Pei Chih Wu

Cardiovascular mortality during heat and cold events: determinants of regional vulnerability in Taiwan

Objectives To identify the vulnerable regions with underlying susceptibility and poor adaptive capability in response to cold and heat events in Taiwan, and to characterise the determinants associated with such an increasing risk to design better adaptive strategies in view of predicted weather changes in the future. Methods The authors used spatial regression models to measure the relationships between the spatial characteristics of temperature, extracted factors from demographic and socio-economic parameters, and the mean cardiovascular mortality 2u2005weeks before and after cold or heat events from 1994 to 2003. Results Metropolitan regions were found to have a substantially lower mortality than rural areas after cold and heat events. Events of cold, compared with heat, had greater impacts on the mortality ratio in most townships. A negative association was identified, using a spatial lag model, between the mortality after cold and heat events and urbanisation, and the availability of medical resources. A higher percentage of older people, vulnerable and aborigines might have contributed to the increasing vulnerability of townships during cold and heat events. Conclusions These data, using an island-wide spatial analysis, suggest that urban areas have a greater adaptive capability than rural areas, plausibly because people in urban areas have a higher socio-economic status and more medical resources. Social inequality across urban and rural townships is apparent and developing customised adaptation programmes for vulnerable regions to cope with heat and cold event should be prioritised.

Relationship between heat index and mortality of 6 major cities in Taiwan

Increased mortality, linked to events of extreme high temperatures, is recognized as one critical challenge to the public health sector. Therefore, this ecological study was conducted to assess whether this association is also significant in Taiwan and the characteristics of the relationship. Daily mean heat indices, from 1994 through 2008, were used as the predictor for the risk of increased mortality in populations from 6 major Taiwanese cities. Daily mortality data from 1994 through 2008 were retrieved from the Taiwan Death Registry, Department of Health, Taiwan, and meteorological data were acquired from the Central Weather Bureau. Poisson regression analyses using generalized linear models were applied to estimate the temperature-mortality relationship. Daily mean heat indices were calculated and used as the temperature metric. Overall, increased risk ratios in mortality were associated with increased daily mean heat indices. Significantly increased risk ratios of daily mortality were evident when daily mean heat indices were at and above the 95th percentile, when compared to the lowest percentile, in all cities. These risks tended to increase similarly among those aged 65 years and older; a phenomenon seen in the cities of Keelung, Taipei, Taichung, Tainan, and Kaohsiung, but not Chiayi. Being more vulnerable to heat stress is likely restricted to a short-term effect, as suggested by lag models which showed that there was dominantly an association during the period of 0 to 3 days. In Taiwan, predicting city-specific daily mean heat indices may provide a useful early warning system for increased mortality risk, especially for the elderly. Regional differences in health vulnerabilities should be further examined in relation to the differential social-ecological systems that affect them.

Feeding Bottles Usage and the Prevalence of Childhood Allergy and Asthma

This study aimed to examine the association between the length of use of feeding bottles or pacifiers during childhood and the prevalence of respiratory and allergic morbidities. A large-scale questionnaire survey was performed in day care centers and kindergartens (with childrens ages ranging from 2 to 7 years) in southern Taiwan, and a total of 14,862 questionnaires completed by parents were finally recruited for data analysis. Effects of using feeding bottles on childrens wheezing/asthma (adjusted OR: 1.05, 95% CI 1.00–1.09), allergic rhinitis (adjusted OR: 1.04, 95% CI 1.00–1.08), and eczema (adjusted OR: 1.07, 95% CI 1.01–1.2) were found. Moreover, significant dose-dependent relationships were further established after an adjustment for confounders was performed that included childrens ages, gender, gestational age, birth weight, length of breastfeeding, the age when first given infant formula or complementary foods, family history, parental educational levels, and smoking status, as well as the problem of indoor water damage. This study was the first to reveal the potential risk of using plastic consumer products such as feeding bottles on the reported health status of preschool children in Asian countries.

Paternal Heredity and Housing Characteristics Affect Childhood Asthma and Allergy Morbidity

ABSTRACT A birth cohort was initiated when each pregnant woman was asked for her own and her husbands history of asthma and allergic diseases at the time of recruitment. They were further inquired to verify their housing conditions, and current health status of children 3 to 5 years old at the time of interview. Paternal history was the most significant risk factor associated with reporting childhood morbidities at age of 3 to 5 years. Housing characteristics became meaningful variables only if the fathers were asthmatic or atopic. A 9-fold increase of risk was found if children with paternal history and also exposed to incense burning and water damage at home. This is the first epidemiological evidence of East Asia suggesting paternal heredity, with concurrent indoor hazardous exposures, as a predominant risk on developing childhood asthma and allergy.