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Background: Continuing education (CE) is essential for health professionals to improve competence in clinical practice, yet many medical technologists still experience barriers to learning in complex clinical settings. To better manage CE and address medical technologists' learning needs, we developed a learner-centred electronic book (e-book) to promote self-directed learning for medical technologists. Methods: A cross-sectional study was conducted to explore the acceptability and learning impacts of the e-book as CE material for medical technologists in two medical centres in Taiwan. We designed the learner-centred context in the e-book based on medical technologists' practice requirements and learning needs. Moreover, we adopted The New World Kirkpatrick Model with four levels (reactions, learning, behaviours and results) to evaluate the e-book's learning impacts on medical technologists. A total of 280 medical technologists were invited to complete a questionnaire and a post-test, providing learning patterns as well as their satisfaction with the e-book and their learning outcomes after using it. Results: Most readers had positive learning experiences and better learning outcomes, including knowledge acquisition and behavioural change, after reading the e-book. The e-book became a new CE activity and reached medical technologists in various types of laboratories. Conclusions: The low-cost and learner-centred e-book effectively overcame CE learning barriers for medical technologists. The interactivity and flexibility of e-learning particularly helped learners to engage in clinical scenarios in laboratory medicine. This study could pave the way for medical educators to build a high-quality e-learning model in CE. [ABSTRACT FROM AUTHOR]

This study examined the trend of blood lead levels (BLLs) in Taiwanese adults and analyzed the variations in the BLL between Linkou (northern) and Kaohsiung (southern) hospital branches. Between 2005 and 2017, 3,804 adult participants received blood lead tests at the Linkou (n = 2,674) and Kaohsiung (n = 1,130) branches of Chang Gung Memorial Hospital. The geometric mean of BLL was 2.77 μg/dL. The adult participants from the Kaohsiung branch were not only age older (49.8±14.1 versus 39.4±14.2 years; P<0.001) and male predominant (65.8 versus 41.7%; P<0.001) but also showed a higher BLL (4.45±3.93 versus 2.82±2.42 μg/dL; P<0.001) and lower estimated glomerular filtration rate (87.62±25.94 versus 93.67±23.88; P<0.001) than those from the Linkou branch. Multivariable logistic regression analysis revealed that the Kaohsiung branch [odds ratio (OR): 7.143; 95% confident interval (CI): 5.682–8.929; P<0.001], older age (OR: 1.008; 95% CI: 1.000–1.015; P = 0.043) and reduced estimated glomerular filtration rate (OR: 1.009; 95% CI: 1.004–1.014; P = 0.001) were significant predictors for BLL > 5 μg/dL. Therefore, this study confirmed a continuous decreasing trend in the BLL in Taiwan after banning leaded petrol in 2000. [ABSTRACT FROM AUTHOR]

An epidemic of enterovirus 71 (EV71) infection compatible with hand, foot and mouth disease and associated with high morbidity and mortality occurred in Taiwan in 1998. We recruited 90 patients (50 males, 40 females) with definite EV71 infections for clinical and laboratory analysis. The neurological signs and symptoms, all of which occurred during the febrile period, in patients with central nervous system (CNS) involvement (aseptic meningitis, encephalitis or myelitis) were myoclonic jerks (23/33), vomiting (10/33), ataxia (7/33), lethargy (6/33), seizure (4/33) and tremor (2/33). Patients with CNS involvement had longer durations of fever (4.6 ± 0.2 vs. 3.1 ± 0.3 d; p< 0.01) and a higher white blood cell count (12,512 ± 658 vs. 10,607 ± 409 cells/mm[sup 3]; p= 0.01) than patients without CNS involvement. The case fatality rate in patients with CNS involvement was 4/33 (12%), whereas no fatalities (0/57) occurred in patients without CNS involvement. Six of 11 patients subjected to MRI showed a high intensity T2-weighted signal in the brainstem. A nested fluorescent RT-PCR for detection of virus in throat and stool specimens showed higher sensitivity than viral culture. Viremia was detectable using RT-PCR in 20% of cases (3/15), whereas no virus was isolated from culture or detected by RT-PCR in cerebrospinal fluid. [ABSTRACT FROM AUTHOR]

• Taiwan has the highest prevalence and incidence of end-stage renal disease. • Early-stage of kidney disease is usually asymptomatic, so patients must rely on routine urinalysis for detection. • Urinary ACR measured by Siemens Novus with Pro12 dipsticks was shown to be a reliable test for detection of microalbuminuria. Taiwan has the highest end-stage renal disease prevalence in the world, and the costs on the maintenance of dialysis imposes a great financial burden on National Health Insurance. Routine urinalysis provides an opportunity for the early detection of microalbuminuria. We evaluated the accuracy of semi-quantitative chemical methods from Siemens Novus Pro12 dipstick for albumin-creatinine ratio (ACR). We collected 1029 random urine samples and performed urinary analytic tests by Siemens Novus with Pro12 dipsticks and also calculated the urinary ACR. The reference method was performed by Hitachi LST008, a quantitative assay. The percentage of exact agreement in ACR was 81.9% between Siemens Novus and Hitachi LST008. The percentage of agreement within 1 level between the 2 methods was 98.5%. When ACR > 30 mg/g was defined as the threshold for positive results, the sensitivity, specificity, positive, and negative predictive values for microalbuminuria were 87.2%, 91.6%, 91.5%, and 87.3%, respectively. There were 778 cases with negative results of urinary protein, analyzed by conventional dipsticks. 149 of 778 (19.2%) cases were positive, measured by Pro12 dipsticks, and 111 of 149 (74.5%) cases were confirmed positive ACR by Hitachi LST008. Urinary ACR measured by Siemens Novus with Pro12 dipsticks was shown to be a reliable test for detection of microalbuminuria. [ABSTRACT FROM AUTHOR]

Background: Acute intermittent porphyria (AIP) is caused by diminished activity of porphobilinogen deaminase (PBGD). The purpose of this study was to validate and compare two assays for PBGD activity. The clinical sensitivity of the PBGD activity assays in AIP diagnosis was also evaluated., Methods: This study included 74 subjects from 18 Taiwanese families including symptomatic patients with AIP, asymptomatic carriers, and healthy family members. The specific mutations in AIP patients were identified by DNA sequencing. PBGD activity was measured in erythrocytes by quantifying formation of coproporphyrin or uroporphyrin by the enzyme using porphobilinogen (PBG) as a substrate and fluorimetry for detection., Results: The calibration curves obtained with pure coproporphyrin or uroporphyrin were linear with correlation coefficients >0.99 in the range of 0-200nM for coproporphyrin and 0-150nM for uroporphyrin. The coefficients of variation for within-run and between-day imprecision were <9.8% for both assays. The three groups of subjects were used to establish the best cut-off of PBGD activity for identifying symptomatic AIP patients by using area under receiver operating characteristic curve analysis. The symptomatic AIP patients and asymptomatic carriers had significantly lower PBGD activity compared with the healthy family members (all p<.001)., Conclusion: Two different PBGD activity assays were validated. The best cut-off for coproporphyrin was derived as 46.4nmol/h/mL RBC with corresponding sensitivity of 100% and specificity of 100% and the best cut-off for uroporphyrin was derived as 43.7nkat/L RBC with corresponding sensitivity of 100% and specificity of 97.4%., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Viruses are a frequent cause of upper respiratory tract infections in children. Like Taiwan, there were few virological surveillance systems for respiratory viral infections among children in developing countries., Materials and Methods: During August 1995 and July 1997, 6-10 throat swab specimens per week were taken from pediatric outpatients with acute, febrile upper respiratory tract infections (URTI). The specimens were randomly obtained by two pediatricians at Chang Gung Children's Hospital and sent for virus isolation and identification., Results: A total of 910 specimens were collected and 365 specimens (40%) were positive for at least 1 virus and included 81 enterovirus, 73 adenovirus, 58 influenza B virus, 54 influenza A virus, 48 cytomegalovirus (CMV), 25 herpes simplex virus-1 (HSV-1), 7 parainfluenza virus, 3 respiratory syncytial virus (RSV) and 16 mixed viruses. Adenovirus and enterovirus were identified throughout the study period. No seasonal variation was noted for adenovirus while enterovirus peaked between May and July and also during September and November. Influenza viruses, both A and B, were identified during two periods, respectively and altogether, influenza viruses could be detected almost throughout the year. An association between the virus type identified and the mean age of patients was found (P-value = 0.0001 by ANOVA test). The mean age of patients infected with influenza viruses, either A or B, was significantly higher than those of patients infected with adenovirus, HSV-1, CMV and enterovirus., Conclusion: The results of this study demonstrate that adenovirus and enterovirus are the two most common viruses isolated from pediatric outpatients with acute, febrile URTIs and can be identified throughout the year in northern Taiwan. Influenza viruses also can be identified throughout the year and during the epidemic, a child older than 5 years of age with acute febrile URTI is likely to be a case of influenza.

Objective: In 1998, an enterovirus 71 (EV71) epidemic in Taiwan was associated with hand, foot, and mouth disease (HFMD)/herpangina and involved 78 fatal cases. We measured EV71 seroprevalence rates before and after the epidemic and investigated risk factors associated with EV71 infection and illness., Methods: Neutralizing antibodies to EV71 were assayed for 539 people before the epidemic and 4619 people of similar ages after the epidemic. Questionnaires, which were completed during household interviews after the epidemic, solicited demographic variables, exposure history, and clinical manifestations., Results: A total of 129 106 cases of HFMD were reported during the epidemic. Age-specific pre-epidemic EV71 seroprevalence rates were inversely related to age-specific periepidemic mortality rates (r = -0.82) or severe case rates (r = -0.93). Higher postepidemic EV71 seropositive rates among children who were younger than 3 years positively correlated with higher mortality rates in different areas (r = 0.88). After the epidemic, 51 (56%) of 91 younger siblings of elder siblings who were EV71-seropositive were EV71-seropositive; otherwise, 2.2% (4 of 186) of younger siblings were EV71-seropositive (matched odds ratio [OR]: 10; 95% confidence interval [CI]: 3.4-29). Stepwise multiple logistic regression revealed other factors associated with EV71 infection to be older age (adjusted OR: 2.5; 95% CI: 1.9-3.4), attendance at kindergartens/child care centers (adjusted OR: 1.8; 95% CI: 1.3-2.5), contact with HFMD/herpangina (adjusted OR: 1.6; 95% CI: 1.2-2.1), greater number of children in a family (adjusted OR: 1.4; 95% CI: 1.1-1.7), and rural residence (adjusted OR: 1.4; 95% CI: 1.2-1.6). Twenty-nine percent of preschool children who were infected with EV71 developed HFMD/herpangina. Younger age and contact with HFMD/herpangina were significant factors for the development of EV71-related HFMD/herpangina in these children., Conclusions: An increased incidence of EV71 infection in young children occurred more often in geographic areas with increased mortality rates. Intrafamilial and kindergarten transmissions among preschool children were major modes of disease transmission during the widespread EV71 epidemic in Taiwan in 1998.