Obesity indices and the risk of total and cardiovascular mortality among people with diabetes: a long-term follow-up study in Taiwan.

BACKGROUND: The association between obesity indicators and mortality in individuals with diabetes remains unclear, and data on cardiovascular mortality are scarce. Therefore, we investigated the associations between the five adiposity indices and both all-cause and cardiovascular mortality in patients with diabetes. METHODS: This cohort study included 34,686 adults with diabetes who underwent a standard health-screening program between 1996 and 2017 in Taiwan. The dates and causes of death till January 2022 were retrieved from the National Death Registry. Cox proportional hazards models were used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cardiovascular mortality in relation to body mass index (BMI), waist circumference, waist-hip ratio (WHR), body fat percentage (BF%), and A Body Shape Index (ABSI), using the third quintile as the reference group. RESULTS: During a median follow-up of 15 years, there were 8,324 deaths, of which 1,748 were attributed to cardiovascular disease. After adjusting for demographics, lifestyle factors and comorbidities, ABSI was associated with all-cause mortality in an exposure-response manner; the HR (95% CI) for first and fifth vs. third quintile was 0.78 (0.69-0.89) and 1.24 (1.14-1.35), respectively. A similar but weaker exposure-response relationship was found between WHR and mortality. People with a lower BMI and BF% had an increased risk of mortality (HR [95% CI] for the first vs. third quintiles, 1.33 [1.22, 1.44] and 1.42 [1.30, 1.56], respectively). No association was observed between waist circumference categories and risk of mortality. Similar results were observed for the association of BF%, waist circumference, and ABSI with cardiovascular mortality. However, no significant association was observed between BMI and cardiovascular mortality. The association between WHR and cardiovascular mortality was stronger than that between WHR and all-cause mortality. CONCLUSIONS: ABSI demonstrated a consistent exposure-response relationship with both all-cause and cardiovascular mortality in this Asian cohort with diabetes. Our findings highlight the importance of monitoring ABSI, a surrogate index of central adiposity, in patients with diabetes.

Associations of Endometriosis and Hormone Therapy With Risk of Hyperlipidemia.

Using claims data from the universal health insurance program of Taiwan, we conducted a retrospective cohort study to investigate whether endometriosis and hormone therapy are associated with the risk of developing hyperlipidemia. We selected 9,155 women aged 20-55 years with endometriosis diagnosed during the period 2000-2013 and 212,641 women without endometriosis with a median follow-up time of 7 years. Among patients with endometriosis, 86% of cases were identified on the basis of diagnosis codes with an ultrasound claim, and 14% were defined by diagnostic laparoscopy or surgical treatments. In a Cox proportional hazards model, the adjusted hazard ratio was 1.30 (95% confidence interval (CI): 1.19, 1.41) for all women, 1.04 (95% CI: 0.81, 1.32) for women under 35 years of age, 1.17 (95% CI: 1.03, 1.32) for women aged 35-44 years, and 1.34 (95% CI: 1.18, 1.52) for women aged 45-54 years. Hysterectomy and/or bilateral oophorectomy accounted for 46.9% of the association between endometriosis and hyperlipidemia, and hormone therapy accounted for 21.6%. Among women with endometriosis, the marginal structural model approach adjusting for time-varying hysterectomy/bilateral oophorectomy showed no association between use of hormone medications and risk of hyperlipidemia. We concluded that women with endometriosis are at increased risk of hyperlipidemia; use of hormone therapy by these women was not independently associated with the development of hyperlipidemia.

Association of Constipation with risk of end-stage renal disease in patients with chronic kidney disease.

BACKGROUND: Chronic Kidney Disease (CKD) is a growing public health problem. Many risk factors were identified and interventions were applied accordingly, but the incidence of end-stage renal disease continued increasing. Some other risk factors may be ignored. Gut microbiota has been recognized as an important endogenous organ. The kidney-gut axis would contribute to gut dysbiosis, which might worsen CKD. Constipation, commonly seen in CKD, was one of the clinical presentation of gut dysbiosis. The clinical impact of constipation to CKD remains unknown. Our study aimed at assessing the risk of ESRD between CKD patients with and without constipation in a nationwide database. METHODS: We identified newly diagnosed cases of CKD without constipation history before in 2000-2011 from the Taiwan National Health Insurance database. Subjects who developed constipation later formed constipation group. The others without constipation matched by propensity score formed non-constipation group. The incidence rates and hazards of ESRD in patients with and without constipation by the end of 2013 were compared by using Cox proportional hazard models with a time-dependent variable. RESULTS: The incidences of ESRD per 1000 person-years were 22.9 for constipation group and 12.2 for non-constipation group, respectively. Cox proportional hazard models with a time-dependent variable revealed an adjusted hazard ratio of 1.90 (95% CI, 1.60-2.27). Compared to the CKD patients without constipation, adjusted hazard ratio for the CKD patients with laxatives < 33, 33-197 and ≥ 198 days per year were 0.45 (0.31-0.63), 1.85 (1.47-2.31) and 4.41 (3.61-5.39) respectively. CONCLUSION: In a population of newly-diagnosed CKD patients, we observed that subjects with de novo constipation, as compared with non-constipation, have increased risk of developing ESRD. More severe constipation would increase the risk further.

Acupuncture Therapy and Incidence of Depression After Stroke.

BACKGROUND AND PURPOSE: We investigated whether use of acupuncture within a 3-month poststroke period after hospital discharge is associated with reduced risk of depression. METHODS: This cohort study included 16 046 patients aged ≥18 years with an initial hospitalization for stroke during 2000 and 2012 in the claims database of a universal health insurance program. Patients who had received acupuncture therapies within 3 months of discharge were defined as acupuncture users (n=1714). All patients were followed up for incidence of depression until the end of 2013. We assessed the association between use of acupuncture and incidence of depression using Cox proportional hazards models in all subjects and in propensity score-matched samples consisting of 1714 pairs of users and nonusers. RESULTS: During the follow-up period, the incidence of depression per 1000 person-years was 11.1 and 9.7 in users and nonusers, respectively. Neither multivariable-adjusted Cox models (hazard ratio, 1.04; 95% confidence interval, 0.84-1.29) nor the propensity score-matching model (hazard ratio, 1.06; 95% confidence interval, 0.79-1.42) revealed an association between use of acupuncture and incidence of depression. CONCLUSIONS: In patients admitted to hospital for stroke, acupuncture therapy within 3 months after discharge was not associated with subsequent incidence of depression.

Water-Soluble Dinitrosyl Iron Complex (DNIC): a Nitric Oxide Vehicle Triggering Cancer Cell Death via Apoptosis.

Nitric oxide (NO) is an important cellular signaling molecule that modulates various physiological activities. Angiogenesis-promoting activities of NO-donor drugs have been explored in both experimental and clinical studies. In this study, a structurally well characterized and water-soluble neutral {Fe(NO)2}(9) DNIC [(S(CH2)2OH)(S(CH2)2NH3)Fe(NO)2] (DNIC 2) was synthesized to serve as a NO-donor species. The antitumor activity of DNIC 2 was determined by MTT assay, confocal imaging, and Annexin-V/PI staining. The IC50 values of DNIC 2 were 18.8, 42.9, and 38.6 µM for PC-3, SKBR-3, and CRL5866 tumor cells, respectively. Moreover, DNIC 2 promoted apoptotic cell death via activation of apoptosis-associated proteins and inhibition of survival associated proteins. In particular, DNIC 2 treatment suppressed PC-3 tumor growth by 2.34- and 19.3-fold at 7 and 21 days, in comparison with the control group. These results indicate that water-soluble DNIC 2 may serve as a promising drug for cancer therapy.

Formation pathway of Roussin's red ester (RRE) via the reaction of a {Fe(NO)2}(10) dinitrosyliron complex (DNIC) and thiol: facile synthetic route for synthesizing cysteine-containing DNIC.

Transformation of {Fe(NO)2}(10) dinitrosyliron complex (DNIC) Fe(CO)2(NO)2 into [{Fe(NO)2}(9)]2 Roussin's red ester (RRE) [(µ-S(CH2)2NH2)Fe(NO)2]2 (3) triggered by cysteamine via the reaction pathway (intermediates) [{Fe(NO)2}(10)]2[(NO)2Fe(µ-CO)(µ-S(CH2)2NH3)Fe(NO)2] (1) → {Fe(NO)2}(9){Fe(NO)2}(10)[(NO)2Fe(µ-S(CH2)2NH2)(µ-S(CH2)2NH3)Fe(NO)2] (2) → RRE 3 is demonstrated. The 1-to-2-to-3 conversion is promoted by proton transfer followed by O2 oxidation and deprotonation. Additionally, a study on facile conversion of complex 3 to complexes [(SR)(S(CH2)2NH3)Fe(NO)2] [SR = 2-aminoethanethiolate (4), benzenethiolate (5)] and [(CysS))(S(CH2)2NH3)Fe(NO)2] (6) via reaction with thiols and the further utility of complex 5 as a template for synthesizing mixed-thiolate-containing reduced RRE (rRRE) [(µ-SC6H5)(µ-S(CH2)2NH3)Fe2(NO)4] (7) provide the methodology for the synthesis and isolation of neutral, pure cysteine-/mixed-thiolate-containing DNIC/RRE. Compared to the conversion of complex 2 to complex 3 via reaction with O2, diphenyl disulfide triggers oxidation of complex 2 to lead to formation of the neutral {Fe(NO)2}(9) DNIC 5 and RRE 3. S-S bond activation of diphenyl disulfide by rRRE 2 may support the decay (oxidation) of rRRE species in ToMOC via the reduction of adjacent protein residues such as cystins, proposed by Lippard.

Acute Bronchitis and Bronchiolitis Infection in Children with Asthma and Allergic Rhinitis: A Retrospective Cohort Study Based on 5,027,486 Children in Taiwan.

This study evaluated the risks of childhood acute bronchitis and bronchiolitis (CABs) for children with asthma or allergic rhinitis (AR). Using insurance claims data of Taiwan, we identified, from children of ≤12 years old in 2000-2016, cohorts with and without asthma (N = 192,126, each) and cohorts with and without AR (N = 1,062,903, each) matched by sex and age. By the end of 2016, the asthma cohort had the highest bronchitis incidence, AR and non-asthma cohorts followed, and the lowest in the non-AR cohort (525.1, 322.4, 236.0 and 169.9 per 1000 person-years, respectively). The Cox method estimated adjusted hazard ratios (aHRs) of bronchitis were 1.82 (95% confidence interval (CI), 1.80-1.83) for the asthma cohort and 1.68 (95% CI, 1.68-1.69) for the AR cohort, relative to the respective comparisons. The bronchiolitis incidence rates for these cohorts were 42.7, 29.5, 28.5 and 20.1 per 1000 person-years, respectively. The aHRs of bronchiolitis were 1.50 (95% CI, 1.48-1.52) for the asthma cohort and 1.46 (95% CI, 1.45-1.47) for the AR cohort relative to their comparisons. The CABs incidence rates decreased substantially with increasing age, but were relatively similar for boys and girls. In conclusion, children with asthma are more likely to develop CABs than are children with AR.

Adjuvant therapy with traditional Chinese medicine and long-term mortality in patients with stroke: A nationwide population-based cohort study in Taiwan.

OBJECTIVES: We investigated whether the use of adjuvant traditional Chinese medicine (TCM) therapy, a form of complementary and alternative medicine, is associated with long-term mortality after stroke. STUDY DESIGN: We conducted a retrospective cohort study and used claims data from Taiwan's National Health Insurance program linked to the National Registry of Death. The cohort included patients aged ≥18 years who were hospitalized for their first stroke event between January 1, 2006, and December 31, 2013. Adjuvant TCM therapy was defined as additional treatments with TCM, which included acupuncture, Chinese herbal medicine, and Tuina, during hospitalization for up to six months. MAIN OUTCOME MEASURE: The mortality rate was measured through to December 31, 2014. RESULTS: Of 321,157 patients with stroke, 14,579 received adjuvant TCM therapy. Propensity score matching resulted in 13,918 matched pairs of patients who did and did not receive adjuvant TCM care. Both multivariable-adjusted Cox proportional hazards models (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.64-0.69) and propensity score-matching analysis (HR, 0.65; 95% CI, 0.60-0.66) revealed a reduced mortality risk associated with the use of adjuvant TCM therapy, as compared with routine inpatient care only. Acupuncture was the most commonly used TCM therapy. Patients treated with acupuncture only, which accounted for 41.3% of TCM users, had a reduced risk of mortality compared with those treated with routine inpatient care. CONCLUSIONS: The use of TCM therapy adjuvant to Western inpatient care in the acute and subacute stages of stroke recovery is associated with a reduced risk of long-term mortality.

Childhood Rotavirus Infection Associated with Temperature and Particulate Matter 2.5 µm: A Retrospective Cohort Study.

No study has ever investigated how ambient temperature and PM2.5 mediate rotavirus infection (RvI) in children. We used insurance claims data from Taiwan in 2006-2012 to evaluate the RvI characteristics in children aged ≤ 9. The RvI incidence rates were higher in colder months, reaching the highest in March (117.0/100 days), and then declining to the lowest in July (29.2/100 days). The age-sex-specific average incident cases were all higher in boys than in girls. Stratified analysis by temperature (<20, 20-24, and ≥25 °C) and PM2.5 (<17.5, 17.5-31.4, 31.5-41.9, and ≥42.0 µg/m3) showed that the highest incidence was 16.4/100 days at average temperatures of <20 °C and PM2.5 of 31.5-41.9 µg/m3, with Poisson regression analysis estimating an adjusted relative risk (aRR) of 1.26 (95% confidence interval (CI) = 1.11-1.43), compared to the incidence at the reference condition (<20 °C and PM2.5 < 17.5 µg/m3). As the temperature increased, the incident RvI cases reduced to 4.84 cases/100 days (aRR = 0.40, 95% CI = 0.35-0.45) when it was >25 °C with PM2.5 < 17.5 µg/m3, or to 9.84/100 days (aRR = 0.81, 95% CI = 0.77-0.93) when it was >25 °C with PM2.5 > 42 µg/m3. The seasonal RvI is associated with frequent indoor personal contact among children in the cold months. The association with PM2.5 could be an alternative assessment due to temperature inversion.

Utilization trends in traditional Chinese medicine for acute myocardial infarction.

ETHNOPHARMACOLOGICAL RELEVANCE: Among heart diseases, acute myocardial infarction (AMI) is the most serious and life-threatening emergency. In Taiwan, heart disease has consistently ranked second among the top 10 leading causes of death since 2007, second only to malignant tumors; however, population-based studies on the use of traditional Chinese medicine (TCM) in AMI cases are limited. AIM OF THE STUDY: This study investigated the characteristics of TCM users and prescriptions of TCM, and their differences between two cohorts of patients with AMI, identified 10 years apart. MATERIALS AND METHODS: A cross-sectional study was conducted using the Taiwan National Health Insurance claims database. From among two random sample of 1 million beneficiaries selected from the claims database, we identified two cohorts of patients with first hospitalization for AMI in between 2000-2001 and 2010-2011. Patients who had received TCM therapy within one year after hospital discharge were defined as TCM users, whereas, all the other patients with AMI were considered non-users of TCM. We compared the characteristics of TCM use and the patterns of prescriptions between the two cohorts. RESULTS: The proportion of patients receiving TCM care was similar between the two AMI cohorts; 20% (85/418) of the patients were diagnosed in 2000-2001 and 21% (169/817) in 2010-2011. In the 2010-2011 AMI cohort, the proportion of men was smaller among TCM users than non-users, and TCM users were less likely to have hyperlipidemia. Among TCM users, the most frequently prescribed herb was Dan-shen (Salvia miltiorrhiza Bunge, Salvia root) in both cohorts. The most commonly used Chinese herbal formulations were Xue-Fu-Zhu-Yu-Tang (Blood Mansion Dispel Stasis) for the 2000-2001 cohort and Zhi-Gan-Cao-Tang (Honey-Fried Licorice Decoction) for the 2010-2011 cohort. CONCLUSIONS: This study revealed the differences in the prescription frequency of Chinese herbal formulation among the two cohort of patients with AMI, suggesting that the practice of prescribing TCM has evolved from post-antique formula to classical remedies during the 10 years evaluated. Further investigations are needed to evaluate if the change in the utilization of Chinese herbal formulations impacts the effectiveness of the treatment.

Characteristics of Traditional Chinese Medicine Use for Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is a common musculoskeletal disorder and an occupational disease caused by repeated exercise or overuse of the hand. We investigated the characteristics of traditional Chinese medicine (TCM) use by practitioners in CTS patients, including demographic variables, socioeconomic status, previous medical conditions, health care use, and hospital characteristics for TCM health care. This cross-sectional study identified 25,965 patients newly diagnosed with CTS based on the first medical diagnosis recorded between 1999 and 2013 in the nationwide representative insurance database of Taiwan. The date of initial CTS diagnosis in outpatient data was defined as the index date, and four patients were excluded because of missing gender-related information. Patients who used TCM care as the first option at their diagnosis were classified as TCM users (n = 677; 2.61%), and all others were TCM non-users (n = 25,288; 97.4%). In the all variables-adjusted model, female patients had an adjusted odds ratio (OR; 95% CI) of TCM use of 1.35 (1.11-1.66). National Health Insurance (NHI) registration was associated with higher odds ratios of TCM use in central, southern, and eastern Taiwan than in northern Taiwan (ORs = 1.43, 1.86, and 1.82, respectively). NHI registration was associated with higher odds ratios of TCM use in rural cities than in urban cities (OR (95% CI) = 1.33 (1.02-1.72)). The TCM group had a 20% less likelihood of exhibiting symptoms, signs, and ill-defined conditions and injury and poisoning. The TCM group had a 56% lower likelihood of having diseases of the musculoskeletal system and connective tissue. Multi-level model outcomes were similar to the results of the all variables-adjusted model, except for the NHI registration outcome in rural and urban cities (OR [95% CI] = 1.33 [0.98-1.81]). Significant associations between the number of TCM visits and TCM use were observed in all logistic regression models. The study presented key demographic characteristics, health care use, and medical conditions associated with TCM use for CTS. Previous experience of TCM use may affect the use of TCM for CTS treatment. This information provides a reference for the allocations of relevant medical resources and health care providers.

Traditional Chinese Medical Care and Incidence of Stroke in Elderly Patients Treated with Antidiabetic Medications.

OBJECTIVES: Experimental research has shown that herbal and traditional Chinese medicines (TCM) may serve as complements to Western medicine treatments in the control of blood glucose and cardiovascular complications, but population-based studies are limited. We investigated the association between TCM use and subsequent risk of stroke in older patients with diabetes. STUDY DESIGN: The database used in this cohort study contained longitudinal medical claims for one million subjects randomly selected among beneficiaries of a universal health care program in Taiwan. We identified a cohort of patients with diabetes aged 65 years and older who initiated anti-diabetic medications from 2000 to 2012. Patients who had at least two TCM outpatient visits after their initiation of anti-diabetic medications were considered TCM users. MAIN OUTCOME MEASURES: The incidence of stroke was measured until 2013. Cox regression models with TCM use as a time-dependent variable were used to calculate the adjusted hazard ratios (HRs) comparing TCM use with no use. RESULTS: Over the 13-year period, 17,015 patients were identified; 4912 (28.9%) of them were TCM users. The incidence of stroke during the follow-up (per 1000 person-years) was 22.8 in TCM users and 25.7 in non-users. TCM users had an adjusted HR of 0.93 for the incidence of ischemic stroke (95% confidence interval [CI] 0.83, 1.04) and of 0.89 for developing hemorrhagic stroke (95% CI 0.66, 1.19), compared with non-users. CONCLUSIONS: In this study, in older patients receiving Western medicine treatments for diabetes, TCM use was not associated with an increased risk of developing ischemic stroke and hemorrhagic stroke.

Oxidative stress associated with indoor air pollution and sick building syndrome-related symptoms among office workers in Taiwan.

This study investigated whether sick building syndrome (SBS) complaints and indoor air pollution for office workers are associated with oxidative stress indicated by urinary 8-hydroxydeoxyguanosine (8-OHdG). With informed consent, 389 employees in 87 government offices of 8 high-rise buildings in Taipei city completed self-reported questionnaires on SBS complaints at work in the past month. Urinary 8-OHdG was determined for each study participant and on-site air pollutants were measured for each office in both indoor and outdoor air. The results showed that urinary 8-OHdG had significant associations with volatile organic compounds and carbon dioxide levels in offices, and with urinary cotinine levels. The mean urinary 8-OHdG level was also significantly higher in participants with SBS symptoms than in those without such complaints (6.16 vs. 5.45 mug/g creatinine, p = .047). The mean 8-OHdG increased as the number of SBS symptoms increased. The multivariate logistic regression analyses showed that the adjusted odds ratios (OR) in relation to micrograms per gram creatinine increase in 8-OHdG were statistically significant for eye dryness (1.12), upper respiratory syndrome (1.17) with particularly nose itching (1.25), sneezing (1.51), dry throat (1.21), skin dryness (1.31), and dizziness (1.19). This study indicates that the 8-OHdG level was significantly associated with SBS complaints after controlling for air pollution and smoking. Whether the 8-OHdG can be used as an effective predictor for SBS symptoms deserves further study.

Characteristics of Traditional Chinese Medicine Use in Pediatric Dislocations, Sprains and Strains.

BACKGROUND AND OBJECTIVES: Dislocations, sprains and strains are common childhood musculoskeletal injuries, requiring medical attention. We investigated the characteristics associated with using traditional Chinese medicine (TCM) for children suffering from these injuries. METHODS: From a nationwide representative insurance database of Taiwan, this cross-sectional study identified 50,769 children with dislocations, sprains and strains under 18 years of age, newly diagnosed between 1999 and 2009, without previous TCM experience. Children who initiated treatment with TCM (n = 24,063, 47.4%) were defined as TCM users, others were in the non-TCM group. Multivariable logistic regression models estimated odds ratios (ORs) of TCM use. RESULTS: Girls and children living in central Taiwan (vs. northern) were associated with higher TCM use. The adjusted ORs (95% confidence interval (CI)) of TCM uses were 1.60 (1.42-1.79) for patients of 3-5 years, 2.20 (1.99-2.42) of 6-12 years and 1.82 (1.64-2.01) of 13-17 years, compared with those of the <2 years group. TCM users were less likely to have outpatient visits for Western medicine care and hospitalizations in the previous year. The TCM group was nearly twice more likely than the non-user group to receive treatments at local clinics (99.1% vs. 53.3%, p < 0.001). CONCLUSIONS: This study reveals important demographic and medical factors associated with TCM uses for children with dislocations, sprains and strains. Interestingly, local clinics are the main healthcare facilities providing TCM services. Further studies are needed to evaluate the outcomes of TCM treatment for these musculoskeletal injuries.

Personal, Psychosocial and Environmental Factors Related to Sick Building Syndrome in Official Employees of Taiwan.

Sick building syndrome (SBS) is a combination of symptoms that can be attributed to exposure to specific building conditions. The present study recruited 389 participants aged 20-65 years from 87 offices of 16 institutions to examine if personal factors, work-related psychosocial stress, and work environments, were associated with five groups of SBS symptoms, including symptoms for eyes, upper respiratory tract, lower respiratory tract, skin, and non-specific systems. Indoor environmental conditions were monitored. Data were analyzed using multivariate logistic regression (MLR) analyses and were reported as adjusted Odds Ratios (aOR). SBS symptoms for eyes were associated with older age, sensitivity to tobacco, and low indoor air flow. Upper respiratory symptoms were related to smoking, low social support, longer work days, and dry air. High indoor air flow was associated with reduced upper respiratory symptoms (aOR = 0.29; 95% confidence interval (CI) = 0.13-0.67). Lower respiratory symptoms were associated with high work pressure, longer work hours, chemical exposure, migraine, and exposure to new interior painting. Recent interior painting exposure was associated with a high estimated relative risk of low respiratory symptoms (aOR = 20.6; 95% CI = 2.96-143). Smoking, longer work days, low indoor air flow, indoor dryness, and volatile organics exposure, were associated with other non-specified symptoms including headache, tiredness, difficulty concentrating, anger, and dizziness. In conclusion, there are various SBS symptoms associated with different personal characteristics, psychosocial, and environmental factors. Psychosocial factors had stronger relationships with lower respiratory symptoms than with other types of SBS symptoms. Good ventilation could reduce risk factors and may relieve SBS symptoms.

Indoor Air Quality in the Metro System in North Taiwan.

Indoor air pollution is an increasing health concern, especially in enclosed environments such as underground subway stations because of increased global usage by urban populations. This study measured the indoor air quality of underground platforms at 10 metro stations of the Taipei Rapid Transit system (TRTS) in Taiwan, including humidity, temperature, carbon monoxide (CO), carbon dioxide (CO2), formaldehyde (HCHO), total volatile organic compounds (TVOCs), ozone (O3), airborne particulate matter (PM10 and PM2.5), bacteria and fungi. Results showed that the CO2, CO and HCHO levels met the stipulated standards as regulated by Taiwan's Indoor Air Quality Management Act (TIAQMA). However, elevated PM10 and PM2.5 levels were measured at most stations. TVOCs and bacterial concentrations at some stations measured in summer were higher than the regulated standards stipulated by Taiwan's Environmental Protection Administration. Further studies should be conducted to reduce particulate matters, TVOCs and bacteria in the air of subway stations.

Controlling Indoor Air Pollution from Moxibustion.

Indoor air quality (IAQ) control of hospitals plays a critical role in protecting both hospital staffs and patients, particularly those who are highly susceptible to the adverse effects of indoor noxious hazards. However, moxibustion in outpatient departments (OPDs) of traditional Chinese medicine (TCM) may be a source of indoor air pollution in hospitals. Some studies have investigated indoor air pollution during moxibustion in Chinese medicine clinics (CMCs) and moxibustion rooms, demonstrating elevated air pollutants that pose a threat to the health of medical staff and patients. Our study investigated the indoor air pollutants of indoor carbon dioxide (CO2), carbon monoxide (CO), formaldehyde (HCHO), total volatile organic compounds (TVOCs), airborne particulate matter with a diameter of ≤10 µm (PM10) and ≤2.5 µm (PM2.5) during moxibustion in an acupuncture and moxibustion room of the OPD in a hospital in Taipei. To evaluate the different control strategies for indoor air pollution from moxibution, a comparison of air pollutants during moxibution among the methods of using alternative old moxa wools, local exhaust ventilation and an air cleaner was conducted. In this study, burning alternative old moxa wools for moxibustion obviously reduced all gaseous pollutants except for aerosols comparing burning fresh moxa wools. Using local exhaust ventilation reduced most of the aerosols after burning moxa. We also found that using an air cleaner was inefficient for controlling indoor air pollutants, particularly gaseous pollutants. Therefore, combining replacing alternative old moxa wools and local exhaust ventilation could be a suitable design for controlling indoor air pollution during moxibustion therapy.

Building-Related Symptoms among Office Employees Associated with Indoor Carbon Dioxide and Total Volatile Organic Compounds.

This study investigated whether sick building syndrome (SBS) complaints among office workers were associated with the indoor air quality. With informed consent, 417 employees in 87 office rooms of eight high-rise buildings completed a self-reported questionnaire for symptoms experienced at work during the past month. Carbon dioxide (CO2), temperature, humidity and total volatile organic compounds (TVOCs) in each office were simultaneously measured for eight office hours using portable monitors. Time-averaged workday difference between the indoor and the outdoor CO2 concentrations (dCO2) was calculated as a surrogate measure of ventilation efficiency for each office unit. The prevalence rates of SBS were 22.5% for eye syndrome, 15.3% for upper respiratory and 25.4% for non-specific syndromes. Tiredness (20.9%), difficulty in concentrating (14.6%), eye dryness (18.7%) were also common complaints. The generalized estimating equations multivariate logistic regression analyses showed that adjusted odds ratios (aORs) and 95% confidence interval (CI) per 100 ppm increase in dCO2 were significantly associated with dry throat (1.10, 95% CI=(1.00-1.22)), tiredness (1.16, 95% CI=(1.04-1.29)) and dizziness (1.22, 95% CI=(1.08-1.37)). The ORs for per 100 ppb increases in TVOCs were also associated with upper respiratory symptoms (1.06, 95% CI=(1.04-1.07)), dry throat (1.06, 95% CI=(1.03-1.09)) and irritability (1.02, 95% CI=(1.01-1.04)). In conclusion, the association between some SBS symptoms and the exposure to CO2 and total VOCs are moderate but may be independently significant.

Oxidative stress of office workers relevant to tobacco smoking and inner air quality.

Studies have used 8-hydroxydeoxyguanosine (8-OHdG) as a biomarker to detect systemic oxidative DNA damage associated with oxidative stress. However, studies on the association between exposure to tobacco smoking and urinary 8-OHdgG give inconsistent results. Limited studies have estimated the oxidative stress among office workers. This study assessed the association between urinary 8-OHdG and cotinine for office workers.  Workers (389) including smokers, ex-smokers and non-smokers from 87 offices at high-rise buildings in Taipei participated in this study with informed consent. Each participant completed a questionnaire and provided a spot urine specimen at the end of work day for measuring urinary 8-OHdG and cotinine. The carbon dioxide (CO2) levels in workers' offices were also measured. The questionnaire reported socio-demographic characteristics, life styles and allergic history. The urinary 8-OHdG level increased with the cotinine level among participants (Spearmans' rho = 0.543, p < 0.001). The mean of urinary 8-OHdG and cotinine was 5.81 ± 3.53 µg/g creatinine and 3.76 ± 4.06 µg/g creatinine, respectively. Comparing with non-smokers, the adjusted odds ratio (OR) of having urinary 8-OHdG greater than the median level of 4.99 µg/g creatinine was 5.30 (95% confidence intervals (CI) = 1.30-21.5) for current smokers and 0.91 (95% CI = 0.34-2.43) for former smokers. We also found workers exposed to 1,000 ppm of CO2 at offices had an adjusted OR of 4.28 (95% CI = 1.12-16.4) to have urinary 8-OHdG greater than 4.99 µg/g creatinine, compared to those exposed to indoor CO2 under 600 ppm. In conclusion, urinary 8-OHdG could represent a suitable marker for measuring smoking and CO2 exposure for office workers.