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Motor disability (MD) is not uncommon in children, but data at the national level are scarce. As the Taiwan government certifies and registers disabled residents for providing services on a routine basis, the registry provides a unique opportunity for studying MD. Using data from the registry, we calculated the prevalence of MD by age, sex, and geographic area and assessed the changes from 2004 to 2010. We excluded cases under 3 years old because the government discourages the certification at this age. We found that cases between 3 and 17 years old decreased from 8187 to 6022 per year from 2004 to 2010 and the prevalence generally decreased every year in all age groups. There were more boy cases than girl cases every year, and the prevalence rate ratios ranged from 1.26 to 1.39 (p<0.05 in all years), with a decreasing trend over time (p<0.01). Rural areas had higher prevalence in all the years, and the prevalence rate ratio decreased from 1.31 to 1.23 (p<0.05 in all years), with a decreasing trend over time (p<0.05). Further studies identifying the risk factors contributing to the decreases might help in the prevention of MD in the future.

Accumulating evidence implicates that subchronic arsenic exposure causes cerebral neurodegeneration leading to behavioral disturbances relevant to psychiatric disorders. However, there is still little information regarding the influence of subchronic exposure to arsenic-contaminated drinking water on mood disorders and its underlying mechanisms in the cerebral prefrontal cortex. The aim of this study is to assess the effects of subchronic arsenic exposure (10 mg/LAs2O3 in drinking water) on the anxiety- and depression-like behaviors in normal mice and in the chemically induced mouse model of depression by reserpine pretreatment. Our findings demonstrated that 4 weeks of arsenic exposure enhance anxiety-like behaviors on elevated plus maze (EPM) and open field test (OFT) in normal mice, and 8 weeks of arsenic exposure augment depression-like behaviors on tail suspension test (TST) and forced swimming test (FST) in the reserpine pretreated mice. In summary, in this present study, we demonstrated that subchronic arsenic exposure induces only the anxiety-like behaviors in normal mice and enhances the depression-like behaviors in the reserpine induced mouse model of depression, in which the cerebral prefrontal cortex BDNF-TrkB signaling pathway is involved. We also found that eight weeks of subchronic arsenic exposure are needed to enhance the depression-like behaviors in the mouse model of depression. These findings imply that arsenic could be an enhancer of depressive symptoms for those patients who already had the attribute of depression.

Objective. To compare quality, quantity, and trends of food supply from 1984 to 2009 and degree of food westernization in Taiwan with Asian countries and world continents by using food balance data.Methods. We compiled data from food balance sheets of Taiwan and Food and Agriculture Organization, including five continents and three most populated countries each in Eastern, Southern, and Southeastern Asia over the period 1984–2009. Quantity of food supply per capita was referenced to Taiwan food guides. The population-weighted means of food supply from Europe, North America, South America, and Australia and New Zealand continents in terms of energy and nutrient distributions, animal/plant sources, and sugar/alcohol contribution were used as indicators of westernization. Trends of food supply per capita of six food groups were plotted, and linear regression was applied to evaluate food changes.Findings. Taiwan’s food supply provided sufficient quantity in food energy, with the lowest cereals/roots supply and rice to wheat ratio, but the highest meat and oil supplies per capita among the 10 studied Asian countries. Taiwan food supply showed the most westernization among these countries.Conclusion. Food supply of Taiwan, although currently sufficient, indicated some security problems and high tendency of diet westernization.

Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS) use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years) and nonelderly ( Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05) fewer (28 (9.2%)) nontransport calls than did the nonelderly (136 (21.4%)). In the transport calls, 276 (35.6%) were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now.

Secondary hyperparathyroidism increases morbidity and mortality in hemodialysis patients. The Kidney Disease Outcomes Quality Initiative Guidelines recommend parathyroidectomy for patients with chronic kidney disease and parathyroid hormone concentrations exceeding 800 pg/mL; however, this concentration represents an arbitrary cut-off value. The present study was conducted to identify factors influencing mortality in hemodialysis patients with parathyroid hormone concentrations exceeding 800 pg/mL and to evaluate the effects of parathyroidectomy on outcome for these patients. Two hundred twenty-one hemodialysis patients with parathyroid hormone concentrations > 800 pg/mL from July 2004 to June 2010 were identified. 21.1% of patients (n= 60) received parathyroidectomy and 14.9% of patients (n= 33) died during a mean follow-up of 36 months. Patients with parathyroidectomy were found to have lower all-cause mortality (adjusted hazard ratio [aHR]: 0.34). Other independent predictors included age ≥ 65 years (aHR: 2.11) and diabetes mellitus (aHR: 3.80). For cardiovascular mortality, parathyroidectomy was associated with lower mortality (HR = 0.31) but with a marginal statistical significance (p= 0.061). In multivariate analysis, diabetes was the only significant predictor (aHR: 3.14). It is concluded that, for hemodialysis patients with parathyroid hormone concentrations greater than 800 pg/mL, parathyroidectomy is associated with reduced all-cause mortality.

Environmental toxicology is a multidisciplinary domain of science, which occupies an important niche, overlapping the fields of toxicology, environmental health, and public policy. While studying the adverse health effects of chemical, biological, and physical agents on living organisms in the ecosystems, environmental toxicology focuses on humans and therefore plays an important role in addressing public health challenges. Over the years, environmental toxicology research has been providing tools and scientific evidence to policy-makers and the public in preventing substantially greater environmental degradation, including adverse human health impacts. In East Asia, with the increasing number of environmental problems, there is a pressing need for immediate health solutions, and environmental toxicology is expected to increasingly play an important role. More fundamental and applied research must be carried out to deal with the public health challenges in terms of environmental problems and to increase the body of scientific knowledge in this field. While environmental toxicology receives increasing attention and shows significant growth, the number of articles published in international journals on environmental toxicology is still relatively limited. As society changes due to introduction of new technologies and the challenge of sustainable development in the face of increased human population, especially in the East Asian region, the role of environmental toxicology in enlightened public health and public policy will become even more important. Air pollution from both natural and anthropogenic sources now constitutes one of the greatest public health challenges in East Asia at the present time. N. F. Suhaimi and J. Jalaludin conducted a search of journal articles and identified seven studies which used biomarkers to understand the association between air particles exposure and the development of respiratory problems resulting from the damage in the respiratory system. While finding the application of biomarkers in epidemiological studies of health effects caused by air particles in both environmental and occupational health to be inchoate, they concluded that biomarkers can unravel the complexity of the connection between exposure to air particles and respiratory health. N. A. M. N. Rawi et al. carried out a cross-sectional study among Malay children in Selangor to determine the indoor air quality (IAQ) and its association with respiratory health. They measured the levels of particulate matters (PM), volatile organic compounds (VOCs), carbon monoxide (CO), carbon dioxide (CO2), air velocity (AV), temperature, and relative humidity and found that abnormality of FVC% among children was associated with the concentrations of PM2.5 and CO, while abnormality of FEV1% among children was associated with the concentration of CO. In addition, they found that wheezing was associated with concentrations of PM2.5, PM10, and CO. M. Watanabe et al. also studied the effects of air pollution on the pulmonary function of school children but targeted at the Asian dust storm (ADS). They identified seven ADS days from 2012 to 2013 in the Shimane Prefecture of Japan and observed a larger change in morning peak expiratory flow (PEF) in children after ADS exposure in 2012 (−8.17 L/min versus −1.17 L/min). Using airborne particles collected on ADS days to stimulate THP-G8 cells, they found interleukin-8 transcriptional activity was also higher when particles collected in 2012 were used. Therefore, they argue that the influence of ADS on pulmonary function of children may be related to interleukin-8 production. J.-F. Zou et al. studied the health effects of CO but focused on patients suffering from CO poisoning. They conducted a study in the Shandong Province of China and found that a positive Babinski reflex was an independent predictor for delayed neuropsychiatric sequelae (DNS). With a specificity of 88.6% and a negative predictive value of 97.3%, this sign is particularly useful for identifying patients with a low risk of developing DNS. Also targeting neurotoxicity, O. Isildak et al. studied β-N-oxalyl-L-α,β-diaminopropionic acid (ODAP), a toxin that can cause spastic paraplegia. They developed a novel potentiometric sensor based on ionophore (Cd(NH2CH2CH2OCH2CH2OCH2CH2NH2)Ag3(CN)5), and detection limit was 2 × 10−6 mol L−1, with a response time shorter than 6 seconds. The sensor exhibits good operational stability for more than one week in dry conditions at 4–6°C and has a reproducible and stable response during continuous work for more than 10 hours. Metal and arsenic contamination of water sources also constitute important environmental problems in East Asia and can have severe impacts on humans. A. Waseem et al. reviewed the heavy metal contamination in several areas of Pakistan in recent years, including arsenic, cadmium, lead, chromium, nickel, copper, manganese, iron, and zinc. They found those metals have affected the drinking water quality, ecological environment, and food chain, which poses serious threats to public health. J.-W. Huang et al. focused their study on arsenic and evaluated its association with diabetes mellitus (DM) in Cambodia. They found that drinking water with arsenic levels above 907.25 μg/L and having skin lesions of arsenicosis were associated with a nearly twofold increase in the risk of DM. However, the increases did not reach statistical significance, most likely because of the small case number. The meta-analysis carried out by T.-C. Sung et al. has provided a more comprehensive picture of the association between arsenic exposure and DM. They identified 38 relevant studies, of which the 32 studies on the ingestion route showed a significant association between arsenic exposure and DM. While the heterogeneity among the studies may affect the results, they concluded that ingested arsenic is associated with the development of DM. The papers of this special issue comprise critical and new areas of research and recent advances on challenging issues in different fields of environmental toxicology. They included contributions from cutting edge researches in environmental toxicology that have been recently conducted in the East Asian region and selected papers from works presented in the third conference organized by the East Asia Chapter of the International Society for Environmental Epidemiology (ISEE) held in Kuala Lumpur in 2012. ISEE's membership is open to environmental epidemiologists and other scientists such as environmental toxicologists, and the biannual conference of the East Asia Chapter provides a forum for discussions, critical reviews, collaborations, and education on issues of environmental exposures and their human health effects, focusing on local interests. How-Ran Guo Zailina Hashim Shih-Bin Su Jochen Bundschuh

Studies on the association between arsenic exposure and diabetes mellitus (DM) yielded inconsistent results. Epidemiologic data on the associations between arsenic exposures via inhalation and DM are limited. Therefore, we conducted a meta-analysis to evaluate the risk of DM associated with arsenic exposure. We searched the related literature through a systematic approach and analyzed the data according to the exposure route (inhalation and ingestion). We used random-effect models to estimate the summary relative risks (RRs) for DM associated with arsenic exposure and usedI2statistics to assess the heterogeneity of studies. We identified 38 relevant studies, of which the 32 on the ingestion route showed a significant association between arsenic exposure and DM (RR = 1.57; 95% CI 1.27–1.93). Focusing on the 24 studies in which the diagnosis of DM was confirmed using laboratory tests or medical records, we found that the summary RR was 1.71 (95% CI 1.32–2.23), very close to the overall estimates. We concluded that ingested arsenic is associated with the development of DM, but the heterogeneity among the studies may affect the results.

Whereas studies in Taiwan found associations between arsenic exposure from drinking water and diabetes mellitus (DM), studies in other countries yielded inconsistent results, and diet might be a confounder. We conducted a study in Cambodia, where people have non-Western style diet, to evaluate the association. We measured well water and urine samples and examined skin signs of arsenicosis to assess arsenic exposure and used questionnaires to collect data on potential risk factors. We performed a fingertip blood glucose test followed by measurement of hemoglobin A1c to assess DM. The 43-male and 99-female participants had an average age of 40.4 years. We found that participants with skin signs of arsenicosis had a higher level of arsenic in the drinking water (1101.1 versus 972.2 μg/L,P=0.02). Drinking water with arsenic levels above the median (907.25 μg/L) was associated with a nearly twofold increase in the risk of DM (odds ratio [OR] = 1.7, 95% confidence interval [CI]: 0.5–5.8), so was having skin sings of arsenicosis (OR = 1.7, 95% CI: 0.5–5.6). The ORs did not reach statistical significance most likely because of the small case number. Therefore, further studies with larger study populations are needed to confirm our findings.