Nai Wen Guo

Serum hormones in boys prenatally exposed to polychlorinated biphenyls and dibenzofurans

Polychlorinated biphenyls (PCBs) and dibenzofurans (PCDFs) are persistent environmental pollutants shown to adversely interact with several functions of the endocrine system. In 1978–1979, over 2000 Taiwanese people ingested rice oil accidentally contaminated with PCBs and PCDFs. This is one of the major toxic exposure episodes that occurred globally and was later called Yucheng (oil disease in Chinese). The children born to exposed Yucheng women were therefore exposed in utero to high doses of PCBs/PCDFs. In 1995, 60 Yucheng and 61 control boys participated in physical examination, and serum hormones were measured by radioimmunoassay (RIA). Age, body weight, body height, Tanner status, testicular size, serum luteinizing hormone (LH), prolactin (PRL), thyroxine (T4), triiodothyronine (T3), and thyroid-stimulating hormone (TSH) levels were not statistically different between Yucheng and control boys in the subgroups of before and at the age of puberty. However, the serum estradiol (E2) levels were significant higher in Yucheng boys at the age of puberty. Yucheng and control boys were further divided into two subgroups, those before (age <13 yr) and those at the age of puberty (age ≥13 yr). There was a decrease of serum testosterone (TT) levels and increase of serum follicle-stimulating hormone (FSH) levels in Yucheng boys at the age of puberty as compared with controls. There was a significant decrease of the square root of TT/E2 and TT/FSH; however, the square root of E2/FSH was increased in Yucheng boys at the age of puberty as compared with controls. Data indicated that prenatal exposure to PCBs and PCDFs may have implications for boys’ sex hormone homeostasis at puberty. Further studies are needed to identify the congeners of PCBs/PCDFs responsible for disruption of the endocrine system, as well as the mechanisms of such disruption.

Neurocognitive Changes among Elderly Exposed to PCBs/PCDFs in Taiwan

Background In 1979 approximately 2,000 people were exposed to polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs) due to ingestion of contaminated cooking oil in Taiwan. Although a previous study has shown delayed developmental milestones and poorer neurocognitive functioning in children born to exposed mothers, it is unclear whether neurocognitive functioning was impaired in people who were directly exposed to the PCBs and PDCFs. Objective The objective of this study was to compare neurocognitive functioning in people exposed to PCBs and PCDFs with that of unexposed sex- and age-matched neighbors. Methods We conducted a retrospective cohort study among exposed and unexposed subjects ≥60 years of age using prospective outcome measurements. We evaluated neurocognitive tests including cognition, memory modalities, learning, motor and sensory function, mood, and daily activity. Results In total, 162 (59%) exposed and 151 (55%) reference subjects completed this study. In exposed men, all test results were similar to the reference group; however, exposed women had reduced functioning in attention and digit span (ADS), visual memory span (VMS), and verbal memory recalls (VMR), especially learning ability. We also found a borderline reduction in the Mini-Mental State Examination. The digit symbol, motor, sensory, depression (determined by the Geriatric Depression Scale-Short Form), and activity of daily life were not different between the exposed and reference groups. A significant dose–response relationship was found for VMR, ADS, and VMS. Conclusion Our study showed dose-dependent neurocognitive deficits in certain aspects of attention, visual memory, and learning ability in women previously exposed to PCBs and PCDFs, but not in exposed men.

Fracture risk and correlating factors of a pediatric population with attention deficit hyperactivity disorder: A nationwide matched study

The aim of this study was to investigate the risk of fracture and the difference between sexes from a nationwide database of fracture risk among children aged 4–17 years with or without attention deficit hyperactivity disorder (ADHD, ICD-9-CD codes 314). The Longitudinal Health Insurance Database (LHID 2000) was used to analyze fracture characteristics of children from the National Health Insurance that covered 96.1% of the Taiwanese population (N=21.4 million). A total of 7200 ADHD children aged between 4 and 17 years whose diagnosis had been confirmed in at least three outpatient clinics between 1 January 2000 and 31 December 2009 were included, and a cohort of 36 000 children without ADHD matched for age, sex, and urbanization was recruited for analysis. The incidence rate of fractures in ADHD children was 21.0 (95% confidence interval=19.4–22.7) per 1000 person-years, significantly (P<0.001) higher than 15.0 (95% confidence interval=14.4–15.6) in non-ADHDs. After adjusting by age, sex, urbanization level, and geographic region, the statistically significant (P<0.001) hazard ratios (HR) of fracture for ADHD children compared with non-ADHD children included 1.62 in girls and 1.38 in boys, 1.53 in the skull, neck, and trunk (ICD-9-CM 800–809), 1.28 in the upper extremity (ICD-9-CM 810–819), and 1.84 in the lower extremity (ICD-9-CM 820–829). The HR also (P<0.001) increased significantly in all age groups, including 1.35 in 4–6, 1.37 in 7–9, and 1.54 in 10–17 years. ADHD should be listed among risk factors of children’s fractures in each sex, all age groups, and all body areas that the parents, teachers, caregivers of ADHD children, and pediatric orthopedists should be aware of. Besides, ADHD girls were more affected than ADHD boys, especially after 10 years of age, whereas the adjusted HR was the highest in the lower extremities. Nationwide analysis matched for age and sex showed that ADHD should be considered the risk factor of children’s fracture, especially for girls older than 10 years of age.

Psychological Outcome of Injured Workers at 3 Months after Occupational Injury Requiring Hospitalization in Taiwan

Psychological Outcome of Injured Workers at 3 Months after Occupational Injury Requiring Hospitalization in Taiwan: Kuan‐Han LIN, et al. Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University School of Public Health, Taiwan—Introduction: After a traumatic event, a significant proportion of victims develop psychiatric disorders. Trauma has been an important ailment among workers. This study aimed to determine the prevalence of post‐traumatic stress disorder (PTSD) and other psychiatric disorders at three months after occupational injuries.

Wisconsin Card Sorting Test Performance after Putaminal Hemorrhagic Stroke

The purpose of this study was to compare the performance differences in the Wisconsin Card Sorting Test (WCST) between 55 patients with putaminal hemorrhage (PH) 3 months after stroke and 69 age‐matched normal controls. Impairment on WCST was defined as performance greater than 1.64 standard deviation below the control mean. A multivariate analysis of covariance (MANCOVA) controlling for education yielded a significant main effect for group but not for education and interaction of group × education. Univariate analyses revealed significant between‐group differences in five WCST measures, including perseverative errors (PE), perseverative responses (PR), conceptual‐level responses (CLR), number of categories completed (NCC), and trials to complete the first category (TCC). For patients with PH, z‐scores for two WCST indices were within the impaired range: TCC and PR. A high percentage of patients (40‐47%) scored in the designated impaired range on NCC, PR, PE, and TCC. The WCST variables discriminated patients from controls with an overall accurate classification rate of 91.9%. Of these, the variables that contributed most to the differentiation between patients and normal controls were PE, CLR, and total number correct (TNC) (a standardized canonical discriminant function coefficient > 0.40). Finally, no significant hemispheric laterality effects emerged on any of the WCST variables. The results of this study provide further evidence of impaired mental set shifting in stroke patients with PH. The implications for rehabilitation professionals are discussed, and recommendations for further research are made.

Determinants of perceived physical environment barriers among community-dwelling elderly in Taiwan

ObjectivesTo test the hypothesis that mobility, activities of daily living, and the interaction between them can play a key role in determining perceived physical environment barriers among community-dwelling elderly.DesignCross-sectional.SettingCommunity.ParticipantsOne hundred and ninety-seven community-dwelling elderly with more than 7 points on the Short Portable Mental State Questionnaire and less than 7 points on the Geriatric Depression Scale (15 items).InterventionNone.MeasurementsTime Get-up and Go test (TUG), the subscales of basic activity of daily living (BADL)/instrumental activities of daily living (IADL) of the Hierarchy of Care Required (HCR), and the physical/structural subscale of the Craig Hospital Inventory of Environmental Factors in Community-dwelling Elderly in Taiwan were used to measure mobility, activities of daily living and perceived physical environment barriers, respectively. Hierarchical linear regression analyses were used to test the study hypothesis.ResultsSignificant and positive relations were found to exist between perceived physical environment barriers and (1) the TUG time (β=.300, p<.05), and (2) the IADL score for the HCR (β=.322, p<.05), respectively. A significant and negative relation existed between perceived physical environment barriers and the interaction term (the TUG time and the IADL score for the HCR) (β=−.211, p<.05).ConclusionMobility, IADL and the interaction between them are found to be significant determinants of perceived physical environment barriers in the community-dwelling elderly under consideration. Strategies targeting the enhancement of mobility among community-dwelling elderly are suggested to lead to improvements in the degree to which physical environment barriers are perceived. This beneficial effect could be greater in the case of elderly individuals with better IADL function.

Construct validity of the Wisconsin Card Sorting Test-64 in patients with stroke.

This study examined the factor structure and contrasted-group validity of the Wisconsin Card Sorting Test-64 (WCST-64) in a stroke sample (n = 112). Confirmatory factor analyses were used to compare five different models suggested by prior factor analyses. The results indicated that the WCST-64 was best represented by a three-dimensional model comprising response inflexibility (factor 1), ineffective hypothesis-testing strategy (factor 2), and set maintenance (factor 3). A significant overall multivariate effect for group (F = 2.87, df = 18,495.46, p < .001) was found in a multivariate analysis of covariance with WCST scores as dependent variables and four different groups (three stroke subgroups with different levels of cognitive function and a normal control group) as independent variable, after controlling for gender. The results of discriminant analysis supported the use of the WCST-64 in stroke patients with cognitive impairment.

The effect of cranioplasty in cognitive and functional improvement: Experience of post traumatic brain injury inpatient rehabilitation

To investigate the effect of cranioplasty on rehabilitation of post‐traumatic brain injury (TBI) patients, 37 patients with TBI were arranged by retrospectively assessment study. Those TBI patients receiving in‐hospital rehabilitation in the Department of Rehabilitation in a medical center of South Taiwan from 2010 to 2015 were assigned into two groups: A and B. All patients entered the multidisciplinary holistic in‐patient rehabilitation training for about 1 month. Patients in Group A received decompressive craniectomy (DC), patients in Group B received DC and cranioplasty. All assessments were arranged right on admission and before discharge. The functional activity evaluation included muscle power and Barthel index (BI), and cognitive function evaluation, including the Rancho Los Amigo Scale, Mini Mental State Examination (MMSE), Community Mental State Examination (CMSE), and the Luria‐Nebraska Neuropsychological Battery‐Screening Test Short Form (LNNBS). The results showed that there were synergetic effects of cranioplasty on post‐TBI patients with rehabilitation training, especially in the BI score, and cognitive improvement in CMSE and LNNBS.

Electroencephalogram valid rate in simple reaction time task as an easy index of children's attention functions

Electroencephalogram (EEG) signal artifacts occur often in children, but an EEG valid rate (VR), constructed by excluding the artifacts, might be meaningful to evaluate childrens neuropsychological functions. The aim of this study was to develop an easy screening index, the EEGVR, and to investigate attention function in children using this index.

The Significance of Impulsive Error in Children With ADHD

A deficit of inhibition ability is a neuropsychological problem in children with attention deficit hyperactivity disorder (ADHD). We investigated whether in children who made impulsive error (IE), less error-related negativity (ERN) would correlate with poorer executive attention functions (EAFs). Ninety children (49 with ADHD and 41 without ADHD) were investigated by a 4-minute simple reaction time task and simultaneous electroencephalogram. When they made IE, the ERN in response-locked event-related potential (ERP) was defined as error awareness. The average area under curve of ERN in the control group with IEs was used as the proper criterion for regrouping the children with ADHD into 2 groups: ADHD children with enough ERN (ADHD-enough ERN) and those with less ERN (ADHD-less ERN). EAFs from Comprehensive Nonverbal Attention Test were used as objective indices, and behavioral questionnaires were used as subjective indices and statistically analyzed within ADHD groups. Forty-eight percent of the children made IEs. ADHD(n = 31, 63%) was significantly more than in the control group (n = 12, 29%; P < .001). The ADHD group had significantly less ERN than did the control group while making IE, especially at frontal and central electrodes (P < .01). Both ADHD-less ERN and ADHD-enough ERN groups had poorer subjective EAFs on questionnaires. Only the ADHD-less ERN group had significant poorer objective EAFs on the Comprehensive Nonverbal Attention Test than did the ADHD without IE. We conclude that investigating the IE and ERN of IE in children with ADHD might help to differentiate subtypes of ADHD with different neuropsychological abilities, and the possibility that ADHD-less ERN children might be confirmed a meaningful subgroup that needs close follow-up, treatments different from standard, or both.