[Health Without Borders: Creating Healthy Cities].

Urbanization, a rapidly rising trend worldwide, is being felt particularly strongly in East Asia. The World Health Organization (WHO) launched a healthy-cities plan in 1986 as a platform to encourage cities around the world to eliminate the problems resulting from increasingly dense urban population densities. The health and quality of life of city residents are seriously affected by the problems associated with urbanization, including environmental pollution, traffic congestion, public insecurity, and inadequate infrastructure, which may exceed the scope of local government plans and expectations. Rather than dealing with these problems individually, urban planners must take a global approach to issue of urbanization. Public and private-sector inputs are critical to facilitating good urban planning and community development by local governments in order to help cities achieve a well-managed urban environment that gives citizens a good environment in which to live, work, and play. The promotion healthy-city plans in Taiwan will foster the creation of cities of health through the integration or cooperation of government health, urban-planning, environmental-protection, industrial-development, transportation, cultural-education, and other departments and agencies. Based on the vision of a healthy city, Taiwan's cities should gradually attain a sustainable, healthy society and healthy environment that promotes the holistic health of their residents. Therefore, we look forward to fulfilling the vision of "health without borders, creating healthy cities" through the implementation of the healthy city plan.

Cooking fuel and risk of under-five mortality in 23 Sub-Saharan African countries: a population-based study.

Relationship between cooking fuel and under-five mortality has not been adequately established in Sub-Saharan Africa (SSA). We therefore investigated the association between cooking fuel and risk of under-five mortality in SSA, and further investigated its interaction with smoking. Using the most recent Demographic Health Survey data of 23 SSA countries (n = 783,691), Cox proportional hazard was employed to determine the association between cooking fuel and risk of under-five deaths. The adjusted hazard ratios were 1.21 (95 % CI, 1.10-1.34) and 1.20 (95 % CI, 1.08-1.32) for charcoal and biomass cooking fuel, respectively, compared to clean fuels. There was no positive interaction between biomass cooking fuel and smoking. Use of charcoal and biomass were associated with the risk of under-five mortality in SSA. Disseminating public health information on health risks of cooking fuel and development of relevant public health policies are likely to have a positive impact on a child's survival.

Changes in urinary Cu, Zn, and Se levels in cancer patients after treatment with Sha Shen Mai Men Dong Tang.

Sha Shen Mai Men Dong Tang (SMD-2; sha shen mài dong tang) is a Chinese medicinal herb (CMH; zhong cǎo yào) used to treat symptoms associated with cancer therapy. The objective of this study was to assess the effect of SMD-2 on the levels of urinary copper (Cu), zinc (Zn), and selenium (Se) in lung cancer patients and head and neck cancer patients receiving chemoradiotherapy. Forty-two head and neck cancer patients and 10 lung cancer patients participated in our clinical trial. Each patient received chemoradiotherapy for 4 weeks. In addition, each patient was treated with SMD-2 for 8 weeks, including 2 weeks prior to and after the chemoradiotherapy treatment. Comparison of urinary Cu, Zn, and Se levels and the ratios of Zn to Cu and Se to Cu at three time points in the two types of cancer were assessed using the generalized estimating equations (GEEs). After the patients received chemoradiotherapy for 4 weeks, SMD-2 treatment was found to be associated with a significant decrease in urinary Cu levels, whereas urinary Zn and Se levels increased significantly. In addition, the ratios of Zn to Cu and Se to Cu in the urine samples of these patients also increased significantly. Both the urinary Zn levels and the ratio of Zn to Cu in head and neck cancer patients were significantly higher than in lung cancer patients. Urinary Zn and Se levels and the ratios of Zn to Cu and Se to Cu, but not urinary Cu levels, increased significantly during and after treatment when assessed using the GEE model. The SMD-2 treatments significantly increased Zn and Se levels in the urine of head and neck cancer patients. Increased Zn and Se levels in urine strengthened immune system.

BCQ+: a body constitution questionnaire to assess Yang-Xu. Part II: Evaluation of reliability and validity.

INTRODUCTION: Integrated medicine has become an important issue in this century. In order to bridge the gap between traditional Chinese medicine (TCM) and modern medicine, we have established a first final version of a Yang-Xu constitution questionnaire, the BCQ+, in a previous study. The objective of the present investigation is to assess the reliability and validity of the BCQ+. PARTICIPANTS AND METHODS: A total of 1,310 eligible participants, aged between 20-60, no disease onset in the past month, who received health examination in teaching hospitals were recruited. The BCQ+ was developed and psychometrically evaluated to ascertain and validate the factor structure of the BCQ+. Furthermore, the reliability and validity of the BCQ+ were examined. RESULTS: 19 items from the BCQ+ were developed. Exploratory factor analysis identified 5 primary domains that represent the Yang-Xu constitution and correspond to the diminishing energy levels of 5 different body areas: head, chest, limbs, abdominal cavity, and body surface. Cronbach's alpha ranged between 0.55-0.88 and the intraclass correlation coefficients were >0.7 for most of the 19 questions. The diagnoses of Yang-Xu by the BCQ+ and an experienced TCM doctor were consistent. Systolic blood pressure (SBP) was used as an indicator of concurrent validity of the BCQ+, and it was found that higher Yang-Xu scores were associated with a lower SBP. CONCLUSIONS: Five domains with 19 items in the BCQ+ were developed. The BCQ+ is a valid and potentially useful tool for evaluating the Yang-Xu constitution in clinical practice and research.

Acupressure and meridian massage: combined effects on increasing body weight in premature infants.

AIMS AND OBJECTIVES: The purpose of this study was to assess the body weight gain of combined acupressure and meridian massage in premature infants. BACKGROUND: Each year in Taiwan, 8-10% of newborns are delivered prematurely. Effective postnatal care is essential to ensure the healthy development of premature infants. Massage therapy has been administered to facilitate weight gain in the neonatal unit. The evidence-based findings in previous studies did not include acupressure or meridian massage. DESIGN: A double-blind clinical trial was conducted in a medical centre in central Taiwan. METHODS: Forty subjects were randomised into two groups. The 20 subjects in the experimental group were given a standard procedure of acupressure at Zhongwan, Zusanli, Yongquan, abdominal rubbing, spleen and stomach meridian massage, and kneading the points along the spine of the bladder meridian. These treatments were administered for 15 minutes per session, one hour before meals, three times daily over 10 days. The control group, also consisting of 20 subjects, underwent routine care and was observed. The infants' body weights and the volume of milk ingested were measured and recorded daily. RESULTS: The daily average weight gain of the infants in the experimental group was 32.7 g (SD = 8.1) compared with 27.3 g (SD = 7.7) in the control group. While in the first week there was no significant difference in weight gain between the two groups; in the second week, the weight gain observed in the experimental group was significantly higher than that observed in the control group. CONCLUSIONS: An experimental trial established the effects of using acupressure and meridian massage on increasing body weight in premature infants. Acupressure and meridian massage have a significant effect on weight gain in premature infants. RELEVANCE TO CLINICAL PRACTICE: Nurses could be trained in acupressure and meridian massage techniques to provide more effective level of clinical care for premature infants.

How to standardize 3 finger positions of examiner for palpating radial pulses at wrist in traditional Chinese medicine.

This study was to provide a standardized definition of the positioning method of finger placement on the radial artery for pulse diagnosis in traditional Chinese medicine (TCM); that is, to define the locations of Cun, Guan and Chi in TCM. A total of 200 subjects (100 males and 100 females, 18-40 years of age) were recruited from the general population. According to ancient TCM records, the "6% of the elbow length" (ELx6%) is used as the standard method of establishing the length of Cun. We hypothesized that the highest point of "prominent bone" (PB) is the lower limit of Cun, so "the distance between the distal wrist crease and the highest point of the PB" (DWP) is considered the length of Cun. If this hypothesis holds, then we can define the locations of Cun, Guan and Chi by using the ratio 6:6:7 from the ancient TCM records. The distribution of relative bias and paired t-test were used to verify the findings. The mean value of relative bias of DWP compared with ELx6% was close to 0% (males = 2.1%, SD = 12.2%; females = 0.2%, SD = 12.6%). The paired t-test confirmed that there was no significant difference (p > 0.05) between the mean values of the DWP and ELx6%. Therefore, it is reasonable to assume that the length of the Cun is equal to the length of the DWP. Our findings confirm that the location of Cun is from the distal wrist crease to the highest point of PB.

Health-related quality of life in the elderly practicing T'ai Chi Chuan.

OBJECTIVE: Previous studies have shown health benefits of T'ai Chi Chuan (TCC). In Taiwan, TCC is a form of exercise that is widely practiced by the elderly. The aim of this cross-sectional study was to investigate the effects of TCC on the health-related quality of life (HRQOL) in the senior population. METHODS: Subjects who regularly practiced TCC in Taiwan were selected by random sampling and included 140 seniors (77 males and 63 females, aged 40-70 years). The questionnaire was separated into 2 parts: demographic information and the SF-36 questionnaire, which used 8 domains to evaluate the subjects' HRQOL. The results were compared with those of 560 age- and sex-matched control subjects that were taken from the general population (308 males and 252 females). Multiple regression analysis was used to compare the quality of life in each of the 8 domains between the 2 groups. RESULTS: The TCC group showed significantly higher quality-of-life scores than the control group in each of the 8 domains with the exception of the bodily pain scales. Using multiple linear regression adjusted for covariates, the TCC group had significantly higher scores in physical functioning, physical roles, general health, vitality, and social-functioning scales than the control group. In most of the domains in both the TCC group and the control group, quality of life became worse with increased age, whereas the scores in vitality and social-functioning domains of the TCC group showed a reverse trend; they remained unchanged or even improved with increased age. CONCLUSIONS: Our study supports the hypothesis that TCC improves quality of life among the elderly in Taiwan, but further study must be conducted to more conclusively show the link between TCC and health-related QOL.

Formation of N-(2-hydroxyethyl)valine in human hemoglobin-effect of lifestyle factors.

The formation of N-(2-hydroxyethyl)valine (HEV) in hemoglobin has been considered as a biomarker to assess exogenous and endogenous exposures to ethylene oxide (EO) and/or ethylene (ET). Factors associated with daily exposures to such compounds might significantly affect the formation of HEV. Tobacco smoke containing EO elicited a significant increase in the levels of HEV amongst smokers, although other factors related to lifestyles may warrant further studies. The objective of this study was to specifically analyze HEV using a modified Edman degradation technique in order to study the association between lifestyle related factors (smoking, second-hand smoke exposure, tea and alcohol consumption) and HEV formation in vivo. Total of 148 Taiwanese volunteers with no history of occupational exposure to either EO or ET were recruited in this study. The HEV levels for smokers (204 +/- 151 pmol HEV/g globin, n = 70 ) were greater than those for non-smokers (57 +/- 46 pmol HEV/g globin, n = 78), HEV level increasing with the number of cigarettes smoked by subjects per day with a rate of 8.8 pmol HEV/g globin per cigarettes per day. Further analysis revealed that the rate of HEV formation in our study subjects was significantly associated with the number of daily cigarettes smoked (P < 0.001), but was not associated with tea or alcohol consumption, second-hand smoke exposure, subject age, or subject gender. These results suggest that the significantly higher levels of HEV for smokers than for non-smokers were mainly due to subject exposure to EO contained in cigarette smoke.

Serum and tissue trace elements in patients with breast cancer in Taiwan.

The objective of this study was to compare levels of four elements (zinc, copper, selenium, and iron) in the serum and tissue of 68 breast tumor patients (benign and malignant), from a teaching hospital in central Taiwan. Samples of normal tissue (5 cm away from tumor) were also taken from patients with malignant tumors. Only serum was taken from the 25 healthy persons in the control group. Results showed that Zn, Cu, Se, Fe, Cu/Zn, Cu/Se, and Cu/Fe were present in different amounts in the serum of each of the three groups. Zn and Se levels were lower in the serum of the two tumor groups compared to the control group. In tissue samples, Zn, Cu, Se, and Fe concentrations were different in each of the three groups. The malignant tissue had the highest levels of all four elements. In advanced-stage malignant tumors, levels of Cu and the ratios of Cu/Fe and Cu/Zn (in both serum and tissue) were highest. The ratios of serum Cu/Zn, Cu/Fe, and Cu/Se were also higher in malignant patients. The cutoff value of serum Cu/Zn was 1.2 (sensitivity and specificity were both 100%). The Cu/Zn ratio was highest in the advanced stages of cancer and was a better diagnostic tool for breast cancer than Cu/Se and Cu/Fe. The authors suggest that change of trace elements in serum and tissue might be useful and significant as biomarkers involving the initial plastic process.