Trong-Neng Wu

The effect of prenatal perfluorinated chemicals exposures on pediatric atopy

BACKGROUND The role of perfluorinated compounds (PFCs) in the immune system and allergic diseases is not well-known. This study examined the effects of pre-natal exposure to PFCs on immunoglobulin E (IgE) levels and atopic dermatitis (AD). METHODS In Taiwan Birth Panel cohort study, newborns with cord blood and peri-natal factors (i.e. birth body weight, weeks of gestation, and type of delivery) gathered at birth were evaluated. At the age of 2 years, information on the development of AD, environmental exposures, and serum total IgE were collected. The AD and non-AD children were compared for the concentration of cord blood serum PFCs measured by Ultra-performance liquid chromatography/triple-quadrupole mass (UPLC-MS/MS). Correlations among cord blood IgE, serum total IgE at 2 years of age, and cord blood PFC levels were made. RESULTS Of 244 children who completed the follow-up and specimen collections, 43 (17.6%) developed AD. Concentrations of cord blood serum perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluorohexane sulfonic acid (PFHxS) were median (range) 1.71 (0.75-17.40), 5.50 (0.11-48.36), 2.30 (0.38-63.87), and 0.035 (0.035-0.420)ng/mL, respectively. PFOA and PFOS levels positively correlated with cord blood IgE levels (per ln-unit: β=0.134 KU/l, p=0.047 for PFOA; β=0.161 KU/l, p=0.017 for PFOS). Analyses stratified by gender revealed that PFOA and PFOS levels positively correlated with cord blood IgE levels only in boys (per ln-unit: β=0.206 KU/l, p=0.025 for PFOA; β=0.175 KU/l, p=0.053 for PFOS). When dividing cord blood serum PFCs into quartiles in the fully adjusted models, AD had no significant association with PFOS. CONCLUSIONS Pre-natal PFOA and PFOS exposures positively correlated with cord blood IgE levels.

Consequences of Exposure to Asian Dust Storm Events on Daily Pneumonia Hospital Admissions in Taipei, Taiwan

In spring, windblown dust storms originating in the deserts of Mongolia and China travel to Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible associations of constituents of ADS with hospital pneumonia admissions of residents in Taipei, Taiwan, during the period 1996–2001. Fifty-four dust storm episodes were identified and were classified as index days. Daily pneumonia admissions on the index days were compared with admissions on comparison days. Two comparison days for each index day, 7 d before the index days and 7 d after the index days, were selected. The study results indicated a statistically significant association between ADS events and daily pneumonia admissions 1 d after the event. It is worthwhile to pay more attention to ADS events and health in the future based on the findings in this investigation.

Outdoor air pollution and female lung cancer in Taiwan.

To investigate the relationship between air pollution and female lung cancer, the authors conducted a matched case-control study using female deaths that occurred in Taiwan from 1994 through 2003. Data on all eligible female lung cancer deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of women who died from causes other than cancer or diseases associated with respiratory problems. The controls were pair matched to the cases by sex, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. A municipality-based aggregate index of long-term exposure to air pollution was created by dividing the annual average of the measured values for each pollutant by the National Ambient Air Quality Standard for that pollutant. The ratios for each pollutant were scaled to a 100-point scale and then averaged together to generate an index value representing the net burden of these pollutants, with each weighted equally. The subjects were divided into tertiles according to the levels of the index just described. Women who lived in the group of municipalities with highest levels of air pollution exposure index were at a statistically significant increased lung cancer risk compared to the group living in municipalities with the lowest air pollution exposure index after controlling for possible confounders (OR = 1.28, 95% CI = 1.02–1.61). The findings of this study warrant further investigation of the role of air pollutants in the etiology of lung cancer.

Childhood Leukemia and Traffic Air Pollution in Taiwan: Petrol Station Density as an Indicator

To investigate the relationship between traffic air pollution exposure and development of childhood leukemia (14 yr of age or younger), a matched case-control study was conducted using childhood deaths that occurred in Taiwan from 1996 through 2006. Data on all eligible childhood leukemia deaths were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. The control group consisted of children who died from causes other than neoplasms or diseases that were not associated with respiratory complications. The controls were pair matched to the cancer cases by gender, year of birth, and year of death. Each matched control was selected randomly from the set of possible controls for each case. Data on the number of petrol stations in study municipalities were collected from the two major petroleum supply companies, Chinese Petroleum Corporation (CPC) and Formosa Petrochemical Corporation (FPCC). The petrol station density (per square kilometer) (PSD) for study municipalities was used as an indicator of a subjects exposure to benzene and other hydrocarbons present in evaporative losses of petrol or to air emissions from motor vehicles. The subjects were divided into tertiles according to PSD in their residential municipality. The results showed that there was a significant exposure-response relationship between PSD and the risk of leukemia development in young children after controlling for possible confounders. The findings of this study warrant further investigation of the role of traffic air pollution exposure in the etiology of childhood leukemia.

Statins are associated with a reduced risk of gastric cancer: A population-based case-control study

OBJECTIVES:Experimental studies have shown that statins have potential protective effects against cancer. The aim of this study was to investigate whether the use of statins was associated with gastric cancer risk.METHODS:We conducted a population-based case–control study in Taiwan. Data were retrospectively collected from the Taiwan National health Insurance Research Database. Cases consisted of all patients who were aged ≥50 years and had a first-time diagnosis of gastric cancer for the period between 2005 and 2008. The controls were matched to cases by age, sex, and index date. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using multiple logistic regression.RESULTS:We examined 337 gastric cancer cases and 1,348 controls. We found that ever-use of any statin was associated with a significant decrease in gastric cancer risk (OR=0.68, 95% CI=0.49–0.95). Compared with no use of statins, the adjusted ORs were 0.90 (95% CI=0.60–1.36) for the group having been prescribed statins with cumulative defined daily doses (DDDs) <134.25 and 0.49 (95% CI=0.30–0.79) for the group with cumulative statin use of ≥134.25 DDDs. Also, there was a significant trend toward decreasing gastric cancer risk with increasing cumulative dose (χ2 for linear trend=7.42, P=0.006).CONCLUSIONS:The results of this study are the first to suggest that statins may reduce the risk of gastric cancer.

Excess mortality after hip fracture among the elderly in Taiwan: A nationwide population-based cohort study

Osteoporotic hip fractures cause high mortality in the elderly population. However, few population studies reported the long-term mortality of hip fracture among the elderly in Asian population. This study assessed the incidence, excess mortality, and risk factors after osteoporotic hip fractures through inpatients aged 60 years or older. A total of 143,595 patients with hip fracture were selected from Taiwan National Health Insurance database in the years 1999 to 2009 and followed up until the end of 2010. Annual incidence, mortality and SMR, and mortality and SMR at different periods after fracture were measured. From 1999 to 2005, hip fracture incidence gradually increased and then fluctuated after 2006. From 1999 to 2009, the male-to-female ratio of annual incidence increased from 0.60 to 0.66, annual mortality for hip fracture decreased from 18.10% to 13.98%, male-to-female ratio of annual mortality increased from 1.38 to 1.64, and annual SMR decreased from 13.80 to 2.98. Follow-up SMR at one, two, five, and ten years post-fracture was 9.67, 5.28, 3.31, and 2.89, respectively. Females had higher follow-up SMR in the younger age groups (60-69 yr of age) but lower follow-up SMR in the older age groups (over 80 yr of age) compared with males. Among the studied patients, incidence is gradually decreasing along with annual mortality and SMR. Hip fracture affects short-term but not long-term mortality.

Increased risk of dementia in patients exposed to nitrogen dioxide and carbon monoxide: a population-based retrospective cohort study.

Background The air pollution caused by vehicular emissions is associated with cognitive decline. However, the associations between the levels of nitrogen dioxide (NO2) and carbon monoxide (CO) exposure and dementia remain poorly defined and have been addressed in only a few previous studies. Materials and Methods In this study, we obtained data on 29547 people from the National Health Insurance Research Database (NHIRD) of Taiwan, including data on 1720 patients diagnosed with dementia between 2000 and 2010, and we evaluated the risk of dementia among four levels of air pollutant. Detailed data on daily air pollution were available from January 1, 1998 to December 31, 2010. Yearly average concentrations of pollutants were calculated from the baseline to the date of dementia occurrence, withdrawal of patients, or the end of the study, and these data were categorized into quartiles, with Q1 being the lowest level and Q4 being the highest. Results In the case of NO2, the adjusted hazard ratios (HRs) of dementia for all participants in Q2, Q3, and Q4 compared to Q1 were 1.10 (95% confidence interval (CI), 0.96–1.26), 1.01 (95% CI, 0.87–1.17), and 1.54 (95% CI, 1.34–1.77), and in the case of CO, the adjusted HRs were 1.07 (95% CI, 0.92–1.25), 1.37 (95% CI, 1.19–1.58), and 1.61 (95% CI, 1.39–1.85). Conclusion The results of this large retrospective, population-based study indicate that exposure to NO2 and CO is associated with an increased risk of dementia in the Taiwanese population.

The Effectiveness of a Training Program on Reducing Needlestick Injuries/Sharp Object Injuries among Soon Graduate Vocational Nursing School Students in Southern Taiwan

The Effectiveness of a Training Program on Reducing Needlestick Injuries/Sharp Object Injuries among Soon Graduate Vocational Nursing School Students in Southern Taiwan: Ya‐Hui Yang, et al. Institute of Occupational Safety and Health, Kaohsiung Medical University, Taiwan—Needlestick/ sharp injuries (NSIs/SIs) are a serious threat to medical/ nursing students in hospital internships. Education for preventing NSIs/SIs is important for healthcare workers but is rarely conducted and evaluated among vocational school nursing students. We conducted an educational intervention for such students after their internship rotations before graduation. This program consisted of a lecture to the students after the internship training and a self‐study brochure for them to study before their graduation. This study used the pre‐test questionnaires completed by all students and the post‐test questionnaires completed by 107 graduates after work experience as licensed nurses to assess the effectiveness of the intervention. After educational intervention, the incidence of NSIs/SIs decreased significantly from 50.5% pre‐test to 25.2% post‐test, and the report rate increased from 37.0% to 55.6%, respectively. In conclusion, this intervention significantly reduced the incidence of NSIs/SIs and increased the report rate of such events.

Correlation Between Air Pollution and Postneonatal Mortality in a Subtropical City: Taipei, Taiwan

With growing evidence of the association between daily mortality and air pollution exposure in adults, it is important to investigate whether infants are also susceptible. The purpose of this study was to examine the relationship between air pollution exposure and postneonatal, defined as infant of more than 27 d and less than 1 yr old, mortality in Taipei, Taiwans largest city, which has a subtropical climate, for the period 1994–2000, using a case-crossover analysis. This design is an alternative to Poisson time-series regression for studying the short-term adverse health effects of air pollution. The air pollutants examined included particulate matter (PM10), sulfur dioxide (SO2), ozone (O3), nitrogen dioxide (NO2), and carbon monoxide (CO). The risk of postneonatal deaths was estimated to increase by 3.1% for PM10, 4.1% for SO2, 1.7% for NO2, 3.8% for CO, and 0.1% for O3 for each interquartile range change, respectively. However, the associations were without statistical significance. The established link between air pollution levels and infant mortality may not be as strong in cities with subtropical climates, although other factors such as differences in pollutant component composition or the underlying health of the postneonates may explain the lack of a strong association in this study. Further studies of this type in cities with varying climates and cultures are needed.

Air Pollution and Hospital Admissions for Asthma in a Tropical City: Kaohsiung, Taiwan

This study was undertaken to determine whether there is an association between air pollutants levels and hospital admissions for asthma in Kaohsiung, Taiwan. Hospital admissions for asthma and ambient air pollution data for Kaohsiung were obtained for the period from 1996 through 2003. The relative risk of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days (≥ 25°C) statistically significant positive associations were found in all pollutants except sulfur dioxide (SO2). On cool days (≤ 25°C) all pollutants were significantly associated with asthma admissions For the two pollutant models, CO and O3 were significant in combination with each of the other four pollutants on warm days. On cool days NO2 remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient pollutants increase the risk of hospital admissions for asthma.