Chong-Shan Wang

Efficacy and cost-effectiveness of influenza vaccination of the elderly in a densely populated and unvaccinated community.

For economic reasons, the few influenza vaccination programs seen in developing countries are aimed at the high-risk elderly. To evaluate its efficacy and cost-effectiveness, we conducted a 2-month influenza vaccination campaign in southern Taiwans A-Lein township for all the elderly. Significant differences in hospitalization and mortality between the vaccinated and unvaccinated groups were found. Age, sex, and risk group were significant for hospitalization and mortality, but only vaccination was significant for prevention. Savings for each person vaccinated were at least three times the cost of vaccination. We strongly recommend that all the elderly-not only high-risk elderly--receive an annual influenza vaccination.

Differences in Risk Factors for Being Either a Hepatitis B Carrier or Anti-Hepatitis C+ in a Hepatoma-Hyperendemic Area in Rural Taiwan☆

This is a study of the differences in the risk factors for being either hepatitis B surface antigen positive [HBsAg(+)] or antibody to hepatitis C virus positive [Anti-HCV(+)] in A-Lein, a rural area in southern Taiwan, an area which also has a high hepatoma mortality rate. Three hundred eighty-five patients age > or =40 years participated in hepatoma screening at the A-Lein Community Health Center during 1995. Those who were HBsAg(-) and anti-HCV(-) or had coinfection of HBsAg(+) and anti-HCV(+) were excluded, leaving 293 patients: 109 HBsAg(+) and 184 anti-HCV(+). The anti-HCV(+) patients had a lower socioeconomic status (as defined by level of education and type of occupation) and were older than HBsAg(+) patients (P < 0.05). Those with higher alanine aminotransferase levels (ALT) also had a higher anti-HCV(+) to HBsAg(+) odds ratio (OR), and a dose response relationship was found, P < 0.0001. Anti-HCV(+) patients were more likely than HBsAg(+) patients to have a spouse who shared the infection, OR = 5.11; 95% CI, 2.30-11.28. Anti-HCV(+) patients were more likely than HBsAg(+) patients to have had blood transfusions (OR = 2.66; 95% CI, 1.20-5.89), frequent medical injections (OR = 2.64; 95% CI, 1.62-4.31), or injections by non-licensed medical providers (OR = 1.91; 95% CI, 1.18-3.09). Multiple logistic regression analysis showed that the significant factors for anti-HCV(+) patients vs. HBsAg(+) patients are drinking habit (OR = 3.45; 95% CI, 1.02-11.60), age (OR = 6.33; 95% CI, 2.93-13.68), and frequent medical injections (OR = 2.88; 95% CI, 1.65-5.03). The transmission of hepatitis C in A-Lein is closely related to low socioeconomic status, age, alcohol abuse, spouses being anti-HCV(+), and frequent medical injections, especially from non-licensed medical providers, including both pharmacists and those with no medical licensing whatsoever. These nonlicensed medical providers sometimes reuse needles to save money, which is a likely route of infection.

Risk factors for adolescent primigravida in Kaohsiung County, Taiwan

OBJECTIVES To study the risk factors for adolescent primigravida in Kaohsiung county, Taiwan. METHODS This is a population survey on primigravida based on household registry to study risk factors affecting pregnancy of 215 women aged < 18; 341 women aged 18-19; and 590 women aged 20-34. RESULTS The mean age of menarche, first intercourse, and first pregnancy, as well as the duration of menarche to the first intercourse increased significantly with the increased age of primigravida (P < 0.001). Adolescent primigravida, when compared to adult primigravida, were less likely to communicate well with their parents or be in a dual parent family (P < 0.05). They were also more likely to have alcoholic fathers, have drinking alcohol and smoking health behavior problems, exhibit poor school performance, have relatives or friends who became pregnant as adolescents, have been raped, and exhibit poorer knowledge of contraception before pregnancy (P < 0.05). Dose-response relationship in the odds ratio was found. Non-dual family, adolescent pregnancy in relatives or friends, smoking before pregnancy, and age of menarche were independent factors in multiple logistic regression on adolescent primigravida. CONCLUSIONS The main risk factors for adolescent primigravida in Kaohsiung county. Taiwan, were family influence, health behavior problems, adolescent pregnancy in relatives or friends, and earlier onset of menarche. The age at which intercourse and smoking start appear to be two crucial factors that can be addressed through education as a means of intervention before pregnancy occurs.

The Prevalence and Motivating Factors of Adolescent Smoking at a Rural Middle School in Taiwan

The purpose of this survey is to study the prevalence and motivating factors of smoking among 1,372 students at a rural middle school in Taiwan. The prevalence of smokers for total, male, and female students is 5.7, 11.5, and 0.4%, respectively. Prevalence increased with age and grade among males, but no significant differences were found among females. Prevalence was higher among students from nuclear families than those from extended families (OR = 2.8, 95% C.I. 1.4-5.5). Prevalence was also higher among students from families with very strict parental control or very little parental control (OR = 4.25, 95% C.I. 2.24-8.08). The majority (70-80%) began smoking during primary school. Smokers who had attempted abstinence in the past had a better understanding of the hazards of smoking and smoked less frequently and with lower average consumption (P < .05). For 60% of the students the first source of cigarettes was friends or classmates; only 22% bought them. Health education increased understanding of the hazards of smoking (OR = 2.2, 95% C.I. 1.10-4.45). In conclusion, the primary factors that affect adolescent smoking are age, family structure, abstinence experience, strictness of upbringing, family influence, peer pressure, and health education.

Community-Based Survey of Low Quantitative Ultrasound Values of Calcaneus in Taiwan

This study investigated prevalence and associated-factors of low quantitative ultrasound (QUS) values by screening calcaneal QUS parameters--broadband ultrasound attenuation (BUA) and speed of sound (SOS)--in population samples of three different Taiwanese communities. The study included 6,322 subjects (2,631 male and 3,691 female), aged 31 yr old or more in Shih-Pai (a metropolitan area in northern Taiwan),Yu-Chi (a mountain area in central Taiwan), and A-Lein (a seaside area in southern Taiwan). The overall response rate was 50.2%. The correlation between BUA and SOS was 0.684, p<0.001. From those who responded, we selected 403 subjects aged 31-40 yr as the reference (the young group), and their BUA was 65.34+/-7.91 dB/MHz. The t-score was calculated from the BUA data of our reference group. The percentile of -2.5<t-score<-1.0 and t-score< or =-2.5 in male subjects was 21.4 and 2.9%, respectively, and in female subjects 24.2 and 14.1%, respectively. The BUA of urban area subjects was higher than that of rural area subjects in almost all age-strata, and overweight was noted to be a protective factor. The effect of age-adjusted odds ratio (AOR) on low QUS values in females was significantly increased every 10 yr from 1.55, 5.13, 13.81, 34.29, to 38.14. This survey showed that age-related decreases in calcaneal ultrasonometry, indicating prevalence of low QUS values, were more obvious in female than male subjects. Overall 38.3% of the female Taiwanese had low QUS values, and this is approximately equivalent to the lifetime risk of fracture at the hip, spine, or distal forearm in Caucasian women. The specific t-score designation, as World Health Organization (WHO) criteria, applied to calcaneal QUS are reasonable when the reference group is selected from the same population.

Hepatitis B surface antigen induces an early‐type hypersensitivity

In addition to the delayed‐type hypersensitivity (DTH), a unique type of hypersensitivity could be induced at a late stage of the immune responses after hepatitis B surface antigen (HBsAg) immunization. This antigen‐specific ear swelling that develops within 1 h after antigen challenge has been referred to as the early‐type hypersensitivity (ETH) in contrast to the 24‐h DTH. Although expression of ETH was earlier than DTH, the induction of the former needed 3 days longer than that of the latter. In ETH, the plasma protein leaked into the tissue and the vasopermeability increased within 15 min, causing the oedema of ETH. The observation that cyproheptadine, not dexametha‐sone, inhibited ETH suggests that it is mediated through the release of histamine and/or serotonin. Furthermore, ETH could be transferred by immune sera. Heat treatment (56°C for 4 h) did not destroy the transfer, suggesting that it was not mediated by IgE. The human anti‐HBs sera from either hepatitis B virus infection or HBsAg vaccinee also contained the activity to transfer the ETH in mice