lower mortality for all causes, [hazards ratio (HR)=0.56], stroke (HR=0.35), renal disease (HR=0.40), diabetes mellitus (HR=0.45), pneumonia (HR=0.47), COPD (HR=0.55), malignancy (HR=0.74), and heart diseases (HR=0.78), p

Signaling by G protein-coupled receptors coupled to Galpha(i) assists in triggering lymphocyte movement into and out of lymph nodes. Here, we show that modulating the signaling output from these receptors dramatically alters B cell trafficking. Intravital microscopy of adoptively transferred B cells from wild-type and Rgs1-/- mice revealed that Rgs1-/- B cells stick better to lymph node high endothelial venules, home better to lymph nodes, and move more rapidly within lymph node follicles than do wild-type B cells. In contrast, B cells from Gnai2-/- mice enter lymph nodes poorly and move more slowly than do wild-type B cells. The Gnai2-/- mice often lack multiple peripheral lymph nodes, and their B cells respond poorly to chemokines, indicating that Galpha(i1) and Galpha(i3) poorly compensate for the loss of Galpha(i2). These results demonstrate opposing roles for Rgs1 and Gnai2 in B cell trafficking into and within lymph nodes.

Background. The role of hepatitis C virus (HCV) infection in thrombocytopenia (defined as a platelet count of

This study investigated prevalence and associated-factors of low quantitative ultrasound (QUS) values by screening calcaneal QUS parameters--broadband ultrasound attenuation (BUA) and speed of sound (SOS)--in population samples of three different Taiwanese communities. The study included 6,322 subjects (2,631 male and 3,691 female), aged 31 yr old or more in Shih-Pai (a metropolitan area in northern Taiwan),Yu-Chi (a mountain area in central Taiwan), and A-Lein (a seaside area in southern Taiwan). The overall response rate was 50.2%. The correlation between BUA and SOS was 0.684, p0.001. From those who responded, we selected 403 subjects aged 31-40 yr as the reference (the young group), and their BUA was 65.34+/-7.91 dB/MHz. The t-score was calculated from the BUA data of our reference group. The percentile of -2.5t-score-1.0 and t-scoreor =-2.5 in male subjects was 21.4 and 2.9%, respectively, and in female subjects 24.2 and 14.1%, respectively. The BUA of urban area subjects was higher than that of rural area subjects in almost all age-strata, and overweight was noted to be a protective factor. The effect of age-adjusted odds ratio (AOR) on low QUS values in females was significantly increased every 10 yr from 1.55, 5.13, 13.81, 34.29, to 38.14. This survey showed that age-related decreases in calcaneal ultrasonometry, indicating prevalence of low QUS values, were more obvious in female than male subjects. Overall 38.3% of the female Taiwanese had low QUS values, and this is approximately equivalent to the lifetime risk of fracture at the hip, spine, or distal forearm in Caucasian women. The specific t-score designation, as World Health Organization (WHO) criteria, applied to calcaneal QUS are reasonable when the reference group is selected from the same population.

This study analyzed the genetic characterization on first imported measles virus of genotype D8 in Chinese mainland. Serums were collected from the suspicious MV patients to detect IgM antibody in ELISA. Throat swabs were cultured in Vero/SLAM cell line to get measles virus isolates. Part of the nucleotide sequence of the 3' terminus of nucleoprotein (N) gene of these isolates were amplified by RT-PCR, and the amplicons were directly sequenced. The phylogenetic analysis was based on the nucleotide sequence about 456 base pairs of the 3' terminus of nucleoprotein (N) gene. Results showed that it reported 1 105 suspicious measles cases in shanghai, 2012, including 590 confirmed cases and 2 clinical case. The reported morbidity was 2.52 per one hundred thousand. 247 measles viruses were isolated from 984 throat swabs specimen. Most of them belonged to sub-genotype H1a except Shanghai12-239 was genotype D8. The homology of nucleotide and amino acid sequences were 97.8% and 98.6% respectively between Shanghai12-239 and WHO reference strain (Manchester. UNK30.94(D8)AF280803). Those were 89.6%-94.5% and 88.7%-95.3% between Shanghai12-239 and WHO reference strains of other genotypes.

To identify characteristics of males who father babies born to adolescent mothers in southern Taiwan.This was a population-based cross-sectional study of male partners of 1,145 primigravidas (555 adolescent primigravidas and 590 adults) in Kaohsiung County, Taiwan, which compared their reports of their male partners' characteristics. Data were collected by a questionnaire that included demographic characteristics, health behavior problems, and attitudes toward the pregnancy.In multiple logistic regression analyses, the males who father babies born to adolescent primigravidas achieved a lower level of education; a greater age discrepancy between themselves and the mothers; a greater unemployment rate; less financial independence; more smoking, drinking, and drug abuse; less supportive attitude toward pregnancy; poorer attendance at childbirth; less provision of postpartum care for mothers and infants; and greater domestic violence than adult primigravidas (p.05). These negative findings persist even after stratification by age discrepancy. Male partners of the adolescent mothers with an age difference of 5 years or more were more likely to report drug abuse and domestic violence than those of adult primigravidas.Males who father babies born to adolescent primigravidas were found to have many negative characteristics that place their partners and offspring at risk. Questions asked of or about the father of the baby during prenatal visits may help identify pregnant adolescents who need support during pregnancy and after delivery.

To evaluate the reliability of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) expression in breast cancer by immunohistochemistry and discuss their influencing factors.The pretreatment biopsy specimens were collected from 148 patients (from Beijing Cancer Hospital between 2004 to 2010) with invasive breast cancer. After reslicing and staining (ER:SP1, PR: 1E2, HER-2: 4B5), the status of ER, PR and HER-2 was analyzed by a pathological expert with automated imaging system Ariol MB-8. And their results were compared with the original reports.The concordance rates between original reports and automated image system were ER:76.35%, PR:49.32%, HER-2:63.51% while Kappa values 0.12 (P = 0.020) , 0.18 (P = 0.002) and 0.08 (P = 0.200) respectively. And the concordance rates between expert reports and automated image system were ER:93.92%, PR:81.08% and HER-2:76.35% while Kappa values 0.77 (P0.001) , 0.67 (P0.001) and 0.32 (P0.001) respectively.For the expressions of ER, PR and HER-2, the disaccording results of original reports and automated image system may be mainly due to the differences of antibodies, staining methods and interpretations.

To study the risk factors for adolescent primigravida in Kaohsiung county, Taiwan.This is a population survey on primigravida based on household registry to study risk factors affecting pregnancy of 215 women aged18; 341 women aged 18-19; and 590 women aged 20-34.The mean age of menarche, first intercourse, and first pregnancy, as well as the duration of menarche to the first intercourse increased significantly with the increased age of primigravida (P0.001). Adolescent primigravida, when compared to adult primigravida, were less likely to communicate well with their parents or be in a dual parent family (P0.05). They were also more likely to have alcoholic fathers, have drinking alcohol and smoking health behavior problems, exhibit poor school performance, have relatives or friends who became pregnant as adolescents, have been raped, and exhibit poorer knowledge of contraception before pregnancy (P0.05). Dose-response relationship in the odds ratio was found. Non-dual family, adolescent pregnancy in relatives or friends, smoking before pregnancy, and age of menarche were independent factors in multiple logistic regression on adolescent primigravida.The main risk factors for adolescent primigravida in Kaohsiung county. Taiwan, were family influence, health behavior problems, adolescent pregnancy in relatives or friends, and earlier onset of menarche. The age at which intercourse and smoking start appear to be two crucial factors that can be addressed through education as a means of intervention before pregnancy occurs.

To assess the prognostic value of lymph node ratio (LNR) in patients with stage III rectal cancer after curative resection.A retrospective review of the clinicopathological data was performed in 161 patients with stage III rectal cancer who received curative surgical excision in our hospital from June 2005 to June 2010. The variables including LNR, age, gender, T stage, N stage, total number of dissected lymph nodes, number of metastatic lymph nodes, and positive rate of lymph node metastasis were studied through univariate and multivariate analyses, and the survival analysis was performed using Kaplan-Meier method and Log rank test.Multivariate analysis revealed that LNR, but not number of positive nodes or number of harvested lymph nodes, had independent prognostic value for overall survival and disease-free survival for patients with stage III rectal cancer. The overall survival in the LNR0.43 and LNR ≥ 0.43 groups was 75.8% and 41.3%, respectively (P0.01), while the disease-free survival was 68.8% and 40.3%, respectively (P = 0.001).The LNR is an independent prognostic factor for survival of patients with stage III rectal cancer, and is more efficient than the number of positive nodes and total number of dissected lymph nodes in the survival prediction.

Summary Smoking may be a risk factor for diabetes, and it has been suggested that viral hepatitis may predispose to diabetes. We studied diabetes and smoking histories in people with viral hepatitis. From 1997 to 2004, we studied the risk of incident diabetes in a community cohort with hyperendemic HBV and HCV infection in southern Taiwan. The cohort involved 3539 people (40–70 years old) without diabetes. Four hundred and twenty-three individuals developed diabetes. Those who were ≥65 years old, frequently consumed alcohol, had a BMI ≥25, had

To make serological analysis and identify the etiology of an outbreak of chickenpox in Zhabei District of Shanghai in 2007.IgM and IgG of the paired serums were detected by ELISA. The collected herpes were inoculated into MRC-5 cells to get VZV isolations and identify them by VZV standard serums. A 268bp fragment was amplified by specific PCR primers.Among the five paired serums, two of the acute phase serums were VZV IgM positive, one was VZV IgG positive, and two were equivocal for anti-VZV IgG. All of the convalescent serums were VZV IgG positive, and four of them were 4 times higher in antibody titer than those of acute phase serums. Viruses were isolated from all of the 5 herpes, and then identified by VZV standard serum. The electrophoresis result of PCR products showed the single specific strap.This outbreak was caused by VZV virus. 47.4% of the patients were inoculated in postnatal or domestic VZV vaccines in China 3 years after delivery. The effectiveness of VZV vaccine has been certified. It is necessary to consider the immunization strategy of VZV vaccine.

Background: The risk of type 2 diabetes on the development of hepatocellular carcinoma remains inconclusive in different hepatitis statuses. Methods: We prospectively followed a community-based cohort with 5,929 persons in southern Taiwan from January 1997 through December 2004, made up of 4,117 seronegative, 982 anti–hepatitis C virus–positive [HCV(+)], 696 hepatitis B surface antigen–positive [HBsAg(+)], and 134 coinfected persons. Before the study, 546 participants had developed diabetes. Hepatocellular carcinoma diagnoses were from the National Cancer Registry. Results: After 50,899 person-years of follow-up, 111 individuals had developed hepatocellular carcinoma. The highest risk of hepatocellular carcinoma, compared with seronegative individuals without diabetes, was in anti-HCV(+) individuals with diabetes [incidence rate ratio (IRR), 76.0], then coinfected (IRR, 46.0), anti-HCV(+) without diabetes (IRR, 26.1), HBsAg(+) with diabetes (IRR, 21.4), and seronegative with diabetes (IRR, 7.2; P < 0.001). Anti-HCV(+) (n = 132) and seronegative individuals (n = 352) with diabetes had a higher cumulative incidence rate of hepatocellular carcinoma than those without diabetes (log-rank test, P < 0.001). Multivariate Cox proportional hazards analysis showed that gender, age, body mass index ≥30, HBsAg(+) [hazards ratio (HR), 12.6], anti-HCV(+) (HR, 18.8), coinfection (HR, 25.9), and diabetes [HR, 2.7; 95% confidence interval (95% CI), 1.7-4.3] were independent predictors of hepatocellular carcinoma (P < 0.05). After stratifying hepatitis status in multivariate Cox analysis, diabetes was significant for seronegative (HR, 5.4; 95% CI, 1.7-17.1) and anti-HCV(+) individuals (HR, 3.1; 95% CI, 1.7-5.4). Body mass index ≥30 was significant for HBsAg(+) individuals (HR, 3.3; 95% CI, 1.3-8.1). Conclusion: Type 2 diabetes is a strong independent predictor of hepatocellular carcinoma in anti-HCV(+) and seronegative individuals but not in HBsAg(+) individuals. (Cancer Epidemiol Biomarkers Prev 2009;18(7):2054–60)

Summary In order to examine the effect of an occlusal splint on the integrated electromyography (EMG) of the masticatory muscles, EMG of bilateral masseter muscles of 23 patients with temporomandibular joint distrubance syndrome (TMJDS), with and without an occlusal spint, was measured and integrated on line during maximum clenching. It was found that the integrated myoelectrical value of the masseter muscle on the involved and non-involved side was reduced with the occlusal splint. The absolute difference between integrated myoelectrical values in the left and right masseter muscles was reduced with an occlusal spint, but the relative difference remained virtually unchanged. These results indicate that the occlusal splint can decrease masseter muscle activity and thus exert a therapeutic effect.

Human bocavirus (HBoV) is a parvovirus recently found to possibly cause respiratory tract disease in children and adults. This study investigated HBoV infection and its clinical characteristics in children younger than five years of age suffering from acute lower respiratory tract infection in Beijing Children's Hospital.Nasopharyngeal aspirates were collected from children suffering from acute lower respiratory tract infection during the winters of 2004 to 2006 (from November through the following February). HBoV was detected by polymerase chain reaction amplification and virus isolation and the amplification products were sequenced for identification.HBoV infection was detected in 16 of 333 study subjects. Coinfections with respiratory syncytial virus were detected in 3 of 16 HBoV positive patients with acute lower respiratory tract infection. The median age for HBoV positive children was 8 months (mean age, 17 months; range, 3 to 57 months). Among the HBoV positive children, 14 were younger than 3 years old, 9 were younger than 1 year old and 7 were younger than 6 months. These 16 positive HBoV children exhibited coughing and abnormal chest radiography findings and more than 60% of these children had wheezing and fever. Ten children were clinically diagnosed with pneumonia, 2 bronchiolitis, 2 acute bronchitis and 2 asthma. One child died.HBoV was detected in about 5% of children with acute lower respiratory infection seen in Beijing Children's Hospital. Further investigations regarding clinical and epidemiologic characteristics of HBoV infection are needed.

Background. The impact of influenza vaccination on major cause-specific hospitalization and the duration of hospital stay is rarely reported. Our purpose was to study the effect of vaccine efficacy on major disease-specific hospitalization and the duration of hospital stays among elderly persons. Subjects and methods. From 1 January through 30 June 2001, we prospectively observed 35,637 vaccinated elderly persons (age, ≥65 years) and 53,094 unvaccinated elderly persons in Kaohsiung County, Taiwan, by computerized linkage to the National Health Insurance database. Of these persons, 21,347 had been assigned a high-risk status by the Department of Health, Taiwan. Univariate and multivariate logistic regression were used for determining vaccine efficacy in hospitalization. Multiple linear regression analyses were performed for determining the length of hospital stays. Results. In both high-risk and low-risk groups, vaccination was associated with reducing the rates of hospitalization for all causes (20% vs. 23%), lung diseases, congestive heart failure (43% vs. 32%), renal disease, and liver disease (P

The Osteoporosis Self-Assessment Tool for Asians (OSTA) index, originally developed for use in postmenopausal Asian populations, is an inexpensive, simple tool based on age and body weight. Calcaneal quantitative ultrasound (QUS) is another simple and low-cost instrument used to prescreen osteoporotic subjects. This study investigated the correlation between these 2 screening methods.OSTA indices were calculated in a total of 3,456 women aged 40 to 95 years (mean, 59.5 +/- 11.7 years) selected from a national epidemiological survey of calcaneal QUS in Taiwan. Age was multiplied by -0.2 and body weight by 0.2. Both values were truncated to yield integers, which were then added together, and compared to the QUS results.When the risk category was defined as OSTA indexor = -1, and low QUS value as t-scoreor = -2.5, the sensitivity and the specificity of the index were 84.0% and 61.0%, respectively, and the area under the curve was 0.81. According to the OSTA research group's classification, the high-risk subgroup (index-4) represented 10.7% of the women 40 years or older, the intermediate-risk subgroup (index -1 to -4) 35.0%, and the low-risk subgroup (index-1) 54.3%. The prevalence of low QUS values was high among the high-risk category (48.5%), and significantly trended downwards among the moderate- and low-risk categories (21.1% vs 4.4%). As the age of the population increased, there was an increasing false-negative rate (p0.001) when using OSTA-1 to predict the normal QUS value.The OSTA index, a simple and free risk assessment tool, can be used to estimate the prevalence of low QUS values in Asian women and may help to increase awareness and prevention of low bone mineral density.

Past studies of the relation between hepatitis C virus (HCV) infection and type 2 diabetes conflict. The authors aimed to elucidate the relation by using a large community-based sample with a wide range of liver conditions. Between October 1997 and February 1998, 2,327 consecutive subjects (aged > or =35 years) were enrolled at the public health facility in Taiwan. Blood sugar, hepatitis B surface antigen, and antibody for HCV (anti-HCV) were tested. Abdominal sonography was performed on viral-hepatitis-positive subjects. In univariate analysis, older age, lower educational levels, sedentary work, body mass index of > or 25 kg/m2, and anti-HCV positivity were significantly associated with type 2 diabetes (p

Although the survival rate of premature infants has improved, the prevalence of premature birth has not changed or has even increased. The purpose of this study is to analyze the demographic, psychosocial support, family planning, and health behavior risk factors for premature birth.This county-based, cross-sectional study collected information on 1,146 first-time mothers, including 556 adolescents (20 years old) and 590 adults (20-34 years old). Univariate and multivariate logistic regression analyses were used to study risk factors associated with premature birth.The prevalence of premature birth was 11.4% for adolescent mothers and 8.4% for adult mothers. Younger adolescent mothers (18 years old) (14.5%), fewer than 10 prenatal visits (12.5% vs. 6.7%), hypertension (33.3% vs. 8.9%), weight gain less than 10 kg (14.6% vs. 8.8%), drinking alcohol (23.1% vs. 9.5%), unintended pregnancy (13.6% vs. 7.4%), no parental support (16.8% vs. 9.1%), and victim of domestic violence (16.0% vs. 9.3%) were associated with a higher risk of premature birth (p0.05). In multivariate logistic regression analysis stratified by mother's age, prenatal visits less than 10 times (OR 2.68; 95% CI [1.38, 5.21]) and drinking alcohol (OR 25.0; 95% CI [1.35-460.49]) were significantly associated with premature birth for adult mothers but unintended pregnancy (OR 2.34; 95% CI [1.28, 4.27]) was the only significant factor for adolescent mothers.Differing risk factors for premature birth were found between adolescent and adult mothers. Effective family planning before gestation, alcohol abstinence, and regular prenatal visits for screening psychosocial, medical, and obstetric conditions during pregnancy are mandatory for the prevention of premature birth.

The efficacy of interferon-alpha and ribavirin combination therapy for GB virus C/hepatitis G virus infection is not well understood. We previously conducted a double-blind, placebo-controlled trial using high-dose interferon-alpha 2b with or without ribavirin for patients with interferon-alpha-relapsed chronic hepatitis C.Fifty-two patients were randomly assigned and completed the 24-week treatment of interferon-alpha 2b (6 million units three times per week) plus ribavirin (1000 to 1200 mg/daily), or plus a matched placebo. Patients were then followed for an additional 24 weeks.Of the 52 patients, 5 patients (9.6%) had hepatitis G virus viremia before or during enrollment. Two patients received interferon-alpha 2b alone and three patients received interferon-alpha 2b and ribavirin combination therapy. At the end of treatment, all of the 5 patients had undetectable hepatitis G virus RNA in sera. Early loss of hepatitis G virus RNA at week 4 of treatment was observed in the 2 patients on combination therapy. Hepatitis G virus RNA reappeared at the end of follow-up in these 5 patients.In conclusion, interferon-alpha 2b and ribavirin combination therapy could induce earlier loss of hepatitis G virus RNA than interferon-alpha 2b alone. Either interferon-alpha 2b alone or interferon-alpha 2b and ribavirin combination therapy achieved transient but not sustained virological response to hepatitis G virus viremia.

We performed a community-based study of 12 villages of southern Taiwan's A-Lein Township to investigate the epidemiology of hepatitis B and hepatitis C virus (HCV) infections. Of 6,095 patients, 13.8% were positive for hepatitis B surface antigen positive (HBsAg(+)) and 17.0% were positive for anti-HCV (anti-HCV(+)). Infection was found to be inversely related to educational level and to be directly related to the frequency of the receipt of parenteral injection for medical purposes. Risk factors for HBsAg positivity were male sex, ageor = 50 years, and a family history of hepatocellular carcinoma. Risk factors for HCV seropositivity were lower education level, frequent parenteral injections, blood transfusion, menial occupations, smoking, and age50 years. Therefore, risk factors for HBsAg(+) and anti-HCV(+) were different in these Taiwanese communities. Safe medical injections and improved health education for high-risk groups are imperative for preventing HCV transmission.

For economic reasons, the few influenza vaccination programs seen in developing countries are aimed at the high-risk elderly. To evaluate its efficacy and cost-effectiveness, we conducted a 2-month influenza vaccination campaign in southern Taiwan’s A-Lein township for all the elderly. Significant differences in hospitalization and mortality between the vaccinated and unvaccinated groups were found. Age, sex, and risk group were significant for hospitalization and mortality, but only vaccination was significant for prevention. Savings for each person vaccinated were at least three times the cost of vaccination. We strongly recommend that all the elderly—not only high-risk elderly—receive an annual influenza vaccination.

This is a study of the differences in the risk factors for being either hepatitis B surface antigen positive [HBsAg(+)] or antibody to hepatitis C virus positive [Anti-HCV(+)] in A-Lein, a rural area in southern Taiwan, an area which also has a high hepatoma mortality rate. Three hundred eighty-five patients age > or =40 years participated in hepatoma screening at the A-Lein Community Health Center during 1995. Those who were HBsAg(-) and anti-HCV(-) or had coinfection of HBsAg(+) and anti-HCV(+) were excluded, leaving 293 patients: 109 HBsAg(+) and 184 anti-HCV(+). The anti-HCV(+) patients had a lower socioeconomic status (as defined by level of education and type of occupation) and were older than HBsAg(+) patients (P < 0.05). Those with higher alanine aminotransferase levels (ALT) also had a higher anti-HCV(+) to HBsAg(+) odds ratio (OR), and a dose response relationship was found, P < 0.0001. Anti-HCV(+) patients were more likely than HBsAg(+) patients to have a spouse who shared the infection, OR = 5.11; 95% CI, 2.30-11.28. Anti-HCV(+) patients were more likely than HBsAg(+) patients to have had blood transfusions (OR = 2.66; 95% CI, 1.20-5.89), frequent medical injections (OR = 2.64; 95% CI, 1.62-4.31), or injections by non-licensed medical providers (OR = 1.91; 95% CI, 1.18-3.09). Multiple logistic regression analysis showed that the significant factors for anti-HCV(+) patients vs. HBsAg(+) patients are drinking habit (OR = 3.45; 95% CI, 1.02-11.60), age (OR = 6.33; 95% CI, 2.93-13.68), and frequent medical injections (OR = 2.88; 95% CI, 1.65-5.03). The transmission of hepatitis C in A-Lein is closely related to low socioeconomic status, age, alcohol abuse, spouses being anti-HCV(+), and frequent medical injections, especially from non-licensed medical providers, including both pharmacists and those with no medical licensing whatsoever. These nonlicensed medical providers sometimes reuse needles to save money, which is a likely route of infection.

BACKGROUND Both hepatitis B and C are major health concerns in Taiwan. The goal of this study was to determine how risk factors for hepatitis B and C differed in this study population. It was also hoped that the data might help determine how age and place of residence affect hepatitis risk factors. METHODS Complete serum and hepatitis marker analysis (HBsAg and AntiHCV) was done for 282 individuals over 65 years old. Of these, 254 were interviewed for risk factor analysis. RESULTS Of the 282 subjects, 8.2% were HBsAg+, 27.3% were AntiHCV+, and 3.2% were both HBsAg+ and AntiHCV+. AntiHCV+ subjects were more likely than AntiHCV-subjects to have had frequent medical injections, odds ratio (OR) = 2.94, 95% confidence interval (CI) (1.68, 5.12), and it was the only independent risk factor for determining AntiHCV+, OR = 3.26, 95% CI (1.85, 6.11) (N = 254). The AntiHCV+ group had higher alanine and asparate aminotransferase levels but lower cholesterol and triglyceride levels than AntiHCV- and HBsAg+ groups (p < .0001). Abnormal ALT existed in 40.3% of AntiHCV+ and 10.7% of AntiHCV- cases. ALT was associated with AntiHCV and sex, although abnormal AST was only associated with AntiHCV. CONCLUSIONS AntiHCV was closely related with frequent medical injections and was the primary risk factor for abnormal ALT and AST levels in this study population. It appears that frequent medical injections are an important risk factor because of the previously common habit of reusing syringes. This is of major concern to elders in Taiwan because of their much greater likelihood of repeated exposure.

This is an analysis of all unnatural deaths (ICD-9, E47-E55) that occurred between 1990 and 1994 in A-Lein, Taiwan. Unnatural deaths for this period totalled 134, or 89.66 per 100,000 per year. The crude accidental mortality rate (E47-E53) and road traffic accident (RTA) mortality rate (E54 is many times larger than in other industrialized countries: 2.1-5.1 times and 2.4-7.7 times, respectively. These figures are even higher for males. The reported suicide rate in A-Lein is approximately equal to that in the UK, but less than other industrialized countries. The actual suicide mortality rate in A-Lein as computed in this survey was 1.8 times higher than reported, which was 2.4 times that of Taiwan as a whole and 2.1 times Great Britain; 30.9 per cent of male and 75 per cent of female unnatural deaths excluding RTAs were suicides (ICD-9 E48-E55). RTA deaths were 3.2 times higher among males than among females (P < 0.05) and 26.8 per cent were associated with alcohol consumption. Only 21.4 per cent of killed motorcyclists wore helmets and only 8.3 per cent of killed car drivers used seat belts. Unnatural deaths excluding RTAs were mostly among people of low socio-economic status aged 50-60 years with less than a college education. Of these, 75 per cent occurred at home or at work. The most common cause of non-traffic unnatural death excluding RTAs was suicide, and the second most common was drowning. In conclusion, it was found that high unnatural death rates in A-Lein are related to low socio-economic level, sex (males), drinking, inadequate safety protection while working and driving, and inadequate law enforcement.

The purpose of this survey is to study the prevalence and motivating factors of smoking among 1,372 students at a rural middle school in Taiwan. The prevalence of smokers for total, male, and female students is 5.7, 11.5, and 0.4%, respectively. Prevalence increased with age and grade among males, but no significant differences were found among females. Prevalence was higher among students from nuclear families than those from extended families (OR = 2.8, 95% C.I. 1.4-5.5). Prevalence was also higher among students from families with very strict parental control or very little parental control (OR = 4.25, 95% C.I. 2.24-8.08). The majority (70-80%) began smoking during primary school. Smokers who had attempted abstinence in the past had a better understanding of the hazards of smoking and smoked less frequently and with lower average consumption (P < .05). For 60% of the students the first source of cigarettes was friends or classmates; only 22% bought them. Health education increased understanding of the hazards of smoking (OR = 2.2, 95% C.I. 1.10-4.45). In conclusion, the primary factors that affect adolescent smoking are age, family structure, abstinence experience, strictness of upbringing, family influence, peer pressure, and health education.

Fifteen subjects with complete natural dentitions were selected for investigation of their occlusal sounds on the left and right sides by means of power spectral analysis. It was found that the occlusal sounds consisted of various frequency components. Their mean power frequencies (MPF) and frequencies at 10, 20, 50, 80 and 90% of cumulative power (F10, F20, F50, F80, F90) on the left and right sides were almost identical (P greater than 0.05). The correlation coefficients between MPF and F50, MPF and F50 with the others were high. The results indicate that F20, MPF or F50 and F80 may be used as indices to describe the power spectral shape, and that power spectral analysis of occlusal sounds may be used as a contribution to diagnosis of occlusal conditions.

The size of soya particles masticated by 10 subjects with natural teeth were directly measured by means of a graphic digitizer and a computer at a varied number of masticatory strokes. The statistical parameters were calculated by computer and a test of normality was used for estimating the frequency distribution. It was found that the frequency distribution of chewed particle size was a positive skew state; its shape was asymmetric, wide, and flat. After natural logarithm transformation the distribution tended toward normal. Increasing the number of masticatory strokes decreased the mean and median of the distribution (p less than 0.01) and did not change the coefficient of variation, skewness, and kurtosis (p greater than 0.05). The results show that the distribution of chewed particle size tends toward a normal logarithmic distribution; the distribution shapes at various numbers of strokes are the same; these parameters can be used for determining masticatory efficiency. Direct measurement of the particles is more convenient and reliable than dyeing particles or fractionating the particles in a sieve system.

The sizes of soya particles masticated by 12 complete denture wearers and 10 subjects with natural dentition were directly measured by means of a graphic digitizer and computer, following a varied number of chewing strokes. It was found that the chewed particle size frequency distributions of the two groups tended to a state of normal logarithm distribution. Compared with the dentate subjects, the mean, 20th, 50th and 80th percentile of the particle sizes chewed by complete denture wearers were increased, whilst the distribution shapes were nearly identical. The results suggest that there are no qualitative differences in the manner in which the two groups break up food. Selection and breakage functions of complete denture wearers are decreased, and this could be related to the denture conditions and the change of oral state in such individuals.

Alcohol consumption is a well-known risk factor for elevated ALT levels, but the role of cigarette smoking is unclear.We collected a cross-sectional sample of 6095 inhabitants 35 years or older in a community with hyperendemic hepatitis B and C virus infections. We assayed levels of serum alanine aminotransferase (ALT), hepatitis B surface antigen (HBsAg), and anti-hepatitis C virus antibody (anti-HCV). Multivariate logistic regression was performed to determine the factors for elevated ALT levels (or =40 U/L) among people with different hepatitis infection statuses.Prevalence of elevated ALT levels in individuals who were seronegative for both infections or seropositive for HBsAg or anti-HCV was 3.9%, 11.1%, and 30.8%, respectively. Subjects with elevated ALT levels were more likely to be seropositive for anti-HCV, male, and seropositive for HBsAg; to drink alcohol; to smoke; and to have undergone blood transfusion (P.05). An association was found between elevated ALT levels and the consumption of cigarettes and alcohol among anti-HCV-seropositive subjects. In multivariate logistic analyses, alcohol consumption (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2-4.1) and smoking (OR, 1.8; 95% CI, 1.1-2.7) were significantly associated with elevated ALT levels among anti-HCV-seropositive subjects, but no such association was found among HBsAg-seropositive subjects. The odds of elevated ALT levels were 7 times higher (95% CI, 2.7-18.8) for the anti-HCV-seropositive patients who smoked 1 or more packs of cigarettes per day and frequently drank alcohol than for those who did not.Smoking and alcohol consumption are independently associated with elevated ALT levels among anti-HCV-seropositive individuals but not among HBsAg-seropositive individuals. Patients who are seropositive for anti-HCV are strongly advised not to smoke and drink alcohol to reduce the possible risk for aggravating the liver dysfunction.

Summary The EMGs of the temporal and masseter muscle, in sixty patients with temporomandibular joint disturbance syndrome (TMJDS) and thirty normal controls, were recorded during rhythmical open-close-clench cycle movement and before and after occlusal splint therapy. The duration of the muscle contraction before initial tooth contact (DMC), the latent period (LP) and the silent period (SP) of the myoelectrical activity were used as indices for exploring their diagnostic value. In contrast with the controls, DMC, LP and SP lengthened in the patients. The DMC was prolonged in those patients where there were TMJ sounds, the inter-cuspated position did not coincide with the muscular contact position and there was deviated mandibular movement. An increase of the SP was related to tooth contact on the balancing side. After treatment, the DMC and SP in the patients returned to the level of the controls. It was found that the internal correction rate of Fisher's linear discriminate function established for the DMC and SP of the temporal and masseter muscles was 80.9% and 85.1% respectively. The results show that the DMC and SP of the temporal and masseter muscles have some value in diagnosing muscular dysfunction and discriminating therapeutic effectiveness.

Electromyograms (EMGs) of the temporal and masseter muscles in sixty patients with temporomandibular joint disturbance syndrome (TMJDS) and thirty controls were recorded and integrated on-line in the postural position and during maximum clenching, before and after occlusal splint therapy. Contrasting with the controls, the myoelectrical activity of the patients was higher in the postural position and lower during maximum clenching, whilst the former in percentage terms increased when compared to the latter. After treatment, the EMG indexes in some patients returned partially, and in others completely, to a normal level. Tenderness in the mandibular elevators, deviated opening and organic change in the TMJ increased the postural myoelectrical activity, in percentage terms, against that of maximum clenching. The myoelectrical activity of the mandibular elevators in the postural position and during maximum clenching was smaller in patients with the occlusal splint than in those without. The results show that the mandibular elevators in the patients with TMJDS were hyperactive and tense, and that the occlusal splint was useful for treating such dysfunction.

Maximum bite force in the region of the right first maxillary molar and the corresponding mean voltage of the right masseter muscle of 29 patients suffering from temporomandibular joint dysfunction and 27 healthy controls were measured. In contrast with the controls, the maximum bite force of the patients was smaller (p less than 0.01), the mean voltage was nearly equal (p greater than 0.05), and the proportionality of the mean voltage to the maximum bite force of the patients was greater (p less than 0.01). These results tend to indicate that the masticatory muscles of patients with temporomandibular joint dysfunction are in a state of hyperactivity and tension. The proportionality method suggested in this article is more convenient and easier to apply than previously proposed methods that measure the slope of voltage/tension curves. It may, therefore, have clinical value in the diagnosis of patients with temporomandibular joint disorders.