Fu-Gong Lin

Universal Hepatitis B Vaccination Reduces Childhood Hepatitis B Virus–Associated Membranous Nephropathy

OBJECTIVE: To compare the incidence of hepatitis B virus (HBV)-associated membranous nephropathy (HBVMN) before and after universal HBV vaccination and to identify factors underlying the change. METHODS: This study included 471 hospitalized children with nephrotic syndrome (NS) and 488 long-term follow-up hepatitis B surface antigen (HBsAg)-carrier children. Horizontal transmission (negative maternal HBsAg status) of HBVMN and HBV was assessed, and the incidence of HBVMN was compared before and after initiation of the universal HBV vaccination program started in 1984. RESULTS: The frequency of HBVMN in children with NS was 11.6% between 1974 and 1984, 4.5% between 1984 and 1994, 2.1% between 1994 and 2004, and 0% between 2004 and 2009. Similarly, the number of HBsAg-seropositive children with NS (mainly via horizontal infection) decreased after universal vaccination. The prevaccination frequency of HBV horizontal transmission in chronic HBsAg carriers from the general population was 36.5% compared with 5% in the postvaccination period. The incidence of HBVMN in these carriers revealed a parallel decline. CONCLUSIONS: Our results revealed a significant decrease in the frequency of HBVMN in children with NS and in long-term follow-up HBsAg carriers. Children with HBVMN are primarily infected with HBV via horizontal transmission; thus, the significant reduction in horizontal transmission in HBsAg-carrier children in the general population after universal HBV vaccination may explain the reduction of HBVMN in the vaccinated population. These findings confirm the effectiveness of HBV vaccination on reducing the incidence of HBVMN, possibly through a significant decline in horizontal HBV infection.

Interactive effects of delayed bedtime and family-associated factors on depression in elementary school children

Shorter sleep time was reported to be associated with psychological functioning in children. We intended to examine the relationship between nocturnal sleep duration and depression status by investigating if delayed bedtime could be one of the enhancement factors for depression in children. A cross-sectional study was performed to investigate the depression status in elementary school children in middle Taiwan. Total 676 participants from 29 schools, in grades 3-6 were recruited to participate in the study. A modified depression scale for domestic school children was used to determine the depression status. Data of depression-related demographic characteristics, family, school variables and bedtime data were collected with a structured questionnaire. The results showed that almost one in five children (18%) had depression status. Delayed bedtime, child-parent relationship, family climate, and peer relationship were found to be the main predictors of childhood depression. Further stratification analysis showed that delayed bedtime significantly interacted with family climate and peer relationship on childhood depression. The risk of depression for children with a delayed bedtime of 10 PM and either in a non-harmonious family life or without a close parent-child relationship was 4.35 and 4.73 times greater than the reference group respectively. This study provides evidence for interactive effects between delayed bedtime and family concern factors which synergistically elevated the risk of childhood depression. This information may serve as a practical guide for parents and school teachers by recognizing that an adequate bedtime schedule could serve as a preventive measure against depression in children.

Disability and hospital care expenses among national health insurance beneficiaries: analyses of population-based data in Taiwan.

Nationwide data were collected concerning inpatient care use and medical expenditure of people with disabilities (N=937,944) among national health insurance beneficiaries in Taiwan. Data included gender, age, hospitalization frequency and expenditure, healthcare setting and service department, discharge diagnose disease according to the ICD-9-CM coding system which has been used in Taiwan NHI diagnosis system. There were 27.88% of persons with disabilities have been hospitalized for treatments during the year 2005 and it was 3.5 times of the general population (7.95%). The mean of annual inpatient care expenditure was 163,544.21 NTD, and male patients use more inpatient care cost than female patients in people with disabilities. However, the hospitalization rate in female patients is statistical higher than male patients in the study (p<0.001). Infectious and parasitic diseases, mental disorders, diseases of the respiratory system, diseases of the circulatory system, injury and poisoning were the top five reasons for hospitalization among the subjects. Our study also found that psychiatry, internal medicine, orthopedic, surgery and neurosurgery are the top five clinical divisions which the cases used more frequently than other clinical departments in hospitalizations. The present study presents the first information of hospitalization care and medical costs in people with disabilities based on a nationwide data analyzes in Taiwan. We suggest the importance of supporting people with disabilities during hospitalizations, following up rehabilitation and there is an urgent need for cost-effective intervention programs for disability prevention, which could be offset against the cost for treating the disabled in the future.

Gene Expression Profiling of Colorectal Tumors and Normal Mucosa by Microarrays Meta-Analysis Using Prediction Analysis of Microarray, Artificial Neural Network, Classification, and Regression Trees

Background. Microarray technology shows great potential but previous studies were limited by small number of samples in the colorectal cancer (CRC) research. The aims of this study are to investigate gene expression profile of CRCs by pooling cDNA microarrays using PAM, ANN, and decision trees (CART and C5.0). Methods. Pooled 16 datasets contained 88 normal mucosal tissues and 1186 CRCs. PAM was performed to identify significant expressed genes in CRCs and models of PAM, ANN, CART, and C5.0 were constructed for screening candidate genes via ranking gene order of significances. Results. The first screening identified 55 genes. The test accuracy of each model was over 0.97 averagely. Less than eight genes achieve excellent classification accuracy. Combining the results of four models, we found the top eight differential genes in CRCs; suppressor genes, CA7, SPIB, GUCA2B, AQP8, IL6R and CWH43; oncogenes, SPP1 and TCN1. Genes of higher significances showed lower variation in rank ordering by different methods. Conclusion. We adopted a two-tier genetic screen, which not only reduced the number of candidate genes but also yielded good accuracy (nearly 100%). This method can be applied to future studies. Among the top eight genes, CA7, TCN1, and CWH43 have not been reported to be related to CRC.

Short-term and long-term influences of family arguments and gender difference on developing psychological well-being in Taiwanese adolescents.

Adolescent mental health is crucial for social competence and accomplishment in later life. The World Health Organization (WHO) estimates that approximately 20% of adolescents suffer from psychological symptoms. However, improving family risk and school environments can largely promote adolescent mental health. A longitudinal survey was conducted to investigate adolescent psychological well-being (PWB) status and associated factors in adolescents 15-20 years of age. Family and school context variables were interviewed and recorded. A total of 2896 participants were included from high, middle, and less urbanized resident areas in Northern Taiwan with completed interview data. Using multivariate regression analysis, factors associated with adolescent PWB at various stages included quarrelsome parents, quarrels with parents, severed friendships, and cigarette and alcohol use. In all three adolescent stages, females yielded higher psychological symptom scores than did males, and diverse weights of risk factors on PWB were observed between genders. Family arguments and cigarette and alcohol use were found to have more pronounced effects on outcomes among females than males. Whereas males are more sensitive to severed friendships than females, cigarette and alcohol use showed more harmful effects on mental health in earlier adolescence than in later life. Moreover, family arguments and severed friendships in earlier adolescence were found to have lasting effects on PWB in later adolescence. In this study, gender differences were observed in the temporal relationship on adolescent mental health. Variables of family arguments and severed friendships exhibited short-term and long-term effects on adolescent mental health across the early to late developmental stages. The family argument environment and regulating cigarette and alcohol use are worthy of focus to promote adolescent mental health.

Depression as a predictor of falls amongst institutionalized elders

Objective: In this study, we set out to examine the combined effects of medical condition and depression status on fall incidents amongst institutionalized elderly people. Methods: A cross-sectional study was carried out to investigate the fall history of institutionalized elders involving 286 subjects. Experiences of falls over the previous year were recorded, with at least two falls during the prior one-year period, or one injurious fall defined as ‘fallers’. The Geriatric Depression Scale-15 was used as a screening instrument for depression status. Results: Based on a multivariate logistic regression and stratification analysis, depression was found to have enhanced effects with various medical conditions on fall risk. As compared with the non-depressive reference group, a five-fold fall risk was discernible amongst depressed elders with multiple medications, whilst a six-fold risk was found amongst depressive elders using ancillary devices, along with a 11-fold amongst depressive elders with neural system diseases. Conclusions: This study provides the evidence of enhancing effects between depression and medical conditions on the risk of falls amongst institutionalized elderly people. Thus, depressed elders with neural system diseases, using ancillary devices or multiple medications, should be specifically listed as very high risk of falling amongst institutionalized elderly, and strictly prevent them from falls. Screening and treatment of depression could also be a useful strategy in the prevention of falls amongst institutionalized elderly with poor medical condition.

DNA Methylation Combinations in Adjacent Normal Colon Tissue Predict Cancer Recurrence: Evidence from a Clinical Cohort Study

Accumulating evidence has suggested the requirement for further stratification of patients in the same tumor stage according to molecular factors. We evaluate the combination of cancer stage and DNA methylation status as an indicator of the risk of recurrence and mortality among patients with colorectal cancer (CRC). A cohort study of 215 patients with CRC (mean age 64.32 years; 50.5% of men) from Tri-Service General Hospital in Taiwan examined the association between cancer stage and risk of CRC recurrence and mortality. A Cox proportional hazard model was used to analyze patient methylation status and clinical information at study entry, and their associations with CRC recurrence and mortality during follow-up. The advanced stage patients with p16, hMLH1, and MGMT methylation were associated with higher risk of CRC recurrence compared with the local stage patients with unmethylation status in tumor tissues, with adjusted hazard ratios (HRs) (95% confidence interval [CI]) of 9.64 (2.92–31.81), 8.29 (3.40–20.22), and 11.83 (3.49–40.12), respectively. When analyzing normal tissues, we observed similar risk of CRC recurrence with adjusted HRs (95% CI) of 10.85 (4.06–28.96), 9.04 (3.79–21.54), and 12.61 (4.90–32.44), respectively. For combined analyses, the risk of recurrence in the patients in advanced stage with DNA methylation in both normal and tumor tissues, compared with local stage with unmethylation, was increased with adjusted HR (95% CI) of 9.37 (3.36–26.09). In the advanced stage patients, methylation status and tissue subtype were associated with increased risk of 5-year cumulative CRC recurrence (p < 0.001). This study demonstrates that clustering DNA methylation status according to cancer stage and tissue subtype is critical for the assessment of risk of recurrence in CRC patients and also indicated an underlying mechanism.

Quarrelsome family environment as an enhanced factor on child suicidal ideation

Suicide is a leading cause of death in adolescents, and develops through a process leading from depression to suicidal ideation and self-injury. In this study, we analyzed and compared suicidal ideation among elementary school children from distinct families and school-related backgrounds. We conducted a cross-sectional study to investigate suicidal ideation in elementary school children in Miaoli County of Western Taiwan. Our study included 979 eligible participants and collected data, including suicidal ideation, depression scores, demographic characteristics, and family and school variables. The results revealed that 175 students (17.9%) exhibited depression, and 146 students (14.9%) had contemplated suicide. A quarrelsome family environment was found to be an important independent factor in child suicidal ideation after controlling for depression status. Children living in quarrelsome families showed a 3.7-fold risk of suicidal ideation compared with children in a harmonious family. Among boys living in quarrelsome family environments, suicidal ideation risk was 7.4-fold higher than for girls living in harmonious families. A 27-fold high increased suicidal ideation risk was also observed among the depressed children who living in the quarrelsome family environment, compared with the non-depressed in the harmonious family environment. This study provides novel evidence indicating the enhanced effects of a quarrelsome family environment combined with depression symptoms and among boys on suicidal ideation. These findings suggest of quarrels in a family environment playing an important role on elementary school childrens psychological development, and may help parents in improving their mental health.

Factors Affecting Treatment Decisions and Outcomes of Root-Resected Molars: A Nationwide Study

BACKGROUND Treatment of furcation-involved molars presents a clinical challenge. This study retrospectively investigates the demographic parameters affecting treatment decisions and outcomes of root-resected molars using a nationwide population-based dataset. METHODS De-identified data from 471 eligible patients were obtained from a representative cohort composed of 1 million of Taiwans population. Demographic factors that influence treatment decisions and outcomes of root-resected teeth were examined. Cox regression was performed to statistically analyze the factors. RESULTS The overall survival rate for root-resected molars was 91.1%. The survival times of the extracted and surviving teeth were 303.0 ± 274.6 and 551.8 ± 327.2 days, respectively (P <0.001). The analyzed patient-related factors, such as living district, urbanization level, medical institution, and monthly income, have remarkable influence on treatment decisions; however, there is no statistically significant difference in survival rate between root-resected molars receiving flap surgery and those that do not (P = 0.504). After adjusting for other factors, patients aged >74 years have 3.33 times (hazard ratio = 3.33; 95% CI = 1.04 to 10.66; P = 0.043) higher rates of molar extraction than younger counterparts. CONCLUSIONS The overall survival rate of root-resected molars was satisfactory. Patients with advanced age (>74 years) had a higher risk of extraction occurrence on resected molars. Patient-related factors may influence the treatment decision of whether molars receive flap surgery. These findings suggest that demographic factors should be carefully evaluated before and after performing root-resection procedures because these factors may eventually impact the outcome of root-resected molars.

Association of CCL5 and CCR5 Gene Polymorphisms With Periodontitis in Taiwanese

BACKGROUND It has been suggested that genetic factors may predispose individuals to periodontal diseases. The present case-control study aims to test whether the -403 single nucleotide polymorphism of chemokine ligand 5 (CCL5-403) and the 32-bp deletion of CCR5 (CCR5Δ32) polymorphisms are associated with susceptibility to chronic and aggressive periodontitis. METHODS Taiwanese participants (N = 213) were grouped into control group (CG), generalized aggressive periodontitis (GAgP), or chronic periodontitis (CP) groups. DNA samples were obtained from peripheral blood. CCL5-403, evaluated by polymerase chain reaction-restriction fragment length polymorphism, and CCR5Δ32, evaluated by polymerase chain reaction, were compared among the three groups. RESULTS There was a significant association between type of periodontitis and having allele A or G in the CCL5-403 polymorphism. GAgP patients were 3.7 times more likely than CP patients and 2.0 times more likely than CG patients to have allele A, instead of allele G, in CCL5-403. GAgP patients were 3.1 times more likely than CG patients to have AG versus GG genotype. GAgP patients were also 5.0 and 19.8 times more likely than CP patients to have AG and AA genotypes, respectively, compared to GG. For the CCR5Δ32 polymorphism, no association was found between the type of periodontitis and having different genotype or allele distributions among GAgP, CP, or CG patients. CONCLUSION The single nucleotide polymorphism of CCL5-403 G substitution by A may play a role in AgP; however, the CCR5Δ32 polymorphism may not.