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Fine particulate matter, particles less than 2.5 um in diameter (PMsub2.5/sub), is an important environmental human health factor to consider. The long- and short-term influence of PMsub2.5/subon health has been extensively studied in relation to many health outcomes, although few investigations examined the consequences of chronic ambient PMsub2.5/subon life expectancy, which constitutes an important gauge of public human health status. Therefore, the aim of this study was to investigate the effects of reducing ambient PMsub2.5/sublevels in Taiwan on life expectancy there from 2000 to 2020. Officially reported island-wide annually average concentrations of ambient PMsub2.5/sub, county-level life expectancies, and demographic and socioeconomic and proxy variable were collected for the prevalence of smoking from various national public agencies and organizations, since variables these might potentially confound life expectancy results. The relationship between changes in ambient PMsub2.5/sublevels and life expectancy were determined using linear regression. Data demonstrated that counties with greater reductions in ambient PMsub2.5/subconcentrations were associated with higher life expectancies. Adjusting for alterations in demographic and socioeconomic variables and proxy parameter, the prevalence of smoking data from a multiple regression model, it was found that a 0.3-year rise in life expectancy was noted for each 10 ug/msup3/supdecrease in PMsub2.5/subin those counties. Our findings show that reducing ambient PMsub2.5/sublevels play an important role for prolongation of life expectancy in Taiwan.

A number of studies investigating the possibility that air pollutant exposures increases the risk of adverse effects on mental health including frequency of suicide and depression, is a major growing public health concern. Human data demonstrated that exposure to various ambient air contaminants including ozone (O

Airborne fine particulate matter (PM

International students face many impediments under the COVID-19 pandemic. The objectives of this study are to assess the association between the perceptions of international students and the lockdown policy for COVID-19. In 2021, three different levels of lockdown policy were enforced, including level I from January to April, level III from May to July, and level II from August to December. We conducted three surveys for international graduate students using a validated questionnaire during the different lockdown levels. We collected 185, 119, and 83 valid questionnaires in level I, II, and III, respectively. There were linear trends in the correlations of lockdown policy with the knowledge (p = 0.052), attitudes (p = 0.002), and practices (p < 0.001) of COVID-19. In brief, the stricter the lockdown policy, the better the students adhered to sufficient knowledge, positive attitudes, and healthy practices. Furthermore, there were significant linear correlations of lockdown policy with the transportation, school study, leisure, family life, and diet behavior. In conclusion, lockdown policy had important impacts on the knowledge, attitudes, practices, and daily lives of international students. The findings indicated that the lockdown system and its corresponding measures appear to affect perceptions in a positive way.

There are few apparent studies regarding the association between fine particulate matter (PM2.5) air pollution and development of depression. Data obtained from epidemiological studies are inconsistent and controversial. The aim of this case-crossover study was to examine the association between short-term exposure to PM2.5 alone and in combination with other pollutants and frequency of hospitalizations for depression from 2009 to 2013 in Taipei, Taiwan. In the single pollutant model without adjustment for other pollutants, 17% and 4% increase in admissions attributed to depression correlated with interquartile range (IQR) rise in PM2.5 levels was noted on warm and cool days, respectively. Data were also analyzed using two-pollutant models and it was found that on warm days, the association continued to be significant after including one of the following pollutants: sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3) or carbon monoxide (CO). On cool days, the significance was lost. In conclusion, the relationship between ambient outdoor PM2.5 exposure and rates of hospitalization for depression appeared to be temperature dependent in Taipei. Further research is needed to verify these observations as well as to distinguish the relative contributions of PM2.5 and temperature to development for hospital admissions for depression.

Among the air pollutants, particulate matter with an aerodynamic diameter less than 2.5 um (PM2.5) is of particular interest to environmental medicine as epidemiologic studies consistently ...

Epidemiologic studies indicated that exposure to ambient air pollutants was associated with increased mortality rates attributed to suicide. The objective of this study was to investigate the potential relationship between ambient ozone (O3) levels and daily number of hospital admissions for suicide attempts in Taipei for the period 2008-2012 using a time-stratified case-crossover analysis. In the single-pollutant model (without adjustment for other pollutants), the risk of committing a suicide attempt increased by 9% on warm days and 27% on cool days for each interquartile range (IQR) rise in O3 levels, respectively. The concentration of O3 was thus significantly associated with daily number of suicide attempts both on warm and cool days. In the two-pollutant models, O3 levels remained significant after the inclusion of other air pollutants (particulate matter (PM10), PM2.5, sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO)) on cool days. However, on warm days, no significant correlation was found between O3 levels and reported daily number of suicide attempts. The relationship between O3 and suicide attempts appeared to be dependent upon temperature; however, the basis for these observations requires further investigation.

Jumping on the bed is a favorite behavior of children; however, no study has investigated the increased air pollutants resulting from jumping on the bed. Therefore, we aimed to investigate the elevated concentrations of particulate matter (PM) and bioaerosols from jumping on the bed and making the bed. Simulation of jumping on the bed and making the bed was performed at sixty schoolchildren's houses in Taiwan. PM10, PM2.5, PM1 (PM with aerodynamic diameter less than 10, 2.5, and 1 μm, respectively) and airborne bacteria, fungi and endotoxin concentrations were simultaneously measured over simulation and background periods. Our results show the increase of PM10, PM2.5, PM1, airborne bacteria and fungi through the behavior of jumping on the bed (by 414 μg m-3, 353 μg m-3, 349 μg m-3, 6569 CFU m-3 and 978 CFU m-3, respectively). When making the bed, the PM10, PM2.5, PM1, airborne bacteria and fungi also significantly increased by 4.69 μg m-3, 4.09 μg m-3, 4.15 μg m-3, 8569 CFU m-3, and 779 CFU m-3, respectively. Airborne endotoxin concentrations significantly increased by 21.76 EU m-3 following jumping on the bed and making the bed. Moreover, when jumping on the bed, higher PM2.5 and PM1 concentrations in houses with furry pets rather than no furry pets, and less airborne fungi in apartments than in townhouses were found. For making the bed, lower airborne fungi was found in houses using essential oils rather than no essential oils using. The airborne endotoxin concentrations were positively associated with furry pets and smokers in the homes and negatively correlated to the home with window opening with a statistical significance during the periods of jumping on the bed and making the bed. In conclusion, significant increases of PM and bioaerosols during jumping on the bed and making the bed may need to be concerned.

In 2014 and 2015, Southern Taiwan experienced two unprecedented outbreaks, with more than 10,000 laboratory-confirmed dengue cases in each outbreak. The present study was aimed to investigate the influence of meteorological and spatial factors on dengue outbreaks in Southern Taiwan and was conducted in Kaohsiung City, which is the most affected area in Taiwan. The distributed lag nonlinear model was used to investigate the role of climatic factors in the 2014 and 2015 dengue outbreaks. Spatial statistics in the Geographic Information System was applied to study the relationship between the dengue spreading pattern and locations of traditional markets (human motility) in the 2015 dengue outbreak. Meteorological analysis results suggested that the relative risk of dengue fever increased when the weekly average temperature was more than 15°C at lagged weeks 5 to 18. Elevated relative risk of dengue was observed when the weekly average rainfall was more than 150 mm at lagged weeks 12 to 20. The spatial analysis revealed that approximately 83% of dengue cases were located in the 1000 m buffer zone of traditional market, with statistical significance. These findings support the influence of climatic factors and human motility on dengue outbreaks. Furthermore, the study analysis may help authorities to identify hotspots and decide the timing for implementation of dengue control programs.

Background: Parents may consider interrupting breastfeeding to manage neonatal jaundice (NJ). Our aims were to determine correlations of breastfeeding with NJ by examining infants' manifestations i...

Numerous epidemiologic studies demonstrated an association between an increase in levels of fine particles (particulate matter less than 2.5 um in diameter, PM2.5) and elevation in the number of ho...

Access to health care is an important determinant of health, but it remains unclear whether having more physicians reduces mortality. In this study, we used Taiwan’s population-level National Death Certification Registry data to investigate whether a greater supply of physicians is associated with lower rates of amenable mortality, defined as deaths that can be delayed with appropriate and timely medical treatment. Our baseline regression analysis adjusting only for age and sex shows that an increase in the number of physicians per 1000 is associated with a reduction of 1.7 ( P

Epidemiologic studies reported an association between exposure to ambient air pollutants and increased mortality rate attributed to suicide and suicide attempts. The investigation sought to determine whether there is an association between short-term ambient ozone (O3) level exposure and daily hospital admissions for depression in Taipei from 2009 to 2013 using a time-stratified case-crossover design. In our single-pollutant model (with no adjustment for other pollutants), the % increase in daily hospital admissions for depression was 12% on warm days and 30% on cool days, per interquartile range (IQR) rise in O3 levels, respectively. Ozone levels were significantly correlated with daily number of depression admissions both on warm and cool days. In our two-pollutant models, O3 levels remained significant after adjusting for other air pollutants, including particulate matter (PM10, PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) both on warm and cool days. Although O3 levels tended to be higher on warm days, admissions for depression were higher on cool days, suggesting that the relationship between O3 concentrations and depression may be affected by temperature. Further study is needed to better understand these findings.

Background: Upper extremity musculoskeletal disorders are highly prevalent work-related injuries. The problem is commonly related to tasks that involve forceful exertion and repetitive motion. This study investigated forearm muscular strength and fatigue when performing a screw driving task using the screw driving model.Methods: Ten male and two female adults participated in this study. The pre- and post-fatigue maximum handgrip, driving torque, push force, insertion rate of the screws and corresponding electromyographic responses were measured to assess the muscle strength loss and fatigue of the forearm when driving screws. Results: After screwing, the maximal grip force, maximal driving torque, and maximal push force losses were approximately 32%, 24% and 27%, respectively. The percentage force loss of grip force and driving torque in the brachioradialis and extensor carpi ulnaris was greater than those of the biceps brachii. The percentage of maximum driving torque and push force decreased significantly on the eighth screw compared with the first screw. The insertion rate decreased linearly with the number of inserted screws; however, a significant decrease in the insertion rate of the fourth screw was observed. Conclusion: Muscle fatigue may occur in subjects who are inserting more than four screws. More muscle force loss and a higher risk of fatigue occurred in the brachioradialis and extensor carpi ulnaris. The results of this study can be used to assess the risk of forearm injury and potential for muscle fatigue due to exposure to repetitive driving tasks. Keywords: muscle fatigue, maximum isometric forces, driving torque

Supplemental material, SupplementalMaterial_20200712_xyz46925bc957877_1 for Associations Between Physician Supply Levels and Amenable Mortality Rates: An Analysis of Taiwan Over Nearly 4 Decades by Brian K Chen, Dakshu Jindal, Y. Tony Yang, Nicole Hair and Chun-Yuh Yang in Health Services Insights

The relationship between exposure to ambient air pollutants and hospital admissions for appendicitis is not known. This study examined whether an association existed between air contaminant levels and frequency of hospital admissions for appendicitis in Taipei, Taiwan. Ambient air pollution and hospital admission data for Taipei were obtained for 2009-2013. Relative risk (RR) of hospital admissions was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single pollutant model, on warm days (> 23°C), number of appendicitis admissions was significantly associated with particulate matter (PM2.5), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). On cool days (

This study investigated the temperature-specific risks of adverse neonatal outcomes in Taiwan. Over 2 million births between 2001 and 2010 were correlated with the daily mean outdoor temperatures at birth. A log-binomial model was used to estimate the risk of adverse neonatal outcomes in relation to ambient temperature at birth after adjusting for possible confounders. There was a significant correlation of temperature extremes with stillbirth, preterm birth, and low birth weight. Maternal exposure to temperature extremes carried greater risks of stillbirth (23.4°C), preterm birth (19.5°C and25.4°C), and low birth weight (15.5°C and23.4°C) than did temperatures of 21.5°C∼23.4°C. In conclusion, infants born to women exposed to temperature extremes possess greater risks for stillbirth, preterm birth, and low birth weight. The data suggest optimal temperatures to minimize overall adverse neonatal outcomes are 21.5°C∼23.4°C.

We previously demonstrated that B1 induced significant cytotoxic effects, cell cycle G1 arrest and apoptosis in human lung cancer A549 cells through the inhibition of DNA topoisomerase II activity. In the present study, we focused on the histone deacetylase (HDAC) modulation of B1 in A549 cells. HDACs, important enzymes affecting epigenetic regulation, play a crucial role in human carcinogenesis. Our findings showed that B1 could suppress the growth of A549 cells in vitro through the inhibition of HDAC activity. Additionally, B1 caused disruption of the mitochondrial membrane potential and induced DNA double-strand breaks (DSBs) in a dose- and time-dependent manner, which consequently led to cell apoptosis. We also observed that B1 inhibited cancer cell migration and angiogenesis-related signal expression, including vascular endothelial growth factor (VEGF) and pro-matrix metalloproteinases-2 and -9 (pro-MMP-2/9). Gelatin zymography suggested that B1 decreased pro-MMP-2 and pro-MMP-9 activity. Transcription factors, signal transducer and activator of transcription 3 (STAT3) and nuclear factor-κB (NF-κB), are vital players in the many steps of carcinogenesis. B1 showed significant dose-response inhibitory effects on cytoplasmic expression and nuclear translocation of both phosphorylated STAT3 (pSTAT3) and NF-κB. It has been well documented that reactivated telomerase confers cancer cells the ability to repair DNA. Real-time PCR results indicated that B1 inhibited STAT3 and NF-κB mRNA expression and telomerase activity. Taken together, our results demonstrated that B1 exerted significant inhibitory effects on HDAC, telomerase activities, oncogenic STAT3 and NF-κB expression. The inhibition of the intricate crosstalk between STAT3 and NF-κB may be a major factor in the molecular action mechanism of B1. The multiple targeting effects of B1 render it a potential new drug for lung cancer therapy.

This study was undertaken to determine whether there was a correlation between fine particle (PM2.5) levels and hospital admissions for hypertension in Taipei, Taiwan. Hospital admissions for hypertension and ambient air pollution data for Taipei were obtained for the period from 2009 to 2013. The relative risk of hospital admissions was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single pollutant model (without adjustment for other pollutants), the risk of hospital admissions for hypertension was estimated to increase by 12% on warm days (>23°C) and 2% on cool days (

Oral rotavirus vaccine (RV) administration in conjunction with other injectable vaccines has been used worldwide. However, whether the sequence of RV administration is associated with the reduction of injection-induced pain remains unclear. In this randomized controlled trial, we enrolled 6–12-wk-old healthy infants. The pain response of the infants was scored on the basis of their crying, irritability, facial expression, gagging and distress. A multivariate logistic regression model was used to compare the pain response after adjustment for possible confounders. We enrolled 352 infants, of whom 176 infants received RV before injection (experimental group) and 176 infants received an RV after injection (comparison group). Sex, number of injections, main caregiver, feeding type, and RV type did not differ significantly between the 2 groups. Multivariate regression analyses showed that, at 30 s after the intervention, the episode of gagging was more frequent in the comparison group than in the experimental group (p = 0.004). At 180 s after the intervention, the infants cried more often in the comparison group (p < 0.001). Furthermore, the infants in the experimental group more often relaxed (p < 0.001), rested quietly (p = 0.001), and were smiling (p = 0.001) than did those in the comparison group. Our results indicate that compared with oral RV administration after injection, oral RV administration before injection is more effective in reducing injection-induced pain in 2-mo-old infants. The findings can provide a clinical strategy for relieving pain from vaccination in young infants.

Background. Infant holding position may reduce vaccination pain. However, the optimal position for young infants remains controversial. Objectives. To compare the effectiveness of holding infants in the supine position and the effectiveness of holding infants in upright position for relieving acute pain from vaccine injection. Methods. This prospective cohort study enrolled 6–12-week-old healthy infants. We examined infant pain responses by evaluating the following three categories: (1) crying, (2) irritability, and (3) facial expression. Results. In total, 282 infants were enrolled, with 103 and 179 held in the supine and upright positions, respectively. At 30 s after vaccination, the infants in the supine position showed a larger decrease in crying (p<0.001), irritability (p=0.002), and pained facial expression (p=0.001) than did those in the upright position. However, there was no significant difference in pain response between two groups at 180 s after intervention. Conclusion. In 2-month-old infants, the supine position may reduce acute pain more effectively than does the upright position. Our findings provide a clinical strategy for relieving vaccination pain in young infants.

Few studies have examined the association between increased risk of colon cancer development and occupation of farming. Data thus far have been inconsistent with respect to a correlation between farming and colon cancer occurrence. This type of study has not been undertaken in Asia. The aim of this investigation was to utilize the mortality odds ratio (MOR) design to estimate the relative risk (RR) of mortality attributed to colon cancer in farmers in Taiwan. Utilizing Taiwan's Death Certificate Registry, data were collected on subjects who died between 1997-2009. Our study group was comprised of individuals 50 years of age and higher who died of colon cancer, while the control group consisted of subjects the same age who died of all other causes excluding cancers. Multiple logistic regression was performed to compute the MOR adjusted for gender, age at death, year of death, marital status, and urbanization levels. Of the 32,456 farmers who died, 558 were attributed to die of colon cancer. Farmers in Taiwan had a significantly lower risk of mortality from colon cancer than non-farmers (MOR = 0.85, 95% CI = 0.78-0.93), similar to estimates reported in previous meta-analyses. Occupational physical activity or higher consumption of vegetables and fruits might have contributed to the lower risk of death due to colon cancer. The basis for these observations requires further examination as it appears that lifestyle is a crucial factor in colon cancer development.

Background. Access to health care is an important determinant of health, but despite years of research, it remains unclear whether having more physicians reduces mortality. In this study, we investigate whether a greater supply of physicians in given administrative areas is associated with lowers rates of amenable mortality, defined as deaths that can be delayed with appropriate and timely medical treatment or public health measures.Methods. We use Taiwan’s population-level National Death Certification Registry data spanning nearly four decades to study the trend in age-standardized amenable mortality rates by area physician supply quartiles. We also conducted multivariate panel data regression analyses of the association between age-standardized amenable mortality rates and physician supply, controlling for mean household income, education attainment, urbanization levels, decade fixed effects, and the implementation of universal health care.Results. The trend analyses (adjusted for age and sex only) show that Taiwanese townships in the top quartile of physician supply consistently had the lowest age-standardized amenable mortality rates. However, in the panel data regression analyses, after controlling for at least mean household income, the negative association between physician supply and overall amenable mortality loses statistical significance, although it remains statistically significant for ischemic heart disease.Conclusions. These findings suggest that physician supply, while important, is but one input that contributes to population health and is likely confounded with other socioeconomic factors correlated with better health. Physician supply levels are not randomly distributed, and doctors likely choose to practice in higher income areas and areas with demonstrated medical need. More research is needed, but policy makers should consider broader social policies, not just healthcare resources, as means to promote population health once a critical mass of physicians is achieved.

High concentrations of air pollutants and increased morbidity and mortality rates are found in industrial areas, especially for the susceptible group, children, however, most studies use atmospheric dispersion modeling to estimate household air pollutants. Therefore, the aim of this study was to assess the indoor air quality, e.g., CO, CO2, NO2, SO2, O3, particulate matter with aerodynamic diameter less than 2.5 &mu, m (PM2.5), and their influence factors in children&rsquo, s homes in an industrial city. Children in the &ldquo, general school&rdquo, &ldquo, traffic school&rdquo, and &ldquo, industrial school&rdquo, were randomly and proportionally selected. Air pollutants were sampled for 24 h in the living rooms and on the balcony of their houses and questionnaires of time&ndash, microenvironment&ndash, activity-diary were recorded. The indoor CO concentration of the traffic area was significantly higher than that of the industrial area and the general area. In regard to the effects of window opening, household NO2 and PM2.5 concentrations during window opening periods were significantly higher than of the reference periods. For the influence of cooking, indoor CO2, NO2, and PM2.5 levels during the cooking periods were significantly higher than that of the reference periods. The indoor air quality of children in industrial cities were affected by residential areas and household activities.

This study investigated the muscle strength and performance fatigability of the forearms in eight male orthopaedic surgeons when performing bone screw fixations. Each surgeon performed an eight-bone screws operations in a porcine femur model to simulate fractural fixation using plating technique. The pre- and post-fatigue maximum isometric forces and corresponding electromyography responses were measured to assess the forearm muscle strength loss and fatigue due to screwing. Results showed that after eight bone screws were inserted, the maximal grip force, maximal driving torque and maximal push force losses were approximately 29%, 20% and 23%, respectively. While the grip force and/or driving torque acting, both the brachioradialis and extensor carpi ulnaris had a higher percentage change of EMG than the biceps brachii. The driving forces decreased with the number of screw insertions; however, the insertion time increased parabolically with the number of screws and significantly decreased the insertion rate of the screws, indicating that forearm muscle fatigue may occur in surgeons who treat fracture fixation using more than eight bone screws.

BACKGROUND To date, the effect of household airborne pollutants on the association between airborne endotoxin and lung function of schoolchildren is unknown. OBJECTIVES The objective of this study is to evaluate whether indoor air pollutants such as carbon monoxide (CO), carbon dioxide (CO2), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), particulate matter with aerodynamic diameter

During bone burring, the heat generated due to friction at the bone–burr interface may cause thermal damage to the bone. Therefore, it is necessary to assess bone temperature distribution around a burring site and identify high-risk regions for thermal necrosis due to bone burring. In this study, a three-dimensional (3-D) dynamic elastoplastic finite element model for the burring process was developed and experimentally validated to investigate the influence of burring parameters (rotational speeds: 3,000, 10,000, 15,000 and 60,000 rpm; feed rates: 0.5, 0.9, 1.5 and 3.0 mm/s) on heat generation and evaluate the risk region for thermal necrosis. Calculated bone temperatures were compared with experimental values and found to be in good agreement with them. The analytical results demonstrated a linear relationship between the burring time and friction energy. In addition, the friction energy increased with the bone temperature. The high-risk thermal necrosis zone was measured from the edge of burring (y-direction) at feed rates of 0.5, 0.9, 1.5 and 3.0 mm/s and was found to be 7.8, 7.3, 6.6 and 5.5 mm, respectively. When the burr rotational speed increased from 3,000 to 60,000 rpm, the high-risk zone for thermal necrosis increased from 4.5 to 8.1 mm. We concluded that both the friction energy and the bone temperature increased in proportion with the burr rotational speed. Reducing burr rotational speeds and/or increasing feed rates may decrease the rise in bone temperature, thus decreasing the potential for thermal necrosis near the burring site. Our model can be used to select the optimal surgery parameters to minimise the risk of thermal necrosis due to bone burring and to assist in the design of optimal orthopaedic drill handpieces.

Several studies suggested short-term exposure to air pollution might be associated with suicide mortality, although results have been inconsistent and vary depending upon the type of air contaminants. While seasonal variation associated with suicide was reported to occur and that in the spring and early summer there are peaks in ozone (O3) distribution, the relationship between these two parameters is not known. The aim of this study was to examine the potential association between O3 levels and daily mortality rate related to suicide in Taipei for the period 2004-2008 using a time-stratified case-crossover analysis. In our single pollutant model without adjustment for other pollutants, the risk of suicide increased by 11% on warm days and 15% on cool days for each interquartile range (IQR) rise in O3 concentration, respectively. The relationship was positive but did not reach significance. In our two-pollutant models, O3 remained non-significant on warm days after inclusion of one of any other ambient air contaminants into the model. However, on cool days, a significant association was found between O3 levels and enhanced risk of mortality due to suicide after nitrogen dioxide (NO2) or carbon monoxide (CO) were included. The overall positive but not significant findings of elevated risk of mortality frequently attributed to suicide on days with higher O3 levels suggest that outdoor exposures to this gaseous contaminant may contribute to increases in daily mortality rate related to suicide.

When physicians own complementary medical service facilities such as laboratories and imaging centers, they gain financially by referring patients to these entities. This creates an incentive for the physician to exploit patients' trust by recommending more services than necessary. Using data from Taiwan, which introduced a “separating” policy, that restricts physician ownership of pharmacies, we estimate that where the policy was binding, eliminating this incentive caused physicians to prescribe 7.1% less in drugs. Taking into account increases in complementary diagnostic services and that drugs are only a part of overall primary care spending, the policy reduced total expenditures by 1.8%. However, a large number of clinics exploited a loophole in the law and either had at baseline or integrated pharmacies into their practices post-policy making them exempt from the policy. As a result, the policy only reduced total drug expenditures by 2.1% and total primary care cost by 0.5%.

This study evaluated the effects of partial and complete island-wide smoking bans on perinatal outcomes in Taiwan. Trends were determined in the yearly prevalence rates for preterm births and low birth weight (LBW) for a 1978 to 1997 pre-ban period, a 1998 to 2008 Phase 1 partial ban period, and a 2009 to 2016 Phase 2 complete ban period. Poisson regression with a yearly time-series model was employed to determine alterations in trends in prevalence rates for preterm births and LBW. Compared with pre-ban period, the rate ratio (RR) for Phase 1 preterm births was 0.969 (95% confidence interval [CI] = 0.968-0.971) and Phase 2 0.995 (95% CI = 0.992-0.998). The Phase 1 RR LBW fell 0.4% (95% CI = 0.2%-0.5%), but Phase 2 RR rose 1.7% (95% CI = 1.4%-2.1%). Data indicated that the risk of preterm births and LBW in Taiwan was reduced significantly after implementation of the smoking ban. These findings are in agreement with growing evidence suggesting that smoke-free legislation exerted a beneficial health effect on pregnant women and their newborn infants.

Prolonged jaundice is a commonly evaluated condition. The aim of this study was to assess the risk factors of jaundice in healthy infants at one month of age. This prospective cohort study enrolled 509 healthy infants from 2013 to 2018. Those with gestational age (GA) less than 35 weeks, birth weight less than 2000 grams, and illness were not enrolled. Jaundice was defined as a transcutaneous bilirubin value ≥5 mg/dL at 25–45 days of age. Umbilical cord blood samples were obtained to examine seven common gene variants. The incidence of prolonged jaundice was 32.2%. Prolonged jaundice was more common in infants with exclusive breastfeeding (p 4 times/d (p

Jumping on the bed is a favorite behavior of children; however, no study has investigated the increased air pollutants resulting from jumping on the bed. Therefore, we aimed to investigate the elevated concentrations of particulate matter (PM) and bioaerosols from jumping on the bed and making the bed. Simulation of jumping on the bed and making the bed was performed at sixty schoolchildren's houses in Taiwan. PM

Many studies examined the short-term effects of air pollution on frequency of daily mortality over the past two decades. However, information on the relationship between exposure to levels of coarse particles (PM(2.5-10)) and daily mortality rate is relatively sparse due to limited availability of monitoring data and findings are inconsistent. This study was undertaken to determine whether an association exists between PM(2.5-10) levels and rate of daily mortality in Kaohsiung, Taiwan, a large industrial city with a tropical climate. Daily mortality rate, air pollution parameters, and weather data for Kaohsiung were obtained for the period 2006-2008. The relative risk (RR) of daily mortality occurrence was estimated using a time-stratified case-crossover approach, controlling for (1) weather variables, (2) day of the week, (3) seasonality, and (4) long-term time trends. For the single-pollutant model without adjustment for other pollutants, PM(2.5-10) exposure levels showed significant correlation with total mortality rate both on warm and cool days, with an interquartile range increase associated with a 14% (95% CI = 5-23%) and 12% (95% CI = 5-20%) rise in number of total deaths, respectively. In two-pollutant models, PM(2.5-10) exerted significant influence on total mortality frequency after inclusion of sulfur dioxide (SO(2)) on warm days. On cool days, PM(2.5-10) induced significant elevation in total mortality rate when SO(2) or ozone (O(3)) was added in the regression model. There was no apparent indication of an association between PM(2.5-10) exposure and deaths attributed to respiratory and circulatory diseases. This study provided evidence of correlation between short-term exposure to PM(2.5-10) and increased risk of death for all causes.

This study was undertaken to determine whether there was an association between coarse particles (PM2.5-10) levels and frequency of hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD, including ischemic heart disease (IHD), stroke, congestive heart failure (CHF), and arrhythmias, and ambient air pollution data levels for Kaohsiung were obtained for the period 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased rates of admissions for CVD were significantly associated with higher coarse PM levels only on cool days (25°C), with a 10-μg/m(3) elevation in PM2.5-10 concentrations associated with a 3% (95% CI = 2-4%) rise in IHD admissions, 5% (95% CI = 4-6%) increase in stroke admissions, 3% (95% CI = 1-6%) elevation in CHF admissions, and 3% (95% CI = 0-6%) rise in arrhythmias admissions. No significant associations were found between coarse particle levels and number of hospital admissions for CVD on warm days. In the two-pollutant models, PM2.5-10 levels remained significantly correlated with higher rate of CVD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. Compared to the effect estimate associated with a 10-μg/m(3) increase in PM2.5 levels, effect estimates of frequency of CVD-related admissions associated with a 10-μg/m(3) rise in coarse PM levels were weaker. This study provides evidence that higher levels of PM2.5-10 enhance the risk of hospital admissions for CVD.

Short-term associations between both hot and cold ambient temperatures and higher mortality have been found worldwide. Few studies have examined these associations on longer time scales. Age-standardized mortality rates (ASMRs) were calculated for 1976-2012 for Hong Kong SAR, People's Republic of China, defining "annual" time periods in 2 ways: from May through April of the following year and from November through October. Annual frequency and severity of extreme temperatures were summarized by using a degree-days approach with extreme heat expressed as annual degree-days >29.3°C and cold as annual degree-days

This study was undertaken to determine whether there was an association between fine particle (PM₂.₅) levels and daily clinic visits for migraine in Taipei, Taiwan. Daily clinic visits for migraine and ambient air pollution data for Taipei were obtained for the period from 2006-2011. The odds ratio of clinic visits was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. Generally, no significant associations between PM₂.₅ levels and migraine visits were observed on cool days. On warm days, however, for the single pollutant model (without adjustment for other pollutants), increased clinic visits for migraine were significantly associated with PM₂.₅ levels, with an interquartile range (IQR) rise associated with a 13% (95% CI = 8%-19%) elevation in number of migraine visits. In bi-pollutant model, PM₂.₅ remained significant after the inclusion of sulfur dioxide (SO₂) or ozone (O₃) on warm days. This study provides evidence that higher levels of PM₂.₅ increase the risk of clinic visits for migraine in Taipei, Taiwan.