Conducting the non-inferiority test for the means with unknown coefficient of variation in a three-arm trial.

BACKGROUND: The non-inferiority test is a reasonable approach to assessing a new treatment in a three-arm trial. The three-arm trial consists of a placebo, reference, and an experimental treatment. The non-inferiority is often measured by the mean differences between the experimental and the placebo groups relative to the mean differences between the reference and the placebo groups. METHODS: To cope with possible estimation distortion due to the allowance of heteroskedasticity, we adjust the measurement of non-inferiority by the incorporation of coefficient of variation (CV) of the experimental, the reference and the placebo groups. In this research, we propose a generalized [Formula: see text]-value based method (GPV-based method) to facilitate non-inferiority tests for the means with unknown coefficient of variation in a three-arm trial. RESULTS: The simulation results show that the GPV-based method can not only adequately control type I error rate at nominal level better but also provide power higher than those from Delta method and the empirical bootstrap method, which verifies the feasibility of our adjustment. CONCLUSIONS: We revise the measurement of non-inferiority by deducting the CV of each kind of treatment from the average effect of trials. CVs are included in the non-inferiority explicitly to help prevent possible estimating distortion if heteroskedasticity is allowed. Through the simulation study, the performance of GPV-based method for facilitating non-inferiority tests for the means with unknown CV in a three-arm trial is better than those from empirical bootstrap method and Delta method for small, medium and large sample sizes. Hence, the GPV-based method is recommended to be used to conduct the non-inferiority test for the means with unknown CV in a three-arm trial. The GPV-based method still performs well in non-normality cases.

Association of advanced paternal age with lung function at school age.

BACKGROUND: Epidemiological studies suggest that advanced paternal age impact offspring health, but its impact on respiratory health is unclear. This study aimed to investigate the association of paternal age with lung function and fraction of exhaled nitric oxide (FeNO) in children. METHODS: We analyzed data from 1330 single-born children (576 girls, 43.3%; mean age, 6.4 years), who participated in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort and received measurements of lung function and FeNO at 6-year follow-up visits. Covariate-adjusted regression analyses were applied. RESULTS: Every 5-year increase in paternal age at birth was associated with 0.51% decrease in FEV1/FVC ratio (95% CI - 0.86 to - 0.15; p = 0.005) and 19.86 mL/s decrease in FEF75 (95% CI: - 34.07 to - 5.65; p = 0.006). Stratified analyses revealed that increasing paternal age at birth was associated with decreasing FEV1/FVC ratio and FEF75 only among children with prenatal exposure to environmental tobacco smoke (ETS) or not being breastfed. Sensitivity analyses using paternal age as a categorical variable found decreasing FEV1/FVC ratio and FEF75 in the groups of paternal age 35-39 and ≥ 40 years. There was no association of paternal age at birth with FeNO. CONCLUSION: Our findings provide novel evidence linking advanced paternal age at birth with decreasing lung function in children at school age. Children with prenatal exposure to ETS or not being breastfed are more vulnerable to the adverse effect of advanced paternal age on childhood lung function. Further studies are warranted to confirm this novel adverse effect of advanced paternal age.

Comorbidities of systemic lupus erythematosus prior to and following diagnosis in different age-at-onset groups.

OBJECTIVES: Systemic lupus erythematosus (SLE) is a female-dominated autoimmune disease that can occur at any age and has a diverse course. The clinical manifestation of this disease can vary depending on the patient's age at onset. The aim of this study was to characterise the comorbidities at the time of SLE diagnosis and after in different age groups. METHODS: A total 1042 incident cases of SLE with a Catastrophic Illness Card in 2005 and 10,420 age- and sex-matched controls from the general population registered in the National Health Insurance Research Database in Taiwan were enrolled in the study. The risk of comorbidities before (adjusted odds ratio, [aOR]) and after (adjusted hazard ratio, [aHR]) of SLE was analysed. The burden of these SLE-associated comorbidities was weight by the Charlson comorbidity index (CCI). We used the cumulative incidence to evaluate the impact of comorbidities on different age onset groups. RESULTS: In this study, musculoskeletal diseases had the highest positive association (aOR, 5.29; 95% confidence interval [CI]: 4.25-6.57) prior to the diagnosis of SLE and they were also the most common developing incident comorbidity after the diagnosis (HR, 13.7; 95% CI: 11.91-15.77). It only took less than 1 year for 50% of the late-onset SLE patients to develop any increase in CCI score. The developing comorbidities attributed to 16.3% all-cause mortality and they had the greatest impact on late-onset SLE patients, with 33.3% cumulative incidence to all-cause mortality. There is no difference in the incidence of infectious diseases across different age groups. The herpes zoster infection had the greatest cumulative incidence among the category of infection diseases in child-onset SLE patients. CONCLUSION: SLE patients had increased risks of multiple pre-existing comorbidities at diagnosis. The developed comorbidity after diagnosis could contribute to all-cause mortality. The herpes zoster infection is primarily an issue in child-onset SLE patients.

Feasibility of endoscopic transoral surgical lung biopsy in a live canine model.

BACKGROUND: The feasibility of using a transoral approach to the thoracic cavity has not yet been measured in humans or animals. The present study aimed to evaluate the feasibility of transoral surgical lung biopsy (TOLB) in 10 canines. METHODS: Through an incision over the vestibulum oris, a homemade metal tube was introduced into the thoracic cavity under endoscopic guidance and used as a working channel of surgical lung biopsy. TOLB was performed on the predetermined lung lobe by using an electrocautery loop and endoscopic grasper. RESULTS: Successful surgical lung biopsy was achieved in 8 of 10 animals in a mean time of 132 minutes (range 130-190 minutes). There were no major intraoperative or postoperative complications, and all animals survived for 2 weeks after surgery. Autopsy showed no evidence of vital structure injury, mediastinitis, or empyema. CONCLUSIONS: TOLB was demonstrated to be safe and feasible in a canine model.

The generalized inference on the ratio of mean differences for fraction retention noninferiority hypothesis.

The fraction retention non-inferiority hypothesis is often measured for the ratio of the effects of a new treatment to those of the control in medical research. However, the fraction retention non-inferiority test that the new treatment maintains the efficacy of control can be affected by the nuisance parameters. Herein, a heuristic procedure for testing the fraction retention non-inferiority hypothesis is proposed based on the generalized p-value (GPV) under normality assumption and heteroskedasticity. Through the simulation study, it is demonstrated that, the performance of the GPV-based method not only adequately controls the type I error rate at the nominal level but also is uniformly more powerful than the ratio test, Rothmann's and Wang's tests, the comparable extant methods. Finally, we illustrate the proposed method by employing a real example.

Association between maternal age at delivery and allergic rhinitis in schoolchildren: A population-based study.

BACKGROUND: Some studies have shown associations of maternal age at delivery with asthma and food allergy in offspring. However, the relationship between maternal age at delivery and allergic rhinitis is largely unclear. This study aimed to investigate the association between maternal age at delivery and allergic rhinitis in a population sample of Asian children, and to explore potential effect modifiers. METHODS: A total of 1344 singleton-birth children (763 boys, 56.8%; mean age, 6.4 years) participating in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort were evaluated by a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and interviewed by pediatricians. Allergic sensitization was determined by using Phadiatop Infant. Multiple logistic regression models with covariates adjustment were performed to investigate the association of maternal age at delivery with allergic rhinitis and allergic sensitization in offspring. RESULTS: Among 1344 study children, 793 (59%) had physician-diagnosed allergic rhinitis. Advanced maternal age at delivery (≥40 years) was significantly associated with increased odds of allergic rhinitis (adjusted odds ratio [AOR] = 4.58, 95% confidence interval [CI]: 1.90-11.03) and allergic sensitization (AOR = 2.86, 95% CI: 1.13-7.22) in offspring. A sex-stratified analysis revealed that the association of advanced maternal age with allergic rhinitis was statistically significant only in female offspring (AOR = 7.02, 95% CI: 1.89-26.14). Stratified analyses by birth order or environmental tobacco smoke exposure during pregnancy did not reveal any significant differences. CONCLUSION: Advanced maternal age at delivery was associated with increased risk of allergic rhinitis in Asian children, probably more pronounced among girls.

Sensation-seeking, Internet dependency, and online interpersonal deception.

This study aimed to elaborate the relationships between sensation-seeking, Internet dependency, and online interpersonal deception. Of the 707 individuals recruited to this study, 675 successfully completed the survey. The results showed high sensation-seekers and high Internet dependents were more likely to engage in online interpersonal deception than were their counterparts.

Effects of a televised two-city safer sex mass media campaign targeting high-sensation-seeking and impulsive-decision-making young adults.

This study evaluates the ability of a safer sex televised public service announcement (PSA) campaign to increase safer sexual behavior among at-risk young adults. Independent, monthly random samples of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community. The 3-month high-audience-saturation campaign took place in Lexington, KY, with Knoxville, TN, as a comparison city. Messages were especially designed and selected for the target audience (those above the median on a composite sensation-seeking/impulsive-decision-making scale). Data indicate high campaign exposure among the target audience, with 85%-96% reporting viewing one or more PSAs. Analyses indicate significant 5-month increases in condom use, condom-use self-efficacy, and behavioral intentions among the target group in the campaign city with no changes in the comparison city. The results suggest that a carefully targeted, intensive mass media campaign using televised PSAs can change safer sexual behaviors.

Predictors of online information seeking by international students when disaster strikes their countries.

This study explores factors influencing international students' likelihood of using the Internet to seek disaster-related information should a disaster affect their countries. A cross-sectional survey was conducted in two universities in America between August 1 and September 30, 2005. Two hundred twenty-nine (n = 229) students completed the self-administered questionnaires. ANOVA analyses found that respondents' Internet self-efficacy had no significant impact on their intentions to seek disaster-related information on the Internet. However, respondents' Internet dependency and attitude toward seeking information online were found to have a significant effect on such intentions.

Personality traits as predictors of intentions to seek online information about STDs and HIV/AIDS among junior and senior college students in Taiwan.

The purpose of this cross-sectional study is to examine how personality traits such as sensation- seeking and impulsive decision-making affect Taiwanese college students' intentions to seek online information about sexually transmitted diseases (STDs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). Five hundred thirty-five (n = 535) junior and senior college students in Taiwan were recruited and completed self-report questionnaires. This study found high sensation-seekers were more likely to seek information about STDs and HIV/AIDS on the Internet than low sensation-seekers. Impulsive decision-makers were less likely than rational decision-makers to seek information about STDs and HIV/AIDS on the Internet. These findings suggest that personality needs to be considered as an exploratory factor which potentially influences intentions to seek STD and HIV/AIDS information on the Internet among Taiwanese college students.

Video-assisted thoracoscopic surgery for hydrothorax in peritoneal dialysis patients - check-air-leakage method.

Hydrothorax developing from pleuroperitoneal communication as a complication of peritoneal dialysis was first described in 1967 [Edward SR, Unger AM. Acute hydrothorax-a new complication of peritoneal dialysis. JAMA 1967; 199:853-5. ]. The incidence of hydrothorax is approximately 1.6-2% of continuous ambulatory peritoneal dialysis (CAPD) patients. The key to successful therapy is obliteration of the transdiaphragmatic route of dialysate leakage with video-assisted thoracoscopic surgery (VATS). The method in which air leakage is checked intraoperatively is the preferred choice and better than all other procedures.

Hemodynamic and inflammatory responses following transumbilical and transthoracic lung wedge resection in a live canine model.

BACKGROUND: Single-port transumbilical surgery is a well-established platform for minimally invasive abdominal surgery. The aim of this study was to compare the hemodynamics and inflammatory response of a novel transumbilical technique with that of a conventional transthoracic technique in thoracic exploration and lung resection in a canine model. METHODS: Sixteen dogs were randomly assigned to undergo transumbilical thoracoscopy (n = 8) or standard thoracoscopy (n = 8). Animals in the umbilical group received lung resection via a 3-cm transumbilical incision in combination with a 2.5-cm transdiaphragmatic incision. Animals in the standard thoracoscopy group underwent lung resection via a 3-cm thoracic incision. Hemodynamic parameters (e.g., mean arterial pressure, heart rate, cardiac index, systemic vascular resistance, and global end-diastolic volume index) and inflammatory parameters (e.g., neutrophil count, neutrophil 2',7' -dichlorohydrofluorescein [DCFH] expression, monocyte count, monocyte inducible nitric oxide synthase expression, total lymphocyte count, CD4+ and CD8+ lymphocyte counts, the CD4+/CD8+ratio, plasma Creactive protein level, interleukin-6 level) were evaluated before surgery, during the operation, and on postoperative days 1, 3, 7, and 14. RESULTS: Lung resections were successfully performed in all 16 animals. There were 2 surgery-related mortality complications (1 animal in each group). In the transumbilical group, 1 death was caused by early extubation before the animal fully recovered from the anesthesia. In the thoracoscopic group, 1 death was caused by respiratory distress and the complication of sepsis at 5 days after surgery. There was no significant difference between the two techniques with regard to the hemodynamic and immunologic impact of the surgeries. CONCLUSION: This study suggests that the hemodynamic and inflammatory changes with endoscopic lung resection performed by the transumbilical approach are comparable to those after using the conventional transthoracic approach. This information is novel and relevant for surgeons interested in developing new surgical techniques in minimally invasive surgery.

Application of optimal designs to item calibration.

In computerized adaptive testing (CAT), examinees are presented with various sets of items chosen from a precalibrated item pool. Consequently, the attrition speed of the items is extremely fast, and replenishing the item pool is essential. Therefore, item calibration has become a crucial concern in maintaining item banks. In this study, a two-parameter logistic model is used. We applied optimal designs and adaptive sequential analysis to solve this item calibration problem. The results indicated that the proposed optimal designs are cost effective and time efficient.

Determinants of intentions among taiwanese women to seek information regarding cervical cancer.

BACKGROUND: Women in Taiwan are at increasing risk of cervical cancer. The determinants of intentions to seek information about cervical cancer among women have not been adequately addressed in previous studies. PURPOSE: This study uses the theory of planned behavior and the concept of perceived risk to explore the determinants of intentions to seek information about cervical cancer among Taiwanese women. METHODS: This cross-sectional study surveyed Taiwanese women aged 35 years and over. Systematic sampling was adopted to identify potential participants from the public telephone directory. A nationwide sample of 1,001 female adults aged 35 years and over completed the telephone-based survey questionnaire from April 13 to 27 of 2010. RESULTS: The results of this study showed that subjective norms, attitude, and perceived behavioral control positively and significantly predicted the information-seeking intentions about cervical cancer of participants. In addition, those seeking information regarding cervical cancer were more concerned about risks to themselves than about risks to others. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This investigation contributes to the literature on theory of planned behavior by documenting perceived personal risks to the patient and risks to others regarding a diagnosis of cervical cancer. It is hoped that this investigation assists scholars of health communication and information-seeking behavior to better understand and positively address the determinants of the intentions of women to seek information about cervical cancer.

The link of sexual sensation seeking to acceptance of cybersex, multiple sexual partners, and one-night stands among Taiwanese college students.

BACKGROUND: Young people in Taiwan have become more liberal and active toward sex. Despite heavy investments of money, time, and effort, sexual education programs have generally lagged expectations. PURPOSE: Personality traits such as sexual sensation seeking are found to be significantly associated with risky sexual behaviors. This study, therefore, attempts to explore the link of sexual sensation seeking to acceptance by Taiwanese college students of cybersex, multiple sexual partners, and one-night stands. METHODS: A cross-sectional study was conducted using the multistage cluster sampling method. Five hundred sixteen students recruited from eight universities/colleges in Taiwan participated in this study, and 507 completed the self-report questionnaire. The valid response rate was 98.26%. RESULTS: The results reveal that high-sexual-sensation seekers were more likely than low-sexual-sensation seekers to accept cybersex, multiple sexual partners, and one-night stands. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study suggests that the designers of campus-based health prevention campaigns should target campaign messages on high-sexual-sensation seekers using novel, thrilling, and complex messages to achieve safe sex educational campaign goals.

Online networks as a venue for social support: a qualitative study of married bisexual men in Taiwan.

Online networks have become a critical venue for bisexual males to communicate with each other and solicit social support. This study reports qualitative feedback gathered from 12 married Taiwanese bisexual men about online social support in their daily lives. The analysis of interviews reveal that online social support provides participants with opportunities to screen potential friends, participate in the bisexual virtual community, come out and release stress, and look for romance. Apparently, for married bisexual men in Taiwan, the Internet offers an opportunity to anonymously manage sexual identity and solicit social support among other bisexuals.

Assessing the Relationship Between Perceived Message Sensation Value and Perceived Message Effectiveness: Analysis of PSAs From an Effective Campaign.

The current study is an analysis of public service announcements (PSAs) from an effective safer sex campaign that utilized a sensation-seeking targeting (SENTAR) approach. Two random samples of heterosexually active young adults (sample one N = 1,463, sample two N = 895) viewed different sets of safer sex PSAs on a laptop computer and answered questions about their perceived sensation value and perceived effectiveness. Multiple regression analyses examined the impact of (a) demographic, (b) individual difference, (c) sexual context, and (d) message variables including perceived message sensation value (PMSV) on the perceived message effectiveness (PME) of the PSAs. Results indicated that females, African Americans, condom users, and those with less education viewed the PSAs as slightly more effective than males, Caucasians, non-condom users, and those with more education. PMSV and personal utility emerged as the strongest predictors of PME, even after controlling for all of the aforementioned variables. Implications for further research on PMSV and perceived and actual effectiveness of PSAs are offered.

Testing a model of the predictors and consequences of body dissatisfaction.

A cross-sectional study, testing a model of predictors and consequences of body dissatisfaction, was undertaken in Taiwan from December 30, 2006 to January 10, 2007. Two hundred and thirty-two female college students enrolled at a major university completed the self-administered questionnaire. Analytical results revealed that body dissatisfaction among respondents increased with BMI (beta=.32, p<.001), perceptions of how others viewed their bodies (beta=.38, p<.001), and upward social comparisons (beta=.17, p<.01). Body dissatisfaction also markedly influenced respondent weight-loss intentions (beta=.51, p<.001). Results imply that medical, psychological and social factors must be considered by school health educators wishing to understand the causes and consequences of body dissatisfaction among female college students.

Optimistic bias, information seeking and intention to undergo prostate cancer screening: A Taiwan study on male adults.

BACKGROUND: This study explores optimistic bias and information seeking in prostate cancer patients and how they impact intention to undergo prostate cancer screening. METHODS: A national sample of 427 Taiwanese male adults aged at least 45 years (mean (M) = 57) were recruited to complete a telephone-based survey questionnaire between April 30 and May 8, 2008. RESULTS: The questionnaire results showed that respondents considered themselves less likely than others to get prostate cancer. The relationship between optimistic bias and intention to undergo prostate cancer screening was non-significant, while information seeking positively and significantly predicted such an intention. CONCLUSIONS: The findings of this study imply that health educators should include risk-awareness strategies and information seeking interventions in the design of cancer prevention programs.