30 years follow-up and increased risks of breast cancer and leukaemia after long-term low-dose-rate radiation exposure.

BACKGROUND: The current study followed-up site-specific cancer risks in an unique cohort with 30 years' follow-up after long-term low-dose-rate radiation exposure in Taiwan. METHODS: Six thousand two hundred and forty two Taiwanese people received extra exposure in residential and school buildings constructed with Co-60-contaminated steel from 1982 until informed and relocated in early 1990s. The additional doses received have been estimated. During 1983-2012, 300 cancer cases were identified through the national cancer registry in Taiwan, 247 cases with minimum latent periods from initial exposure. The hazard ratios (HR) of site-specific cancers were estimated with additional cumulative exposure estimated individually. RESULTS: Dose-dependent risks were statistically significantly increased for leukaemia excluding chronic lymphocytic leukaemia (HR100mSv 1.18; 90% CI 1.04-1.28), breast cancers (HR100mSv 1.11; 90% CI 1.05-1.20), and all cancers (HR100mSv 1.05; 90% CI 1.0-1.08, P=0.04). Women with an initial age of exposure lower than 20 were shown with dose response increase in breast cancers risks (HR100mSv 1.38; 90% CI 1.14-1.60; P=0.0008). CONCLUSIONS: Radiation exposure before age 20 was associated with a significantly increased risk of breast cancer at much lower radiation exposure than observed previously.

Ranking regional drowning mortality rates: population-based versus aquatic area-based rate.

Population, the most often used denominator in calculating drowning mortality rate, might not be a good measure of risk exposure. In this study, we sought to compare the rankings of township drowning mortality according to population-based rates with those according to aquatic area-based rates in Taitung County, Taiwan. The township with the highest mortality rate using population as the denominator (deaths per 100 000 persons) was Changbin (32.3) followed by Lanyu (22.4), Donghe (19.6) and Chenggong (18.0). On the other hand, the township with the leading mortality rate using aquatic area as the denominator (deaths per 100 000 km2) was Lanyu (353) followed by Lyudao (307), Chenggong (282) and Taitung City (219). Taitung City ranked 10th according to the population-based rate, but ranked 4th according to the aquatic area-based rate. In conclusion, rankings of regional drowning mortality rates using aquatic area as the denominator differ from those using population as the denominator.

Sex-Specific Temporal Trends in Overweight and Obese Among Schoolchildren From 2009 to 2018: An Age Period Cohort Analysis.

Background: Our study examined the age, period, and cohort effects on overweight and obesity in children using a 10-year dataset collected from schoolchildren in Hualien, Taiwan. Methods: We used data from the annual health checkup of a total of 94,661 schoolchildren in primary schools and junior high schools in Hualien from 2009 to 2018. Children were defined as overweight or obese by the gender- and age-specific norm of the body mass index. We conducted the age-period-cohort (APC) analysis in boys and girls separately. Results: From 2009 to 2018, the rates of children overweight and obese were 12.78 and 14.23%, respectively. Boys had higher rates of overweight and obesity than girls (29.73 vs. 24.03%, P < 0.001). Based on APC analysis results, positive age effect existed regardless of gender. The risk of overweight or obesity of children aged 9 or 12 years was significantly higher compared to the average rate. As for period effect, a fluctuating downward trend in overweight was evident in 2016, and a similar trend in obesity was seen in 2017 across gender groups. The birth cohort of 2007 to 2009 had a significant higher proportion of overweight and obese than other birth cohorts. This indicated that the proportion of children overweight and obese in the young generation is higher than that in the old generation. Conclusion: An increased risk of children overweight or obese was associated with age and later birth cohort. For the period effect, the trend in the prevalence of overweight and obesity fluctuated downward slowly from 2016 to 2017.

Bathtub drowning mortality among older adults in Japan.

We examined the bathtub drowning mortality among older adults in Japan. Mortality data from Japan and 30 other Organization for Economic Co-operation and Development (OECD) countries were extracted from World Health Organization Cause of Death Query Online. During 2012-2014, unintentional drowning mortality rates in Japan were 9.5, 28.2 and 39.7 per 100,000 population for adults aged 65-74, 75-84 and ≥85 years, respectively-rates highest among the 31 OECD countries. In total, 6377 older adults aged ≥65 years died from unintentional drowning in 2014, of which 4857 (76%) deaths involved bathtubs. During 1995-2014, the bathtub drowning mortality rate for adults aged ≥65 years was stable in Japan. During 2011-2014, approximately 4800 older adults died from bathtub drowning annually. Death predominantly occurred 'while in a bathtub', rather than 'following a fall into a bathtub'. In 2014, 95% and 87% of bathtub drowning deaths among older women and men aged ≥65 years, respectively, occurred at home. In conclusion, bathtub drowning deaths at home is an important public health problem among older adults Japanese and efforts are needed to reduce these preventable deaths.

Drowning mortality by intent: a population-based cross-sectional study of 32 OECD countries, 2012-2014.

OBJECTIVE: To compare the drowning mortality rates and proportion of deaths of each intent among all drowning deaths in Organisation for Economic Co-operation and Development (OECD) countries in 2012-2014. DESIGN: A population-based cross-sectional study. SETTING: 32 OECD countries. PARTICIPANTS: Individuals in OECD countries who died from drowning. MAIN OUTCOME MEASURES: Drowning mortality rates (deaths per 100 000 population) and proportion (%) of deaths of each intent (ie, unintentional intent, intentional self-harm, assault, undetermined intent and all intents combined) among all drowning deaths. RESULTS: Countries with the highest drowning mortality rates (deaths per 100 000 population) were Estonia (3.53), Japan (3.49) and Greece (2.40) for unintentional intent; Ireland (0.96), Belgium (0.96) and Korea (0.89) for intentional self-harm; Austria (0.57), Korea (0.56) and Hungary (0.44) for undetermined intent and Japan (4.35), Estonia (3.70) and Korea (2.73) for all intents combined. Korea ranked 12th and 3rd for unintentional intent and all intents combined, respectively. By contrast, Belgium ranked 2nd and 15th for intentional self-harm and all intents combined, respectively. The proportion of deaths of each intent among all drowning deaths in each country varied greatly: from 26.2% in Belgium to 96.8% in Chile for unintentional intent; 0.7% in Mexico to 57.4% in Belgium for intentional self-harm; 0.0% in nine countries to 4.9% in Mexico for assault and 0.0% in Israel and Turkey to 38.3% in Austria for undetermined intent. CONCLUSIONS: A large variation in the practice of classifying undetermined intent in drowning deaths across countries was noted and this variation hinders valid international comparisons of intent-specific (unintentional and intentional self-harm) drowning mortality rates.

Using matrix frame to present road traffic injury pattern.

BACKGROUND: Although many epidemiological studies have presented road traffic injuries (RTIs) according to the victim's mode of transport, very few have mentioned the mode of transport of the victim's counterparts. We sought to use matrix frame to present the pattern of RTIs based on the International Classification of Diseases, Tenth Revision (ICD-10) codes. METHODS: Patients admitted to Hualien Tzu Chi Hospital, Taiwan, for RTIs from January 1, 2013 to December 31, 2016 were included. The numbers and proportions of various crash types of RTIs were presented using a matrix frame. The row margin of the matrix is the second character of ICD-10 codes V00-V79 (victim's mode of transport), and the column margin of the matrix is the third character of ICD-10 codes V00-V79 (mode of transport of victim's counterpart), constituting a 80-cell grid. RESULTS: In total, 2727 patients were included. The cell with the highest proportion in the matrix grid was ICD-10 code V23 "motorcycle rider injured in collision with car, pick-up truck or van" (27.0%, 737/2727), followed by that of V27 "motorcycle rider injured in collision with fixed or stationary object" (12.5%, 342/2727) and V28 "motorcycle rider injured in noncollision transport accident" (12.2%, 334/2727). The matrix pattern of RTIs differed with sex and age. CONCLUSIONS: By using the matrix frame, we can easily understand the RTI pattern for different demographic groups and identify the priority crash types.

A survey of the perception of well-being among emergency physicians in Taiwan.

OBJECTIVES: The objective of this study is to investigate the feelings (well-being) of emergency physicians in Taiwan regarding their job and the relationship between these feelings and the work environment. MATERIALS AND METHODS: A questionnaire was used to survey emergency physicians across Taiwan from January to June 2014. The questionnaire contents were categorized into five specific factors that could affect well-being, including "emergency quality, emergency safety, support environment, workload, and salary and benefits." Well-being was rated directly on a scale of 1-10, with 10 indicating the highest level of happiness. Physician retention was also surveyed. The correlations among the five factors, well-being, and physician retention were analyzed. The five factors were quantified as a "happiness index" and compared between religious and nonreligious hospitals and medical centers and regional hospitals. RESULTS: A total of 398 questionnaires were received, and the response rate was 39%. Of these, 42.7% of responders reported high ratings for well-being (scores of 7-10, 1 is the worse, and 10 is the best) and 40.3% felt neutral (scores of 5-6). Only 12.3% doctors did not think they would stay at the same position for the next 3 years. All five factors had moderately significant correlations with each other (γ = 0.195-0.534, P < 0.01). All five factors also significantly correlated with well-being. Emergency safety (γ = 0.121, P < 0.05), salary and benefits (γ = 0.143, P < 0.05), and well-being (γ = 0.189, P < 0.01) were correlated with physician retention. The happiness indices of emergency quality, support environment, and workload were significantly higher in regional hospitals than medical centers. CONCLUSIONS: All five indicators had impacts on well-being. The respondents reported heavy workloads, including high stress and even poorly met physiological needs. In addition, the threat of violence, salaries, and well-being correlated with physician retention. Hospital administrators can make efforts to improve the well-being of doctors and physician retention by adjusting environmental factors.

Emergency Physician Compliance with Quality Indicators of Septic Shock and Severe Sepsis in Eastern Taiwanese Community Hospital.

BACKGROUND: A retrospective review was conducted, examining patient charts at a community hospital in Eastern Taiwan during a 2-year period, from April 2013 to March 2015. AIMS: The goal was assessment of adherence to quality indicators (QIs) in septic shock and severe sepsis (4S status) by emergency physicians (EPs). METHODS: Based on the Surviving Sepsis Campaign (SSC) guidelines, data was electronically retrieved from the Hospital Information System (HIS); and beginning in April 2014, our staff was regularly educated on this topic during monthly meetings. A Sepsis Bundle Care Set (SBCS) was also launched in September 2014. The Chi-square post hoc test was utilized in statistical analysis, setting signifi cance at p < 0.05. In patients with septic shock (n = 81) or severe sepsis (n = 572), QIs before and after educational initiatives were 36 vs. 45 and 259 vs. 313, respectively. RESULTS: In terms of septic shock, QIs that improved signifi cantly after education were C-reactive protein (CRP: 66.67% vs. 91.11%), arterial blood gas (ABG: 58.33% vs. 80.00%), and intravenous (IV)-fluid infusion rate (0.00% vs. 40.00%). QIs that significantly improved in the context of severe sepsis were CRP (59.46% vs. 84.66%), serum lactate (75.68% vs. 86.26%), intensive care unit (ICU) admission within 4 hours (72.97% vs. 81.79%), and IV-fluid infusion rate (0.00% vs. 18.85%). In comparing QI adherence rates by educational period subsets, two-set IV line showed signifi cant improvement after 7 months of education, and admission to ICU within 4 hours after 4 months of education. However, most QIs associated with severe sepsis (except serum lactate and antibiotic given in 1 hour) showed signifi cant improvement after 3 months of education. CONCLUSIONS: We concluded that there is much room to improve QI adherence rates in patients with 4S status, using educational initiatives.

Determinants of the public intent to receive the seasonal influenza vaccine and protective behaviors: a population-based study in Taiwan.

BACKGROUND AND STUDY AIMS: this study aims to identify the determinants of perceived changes in protective behaviors against seasonal influenza and the intent to receive the seasonal influenza vaccine among Taiwanese in 2011. METHODS: During the early 2011-2012 influenza season, we conducted a nationwide survey with randomly stratified samples and collected 1400 self-reported questionnaires from respondents aged 15 years and above using the computer-aided telephone interviewing software in Taiwan. RESULTS: One-third of the respondents intended to receive the seasonal influenza vaccine. Knowledge of protective behaviors against influenza was the most common predictor of perceived changes in different protective behaviors and the intent to receive the seasonal influenza vaccine. Older respondents were significantly more inclined to perceive changes in protective behaviors than younger respondents (adjusted odds ratio [AOR] ranging from 1.7 to 2.5). Female respondents were significantly more likely to change their behavior in wearing a face mask (AOR=1.5; 95% CI, 1.09 to 2.07) and buying antimicrobial products (AOR=1.45; 95% CI, 1.09 to 1.92) compared with males. Furthermore, recipients of past H1N1 (AOR=4.45; 95% CI, 3.03 to 6.53) and seasonal influenza vaccines (AOR=6.1; 95% CI, 3.31 to 11.23) were more likely to obtain the seasonal influenza vaccine. In contrast, individuals aged 30-49 (AOR=0.53; 95% CI, 0.38 to 0.74) and females (AOR=0.65; 95% CI, 0.48 to 0.87) were significantly less likely to intend to receive the seasonal influenza vaccine. CONCLUSIONS: The findings suggest that the predictors of perceived changes in protective behaviors and intent to receive the seasonal influenza vaccine differ. We provide perspectives and suggestions for overcoming the perceived barriers and for developing targeted risk-communication campaigns.

Perceived environmental and health risks of nuclear energy in Taiwan after Fukushima nuclear disaster.

After the nuclear disaster in Fukushima in Japan in 2011, a nation-wide survey using a standardized self-administered questionnaire was conducted in Taiwan, with a sample size of 2,742 individuals including the residents who live within and beyond 30 km from a nuclear power plant (NPP), to evaluate the participants' perceived nuclear risk in comparison with their perceived risks from selected environmental hazards and human behaviors. The three leading concerns of nuclear energy were "nuclear accidents (82.2%)," "radioactive nuclear waste disposal (76.9%)" and "potential health effects (73.3%)." Respondents (77.6%) perceived a higher relative risk of cancer incidence for those who live within 30 km from an NPP than those who live outside 30 km from an NPP. All the participants had a higher risk perception of death related to "nuclear power operation and nuclear waste" than cigarette smoking, motorcycling, food poisoning, plasticizer poisoning and traveling by air. Moreover, the residents in Gongliao where the planned fourth NPP is located had a significantly higher perceived risk ratio (PRR) of cancer incidence (adjusted odd ratio (aOR)=1.84, p value=0.017) and perceived risk of death (aOR=4.03, p value<0.001) related to nuclear energy. The other factors such as female gender (aOR/p value, 1.25/0.026 and 1.34/0.001 respectively), lower education levels (aOR/p value: 1.31/0.032; 2.03/<0.001) and the participants' concerns about nuclear accidents (aOR/p value: 1.33/0.022; 1.51/<0.001) and potential health effects (aOR/ p value: 2.95/ <0.001; 2.56/<0.001) were found to be commonly associated with the PRRs of "cancer incidence" and "perceived risk of death" related to nuclear energy, respectively. In addition, the respondents' concerns about nuclear waste disposal and possible eco-environmental damage made significant contributions (aOR/ p value: 1.39/ 0.001; 1.40/<0.001) to predict their perceived risk of death related to nuclear power. These factors are considered as important indicators and they can be used for suggesting future policy amendments and public referendum on the decision of the operation of the planned NPP.

AAV2-mediated interleukin-12 in the treatment of malignant brain tumors through activation of NK cells.

Interleukin-12 has been elucidated as a powerful anti-cancer factor in pre-clinical research. However, the obstacles of this modality that emerged from human clinical trails included the toxicity of repeated large dose administration and short effective duration. Therefore, a prolonged, constant therapeutic level of interleukin-12 is required to reduce the adverse effects and enhance the therapeutic efficacy. In this study, 54 nude mice were divided into three groups treated with rAAV2 encoding interleukin-12, rAAV2 vector, and PBS, respectively. All nude mice received human glioblastoma multiforme cell line DBTRG implantation. The biochemistry studies included serum levels of interleukin-12, isotypes of immunoglobulin, interferon-gamma, and TNF-alpha. The activated NK cells were sorted from the spleen by flow cytometry and the cytotoxicity of NK cells were evaluated by LDH assay. In the rAAV2 encoding interleukin-12 group, substantial expression of interleukin-12 was obtained with a serum level of 120-150 pg/ml through the experimental course and a significant increase of activated NK cells was achieved. The splenocytes extracted from the spleen in rAAV2 encoding IL-12 mice strongly exhibited cytotoxic activity compared to the control groups (p<0.001). The IgG1, IgG2a, and IgM also showed a significant increase in the rAAV2 encoding IL-12 group compared to the control groups (p<0.05). The tumor growth rate decreased obviously in the rAAV2 encoding IL-12 group with a significant difference from the control groups (p<0.001). This study demonstrated an encouraging result of immunomodulative therapy in malignant brain tumors by rAAV2 carrying IL-12 through activating NK cells.