Ching-Hui Loh

Received, understanding and satisfaction of National Health Insurance premium subsidy scheme by families of children with disabilities: a census study in Taipei City.

The purposes of the present study are to provide the first data on utilization, understanding and satisfaction of the National Health Insurance (NHI) premium subsidy for families of children with disabilities in Taipei. Data from the 2001 Taipei Early Intervention Utilization and Evaluation Survey for Aged 0-6 Children with Disabilities were analyzed. In the study, a total of 1006 questionnaires were mailed, of which 340 valid questionnaires were returned, giving a response rate of 33.8%. More than one-third of families of children with disabilities did not receive any financial subsidy of National Health Insurance (NHI). Less than half of the respondents (43.8%) understood the NHI premium subsidy policy completely, while 28.7% partial understood and 27.5% still did not know this auxiliary policy. Approximately 38.5% of the respondents were specifically very satisfied or satisfied, with the NHI subsidy program. There were 18.9% respondents who felt dissatisfied or very dissatisfied with the NHI scheme for children with disabilities in Taiwan. Chi-square or t-test analyses were significant for the caregivers age (p<0.05), childrens disability onset and disability diagnosed age and disability level (p<0.01) on receiving the subsidy assistance. A multiple stepwise logistic regression revealed that the factor of onset age of disability was slightly significant associated with the use of NHI premium subsidy (OR=0.966; 95% CI=0.947-0.986). Health policies should aim to reduce the inequity in NHI premium subsidy utilization and improve their understanding and satisfaction toward this subsidy scheme.

The association between frequencies of mitomycin C-induced sister chromatid exchange and cancer risk in arseniasis

In order to examine whether biomarkers of cytogenetic damage and susceptibility, such as spontaneous and mitomycin C-induced sister chromatid exchange (SCE) can predict cancer development, a nested case-control study was performed in a blackfoot endemic area with known high cancer risk. A cohort of 686 residents was recruited from three villages in the arseniasis area. Personal characteristics were collected and venous blood was drawn for lymphocyte culture and stored in a refrigerator. The vital status and cancer development was followed using the National Death Registry, Cancer Registry, and Blackfoot Disease Registry. The follow up period was from August 1991 to July 1997. During this 6-year-period, 55 residents developed various types of cancer. Blood culture samples from 23 of these subjects were unsuitable for spontaneous SCE experiments and 45 of these subjects were unsuitable for mitomycin C-induced SCE experiments due to improper storage. Finally, a total of 32 cancer cases had cytogenetic samples that could be analyzed. About 32 control subjects were selected from those who did not develop cancer in the study period and these subjects were matched to cases by sex, age, smoking habits, and residential area. The results showed that there was no significant difference in the frequencies of spontaneous and mitomycin C-induced SCE between the case and control groups. There was also no significant difference in the net difference of spontaneous and mitomycin C-induced SCE between the case and control groups. These results suggest that SCEs, either spontaneous or mitomycin C-induced, might not be good markers to predict cancer risk.

Metabolic Syndrome and Short-Term Heart Rate Variability in Adults with Intellectual Disabilities.

Metabolic syndrome (MetS) increases the risk of cardiovascular events. Heart rate variability (HRV) represents autonomic functioning, and reduced HRV significantly increases cardiovascular mortality. The aims of the present paper are to assess the prevalence of MetS in adults with intellectual disabilities (ID), the difference in short-term HRV between the healthy and ID population, and the association of short-term HRV with MetS. In this study, we analyzed 129 ID subjects who participated in routine health check-ups in October 2010. We measured their metabolic components and evaluated the relationships of MetS with short-term HRV indices. The study found that MetS and obesity are common in persons with ID. ID subjects have significantly lower HRV than healthy adults, and persons with ID persons with MetS have significantly lower HRV than ID subjects without MetS. The individual components of MetS are differentially associated with HRV in ID men and women. Metabolic syndrome adversely affects autonomic cardiac control, and reduced autonomic cardiac control could contribute to an increased risk of subsequent cardiovascular events in individuals who exhibit metabolic syndrome. Sex differences in vagal activity and sympathovagal balance may partly explain the greater increase in cardiovascular risk associated with MetS in ID women compared with ID men.

Elemental and organic carbon exposure in highway tollbooths: a study of Taiwanese toll station workers.

The carbon composition of fine particles (PM(2.5)) from traffic exhausts may play a role in adverse health effects. The objective of this study was to assess the concentrations of elemental and organic carbon in PM(2.5) in traffic exhausts from different types of vehicles in the booths of Taiwanese toll station workers and estimate the relations between traffic density and carbon concentrations. Tollbooth indoor monitoring samples were collected for 10 days to assess the 8 h integrated PM(2.5) concentration. Particle samples were analyzed for the content of total carbon, and elemental, and organic carbon. The mean carbon concentrations in the bus and truck lanes were [total: 167.7 microg/m(3) (SD 79.8 microg/m(3)); elemental: 131.7 (66.2); organic: 36.0 (25.8)], substantially higher compared with the car lanes with cash payment [39.2 (29.5); 20.2 (19.5); 19.2 (14.6)] and the car lanes with ticket payment [34.1 (26.1); 15.8 (17.6); 18.5 (12.2)]. The increase in elemental carbon concentration per vehicle in the bus and truck lane was 14 and 9 times greater than that of car lanes of ticket payment and car lanes of cash payment. The mass fraction of carbonaceous species in PM(2.5) accounted for 54% in bus and truck lanes, whereas the corresponding figure was 30-31% for car lanes. Elemental carbon is an important component of diesel exhaust. Workers in toll stations are exposed to high levels of both elemental and organic carbon.

Haematological effects among silk screening workers exposed to 2-ethoxy ethyl acetate

Background: 2-Ethoxy ethyl acetate (2-EEA) is a solvent with broad industrial and commercial applications. It has been reported to cause hematological toxicity, infertility, and teratogenesis. Aims: To investigate the haematological effects in 2-EEA exposed workers. Methods: Workers from one silk screening shop (n = 29), using 2-EEA as the major cleaning and printing solvent, were recruited as a high exposure group. Workers with indirect and non-exposure to 2-EEA (n = 56) were recruited as the comparison group. Venous blood was collected for blood routine examination. Air concentration of 2-EEA in this plant was measured by eight hour personal sampling. Results: The geometric mean (GM) of air concentration of 2-EEA in the high exposure group was 7.41 ppm (range 1.35–16.5 pppm). The mean exposure of female workers (GM = 9.34 ppm) was significantly higher than that of male workers (GM = 4.87 ppm). The GM of air 2-EEA concentration in the comparison group was 0.07 ppm (range: non-detectable to 3.62 ppm, n = 26). The haemoglobin and haematocrit in the female high 2-EEA exposure workers were significantly lower than those of female workers in the comparison group. No difference was found between male 2-EEA high exposure and comparison group workers. The haemoglobin, haematocrit, and RBC count in the study population had a significant dose-response relation with air 2-EEA levels. Conclusion: Results suggest that 2-EEA is a haematological toxicant, which leads to anaemic status in high exposure female workers.

Occupational bladder cancer in a 4,4 -methylenebis(2-chloroaniline) (MBOCA)-exposed worker.

A 52-year-old male chemical worker was admitted to the hospital with a history of paroxysmal microscopic hematuria for about 2 years and nocturia with gross hematuria about five times per night for 2 months. He was a nonsmoker and denied a history of any other bladder carcinogen exposure except for occasional pesticide application during agricultural work. Intravenous urogram imaging showed a mass occupying half of the bladder capacity. Cystoscopy revealed a mass over the left dome of the bladder. Cystoscopic biopsy revealed a grade 3 invasive transitional cell carcinoma with marked necrosis. From 1987 until hospital admission in 2001, the patient had worked in a company that produced the 4,4′-methylenebis(2-chloroaniline) (MBOCA) curing agent. He did not wear any personal protective equipment during work. Ambient air MBOCA levels in the purification process area (0.23–0.41 mg/m3) exceeded the U.S. Occupational Safety and Health Administration’s permissible exposure level. Urinary MBOCA levels (267.9–15701.1 μg/g creatinine) far exceeded the California Occupational Safety and Health Administration’s reference value of 100 μg/L. This patient worked in the purification process with occupational exposure to MBOCA for 14 years. According to the environmental and biologic monitoring data and latency period, and excluding other potential bladder carcinogen exposure, this worker was diagnosed as having occupational bladder cancer due to high exposure to MBOCA through inhalation or dermal absorption in the purification area. This case finding supports that MBOCA is a potential human carcinogen. Safe use of skin-protective equipment and respirators is required to prevent workers from MBOCA exposure.

Case report: Hexachloroethane smoke inhalation: A rare cause of severe hepatic injuries

Context We report on two patients, a 23-year-old man and a 24-year-old man, who had chemical pneumonitis and respiratory distress after inhaling hexachloroethane/zinc oxide (HC/ZnO) smoke during military training. Case Presentation The patients had been healthy previously and denied any history of alcohol or drug abuse. Hematologic tests revealed leukocytosis with neutrophils predominant. The respiratory conditions of both patients improved after steroid therapy and oxygen support, but deterioration of liver function was found. The laboratory results showed that alanine aminotransferase (ALT) and γ-glutamyl transpeptidase levels were elevated about 1.5-fold the normal limits and that aspartate aminotransferase (AST) levels were marginally elevated. The elevation of liver aminotransferase started from day 1 and day 2 and peaked from day 18 to day 22. ALT/AST levels then returned to normal in 6 weeks. Common viral hepatitis was ruled out after serologic tests. Abdominal sonography and physical examination failed to show any specific findings. Discussion The hepatotoxic effect was attributed to inhalation of high-concentration HC/ZnO smoke in an enclosed area, where several hepatotoxicants, including ZnCl2, HC, and chlorinated vapors, could have been generated and mixed in the smoke. Relevance to clinical practice These case reports elaborate the hepatic effects that may occur in addition to pulmonary effects of HC/ZnO smoke.

Hepatic injuries of hexachloroethane smoke inhalation: the first analytical epidemiological study.

UNLABELLEDnThere has been no human epidemiological data regarding the hepatic injuries of hexachloroethane-zinc oxide (HC/ZnO) inhalation. This is the first epidemiological study to investigate whether HC/ZnO inhalation exposure can induce hepatic dysfunction in exposed soldiers. Twenty soldiers, exposed to high concentration of HC/ZnO smoke for 3-10 min in a narrow tunnel (0.6 m in width) during military training, were recruited as exposed group and they were divided into high-exposed group (n=10) and low-exposed group (n=10) by the distance from the explosion locale as a surrogate of exposure condition. Another 64 soldiers, not visiting the explosion areas, were recruited as referents. Venous blood was collected for liver function analyses. After log transformation of alanine aminotransferase (ALT) and adjustment for potential confounders, serum ALT in high-exposed soldiers was statistically significantly higher than those of referents for the 3 weeks following exposure. The serum ALT in low exposed soldiers was statistically significantly higher than those of referents at the 3rd week following exposure. The mean ALT levels also showed decreasing gradients by the distance from exposure locale. In addition, the proportions of abnormality on ALT (>40U/L) were also significantly different among three exposure conditions. Follow-up study showed that the hepatic dysfunction started from 1 to 2 weeks and peaked from 3rd to 5th week after exposure. ALT level was then returned to normal within 6-8 weeks after removing from HC/ZnO smoke exposure. No sequelas in hepatic dysfunction were found until 72 weeks follow-up.nnnCONCLUSIONnWe concluded that inhalation of HC/Zn smoke can induce acute, dose-dependent and definite temporal relationship hepatic dysfunction.

Knowledge and attitudes regarding cervical cancer screening among women with physical disabilities living in the community

The study aims to explore knowledge and attitudes regarding cervical cancer screening and to examine its determinants based on the perspectives of Taiwanese women with physical disabilities living in the community. A cross-sectional survey was employed in the study, and we recruited 498 women aged more than 15 years who were officially registered as having physical disabilities in Taipei County, Taiwan, in March 2009. A mail-out structured questionnaire designed to collect data concerning the participants demographics, reported use, health experience and perception (understanding and attitudes) of cervical cancer screening among women with physical disabilities. We used a scoring system (range 0-10) to categorize the study subjects awareness of screening (low vs. high). The results showed that 77.3% of subjects reported a low level of awareness (score < [double bond] 7), whereas 22.7% were in the high awareness level group (score > 7). The logistic regression model revealed that married women (OR = 3.30, 95%CI = 1.25-8.71), those with a higher educational level (OR = 2.88, 95%CI=1.51-5.53), and those with a high familiarity with Pap smear resources (OR = 5.31, 95%CI = 2.82-9.98) had a significantly higher perception level of cervical cancer screening among women with physical disabilities. This study highlights the necessity of increasing the knowledge and awareness of cervical cancer screening and reducing the barriers to cervical cancer screening experienced by women with disabilities.

The relationship between plasma and urinary 8-hydroxy-2-deoxyguanosine biomarkers measured by liquid chromatography tandem mass spectrometry

Although 8-hydroxy-2-deoxyguanosine (8-OHdG) is a widely used promising biomarker of DNA damage, there are concerns about which tissues or body fluids should be sampled. The objective of this study is to evaluate the correlation of DNA oxidative damage biomarkers, 8-OHdG, between blood and urine and risk factors associated with 8OHdG. The study population was recruited from a baseline survey of a worksite lifestyle study including 92 office workers aged 23 to 60xa0years. A self-administered questionnaire was used to collect information on personal characteristics. The plasma and urinary 8-OHdG was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS). In linear regression, a positive relation was found (pu2009<u20090.01) between the log-transformed plasma and urinary 8-OHdG levels adjusted for gender, age, BMI, and smoking status. Our findings showed that age, gender and smoking were significantly associated with plasma 8-OHdG, but not with urinary 8-OHdG. Our results suggest that there is a positive relation between the biomarkers of plasma (steady state DNA damage) and urinary 8-OHdG (total DNA damage). However, the plasma 8-OHdG is more sensitive than urinary 8-OHdG to detect increased oxidative damages induced by risk factors.