Relationship of initial glucose level and all-cause death in patients with ischaemic stroke: the roles of diabetes mellitus and glycated hemoglobin level.

BACKGROUND AND PURPOSE: Previous studies demonstrated that post-stroke hyperglycemia was associated with poor outcome in non-diabetic patients. However, evidence was inconclusive amongst patients with diabetes. The aim of this study was to evaluate the relationship between initial glucose levels and mortality amongst patients with acute ischaemic stroke, and further, to assess whether the association varied by diabetes mellitus and glycated hemoglobin (HbA(1c) ) levels. METHODS: Data were collected from the medical records of 1277 first-ever stroke patients admitted to the emergency room between January 1, 2008 and June 30, 2009. Cox regression analysis was performed to assess the relationship between initial glucose level and mortality. RESULTS: Compared with the lowest quartile of initial glucose level, a significant association with all-cause death [hazard ratio (HR), 2.18; 95% CI, 1.36-3.48] and cardiovascular death (HR, 1.91; 95% CI, 1.01-3.61) was seen in the highest quartile. In non-diabetic subgroup, those patients within the highest quartile of initial glucose level had a 3.29-fold relative risks (RR) [95% confidence interval (CI), 1.62-6.68] for all-cause and a 2.54-fold RR (95% CI, 1.43-8.77) for cardiovascular death compared with those within the lowest quartile. However, the association between initial glucose levels and the risk of death was not significant amongst those with diabetes (P for interaction = 0.01). In addition, the risk amongst patients with diabetes varied by the HbA(1c) levels. CONCLUSIONS: A significant association was confirmed between initial glucose level and mortality in non-diabetic ischaemic stroke patients. The possible relationship between initial glucose level, HbA(1c) level, and mortality amongst ischaemic stroke patients with diabetes warrants further research.

A high throughput in vitro analytical approach to screen for oxidative stress potential exerted by nanomaterials using a biologically relevant matrix: human blood serum.

Limited studies have shown that selected nanomaterials (NMs) impart various forms of toxicity in biological systems; however, a common metric to screen for potential toxicity is needed. This study optimized and utilized a 'Ferric reducing ability of serum (FRAS)' assay as a screening tool to quantitate the degree of oxidative damage induced by NMs on human blood serum. Antioxidants in blood protect against oxidative damage caused by free radicals via chemical quenching and will decrease when exposed to oxidatively stressful materials. Using this approach, the antioxidant capacity of NM treated serum was significantly decreased by nano-silver, a series of nano-carbon blacks, fullerene soot, and nano-TiO(2) (anatase, p<0.05), but not with nano-alumina, fullerite, purified fullerene, fine TiO(2) (rutile) and Min-U-Sil 5. Particle surface area and not biological particle size was highly associated with the degree of oxidative stress observed. This approach appears responsive to multiple determinants of oxidative damage, including particle chemistry, surface area and impurities, and may be a valid screening method to determine oxidative damage imparted by nanomaterials.

Physical activity in adolescence and young adulthood and breast cancer risk: a quantitative review.

Physical activity habits are potentially modifiable and could therefore be targeted in a primary prevention strategy against breast cancer, provided there is causality and a sufficiently strong relationship. Our objective of this quantitative review was to provide a summary estimate of the association of moderate/vigorous recreational physical activity during adolescence/young adulthood with breast cancer risk, and to determine whether a dose-response relationship exists. Data sources included studies in humans relating physical activity to breast cancer risk, published between January 1966 and October 2002, identified on Medline, the Web of Science, from reference lists and related reviews. The main characteristics of each study, the point estimates of relative risk (RR) and confidence intervals (CI) were extracted from 19 case-control and four cohort studies. Comparing the highest to the lowest category of physical activity, the summary RR from the random effects model was 0.81 (95% CI 0.73-0.89). This almost 20% risk reduction proved to be fairly consistent, despite variation in populations and methods. Each one-hour increase of recreational physical activity/week during adolescence was associated with a 3% (95% CI 0-6%) risk reduction. Physical activity in 12-24-year-old females significantly reduces risk of breast cancer. Heterogeneity may be explained by different methods to measure activity.

Comparison of nursing interventions classification and current procedural terminology codes for categorizing nursing activities.

PURPOSE: To compare the frequency with which nursing activity terms could be categorized using Nursing Interventions Classification (NIC) and Current Procedural Terminology (CPT) codes. DESIGN: Descriptive. The sample was 201 patients with AIDS hospitalized 1989-1992 for pneumocystis carinii pneumonia in three US medical centers. METHODS: Nursing activity terms (n = 21,366) were collected from patient interviews, nurse interviews, intershift reports, and patient records, then were categorized using NIC and CPT codes. RESULTS: Nursing activity terms were categorized into 80 NIC interventions across 22 classes and into 15 CPT codes. All terms in the data set were classifiable using the NIC system and the majority (60%) of the terms were classified into 14 NIC intervention categories; 6% of the terms were classifiable by CPT codes. The most frequently used CPT code was "pulse oximetry." Significantly (p < .0001) greater numbers of nursing activity terms could be categorized in the NIC system compared to the CPT system. CONCLUSIONS: Findings provide evidence that NIC is superior to CPT for categorizing nursing activities in this study's population. The findings support the importance of discipline-specific classifications for categorization of health care interventions. Nursing-specific intervention classification systems such as NIC, the Omaha System, and the Home Health Care Classification are essential to defining the contribution of nursing to both quality and cost outcomes.

An evaluation of the utility of the Home Health Care Classification for categorizing patient problems and nursing interventions from the hospital setting.

The purpose of this study is to evaluate the utility of the Home Health Care Classification for categorizing patient problems and nursing interventions from the hospital setting. The data set comprised 5,844 problem terms and 20,055 interventions terms. All terms could be categorized using the Nursing Components and Major Categories for Nursing Diagnoses and Interventions. A total of 1,767 (30.2%) patients problem terms could be placed into Major Nursing Diagnosis categories, but not subcategories even though there were subcategories related to the major category. All intervention terms whether they were classified at the Intervention Category or Subcategory could be coded according to Type of Nursing Action. These findings demonstrate that the Home Health Care Classification, at the level of Nursing Components and Major Categories, was domain complete for the data set. The fact that not all terms could be classified according to the existing subcategories suggests some areas for future development, but is also a reflection of the level of detail expressed in the data set itself. The results suggest that the Home Care Classification will be adequate and appropriate for categorizing problems and interventions across setting for the next phases of the research project.

A cohort study on mortality and exposure to polychlorinated biphenyls.

In 1979, an outbreak of food poisoning ("Yu-Cheng") occurred in Central Taiwan, ROC, involving more than 2000 people. The event was caused by ingestion of rice oil contaminated with polychlorinated derivatives of biphenyls, dibenzofurans, and quaterphenyls. A retrospective cohort study on mortality was undertaken, and possible long-term health effects in the affected individuals were studied. The mortality experience of 1940 victims (929 males, 1011 females) between 1980 and 1991 was compared with the expected numbers, which were calculated from national and local mortality rates. By the end of 1991, 102 deaths were identified, thus producing a standardized mortality ratio (SMR) of overall mortality of 0.99 for males and 1.34 for females. Total cancer mortality was lower than in each comparison group. Mortality from liver diseases was elevated significantly (SMR = 3.22), especially during the first 3 y after the food-poisoning event (SMR = 10.76). Increased clinical severity of polychlorinated biphenyl intoxication was associated with increased mortality from all causes and from liver diseases. In summary, there was a positive association between mortality and intoxication dose, and severe polychlorinated biphenyl poisoning acutely affected mainly the liver. A continued follow-up of this cohort would be valuable in the study of long-term health effects of polychlorinated biphenyl poisoning.

[Issues on aboriginal health in Taiwan].

In recent years health professionals have been concerned about the health of aborigines which has been neglected for a long time. Health disparities are known to exist among aborigines and non-aborigines in the United States or other countries. In Taiwan, there are nine main aboriginal tribes consisting of approximately 330,000 people. In general, their health status, evaluated by life expectancy, mortality rates and the prevalence and incidence of various diseases amongst them, is worse than amongst the rest of the Taiwanese (general) population. Current investigations indicate that life expectancy for aborigines is on average 10 years less than that of the general population; 12.5 years less for men, 6 years less for women; approaching a standardized mortality ratio of 2 fold, that is 2.1 fold in men, 1.7 fold in women. Accidental injures, suicide, tuberculosis, liver cirrhosis, alcoholism, pneumonia, bronchitis, parasite infections are the most important sources of diseases. Hypertension, heart disease, some selected sites of cancer, nutrition and lack of adaptation are gradually becoming important new sources of disorders. Although aboriginal health has improved over the decades, the author estimates that their overall health status is 25-30 years behind that of the general population or of off-shore islanders. The extent of their development varies with tribes. It is necessary to study the cause of why aborigines die so young. It may be due to insufficient medical care for heart disease whose prevalence is relatively low among aborigines but resultant mortality is nevertheless high. However, insufficient medical care cannot explain the high incidence of a number of cancers and resultant mortality. All factors relating to the environment, agents, hosts and diseases should be taken into consideration, such culture, transportation, life style, health behavior etc, and compared to those of non-aborigines. A series of studies are proposed to address the specific, multi-dimensional health demands of the aborigines. The author suggests the development of prevention and intervention strategies designed to overcome difficulties and barriers to eliminate these disparities among the people of Taiwan.

[Mortality patterns of Taiwan aborigines due to accidents].

The purpose of this investigation was to study ethnic differences in mortality patterns due to accidents in the various aboriginal areas of Taiwan. Mortality data was collected from the National Health Department. To compare the accident mortality of aborigines with that of the general population of Taiwan, and then calculated standardized mortality ratios for accidents in the various aboriginal groups by using the cause specific accident mortality of the general population as standardized mortality and found that mortality in Taiwan between 1971 and 1990 was 60.1 per hundred thousand due all causes of injuries 72.2 (102.2 for males and 39.5 for females). The same figures for the aborigines were 194.9 (274.1 for males and 98.7 for females), respectively. The leading causes of accidental death among the aborigines were motor vehicle accidents, suicide, drowning, accidental falls for males and suicide, motor vehicle accidents and non-drug poisoning for females. Our investigations show that the standardized mortality ratio due to accidents in the aboriginal areas is two to three times higher than that in the general population of Taiwan. These figures were differences among the aboriginal tribes, despite similarities in medical care, environmental and economic circumstances. Mortality due to accidents, especially due to suicide and poisoning, in the Atayal and Bunun tribes were particularly higher than in other tribes. Thus, the risk of an accident in these regions may be associated not only with the environment and the lack of medical resources, but with some socio-cultural factors.

[Leading causes of death in the aborigines in Taiwan].

Leading causes of death were analyzed among Aboriginal tribes in Taiwan in the decades of 1971-80 and 1981-90. Sex and tribe specific standardized mortality ratios were calculated from death certificate data and compared with the number of expected deaths derived from the mortality of the total population in Taiwan. In all, 35,221 cases of death in Aborigines were contrasted with 1,695,479 cases of death in the total population in Taiwan. Generally speaking during the two decades the SMR increased considerably suggesting more attention should be paid to the aborigines. Mortality due to accidents was statistically significantly higher than expected among Atayal, Bunun, Paiwan and Rukai men and among Atayal, Bunun and Paiwan women, as was mortality from tuberculosis among Atayal, Bunun, Paiwan and Rukai men and women, mortality due to liver cirrhosis as well as pneumonia among the Atayal, Bunun and Paiwan men and women, mortality from suicide among Atayal, Bunun, and Paiwan men, and among Atayal and Bunun women, mortality due to cancer among Bunun and Paiwan men and women, and mortality due to cardiovascular diseases among Atayal, Bunun and Paiwan men in 1981-90 decade. The SMR for ill-defined conditions was on average twice as high as expected; but among the Yami tribe in particular it was elevated 12 fold, indicating insufficient medical care. Factors relating to the cause of increased deaths need to be further studied.

[Cancer mortality analysis among aborigines in Taiwan].

Mortality among Aborigines tribes in Taiwan from malignant neoplasms in the 1971-80 and 1981-90 decades were analyzed. Sex and tribe specific standardized mortality ratios were calculated from death certificate data and compared with the number of expected deaths derived from the cancer mortality of the entire population of Taiwan. Mortality due to oral cancer was statistically significantly higher than expected among Paiwan men in the 1971-80 decade and among Paiwan women from 1971-80 and 1981-90; as was mortality from nasopharyngeal cancer among Bunun, Paiwan and Rukai men from 1981-90 and among Bunun and Paiwan women from 1971-80 and 1981-90; mortality due to stomach cancer among the Atayal, Bunun and Paiwan people from 1971-80 and 1981-90, among Rukai men from 1971-80 and among the Tsou and mixed group women from 1981-90; mortality from liver cancer among Atayal and Bunun men in 1971-80, among Bunun women from 1971-80 and 1981-90 and among Paiwan women in 1981-90; mortality due to nasal cavity, middle ear and paranasal sinuses cancer among Rukai men from 1981-90; and mortality due to bone cancer among Tsou men and Atayal women from 1981-90. Mortality due to colorectal cancer was statistically significantly lower than expected among mixed group men from 1971-80 and in Atayal women from 1981-90; as was mortality from lung cancer among Atayal men and Paiwan women from 1971-80 and among Paiwan and mixed group men in the 1981-90 decade. Overall, the standardized mortality ratio of all cancers in aborigines was a little higher than in the general population of Taiwan. However, differences for ratio or site existed in different tribes.

[Prevalence of smoking, drinking and betel quid chewing and related factors among aborigines in Wufeng District].

This study surveyed the prevalence of smoking, drinking, betel quid chewing and related factors among adult Aborigines in Wufeng District, Hsinchu county, Northern Taiwan, as determined in a cross-sectional study (N = 504), based on random sampling. In house to house survey, 420 residents were interviewed in their homes by a structured questionnaire (with a response rate of 83.3%) and a complete set of data was collected for 360 Atayal and Saisiat Aborigines. The survey only included adults (N = 302), as the number of children were few. The life-time prevalence rate of smoking, drinking and betel quid chewing was 71.1%, 85.5%, 49.7% in men and 25.2%, 58.0%, 6.3% in women, respectively. In contrast, the one year prevalence rates were 61.0%, 65.4%, 27.0% in men and 16.8%, 25.97%, 1.4% in women, respectively. The result of multiple logistic regression were that (1) the male drinker and betel quid chewer was the highest risk group for smoking; (2) the male smoker was the highest risk group for drinking and (3) the married male smoker was the highest risk group for betel quid chewer.

Seroepidemiology of human T-lymphotropic virus type I infection among intravenous drug abusers in Taiwan.

In order to assess seroprevalence of human T-lymphotropic virus type I (HTLV-I) infection among intravenous drug abusers in Taiwan, serum samples were collected from 858 male study subjects. Antibodies against HTLV-I (anti-HTLV-I) in sera were tested by enzyme-linked immunosorbent assay and confirmed by Western blotting. The overall prevalence of anti-HTLV-I (2.3%) in drug abusers was significantly higher than that in the general population in Taiwan with a relative risk of 4.9, but it was only slightly higher than that in prostitutes (1.9%). There was a statistically significant increase in prevalence with age. Drug abusers engaged in prostitution had a significantly higher prevalence (18.2%) than those who were not (2.1%). No significant association with anti-HTLV-I positivity was observed with marital status and educational level. Tatooed abusers had an increased prevalence (2.7%) compared with the untattooed (1.4%). Drug abusers tattooed before 1980 had a significantly higher prevalence (3.5%) than those tattooed after 1980 (0.8%). Anti-HTLV-I prevalence was higher for those who had been blood transfused (4.5%) than untransfused abusers (2.0%).

Current seroepidemiology of hepatitis D virus infection among hepatitis B surface antigen carriers of general and high-risk populations in Taiwan.

In order to assess the current seroepidemiology of hepatitis D virus (HDV) infection in Taiwan where hepatitis B virus (HBV) is hyperendemic, a total of 756 voluntary blood donors, 641 prostitutes, 1,014 patients with sexually transmitted diseases (STDs), and 628 drug abusers were studied. Radioimmunoassays were used for testing HBV infection markers and antibody against HDV (anti-HDV) among HBsAg carriers. The anti-HDV prevalence among HBsAg carriers was significantly higher in STD patients (9.6%), prostitutes (33.1%), and drug abusers (68.1%) than in blood donors from the general population (2.2%). The prevalence gradually increased with age in blood donors and STD patients, but reached a plateau at a young age in prostitutes and drug abusers. Males had a higher prevalence than females in blood donors (2.7% vs. 0), STD patients (8.2% vs. 7.5%), and drug abusers (69.0% vs. 57.1%), but the difference was not statistically significant. STD patients with syphilis had a higher prevalence (19.5%) than those affected with non-ulcerating STDs (5.3%). While unlicensed prostitutes had a lower prevalence (13.6%) than licensed prostitutes (44.9%), intravenous drug abusers had a higher prevalence (73.1%) than non-intravenous drug abusers (34.6%). There was a twofold increase in anti-HDV prevalence from 1986 to 1989 among prostitutes, but the prevalence remained unchanged in the general population and drug abusers. HDV infection remains limited to the high-risk groups and spread mainly by promiscuity and needle sharing in Taiwan.

Prevalence of betel quid chewing habit in Taiwan and related sociodemographic factors.

The prevalence of betel quid chewing habit in Taiwan was surveyed in a group of Chinese people from Kaohsiung city and in a second group from the aboriginal inhabitants of South Taiwan. In all 1299 participants constituted Group 1 (85.2% response rate) and 827 Group 2 (70.1% response rate). People were interviewed in their homes in house-to-house survey, according to a structured questionnaire developed and evaluated by the authors. Of the Kaohsiung inhabitants covering all ages and both sexes, 6% was a current betel chewer and 4% was an ex-chewer, whereas 42% of the aborigines aged over 15 yr was a current chewer and 1% an ex-chewer. Lifetime prevalence was 10%. Betel chewing enjoys islandwide popularity among the 20 million inhabitants of Taiwan; the number of current and ex-users was estimated at 2.0 million (95% CI 1.6-2.4 million). The betel quid was prepared in two different ways. In one, used mainly by aborigines, fresh areca nut was simply wrapped with betel leaf and in another, popular mainly among Chinese, a lengthwise piece of betel fruit and lime paste was sandwiched between two halves of an areca nut. A high proportion of chewers was also a smoker and drinker, but tobacco was not found to be chewed together with betel quid. Consumption varied between 14 to 23 portions per day, with individual frequencies ranging widely from 1 to over 200 portions a day. A statistical analysis of sociodemographic factors showed that lesser educated older men, blue collar workers, smokers and drinkers were the likeliest betel chewers.

[The study of Apgar score and infant birth weight in the central Taiwan].

The objective of this study was to assess the relationship between birth weight and the Apgar Score. We collected data on the birth weights and the 1 min and 5 min Apgar Score of new born infants between 1982 and 1987 at a teaching hospital in Central Taiwan. Compared to babies with normal Apgar Score, infants with low Apgar Scores were found to born with low and very low birth weights. In the 1 min of life test, the relative risks of low birth weights among infants with Apgar Scores of 0 to 3 and 4 to 6 were 115.0 and 5.9 times higher than those of normal infants, respectively. In the very low birth weight category, the relative risks of the above score were 252.5 and 51.1, in this order. In the 5 min of life test, the relative risks of the above scores were 16.2 and 12.1 in the low birth weight category, respectively. However, among babies of very low birth weight, the relative risks of the same scores were 121.2 and 84.9, in this order. In conclusion, the 5 min Apgar Score might be a useful prognostic index for the relationship between health and birth weight of new born infants.

[A study of weight and weight/birth at birth by gestational week].

A study of 35,919 live neonates was conducted from 1976 to 1987 (excluding 1980) at a teaching hospital in Central Taiwan. Our goal was to determine the proportions of low birth weight (LBW) and very low birth weight (VLBW) and birth weight/birth length ratios by gestational week. The results showed that LBW and VLBW neonates were 6.3% and 1.1%, respectively. In LBW neonates groups, there was a rapid decline after the 33rd gestational week, then as low as 6.9% by the 38th gestational week. After the 28th gestational week, there was a rapid decline in VLBW proportion, then a further decline to 9.3% at the 32nd gestational week. Birth weight/birth length ratios were 2.94 and 6.25 at the 28th and 39th gestational weeks, respectively. There were no differences in birth weight/birth length ratios between male and female babies. Based on the above findings, we tried to set a norm from birth weight/birth length ratios by gestational week.

[The use of extended family APGAR index in OPD].

The present study was designed to evaluate the clinical availability of extended family APGAR in OPD. Five hundred and twenty two patients were collected from three different out-patient departments were studied during a 6 month period. All 522 patients were over 12 years of age and asked to completed an extended family function questionnaire. The patient's age, sex, marital status, occupation, education, family role, socioeconomic status and religion were also recorded. The results showed that there were significant difference among the extended scores of patient's marital status and the socioeconomic status. We also found that patients suffering from family problems, psychosomatic problems and multiple problems have significantly lower extended scores. Because only 3 patients were diagnosed as having family problems by a chart reviewed in all 522 patients, we suggest further research on the extended family APGAR before widely using it in OPD.

[Frequency distribution of birth weight and gestational age in Taiwan].

Perinatal mortality rate is closely related to birth weight. We collected data on 35919 single liveborn babies at a teaching hospital in central Taiwan between 1977 and 1987, excluding 1980. The average birth weights of the two sexes combined, and of male and female live births separately, were 3163 +/- 486 gm, 3211 +/- 499 gm (N = 18865) and 3110 +/- 466 gm (N = 17054), respectively. The average gestational age of these live births was 39.7 +/- 2.1 weeks. The skewness and kurtosis of birth weight and gestational age distribution were -0.86 and 3.13, and -2.11 and 10.29, respectively. The two distributions indicated high kurtosis and left skewness, and were approximately normally distributed. Because birth weight and gestational age are highly associated, the skew-to-left residual distribution of birth weight might have been induced by low gestational age. Babies of low gestational age might not be able to develop mature organs and tissues, which, thus, results in high perinatal mortality. The distribution of birth weight intersects the normal curve within the region between 1500 gm and 2000 gm, which means that we may divide it into a predominant part and a residual part. Many articles have shown that the residual part is highly correlated to perinatal mortality rate and deserves further analysis. The average birth weight with gestational age at 40 weeks was 3239 +/- 385 gm, skewness and kurtosis were 0.16 and 0.75, respectively. The birth-weight distribution for a given number of gestational weeks is closer to the normal distribution. This paper provides standard figures and tables of birth weight with specific gestational age as a norm for related medical research.

The determination of high density lipoprotein cholesterol separated by electrophoresis and sodium phosphotungstate/Mg2+ precipitation: a physical evaluation.

Epidemiologic studies show that the risk of clinically evident atherosclerosis correlates negatively with concentrations of high density lipoprotein (HDL) and the influence of different factors on variations in the concentration of HDL cholesterol. We measured HDL cholesterol by both the electrophoresis and the precipitation method, and then proposed reference intervals for HDL cholesterol, adjusted for age and sex. Our findings show that the HIDL cholesterol concentration was lowest in cord blood. The concentration increased between the ages of 1 to 15 years, but lowered between the ages of 16 to 20 years. After this age period our study shows that the HDL cholesterol levels began to rise again before leveling off between the ages of 21-30 years. There was a significant difference in concentrations of HDL cholesterol between males and females. Our findings also show that the precision of the precipitation method is better than that of the electrophoresis method. The C.V. of the within-run analysis was 4.8% vs. 10.7%, while the C.V. of the between-run analysis was 4.3% vs. 14.6%. However, a significant correlation (r = 0.77) was noted between the precipitation method and electrophoresis. The electrophoresis method can be recommended as an aid in lipoprotein phenotyping, so we suggest it as a routine clinical method for HDL cholesterol analysis.