A Comparison of the Risk of Fracture in Rheumatoid Arthritis Patients with and without Receiving Chinese Herbal Medicine.

OBJECTIVE: Patients with rheumatoid arthritis (RA) often suffer from bone complications due to persistent joint inflammation, especially incident fracture. Nowadays, Chinese herbal medicines (CHMs) have provided safe and effective therapy for treating skeletal conditions, but it is unclear whether CHMs can prevent fracture onset among RA individuals. This study aimed to determine the association between the use of CHMs and the risk of fracture among them. METHODS: This retrospective, population-based study retrieved administrative health data from the Taiwan National Health Insurance (NHI) database to identify patients with newly diagnosed RA between 2000 and 2009. Of the 6178 incident RA patients, 2495 matched pairs of CHMs users and non-CHMs users were identified by propensity score matching. Enrollees with hip fractures prior to RA onset were excluded. Included subjects were followed until the end of 2013. Incidence and adjusted hazard ratios (HR) of new-onset bone fracture in the multivariable Cox proportional hazard model were measured with 95% confidence interval (CI). RESULTS: Fracture incidence was lower in CHMs users than in the comparison cohort (26.91 vs 32.94 per 1000 person-years, respectively), with an adjusted HR of 0.82 (95% CI: 0.73-0.92). Subjects receiving CHMs for more than 2 years had a much lower risk of fracture onset by more than 50%. Some CHMs prescriptions (Yan Hu Suo, Bei Mu, Da Huang, Dang Shen, Fu-Zi, Shu-Jing-Huo-Xue-Tang, Dang-Gui-Nian-Tong-Tang, Jia-Wei-Xiao-Yao-San, Gan-Lu-Yin, and Gui-Zhi-Shao-Yao-Zhi-Mu-Tang) were associated with reduced fracture risk. CONCLUSION: Adding CHMs to routine treatment was found to be related to lower fracture risk in RA patients.

An Investigation of Airborne Bioaerosols and Endotoxins Present in Indoor Traditional Wet Markets before and after Operation in Taiwan: A Case Study.

Customers in Taiwan prefer to purchase fresh foods and household supplies at indoor traditional wet markets (TWMs). The health risk to indoor TWM staff exposed to bioaerosols needs to be evaluated, since these workers spend long periods of time in the market for stall preparation, selling, and stall cleaning. This study investigated the bioaerosols present in two indoor TWMs. The results showed that the cleaning process at Market A after operations, involving the use of an agitated waterspout, was able to decrease the concentration of bacterial bioaerosols (BBs) by an average of 64%, while at the same time increasing the concentration of fungal bioaerosols (FBs) by about 2.4 fold. The chemical sanitization process at Market B after operations was able to bring about average decreases of 30.8% in BBs and 19.2% in FBs, but the endotoxin concentration increased. Hotspots were found to be associated with vendors of fresh, live poultry and fresh, raw meat/seafood. Pseudomonas spp. and Clostridiumperfringens, both of which can be pathogenic, were found to be the dominant species present in these markets, making up 35.18% to 48.74% and 9.64% to 11.72% of the bacteria present, respectively. Our results provide fundamental information on the distributions of bioaerosols and endotoxins within indoor TWMs both before and after operation.

Systemic vasculitis is associated with a higher risk of lower extremity amputation in patients with severe peripheral arterial occlusive disease: a secondary analysis of a nationwide, population-based health claims database.

Previous research has shown that diabetes mellitus increases the risk of lower extremity amputation in patients with peripheral arterial occlusive disease. However, to our knowledge, no studies have investigated whether systemic autoimmune disease, in particular systemic vasculitis is associated with a higher risk of lower extremity amputation in these patients. To investigate the association between systemic autoimmune disease and lower extremity amputation in patients with severe peripheral arterial occlusive disease based on a secondary analysis of a nationwide, population-based health claims database. Using the inpatient datafile of the Taiwan's National Health Insurance Research Database (NHIRD), we identified 432 patients with severe peripheral arterial occlusive disease that required hospitalization between 2000 and 2012. We also identified patients who had undergone lower extremity amputation and their comorbidities using the same datafile. The risk of lower extremity amputation was assessed using multiple logistic regression analysis, adjusting for age, sex, insured amount, the urbanization level of residence, and the presence of comorbidities. Among patients with severe peripheral arterial occlusive disease, those with systemic vasculitis exhibited a significant higher risk of lower extremity amputation (adjusted odds ratio [aOR] = 6.82, p < 0.001). Diabetes mellitus (aOR = 4.90, p < 0.001) and chronic obstructive pulmonary disease (aOR = 2.87, p = 0.007) were also significantly associated with a higher risk of lower extremity amputation. Among patients with severe peripheral arterial occlusive disease, a significantly higher risk of lower extremity amputation was observed in those with systemic vasculitis.

A suicide education programme for nurses to educate the family caregivers of suicidal individuals: a longitudinal study.

Family members lack the ability to care for suicidal relatives. Nurses have a responsibility to improve family members' ability to care for their suicidal relatives. The aims of this study were to design a suicide education programme for nurses to educate family caregivers and to evaluate the longitudinal (12 months after the educational programme) effects of a suicide care education programme on the ability of families to care for suicidal relatives. A randomised controlled trial was conducted. The study population (n=61) was composed of the family caregivers of suicidal individuals. Several caregivers (n=26) were randomly allocated to an experimental group who attended a two-hour suicide care education programme, and the other caregivers (n=35) represented a control group who did not attend the education programme. All of the participants were given a questionnaire at baseline, 3 months, and 12 months during the period from 2009 to 2011. The results of the longitudinal effects of the suicide care education programme demonstrated that there were statistically significant differences after the educational programme as compared to before the programme with regard to "seeking assistance from resources" and the ability to care for those who were once suicidal. The longitudinal results of both groups showed that there was a significant difference in terms of "caring ability" at 12 months. The results of a multiple linear regression analysis indicated that evaluations performed at the three-month time point were able to effectively predict success in "seeking assistance from resources", "caring ability"; caring ability was also significantly improved among those who engaged in the educational programme at the 12-month time point. The suicide care education programme had long-term effects for family caregivers caring for their suicidal relatives. Nurses could employ this suicide care education programme to improve the ability of family caregivers to care for their suicidal relatives.

Bacterial growth and substrate degradation by BTX-oxidizing culture in response to salt stress.

Interactions between microbial growth and substrate degradation are important in determining the performance of trickle-bed bioreactors (TBB), especially when salt is added to reduce biomass formation in order to alleviate media clogging. This study was aimed at quantifying salinity effects on bacterial growth and substrate degradation, and at acquiring kinetic information in order to improve the design and operation of TBB. Experiment works began by cultivating a mixed culture in a chemostat reactor receiving artificial influent containing a mixture of benzene, toluene, and xylene (BTX), followed by using the enrichment culture to degrade the individual BTX substrates under a particular salinity, which ranged 0-50 g l(-1) in batch mode. Then, the measured concentrations of biomass and residual substrate versus time were analyzed with the microbial kinetics; moreover, the obtained microbial kinetic constants under various salinities were modeled using noncompetitive inhibition kinetics. For the three substrates the observed bacterial yields appeared to be decreased from 0.51-0.74 to 0.20-0.22 mg mg(-1) and the maximum specific rate of substrate utilization, q, declined from 0.25-0.42 to 0.07-0.11 h(-1), as the salinity increased from 0 to 50 NaCl g l(-1). The NaCl acted as noncompetitive inhibitor, where the modeling inhibitions of the coefficients, K ( T(S)), were 22.7-29.7 g l(-1) for substrate degradation and K ( T(mu)), 13.0-19.0 g l(-1), for biomass formation. The calculated ratios for the bacterial maintenance rate, m (S), to q, further indicated that the percentage energy spent on maintenance increased from 19-24 to 86-91% as salinity level increased from 0 to 50 g l(-1). These results revealed that the bacterial growth was more inhibited than substrate degradation by the BTX oxidizers under the tested salinity levels. The findings from this study demonstrate the potential of applying NaCl salt to control excessive biomass formation in biotrickling filters.