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Background: To promote sexual health in adults with an intellectual disability (ID) in Taiwan, sexual health programmes were provided to adults with ID, their parents and service workers. This study evaluates the impact of these programmes that involved the parents and service workers. Methods: Intervention and participatory research paradigms were applied to develop, implement and evaluate programmes that address the challenges that relate to the sexual rights of adults with ID. Additionally, the programmes fostered open dialogue among the participants concerning the sexual health of people with ID. In total, 57 parents and 164 service workers were involved in the programmes. A quasi‐experimental design and standardised questionnaires (Attitudes to Sexuality Questionnaire – Individuals with an Intellectual Disability), as well as in‐depth interviews, were used to collect both quantitative and qualitative data on the programmes' effectiveness and participants' experiences between April 2012 and July 2015. Results: The findings revealed that after the programmes were implemented, attitudes towards the sexual rights of people with ID were significantly more positive among both the parents and service workers. Participation in the sexual health programmes facilitated constructive dialogue by revealing hidden concerns and by transforming the perspectives of the parents and service workers from viewing sexuality as a social problem to understanding the sexual rights of adults with ID. Conclusions: Both the quantitative and qualitative results demonstrate that the programmes had a positive impact on the parents and service workers in terms of their attitudes towards the sexual rights of people with ID. Open dialogue and reciprocal interaction strategies caused transformations in the perspectives of parents and service workers on sexual health. [ABSTRACT FROM AUTHOR]

BACKGROUND: A mouse is an important communication interface between a human and a computer, but it is still difficult to use for the elderly or disabled.OBJECTIVE: To develop a low-cost computer mouse auxiliary tool. METHODS: The principal structure of the low-cost mouse auxiliary tool is the IR (infrared ray) array module and the Wii icon sensor module, which combine with reflective tape and the SQL Server database.RESULTS: This has several benefits including cheap hardware cost, fluent control, prompt response, adaptive adjustment and portability. Also, it carries the game module with the function of training and evaluation; to the trainee, it is really helpful to upgrade the sensitivity of consciousness/sense and the centralization of attention. The intervention phase/maintenance phase, with regard to clicking accuracy and use of time, p value (p< 0.05) reach the level of significance. CONCLUSIONS: The development of the low cost adaptive computer mouse auxiliary tool was completed during the study and was also verified as having the characteristics of low cost, easy operation and the adaptability. To patients with physical disabilities, if they have independent control action parts of their limbs, the mouse auxiliary tool is suitable for them to use, i.e. the user only needs to paste the reflective tape by the independent control action parts of the body to operate the mouse auxiliary tool. [ABSTRACT FROM AUTHOR]

Objectives: 1) to correlate thigh muscle volume measured by magnetic resonance image (MRI) with anthropometric measurements and physical function in elderly subjects; 2) to predict MRI-measured thigh muscle volume using anthropometric measurements and physical functional status in elderly subjects. Design: Crosssectional, nonrandomized study. Setting: Outpatient clinic in Taiwan. Participants: Sixty-nine elderly subjects (33 men and 36 women) aged 65 and older. Measurments: The anthropometric data (including body height, body weight, waist size, and thigh circumference), physical activity and function (including grip strength, bilateral quadriceps muscle power, the up and go test, chair rise, and five meters walk time) and bioelectrical impedance analysis data (including total body fat mass, fat-free mass, and predictive muscle size) were measured. MRI-measured muscle volume of both thighs was used as the reference standard. Results: The MRI-measured thigh volume was positively correlated with all anthropometric data, quadriceps muscle power and the up and go test as well as fat-free mass and predictive muscle mass, whereas it was negatively associated with age and walk time. In predicting thigh muscle volume, the variables of age, gender, body weight, and thigh circumference were significant predictors in the linear regression model: Muscle volume(cm) =4226.3−42.5×Age(year)−955.7×gender(male=1, female=2)+45.9×body weight(kg) +60.0×thighcircumference (cm) (r = 0.745, P < 0.001; Standard Error of the Estimate = 581.6cm). Conclusion: The current work provides evidence of a strong relationship between thigh muscle volume and physical function in the elderly. We also developed a prediction equation model using anthropometric measurements. This model is a simple and noninvasive method for everyday clinical practice and follow-up. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Lin C, Yang C, Shih Y, Hsu H, Yang T, Cheng Y, Chang C, Hsieh L, Chen B, Lee C, Huang Y. Rubella seroepidemiology and estimations of the catch-up immunisation rate and persistence of antibody titers in pregnant women in Taiwan. BJOG 2011;118:706-712. To examine rubella seroepidemiology, and estimate rates of catch-up immunisation and persistence of antibody titers in pregnant women in Taiwan after mass immunisation. A retrospective study. Two medical centres and four regional hospitals specialising in obstetric care. A total of 43 640 prenatal rubella test results for pregnant women from 2001 to 2008. Rubella immunoglobulin G (IgG) antibody assay. Seronegativity, rate of catch-up immunization, and antibody decline. The seronegativity was 10.9% in all pregnant women. Immigrant women had higher seronegativity than indigenous women (OR 2.86; 95% CI 2.65, 3.01). Indigenous women born prior to implementation of the vaccination programmes were more susceptible (20.1%) to rubella infection than were women born thereafter (6.7%). Rates of seropositive conversion were low in both Taiwanese-born and foreign-born women (11.5 and 30.7%, respectively). The rubella antibody titers for vaccinated Taiwanese women in the 1971-1976 and after-1976 birth cohorts declined by 0.6 and 2.3% per year, respectively. This study demonstrates high seronegativity of older indigenous and immigrant women, a low catch-up immunisation rate, and the persistence of rubella antibodies in Taiwan after mass vaccination. Our study suggests that a single dose of rubella vaccine in teenagers effectively increased rubella seropositivity during their childbearing years. This finding is useful for countries that lack the resources necessary for a two-dose regimen. We recommend free rubella antibody tests to women of childbearing age and free vaccination as required. All postpartum women testing negative for rubella antibodies should be vaccinated before they leave hospital. [ABSTRACT FROM AUTHOR]

In the present study, a stage-classified exposure model is developed to better characterize long-term arsenic (As) accumulation of both genders of children, adolescents, and adults through tilapia consumption in Taiwan. Ingestion rate as well as elimination rate of As are treated dynamically and are used to parameterize the stage-classified accumulation model. Model simulations are carried out to produce temporal changes of As body burden of the residents who consume tilapia from blackfoot disease (BFD)-endemic area in three major cities in Taiwan. The model presented here can be served as a strong framework for refining human health risk assessments through fish consumption. [ABSTRACT FROM AUTHOR]

Background:Although the health benefits of vegetarian diets have been well documented among Western population, there are geographic differences of vegetarian diets and the health benefits of the Taiwanese vegetarian diet have not been studied extensively. In addition to conventional risk factors, homocysteine and high-sensitivity C-reactive protein (hs-CRP) levels have been found to predict first atherothrombotic events. We undertook this study to examine the total risk profile of Taiwanese vegetarians.Methods:A total of 198 healthy subjects (99 vegetarians and 99 omnivores) were recruited. Fasting blood samples were analyzed for glucose, cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), white blood cell count, hs-CRP and homocysteine.Results:There was no significant difference in age, body mass index, blood glucose, white blood cell count, triglyceride and HDL-C between the two groups. The vegetarian group had significantly more females (65.7 vs 46.5%); lower body weight (58.66±11.13 vs 62.88±12.24 kg); shorter height (159.14±7.88 vs 162.53 ±8.14 cm); lower total cholesterol (184.74±33.23 vs 202.01±41.05 mg/dl); and lower LDL-C (119.63±31.59 vs 135.89±39.50 mg/dl). Hs-CRP was significantly lower (0.14±0.23 vs 0.23±0.44 mg/dl, P=0.025), whereas homocysteine was significantly higher (10.97±6.69 vs 8.44±2.50 μmol/l, P=0.001) in vegetarians than omnivores.Conclusions:Taiwanese vegetarians have lower total cholesterol, LDL-C and hs-CRP levels, and higher homocysteine levels than omnivores. Owing to different predictive value of each risk factor, the Taiwanese vegetarians had a better cardiovascular risk profile than omnivores. Whether the Taiwanese vegetarian diet should be supplemented with vitamin B12 to lower serum homocysteine level remains to be addressed.European Journal of Clinical Nutrition (2008) 62, 138–144; doi:10.1038/sj.ejcn.1602689; published online 14 March 2007 [ABSTRACT FROM AUTHOR]

Objectives: High-throughput techniques such as cDNA microarray, oligonucleotide arrays, and serial analysis of gene expression (SAGE) have been developed and used to automatically screen huge amounts of gene expression data. However, researchers usually spend lots of time and money on discovering gene-disease relationships by utilizing these techniques. We prototypically implemented an algorithm that can provide some kind of predicted results for biological researchers before they proceed with experiments, and it is very helpful for them to discover gene-disease relationships more efficiently.Methods: Due to the fast development of computer technology, many information retrieval techniques have been applied to analyze huge digital biomedical databases available worldwide. Therefore we highly expect that we can apply information retrieval (IR) technique to extract useful information for the relationship of specific diseases and genes from MEDLINE articles. Furthermore, we also applied natural language processing (NLP) methods to do the semantic analysis for the relevant articles to discover the relationships between genes and diseases.Results: We have extracted gene symbols from our literature collection according to disease MeSH classifications. We have also built an IR-based retrieval system, "Biomedical Literature Retrieval System (BLRS)" and applied the N-gram model to extract the relationship features which can reveal the relationship between genes and diseases. Finally, a relationship network of a specific disease has been built to represent the gene-disease relationships.Conclusions: A relationship feature is a functional word that can reveal the relationship between one single gene and a disease. By incorporating many modern IR techniques, we found that BLRS is a very powerful information discovery tool for literature searching. A relationship network which contains the information on gene symbol, relationship feature, and disease MeSH term can provide an integrated view to discover gene-disease relationships. [ABSTRACT FROM AUTHOR]

The article presents a study to establish the chronic toxicity of zinc followed by a standardized growth toxicity test and to determine the growth rates, the no-observed effect concentration, the lowest-observed effect concentration and the median effected concentration of abalone after 20 day chronic exposure. A total numbers of 240 abalone Haliotis diversicolor supertexta with an average shell length were collected from Toucheng, the most important farming areas for the production of abalone on the north coast of Taiwan, on August 4, 2002, for the chronic toxicity test.

Six isolates of infectious pancreatic necrosis virus (IPNV) were obtained from trout or eel farms in Taiwan in 1987. By using the electrophoretic analysis of 35S-methioninelabelled early viral polypeptide patterns and silver-stained ds RNA gel patterns, a comparison of these isolates with the three archetypal IPNV serotypes (AB, SP and VR-299) was made. They were all identical with VR-299, both in the RNA and early viral polypeptide patterns. From the results obtained, it was apparent that the VR-299 serotype of IPNV was just as widespread in eel as in trout in Taiwan. This is the first case of VR-299 isolation from eel. [ABSTRACT FROM AUTHOR]

Pay-for-Performance (P4P) to better manage chronic conditions has yielded mixed results. A better understanding of the cost and benefit of P4P is needed to improve program assessment. To this end, we assessed the effect of a P4P program using a quasi-experimental intervention and control design. Two different intervention groups were used, one consisting of newly enrolled P4P patients, and another using P4P patients who have been enrolled since the beginning of the study. Patient-level data on clinical indicators, utilization and expenditures, linked with national death registry, were collected for diabetic patients at a large regional hospital in Taiwan between 2007 and 2013. Net value, defined as the value of life years gained minus the cost of care, is calculated and compared for the intervention group of P4P patients with propensity score-matched non-P4P samples. We found that Taiwan's implementation of the P4P program for diabetic care yielded positive net values, ranging from $40,084 USD to $348,717 USD, with higher net values in the continuous enrollment model. Our results suggest that the health benefits from P4P enrollment may require a sufficient time frame to manifest, so a net value approach incorporating future predicted mortality risks may be especially important for studying chronic disease management. Future research on the mechanisms by which the Taiwan P4P program helped improve outcomes could help translate our findings to other clinical contexts., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

As nations strive to achieve and sustain universal health coverage (UHC), they seek answers as to what health system structures are more effective in managing health expenditure inflation. A fundamental macro-level choice a nation has to make is whether to adopt a single- or a multiple-payer health system. Using Taiwan's National Health Insurance (NHI) as a case, this paper examines how a single-payer system manages its health expenditure growth and draws lessons for other countries whose socioeconomic development is similar to Taiwan's. Our analyses show that as a single payer, Taiwan's NHI is able to exercise its monopsony power to manage its health expenditure growth. This is achieved primarily through the adoption of a system-wide global budget. The global budget sets a hard aggregate budget cap to limit NHI's total spending to its expected revenue, with the annual budget growth rate established by a process of negotiation among key stakeholders. The global budget system is complemented by comprehensive and continuous monitoring and review of encounter records of all providers and patients, enabled by the NHI's advanced information technology. However, by paying its providers using a point-based fee schedule, Taiwan's NHI suffers from inefficient service provision. In particular, providers have incentives to increase use of services and drugs with positive profit margins. Furthermore, Taiwan demonstrates that its control of NHI expenditure growth might be leading it to inadequately meet the changing needs of the population, resulting in the rapid growth of private insurance to cover services excluded or not fully covered by the NHI. If this trend persists and results in a two-tier system, Taiwan's NHI may risk compromising the equity it has achieved in the past two decades., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Chen Zi(1878-1927), who also styled himself as "Yi Qing" or "Yi Qin" , was a famous ophthalmologist in the early period of the Republic of China.He compiled and translated serial of classical Japanese modern medical books thus promoted western medicine propagation to the east in the early period of the Republic of China, and founded the first Chinese-established eye hospital in China to serve the patients from Shanghai as well as other places in China.Also, Dr. Chen devoted himself to the combination of traditional Chinese medicine and Western medicine for his whole life.He wrote the book of Zhong Xi Yan Ke Hui Tong (, Combination of Western and Eastern Medicine in Ophthalmology )which has promoted traditional Chinese medicine into modernization.In Dr.Chen's life, he was associated with some figures from army and in political circles at that time. Besides, he did a lot of things to support the education in his hometown.Dr. Chen was a typical model to understand the clinical doctors in the early period of the Republic of China.

Background: Costs of medical care have been found to be highest at the end of life., Aim: To evaluate the effect of provider reimbursement for hospice care on end-of-life costs., Design: The policy expanded access to hospice care for end-stage renal disease patients, a policy previously limited to cancer patients only. This study employed a difference-in-differences analysis using a generalized linear model. The main outcome is inpatient expenditures in the last 30 days of life., Setting/participants: A cohort of 151,509 patients with chronic kidney disease or cancer, aged 65 years or older, who died between 2005 and 2012 in the National Health Insurance Research Database, which contains all enrollment and inpatient claims data for Taiwan., Results: Even as end-of-life costs for cancer are declining over time, expanding hospice care benefits to end-stage renal disease patients is associated with an additional reduction of 7.3% in end-of-life costs per decedent, holding constant patient and provider characteristics. On average, end-of-life costs are also high for end-stage renal disease (1.88 times higher than those for cancer). The cost savings were larger among older patients-among those who died at 80 years of age or higher, the cost reduction was 9.8%., Conclusion: By expanding hospice care benefits through a provider reimbursement policy, significant costs at the end of life were saved.

Objective: To examine the impact of provider competition under global budgeting on the use of cesarean delivery in Taiwan., Data Sources/study Setting: (1) Quarterly inpatient claims data of all clinics and hospitals with birth-related expenses from 2000 to 2008; (2) file of health facilities' basic characteristics; and (3) regional quarterly point values (price conversion index) for clinics and hospitals, respectively, from the fourth quarter in 1999 to the third quarter in 2008, from the Statistics of the National Health Insurance Administration., Study Design: Panel data of quarterly facility-level cesarean delivery rates with provider characteristics, birth volumes, and regional point values are analyzed with the fractional response model to examine the effect of external price changes on provider behavior in birth delivery services., Principal Findings: The decline in de facto prices of health services as a result of noncooperative competition under global budgeting is associated with an increase in cesarean delivery rates, with a high degree of response heterogeneity across different types of provider facilities., Conclusions: While global budgeting is an effective cost containment tool, intensified financial pressures may lead to unintended consequences of compromised quality due to a shift in provider practice in pursuit of financial rewards., (© Health Research and Educational Trust.)

Global budget payment is one of the most effective strategies for cost containment, but its impacts on provider behavior have not been explored in detail. This study examines the theoretical and empirical role of global budget payment on provider behavior. The study proposes that global budget payment with price adjustment is a form of common-pool resources. A two-product game theoretic model is derived, and simulations demonstrate that hospitals are expected to expand service volumes, with an emphasis on products with higher price-marginal cost ratios. Next, the study examines the early effects of Taiwan's global budget payment system using a difference-in-difference strategy and finds that Taiwanese hospitals exhibited such behavior, where the pursuit of individual interests led to an increase in treatment intensities. Furthermore, hospitals significantly increased inpatient service volume for regional hospitals and medical centers. In contrast, local hospitals, particularly for those without teaching status designation, faced a negative impact on service volume, as larger hospitals were better positioned to induce demand and pulled volume away from their smaller counterparts through more profitable services and products such as radiology and pharmaceuticals., (Copyright © 2014 John Wiley & Sons, Ltd.)

Objective: To examine rubella seroepidemiology, and estimate rates of catch-up immunisation and persistence of antibody titers in pregnant women in Taiwan after mass immunisation., Design: A retrospective study., Setting: Two medical centres and four regional hospitals specialising in obstetric care., Sample: A total of 43,640 prenatal rubella test results for pregnant women from 2001 to 2008., Methods: Rubella immunoglobulin G (IgG) antibody assay., Main Outcome Measures: Seronegativity, rate of catch-up immunization, and antibody decline., Results: The seronegativity was 10.9% in all pregnant women. Immigrant women had higher seronegativity than indigenous women (OR 2.86; 95% CI 2.65, 3.01). Indigenous women born prior to implementation of the vaccination programmes were more susceptible (20.1%) to rubella infection than were women born thereafter (6.7%). Rates of seropositive conversion were low in both Taiwanese-born and foreign-born women (11.5 and 30.7%, respectively). The rubella antibody titers for vaccinated Taiwanese women in the 1971-1976 and after-1976 birth cohorts declined by 0.6 and 2.3% per year, respectively., Conclusions: This study demonstrates high seronegativity of older indigenous and immigrant women, a low catch-up immunisation rate, and the persistence of rubella antibodies in Taiwan after mass vaccination. Our study suggests that a single dose of rubella vaccine in teenagers effectively increased rubella seropositivity during their childbearing years. This finding is useful for countries that lack the resources necessary for a two-dose regimen. We recommend free rubella antibody tests to women of childbearing age and free vaccination as required. All postpartum women testing negative for rubella antibodies should be vaccinated before they leave hospital., (© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.)

The long-term outcome of 1390 children with acute lymphoblastic leukemia (ALL), treated in two successive clinical trials (Taiwan Pediatric Oncology Group (TPOG)-ALL-97 and TPOG-ALL-2002) between 1997 and 2007, is reported. The event-free survival improved significantly (P=0.0004) over this period, 69.3+/-1.9% in 1997-2001 to 77.4+/-1.7% in 2002-2007. A randomized trial in TPOG-97 testing L-asparaginase versus epidoxorubicin in combination with vincristine and prednisolone for remission induction in standard-risk (SR; low-risk) patients yielded similar outcomes. Another randomized trial, in TPOG-2002, showed that for SR patients, two reinduction courses did not improve long-term outcome over one course. Decreasing use of prophylactic cranial irradiation in the period 1997-2008 was not associated with increased rates of CNS relapse, prompting complete omission of prophylactic cranial irradiation from TPOG protocols, beginning in 2009. Decreased use of etoposide and cranial irradiation likely contributed to the low incidence of second cancers. High-risk B-lineage ALL, T-cell, CD10 negativity, t(9;22), infant, and higher leukocyte count were consistently adverse factors, whereas hyperdiploidy >50 was a consistently favorable factor. Higher leukocyte count and t(9;22) retained prognostic significance in both TPOG-97 and TPOG-2002 by multivariate analysis. Although long-term outcome in TPOG clinical trials is comparable with results being reported worldwide, the persistent strength of certain prognostic variables and the lower frequencies of favorable outcome predictors, such as ETV6-RUNX1 and hyperdiploidy >50, in Taiwanese children warrant renewed effort to cure a higher proportion of patients while preserving their quality of life.

Objective: To understand the association between the SARS outbreak and the environmental temperature, and to provide a scientific basis for prevention and control measures against it., Methods: The daily numbers of the probable SARS patients and the daily meteorological factors during the SARS outbreak period in Hong Kong, Guangzhou, Beijing, and Taiyuan were used in the data analysis. Ecological analysis was conducted to explore the association between the daily numbers of probable SARS patients and the environmental temperature and its variations., Results: There was a significant correlation between the SARS cases and the environmental temperature seven days before the onset and the seven day time lag corresponds well with the known incubation period for SARS. The optimum environmental temperature associated with the SARS cases was between 16 degrees C to 28 degrees C, which may encourage virus growth. A sharp rise or decrease in the environmental temperature related to the cold spell led to an increase of the SARS cases because of the possible influence of the weather on the human immune system. This study provided some evidence that there is a higher possibility for SARS to reoccur in spring than that in autumn and winter., Conclusion: Current knowledge based on case studies of the SARS outbreak in the four cities suggested that the SARS outbreaks were significantly associated with the temperature and its variations. However, because the fallacy and the uncontrolled confounding effects might have biased the results, the possibility of other meteorological factors having an affect on the SARS outbreaks deserves further investigation.

Microbial contamination levels at broiler slaughter plants were investigated at three major slaughter plants in Taiwan during the summer and winter. The microbial contamination levels in chicken carcasses and on food contact surfaces were examined using the swab method. The results indicated that the bacterial counts were affected by the slaughter processing plant, processes, and season (P < 0.05). The bacterial counts on food contact surfaces of the equipment before operation were not significantly lower than those after processing. Regardless of the bacterial type, bacterial counts of chicken carcasses generally decreased from the scalding step to the washing step before evisceration and then increased. The cleaning procedures for food contact surfaces should be evaluated, and special attention should be given to utensils used during processing, such as gloves, baskets, and hand tools.

Persistent humoral autoimmunity to the enzyme glutamic acid decarboxylase (GAD) has been described in a substantial proportion of patients with type 1 diabetes mellitus. Higher prevalence of GAD antibody in diabetes patients using a new radioligand-binding assay with recombinant human GAD65 antibodies (GAD65Ab) has been seen in several studies. Using this method, we have reassessed the prevalence of GAD65Ab and investigated the association of GAD65Ab with HbA1C values, C-peptide values, HLA-DR typing and thyroid autoimmune antibody in 70 Chinese children with type 1 diabetes mellitus (mean age of onset 8.21+/-3.84 years, mean duration 3.39+/-2.54 years). Our result revealed that GAD65 antibodies were present in 54.3% (38/70) of diabetes children. There was no significant difference in gender, diabetes onset and duration, HbA1c, C-peptide concentration and frequencies of HLA DR3, DR4, DR9, DR3/DR4, DR3/DR9 and DR4/DR9 genotypes between GAD65Ab+ and GAD65Ab- groups. There was no negative correlation between GAD65Ab values and duration of diabetes in those with GAD65Ab positivity (r=-0.239, P>0.05). The frequencies of antimicrosomal and anti-thyroglobulin antibodies in GAD65Ab+ (13.5,8.1%, respectively) were not different from GAD65- patients (9.4,12.5%, respectively).

Screening for the human T-cell lymphotropic virus type I (HTLV-I) and-II in blood donors was implemented in Taiwan beginning in February 1996. The purpose of the present study was to investigate the changes in HTLV-I seroprevalence in all unpaid blood donors in Taiwan during the period from February 1996 to December 1999 and to determine the influence of age and sex on the HTLV-I seropositivity of donors. HTLV-I and HTLV-II screening was performed using combined HTLV-I/II immunoassay. Repeated reactive samples were confirmed by Western blot analysis. Of a total of 3,701,087 donors in all 6 blood centers in Taiwan, 2,311 (0.058%) were seropositive for HTLV-I. The HTLV-I seropositivity was 0.130%, 0.063%, 0.044%, and 0.032% in the years 1996, 1997,1998, and 1999, respectively. There was a linear increase of HTLV-I seropositivity with advancing age. The HTLV-I carrier rate for female donors was twice that for the male donors. Ninty-seven percent of HTLV-I seropositive results came from first-time donors. Our findings suggest that Taiwan is a low-prevalence nonendemic area for HTLV-I infection. The large-scale HTLV-I screening program has decreased HTLV-I seropositivity among blood donors and is useful for preventing HTLV-I transmission via blood transfusion.

The purpose of this study was to examine differences between Taiwanese children with autism and their typically developing peers on the Wisconsin Card Sorting Test (WCST). Twenty-six children with autism of normal IQ were included, and matched for chronological age with 52 controls. The WCST scores of the typically developing children were significantly higher for categories completed and percent conceptual level than in the autism group. Scores on perseverative responses, perseverative errors, the number of trials to complete the first category and non-perseverative errors were significantly higher in the autism group. The implications of these findings are discussed.

Infection of cytomegalovirus (CMV) via contaminated blood may endanger immunocompromised patients that require transfusion therapy. The aim of this study is to determine the prevalence of CMV antibodies in the blood donor population in Southern-central Taiwan. A total of 1800 consecutive sera, obtained from Tainan Blood Center of Chinese Blood Services Foundation (CBSF), were tested for CMV antibodies by two commercial enzyme immunoassays (EIAs). Of the sera tested, 150 (8.3%) were found to be CMV seronegative. The frequency of CMV seropositivity revealed no significant difference between male and female donors. The frequency of CMV seronegativity showed a stepwise decrease with the increase of donor age. In addition, the prevalence of HBsAg, antibodies to hepatitis C virus (anti-HCV), antibodies to human immunodeficiency viruses type 1 and 2 (anti-HIV 1 + 2) and antibodies to human T-cell lymphotropic viruses type I and II (anti-HTLV I/II) were compared between CMV seropositive and seronegative groups. Our results showed that there was no significant difference in seroprevalence of these markers between CMV seropositive and seronegative groups. Our findings also showed that six out of twenty (30.0%) premature neonates were CMV-seropositive. These premature specimens and those EIA discrepancy samples were confirmed by specific nucleic acid amplification using polymerase chain reaction (PCR). Our results suggest that a program which aims to supply CMV seronegative blood or blood components to the patients, should not solely depend on current antibody screening methods in an area where CMV infection is highly endemic. Amendments such as PCR testing, leukocyte reduction by filtration before transfusion may be more practical.

Taipei China had been free from foot and mouth disease (FMD) over 68 years before the disease occurred in March 1997. The first suspected case was recorded on a pig farm in the Hsinchu Prefecture on 14 March 1997. Based on clinical signs, gross histopathological findings, and results of enzyme-linked immunosorbent assays and reverse-transcriptase polymerase chain reaction tests, diagnosis of FMD was confirmed by the Taiwan Animal Health Research Institute on 19 March 1997 and was reconfirmed by the FMD World Reference Laboratory in Pirbright (United Kingdom), on 25 March 1997. By the end of July 1997, 6,147 pig farms (about a quarter of the pig farms in Taipei China), were affected. The disease was well under control within two months by means of stamping-out and blanket vaccination. The Government purchased 21 million doses of inactivated oil-adjuvant FMD vaccine, which allowed for two injections per pig and one injection of other cloven-hoofed animals. Before the vaccine was used, the stamping-out policy was implemented, ensuring that all pigs in the affected farms were destroyed. After blanket vaccination, a partial stamping-out policy was adopted, i.e. only pigs showing clinical signs were destroyed.

Thirty paediatric patients with acute lower respiratory tract infections (ALRI) caused by simultaneous multiple viral infections (SMV) in a 3-year interval were reviewed. Twenty patients were infected with two viruses simultaneously; nine patients with three viruses; and one patient with four viruses. The frequency of individual viruses were: adenovirus, 18 (60 per cent); respiratory syncytial virus, 7 (23 per cent); influenza virus type A, 6 (20 per cent); influenza virus type B, 15 (50 per cent); parainfluenza virus type 1, 11 (37 per cent); parainfluenza virus type 3, 13 (43 per cent). There was no difference between the clinical presentations of ALRI with SMV and those of ALRI with a single virus. In conclusion, SMV was not uncommon in children with ALRI; the clinical presentations of multiple viral infection were similar to those of single viral infection.

To characterize mutations in the glucose-6-phosphate dehydrogenase (G6PD) gene in Chinese infants, we studied 213 G6PD-deficient infants without blood exchange transfusion (BET) therapy, and 34 patients who required BET therapy for their severe hyperbilirubinaemia after birth. Nine different point mutations were characterized in all infants. Of these mutations, the G to T substitution at cDNA nucleotide (nt) 1376, which accounts for the mutations in 131 (53.0%) neonates, followed by G to A substitution at nt 1388 in 18 (10.5%) infants, A to G substitution at nt 493 in 17 (6.9%) infants, A to G substitution at nt 95 in 10 (4.1%) infants, C to T substitution at nt 1024 in six (2.4%) infants, and G to T substitution at nt 392 in three (1.2%) infants, G to A substitution at nt 487 in two (0.8%) infants, C to T substitution at nt 1360 in two (0.8%) infants and C to T substitution at nt 592 in two (0.8%) infants. Mutations in 48 (19.5%) G6PD-deficient infants were not characterized. Most (64.7%) mutations in the G6PD-deficient infants who required BET therapy after birth result from a G to T substitution at nt 1376. The enzyme activity of G6PD deficient infants who required BET therapy is significantly lower than for those who did not, even in a group with the same variant (as in 1376 mutation). Severe neonatal jaundice requiring BET therapy can take place with the majority of variants encountered in this area.

We encountered five children with peripheral T-cell lymphoma (PTL) at National Taiwan University Hospital (NTUH) from 1985-1989. The patients were four boys and one girl, aged between 5 and 13 years. The duration of prediagnostic symptoms varied from 1 month to 5 years. All had pyrexia and lymphadenopathy; one had a prolonged history of granulomatosis with repeated infection. Four had hepatosplenomegaly. One patient presented with diffuse pulmonary infiltration and impending respiratory failure. All patients were negative for human T-cell leukemia virus (HTLV)-I antibody, and positive for HBsAg. Four patients who had EBV-viral capsid antigen (VCA) IgG and who were IgM tested were positive for EBV-VCA IgG, but only two had evidence of active EBV infection. Tumor cell markers were examined and showed the following phenotypes: all patients were CD2, CD3, and CD7 positive but CD19 and CD20 negative; three patients were CD4 positive and CD8 negative; the other two patients were CD4 negative and CD8 positive. Four patients died 2-7 months after diagnosis. The remaining patient received allogeneic bone marrow transplantation and has survived free of disease for more than 22 months after transplant. Our five cases reconfirm the high frequency of diagnostic delay, the heterogenous immunophenotypes, high mortality, and poor responsiveness to conventional therapy for PTL. Bone marrow transplantation in the early stage might be a possible cure of this disease.

Chlamydia pneumoniae (TWAR) is a relatively newly discovered respiratory tract pathogen which was first isolated in Taiwan. In order to describe the seroepidemiology of C. pneumoniae in Taiwan, we evaluated 1,085 stored serum samples: 904 from patients, 97 from umbilical cord blood samples, and 84 from medical personnel at the Veterans General Hospital-Kaohsiung, between January 1 and April 30, 1991. Antibodies were determined by the use of a microimmunofluorescence test using elementary bodies of C. pneumoniae AR-39 as antigen. Sera were tested with screening titres of 16 and 512 for immunoglobulin G antibody. The antibody prevalence was found to be 23.1% in young children (6 months to 10 years old), rising to 66.7% in teenagers, and to 96.2% in older age groups. These rates were higher than any reported earlier. The progressively increasing rates of seropositivity found in older individuals indicated a surge of reinfection in these age groups. Only 5 cases were found with micro-IF IgG titres equal to or greater than 512. All were asymptomatic according to the hospital records. In addition to a high prevalence rate in Taiwan, the data also showed high infection rates in teenagers and elderly people.

The prevalence of amphetamine use was studied using an anonymous questionnaire given to 3548 adolescent students aged 12--15, with a response rate of 98.6%. This questionnaire was developed and evaluated by the authors. A complete set of data was collected on 3200 subjects, making up 90.2% of all students surveyed. Eighty-five (2.7%) students admitted that they had used amphetamines; that is, 64 of the 1,584 male (4.0%), and 21 of the 1,616 female (1.3%) respondents. The life-time prevalence odds ratio estimation was elevated in male (POR = 3.2, 95% CI 1.9--5.3), as compared to female students. The life-time prevalence rates increased with age only among male students (P trend = 0.01). Seven hundred and twenty four male students were randomly tested for the presence of amphetamines in their urine using thin layer chromatography and fluorescence polarization immunoassay. Of six students who tested positive, five asserted that they had not used amphetamines. The point prevalence rate of amphetamine use based on the urine tests was 0.9% among the 652 students who had completed questionnaires. This rate was higher than on self-reported use of amphetamines (rate difference 0.9%, 95% CI 0.2--1.6%). In this group, 27 (4.1%) admitted that they had used amphetamines. The estimated overall life-time prevalence rate was at least 4.9% (32/652), with 95% CI between 3.2% and 6.6%.

During a 2-year period from January 1988 to December 1989, 125 patients (68 boys, 57 girls), aged 30 days to 9 years, were diagnosed as rotavirus gastroenteritis at this hospital. Diagnosis was made by identification of the rotavirus antigen in stool samples by latex agglutination assay. Ninety-nine (79.2%) of them were under 2 years of age. The seasonal peak in incidence was from January to March. The most common clinical characteristics were watery diarrhea (100%), followed by vomiting (68.8%), fever (68.0%), cough (42.4%), rhinorrhea (17.6%), convulsions (6.4%) and moderate to severe dehydration (1.6%). Fecal occult blood was positive in 4 patients and fecal leukocytes were positive in one patient. Stool cultures revealed concomitant infections with enteropathogenic Escherichia coli in 4 patients. Of the 106 patients who underwent serum electrolyte examinations, serum sodium concentrations ranged from 135-145 meq/L in 81.9% (86/106) and serum potassium concentrations ranged from 3.5-5.0 meq/L in 86.8% (92/106). Leukocyte counts greater than 15,000/mm3 were found in 10.8% (13/120) of the patients. All 125 patients recovered from the diarrheal illness on follow-up. Our results showed a different seasonal distribution of this disease from that of a previous observation between 1983-1984 in Taipei City and provides original clinical information on rotavirus gastroenteritis in children living in an area of Taipei County. Using the simple and rapid latex agglutination assay, we can make early diagnosis of rotavirus gastroenteritis. Thus, early treatment and early isolation of patients to prevent nosocomial infection among hospitalized patients is possible.

A study was made of the cellular and molecular characteristics of nine Chinese infants, consecutively presenting with acute leukemia. Five cases were acute lymphoblastic leukemia (ALL); four were acute nonlymphoblastic leukemia (ANLL). Hyperleukocytosis, hepatosplenomegaly, and poor response to conventional therapy were common features, and CNS involvement was detected at diagnosis in three cases. The blast cells from all five cases with ALL expressed early B-cell markers, i.e., HLA-DR+, CD19+, but CD10-. Terminal deoxynucleotidyl transferase (TdT) was present in blasts from four of the five cases and periodic acid-Schiff staining in blasts from two patients only. The leukemic cells of one patient also showed positive nonspecific esterase activity and expressed myeloid-associated antigens CD33 (My9), CD11 (OkM1), and CD14 (My4 and Mo2). Molecular analysis of leukemic cell DNA from this and two other patients showed rearrangement of the immunoglobulin (Ig) heavy-chain genes, but without any evidence of kappa light-chain gene rearrangement. T-cell receptor (TCR) genes remained in the germline configuration in these cases. Cytogenetic analysis showed translocation t(4;11) (q21;q23) in all four cases studied. In the group of ANLL, three cases belonged to the M4 and one to the M2 subtype. Chromosomal abnormality involving 11q23 was also detected in two patients: t(11;17)(q23;q11) and del(11)(q14q23) in each case respectively. Neither Ig nor TCR gene rearrangement was present in blast cells from patients with ANLL. The data indicate that chromosomal rearrangement of band 11q23 was quite common in Chinese infants with either form of leukemia, a finding that may have pathogenetic implications.

The prevalence of dental caries and dental fluorosis was assessed in 5,107 children (2,669 boys and 2,438 girls) aged 6 to 16 years who were lifelong residents of Shenkang Hsiang. The drinking water in the various villages in this area contains negligible, optimal, and above-optimal concentrations of natural fluoride. The prevalence of caries in the optimal fluoride areas was 10.7% lower than in the negligible fluoride area. In the above-optimal fluoride areas, even greater protection from caries was evident. Caries protection was compromised, however, in children with severe fluorosis. The effect may result from food, debris, or plaque being entrapped in the hypoplastic defects of severely fluorosed enamel. Data from children residing in the optimal and above-optimal fluoride areas show that older children are affected more by fluorosis than younger children, according to the Tooth Surface Index of Fluorosis. The relevant variables associated with secular changes in the prevalence of fluorosis are explored. Of the 14 communities studied, chyuarnshing, Dahturng, and Haaiweei, according to the Community Fluorosis Index, represent a medium fluorosis problem, while Dihngsing and Shehgun represent a slight public health fluorosis problem. The remaining communities have no public health fluorosis problem.