Yea Shwu Hwang

Musculoskeletal symptoms and associated risk factors among office workers with high workload computer use.

OBJECTIVE Although the prevalence of reported discomfort by computer workers is high, the impact of high computer workload on musculoskeletal symptoms remains unclear. The purpose of this study was to investigate the prevalence of musculoskeletal symptoms for office workers with high computer workload. The association between risk factors and musculoskeletal symptoms was also assessed. METHODS Two questionnaires were posted on the Web sites of 3 companies and 1 university to recruit computer users in Tainan, Taiwan, during May to July 2009. The 12-item Chinese Health Questionnaire and Musculoskeletal Symptom Questionnaire were chosen as the evaluation tools for musculoskeletal symptoms and its associated risk factors. Chinese Health Questionnaire greater than 5 and computer usage greater than 7 h/d were used to as the cutoff line to divide groups. Descriptive statistics were computed for mean values and frequencies. χ(2) Analysis was used to determine significant differences between groups. A 0.05 level of significance of was used for statistical comparisons. RESULTS A total of 254 subjects returned the questionnaire, of which 203 met the inclusion criteria. The 3 leading regions of musculoskeletal symptoms among the computer users were the shoulder (73%), neck (71%), and upper back (60%) areas. Similarly, the 3 leading regions of musculoskeletal symptoms among the computer users with high workload were shoulder (77.3%), neck (75.6%), and upper back (63.9%) regions. High psychologic distress was significantly associated with shoulder and upper back complaints (odds ratio [OR], 3.46; OR, 2.24), whereas a high workload was significantly associated with lower back complaints (OR, 1.89). Females were more likely to report shoulder complaints (OR, 2.25). CONCLUSIONS This study found that high psychologic distress was significantly associated with shoulder and upper back pain, whereas high workload was associated with lower back pain. Women tended to have a greater risk of shoulder complaints than men. Developing an intervention that addresses both physical and psychologic problems is important for future studies.

Effects of prefeeding oral stimulation on feeding performance of preterm infants

ObjectiveTo investigate the effects of a prefeeding oral stimulation program on the feeding performance of preterm infants.MethodsA crossover design was used. Nineteen preterm infants who were in the transitional time to full oral feeding served as their own controls. A 5-min oral stimulation program was applied to infants prior to feeding in two of 4 feedings on two consecutive days. Feeding, behavioral state, and physiological parameters of infants in the intervention and control feeding conditions were compared using SPSS software.ResultsThere were two significant findings: (1) Compared to the control condition, infants in the intervention condition achieved a greater intake rate in the initial 5 min of the feeding (P = 0.021). (2) After receiving oral stimulation, a higher percentage of infants moved to the drowsy or quiet alert state from sleep or restlessness before feeding, both on Day 1 (P= 0.016) as well as Day 2 (P = 0.016). No significant differences were found in other feeding parameters, feeding-induced physiological changes (peripheral oxygen saturation levels and pulse rate) and behavioral states between two feeding conditions.ConclusionsOral stimulation had a modulating effect on the prefeeding behavioral states and short-lived beneficial effects on the feeding efficiency of preterm infants.

Association of Cord Plasma Leptin With Birth Size in Term Newborns

BACKGROUND Leptin is secreted from adipose tissue and plays an important role in obesity. Recent studies have shown that the relationship between Leptin and body fat mass may have ethnic differences. The purpose of our study was to investigate the relationship between venous umbilical cord plasma Leptin and anthropometric markers in term healthy Taiwanese newborns. METHODS Umbilical venous plasma samples were obtained from 98 term neonates (48 males and 50 females) and leptin Levels were analyzed by enzyme-linked immunosorbent assay. RESULTS Umbilical cord plasma Levels of leptin were significantly higher in the female neonates than in males (p<0.001). The large-for-gestationaL age and appropriate-for-gestational age newborns had significantly higher Leptin cord plasma levels than the small-for-gestational age newborns (p<0.01 and p<0.05, respectively). In both male and female neonates, umbilical Leptin Levels showed significant positive correlations with birth weight and birth Length. Multiple Linear regression analysis revealed that birth weight was the only significant predictor of umbilical cord plasma Leptin levels in both male and female neonates. However, the slopes of the regressions between Leptin and birth weight in male and female neonates were not different. CONCLUSION In Taiwanese healthy term neonates, leptin umbilical cord plasma Levels are associated with sex and birth weight of the neonate. The relationship between Leptin and birth weight may differ among different ethnic groups. These findings imply that the relationship between leptin and body fat mass may develop early in life.

Associations among perinatal factors and age of achievement of full oral feeding in very preterm infants.

BACKGROUND Progress to full oral feeding from a tube or parenteral feeding is a complex process for very preterm infants born before 32 weeks of gestation. The influence of infant characteristics and medical complications on feeding progression has not been studied thoroughly. The aim of this study was to constitute a regression model to estimate the postmenstrual age (PMA) of full oral feeding and the length of transition time from the initiation to completion of oral feeding. METHODS A chart review was conducted on very preterm infants born between 2005 and 2010 in one medical center in Taiwan. All enrolled infants were able to take all nutrition by mouth before discharge. RESULTS A total of 117 infants fulfilling the criteria were included. The mean PMAs for the initiation and completion of oral feeding were 33.9 ± 1.7 and 35.1 ± 2.0 weeks, respectively. Infants required 7.5 ± 6.6 days from initiation to full oral feeding. The results of a stepwise regression revealed that the reciprocal of birth weight (beta coefficient = 3.81, p < 0.001), moderate-severe bronchopulmonary dysplasia (beta coefficient = 1.21, p < 0.001), necrotizing enterocolitis (beta coefficient = 0.84, p < 0.005), and patent ductus arteriosus (beta coefficient = 0.69, p < 0.01) were predictors for the PMA of full oral feeding. The regression model incorporating those factors explained 62.5% of the variation in the feeding outcome (p < 0.001). Gender, multiple gestations, mild bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis had no effect on the feeding outcome. None of the explored factors were significantly correlated with transition time. CONCLUSION A regression model incorporating significant predictors to estimate the PMA of full oral feeding in very preterm infants was suggested. It could enhance communication between health professionals and parents about the feeding progress of infants born very prematurely.

Home-based DIR/Floortime™ Intervention Program for Preschool Children with Autism Spectrum Disorders: Preliminary Findings

ABSTRACT Improving parent–child interaction and play are important outcomes for children with autism spectrum disorder (ASD). Play is the primary occupation of children. In this pilot study conducted in Taiwan, we investigated the effects of the developmental, individual difference, and relationship-based (DIR)/Floortime™ home-based intervention program on social interaction and adaptive functioning of children with ASD. The participants were 11 children with ASD, ages from 45–69 months, and their mothers. Mothers were instructed the principles of the approach by an occupational therapist. All 11 children and their mothers completed the 10-week home-based intervention program, undergoing an average of 109.7 hr of intervention. Children made significant changes in mean scores for emotional functioning, communication, and daily living skills. Moreover, the mothers perceived positive changes in their parent-child interactions. The findings of this pilot study contribute to knowledge regarding the effects of home-based DIR/Floortime™ intervention program on increasing the social interaction and adaptive behaviors of children with ASD in Taiwan.

Higher prevalence of autism in Taiwanese children born prematurely: A nationwide population-based study

The reported prevalence of autism in preterm and full-term children varies partially because of small sample sizes. Moreover, little is known about the specific factors that contribute to the risk of autism in preterm children. We aimed to compare the prevalence of autism in preterm and full-term children and to identify neonatal risk factors for autism in preterm children using a large national health system database. We analyzed data from 1078 early preterm (<28 weeks of gestation or birth weight<1000 g), 28,947 later preterm (28-36 weeks), and 1,104,071 full-term (≥ 37 weeks) children who were 8-11 years old in 2009. The descending order of prevalence was early preterm (2.2%), later preterm (1.3%), and full-term (0.6%). The prevalence of autism was approximately 2-4 times higher in preterm children than in children born at full-term. The male-female ratio (4:1) in preterm and full-term children was not significantly different. Most of the children were first diagnosed with autism between 3 and 6 years old. Preterm children with autism were not diagnosed earlier than were full-term children. Regression analysis showed that male gender, a very low birth weight, and neonatal cerebral dysfunction were risk factors for autism in the preterm group. We conclude that autism is more prevalent in preterm children. Preventing extremely preterm birth and significant early brain insults may be helpful in reducing the risk of autism in preterm children.

Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants.

Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ≦2, 3-14, ≧15 days). After adjusting for demographic and medical factors, the infants in the ≧15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50-4.59; p<0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02-3.76; p<0.05), than did infants in the ≦2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ≧15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants.

CONGENITAL CHYLOTHORAX IN A LATE PRETERM INFANT AND SUCCESSFUL TREATMENT WITH OCTREOTIDE

Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space and is a rare condition in neonates. Chylothorax causes respiratory and nutritional problems and a significant mortality rate. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax. Here, we report a premature baby with severe bilateral pleural effusion diagnosed by prenatal ultrasound and subsequently confirmed to be congenital chylothorax after birth. This newborn baby was initially treated with bilateral chest tube insertion to relieve severe respiratory distress. However, the chylothorax recurred after a medium-chain-triglyceride-enriched formula was initiated. The accumulation of chylothorax diminished after the administration of octreotide. Therefore, octreotide may allow the patient to avoid invasive procedures, such as reinsertion of chest tubes or surgery.

Relationship between umbilical cord blood insulin-like growth factors and anthropometry in term newborns.

BACKGROUND Birth size is associated with long-term morbidity. Insulin-like growth factor (IGF) system is the most important endocrine factor influencing fetal growth. During rapid somatic growth, free-to-total IGF-I ratio is increased, resulting in higher IGF-I bioavailability. The purpose of this study was to investigate the association of free-to-total IGF-I ratios, IGF-II, and IGF-binding protein (IGFBP)-3 umbilical cord levels with anthropometric data of term neonates. METHODS Umbilical venous plasma samples were obtained from 95 term neonates and analyzed by enzyme-linked immunosorbent assay. RESULTS The large-for-gestational age (LGA) neonates had higher free IGF-I, total IGF-I, and IGFBP-3 levels than small-for-gestational age (SGA) neonates (P < 0.01, 0.001, 0.01, respectively) and higher total IGF-I and IGFBP-3 levels than appropriate-for-gestational age (AGA) neonates (P < 0.05, 0.01, respectively). The free-to-total IGF-I ratios and IGF-II levels were not different among SGA, AGA, and LGA neonates. Free IGF-I, total IGF-I, and IGFBP-3 levels were positively correlated with birth weight (r = 0.34, P < 0.001; r = 0.41, P < 0.001; r = 0.25, P < 0.05, respectively). Multiple linear regression analyses revealed that only total IGF-I levels was the independent predictive variable for birth weight. CONCLUSIONS Our data suggest total IGF-I is the most important factor in the IGF system for determining fetal growth, at least near term gestation. Free-to-total IGF-I ratios may mostly be determined by total IGF-I. If birth size is associated with adult chronic metabolic diseases, total IGF-I may be involved in the pathogenesis.

Factors affecting early feeding performance in preterm infants below 32 weeks gestation

OBJECTIVE To identify the influence of various physiological and behavioral factors on feeding performance of preterm infants in the transition to full oral feeding. METHODS We retrospectively reviewed data from a feeding assessment conducted on 24 preterm infants born at 25-31 weeks without severe brain complications. RESULTS Prolonged oxygen use and low current weight are two adverse factors for feeding efficiency (volume of milk ingested orally per minute in the initial 5 min of feeding) and proficiency (percentage of prescribed volume ingested orally over the entire feeding). Young post-menstrual age, low baseline oxygen saturation and high feeding efficiency were risk factors for oxygen desaturation during the initial feeding. CONCLUSION Proper feeding strategies are needed for preterm infants with those disadvantageous factors to improve their early feeding performance.