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This study evaluated the correlations between spiritual beliefs and health-related quality of life (HRQOL) of hemodialysis (HD) patients in Taiwan. Participants had to complete two questionnaires: the 36-item Short Form Health Survey Questionnaire and the Royal Free Interview for Spiritual and Religious Beliefs. They were then divided into three groups according to their strength of spiritual beliefs—having no, weak, or strong beliefs. Demographic, clinical, and laboratory data among groups were compared. Correlations between spiritual beliefs and HRQOL were then determined by the analysis of covariance and the post hoc Scheffe tests. Six hundred thirty-three patients completed the study. There were more women in the group of patients with strong beliefs (P = 0.005) and more less-educated patients in the group of patients with weak beliefs (P = 0.005). Patients with no or with strong spiritual beliefs had higher role physical (P = 0.01) and social functioning (SF) (P = 0.001) scores than patients with weak beliefs. After adjustment for gender, age, marital status, education, comorbidities, and time on dialysis, patients with no or with strong spiritual beliefs were found to have higher SF scores (P = 0.02) than patients with weak beliefs. HD patients with no or strong spiritual beliefs had higher SF HRQOL than those with weak spiritual beliefs.

Background Previous studies have reported several conflicting findings regarding neuropsychiatric symptoms when comparing patients with Alzheimer's disease (AD) and patients with vascular dementia (VaD). Objectives The purpose was to: (1) compare the prevalence of neuropsychiatric symptoms among patients with AD and VaD after controlling for demographic characteristics in difference setting and (2) rank and contrast the severity the common symptoms between the two groups in north of Taiwan. Methods This study was a cross-sectional comparative design. Data were collected from clinical interviews using three instruments: the Mini-Mental Status Examination (MMSE), the Clinical Dementia Rating Scale (CDR), and the Neuropsychiatric Inventory (NPI). Results A total of 154 subjects participated in this study. The male subjects with VaD from the outpatient setting had lower NPI scores. In the OPD, the subjects with AD had more nighttime behavior than subjects with VAD. In the nursing home setting, the subjects with VaD had higher prevalence of depression, irritability, and appetite changes than subjects with AD. The subjects with AD had more euphoria and nighttime behavior than subjects with VaD. The average of total NPI scores for people with AD and VaD from the nursing home setting indicate higher scores. In the nursing home group, the VaD subjects evidenced significantly higher irritability scores than the AD subjects. Conclusions This was first care unit based study in north Taiwan. Our results showed the significant differences between AD and VaD groups of NPI symptoms. Understanding those differences may aid differential diagnosis of dementia subtypes and help develop proper interventions. Copyright © 2008 John Wiley & Sons, Ltd.

Bilirubin, an antioxidant in the blood, plays a role in protection from atherosclerosis. The level of bilirubin is highly correlated to the incidence of coronary artery disease (CAD). Unconjugated bilirubin is conjugated with glucuronic acid through the reaction of uridine 5′-diphosphate-glucuronosyl transferase 1A1 (UGT1A1). The interactions of CAD and the variations in the coding regions of the UGT1A1 gene have never been evaluated. The purpose of this study was to analyze the influence of the UGT1A1 variant on the incidence of CAD. There were 135 participants in this study: 61 in the experimental group, who had CAD, and 74 in the control group, who did not have CAD. The blood samples from all 135 participants were collected and assayed to clarify the relationship between bilirubin and CAD. The assay of the polymerase chain reaction and the sequence of the UGT1A1 gene were examined to find the gene’s polymorphisms. The bilirubin levels for the participants in the control group were significantly higher than for the patients in the CAD group. Although the concentration of bilirubin in the UGT1A1 variant was higher than the wild type for the patients in the CAD group, there was no significant difference in the polymorphism of UGT1A1 between the patients in the CAD group and the participants in the control group.

Developmental status at birth and subsequent obesity have been implicated in the development of childhood atopic dermatitis (AD) and allergic rhinitis (AR).The current study analysed the cohort data of 74 688 junior high school students from a national retrospective birth cohort study in Taiwan. A random 10% sample was selected from singleton livebirths with complete data on the analytical variables of interest. Atopic disorders, including AD and AR, were assessed by questionnaires (International Study of Asthma and Allergies in Childhood). Logistic regression analyses were applied with adjustments for related risk factors.Among subjects mainly 13-15 years of age, the estimated prevalence was 7.6% for AD and 22.4% for AR. While the role of fetal growth in allergic disorders was less evident, the risk of developing AD and AR were both influenced by a combination of fetal growth status and adolescent body mass index (BMI). Compared with those with normal fetal growth and school-aged BMI, the risk of developing AD increased 64% among adolescents with both restricted fetal growth and high BMI (odds ratio 1.64, 95% confidence interval 1.37, 1.97). The risk for this combination was higher than that for either restricted fetal growth or high BMI alone. Nevertheless, the overall interaction between BMI and fetal growth status on atopic disorders did not reach statistical significance.Excessive weight gain could be an important risk factor related to developing atopic dermatitis and allergic rhinitis during adolescence, especially among infants born small for gestational age.

The nursing profession has generally accepted humor as beneficial to health care. As nursing has always emphasized holistic care and the importance of individual needs, the profession values the ability of humor to positively affect all aspects of a patient's well being. The purposes of this study were to develop a "Chinese Humor Scale (CHS)" for the nursing profession and then test its reliability and validity. The 405 individuals selected for participation in this study included nursing on-the-job students from a medical university and professional nurses practicing at four hospitals in north Taiwan. Researchers developed a list of 57 key humor measures which were filled out and returned by study participants. An evaluation of results using Cronbach's alpha coefficients demonstrated good consistency (alpha=.93) for the developed CHS. Intercorrelations amongst the four sub-scales were generally quite low, indicating each sub-scale measures dimensions relatively distinct from one another (r=.24 approximately .48, both p's.001). The CHS was tested using item analysis. The scale was constructed in accordance with exploratory factor analysis (EFA) (K.M.O.=.92). Thirty CHS items, categorized under the four indices of "humorous creativity", "tendency to laugh", "perceptivity to humor", and "humorous attitude", were found to explain 55.42% of total variances. The CHS was found to provide good validity using a content validity index (CVI) developed by five experts. The results of this study provide encouraging evidence for the construct validity and reliability of the proposed humor scale and support its application by nursing educators and clinicians to further test and assess concepts related to humor. Further research is needed to explore more fully the implications of humor in nursing.

Previous studies showed that yeast VAS1 encodes both the cytoplasmic and mitochondrial forms of valyl-tRNA synthetase (ValRS), using alternative transcription and translation. The ValRS isoforms have identical polypeptide sequences, except for a 46-amino acid leader peptide that functions as a mitochondrial targeting signal. Although the two forms of the enzyme exhibit indistinguishable tRNA specificities in vitro, they cannot substitute for each other in vivo because of their different localizations. Here we show that the 46-residue leader sequence can be divided into two nonoverlapping peptides, each of which retains the ability to target the enzyme into mitochondria. The engineered proteins (with truncated leader sequences) are dual-targeted, rescuing both the cytoplasmic and mitochondrial defects of a vas1 knockout strain. Thus, in addition to alternative splicing and alternative translation initiation as mechanisms by which a single gene can encode cytoplasmic and mitochondrial activities, the inherent characteristics of a single polypeptide may enable it to be distributed simultaneously between two cellular compartments. This mechanism may explain how certain other single genes in Saccharomyces cerevisiae provide dual functions.

Pulmonary embolism is a common and potentially life threatening condition. Delays in pulmonary embolism diagnosis represent an important problem. It is crucial to have early diagnosis of pulmonary embolism if one wishes to reduce its complication. We retrospectively reviewed our patients who visited our emergency department with a final diagnosis of pulmonary embolism. We found that delayed diagnosis of pulmonary embolism usually happened when patients did not present with the classical symptoms and signs leading to other medical diagnosis at first. Clinical signs and symptoms for pulmonary embolism are mostly non-specific; therefore, patients suspected of having pulmonary embolism—because of unexplained chest pain, shortness of breath or tachycardia with or without the risk factors for pulmonary embolism—must undergo diagnostic tests including D-dimer or CT pulmonary angiography if indicated until the diagnosis is ruled out.

The purpose of this case-control study was to investigate the relationship between the electrical resistance of the skin at biologically active points (BAPs) on the main meridians and upper gastrointestinal bleeding (UGIB). Electrical resistance to direct current at 20 BAPs on the fingers and toes of 100 patients with (38 men, 12 women; mean age [range], 58.20 ± 19.62 [18–83] years) and without (27 men, 23 women; 49.54 ± 12.12 [22–74] years) UGIB was measured through electrodermal screening (EDS), based on the theory of electroacupuncture according to Voll (EAV). Data were compared through analysis of variance (ANOVA), receiver operating characteristic (ROC) curve analysis, and logistic regression. The initial readings were lower in the UGIB group, indicating blood and energy deficiency due to UGIB. Significant differences in indicator drop values were observed at nine BAPs (p < 0.05) on the bilateral small intestine, bilateral stomach, bilateral circulation, bilateral fibroid degeneration, and right lymph meridians. The area under the ROC curve values of the BAPs on the bilateral small intestine and stomach meridians were larger than 0.5, suggesting the diagnostic accuracy of EDS for UGIB on the basis of the indicator drop of these BAPs. Logistic regression revealed that when the indicator drop of the BAP on the left stomach meridian increased by one score, the risk of UGIB increased by about 1.545–3.523 times. In conclusion, the change in the electrical resistance of the skin measured by EDS at the BAPs on the bilateral small intestine and stomach meridians provides specific information on UGIB.

Mental health is a human right and fundamental to good personal health. Developing, planning, and implementing mental health programs is a key part of health policies worldwide. This paper uses the perspective of "mental health mainstreaming" to define mental health and explore its relationship with mental illness and psychiatric disease. Further, we apply this perspective to Taiwan's three-tiered community mental illness prevention strategy as a reference for mental health promotion and rehabilitation programs in hopes that all healthcare providers help facilitate holistic community health.心理健康主流化—促進與復元心理健康是人權，也是健康的基礎，而心理健康的發展、計畫與執行是全球健康政策發展的重要趨勢。本文目的將採用心理健康主流化的觀點，說明心理健康定義，與心理疾病的關係，進而闡述社區心理衛生的三段預防策略，藉此作為推動社區心理衛生的心理健康促進行動與復健方案之參考，期盼所有健康服務從業人員可朝全民均健的目標邁進。

To determine the psychological and physiological effects of a Laughing Qigong Program on an elderly population in an institutionalized setting.Participants were recruited from a long-term care institution in northern Taiwan. A total of 99 residents were interviewed and 66 enrolled, there were 33 control participants and 33 experimental participants. The participants were matched according to their abilities as measured by the Barthel Index of Activities for Daily Living. Experimental participants attended the Laughing Qigong Program, twice a week for 4 weeks. Comparisons were made on the Mini-Mental State Examination, Faces Scale, Geriatric Depression Scale and cortisol levels.Psychometric measures for participants in the experimental group improved, whereas those in the control group decreased. The experimental group showed the following changes: improved Mini-Mental State Examination scores (Z=-2.28; P0.05), improved mood states (Z=-4.47; P0.001) and decreased Geriatric Depression Scale scores (Z=3.79; P0.001). There were no significant changes for the experimental group in cortisol levels. By comparison, the control group showed: decreased mood states (Z=2.53; P0.011), increased Geriatric Depression Scale scores (Z=4.34; P0.001) and significant increases in cortisol levels (Z=2.62; P0.009).The Laughing Qigong Program has shown to be an effective, cost-effective non-pharmacological therapy for cognitive impairment, mood states and elderly depression.

Individuals with mental illness are highly vulnerable to personal health and safety threats. In recent years, the increasing incidence of accidental falls among residents of long-term care facilities has been attributed to aging, disease symptoms, and sedative drug effects.This project aimed to reduce the fall incidence rate for mentally ill residents in our hospital from 0.0015% to 0.0012% in order to reduce patient injuries and avoid the long-term health consequences of these injuries.This project was conducted between January 1st, 2011 and December 31st, 2011. Our approach included direct observation, literature review, meeting discussions, and data compilation. The intervention composed four facets: (1) Staff: providing education and training skills to prevent patient falls; (2) residents: enhancing patient motivation to keep physically fit and assess medication side effects; (3) environment: increasing living condition safety; (4) policy: replacing defective equipment, performing equipment checks on schedule, and managing a fall-prevention program.The post-intervention fall incidence rate for mentally ill residents was 0.0007%, which was significantly better than our target.We reviewed plans and improved the fall-prevention strategy for mentally ill residents of long-term care facilities. This project provides a reference for care program planners and administrators.降低長期照護機構的精神障礙住民跌倒發生率之改善專案罹患精神疾病的個案在健康維護與生活安全會感受到較大的威脅。近年來長期居住在機構中的住民隨著年齡增長、疾病特性以及藥物鎮靜作用影響，發生跌倒的意外事件次數增加。本專案旨在降低精神障礙住民跌倒發生率，改善目標由0.0015%降低至0.0012%，以避免意外事件的傷害。自2011年1月1日至12月31日，透過專案成員的內部觀察、研讀文獻、會議討論以及文件整理，歸納出本機構住民預防發生跌倒因素可分為四大方面，從(1)照顧人員：提供防跌教育之專業知能；(2)住民面：增強參與體適能活動動機、接受定期藥物副作用的評估；(3)照護環境：營造安全生活環境；(4)制度面：汰換老舊輔具並定期確認輔具安全、落實防跌制度之行政管理。精神障礙住民跌倒發生率為0.0007%，達成專案目標；並完成專案內容的四個核心方向的任務。本專案提供精神疾患住民於機構內發生跌倒意外事件之問題檢討與改善策略，可做為未來照顧之參考。

In this work, CMOS-based tactile sensors using oxide as the sacrificial layer was demonstrated. The multiple metal layers and dielectric layers in the backend of CMOS processes were used to fabricate the moveable membrane of capacitive-based tactile sensors. The sensor was fabricated by the commercial 0.35 μm CMOS process and our self-developed post CMOS oxide etching. Three different via designs were proposed to adjust mechanical strength of the membrane electrode. A multivibrator circuit was utilized to decrease the parasitic effect of the capacitive sensors. The tactile sensors with point-type vias showed the best sensitivity of 2.65 Hz/mmHg with the dynamic range 0-388 mmHg.

A retrospective analysis of the Taiwanese National Birth Defect Registration and Notification System was conducted in order to determine the live birth- and stillbirth rates in infants with Down syndrome, trisomy 18, trisomy 13 and Turner syndrome between 2001 and 2010. The objective was to investigate the impact of Down syndrome screening on the Taiwanese Down syndrome live birth rate. In addition, the results of first-trimester Down syndrome screening between 2006 and 2011, and of second-trimester quadruple testing between 2008 and 2011, were obtained from the National Taiwan University Hospital. All Taiwanese infants born between 2001 and 2010 were included in the first part of the analysis, and women receiving first-trimester Down syndrome screening or second-trimester quadruple testing from the National Taiwan University Hospital were included in the second part. The live birth rate of infants with Down syndrome, per 100 000 live births, decreased from 22.28 in 2001 to 7.79 in 2010. The ratio of liveborn DS to total DS was 48.74% in 2001, and then decreased to 25.88% in 2006, when first-trimester screening was widely introduced in Taiwan. This ratio dropped to 20.64% in 2008, when the second-trimester quadruple test was implemented. The overall positive rate in first-trimester screening in the National Taiwan University Hospital was 3.1%, with a Down syndrome detection rate of 100%; the quadruple test had values of 9.0% and 75%, respectively. The use of first-trimester screening and the second-trimester quadruple test may be responsible for the marked decrease in the Taiwanese Down syndrome live birth rate observed between 2001 and 2010.

Optimal methadone dosage and service profile is challenging in treatment of opioid dependence. This study explores the impact of methadone dosage on the mortality of opioid-dependent patients in methadone maintenance therapy by using a large-scale and continual supervised dosing registry information system. Database of nationwide enrolled opioid-dependent patients at methadone clinics in Taiwan during 2006-2008 was assessed. The relative risk of age, sex, marital status, HIV infection and methadone dosage were analyzed by Cox regression analysis. Among all of the 33,549 recruited patients, the crude mortality rate was 134.78/10,000 person-years, and the standardized mortality ratio was 4.68. A dose-response relationship of higher- vs. lower-dosage groups on the risk of mortality risk was observed (adjusted HR = 0.68, P = 0.016). In further sub-grouping analysis, this trend was more significant in HIV positive patients, in subgroup of patients who continuously staying in MMT, and in subgroup of patients who re-enter MMT. This dosage effect is not significantly seen in patients receiving MMT more than 365 days. Further exploration of other treatment-related factors may be important for understanding the long-term treatment outcome of opioid addiction patients.

The occurrence of allergic rhinitis (AR) may be significantly influenced by air pollution. This study examined the association between the first occurrence of AR in preschool children and the pre-incident levels of air pollutants in Taiwan. We identified 9960 eligible subjects from a systematic sampling cohort database containing 400,000 insureds of the National Health Insurance from 2007 to 2011 and matched them with the environmental monitoring data from 2006 to 2011 according to the locations of their clinics. Pre-incident levels were determined using the average concentrations of air pollutants one or two weeks prior to the AR diagnoses. Logistic regression analyses were performed to determine any significant relationships between AR and specific air pollutants. The first AR incidence for Taiwanese preschool children, which increased with age, was 10.9% on average; boys appeared to have a higher percentage (14.2%) than girls (8.27%). Among the air pollutants, carbon monoxide (CO) and nitrogen oxides (NOX) were significantly related to AR after adjusting for age and gender (p < 0.05). Because both pollutants are considered to be traffic emissions, this study suggests that traffic emissions in Taiwan need to be controlled to lower the prevalence of children’s AR.

This paper reports the high light extraction efficiency will be obtained by considering the systematic design of two-dimensional sub-wavelength photonic crystals, which is created on the p-side of InGaN-based light emitting diodes.

Childhood asthma, a growing health concern, has been associated with low birth weight and elevated body mass index. This study tested the hypothesis that overweight and obese adolescents with a history of low birth weight are at even greater risk of developing asthma. A cohort of 75,871 junior high school students was screened for asthma during 1995–1996 in Taiwan. Birth weight and estimated gestational age were obtained from the birth registry. Logistic regression and simple regression analyses were adjusted for confounding variables. Asthma was more prevalent in those with birth weights below 3,000 g and higher adolescent body mass indexes. Furthermore, those with both characteristics were consistently most likely to have asthma. Whether the asthma diagnosis among low-birth-weight subjects was assigned by physicians or medical questionnaire, the risks were elevated for both overweight (physician diagnosis: odds ratio ¼ 1.41; medical questionnaire: odds ratio ¼ 1.25) and obese (physician diagnosis: odds ratio ¼ 1.38; medical questionnaire: odds ratio ¼ 1.47) boys as well as overweight (physician diagnosis: odds ratio ¼ 1.63; medical questionnaire: odds ratio ¼ 1.30) and obese (physician diagnosis: odds ratio ¼ 1.44; medical questionnaire: odds ratio ¼ 1.32) girls (P < 0.05). Low birth weight predisposes one to develop asthma, and excess body mass amplifies the risk. A sex difference was observed. This study suggests that prenatal care and nutritional counseling could reduce asthma prevalence.

Apathy is a well-recognized symptom of Alzheimer's disease (AD). The aim of the present study was to validate the Taiwanese version of the Apathy Evaluation Scale, clinician version (AES-C) and assess the severity of apathy in patients with AD.Comprehensive evaluations were conducted in a total of 144 AD patients. This study used a cross-sectional comparative design. Data were collected from clinical interviews using the AES, the Mini-Mental Status Examination (MMSE), the Neuropsychiatric Inventory (NPI), and the Clinical Dementia Rating Scale (CDR).Internal consistency was indicated by Cronbach's alphas of 0.85; test-retest reliability was 0.89 over a period of 3 days. Criterion-related validity was supported by the fact that AES-C significantly correlated with the apathy scores of the NPI. Factor analysis indicated a three-factor structure. Convergent validity was supported by a positive correlation between the AES-C score and the anxiety score of the NPI. Discriminant validity was supported by the fact that the AES-C scores did not correlate with the depression subscale of the NPI, and the correlation between the AES-C score and the euphoria score of the NPI score was negative. Known-group validity was supported by results showing that AD patients in a moderate stage of dementia (CDR = 2) had significantly higher scores on the AES-C than patients with mild-stage dementia (CDR = 1).The AES-C is a reliable and valid instrument for measuring symptoms of apathy among AD patients in Taiwan.

Background and Aims: The evidence of exposure to environmental tobacco smoke (ETS) on children’s growth and obesity is limited and not sufficient to conclude a definitive relationship. The aim of t...

OBJECTIVE The aim of this study was to examine whether infant metabolic gene polymorphisms modify the effect of maternal environmental tobacco smoke (ETS) on neonatal neurobehavior. METHODS We conducted a birth cohort study of 87 nonsmoking women who delivered single births of normal birth weight. We enrolled the women before delivery, interviewed them using a structured questionnaire, and collected umbilical cord blood. Umbilical cord cotinine, a blood indicator of prenatal ETS exposure, was analyzed. The Neonatal Neurobehavioral Examination-Chinese Version (NNE-C) was administrated within 5 days after delivery to examine neonatal neurobehavior. Four infant metabolic genes, CYP1A1 MspI, CYP1A1 Ile462Val, GSTT1, and GSTM1, were identified. RESULTS Maternal ETS exposure during pregnancy was not related to neonatal neurobehavior when infant genetic polymorphisms were not considered. However, maternal ETS exposure did cause adverse effects in neonates with the absent type of GSTM1. Adverse effects were seen on the total NNE-C (β = -2.55; p = .02) and on primitive reflexes (β = -1.70; p = .004), especially in grasp reflexes (β = -.36; p = .011) and tonic neck reflexes (β = -.36; p = .049). In addition, there was a significant interaction between maternal ETS exposure and infant GSTM1 genotype on neonate grasp reflexes (p for interaction = .019). CONCLUSIONS These data indicate that weaker responses in neonatal primitive reflexes in infants with the absent type GSTM1 were related to maternal ETS exposure during pregnancy.

Many variables influencing quality of life (QOL) for outpatients with schizophrenia have been identified from prior studies. Symptom severity, psychosocial rehabilitation activities, and empowerment have all been clearly identified as key variables. However, which variables are the most influential and important factors remains unknown; factors influencing QOL, either directly or indirectly and to what degree, need to be examined. The aim of this study was to test the hypothesis that empowerment is a possible mediator of how (a) psychiatric symptoms and (b) psychosocial rehabilitation activities affect QOL for outpatients with schizophrenia in the community. We used the probability proportional to size random sampling for 190 outpatients with schizophrenia at 10 community rehabilitation centers in Taipei, such that samples consisted of adults who fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The instruments included the questionnaire to gather demographic and disease information, the Empowerment Scale, the Psychiatric Symptoms Scale, the psychosocial rehabilitation activity (PRA), and the Quality of Life Scale for Psychiatric Patients. Beyond descriptive statistics, correlation and structural equation models were computed. Findings showed that empowerment in outpatients with schizophrenia mediates QOL, whereas psychosocial rehabilitation activities seem to increase empowerment, which may in turn increase QOL. Psychotic symptoms seem to have a direct effect of decreasing QOL that could not be mediated by empowerment. Empowerment had a significant effect on QOL for outpatients with schizophrenia. The findings of this study support the importance of empowerment and rehabilitation activities for promoting QOL among community outpatients. We suggest that various rehabilitation programs and empowerment health education are needed to enhance QOL for schizophrenia outpatients in the community.

The purpose of this research is to investigate the relationships of entrepreneurship, marketing capability, innovative capability, and sustained competitive advantage; hopefully to propose some new points of views in managing enterprises. We investigate the top 1000 Taiwan manufacturers in 2009 issued by Commonwealth magazine of Taiwan in this research. In total, 116 effective samples are collected. We use SEM linear structure equation model, and LISREL 8.7 editions of software for data analyses, and verify our hypotheses. The empirical results show: 1.entrepreneurship directly influence marketing capability, innovative capability and sustained competitive advantage respectively; and indirectly influence sustained competitive advantage through marketing capability and innovative capability respectively; 2.although marketing capability does not influence sustained competitive advantage directly, but influence sustained competitive advantages indirectly through innovative capability; in the other way, innovative capability influence sustained competitive advantage directly. Therefore, we suggest that an enterprise needs to develop its organizational culture of entrepreneurship and the two kinds of capabilities, marketing and innovation, hopefully to enhance its sustained competitive advantage.

Osteopaenia commonly occurs in preterm infants; however, its diagnosis is often delayed when based on radiological findings. The aim of this study was to examine whether serial measurements of bone turnover markers are useful for early prediction of osteopaenia in preterm infants.Premature infants of ≤ 34 weeks gestation were enrolled. Serum alkaline phosphatase (ALP), bone form ALP (BALP), calcium and inorganic phosphate were concurrently measured biweekly from 3 weeks post-natal age until 40 weeks post-conceptional age. Radiographic examination of the forearm was performed at term age. Osteopaenia was defined as positive radiographic findings according to Koo's criteria.Of the 46 premature infants completing the follow-up study at term age, 18 showed osteopaenia in radiographic examination. Serum ALP was highly correlated with BALP (R(2) = 0.93, P0.001). Infants who had osteopaenia showed a higher level of ALP and BALP after 3 weeks post-natal age than those who had no osteopaenia. ALP concentration exceeding 700 IU/L at 3 weeks post-natal age was predictive of osteopaenia at term age (sensitivity 73% and specificity 73%) and so did for the predictive value of BALP concentration exceeding 95 ug/L (sensitivity 73% and specificity 80%). BALP measures provided no greater benefit of diagnostic performance than ALP in early detection of osteopaenia. Furthermore, premature infants with osteopaenia showed similar levels of calcium and inorganic phosphatase concentration compared with those without.Serum ALP concentration exceeding 700 IU/L at 3 weeks post-natal age can predict the risk of osteopaenia in preterm infants.

Introduction: Maternal environmental tobacco smoke (ETS) has been identified as a key risk factor for problem behavior in children, but the role of genetic susceptibility is not clear. The purpose of this study was to examine the metabolic genetic modification effect of exposure to ETS in nonsmoking mothers on child behavior at 2 years of age. Methods: A prospective cohort study was conducted among 191 mothers who gave births between 2004 and 2005 and their infants in Taiwan. The mothers completed a questionnaire before delivery in which they provided information on exposure to ETS during pregnancy. Four metabolic genes, CYP1A1 MspI, CYP1A1 Ile462Val, GSTT1, and GSTM1 were isolated from both maternal and infant DNA samples. Children's behavior problems at 2 years of age were reported by their mothers using the Child Behavior Checklist/1.5-5. Multiple linear models were used to estimate the effects of ETS and genotype on child behavior. Results: Maternal ETS exposure was associated with the anxious score. The ETS-exposed group with both the CYP1A1 MspI and the CYP1A1 Ile462 Val variants had higher scores, as reflected in total CBCL score as well as scores on the internalizing scale and its emotional subdomain, the anxious scale, and the externalizing scale and its aggressive subdomain. Conclusions: Child behavioral problems may be associated with prenatal ETS exposure, and this effect may be modified by infant CYP1A1 MspI and CYP1A1 Ile462 Val genes.

This paper focused on the experience of the authors in providing nursing care to a patient with bulimia nervosa who sought psychiatric assistance upon her first episode. The nursing period spanned a period from April 21, 2008 to June 16, 2008. After primary diagnosis, relevant data was collected by observation, interview, and a review of medical records. The patient's disease was assessed from five dimensions. Care problems faced for this patient included: altered nutrition profile, abnormal eating patterns, ineffective individual coping, and body image disturbance. The authors adopted a three-stage nursing intervention based on cognitive behavior theory (CBT). First, a caring attitude was employed to establish a good nurse-patient relationship, after which the patient was instructed to maintain a diet diary, which could be used to help identify the underlying causes of her bulimia nervosa condition. Secondly, we assisted the patient to express her emotions and feelings in order to help her disentangle herself from unhealthy perceptions regarding body image and weight. Thirdly, we assisted the patient to develop critical problem-solving abilities and coping skills that would help avoid symptom recurrence. We followed up on patient progress by telephone for one month after treatment. The treatment had successfully stabilized her emotions and bulimia nervosa did not recur. Her body weight was kept within a satisfactory range. Furthermore, she applied cognitive behavior skills in daily life continuously, and she did exercise and kept company with an individual who helped reinforce appropriate behavior. It is hoped that this report can help nurses better understand bulimia nervosa and be used as a reference in clinical care.

Objectives This study explored the effectiveness of group music intervention against agitated behavior in elderly persons with dementia. Methods This was an experimental study using repeated measurements. Subjects were elderly persons who suffered from dementia and resided in nursing facilities. In total, 104 participants were recruited by permuted block randomization and of the 100 subjects who completed this study, 49 were in the experimental group and 51 were in the control group. The experimental group received a total of twelve 30-min group music intervention sessions, conducted twice a week for six consecutive weeks, while the control group participated in normal daily activities. In order to measure the effectiveness of the therapeutic sessions, assessments were conducted before the intervention, at the 6th and 12th group sessions, and at 1 month after cessation of the intervention. Longitudinal effects were analyzed by means of generalized estimating equations (GEEs). Results After the group music therapy intervention, the experimental group showed better performance at the 6th and 12th sessions, and at 1 month after cessation of the intervention based on reductions in agitated behavior in general, physically non-aggressive behavior, verbally non-aggressive behavior, and physically aggressive behavior, while a reduction in verbally aggressive behavior was shown only at the 6th session. Conclusions Group music intervention alleviated agitated behavior in elderly persons with dementia. We suggest that nursing facilities for demented elderly persons incorporate group music intervention in routine activities in order to enhance emotional relaxation, create inter-personal interactions, and reduce future agitated behaviors. Copyright © 2010 John Wiley & Sons, Ltd.

BACKGROUND: The purpose of this study was to explore risk factors including age at menarche body mass index (BMI) psychiatric stress and physical exercise on the menstrual cycle of healthy Taiwanese college nursing students. METHODS: We conducted a cross-sectional survey involving 1300 female college students in the nursing curriculum between December 2002 and March 2003. We provided a structured questionnaire for each student. Information on the womens demographics lifestyles and reproductive history related to menstrual cycle characteristics was requested. A total of 1095 healthy students were included in the analysis. A logistic regression was used to estimate the odds ratios for each of the menstrual cycle characteristics. RESULTS: We found that age at menarche BMI and psychiatric stress were associated with menstrual cycle characteristics in healthy college nursing students. In addition to menarche at the age of 14 years or later obesity and psychological stress menarche before 12 years of age was an important risk factor for menstrual dysfunction. Moreover obese students had the highest risk of having a longer cycle and cycle irregularity. CONCLUSIONS: Early menarche might be related to menstrual dysfunction in addition to late menarche obesity and psychological stress. Moreover obese students are at the highest risks for longer cycles and cycle irregularity.

Aim: Reference ranges of haematological parameters in preterm infants are limited. The aim of this study is to determine the reference values of haematological parameters in preterm infants in Taiwan, and to assess the impact of gestational age and mode of delivery on these parameters. Method: Medical records were retrospectively reviewed in preterm infants admitted to National Taiwan University Hospital from January 2001 to December 2004. The inclusion criteria included infants with

The objective of this study was to investigate disordered eating among female college students. The study sought to establish a predictive model for the risk of eating disorders in young female university students in Taiwan. A group of 336 student participants were recruited with the results showing that more than one third (43.2%) of the college women surveyed were identified to be at risk for developing an eating disorder. The results of multiple logistic regression showed that bulimia score, elevated depression index, eating binges, the use of laxatives and medicine to control weight, and having lost 20 lb, or more, in the past 6 months were all considered to be risk factors for developing an eating disorder (the corresponding area under receiver operating characteristic curve = 0.905). The results demonstrate that unhealthy dietary behaviors are rapidly spreading among young Taiwanese female students. For the sample described in this article, 67.6% of the female college students had lost weight: 51% had dieted at least once to lose weight, 43% used exercise to lose weight, 24% used low-calorie diets to lose weight, 11% used healthy food to lose weight, 9.2% used rubber clothing and a diet patch to lose weight, 17.9% of the students used weight-loss drugs, and a few students sought medical assistance from weight-loss clinics or actually underwent liposuction (1.5%).

Maternal exposure to environmental tobacco smoke (ETS) has been reported to be associated with children's neurobehavioral development but there was no studies investigating the genetic susceptibilities to maternal ETS exposure on children's neurodevelopment. The aim of the study was to explore the modification effect of metabolic gene polymorphisms to cord blood cotinine on children's neurodevelopment at the 2 years of age. This study is one investigation of the Taiwan Birth Panel Study and a total of 145 pregnant women and their neonates were recruited between April 2004 and January 2005. We interviewed them by a structured questionnaire after delivery and collected umbilical cord blood at birth. Cotinine in umbilical cord blood as an indicator of environmental tobacco smoke was analyzed by using HPLC–MS/MS and the detection limited of this method was 0.05 ng/mL. Four metabolic genes, CYP1A1 MspI, CYP1A1 Ile462Val, GSTT1 and GSTM1 were identified. The Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) was used for assessing children's neurodevelopment at the 2 years of age accompanying with the measurement of Home Observation for Measurement of the Environment scale. We used multiple linear regression models to estimate the effects of cord blood cotinine and gene modification. Cotinine levels were significantly negatively associated with developmental quotients (DQs) of the whole test, and cognitive, language, fine-motor and social subtests of the CDIIT. Lower cognitive and language DQs were found in exposed group with absent type of GSTT1. In addition, the lowest scores in fine-motor and whole test DQs were detected in exposed group with CYP1A1 Ile462Val variant type and GSTT1 absent type. It can be concluded that CYP1A1 Ile462Val and GSTT1 metabolic genes can modify the effect of cord blood cotinine on early child neurodevelopment especially for language and fine motor development.

This study aimed to evaluate the efficacy of hydrodistention (HD) and bladder training for interstitial cystitis (IC). From 1997 to 2006, 361 consecutive IC patients were treated by HD, followed by bladder training. Each patient was followed up using a diary for 8 weeks after HD weekly and monthly thereafter. The efficacy of the treatment was evaluated using the average of the voided volumes and the voiding frequency. The mean +/- standard deviation of the pre-HD daytime voided volumes and voiding frequency were 110.0 +/- 47.0 ml and 14.7 +/- 11.0, respectively. Furthermore, the nocturnal values were 173.1 +/- 91.8 ml and 2.8 +/- 1.7, respectively. After 72 weeks post-HD, the 185 patients who completed the follow-up had volumes/frequency of daytime, 306.5 +/- 80 ml and 6.9 +/- 2.1, respectively, and nocturnal, 325.8 +/- 122.4 ml and 1.3 +/- 0.6, respectively. The implementation of HD and bladder training is crucially important for long-term remission among IC patients.

BackgroundHuman mast cells are multifunctional cells capable of a wide variety of inflammatory responses. Baicalein (BAI), isolated from the traditional Chinese herbal medicine Huangqin (Scutellaria baicalensis Georgi), has been shown to have anti-inflammatory effects. We examined its effects and mechanisms on the expression of inflammatory cytokines in an IL-1β- and TNF-α-activated human mast cell line, HMC-1.MethodsHMC-1 cells were stimulated either with IL-1β (10 ng/ml) or TNF-α (100 U/ml) in the presence or absence of BAI. We assessed the expression of IL-6, IL-8, and MCP-1 by ELISA and RT-PCR, NF-κB activation by electrophoretic mobility shift assay (EMSA), and IκBα activation by Western blot.ResultsBAI (1.8 to 30 μM) significantly inhibited production of IL-6, IL-8, and MCP-1 in a dose-dependent manner in IL-1β-activated HMC-1. BAI (30 μM) also significantly inhibited production of IL-6, IL-8, and MCP-1 in TNF-α-activated HMC-1. Inhibitory effects appear to involve the NF-κB pathway. BAI inhibited NF-κB activation in IL-1β- and TNF-α-activated HMC-1. Furthermore, BAI increased cytoplasmic IκBα proteins in IL-1β- and TNF-α-activated HMC-1.ConclusionOur results showed that BAI inhibited the production of inflammatory cytokines through inhibition of NF-κB activation and IκBα phosphorylation and degradation in human mast cells. This inhibitory effect of BAI on the expression of inflammatory cytokines suggests its usefulness in the development of novel anti-inflammatory therapies.

Poor health outcomes among neonates born to aborigines has been reported in many countries. This study was aimed to examine the nationwide characteristics of live births, adverse birth outcomes, and age-specific mortality among neonates born to non-aboriginal and aboriginal parents in Taiwan.All neonates born alive during the period of 2000 to 2003 in Taiwan were included. The adverse birth outcomes including low birth weight, preterm, and small-for-gestational-age births, and age-specific mortality were obtained. Logistic regression analysis was used to estimate odds ratios for parental ethnicity in relation to birth outcomes, while Cox's proportional hazards regression models were used to estimate hazard ratios for parental ethnicity in relation to age-specific infant deaths.A total of 947,317 live births were included that consisted of 9,381 born to aboriginal mothers, 6,429 born to aboriginal fathers, and 15,354 born to aboriginal parents. There was a gradual increase in the risk of having a baby with low birth weight, preterm, or small for gestational age born to the four parental aboriginal ethnicity groups: non-aboriginal parents, aboriginal mother only, aboriginal father only, and aboriginal parents. Similar trends were also found for early neonatal, neonatal, and infant mortalities after stratification of residential areas. The neonates born to both aboriginal parents with residence in rural or mountain areas were at highest risk of adverse birth outcomes and age-specific mortality.Our results demonstrated that aboriginality and residential area are important risk factors for adverse perinatal and infant outcomes.

The living style, health-care system and socio-economic environments have changed substantially in Taiwan over past 20 years. This study was aimed to estimate the current perinatal cytomegalovirus (CMV) seroprevalence in northern Taiwan.In a Taiwan Birth Panel Study, 483 pairs of mothers and neonates were prospectively recruited from one tertiary medical center, one local hospital, and two obstetric clinics located in northern Taiwan from April 2004 through January 2005. Sera of their paired maternal and cord blood were tested by an enzyme-linked immunosorbent assay method for CMV IgG and IgM antibodies. Additional data were collected for health measures and epidemiological characteristics through trained interviewers utilising structured questionnaires.Among 483 mothers studied, 93% were Taiwanese, 6.4% were immigrants from the south-eastern Asia and Mainland China, and 0.6% was aborigines. The seropositive rate of CMV IgG and IgM among the mothers was 91.1% and 3.5%, respectively. The immigrant mothers and the mothers younger than 20 years of age had a higher IgM seroprevalence (P0.05). Furthermore, 90.8% of the offspring had CMV IgG seropositivity and yet none of the neonates were CMV IgM positive.The seroprevalence of CMV among childbearing women is high in northern Taiwan. The immigrant mothers and the teenage mothers appear to have higher seropositivity of CMV IgM.

There are limited nationwide population-based data about birth weight percentiles by gestational age in Taiwan. The purpose of this study was to develop updated intrauterine growth charts that are population based and contain the information of birth weight percentiles by gestational age for singleton newborns in Taiwan. We abstracted and analyzed the birth registration database from the Ministry of the Interior in Taiwan during the period of 1998-2002 that consisted of over one million singleton births. Percentiles of birth weight for each increment of gestational week from 21 to 44 weeks were estimated using smoothed means and standard deviations. The analyses revealed that birth weight rose with advancing gestational age, with greater slopes during the third trimester and then leveled off beyond 40 weeks of gestational age. The male to female ratio ranged from 1.088 to 1.096. The mean birth weights during the period of 1998-2002 were higher than those previously reported for the period of 1945-1967; while the birth weight distribution and percentile during the period of 1998-2002 were similar to those reported for the period of 1979-1989. The 10th, 50th, and 90th percentiles of birth weigh at 40th gestational age among the male newborns were 2914, 3374, and 3890 g respectively; and for the female newborns 2816, 3250, and 3747 g. At the gestational age of 37 weeks, the 10th, 50th, and 90th percentiles of birth weigh among the male newborns were 2499, 2941, and 3433 g respectively; and for the female newborns 2391, 2832, and 3334 g. From 1998 to 2002, there was a gradual increase in the prevalence of low birth weight and preterm birth together with the percentage of infants born to foreign-born mothers. This study provides the first nationwide singleton intrauterine growth charts in Taiwan that are population-based and gender-specific. The normative data are particularly useful for the investigation of predictors and outcomes of altered fetal growth.

Background Tuberous sclerosis complex (TSC) is an autosomal dominant disease characterized by the development of multiple hamartomas in many internal organs. Mutations in either one of 2 genes, TSC1 and TSC2, have been attributed to the development of TSC. More than two-thirds of TSC patients are sporadic cases, and a wide variety of mutations in the coding region of the TSC1 and TSC2 genes have been reported. Methods Mutational analysis of TSC1 and TSC2 genes was performed in 84 Taiwanese TSC families using denaturing high-performance liquid chromatography (DHPLC) and direct sequencing. Results Mutations were identified in a total of 64 (76 %) cases, including 9 TSC1 mutations (7 sporadic and 2 familial cases) and 55 TSC2 mutations (47 sporadic and 8 familial cases). Thirty-one of the 64 mutations found have not been described previously. The phenotype association is consistent with findings from other large studies, showing that disease resulting from mutations to TSC1 is less severe than disease due to TSC2 mutation. Conclusion This study provides a representative picture of the distribution of mutations of the TSC1 and TSC2 genes in clinically ascertained TSC cases in the Taiwanese population. Although nearly half of the mutations identified were novel, the kinds and distribution of mutation were not different in this population compared to that seen in larger European and American studies.

Hardiness is a personality trait in which the ability to buffer the health related effects of stress is inherent. It has been frequently and enthusiastically investigated in connection with human health. In order to understand hardiness in psychiatric nurses, to prevent burnout, and to enhance the quality of nursing care, this study sought to investigate the relationships between hardiness, burnout and quality of nursing care. One hundred and forty-seven psychiatric nurses were selected in a stratified random sample from the psychiatric units of district hospitals in Taipei City. Data were collected through structured questionnaires and concerned: (1) demographic variables, (2) the Health Related Hardiness Scale, (3) the Jalowiec Coping Scale, and (4) the Maslach Burnout Inventory. The main results indicated that: (1) Most respondents enjoyed high levels of hardiness (M = 157.84, SD = 18.42); (2) Respondents' levels of hardiness were positively correlated to the use of confrontational coping styles, optimistic coping styles, supportive coping styles and self-reliant coping styles; (3) Levels of hardiness were negatively correlated to emotional exhaustion but positively correlated to personal accomplishment; (4) There was a significantly positive correlation between the evasive coping style and emotional exhaustion; (5) The confrontational, optimistic and self-reliant coping styles were positively correlated to personal accomplishment. The findings of this study should contribute to our understanding of the relationship between hardiness, coping strategies and burnout in psychiatric nurses.

Proposes a common global variable reassignment and an integrated approach which takes advantage of the complementary relationship of (1) in-lining and (2) interprocedural register allocation to reduce the procedure call overhead without causing any additional negative effect. Our approach is based on the observation of analyzed program characteristics to identify the heavily called procedure regions, and on register usage information to optimize the placement of resister save/restore code. This method also takes full advantage of free-use registers at each procedure call site. The average performance improvement is 1.233 compared with previous schemes that performed either (1) or (2) independently.

Phosphoglucose isomerase catalyzes the isomerization between glucose 6-phosphate and fructose 6-phosphate in cytoplasm, and functions as autocrine motility factor and neuroleukin outside the cells. A phosphoglucose isomerase from Bacillus stearothermophilus (pgiA) was subjected to mutagenesis study to address the catalytic function of the conserved anionic residues and those probably interacting with the phosphate group of substrates. The results suggest that Glu290 works concertedly with His311 as a general acid–base pair to initiate the isomerization step, and Glu150 assists the base function of His311. The conserved loop structure consisting of Gly205–Gly206–Arg207 plays a critical role for the recognition of substrates.

Objectives In 1979, approximately 2000 victims in central Taiwan accidentally ingested rice oil contaminated with polychlorinated biphenyls/dibenzofurans (PCBs/PCDFs). In this study, we compared mortality between the exposed subjects and their neighbourhood referents 30 years after Yucheng accident. Methods We obtained age- and gender-matched referents from the 1979 neighbourhood of the exposed people. Cause-specific mortality (classified by ICD-9 codes) was compared between exposed subjects (N=1803) and their neighbourhood referents (N=5170). Age-modified indirect standardised mortality ratios (indirect-SMR) were calculated utilising the Yucheng subjects9 neighbourhood referents as reference group. Total person-years of Yucheng subjects and neighbourhood referents were 48 751 and 141 774, respectively. Results All-cause mortality was significantly elevated in Yucheng subjects (SMR 1.2, 95% CI 1.1 to 1.3). Among Yucheng males, SMRs for chronic liver disease and cirrhosis (2.5, 1.5 to 3.9), stomach cancer (3.5, 1.5 to 7.0) and lymphatic and haematopoietic cancer (3.0, 1.1 to 6.6) were increased. Among Yucheng females, SMRs for disease of the circulatory system (1.5, 1.0 to 2.1) and systemic lupus erythematosus were increased (5 in Yucheng females, 0 in neighbourhood referents). Conclusions This is a long-term follow-up study comparing the mortality experience in people highly exposed to PCBs and PCDFs 30 years ago to that in a socio-economically comparable referent group. We found an increase in overall mortality, as well as other organ systems and some malignancies.