Relationships among Antecedents, Processes, and Outcomes for Shared Decision Making: A Cross-Sectional Survey of Patients with Lumbar Degenerative Disease.

BACKGROUND: Among musculoskeletal disorders, lumbar degenerative disease (LDD) is the leading cause of total disability-adjusted life years globally. Clinical guidelines for LDD describe multiple treatment options in which shared decision making becomes appropriate. OBJECTIVES: To explore the relationships among measures of decision antecedents, process, and outcomes in patients with LDD. METHODS: Patients with LDD were recruited from outpatient clinics in a teaching hospital in Taiwan and administered surveys to collect measures of decision antecedents, processes, and outcomes. Multiple linear regression was conducted to assess the association between decision antecedents and the decision making process. Hierarchical linear regression was conducted to assess the relationships among decision antecedents, the decision making process, and decision outcomes. RESULTS: A total of 132 patients (mean age, 61 years) completed the survey. After adjustment for personal factors, 2 decision antecedents (namely, decision making self-efficacy and readiness) significantly predicted patients' experiences of engaging in shared decision making (SDM). Decision making readiness and process were associated with fewer decisional conflicts and greater decision satisfaction. LIMITATIONS: Models derived from cross-sectional surveys cannot establish causal relationships among decision antecedents, decision making processes, and decision outcomes. CONCLUSIONS: Our results support the SDM framework, which proposes relationships among decision antecedents, the decision making process, and decision outcomes.

Sulfur-rich geothermal emissions elevate acid aerosol levels in metropolitan Taipei.

Several studies have demonstrated that millions of people globally are potentially exposed to volcanic gases. Hydrogen sulfide is a typical gas in volcanic and geothermal areas. The gas is toxic at high concentrations that predominantly affects the nervous, cardiovascular, and respiratory systems. The WHO air quality guideline for hydrogen sulfide is 150 microg m(-3) (105 ppb). The northwest part of Taipei is surrounded by sulfur-rich geothermal and hot springs. Active fumaroles and bubbling springs around the geothermal area emit acidic gases. In combination with automobile emissions, the pollution of acid aerosols is characteristic of the metropolis. This study considered sulfur-rich geothermal, suburban and downtown locations of this metropolis to evaluate geothermally emitted acid aerosol and H(2)S pollution. Acid aerosols were collected using a honeycomb denuder filter pack sampling system (HDS), and then analyzed by ion chromatography (IC). Results indicated that long-term geothermal emissions, automobile emissions and photochemical reactions have led to significant variations in air pollution among regions of metropolitan Taipei. The highest H(2)S concentration was 1705 ppb in the geothermal area with low traffic density and the mean concentration was 404.06 ppb, which was higher than WHO guideline and might cause eye irritation. The SO(2) concentrations were relatively low (mean concentration was 3.9 ppb) in this area. It may partially result from the chemical reduction reaction in the geothermal emission, which converted the SO(2) gas into SO(4)(2-) and H(2)S. Consequently, very high sulfate concentrations (mean concentration higher than 25.0 microg m(-3)) were also observed in the area. The geothermal areas also emitted relatively high levels of aerosol acidity, Cl(-), F(-), PO(4)(3-), and N-containing aerosols. As a result, concentrations of HNO(3), NO(2)(-), PO(4)(3-), and SO(4)(2-) in metropolitan Taipei are significantly higher than those in other urban areas considered in other studies. These results provide evidence that geothermal emissions represent a significant source of acid aerosols in metropolitan Taipei. Therefore, in this metropolitan area, the combined health effects of air pollutants from automobiles and geothermal emissions should be particular concern.

Association between nonylphenol exposure and development of secondary sexual characteristics.

Previous studies have reported that p-nonylphenol (NP) can advance the age at vaginal opening in prepubertal rats. A significant exposure levels of NP was found in Taiwanese population even from the prenatal stage. The purposes of this study are to examine the urinary NP concentration of pubertal students in Taiwan and to explore its association with the development of secondary sexual characteristics. 786 pubertal students were recruited. The NP was determined using solid-phase extraction and high-performance liquid chromatography with fluorescent detection. A self-administered questionnaire was used to collect the data on occurrence of secondary sexual characteristics in the subjects. About 30% of the urine samples were positively detected. The NP concentrations ranged from ND to 178.25 microg g(-1) cr. Fifteen percent of the Taiwanese girls between 10.5 and 10.9 years old reported having undergone menarche, which was higher than the white girls (4.6%) and the black girls (8%). There was no significant difference of urinary NP levels between groups of having and not having secondary sexual characteristics because body mass index (BMI) had significant effects on sexual development. After adjusting the effect of age and BMI, the menarcheal age remained inversely correlated with the increase of urinary NP levels. Nonylphenol exposure could disturb pubertal development and the pubertal girls seem more sensitive than pubertal boys to the exposure of endocrine disruption chemicals (EDCs). The effects of early maturation as well as the health implications need further study.

Quantification of prenatal exposure and maternal-fetal transfer of nonylphenol.

Nonylphenol (NP) is an environmental hormone commonly found in daily foodstuffs. This study examined maternal and umbilical-cord blood samples to explore prenatal exposure levels to nonylphenol and placental protection against NP exposure. One hundred and seventy-four mixed cord blood samples were collected. Among them, 42 pairs of expectant mothers and their prenatal fetus were matched to compare nonylphenol levels between mothers and fetuses. An additional 30 mother-infant dyads were chosen to give maternal, umbilical arterial and venous blood samples. Plasma samples were enzymatically deconjugated and then cleaned up with solid-phase extraction. After extraction, samples were analyzed with reversed-phase high-performance liquid chromatography coupled with fluorescence detection. Analytical results identified prenatal exposure to NPs and relatively high prenatal exposure levels in metropolitan areas. The concentrations ranged from undetectable (below 1.82 ng/g plasma) to 211 ng/g plasma. Concentrations of NP in mother-infant dyads showed the NP concentrations in maternal plasma were not definitely higher than that in fetal plasma. Still, 63.6% of NP detectable mother-infant dyads showed a higher concentration in umbilical venous plasma than those in umbilical arterial plasma. Through the repeated exposure from expectant mothers' dietary intake, fetuses could encounter high NP exposure level due to transplacental absorption, partitioning between the maternal and fetal compartments, as well as poor detoxification mechanisms of the developing organism. Some mechanisms may contribute to the reduction of NP levels in fetal blood circulation but those remain unclear.