Search

Purpose: Previous suicide behavior predicts future suicide risk. Studies of suicide repetition are important for suicide prevention. This study examined the clinical characteristics and psychiatric comorbidities of pesticide self-harm as associated with suicide attempt repetition status. Patients and Methods: This retrospective, observational study included patients admitted to a medical center in northern Taiwan between 2000 and 2015 following suicide attempts by pesticide. Diagnoses were made by a consultation-liaison psychiatry team based on the DSM IV-TR criteria. Independent samples t-test was used to analyze the quantitative variables and Pearson's Chi-squared test with a Bonferroni adjustment for categorical variables. Univariate binary logistic regression analysis was conducted to determine the predictors for repeated suicide attempt and multivariate binary logistic regression analysis to identify significant associated factors. Results: Among 151 patients, organophosphate pesticides were the most used (80.8%). The average age was 52.9± 17.2 years. Most patients were married males from rural areas, with depressive disorder most often diagnosed (40.4%). Nearly one-third of them were suicide repeaters (n=43, 28.5%); these patients were less likely to be married (53.5%, p=0.001), had previously used psychiatric services (72.1%, p< 0.001) and chose complex suicide (46.5%, p=0.014) more often compared to nonrepeaters. No significant differences were found between repeaters and nonrepeaters regarding psychiatric comorbidities. Multivariate logistic regression analysis revealed that marital status (odds ratio: 2.916, 95% confidence interval: 1.234– 6.891, p=0.015) and previous psychiatric services usage (odds ratio: 6.897, 95% confidence interval: 3.012– 15.625, p< 0.001) were significant risk factors associated with suicide repetition. Conclusion: Pesticide suicide repeaters were characterized by less likely to be married and more likely to use psychiatric services before suicide attempts. These features help ensuring that the needs of people who have made a suicide attempt are addressed, and it reduces the likelihood of repetition. [ABSTRACT FROM AUTHOR]

Patients in intensive care units (ICUs) often experience stress and anxiety. Although stress and anxiety can be pharmacologically attenuated, some drugs cause adverse side effects such as bradycardia, immobility, and delirium. There is thus a need for an alternative treatment with no substantial adverse effects. Music intervention is a potential alternative. In the present study, we used cortisol levels, subjective questionnaires, and physiological parameters to explore the anxiety-reducing effects of music intervention in a sample of ICU patients on mechanical ventilation. Patients admitted to the ICU for ≥ 24 hr were randomly assigned to the music intervention (n = 41) or control group (n = 44). Music group patients individually listened to music from 4:00 to 4:30 p.m.; control group patients wore headphones but heard no music for the same 30 min. Anxiety was measured using serum cortisol levels, the Chinese Version of the State-Trait Anxiety Inventory, the Visual Analogue Scale for Anxiety, heart rate, and blood pressure. After adjusting for demographics, analysis of covariance showed that the music group had significantly better scores for all posttest measures (p < .02) and pre–post differences (p < .03) except for diastolic blood pressure. Because of music intervention’s low cost and easy administration, clinical nurses may want to use music to reduce stress and anxiety for ICU patients. A single 30-min session might work immediately without any adverse effects. However, the duration of the effect is unclear; thus, each patient’s mood should be monitored after the music intervention. [ABSTRACT FROM AUTHOR]

While there is considerable research exploring the link between high-commitment human resource ( HR) practices and firm performance, the contingencies (or boundary conditions) that might affect this relationship have received little attention. This paper proposes to explore this gap by analysing data drawn from a service industry (hair salons) in Taiwan. Building upon social exchange theory, the paper tests four hypotheses exploring the link between high-commitment HR practices and store performance, the mediating role of 'helping' or organizational citizenship behaviour ( OCB), and the moderating effects of demographic and functional diversity. One finding is that age diversity, the most applicable indicator of demographic diversity, was found to undermine the linkages between high-commitment HR practices, helping behaviour and store performance. In contrast, educational diversity - a key indicator of functional diversity - reinforced those relationships. This study also compares the relative moderating strengths of two diversity dimensions upon the mediation relationship of the HRM bundle, OCB and store performance and shows that functional diversity is the more potent moderator. The paper supports the view that there is no direct and universal relationship between high-commitment HR practices and performance. Instead the relationship is heavily moderated by contingent factors such as the various dimensions of workforce diversity. [ABSTRACT FROM AUTHOR]

Background Postnatal exposure to anesthetics can cause neural apoptosis and degeneration in animals, but results from studies conducted on humans were discordant. Previous studies contained no information on the relationship between neurobehavioural disorders and anesthesia exposure in Asian children. We conducted a retrospective matched-cohort study in Taiwan to investigate the association of early life anesthesia exposure with risk of attention deficit/hyperactivity disorder ( ADHD). Methods Data were obtained from the National Health Insurance Research Database of Taiwan. Children born between January 1, 2001 and December 31, 2005 were included. Each child with anesthesia exposure before 3 years of age was matched to four unexposed children. Observation was concluded on December 31, 2010. Proportional hazards regression was used to assess the association of anesthesia exposure with ADHD. Analyses were also made based on exposure number and age at the time of first exposure. Results This matched-cohort comprised of 16 465 children, among which 3293 were exposed to general anesthesia before age 3 years. The adjusted hazard ratio of developing ADHD was 1.06 (95% CI: 0.86,1.31) for general anesthesia exposure. The adjusted hazard ratio of developing ADHD for single and multiple exposures were 1.11 (95% CI: 0.88, 1.41) and 0.96 (95% CI: 0.71,1.31), respectively. No trend of increasing risk was noted based on age at the time of first exposure. Conclusions Exposure to general anesthesia before 3 years of age was not associated with ADHD. [ABSTRACT FROM AUTHOR]

This paper investigates prenatal care utilization, identifies factors affecting the adequacy of prenatal care, and explores the effect of adequate initial timing of prenatal care on total prenatal care visits among Taiwan new immigrant females. Data was obtained from the 2008 Prenatal Care Utilization among Taiwan New Immigrant Females Survey on women who either had at least one preschool-aged child or had delivered their infants but were still hospitalized (N = 476). The Adequacy of Prenatal Care Utilization Index was applied to rate the prenatal care adequacy. The logistic regression model was used to investigate factors associated with the adequacy of prenatal care utilization, and the linear regression model was estimated to identify the impact of influential factors on the prenatal care usage. Females' nationality, employment, and transportation convenience increased the likelihood of receiving adequate prenatal care. Having adequate initial timing of prenatal care was found to be positively related to the frequency of prenatal care visits. Prenatal care utilization can be affected by factors within the health care system and by characteristics of the population; therefore, a measure of prenatal care utilization cannot distinguish these factors but reflects the result of all of them in varying combinations. [ABSTRACT FROM AUTHOR]

Antenatal clinical breast examinations (ANCBEs) performed by physicians or nurses during prenatal care visits are recommended by the Department of Health in Taiwan. This study aimed to assess the level of acceptance of ANCBE in Taiwan and the determinants associated with behavior toward them. This was a clinic-based study conducted from 30 November 2008 to 30 April 2009 by using a structured questionnaire for 492 pregnant women. Only 2.8% of the patients received ANCBE, and 95.9% were not aware of the availability of ANCBE. History of breast surgery and awareness of ANCBE availability were significantly associated with receiving ANCBE (P < .001). Furthermore, multiparity was statistically different for the awareness of ANCBE availability (P = .04). Acceptance of ANCBE was determined by personal history of breast surgery and awareness of ANCBE availability. [ABSTRACT FROM PUBLISHER]

Abstract: The objectives of the present study were to quantify (1) the emission factors of a variety of dioxin emission sources; (2) the overall dioxin emission inventory in Taiwan as well as in a major metropolitan (KC area); and (3) the contribution of power plants to the overall PCDD/F emission. To achieve these goals, a total of 95 flue gas samples were collected and analyzed for 17 PCDD/Fs from 20 sources to develop emission factors. The emission factor of PCDD/Fs from coal-fired power plants (0.62μgI-TEQton−1) obtained in this study is considerably higher than the values reported from different countries including UK, USA, and Spain by a factor of 2–265. It means that the air pollution control devices in certain power plants need to be more efficient. The emission data showed that there is a total annual release to air of 6.1 and 95gI-TEQ from major sources in the KC area and Taiwan, respectively. The dominant sources of PCDD/Fs in the KC area are the coal-fired power plants, secondary aluminum smelting, electric arc furnaces, and open burning of rice straw, which contributed for 56%, 17%, 13%, and 3.3% to the total, respectively. However, in Taiwan, the dominant sources of PCDD/Fs are the iron ore sintering, coal-fired power plants, electric arc furnaces, and open burning of rice straw, which contributed for 32%, 28%, 23%, and 8.1% to the total, respectively. The results of this study showed that coal-fired power plants are very significant sources of PCDD/Fs and also provide an important database to assist the decision makers for formulating policies to alleviate dioxin concerns. [Copyright &y& Elsevier]

Cigarette smoke is one of the most important environmental risk factors for the development of cervical intraepithelial neoplasms (CINs). Given that the prevalence of cigarette smoking in Taiwanese women is very low, compared with Caucasian women (3-4% vs. -28%, respectively), direct smoking is likely a minimal risk factor in the Taiwanese group. However, the evaluation of the association between indirect tobacco exposure, or exposure to environmental tobacco smoke (ETS), and CIN risk in Taiwanese women may be enlightening. The authors designed a community-based nested case-control study to examine the association between ETS exposure and CIN risk among Taiwanese women who were nonsmokers. The study was conducted in Chia-Yi, a city in southwestern Taiwan. The test population comprised adult females (n = 32,466) who had undergone Pap smear screening during the 14-mo period that preceded this study. Potential cases were chosen from individuals who demonstrated positive Pap smear results, which were indicative of at least a level II cervical intraepithelial neoplasm (i.e., > CIN2), as confirmed by cervical biopsy (n = 116). The authors chose 2 matched controls for each case; criteria used were (a) the 2 controls for each case had to be approximately the same age (± 2 yr) as the case; (b) each case and respective control lived in the same residential area; and (c) each control had a negative Pap smear, determined during the same time frame (± 6 mo) that the matched study subject was tested. A total of 100 study subjects and 197 control females (3 cases had only 1 control) underwent interviews by public health nurses, who obtained information about the participants' active and passive smoking histories and other potential risk factors. The incidence of cigarette smoking was low (5.0% [n = 5]) in study subjects and lower in controls (3.1 % [n = 6]). The authors' final analysis was restricted to 89 nonsmoking pairs (89 subjects and 175 controls). Of the affected subjects, 85.4% reported exposure to passive smoke at home during their adulthood, vs. 61.1% of controls. The authors found that, after adjusting for other covariates, there was a 2.73-fold increased risk of contracting CIN (95% confidence interval [CI] = 1.31, 5.67) among ETS-exposed individuals. The authors assessed cumulative dose in terms of pack-years (i.e., average daily exposure [number of packs smoked] multiplied by the number of years the same exposure continued). Compared with nonsmokers, women exposed to 1-20 pack-yr and more than 20 pack-yr had 1.90-fold (95% CI = 0.72, 5.03) and 2.99-fold (95% CI = 1.10, 8.09) increased risks, respectively, of developing CIN. The authors concluded that lifetime ETS exposure is a major determinant for contracting cervical neoplasms among nonsmoking women in Taiwan. [ABSTRACT FROM AUTHOR]

Background: Apart from the workplace, drawing support from family and religion is critical to maintaining the well-being of high-technology employees. Relying on the job demands-resources model and the positive affective spillover effect, the aim of this study was to investigate the mediated relationship of family support, work engagement and subjective well-being, and the moderating effect of religious attendance on the mediated relationship. Methods: A cross-sectional research design was adopted. Mediation and moderated mediation were tested using the PROCESS macro v3.5 for the SPSS supplement. Purposive sampling was used for the distribution of questionnaires to high-technology employees in Taiwan. Results: Results from the data of 603 high-technology employees indicated that family support, work engagement, and subjective well-being exhibited a significant mediated relationship, and the mediated relationship was stronger among individuals with religious attendance experience. Conclusions: This study emphasizes the driving effect of family support on high-technology employee well-being and the moderating effect of religious attendance as a situational strength. We recommend closely attending to employee well-being because doing so is conducive to both the personal quality of life of employees and the sustainable development of organizations. [ABSTRACT FROM AUTHOR]

In this study, a truncated organophosphate-degrading (opd) gene encoding a Brevundimonas diminuta phosphotriesterase (Bd PTE) without its leader peptide was artificially synthesized and cloned into the expression vector pQE-30 to yield pQE- Bd PTE. The His 6 -tagged 37.8-kDa enzyme was purified from the cell-free extract of isopropyl thio-β- d -galactoside (IPTG)-induced E. coli M15 (pRep4) cells harboring pQE- Bd PTE to near homogeneity by metal chelate affinity chromatography. The assay conditions for His 6 -tagged Bd PTE activity were optimized at 60 °C, pH 8.0, and 1.0 mM Co2+ ion. Kinetic analysis of His 6 -tagged Bd PTE-catalyzed hydrolysis of diethyl p -nitrophenyl phosphate (paraoxon-ethyl) showed that its K m and k cat values were 21.9 ± 1.4 μM and 311.6 ± 12.3 s−1, respectively. Also, the recombinant enzyme had the ability to efficiently degrade the two most commonly used OP pesticides, ethion and fenthion, in Taiwan. His 6 -tagged Bd PTE with 1 mM Co2+ was very stable during the storage period of 35 days at 4 °C. Urea- and guanidine hydrochloride (GdnHCl)-induced denaturation studies showed that the purified enzyme had [denaturant] 0.5,N – U values of 6.7 and 3.4 M, respectively. Notably, His 6 -tagged Bd PTE did exhibit some degree of tolerance to a variety of water-miscible organic co-solvents. Dimethyl sulfoxide (DMSO), acetone, dimethylformamide (DMF), and ethanol were obviously harmful to the hydrolytic activity of the enzyme at concentrations above 50% (v/v), while acetonitrile was the highest tolerated co-solvent. The organic solvent-tolerant feature verifies His 6 -tagged Bd PTE highly suitable as a remediation agent for the biodegradation of non-polar OP pesticides. • A recombinant phosphotriesterase of B. diminuta (His 6 -tagged Bd PTE) is successfully expressed in E. coli. • His 6 -tagged Bd PTE has the ability to efficiently hydrolyze ethion and fenthion. • The recombinant enzyme is very stable in the presence of 1 mM Co2+. • The [denaturant] 0.5,N – U values of urea and guanidine hydrochloride for the enzyme are 6.7 and 3.4 M, respectively. • His 6 -tagged Bd PTE exhibits a high degree of tolerance to acetonitrile. [ABSTRACT FROM AUTHOR]

The effects of genetic variants on the interaction between hyperlipidemia and sex have not been investigated among gout patients in Taiwan. Using Taiwan Biobank and the National Health Insurance Research Database (NHIRD), we examined hyperlipidemia, sex, and their relationship with gout among Taiwanese adults with the human leukocyte antigen B (HLA-B) genetic variants. Hyperlipidemia was present in 1437 patients with gout. Sex and hyperlipidemia had significant associations on gout risk, with hyperlipidemia showing a relatively stronger effect. Gout was present in men, with an odds ratio (OR) of 1.945 (95% confidence interval (CI) 1.568–2.411) compared to women, and in hyperlipidemic (OR = 4.032; 95% CI: 3.581–4.540) compared to non-hyperlipidemic patients. The interaction of sex and hyperlipidemia was significant for rs2523608 GG (p = 0.0402) and rs4713518 AA (p = 0.0003) genotypes. After stratification, hyperlipidemia remained a risk factor in women (OR = 4.735, 95% CI: 3.375–6.643) and men (OR = 3.640, 95% CI: 2.916–4.544) with rs2523608 GG genotype. The odds ratio in hyperlipidemic women and men with rs4713518 AA genotype was 7.454 (95% CI 5.103–10.888) and 3.585 (95% CI 2.854–4.503), respectively. Our study indicates that hyperlipidemia-sex interactions exist for gout risk in Taiwanese adults with rs2523608 GG and rs4713518 AA genotypes. [ABSTRACT FROM AUTHOR]

Abstract: Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) levels in a total of 25 food items in Taiwan were surveyed. It was observed that shellfish and saltwater fish possessed the highest PCDD/Fs levels, 9.82 and 3.60pg WHO-TEQ/g, respectively, on the lipid basis. The dietary intakes of humans at the ages of 12–18, 19–64, and over 65 were determined. The estimated intake were between 21.8pg (female teenagers) and 37.6pg (male seniors) WHO-TEQ/day; the levels varied with the dietary habits. The PCDD/F intakes for all human groups are far below the tolerable limit of 70pg WHO-TEQ/kg b.w./month. In addition, the daily PCDD/F intake levels for duck-farmers consuming average and large amounts of PCDD/F contaminated duck eggs were examined. The result shows that consuming more than one duck egg with level higher than 10pg WHO-TEQ/g lipid of PCDD/Fs per day could lead to a PCDD/F intake level higher than the tolerable limit. However, for normal population, there is a little risk to ingest intolerable amount of PCDD/Fs because of consuming contaminated duck eggs. [Copyright &y& Elsevier]

In southern Taiwan, two areas (L- and Y-) with/without biomass open burning were selected to compare the PCDD/F concentrations and their congener profiles in the ambient air. The results of this study indicate that biomass (rice straw) open burning exhibited a significant impact on the PCDD/F concentration level in the ambient air. During the biomass burning season, the total PCDD/F I-TEQ concentrations in the ambient air of L- and Y-areas were approximately 4 and 17 times higher than those without biomass open burning, respectively. When 10% mass fraction of rice straw was burned, the contribution fraction of biomass burning on annual total PCDD/F I-TEQ emission was 3.28 and 8.11% for KC County and for Taiwan, respectively; however, when the calculation was on a weekly basis, the contribution fraction of biomass burning on weekly total PCDD/F I-TEQ emission was 30.6 and 53.4% for KC County and for Taiwan, respectively. The results of this study imply that during the week of biomass burning, it appears to be the most significant source of total I-TEQ PCDD emission. The results of this research can be applied to the study of other agricultural areas. [Copyright &y& Elsevier]

Increasing patient loyalty through improved health care quality and patient-provider relationships becomes the key factor in medical providers' successes. This study explored the mediated relationship of patients' perceived value, patient commitment, and patient loyalty and the moderating effect of patient trust on the mediated relationship. A cross-sectional research design was adopted. Mediation and moderated mediation were tested using the PROCESS macro v3.5 for the SPSS supplement. Convenience sampling was used for the distribution of questionnaires to members of the public with experience of seeking medical attention in Taiwan. Among the 254 valid questionnaires recovered, 59.4% of the respondents were male, 38.6% were married, 90.2% were in the 20 to 49 year age range, and 54.7% had a bachelor's degree or above. This study indicated a significant mediated relationship among patients' perceived value of medical services, commitment to the patient-provider relationship, and patient loyalty. Furthermore, when the patient demonstrated higher levels of trust in a healthcare provider, the relationship of perceived value, commitment, and patient loyalty was also enhanced. This study discussed and demonstrated the effect of perceived value, trust, and commitment on patient loyalty. The research suggests that improving patient loyalty benefits sustainable operation of medical providers and the treatment effects for patients.

Low high-density lipoprotein cholesterol (HDL-C) is a major risk factor for cardiovascular diseases (CVDs), the leading cause of global mortality. We aimed to determine the effect of coffee drinking and sex and their interaction, as well as rs1800588 and rs1800775 polymorphisms on HDL-C levels in Taiwanese adults. Data of 4262 men and 4813 women, aged 30-70 years, were retrieved from Taiwan Biobank. The interaction between sex and coffee drinking on HDL-C was significant ( p = 0.0452). Coffee consumption was significantly associated with higher HDL-C levels in only women (β = 0.81679; p = 0.0246). However, rs1800588 and rs1800775 variants were significantly associated with HDL-C in both sexes. In women, β-values were 0.99080; p = 0.0059 and 3.16277; p < 0.0001 for rs1800588 CT and TT genotypes, respectively and -1.80954; p < 0.0001 and -2.81512; p < 0.0001 for rs1800775 AC and CC genotypes, respectively. In men, β-values were 1.32430; p < 0.0001 and 3.24976; p < 0.0001 for rs1800775 CT and TT genotypes, respectively and -1.96232; p < 0.0001 and -2.71536, p < 0.0001 for the AC and CC genotypes, respectively. In conclusion, coffee drinking was significantly associated with higher high-density lipoprotein (HDL) levels in women but not men after adjusting for confounders including rs1800588 (LIPC) and rs1800775 (CETP) variants.

Education, sex, and the APOE-rs405509 variant are associated with Alzheimer's disease and cognitive performance. We investigated if the rs405509 TT, TG, and GG genotypes modulate the effect of sex and education on cognitive impairment in Taiwanese adults. Data on cognitive health (defined by Mini-Mental State Examination (MMSE) scores) and rs405509 were from Taiwan Biobank. Participants included 2105 men and 2027 women with a mean age of 64 years. Education below university level was significantly associated with lower MMSE scores. The odds ratios (ORs) were 1.82; 95% confidence interval (CI) 1.38-2.41 for senior high school, 3.39; 95% CI 2.50-4.59 for junior high school, and 11.94; 95% CI 9.91-15.50 for elementary school and below ( p -trend < 0.05). The association between MMSE score and sex was significant only in the lowest educational group (elementary and below), with lower odds of having a low MMSE score in men compared to women (OR = 0.51; 95% CI 0.34-0.77). After stratification by rs405509 genotypes, this association was significant only among TT genotype carriers (OR = 0.481; CI = 0.253-0.915). In conclusion, a significant association between MMSE score and sex was observed in the lowest educational group, especially among carriers of rs405509 TT genotypes.

Background: Deficits of learning, memory and cognition have been observed in newborn animals exposed to general anaesthetics. However, conclusions from clinical studies conducted in humans to investigate the relationship between anaesthesia and neurodevelopmental disorders have been inconsistent. Autistic disorder is typically recognised earlier than other neurobehavioural disorders. Although certain genes apparently contribute to autistic disorder susceptibility, other factors such as perinatal insults and exposure to neurotoxic agents may play a crucial role in gene-environmental interaction., Objective: This study was designed to investigate the association of exposure to general anaesthesia/surgery with autistic disorder. We hypothesised that exposure to general anaesthesia and surgery before 2 years of age is associated with an increased risk of developing autistic disorder., Design: A retrospective matched-cohort study., Setting: A medical university. Data from the National Health Insurance Research Database of Taiwan from 2001 to 2010 were analysed., Patients: The birth cohort included 114,435 children, among whom 5197 were exposed to general anaesthesia and surgery before the age of 2 years. The 1 : 4 matched controls comprised 20,788 children., Main Outcome Measures: The primary endpoint was the diagnosis of autistic disorder after the first exposure to general anaesthesia and surgery., Results: No differences were found in the incidence of autistic disorder between the exposed group (0.96%) and the unexposed controls (0.89%) (P = 0.62). Cox proportional regression showed that the hazard ratio of exposure to general anaesthesia and surgery was 0.93 [95% confidence interval (95% CI) 0.57 to 1.53] after adjusting for potential confounders. Age at first exposure did not influence the risk of autistic disorder. No relationship was found between the total number of exposures and the risk of autistic disorder., Conclusion: Exposure to general anaesthesia and surgery before the age of 2 years age at first exposure and number of exposures were not associated with the development of autistic disorder.

Objective: To estimate the expression of plasma soluble E-cadherin and the gene polymorphism in patients with pelvic inflammatory disease (PID)., Design: Hospital-based case-control study., Setting: University hospital., Patient(s): Sixty-four women with PID., Intervention(s): Blood specimen collection from patients before and after they received treatment., Main Outcome Measure(s): Enzyme-linked immunosorbent assay and polymerase chain reaction-restriction fragment length polymorphism were respectively used to measure the plasma soluble E-cadherin level and E-cadherin polymorphism., Result(s): The level of plasma E-cadherin was significantly elevated in patients with PID as compared with that in normal controls; it decreased significantly after treatment when compared with levels noted in the same patients before they received treatment. When the cutoff level of plasma E-cadherin level was set to 20.22 ng/mL on the basis of receiver-operating characteristic curve (ROC), the sensitivity, specificity, and the area under the curve of plasma E-cadherin level for predicting PID were 0.81, 0.80, and 0.835 (95% confidence interval 0.76-0.90), respectively. The adjusted odds ratio for age, white blood cell count, and C-reactive protein levels was 19.66 (5.48-70.47)., Conclusion(s): Elevated plasma soluble E-cadherin expression was involved in the pathogenesis of PID and is useful for the diagnosis of PID., (Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: This study aimed to investigate the association of stromal cell-derived factor 1 (SDF-1) gene polymorphisms with the neoplastic lesions of uterine cervix in Mid-Taiwan women., Materials and Methods: Four hundred ninety-eight blood samples were collected from 161 patients with neoplasia of uterine cervix, including 76 cancer patients, 61 patients with high-grade dysplasia, and 24 with low-grade dysplasia, and 337 healthy controls who lived in Mid-Taiwan. Polymorphism of the SDF-1 gene was examined using polymerase chain reaction-restriction fragment length polymorphism., Results: For SDF-1 gene polymorphisms, the wild-type homozygous alleles (G/G) yielded 100- and 193-bp products, the heterozygous alleles (G/A) yielded 100-, 193- and 293-bp products, whereas the mutated-type homozygous alleles (A/A) yielded a 293-bp product. We found no significant difference in genotypes or alleles distribution of SDF-1 polymorphisms between patients with cervical neoplasia and healthy women (P = 0.530). Compared with the homozygous GG subgroup, GA and AA subgroups do not increase the risk of cervical neoplasia., Conclusions: Although the expression of SDF-1 was reported to be significantly increased in cervical carcinogenesis in previous studies, our results, however, show that SDF-1 gene polymorphism could not be considered as a factor related to an increased susceptibility to cervical neoplasia.

Hypothesis: Single-nucleotide polymorphisms (SNP) in promoter of human nonmetastatic clone 23 type 1 (nm23-H1) may affect their binding with transcription factors and affect promoter activity as well as gene transcription. Therefore, we investigated the impact of the nm23-H1 gene polymorphisms on the neoplastic lesions of uterine cervix in mid-Taiwan women (women who live in the central area of Taiwan). We expected that women with different genotypes in nm23-H1 polymorphisms, such as rs34214448, rs16949649, or rs2302254, may have different incidences of cervical neoplasia., Materials and Methods: In total, 366 blood samples were collected from 244 healthy women and 122 patients with cervical neoplasia to analyze 3 nm23-H1 gene single-nucleotide polymorphisms (rs34214448, rs16949649, and rs2302254)., Results: The heterozygous genotypes, TG in rs34214448 or TC in rs16949649, were differentially distributed between patients with cervical neoplasia and normal women (Hommel adjusted P = .0440 and .0435, respectively) as compared to their homozygotes. Moreover, compared to those with wild-type homozygotes and heterozygotes, women with variant homozygotes TT in rs34214448 or CC in rs16949649 exert different distributions between patients with cervical neoplasia and normal women (P = .058 and .058). Interestingly, we found the genotype distribution of rs34214448 has significant association with that of rs16949649 with high consistency., Conclusions: Mid-Taiwan women with the polymorphic heterozygotes TG in rs34214448 or TC in rs16949649 of human nonmetastatic clone 23 type 1 promoter have the tendency to develop cervical neoplasia while compared to their homozygous counterparts. However, women with variant homozygotes TT in rs34214448 or CC in rs16949649 exhibit less tendency as compared to those with wild-type homozygotes and heterozygotes.

The purpose of this study was to evaluate the effects of the suicide awareness program (SAP) in enhancing community volunteers' awareness of suicide warning signs (SWSs). Seventy-six participants were recruited in this study to complete the Awareness of Suicide Warning Signs Questionnaire before and after they received a 90-minute SAP. After the educational intervention, the mean score of the participants on awareness of SWSs was elevated from 3.97 to 4.53. The percentage of SWSs perceived increased from 46.88% to 84.38%. This shows that the SAP for community volunteers is effective in promoting suicide awareness., (2009 Elsevier Inc. All rights reserved.)

Objectives: To study the expression of matrix metalloproteinase-2 (MMP-2) in cancer of uterine cervix and correlate its expression with clinicopathological parameters, recurrence and survival of patients., Methods: Twenty cervical cancer and 20 normal tissues from the same patients were collected to detect MMP-2 mRNA expression. From them, 16 cancer and 16 normal tissues were collected and added with another 64 cancer tissues to construct a 96-tissue core microarray for immunohistochemical study. We evaluated the relationships among MMP-2 immunoreactivity using semiquantitative H scores, obtained by multiplying proportion score of stained cells and their mean digital density, and clinicopathological variables, recurrence and survival in cervical cancer patients. We used univariate and multivariate analyses of all parameters for recurrence and survival, further including time interval for evaluation., Results: MMP-2 mRNA expression was higher in most of cervical cancerous tissues than normal counterparts. H score of MMP-2 was significantly higher in cancerous tissue cores than normal counterparts (median H scores: 1.5 vs. 0.3, P<0.001). MMP-2 expression was significantly associated with parametrium invasion (P=0.004) and lymph node metastasis (P=0.015), but not with cancer recurrence, recurrence-free and overall survival rates of these patients. However, poor tumor cell differentiation and positive parametrium invasion significantly increased the recurrence and poor cell differentiation increased the risk of death., Conclusions: MMP-2 is highly expressed in cervical cancer tissues at mRNA and protein levels and associated with lymph node metastasis and parametrium invasion but not predictive of recurrence and survival in cervical cancer patients.

Introduction: Problem-based learning (PBL) embraces principles of good learning and teaching. It is student-directed, fosters intrinsic motivation, promotes active learning, encourages peer teaching, involves timely feedback, and can support student self and peer assessment. The most important function of the assessment process is to enhance student learning, to improve the curriculum and to improve teaching., Materials and Methods: To improve the PBL tutorial in Chung Shan Medical University, we developed an online evaluation system containing the evaluation forms for students, tutor, self and peer. The Cronbach alpha reliability coefficients were 0.9480, 0.9103, and 0.9198 for the Student, Tutor and Self and Peer Evaluation Form, respectively. The online evaluations were mandatory to both students and tutors, and the information was completely anonymous., Results and Conclusions: The survey response rates of the online evaluations ranged from 95.6% to 100%. The online evaluations provided a documented feedback to the students on their knowledge, skills and attitudes. Correspondingly, tutors too received feedback from students in evaluating their performance on the appropriateness and effectiveness of tutoring the group. Although there was an initial lack of coordination regarding responsibilities and how to use the online system for both students and the Faculty, the system enabled us to look into how effective our PBL course had been, and it provided both process and outcome evaluations. Our strategy for evaluating the success of PBL is only at its initial stage; we are in an ongoing process of collecting outcome data for further analysis which will hopefully provide more constructive information to the PBL curricula.

Purpose: To determine, in Taiwanese patients, the genetic basis of congenital fibrosis of the extraocular muscles (CFEOM) type 1 and 3, a group of diseases characterized by congenital restrictive ophthalmoplegia affecting muscles innervated by the oculomotor nerve., Methods: Linkage analysis with microsatellite markers at chromosome 12q and direct sequence analysis of the KIF21A gene were performed on three families and one sporadic CFEOM case., Results: Two of the families were classified by clinical criteria as CFEOM1 and another family as CFEOM3. All three families were shown to be linked to the 12q CFEOM1 locus. Sequence analysis disclosed a heterozygous c.2860C>T mutation in the KIF21A gene in all families and in the sporadic case. Affected family members were further confirmed by a BsrDI polymorphism., Conclusions: CFEOM is present in Chinese populations. Both CFEOM1 and CFEOM3 can be caused by the same mutation at the KIF21A gene. The occurrence of this mutation in different ethnic groups suggests a mutation hot spot.

Objectives: To evaluate whether the increasing occurrence of urinary and voiding dysfunction is independently influenced by the transition from pre- to postmenopause or by the interactive and additive effects of age-associated changes in bladder and urethral function., Design: Of the 1,584 women randomly sampled from a community-based health population, 1,253 (79.1%) were successfully interviewed. The participants were asked to reply to the Bristol Female Urinary Tract Symptoms Questionnaire regarding various storage symptoms and voiding dysfunction. The chi2 test and Cochran-Armitage trend test were used for analysis., Results: The prevalence of storage symptoms such as frequency, urgency, nocturia, and urge incontinence in premenopausal and menopausal groups was 18.0% versus 29.8%, 9.8% versus 20.7%, 21.2% versus 38.2%, and 6.8% versus 15.7%, respectively (all P < 0.05). In premenopausal and menopausal groups, the prevalence of hesitancy, poor stream, incomplete emptying, voiding with abdominal straining, discontinuous urine flow, and dribbling was also significantly different (17.2% v 22.9%, 17.8% v 25.7%, 12.7% v 21.9%, 4.9% v 11.6%, 16.2% v 24.5%, and 9.4% v 17.6%, respectively; all P < 0.05). However, the occurrences of various storage symptoms, namely, frequency, urgency, nocturia, and urge incontinence, as well as voiding symptoms such as incomplete emptying, discontinuous urine flow, and dribbling, were also significantly associated with the normal aging process (P < 0.05)., Conclusions: Our results imply that the increasing occurrences of storage and voiding dysfunctions are not only affected by pre- and postmenopausal transition but are also closely associated with aging changes.

Background and Purpose: Cisplatin-based chemotherapy is the main therapy for patients with advanced stage non-small cell lung cancer (NSCLC). The dose of cisplatin is adjusted according to the patient's renal function. Calculation of creatinine clearance (CCr) by 24-hour urine collection is the most common method for estimating the glomerular filtration rate but is time-consuming and inconvenient. Estimation of CCr using the Cockcroft-Gault formula has been suggested to be accurate, reproducible, and less costly. This study compared CCr values obtained by measured and estimated methods during cisplatin-based chemotherapy in NSCLC patients in Taiwan., Methods: A total of 92 patients (58 men, 34 women) with advanced NSCLC who completed 6 cycles of chemotherapy participated in the study. The dose of cisplatin per cycle was 80 mg/m(2) every 28 days, reduced to 50 mg/m(2) if CCr was 30 to 60 mL/min by the measured method. When urine collection was finished, serum and urine creatinine levels were measured simultaneously. Estimated values were calculated before each cycle of chemotherapy., Results: The mean measured CCr was 85.2 mL/min, 25.7 mL/min higher than the mean estimated value. CCr values obtained by both methods were significantly reduced during the 6 cycles of chemotherapy. There was no significant difference in CCr values between patients aged < 65 years or >/= 65 years (-19.9 vs -15.1 mL/min, p = 0.15). Using a cut-off of measured CCr >/= 60 or < 60 mL/min, agreement on the dosage for both methods was 51% for all patients, 77.7% for patients < 65 years, and 26.7% for patients >/= 65 years., Conclusions: The Cockcroft-Gault formula underestimated measured CCr by about 25 mL/min in this study. Cisplatin-based chemotherapy reduced CCr, with no significant difference between older and younger patients. Use of the estimated method would result in significant under-dosing, especially for patients >/= 65 years old.

Anal incontinence and constipation are not only physically and psychologically disabling symptoms but also a significant social and public health problem. The epidemiology of anal incontinence and constipation from community-bases remains largely unknown, especially in Asian women. This study is a continuation of a previous survey taken on the epidemiology of urinary incontinence and overactive bladder in Taiwanese women by using a second questionnaire (correlation coefficient for symptoms, r=0.87; P<0.05). We evaluated the prevalence and potential risk factors associated with anal incontinence and constipation in the general population. Of the 1,584 (2.92%) women sampled, 1,253 (79.1%) were successfully interviewed at home. The prevalence of fecal incontinence and flatus incontinence was 35 (2.8%) and 107 (8.6%), respectively. There were 306 (24.5%) participants who reported constipation. However, according to the current medical criteria for constipation, the prevalence of constipation was only 2.7%. The prevalence of anal incontinence did not increase after the age of 65 years (9.7%, including 3.5% of elderly women with fecal incontinence and 6.2% of elderly women with flatus incontinence). The prevalence of constipation significantly increased in the women aged 65 years and over (self-reported prevalence: 32.4%, fitted in medical criteria for constipation: 8.3%). Our results demonstrated that constipation shares some of the same risk factors, namely, symptoms of uterovaginal prolapse, prior gynecologic surgery, and overactive bladder that predispose women to the occurrence of anal incontinence. The questionnaire needs a higher discriminatory capacity, and a longitudinal study should be conducted to clarify this conflict further., (Copyright 2003 Wiley-Liss, Inc.)

Aims: We randomly sampled a community-based, healthy population to evaluate the prevalence and correlation of urinary incontinence and overactive bladder. We also assessed the influences of these conditions on quality of life and associated risk factors., Methods: Of the 1,581 women sampled (2.92% of registered female residents aged 20 years and older), 1,253 (79.1%) women were successfully interviewed by using the Bristol Female Urinary Tract Symptoms Questionnaire (r=0.87, P<0.05) and the Questionnaire of Impact index regarding the impact on quality of life (r=0.91, P<0.05)., Results: A total of 53.7% of the women sampled suffered from urinary incontinence and related symptoms. The prevalence of stress urinary incontinence, overactive bladder, and mixed incontinence, mutually exclusive of each, was 18.0%, 18.6%, and 17.1%, respectively, from the patients' perceptions. Judging by the criteria of the International Continence Society, the prevalence of the above three conditions was 4.3%, 2.4%, and 1.8%, respectively. Of the women who perceived storage symptoms, 21.1% experienced frequency, 12.6% had urgency, 25.5% had nocturia, and 9.1% had urge incontinence. The occurrence of stress urinary incontinence increased with age up to 65 years old (25% in 50-65-year-old cohort), and the number of overactive bladder conditions significantly increased in the elderly women (over 65 years old, 39.3%). Approximately two thirds of the incontinent women had restricted their social activities (due to worrying about wetting or leakage and no toilet facilities available), and approximately 19% of the incontinent women had an affected sexual life. However, only 27.1% of the women with urinary incontinence and related symptoms in this study had reported seeking medical services to solve these problems., Conclusions: The prevalence of urinary incontinence and overactive bladder in Taiwanese women is similar to that of Western women., (Copyright 2003 Wiley-Liss, Inc.)