Yu-Wen Chiu

Effects on uric acid, body mass index and blood pressure in adolescents of consuming beverages sweetened with high-fructose corn syrup.

Objective:The dietary intake of fructose-rich sugar-sweetened beverages (SSB) may have a significant role in raising serum uric acid (SUA) levels as well as the risk of contracting gout and cardiovascular risk factors. Our objective was to investigate the impact of SSB intake on SUA, body mass index (BMI) and systolic blood pressure (SBP) among adolescents in Taiwan.Methods:We evaluated data from 2727 representative adolescents who were multistage sampled from 36 Junior High schools in Taiwan. We cross-sectionally collected demographic, physical, dietary and anthropometric variables, and prospectively measured clinical outcomes. Data were analyzed using multiple regression and logistic models adjusted for covariates.Results:We found that 87.7% of adolescents were SSB drinkers, with 25.1% drinking >500 ml per day of such beverages. Increased SSB intake was associated with increased waist and hip circumferences, body fat, BMI, SBP and SUA. As compared with non-drinkers, SSB drinkers had a 3.2–4.9 elevated risk of obesity. The prevalence of hyperuricemia in heavy SSB users (40.2–49.4%) was appreciably greater than that for non-users (24.2%). Adolescents who consumed >500 ml per day of heavy high-fructose corn syrup (HFCS) containing beverages had a 0.42 mg dl−1 higher SUA level and a 2.0–2.1 increased risk of developing hyperuricemia than non-drinkers. The consumption of HFCS-rich beverages was also found to interact with obesity in determining higher levels of SUA (2.2–2.4 mg dl−1 increases).Conclusion:High SSB consumption has a notable effect on increased levels of BMI and SUA. The intake of HFCS-rich beverages and BMI were likely to interactively strengthen SUA levels among obese adolescents.

Factors Influencing Women’s Quality of Life in the Later Half of Life

Background Among older women in East Asia, and Taiwan in particular, there is little research on quality of life and the health care they receive to address the symptoms of menopause. This study evaluated factors which influence quality of life among post middle-age women in Taiwan. Methods This cross-sectional study recruited 1250 women between 43 and 77 years of age during the year 2002. The factors investigated were demographics, menstruation status, menopausal symptoms, osteoporosis status, and use of hormone replacement therapy (HRT). SF-36 was used to assess the health-related quality of life of these women. Correlation, multiple regression and path analysis were used to test for direct and indirect relationships among the variables. Results There are statistical significances between menopause symptoms and quality of life across different age groups. Path analysis shows a direct positive effect of HRT and a direct negative effect of climacteric symptoms on both physical and mental components of quality of life. Age, marital status, education and osteoporosis also have direct and indirect effects, some positive and others negative, on the components of quality of life. Conclusions When developing programs to enhance health in post middle-age women, consideration should be given to symptom relief as well as quality of life.

Bereaved females are more likely to suffer from mood problems even if they do not meet the criteria for prolonged grief

Purpose: The goal of this study was to describe the gender difference of grief experience and mood distress among caregivers who cared for terminal cancer patients residing in a hospice ward.

Comparison of Plasma Antioxidant Levels and Related Metabolic Parameters Between Smokers and Non-smokers

The relationship between cigarette smoking and cell damage is complicated, particularly considering the role of oxidative stress. The aim of this study was to identify the relationships among plasma nicotine metabolites, lipophilic antioxidants, and metabolic parameters in smokers and non‐smokers. This cross‐sectional study recruited 100 subjects who visited the Department of Family Medicine at Kaohsiung Medical University Hospital. Excluding 14 ineligible cases, 46 smokers and 40 non‐smokers were enrolled. Plasma nicotine metabolites, lipophilic antioxidants (including retinol, lycopene, α‐carotene, β‐carotene, δ‐tocopherol, γ‐tocopherol and α‐tocopherol), related metabolic parameters, and body composition (including height, weight, body mass index, body fat, and waist circumference) were examined by comparison of means, correlations and regressions. Significant correlations among nicotine metabolites, age, sex, body composition and plasma lipophilic antioxidants were noted. Nicotine metabolites, age, body height and body weight were closely associated with plasma antioxidant levels (p < 0.05) in multiple linear regression. The levels of α‐carotene, β‐carotene, γ‐tocopherol and lycopene were lower in smokers than in non‐smokers (p < 0.01). The plasma level of high‐sensitivity C‐reactive protein (hsCRP), which is a marker for high cardiovascular risk, was higher in smokers than in non‐smokers (p = 0.003). We conclude that the lower plasma antioxidant levels and the higher level of hsCRP in smokers may lead to decreased protective efficacy compared with non‐smokers. Further studies are warranted to support our hypothesis.

Metallothionein 1A polymorphisms may influence urine uric acid and N-acetyl-beta-d-glucosaminidase (NAG) excretion in chronic lead-exposed workers

Lead is a renal toxin, and susceptibility to lead varies between individuals. Metallothionein (MT) is known for its metal scavenging role. The aim of the study was to investigate the association of blood lead levels, urinary uric acid (UA) and N-acetyl-beta-d-glucosaminidase (NAG) in chronic occupational lead-exposed workers, and to study whether the association was influenced by MT1A gene polymorphisms. In this cross-sectional study, 412 lead-exposed workers participated. Their annual health examination data and renal function markers were collected after the Institutional Review Broad of Kaohsiung Medical University Hospital approved the study and consent letters were obtained. From the blood samples, DNA was extracted and used for real-time PCR typing of 2 MT1A single nucleotide polymorphisms (SNPs): rs11640851 and rs8052394 on exons 2 and 3. Descriptive analysis, one-way ANOVA, and multiple linear regressions were performed. There was a significant inverted relationship of creatinine-adjusted urine UA concentrations and the time-weighted index of cumulative blood lead levels (TWICL) that may be significantly influenced by the AC genotypes of rs11640851 in exon 2 and rs8052394 in exon 3. After controlling for potential confounding factors, the creatinine-adjusted urine NAG concentrations were shown to be influenced by the GG genotype of rs8052394 in exon 3, and were weakly increased with TWICL. Therefore, we concluded that the variations of MT1A SNPs may influence urine UA and NAG excretion in chronic lead-exposed workers, and urine creatinine-adjusted urine UA as a biomarker of lead toxicity should be considered.

A comprehensive approach in hospice shared care in Taiwan: nonelderly patients have more physical, psychosocial and spiritual suffering.

While symptomatic differences exist between younger and older advanced cancer patients, few studies have examined the differences in their care with respect to age. Our goals were to examine the influences of age differences on physical, psychosocial and spiritual distress among advanced cancer patients. Advanced cancer patients who resided in Kaohsiung Medical University Hospital during 2007–2008 were recruited. Data were collected through professional consultants. The influences of age variations on physical, psychosocial and spiritual distress in nonelderly (<60 years old) and elderly (≧60 years old) patients were analyzed. A total of 1013 advanced cancer patients were included in the analyses with 467 nonelderly patients and 546 elderly patients. Nonelderly patients were identified to have a higher baseline pain level (4.0 vs. 2.8, p < 0.001), breakthrough pain (19.3% vs. 9.9%, p < 0.01), insomnia (6.4% vs. 2.7%, p = 0.006), emotional distress (69.0% vs. 60.6%, p = 0.013), and unwillingness to pass away because of concern for loved ones (18.8% vs. 11.9%, p = 0.003) with significant difference. Elderly ones were concerned about unfulfilled wishes (29.7% vs. 18.4%, p < 0.001) in spiritual concerns. After adjustments in regression models, nonelderly age (<60 years old) still revealed significant positive or negative impact on all categories of distress. Patients aged under 60 years have more physical, psychosocial and spiritual suffering. This study suggested that professional practitioners should provide intensive care for vulnerable terminally ill cancer patients.

Chronic fatigue of the small enterprise workers participating in an occupational health checkup center in southern Taiwan

PurposeThere has been increasing interest in the occupational health of workers in small enterprises, especially in developing countries. This study examines the association between psychosocial job characteristics and fatigue, and attempts to identify risk factors for fatigue among workers of small enterprises in southern Taiwan.MethodsA structured questionnaire was administered to workers receiving regular health examinations between August 2005 and January 2006. The questionnaire collected demographic information and data on working conditions, personal health status and life styles. It also collected information on psychosocial job characteristics, fatigue and psychological distress using three instruments.ResultsA total of 647 workers with mean age of 43.7 were completed. Probable fatigue was found in 34.6% of the sample. Fatigue was found by multiple logistic regressions to be associated with the lack of exercise, working in shifts, depression score and lack of social support at workplace.ConclusionsThis study found associations between life style, psychosocial job characteristics and fatigue. Because the high prevalence of probable fatigue was found in such small enterprises, the authors suggest that a short interview with some quick questionnaires in health checkup for these small enterprise workers are helpful to early detect psychosocial and fatigue problems.

The association of prolonged QT interval on electrocardiography and chronic lead exposure.

Objectives: The aim of this study was to examine the association of lead exposure with cardiac conduction disturbance among lead-exposed and nonexposed workers in Taiwan. Methods: The participants comprised 312 lead workers and 329 referents who had no known occupational lead exposure. During their annual health examination, they were invited to take part in the survey. Standard resting 12-lead electrocardiograms were obtained and the electrocardiographic features studied were related to blood lead levels (BLLs). Results: The mean BLLs were 26.05 (SD = 13.98) and 2.62 (SD = 1.42) &mgr;g/dL in lead-exposed and reference groups, respectively. Compared with the referents, lead workers had significantly shorter PR interval and longer QTc interval. Especially, workers with BLL > 30 &mgr;g/dL had the highest risk after adjusting for age, sex, body mass index, and other potential confounders. Conclusion: The data suggest that lead exposure is positively associated with prolonged QTc interval.

Occupational risks of esophageal cancer in Taiwanese men.

This study aims to explore whether certain occupations were associated with the risk of esophageal squamous cell carcinoma (ESCC) in Taiwan. In a hospital‐based case‐control study, we collected 326 newly diagnosed ESCC patients and 386 age‐matched controls (the ratio of case patients: controls = 1:1–2). All respondents completed a questionnaire, including 33 occupations in which environments potential exposure to cancer‐related hazards are present. Workers with dust and metal exposure were categorized into Groups A and B, respectively. Relative risks for ESCC were estimated by odds ratios adjusting for covariates (AOR). Compared with the controls, farmer/gardener (AOR = 2.08, 95% CI = 1.02–4.24) and workers in Group A (AOR = 2.80, 95% CI = 1.21–6.47) had significantly higher risk for developing ESCC. A tendency of increased risk was also found in workers in group B (OR = 5.72 95% CI = 2.33–14.03), but such association was not significant after adjusting for other covariates (AOR = 1.57, 95% CI = 0.54–6.61). Our results suggested that farmer/gardener and workers with exposure to dust had a significant excess risk of ESCC. This study added further evidence to the current knowledge that occupational hazards are important in the development of ESCC.

The use of fine nets to prevent the breeding of mosquitoes on dry farmland in southern Taiwan.

OBJECTIVES The stagnate water stored in buckets traditionally used by farmers in southern Taiwan to irrigate their dry farmland, serves as favorable breeding ground for Aedes aegypti, the vector of the dengue virus. The public health bureau there distributed fine nets to the farmers to cover their buckets to reduce vector breeding sites. The goal of this study was to compare the container index (CI) in Alian and Tianliao Townships, Kaohsiung County in southern Taiwan over a 2-year period, for 1 year before the fine nets were distributed and 1 year after. METHODS In March 2005, we selected eight villages in Alian Township and 10 in Tianliao Township. Specialists monitored the local Stegomyia indices every month. We compared the 2005 CI to the 2004 CI, representing the years before and after the nets were used. The results of the comparisons were analyzed by paired t-test and Wilcoxon rank test. RESULTS In Alian Township, mean CI had significantly reduced to 1.63 levels (May 2005) from a mean 5.88 level in May 2004 (paired t-test, p=0.001 and Wilcoxon rank signed test, p=0.0012). In Tianliao Township, CI was reduced to 1.2 from 2.3 in May 2004 (p<0.0001 and p=0.007, paired t-test and Wilcoxon rank signed test, respectively). CONCLUSIONS The nets effectively reduced the CIs in these townships, and might be considered for wide scale use. The mosquito nets were generally welcomed by the farmers who found them to be convenient, inexpensive and practical.