Antipsychotic exposure prior to acute myocardial infarction in patients with serious mental illness.

OBJECTIVE: To investigate the association between acute myocardial infarction (AMI) and recent exposure to antipsychotic agents in people with serious mental illness (SMI), and modifying influences. METHOD: A case-crossover design was applied using the Taiwan National Health Insurance Research Database (NHIRD) to compare the exposure frequency of antipsychotic agents within individuals of schizophrenia or bipolar disorder between 60-day case and control periods prior to their first AMI episode during 1996-2007. RESULTS: A sample of 834 patients with incident AMI was analysed. AMI was significantly associated with more recent antipsychotic exposure in schizophrenia after adjustment (OR 1.87, 95% confidence interval 1.15-3.03) bipolar disorder (OR 1.06, 0.51-2.21). This association in schizophrenia was significantly stronger in men and in patients without previous diagnoses of cardiovascular risk factors. CONCLUSION: These findings are consistent with a short-term risk effect of antipsychotic exposure on risk of AMI and identify potentially vulnerable groups. Further research is required to clarify underlying biological mechanisms.

The impact of years since menopause on the development of impaired glucose tolerance.

This is a community-based population survey carried out by the Yang-Ming Crusade to investigate the impact of years since menopause on the development of glucose intolerance in post-menopausal women. A total of 5412 women were screened with fasting plasma glucose. Those with fasting plasma glucose levels between 5.5 and 7.8 mM were given an oral glucose tolerance test. Among the 5412 women screened, 2039 (37.7%) were post-menopausal with a median age at menopause of 49 years. Pre-menopausal women showed impaired glucose tolerance (IGT) and diabetes mellitus (DM) prevalences of 3.7% and 3.1% respectively, whereas the corresponding figures for post-menopausal women were 8.4% and 17.6%, respectively. Comparing DM versus normal glucose tolerance (NGT) and IGT versus NGT as dependent variables in logistic regression analysis, menopause status was significantly associated with DM and IGT. In post-menopausal women, after maintaining body mass index, waist-hip ratio, systolic blood pressure, diastolic blood pressure, family history of DM, age at menopause, cholesterol, high density lipoprotein cholesterol and triglycerides as controls, years since menopause was the only significant factor associated with IGT (OR = 1.05, 95%CI 1.01-1.08) and years since menopause was not associated with DM. Further analysis indicated years since menopause (OR = 1.06, 95%CI, 1.01-1.11) was the only factor significantly associated with IGT for women whose age at menopause was greater than 49 years. Our study indicates that in subjects who have not undergone hormone replacement therapy and whose age at menopause is greater than 49 years, an increase in years since menopause confers a negative influence on glucose tolerance and increases the risk of IGT by 6% for each year after menopause.

Prevalence of goiters in school children residing in villages where underground water is used.

A representative of Fuder village in Taichung County complained that many residents had a goiter problem, which he felt might be related to pollution from the nearby Youshi industrial area. The purpose of this study was to determine whether school children in the Fuder area have a high prevalence of goiters. We chose children of the Schichi elementary school in the Fuder area as the study population, and children of the Goumei elementary school, far from the Youshi industrial area, as controls. Both groups were from a similar geographic location (near the sea), had similar socioeconomic status, and both drank underground water. Thyroid enlargement was examined by palpation as recommended by the World Health Organization. Thyroid antibodies and hormones were determined in school children with a goiter and age-sex-matched normal control children using the particle agglutination method and radioimmunoassay, respectively. In total, 1,692 school children were examined, including 875 males and 817 females. Of these, 126 school children (7.4%) had a goiter of Grade I or above. The prevalence of goiters in Shichi and Goumei were 8.8% (59/671) and 6.6% (67/1,021), respectively. There was no significant difference between these two areas. We compared the prevalence of goiters in these two schools where underground water is drunk with another previous study in Peimen and Putai where tap water is used. There was a statistically significant difference (7.4% vs 2.6%, p < 0.0001). This suggests that the higher prevalence rate of goiters in Shichi and Goumei is related to the drinking of underground water. We recommend that the use of tap water and continued salt iodization is the way to prevent endemic goiter in these areas. A further comprehensive study is needed to determine the nature of the goitrogen in the underground drinking water of the Fuder area.

Motor vehicle injuries in Taiwan.

In Taiwan, motor vehicle fatalities have increased significantly in the past two decades and are now a leading cause of mortality, especially among younger age groups. In this paper, we review vital statistics and hospital morbidity data to provide an overview of the problem of motor vehicle injuries in Taiwan and make several suggestions for improving injury surveillance.

An analysis of traffic injuries in Taiwan in relation to alcohol use and economic loss.

Breath alcohol analysis of 449 patients with motor vehicle injuries attending the emergency department of a Taiwan urban general hospital during a 10-week period showed that 19.2 per cent had breath alcohol concentration (BAC greater than 0.002 per cent and 8.5 per cent greater than or equal to 0.05 per cent). Injured males were more likely to have BAC greater than or equal to 0.05 per cent than women (11 per cent vs 0 per cent). Injuries resulting from alcohol-associated collisions were about 6.7 times more likely to occur between 1800 and 0600 than at other time periods. A telephone survey after hospital discharge showed that the risk factors of alcohol use, speed at time of collision and type and site of collision were significantly associated with degree of economic loss resulting from the accidents. Logistic regression analysis showed that the odds of high economic loss associated with BAC greater than 0.002 per cent were three times greater than for persons in whom no alcohol was detected. This is the first study in Taiwan to use breath alcohol analysis in assessing the effect of alcohol consumption on motor vehicle injuries. The results show that alcohol use is an important cause of motor vehicle injuries. Preventive measures such as strict legal control of drunk driving and limitation of the hours that drinking places can stay open at night are recommended to reduce the damage caused by this severe public health problem.

Cloning and characterization of a periplasmic nuclease of Vibrio vulnificus and its role in preventing uptake of foreign DNA.

We have cloned a nuclease gene, vvn, from Vibrio vulnificus, an estuarine bacterium that causes wound infections and septicemia in humans and eels. The gene contained a 696-bp open reading frame encoding 232 amino acids (aa), including a signal sequence of 18 aa. The deduced amino acid sequence of the mature nuclease predicted a molecular mass of 25 kDa, which was confirmed by vital stain, and a pI of 8.6. Vvn was produced in the periplasm of either V. vulnificus or recombinant Escherichia coli strains and was active in the oxidized (but not the reduced) form. This nuclease was able to digest DNA and RNA, with differential thermostability in DNase and RNase activities. Expression of Vvn in E. coli DH5alpha reduced the frequencies of transformation with the divalent ion-treated cells and electroporation by about 6 and 2 logs, respectively. In addition, the transformation frequency of a Vvn-deficient V. vulnificus mutant (ND) was 10-fold higher than that of the parent strain. These data suggested that Vvn may be involved in preventing uptake of foreign DNA by transformation. However, Vvn expressed in the recipients had little effect on the conjugation frequency in either E. coli or V. vulnificus. Some other DNase(s) may be present in the periplasm and responsible for a residual DNase activity, which was about one-fourth of that of the parent strain, detected in the ND mutant. We also demonstrated that Vvn was not required for the virulence of V. vulnificus mice.

Data quality of a computerized medical birth registry.

Processed by a computerized medical birth registry system, the birth records of 20,103 deliveries, from February 1992 to February 1993, were digitized with medium registry. From 1 January to 28 February 1993, the original records (n = 2840 cases) of all 10 collaborative hospitals were requested for assessment of data quality. Thirty-six items were scored, data of poor quality was found in eight; acceptable quality in four; and good quality in 28. The feasibility of data transfer by floppy disc and per modem was evaluated. This registry system had effectively shortened data processing time and improved mutual feedback between the data centre and the delivery units. Errors resulting from technical faults originating in the preparation of data for computerization at hospital level could be effectively reduced. The validity of diagnosis remained as the major source of errors.

A quality study of a computerized medical birth registry.

Processed by a computerized medical birth registry system, the birth records of 20,103 deliveries, from February 1992 to February 1993, were digitized with medium registry. From January 1, to February 28, 1993, the original records (n = 2,840 cases) of all 10 collaborative hospitals were requested for assessment of the data quality. Thirty-six items were scored, data of poor quality was found in 8 items; acceptable quality in 4 items; and good quality in 28 items. The feasibility of data transfer by floppy disc and per modem was evaluated. This registry system had shortened data processing time effectively and improved mutual feedback between data center and delivery units. Errors resulting from technical faults originating in preparation of the data for computerizing at hospital level could be effectively reduced. The validity of diagnosis remained as the major source of errors.