Prescription of atropine eye drops among children diagnosed with myopia in Taiwan from 2000 to 2007: a nationwide study.

PURPOSE: This study was conducted to examine the atropine eye drop prescription trend for children diagnosed with myopia, and to determine the factors associated with the prescription of atropine eye drops. DESIGN: This was a population-based cross-sectional study. METHODS: This study was conducted using a national representative sample from the National Health Insurance (NHI) claims data. All school children between 4 and 18 years of age who had visited an ophthalmologist and were diagnosed with myopia between 2000 and 2007 were included herein. The main outcome measure was the proportion of subjects who were prescribed atropine eye drops in each year. Logistic regression was used to identify the factors associated with atropine eye drops being prescribed. RESULTS: The prescription of atropine eye drops for children diagnosed with myopia increased significantly from the school years 2000 (36.9%) to 2007 (49.5%). There was also a shift from prescribing high concentrations (0.5 and 1%) of atropine eye drops to lower concentration ones (0.3, 0.25, and 0.1%) within this period. Atropine eye drops were more frequently prescribed to 9-12-year-old children (OR=1.26-1.42, compared with those 7-8 years old), and to children from families with a high socioeconomic status (OR=1.19-1.25); however, they were less prescribed to those living in mid to low urbanized areas (OR=0.65-0.84). CONCLUSIONS: This study revealed an increasing trend of atropine eye drop prescription for children with myopia in Taiwan. Our study provides eye-care professionals worldwide a reference for the potential integration of atropine eye drops into their clinical practice toward children with myopia.

Increased stroke risk in Bell's palsy patients without steroid treatment.

BACKGROUND AND PURPOSE: To investigate the risk of stroke development following a diagnosis of Bell's palsy in a nationwide follow-up study. METHODS AND MATERIALS: Information on Bell's palsy and other factors relevant for stroke was obtained for 433218 eligible subjects without previous stroke who had ambulatory visit in 2004. Of those, 897 patients with Bell's palsy were identified. Over a median 2.9 years of follow-up, 4581 incident strokes were identified. We estimated hazard ratios (HR) and 95% confidence intervals [CI] with Cox proportional hazard models adjusting for age, sex, co-morbidities, and important risk factors. Standardized incidence ratio of stroke amongst patients with Bell's palsy was analyzed. RESULTS: Compared with non-Bell's palsy patients, patients with Bell's palsy had a 2.02-times (95% CI, 1.42-2.86) higher risk of stroke. The adjusted HR of developing stroke for patients with Bell's palsy treated with and without systemic steroid were 1.67 (95% CI, 0.69-4) and 2.10 (95%, 1.40-3.07), respectively. CONCLUSIONS: Patients with Bell's palsy carry a higher risk of stroke than the general population. Our data suggest that these patients might benefit from a more intensive stroke prevention therapy and regular follow-up after initial diagnosis.

Treatment and survival in breast cancer in the Eastern Region of England.

BACKGROUND: The reasons for variation in survival in breast cancer are multifactorial. METHODS: From 1999 to 2003, the vital status of 9051 cases of invasive breast cancer was identified in the Eastern Region of England. Survival analysis was by Cox proportional hazards regression. Data were analysed separately for patients aged <70 years and those older due to differences in treatment policies. RESULTS: Overall 5-year survival was 78%. In patients aged <70 years, significant differences in survival lost their formal significance after adjustment for detection mode and node status, although this remained close to statistical significance with some residual differences between relative hazards. There was significant negative ecological correlation between proportion with nodes positive or not examined and 9-year survival rates. Patients with estrogen receptor (ER) status unknown were at significantly higher risk of dying than ER-positive patients. There was a clear trend of increasing hazard of dying with increasing deprivation. Survival differences in women aged > or =70 years were related to whether surgery was included as part of treatment. CONCLUSION: This variation in treatment and survival may be attributed to lack of information, in particular nodal and ER status, thereby impacting on staging and prescription of adjuvant therapy.

The prognostic influence of prevertebral space involvement in nasopharyngeal carcinoma.

OBJECTIVES: The purpose of this study was to evaluate the effect of prevetebral space involvement on treatment outcomes in patients with nasopharyngeal carcinoma (NPC) who were treated with radiotherapy/concurrent chemoradiotherpy or concurrent chemoradiotherpy with adjuvant chemotherapy. DESIGN: A retrospective review of case notes from the Kaohsiung Veterans General Hospital archives was performed. SETTING: A medical centre in Taiwan. PARTICIPANTS: There were 145 newly diagnosed cases of NPC. Thirty-nine patients were excluded because of the presence of distant metastasis at the time of presentation, loss of follow-up and incomplete image information. MAIN OUTCOME MEASURES: Pearson's chi-square tests were used to analyse correlation between tumour invasion and prevetebral space involvement during univariate analysis and logistic regression was applied during multivariate analysis. Kaplan-Meier survival curves were constructed. Multivariate analysis was performed to examine the impact of various prognostic factors. Pearson's chi-square and Fisher's exact test were also used to evaluate the correlation between failure patterns and treatment modality. RESULTS: A total of 106 patients with newly diagnosed NPC were enrolled in this study. Forty-three patients (41%) in this series were found to have prevertebral space involvement. Patients with prevertebral space involvement conferred a poor overall survival rate and metastasis-free survival rate compared with those without prevertebral space invasion (P = 0.04 and 0.02 respectively). Multivariate analysis showed that prevertebral space invasion was associated with an increased risk for distant metastasis [hazard ratio (HR) 14, 95% confidence interval (CI) 1.0-17.4; P = 0.03)] and overall survival (HR 7, 95% CI 1.1-135; P = 0.04). In patients with prevertebral space involvement, their metastasis-free survival rate, with and without adjuvant chemotherapy, was 100% and 72.7% (P = 0.047). This phenomenon was not observed in NPC patients without prevertebral space invasion. CONCLUSIONS: The present data revealed that prevertebral space involvement has a close relationship with survival rates and recurrence rates of patients with NPC. Nasopharyngeal carcinoma patients with prevertebral space involvement have more recurrence and poorer survival rates and should be the group to benefit from concurrent chemoradiotherapy followed by adjuvant chemotherapy. Inclusion of prevertebral space involvement may be needed to predict prognosis of NPC and help us to identify the high-risk group.

Shock resuscitation with acupuncture: case report.

A 77 year old aboriginal woman in an isolated village became drowsy and shocked. Poor weather conditions delayed the arrival of the medical and support team--the roads had been seriously destroyed by torrential rains and helicopter was the only means for delivering critical medical care and support. While waiting for the arrival of the helicopter, and in the absence of the necessary emergency medical equipment, the patient's condition deteriorated. Administration of persistent emergency acupuncture stimulation for 80 minutes helped maintain the patient's vital signs until successful transfer of the patient to hospital. She recovered without any complications of shock and was discharged six days later.

Effects of electroacupuncture in reducing weight and waist circumference in obese women: a randomized crossover trial.

OBJECTIVE: To compare the effects of weight control on simple obese women between electroacupuncture and sit-up exercise. DESIGN: Randomized and crossover trial conducted from 1 January 2002 to 31 December 2002. The subjects were randomly divided into groups A and B. Group A received electroacupuncture treatment first while group B received sit-up exercise treatment first. After 6 weeks of treatment and 7 days of washout, group A switched to sit-up exercise treatment and group B received electroacupuncture treatment for another 6 weeks. PATIENTS: In total, 54 simple obese women, with waist circumference (WC)>90 cm and body mass index (BMI)>30 kg/m(2), and who had not received any other weight control maneuver within the last 3 months. MEASUREMENT: The measurements of body weight (BW), BMI and WC were performed at the beginning, 6, 8 and 13 weeks. The data at different time periods were compared and expressed as % reductions. RESULTS: Electroacupuncture (n=46) showed significant differences in the % reductions in BW (P=0.001), BMI (P=0.003) and WC (P=0.005) compared with sit-up exercise. At the end of 13 weeks, there were no significant difference between groups A (n=24) and B (n=22) in all the measurements. At the end of the study, groups A and B showed significant differences in the % reductions in BW (P=0.004; 0.001), BMI (P=0.003; 0.021) and WC (P< or =0.001; 0.001) compared with the initial values. CONCLUSIONS: Electroacupuncture treatment is more effective than sit-up exercise in reducing weight and WC, making it an alternative treatment option for weight and WC control on obese women.

Factors related to utilization of traditional Chinese medicine in Taiwan.

Complementary and alternative medicine use is increasing worldwide. Expenses for complementary and alternative medicines are high, while the effectiveness of such medicines is still in debate. This paper reviewed the utilization of complementary and alternative medicines. Complementary and alternative therapies are used frequently and increasingly. Alternative therapies were used often for chronic conditions, including back problems, anxiety, depression and headaches in the United States. Musculoskeletal and respiratory complaints were the most frequent causes for complementary and alternative medicine consultation in Israel. In Taiwan, a systematic series of studies on factors related to utilization of traditional Chinese medicine (TCM) were conducted, including: (1) factors related to the choice of medical service (single or dual approach); (2) factors related to the choice of clinic type between TCM and western medicine among patients with single approach and among patients with dual approach; (3) factors related to patient choice of institute providing TCM (between TCM department in teaching hospital and regular TCM clinic) among patients using TCM only; and (4) knowledge, attitude and behavioral intention regarding TCM among patients using TCM only and among community residents over 30 years old. The findings of the above studies are summarized and presented accordingly.

Acupuncture utilization in Taiwan.

BACKGROUND: The objective of this study was to examine the prevalence of acupuncture utilization in Taiwan by people over 20 years of age. METHODS: Stratified cluster sampling was used to randomly select 20 villages and neighborhoods (townships), a total of 8,280 people, from northern, central, southern and eastern Taiwan. A structured questionnaire was used to collect information during home visits. A total of 5,805 questionnaires were valid for use in the study. RESULTS: The complete rate of home visits was 70.1%; 73.2% of those interviewed recognized acupuncture as one of the common therapeutic methods used in traditional Chinese medicine, whereas only 12.4% had received acupuncture treatment. Typical interviewees who had received acupuncture treatment were generally ethnic from southern Fukien and aged from 30-39 years; 58.3% of the 716 interviewees had received acupuncture treatment from licensed practitioners, while the remainder were treated by non-licensed practitioners. CONCLUSIONS: The response rate to the questionnaire was high (70.1%). However, the percentage of people who had received acupuncture treatment was only 12.4%, while many people (73.2%) were familiar with it. Approximately 40% of those who received acupuncture treatment did so from non-licensed practitioners. This may reveal either a lack of awareness by the public or a lack of public protection of health and safety.

Factors related to the choice between traditional Chinese medicine and modern Western medicine among patients with two-method treatment.

BACKGROUND: The aim of this paper is to investigate the different factors influencing patients' choice of traditional Chinese medicine or modern western medicine, applying Andersen's health-service utilization model to analyze the basic demographic, enabling and need factors related to the choice of clinics by patients who use two-method treatment (i.e. both Chinese medicine and western medicine). METHODS: Systemic sampling was done and a structured questionnaire survey was carried out among patients from the outpatient departments of 13 teaching hospitals accepting reimbursement by Labor Medical Insurance in Taiwan. RESULTS: The total number of valid respondents was 549. Of them 181 (33%) were visiting western medicine clinics and 368 (67%) visiting Chinese medicine clinics. There were 279 (51%) males and 270 (49%) females, whose age distribution was in the range from 16 to 87 years old, with a mean of 42.7 years. Under univariate analysis, the significant variables (p < 0.05) related to visiting the two types of clinics were: applicability of medical insurance, bed rest from discomfort in recent years, the amount of discomfort from this disease episode, respiratory disease, circulatory disease, endocrine or metabolic disease, and sense organ and skin disorders. By logistic regression analysis, the significant variables (p < 0.05) related to visiting the two types of clinics were religion, bed rest during the past year, discomfort associated with the episode, respiratory disease, and endocrine or metabolic diseases. CONCLUSIONS: Patients with folk-religion beliefs or respiratory diseases favored Chinese medicine; patients with illness requiring bed rest in the past year, who experienced discomfort in this episode, or who suffered from endocrine or metabolic diseases were likely to visit western medicine clinics.

[Factors related to the choice of clinic between Chinese traditional medicine and Western medicine].

The study applied Andersen's health-service utilization model to analyze the basic demographic, enabling and need factors related to the choice of traditional Chinese medicine clinic or modern Western medicine clinic by single-method-treatment (i.e. traditional Chinese medicine or modern Western medicine only) patients. During the period from August 1989 to October 1989, systemic sampling was done and a structured questionnaire survey was carried out among patients from the Out-patient Departments of 13 teaching hospitals accepting reimbursement by Labor Medical Insurance in Taiwan. The total number of valid respondents was 579: 378 (65.3%) were visiting modern Western medicine clinics and 201 (34.7%), traditional Chinese medicine clinics. There were 339 (58.6%) males and 240 (41.4%) females, aged from 15 to 85 years old, with a mean of 40.7 years. Under univariate analysis, the significant variables (p < 0.05) related to visiting the two types of clinics were: nativity, religious belief, career, general health condition, severity of illness of this episode, types of disorder as neuromusculoskeletal, digestive, circulatory, endocrine-metabolic and sense-and-skin. By logistic regression analysis, the significant variables (p < 0.05) relating to visiting two types of clinics were religion, career, and two kinds of disorders. Folk-religion believers, farmers and businessmen favored traditional Chinese medicine; and patients who suffered from musculoskeletal, sense organs or skin disorders were also likely to visit traditional Chinese medicine clinics.

Further analysis of a pilot study for planning an extensive clinical trial in traditional medicine--with an example of acupuncture treatment for stroke.

Statistical methods for evaluating the effects of treatments and prognostic factors in clinical trials are discussed. Exploratory data analysis, nonparametric methods, regression modeling, and regression diagnostics of influential cases are applied to the analysis of a pilot 'randomized' controlled trial on the treatment of acute stroke with acupuncture. The utility of this analysis for modifying patient eligibility criteria, determining required sample size and utilizing stratified randomization in a future extensive stroke trial is discussed.

[Factors related to the choice of different hospitals providing Chinese traditional medicine].

A structured questionnaire was answered by patients who used the Outpatient Departments of two types of Chinese traditional medicine clinics: clinics associated with western-style teaching hospitals, and regular Chinese medicine clinics which were area-matched with, but not located in the teaching hospitals. The study applied the Andersen behavior model and discussed the factors related to the choice of one type or the other clinic by one-method-treatment (i.e. traditional only, not mixed with western, medicine) patients. The total number of valid questionnaires was 362. Under the analysis of logistic regression, the variables which were significantly related to the choice of the types of the hospitals were age, insurance status, first visit or follow-up, general health condition, severity of illness, musculoskeletal and neurological disorders. The older the patients, the more likely they were to visit teaching hospitals. First-visit or uninsured patients also favored teaching hospitals. Patients with perceived stable conditions or more serious illness were likely to use teaching hospitals. Patients with musculoskeletal or neurological disorders favored regular clinics.

A randomized controlled trial on the treatment for acute partial ischemic stroke with acupuncture.

The effectiveness of acupuncture in acute stroke remains largely untested and unproved. A randomized, controlled trial was carried out to study the feasibility of acupuncture in combination with conventional supportive treatment for acute stroke patients. A total of 30 patients, aged 46-74, with the onset of symptoms within 36 h were enrolled into the study after appropriate screening. All patients gave informed consent. Basing on the same supportive treatment, patients were randomly assigned to a treatment with or without acupuncture. The procedure and acupoint selection were discussed and decided through several meetings of a group of senior acupuncture doctors in Taiwan. Acupuncture was applied 3 times/week for 4 weeks. During the study period, there were no problems in conducting this trial in terms of patient availability and acceptance, and physician cooperation. A significantly better neurologic outcome was observed in the acupuncture group on day 28 and day 90. The improvement in neurologic status was greatest in patients with a poor neurologic score at baseline. There were no important side effects except for one episode of dizziness related to acupuncture treatment. The data and results of this study will be used as a guideline for planning a full-scale clinical trial, e.g. sample size calculation, method of randomization with stratification of prognostic factors, choosing acupuncture points and technique of acupuncture.

[Two-phase test of fecal occult blood screening for colorectal cancer].

The detection of colorectal cancer in an early curable stage has become the focus of considerable interest recently. A two-phase test using both guaiac test and Hemolex latex immuno-agglutination test was applied for fecal occult blood screening of colorectal cancer. A total of 4,725 veterans aging 60 to 69 years were registered, and 2,176 persons (average age 66 years) completed the test giving a compliance rate of 46%. The positive rates of both tests were accounted 20.5% and 6.7% respectively. Five hundred and forty five persons had positive reaction for at least one of the tests. Of these, 90 had a follow up diagnosis with colonoscopy or combined with barium enema. Three rectal adenocarcinomas were detected, of which only one was positive by guaiac test, but two by Hemolex test. A rectal carcinoid was found by rectodigital examination. It was negative by both tests. Nineteen cases were detected to have one or more polyps in colon or rectum, of which only 6 were positive by guaiac test, but 18 by Hemolex test. Hemolex test using antibody against human hemoglobin is based on latex agglutination reaction. It is more sensitive and specific than guaiac test. Moreover, no dietary restriction is required. In the view point of cost-effectiveness, mass screening for colorectal cancer in general public is not recommended, but hospital-based screening for high risk group is still worthwhile to study.

[Community-based epidemiological study on hypertension and diabetes--community-based preventive medicine by Yang-Ming Crusade in 1989].

A community-based preventive medicine project was carried out by the Yang-Ming Crusade, organized by more than 180 students of National Yang-Ming Medical College, in July 1989. All of the registered residents over 40 years old of 13 villages (from 8 towns) were chosen for the study population. Their blood pressure, urine sugar, urine protein, high and weight were taken by the crusaders through door by door interviews. The screening positive cases were referred to the local Group Practice Center for confirm diagnosis and follow-up treatment. Among 7598 study population. 5088 (67%) were interviewed including male 48.9% and female 51.0%. About one third of the interviewee were in 50-59 age group. 762 hypertensive cases out of 3462 interviewee with blood pressure taken were found. The prevalence of hypertension was 21.0%. 334 diabetes cases out of 4713 interviewee with urine sugar taken were found. The prevalence of diabetes was 7.1%. Among 762 hypertensive cases, 560 (77.1%) were self-recognized and treated with the following methods: modern medicine 79.2%, traditional medicine 8.7%, drug stores 6.4%, and herbs 2.8%. Among 334 diabetes cases, 203 (60.8%) were self-recognized and only 171 (51.2%) were treated with the following methods: modern medicine 79.5%, traditional medicine 8.2%, drug stores 3.5%, and herbs 4.1%. Univariate analysis on hypertension showed that age, ethnicity, obesity, diabetes, hypertension history of mother, and hypertension history of siblings were significant variables. All of the above 6 variables were significant in multiple logistic regression analysis. Univariate analysis on diabetes showed that age, ethnicity, obesity, hypertension, diabetes history of father, diabetes history of mother, and diabetes history of siblings were significant variables. However only 4 variables, age, hypertension, diabetes history of mother, and diabetes history of siblings, were significant in multiple logistic regression analysis.

Determination of vitamin E in microsamples of serum by liquid chromatography with electrochemical detection.

In this procedure for determination of vitamin E by "high-performance" liquid chromatography with electrochemical detection, 25-microL serum specimens are deproteinized with ethanol. Vitamin E (alpha-tocopherol), its derivatives (beta- and gamma-tocopherols), and the internal standard (delta-tocopherol) are extracted into heptane and the extract is evaporated and the residue reconstituted with methanol before injection into the chromatograph. Within- and between-run CVs for an alpha-tocopherol concentration of 13.6 mg/L were 5.1% (n = 28) and 6.0% (n = 5), respectively. The standard curve is linear to 100 mg/L; the minimum concentration detectable is 0.1 mg/L. Analytical recovery ranged from 99.8% to 104.8%. In 36 specimens collected from apparently healthy subjects who were not taking vitamin supplements, alpha-tocopherol as determined by this method ranged from 4.3 to 9.7 mg/L, from 1.8 to 3.9 mg/L for beta- and gamma-tocopherols. Results by this method (y) and an HPLC-ultraviolet method (x) correlate reasonably (r = 0.81): y = 0.88x - 0.55 mg/L (n = 45). This procedure is adaptable to automated analysis, and the small sample requirement facilitates its applicability to neonates.

The role of central 5-hydroxytryptamine in acupuncture analgesia.

The role played by central 5-hydroxytryptamine (5-HT) in acupuncture analgesia (AA) has been studied in rats with the tail-flick response as the antinociceptive test. The analgesic effect of acupuncture can be enhanced or lowered by the increment or the decrement of the 5-HT level in the CNS. Furthermore, the turnover rate of 5-HT in the CNS has been found to be greatly facilitated during the period of acupuncture. The results imply that 5-HT in the CNS may be one of the most important neurochemical agents mediating AA.