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The World Health Organization Five Well-Being Index (WHO-5) has been developed to measure psychological wellbeing. Translation and linguistic validation of the WHO-5 into a Cantonese version has been accomplished for local use but it is not yet validated in people with severe mental illness in Hong Kong. This study aimed to examine the applicability of WHO-5 in measuring the psychological wellbeing dimension of people with severe mental illness. A brief and easily administrated tool to measure psychological wellbeing of people with severe mental illness can be used to provide an outcome measure in research studies and clinical trials.Subjects were randomly recruited from the Extended-Care Patient Intensive Treatment, Early Diversion and Rehabilitation Stepping-Stone Project (EXITERS) and the Rehabilitation Activity Centre (RAC) of Kwai Chung Hospital in Hong Kong. They were invited to complete the abbreviated version of Hong Kong Chinese World Health Organization Quality of Life (WHOQOL-BREF [HK]) and WHO-5 (Cantonese version) separately and concurrent validity was examined.A total of 84 subjects were recruited, 42 each from EXITERS and RAC. In all, 49 (58%) were male and 35 (42%) were female. The mean ± standard deviation age was 43.2 ± 9.7 years. Their mean duration of mental illness was 16.4 ± 10.5 years and the mean years of education was 10.17 ± 2.5 years, i.e. about junior secondary school level in Hong Kong. The internal consistency of the WHO-5 was satisfactory (0.86) and was comparable with previous reports. Regarding validity, 1-factor structure with an eigenvalue of 3.24 explained 64.8% of total variance of WHO-5 for people with severe mental illness. Concurrent validity was established with moderate correlation (0.41-0.51) between WHO-5 and 4 domains of the WHOQOL-BREF (HK).The WHO-5 (Cantonese version) is a reliable and valid tool to assess the psychological wellbeing of people with severe mental illness in Hong Kong. It can be used to monitor the effectiveness of psychological intervention aimed at improving the wellbeing of such patients.

AIMS: To investigate whether optical coherence tomography (OCT) with associated infra-red images provide enough information to determine treatment decisions in the management of neovascular age-related macular degeneration (nAMD), or whether retinal colour photography is also necessary. METHODS: In all, 87 OCT scans of 82 eyes with nAMD undergoing monitoring post ranibizumab treatment were taken using the Zeiss Stratus (Carl Zeiss Meditec, Jena, Germany; n=87) together with their corresponding infra-red images. Fundus colour photographs were also taken. These images were reviewed by an experienced assessor, and a ranibizumab treatment decision was made during a multidisciplinary team retinal image review meeting. RESULTS: In all, 30 OCT scans (34.5%) showed intraretinal or subretinal oedema. A total of 24 colour photographs (19.5%) demonstrated retinal haemorrhage. Corresponding OCT infra-red images gave poor sensitivity in detecting haemorrhages (0.176). In 16.7% of decisions to treat, haemorrhage alone was the deciding factor. Signs of disease activity seen only on colour photography were the deciding factor in clinical decisions for 8% of scans assessed. CONCLUSIONS: The presence or increase of intra-retinal oedema is an important sign of activity triggering ranibizumab retreatment, but some eyes show signs of retinal haemorrhage without coexisting oedema. These haemorrhages are often only seen on either colour imaging or fundoscopy and are unclear or invisible on OCT scans and infra-red images. Therefore, although retinal colour photography creates additional expense, it is indispensable for making informed retreatment decisions, if patients are monitored using retinal imaging alone.

Historical review of the evolvement over some 40 years of the initial Maternal and Child Health Association of China and the euphemistically-termed Pre-Pregnancy Health Program of Taiwan through to the present Planned Parenthood Association of Taiwan (PPAT) and Taiwan's national Family Health Program. Program recommendations for consideration for future implementation by the PPAT are offered on the joyous occasion of its 40th anniversary celebration in Taipei, March 10, 2004.

Screening in ovarian cancer is progressively finding out candidate genes and proteins which may work as screening biomarkers and play a role in tumor progression. We examined the protein expression patterns of ovarian cancer tissues using two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization-time of fight mass spectrometry (MALDI-TOF MS).Tissues from 36 ovarian cancers and 20 normal ovaries were examined by 2-DE. The images of silver stained gels were analyzed by ImageMaster 2D Elite. The peptide mixtures, after in-gel digestion, were determined by MALDI-TOF MS for fingerprinting. The de-isotope tryptic peptide profiles were matched by using the Mascot search engine based on the entire NCBI and Swiss-Prot protein databases. Western/dot blots were then applied to verify the findings.In ovarian cancer, 12 proteins that showed differential expressions were identified unequivocally. Among these proteins, five proteins (galectin-1, cathepsin B, ubiquitin carboxy-terminal hydrolase L1, HLA class II antigen DRB1-11 and heat shock protein 27) were up-regulated and seven proteins (cellular retinol-binding protein, transthyretin, SH3 binding glutamic-rich-like protein, tubulin-specific chaperone A, DJ-1, gamma-actin and tropomyosin 4) were down-regulated.The present study is the first to report the up-regulation of ubiquitin carboxy-terminal hydrolase L1 and the down-regulation of SH3 binding glutamic-rich-like protein, tubulin-specific chaperone A, and tropomyosin 4 in human ovarian cancer tissues. Further cloning and functional analysis of these salient proteins will provide more information on their pathophysiologic roles in ovarian cancer.

Background and aims To evaluate donor cell engraftment and the kinetics of cell repopulation in the injured mouse liver following human umbilical cord blood cell transplantation. Methods Nonobese diabetic/severe immunodeficient mice were treated with allyl alcohol to induce liver injury. Twenty-four hours later, umbilical cord blood derived mononuclear cells were transplanted by intra-splenic injection. Mice were sacrificed from 1 to 180 days after transplantation. Temporal changes in the ratio of human cells and fluorescence counts of human sex-determining region Y alleles in mouse liver were determined to evaluate the kinetics of cell repopulation. Mouse liver and sera were examined for the presence of human albumin. Results Human cell repopulation was extremely rapid in the first week following transplantation, with a doubling time of 1.16–1.39 days apparent. Thereafter cell doubling rate slowed significantly. Cells displaying characteristics of human hepatocytes were still evident at 180 days. Human albumin was detected in mouse liver and sera. Conclusion These findings confirm those from previous studies demonstrating that cells derived from human umbilical cord blood have the capacity to differentiate into cells with human hepatocyte characteristics in mouse liver following injury. Moreover, the detailed information collected regarding the kinetics of human cell repopulation in mouse liver will be of relevance to future studies examining the use of umbilical cord blood cells in liver transplantation therapy.

Our studies suggest a tripartite structure for the 60-kDa allergen of Bermuda grass pollen (BG60) including a short N-terminal segment, a FAD-binding domain, and a C-terminal domain. The lower molecular weight isoallergens lack the N-terminal segment. The higher protease susceptibility and the lower melting temperature of approximately 20 degrees C of the lower molecular weight isoforms suggest that the N-terminal segment is essential for a compact structure. Database screening reveals that the protease-digested peptide sequences (approximately 180 residues in total) share 40% identity with the plant berberine bridge enzymes. In particular, a 24-residue peptide sequence displays high similarity to a conserved FAD-binding motif. The spectroscopic and SDS-PAGE analyses suggest that the cofactor FAD is covalently linked to the central domain. Therefore, we conclude that BG60 is identified as the first flavinylated allergen.

Background Sorafenib is currently the only approved agent for hepatocellular carcinoma (HCC). However, its clinical efficacy in HCC is limited. Previous studies indicate that compensatory activation of AKT may contribute to the resistance to sorafenib. We hypothesized that combination of sorafenib and AKT inhibitors could enhance the antitumor effect of sorafenib in HCC. Methods We analyzed the cellular and molecular effects of sorafenib in combination with inhibitors of AKT in human HCC cell lines, and evaluated their combinational effects against HCC in vitro and in vivo. Results HCC cells, including Huh7, Hep3B, and SKhep1 cells, expressed high levels of p-AKT in a prompt and sustained manner upon treated with sorafenib. Down-regulation of AKT by siRNA or inhibition of phospho-AKT by AKT inhibitors (MK-2206 or perifosine) enhanced the anti-proliferative effect of sorafenib in cultured HCC cells. The combination indexes of sorafenib and AKT inhibitors were Conclusions Inhibition of AKT by AKT inhibitors improved the antitumor effect of sorafenib against HCC in vitro and in vivo. Combination of AKT inhibitors and sorafenib warrants further consideration for clinical development in HCC. (The study was supported by NSC97-2628-B-002-004-MY3 and NSC100-2325-B-002-043-.)

Response to ‘Combined OCT and colour fundus photography in virtual clinic assessments of wet AMD patients’

A highly specific monoclonal antibody (anti-AFP) against alpha-fetoprotein (AFP) was linked to N-succinimidyl-3-(2-pyridyldithio)propionate (SPDP) to form conjugates which were purified with a protein A-sepharose CL-4B affinity column. The conjugate, PDP-Anti-AFP was then covalently coupled to the toxic abrin-A chain to synthesize immunotoxins. The immunotoxin, anti-AFP-abrin-A conjugate, which was also purified with a protein A-sepharose CL-4B affinity column, had a molecular weight of 180,000 and had 80% antigen-binding activity that of anti-AFP activity and 92% toxicity of abrin-A chain. The immunotoxin showed selective cytotoxicities toward the AFP secreting human hepatoma cell lines, such HepG2 and Hep3B, but not toward AFP non-secreting human hepatoma cell line, PLC/PRF/5.

In 1988-1989 researchers analyzed data on 15178 induced abortions among 15-29 year old single women from 5 districts of Shanghai China to determine trends in abortion among single women. They also looked at medical records at Hua-chuan General Hospital in Shanghai to learn the percentage of single women who experienced late abortions. The highest abortion rate was among 20-24 year old women (]59) followed by 25-29 year old women (94) and 15-19 year old women (56). In fact 21 year olds experienced the most abortions (182.7) and 15 year olds the least (0). Among teenagers the rate stood 57% higher in the rural districts than the urban districts (72.2 vs. 45.9). Further abortion rates rose rapidly in the rural districts with age peaking at 20 years (264.1) then fell sharply to 23 among 28 year olds. On the hand the increase was more gradual among urban women and peaked at 21 (224.9) and the ensuing fall was more steady and was higher than rural areas. In 1982 in the 3 urban districts 14% of abortions occurred in single women. By 1986 it increased to 28%. It fell slightly to 25% in 1988. These corresponding figures for the rural districts were 14% 20% and 24%. Between 1982-1988 the abortion rate of 15-19 year olds rose from 5-56. Further abortion rates among 20-24 year olds and 30-34 year olds rose 4 times and among 25-29 year olds more than twice. 43% of all 2nd and 3rd trimester abortions occurred in unmarried women in 1982 by 1988 this figure soared to 63%. This indicated that single women were more likely to obtain an abortion late in their pregnancies than married women. The Chinese family planning program encourages women to delay marriage until age 23 and improved health and nutrition have reduced the age of menarche thus leaving women a longer period of sexual maturity. This coupled with the fact that cultural mores stress sexual abstinence outside of marriage and premarital pregnancy brings shame the considerable abortion rate among single women in Shanghai was not surprising.

This article presents a new randomizing device to obtain discrete quantitative as well as qualitative data on sensitive problems. The total number of balls in the randomizing device and the ratio of the different color balls which represent different sensitive characteristics are shown to affect the efficiency of estimates.

A methodological study of four procedures for obtaining information about induced abortion was done in Taiwan in 1970 and 1971. About 2000 women were in a repeat interview group and seen every six weeks for nine rounds; one-half of these were also asked to provide urine on each round for a pregnancy test. Another 2000 women were interviewed only once; about one-half were asked "standard" knowledge, attitude, and practice questions about their reproductive history, including abortion. The other one-half were asked the same questions except they were not queried about their practice of abortion, but rather were asked to participate in the randomized response technique (RRT). Three methods produced estimates that 13-14% of the women had had an induced abortion. The RRT gave a significantly higher estimate, 28%. All methods used were judged feasible, although there is a suggestion that, without some improvement, the RRT may be difficult to use in low literacy populations. The repeat interview did not demonstrate advantage over the single interview in obtaining prevalence of women with a history of induced abortion. Ths use of a shorter interval with probing when the pregnancy test is positive might improve identification of recent abortions.

In order to assess attitudes to knowledge about and practice (KAP) of family planning a 10% sample of 794 of all the married women in two Taiwan townships was drawn. The women who were between the ages of 20 and 44 were interviewed in August 1964. The aim was to measure the effect of small group meetings on changes in KAP of family planning; in particular to see the effectiveness of such meetings in motivating women to accept loops. Results showed that a) the meetings were effective in changing the womens attitudes knowledge and practice of family planning b) those not attentding the meetings also changed but less c) the cost per acceptance was lower in the area in which the meetings were held in every other neightborhood rather than in every neighborhood.

A strong argument for overall family limitation in less developed countries (LDC) may hinge on the ability of family planners to show parents how to have better babies who will not only survive but also develop to their full mental and physical potential. An adequate diet, especially with respect to protein, during both pregnancy and lactation will result in a better baby. This paper presents unpublished findings on survival rates and physical performances of offsprings whose mothers received different diets during pregnancy and lactation. Experiments on rats show that underfeeding them during pregnancy and lactation results in poor survival, permanent growth stunting, and delayed achievement in physical performance of the progeny. However, giving an adequate diet, especially in terms of protein, to mothers during both pregnancy and lactation results in offsprings with greater neonatal and infant survival rates, normal physical development, and complete physiological performance tasks at earlier ages. In addition, such offsprings are more efficient users of food throughout their life spans, require less food for growth and/or maintenance of body weight, and exhibit superior neuromotor and behavior development. These findings should be incorporated in family planning programs through the implementation of a systematic campaign to improve maternal nutrition. Mothers should be educated on the importance of adequate protein intake during pregnancy and lactation, and protein supplements should be provided to these mothers to ensure protein intake. These educational efforts should be applied particularly in areas where cultural patterns are such that pregnant and lactating mothers who need the most nutrients often get the least. Family planning programs which focus on the positive aspects of education and nutrition rather than the negative aspect of contraception may find greater support from organizations and governments. Family planning should come to mean "fewer babies--but better babies".

Assuming three patterns of changes in number of new IUD insertions, three stochastic models have been developed for the estimation of the “prevalence” of IUD in situ at a given point of time. The advantages of these models, compared with the conventional ways of estimating IUD prevalence, rest with their ease of use and simplicity of method for calculating variances of the estimates. The models are also useful for family planning administrators to set program targets. A correction factor to estimate the number of IUDs which, although “currently in situ,” are worn by women who have “passed over” the upper age limit of their reproductive spans has also been developed. This is particularly useful in estimating the “effective retention” of IUD.

Several of the countries in the Pacific region are pioneers in the national family planning movement of the developing world. Programs there focus on clearly specified demographic goals and operational targets and are usually given a high status. Several are among the most successfully implemented programs in the world. Good evaluation systems and innovative approaches are among their special characteristics. The programs have some weaknesses in common, however. Among these are inadequate input, failure to reach the hard-to-reach, inability to lower the norm of family size, and failure to encourage the use of some effective means of fertility control such as induced abortion. Some programs are also approaching an important stage of transition: a plateau of acceptance, a changing age structure of the population, and a possibly improved fecundability will, henceforth, make attainment of program goals increasingly difficult. More innovative approaches and dynamic leadership to save programs from the natural process of “aging” will be required in the future. Notwithstanding these weaknesses, the countries in the Pacific have a unique opportunity to demonstrate to the world that human fertility may be reduced through planned and organized effort.

A coupon system of evaluation that has been developed in Taiwan to provide accurate and prompt feedback on IUD insertions is described. The 3-part coupon provides the following information: name and address and characteristics of the acceptor (age number of living children by sex level of education) person issuing the coupon and date data on last live birth spacing and limitation data contraception previously used first or reinsertion date and type of device inserted name and address of doctor who inserted the IUD. Part 1 stays with the fieldworker; Parts 2 and 3 are given to the acceptor who in turn gives them to the physician upon insertion of the IUD. The physician keeps Part 3 and returns Part 2 to program headquarters. The coupon adequately fulfills 3 needs: administrative by functioning as part of a monthly financial auditing system to determine payments to physicians and eliminating over-reporting; educational by expediting decision-making; and evaluative. Evaluation of data collected since 1964 revealed that the program has been recruiting more lower-parity younger and less-educated wives. Follow-up interviews conducted in 1964 revealed that 88% of the women came in for IUD insertions within 3 months of receiving coupons and also suggested that the women who accepted coupons but not the loop might have been convinced by more health educationy Long-term advantages of the coupon system include easy sampling since the coupons are stored in 1 central location.

Data from a 1982 sample survey of 3,830 married women below age 50 in a district of Beijing City are applied to the Bongaarts model of the proximate determinants of fertility. A total fertility rate (TFR) of 0.75 births per woman is estimated from the model, compared with a TFR of 1.24 actually observed from the survey. The estimated TFR (0.75) results from the assumed total fecundity (TF) of 15.30 births per woman being inhibited by the indexes of the proximate determinants of fertility, most notably non-marriage (.280), contraception (.315), and induced abortion (.586). The effects of two other proximate determinants, lactational infecundability and spousal separation, were negligible. Comparative data from other countries confirm that the study area has very low levels of fertility and marriage, a very high prevalence of induced abortion, and a small effect of lactational infecundability. The extremely low level of fertility was, thus, achieved through a high level of induced abortion. Future research needs and policy implications associated with the study are discussed.Data from a 1982 sample of 3,830 married women age 50 in the Xi Cheng district of Beijing City are applied to the Bongaarts model postulating 7 proximate determinants of fertility, through which social, cultural, and economic conditions affect fertility. The sample was selected from a total of 115,279 eligible women, using a 2-stage areal sampling technic. A total fertility rate (TFR) of 0.75 births/woman is estimated from the model, compared to a TFR of 1.24 actually observed from the survey. The estimated TFR (0.75) results from the assumed total fecundity (TF) of 15.30 births/woman being inhibited by the indexes of the proximate determinants of fertility, most notably non-marriage (.280), contraception (.315), and induced abortion (.586). The effects of 2 other proximate determinants, lactational infecundability and spousal separation, were negligible (even though spousal separation was especially considered, on the belief that it is strongly affected by employment patterns). Comparative data from other countries confirm that the study area has very low levels of fertility and marriage, a very high prevalence of induced abortion, and a small effect of lactational infecundability. The extremely low level of fertility was, thus, achieved through a high level of induced abortion. This situation was considered undesirable from the standpoints of both health and the burden on the health service system. Future research needs and policy implications of the study include the low prevalence of breastfeeding, and high levels of contraceptive failure.

A modification of the randomized response technique developed by S.L. Warner to obtain valid responses to sensitive interview questions was applied in Taoyuan, Taiwan, in an effort to determine the incidence of abortion. This article assesses the feasibility of using the technique in a cultural context different from that of the United States where it originated. The technique allows the respondent to answer 1 of 2 questions selected on the basis of probability without divulging the information to the interviewer. 2497 currently married women aged 15 to 49 were divided into 2 groups, one of which was asked directly about their abortion experience while the technique was used with the other group. It was estimated that 28.2% of women using the technique had undergone at least 1 induced abortion. Only 12.7% of women who responded to a direct question admitted to having had an aboution. About 32% of respondents refused to cooperate in the study of the technique, and cooperation was found to be closely related to education, with age and extent of knowledge of abortion and family planning also related to refusal. The fact that the differences in rates of the 2 groups is in the expected direction suggests that use of the techniques can help reduce underestimation.

It has been proven theoretically that repeated administration of two-related-question randomized response technique (RRT) substantially increases the efficiency by reducing the variance of the estimate. The realtive efficiency of RRT to direct question with various number of trials per respondent under various degrees of truthful response and various conditions has also been examined. However, if the respondent becomes more concerned about his anonymity, then the mean square error may be larger. A field study of limited scope conducted in Taichung, Taiwan indicated that this multiple trial RRT model is at least as feasible as, if not more feasible than, the conventional single trial RRT. There was no sign suggesting cooperation of respondents had deteriorated because each was asked to repeat the procedures three times. If the number of trials did not exceed three, we believe that the increase in the cost of survey and "exhaustion" of respondents from repeated administration of the same set of questions would be negligible. Hence, we believe that this multiple trial technique is a feasible and useful survey method for study of various contemporary social problems of sensitive nature. More field testing, particularly in different socio-cultural settings, is necessary however, before a general conclusion may be drawn.

In Taiwan, aspiration for a life of high quality is a legitimate objective actively pursued by both the individual and the Government. Since good health is essential to achieve high quality of life, research to facilitate the formulation of health policy is essential to help achieve the objective. Various social and health problems of contemporary society in Taiwan are, to a large extent, our own makings. They are both the causes as well as the consequences of socio-economic development. To undertake policy research in Taiwan, we have the advantages of the experience of the West, more knowledge and technique for policy analysis, and our cultural heritage of stronger familial relationship. We can always learned from the strength as well as the failure of others. Although the policy formulation process in the U.S. has several strength, there are also weaknesses. In spite of the abundance of both resources and technology at her disposal, U.S. has not been able to develop health policies which will assure equity of services to all of her population. The U.S. is not "the healthiest country on earth," and the racial differentials in health status are still substantial. There are large "pockets" of disadvantaged population who do not have any health insurance and therefore, are inaccessble to health care. Six subjects are listed for health policy research of higher priority for Taiwan. These are: 1. Establishment of epidemiologic surveillance system and systems for collection of health information and statistics 2. Setting National Health Objectives for Year 2000 3. The balance between preventive and curative medicine 4. Medical care for the aging population 5. Health and safety of workplaces 6. Medical care cost and universal health insurance program It is the responsibility of academic institutions to help the Government in undertaking these and other policy research to facilitate informed policy decision-making.

A study to examine the acceptance of and drop-out from family planning clinic services in Maryland was undertaken during 1984-85 by interviewing a random sample of 1,020 women who came to the clinics as "new clients" during 1980 through 1982 when they were 20 through 39 years of age. This article examines the contraceptive and fertility behavior after their last clinic visits. The results showed that most of these women were "protected" from pregnancy risk considerably beyond their last clinic visit. However, the analysis also revealed that in spite of the reported high contraceptive use rate, unplanned pregnancies occurred after the client's last clinic visit, suggesting that contraceptive use was either inconsistent or ineffective. These findings suggest that instead of allocating a large proportion of resources to follow-up acceptors to bring the "drop-outs" back to the clinics, a more effective program strategy would be to systematically and effectively educate and counsel the clients during their clinic attendance, especially during their first clinic visit.