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ABSTRACT: Immigrants lack appropriate health care access and other resources needed to reduce their exposure to preventable environmental health risks. Little is known about the impact of lead exposure and oxidative stress among immigrants. Thus, this study was to examine the differences between the blood lead levels (BLLs) and oxidative stress levels of immigrants and non-immigrants, and to investigate the determinants of increased BLLs or oxidative stress levels among immigrants. We collected demographic data of 239 immigrant women and 189 non-immigrant women who resettled in the central area of Taiwan. Each study participant provided blood samples for genotyping and for measuring blood metal levels and oxidative stress. Recent immigrants were at risk for elevated BLLs. Decreased BLLs, malondialdehyde (MDA), and increased blood selenium levels were significantly associated with duration of residence in Taiwan. Elevated BLLs and MDA in recent immigrants may serve as a warning sign for the health care system. The nation's health will benefit from improved regulation of living environments, thereby improving the health of immigrants.
Journal of Immigrant and Minority Health 04/2013; · 1.16 Impact Factor
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ABSTRACT: BACKGROUND: Shipbreaking workers are typically exposed to a wide range of hazardous chemicals. However, long-term follow-up studies of their mortality patterns are lacking. This study examined mortality among shipbreaking workers over a 24-year follow-up period. METHODS: A total of 4,962 shipbreaking workers were recruited from the database of the Kaohsiung Shipbreaking Workers Union. The data were then linked to the Taiwan National Death Registry from 1985 to 2008. The mortality ratios-standardized for age and calendar years-(SMRs) for various causes of deaths were calculated with reference to the general population of Taiwan. RESULTS: Among men workers, a statistically significant increased SMR was observed for all causes (SMR = 1.28), all cancers (SMR = 1.26; particularly noteworthy for lesions of oral and nasopharyngeal: SMR 2.03, liver: SMR 4.63, and lung: SMR 1.36), cirrhosis of the liver (SMR = 1.32), and accidents (SMR = 1.91). A statistically significant increase in mortality was observed for respiratory system cancer (SMR = 1.87) and lung cancer (SMR = 1.91) among workers with a longer duration of employment (≥7 years). The result also showed that among shipbreaking workers who were still alive, two people had mesothelioma and 10 people have asbestosis. CONCLUSIONS: Those employed in shipbreaking industries experienced an increase in mortality from all causes. The increased SMR for lung cancer was probably related to asbestos, metals, and welding fume exposure. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
American Journal of Industrial Medicine 03/2013; · 1.63 Impact Factor
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American journal of infection control 03/2013; · 3.01 Impact Factor
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ABSTRACT: Lung cancer is not only one of the most prevalent cancers but is also a lethal disease with a very low 5-year survival rate. Delay in diagnosis further reduces the chance of early treatment and worsens patients' survival. The purpose of this study was to understand the delay in the diagnosis of lung cancer under the healthcare system in Taiwan, and to identify the factors associated with it.
A total of 840 patients diagnosed with lung cancer who had completed or were undergoing cancer treatments were recruited from a medical center in central Taiwan from July 2007 to January 2011. Structured questionnaires were administered regarding demographic characteristics, factors associated with their time to diagnosis and the length of delay in days.
Mean age was 62.68 years with 52.16 days to diagnosis on average. Number of hospital visits before confirmation of diagnosis differed significantly with the level of healthcare institution initially visited (P < 0.001). Compared with patients who had three or more hospital visits, patients who only visited two and one hospital(s) had a significant 34.91-day (95% confidence interval: 16.29-53.53) and 42.25-day (95% confidence interval: 20.76-63.76) reduction in their time to diagnosis (P < 0.001).
As the number of hospital visits increased, the delay in diagnosis also increased. It is vital to shorten the time to diagnosis for lung cancer patients by limiting the number of medical visits and educating the public to restrict excessive use of medical resources and strengthen their trust in medical professionals.
Japanese Journal of Clinical Oncology 07/2012; 42(10):934-9. · 1.78 Impact Factor
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ABSTRACT: The objectives of this study were to (1) examine the relationship between nitrate levels in public water supplies and risk of death from gastric cancer and (2) determine whether calcium (Ca) and magnesium (Mg) levels in drinking water might modify the effects of nitrate on the risk of gastric cancer development. A matched cancer case-control study was used to investigate the relationship between the risk of death attributed to gastric cancer and exposure to nitrate in drinking water in Taiwan. All deaths due to gastric cancer in Taiwan residents from 2006 through 2010 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Deaths from other causes served as controls and were pair-matched to cancer cases by gender, year of birth, and year of death. Information on the levels of nitrate-nitrogen (NO(3)-N), Ca, and Mg in drinking water were collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cancer cases and controls was presumed to be the source of the subject's NO(3)-N, Ca, and Mg exposure via drinking water. Relative to individuals whose NO(3)-N exposure levels were <0.38 ppm, the adjusted odds ratio (OR) and 95% confidence interval (CI) for gastric cancer occurrence was 1.16 (1.05-1.29) for individuals who resided in municipalities served by drinking water with a NO(3)-N exposure ≥ 0.38 ppm. There was apparent evidence of an interaction between drinking water NO(3)-N levels and low Ca and Mg intake via drinking water. Our findings showed that the correlation between NO(3)-N exposure and risk of gastric cancer development was influenced by Ca and Mg levels in drinking water. This is the first study to report effects modification by Ca and Mg intake from drinking water on the relationship between NO(3)-N exposure and risk of gastric cancer occurrence. Increased knowledge of the mechanistic interactions between Ca, Mg, and NO(3)-N in reducing risk of gastric cancer development will aid in public policy decisions and setting threshold standards.
Journal of Toxicology and Environmental Health Part A 06/2012; 75(12):684-93. · 1.83 Impact Factor
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ABSTRACT: We examined the association between parity and risk of lung cancer.
The study cohort consisted of all women with a record of a first singleton birth in the Taiwanese Birth Register between 1978 and 1987. We tracked each woman from the time of their first childbirth to 31 December 2009. Follow-up was terminated when the mother died, when she reached age 50 years, or on 31 December 2009, whichever occurred first. The vital status of mothers was ascertained by linking records with the computerized mortality database. Cox proportional hazard regression models were used to estimate hazard ratios (HRs) for death from lung cancer associated with parity.
There were 1375 lung cancer deaths during 32 243 637.08 person-years of follow-up. The mortality rate of lung cancer was 4.26 cases per 100,000 person-years. As compared with women who had given birth to only 1 child, the adjusted HR was 1.13 (95% CI, 0.94-1.35) for women who had 2 children, 1.10 (0.91-1.33) for those who had 3 children, and 1.22 (0.96-1.54) for those who had 4 or more children.
The findings suggest that premenopausal women of higher parity tended to have an increased risk of lung cancer, although the trend was not statistically significant.
Journal of Epidemiology 04/2012; 22(4):364-9. · 1.86 Impact Factor
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ABSTRACT: The objectives of this study were to (1) examine the relationship between total trihalomethanes (TTHM) levels in public water supplies and risk of development of kidney cancer and (2) determine whether hardness levels in drinking water modify the effects of TTHM on risk of kidney cancer induction. A matched case-control study was used to investigate the relationship between the risk of death attributed to kidney cancer and exposure to TTHM in drinking water in 53 municipalities in Taiwan. All kidney cancer deaths in the 53 municipalities from 1998 through 2007 were obtained. Controls were deaths from other causes and 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 cancer case. Data on TTHM levels and levels of hardness in drinking water were also collected. The municipality of residence for cancer cases and controls was presumed to be the source of the subject's TTHM and hardness exposure via drinking water. Relative to individuals whose TTHM exposure level was <4.9 ppb, the adjusted OR (95% CI) for kidney cancer was 0.98 (0.77-1.25) for individuals who resided in municipalities served by drinking water with a TTHM exposure ≥4.9 ppb. However, evidence of an interaction was noted between the use of soft water and drinking water TTHM concentrations. Increased knowledge of the interaction between hardness and TTHM levels in reducing risk of kidney cancer development will aid in public policy decision and establishing standards to prevent disease occurrence.
Journal of Toxicology and Environmental Health Part A 03/2012; 75(6):340-50. · 1.83 Impact Factor
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ABSTRACT: Recent studies showed that air pollution is a risk factor for hospitalization for myocardial infarction (MI). However, there is limited evidence to suggest which subpopulations are at higher risk for MI arising from air pollution. This study was undertaken to examine the modifying effects of specific secondary cardiovascular diagnosis (including hypertension, diabetes, congestive heart failure, and arrhythmias) on the relationship between hospital admissions for MI and exposure to ambient air pollutants. Hospital admissions for MI and ambient air pollution data for Taipei were obtained for the period 1999-2009. The relative risk of hospital admissions for MI was estimated using a case-crossover approach. None of the secondary diagnosis examined showed significant evidence of effect modification. It would appear that the correlation between air pollutant exposure and MI occurrence is not affected by predisposing factors present in other cardiovascular diseases.
Journal of Toxicology and Environmental Health Part A 02/2012; 75(4):242-51. · 1.83 Impact Factor
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ABSTRACT: The aim of this study was to investigate whether the use of statins was associated with a decreased risk of gallstone disease.
We conducted a population-based case-control study in Taiwan. Cases consisted of all patients who were aged 50 years and older and had a first-time diagnosis of gallstone disease or cholecystectomy for the period between 2005 and 2009. 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.
We examined 1014 gallstone disease cases and 1014 controls. The unadjusted ORs for any statin prescription was 1.06 (95% CI 0.86 to 1.29), and the adjusted OR was 1.14 (95% CI 0.90 to 1.43). Compared with no use of statins, the adjusted ORs were 1.05 (95% CI 0.72 to 1.54) for the group having been prescribed statins with cumulative defined daily doses (DDDs) below 41.53, 1.12 (95% CI 0.84 to 1.50) for the group with cumulative dose between 41.54 and 334.81 DDD, and 1.30 (95% CI 0.86 to 1.95) for the group with cumulative statin use of 334.81 DDDs or more.
This study does not provide support for a beneficial association between usage of statin and gallstone disease.
Expert Opinion on Drug Safety 01/2012; 11(3):369-74. · 3.02 Impact Factor
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ABSTRACT: To investigate whether the use of statins is associated with colorectal cancer risk.
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 older and had a first-time diagnosis of colorectal cancer between the period 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 using multiple logistic regression.
We examined 1156 colorectal cancer cases and 4624 controls. The unadjusted ORs for any statin prescription was 1.10 (95% CI = 0.94-1.30) and the adjusted OR was 1.09 (95% CI = 0.91-1.30). When statin use was categorized by cumulative dose, the adjusted ORs were 0.99 (95% CI = 0.78-1.27) for the group with cumulative statin use below 105 defined daily doses (DDDs); 1.07 (95% CI = 0.78-1.49) for the group with cumulative statin use between 106 and 298.66 DDDs; and 1.30 (95% CI = 0.96-1.75) for the group with cumulative statin use of 298.66 DDDs or more compared with nonusers.
This study does not provide support for a protective effect of statins against colorectal cancer.
World Journal of Gastroenterology 12/2011; 17(47):5197-202. · 2.47 Impact Factor
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ABSTRACT: Data regarding the occurrence of stroke in dialysis patients are limited and epidemiologic studies to date are controversial with respect to the stroke subtype among dialysis patients. The aim of this study was to perform a population-based study with a retrospective cohort design to investigate the risk of stroke after the initiation of haemodialysis (HD) among end-stage renal disease (ESRD) patients in Taiwan - a country with the highest incidence of ESRD in the world.
Data were retrospectively obtained from the Taiwan National Health Insurance Research Database. In total, 644 patients who were beginning HD between 1999 and 2003 were recruited as the study cohort and 3220 patients matched for age and sex were included as the comparison cohort. Multivariate Cox proportional hazard regression models were used to adjust for confounding and to compare the 5 year stroke-free survival rate between these two cohorts.
The incidence rate of stroke (41.76 per 1000 person-years) was significantly higher in the HD cohort than in the control cohort (24.29 per 1000 person-years). After adjusting for potential confounders, the adjusted hazard ratios of ischaemic stroke and haemorrhagic stroke were 2.16 (95% confidence interval = 1.57-2.97) and 3.78 (95% confidence interval = 1.90-7.55), respectively.
We conclude that HD patients were at an increased risk for both ischaemic and haemorrhagic stroke compared with the general population.
Nephrology 12/2011; 17(3):243-8. · 1.31 Impact Factor
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ABSTRACT: In order to compare the transmissibility of the 2009 pH1N1 pandemic during successive waves of infections in summer and fall/winter in the Northern Hemisphere, and to assess the temporal changes during the course of the outbreak in relation to the intervention measures implemented, we analyze the epidemiological patterns of the epidemic in Taiwan during July 2009-March 2010.
We utilize the multi-phase Richards model to fit the weekly cumulative pH1N1 epidemiological data (numbers of confirmed cases and hospitalizations) as well as the daily number of classes suspended under a unique "325" partial school closing policy in Taiwan, in order to pinpoint the turning points of the summer and fall/winter waves, and to estimate the reproduction numbers R for each wave.
Our analysis indicates that the summer wave had slowed down by early September when schools reopened for fall. However, a second fall/winter wave began in late September, approximately 4 weeks after the school reopened, peaking at about 2-3 weeks after the start of the mass immunization campaign in November. R is estimated to be in the range of 1.04-1.27 for the first wave, and between 1.01-1.05 for the second wave.
Transmissibility of the summer wave in Taiwan during July-early September, as measured by R, was lower than that of the earlier spring outbreak in North America and Europe, as well as that of the winter outbreak in Southern Hemisphere. Furthermore, transmissibility during fall/winter in Taiwan was noticeably lower than that of the summer, which is attributable to population-level immunity acquired from the earlier summer wave and also to the intervention measures that were implemented prior to and during the fall/winter wave.
BMC Infectious Diseases 12/2011; 11:332. · 3.12 Impact Factor
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ABSTRACT: The present study used insurance claims data to investigate infections associated with short-term water outage because of constructions or pipe breaks.
The present study used medical claims of one million insured persons for 2004-2006. We estimated incidences of gastroenteritis and eye and skin complaints for 10 days before, during, and after 10 days of water supply restriction for outpatient visits and for emergency and in-patient care combined.
There was an increase in medical services for these complaints in outpatient visits because of water outages. Poisson regression analyses showed that increased risks of medical services were significant for gastroenteritis (relative risk [RR] 1.31, 95% confidence interval [CI] 1.26-1.37), skin disease (RR 1.36, 95% CI 1.30-1.42), and eye disease patients (RR 1.34, 95% CI 1.26-1.44). Similar risks were observed during 10-day lag periods. Compared with those in cool days, risks of medical services are higher when average daily temperature is above 30 °C for gastroenteritis (RR 12.1, 95% CI 6.17-23.7), skin diseases (RR 4.48, 95% CI 2.29-8.78), and eye diseases (RR 40.3, 95% CI 7.23-224).
We suggest promoting personal hygiene education during water supply shortages, particularly during the warm months.
BMC Public Health 09/2011; 11:726. · 2.00 Impact Factor
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ABSTRACT: To investigate the relationship between air pollution and risk of death attributed to gastric cancer, a matched cancer case-control study was conducted using deaths that occurred in Taiwan from 2004 through 2008. Data for all eligible gastric cancer deaths were obtained and compared to a control group consisting of individuals who died from causes other than neoplasms and diseases that were associated with gastrointestinal (GIT) disorders. The controls were pair-matched to the cancer cases by gender, year of birth, and year of death. Each matched control was randomly selected from the set of possible controls for each cancer case. Data for the number of petrol stations in study municipalities were collected from two major petroleum supply companies. The petrol station density (per square kilometer) (PSD) for study municipalities was used as an indicator of a subject's exposure to benzene and other hydrocarbons present in ambient evaporative losses of petrol or to air emissions from motor vehicles. The exposed individuals were subdivided into three categories (≤25th percentile; 25th-75th percentile; >75th percentile) according to PSD in the residential municipality. Results showed that individuals who resided in municipalities with the highest PSD were at an increased risk of death attributed to gastric cancer compared to those subjects living in municipalities with the lowest PSD. The findings of this study warrant further investigation of the role of traffic air pollution exposure in the etiology of gastric cancer.
Journal of Toxicology and Environmental Health Part A 09/2011; 74(18):1215-24. · 1.83 Impact Factor
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ABSTRACT: The objective of this study was to explore whether calcium (Ca) levels in drinking water modified the effects of nitrate on colon cancer risk. A matched case-control study was used to investigate the relationship between the risk of death from colon cancer and exposure to nitrate in drinking water in Taiwan. All colon cancer deaths of Taiwan residents from 2003 through 2007 were obtained from the Bureau of Vital Statistics of the Taiwan Provincial Department of Health. Controls were deaths from other causes and were pair-matched to the cases by gender, year of birth and year of death. Information on the levels of nitrate-nitrogen (NO(3)-N) and Ca in drinking water have been collected from Taiwan Water Supply Corporation (TWSC). The municipality of residence for cases and controls was assumed to be the source of the subject's NO(3)-N and Ca exposure via drinking water. We observed evidence of an interaction between drinking water NO(3)-N and Ca intake via drinking water. This is the first study to report effect modification by Ca intake from drinking water on the association between NO(3)-N exposure and risk of colon cancer mortality.
Journal of Water and Health 09/2011; 9(3):498-506. · 1.37 Impact Factor
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ABSTRACT: 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.
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.
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 (χ(2) for linear trend=7.42, P=0.006).
The results of this study are the first to suggest that statins may reduce the risk of gastric cancer.
The American Journal of Gastroenterology 08/2011; 106(12):2098-103. · 7.28 Impact Factor
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ABSTRACT: In 1981, a Petrol-Lead Phase-Out Program (PLPOP) was launched in Taiwan for the abatement of environmental lead emissions. The present study was intended to examine whether the high Petrol-Lead Emission Areas (PLEA) would result in an increase in the incidence rate of brain cancer based on a national data bank.
The national brain cancer incidence data was obtained from the Taiwan National Cancer Registry. Age standardized incidence rates were calculated based on the 2000 WHO world standard population, and gasoline consumption data was obtained from the Bureau of Energy. The differences in the trend tests for age-standardized incidence rates of brain cancer between high, median, low, and small PLEA were analyzed.
A significant increase was found from small to high PLEA in age-standardized incidence rates of brain cancer. By taking six possible confounders into account, the age-standardized incidence rates for brain cancer were highly correlated with the median and high PLEA by reference to the small PLEA.
After being adjusted for a number of relevant confounders, it could be concluded that high PLEA might result in an increase in the incidence rate of brain cancer resulting from high lead exposures.
Environment international 08/2011; 40:97-101. · 4.79 Impact Factor
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ABSTRACT: The objective of this research was to identify the influence of applied force (AF) and the compressive strength (CS) of concrete on particle exposure concentrations during concrete cutting processes. Five cutting conditions were selected with AF varied between 9.8 and 49 N and CS varied between 2500 and 6000 psi. For each selected cutting condition, the measured total dust concentrations (C(tot)) were used to further determine the corresponding three health-related exposure concentrations of the inhalable (C(inh)), thoracic (C(thor)), and respirable fraction (C(res)). Results show that particle size distribution was consistently in a bimodal form under all selected cutting conditions. An increase in CS resulted in an increase in coarse particle generations leading to an increase in the four measured particle exposure levels. An increase in AF resulted in an increase in exposure concentrations with a higher fraction of fine particles (i.e., C(tho) and C(res)) However, for particle exposure concentrations with a higher fraction of coarse particles (i.e., C(tot) and C(inh)), an increase in AF resulted in an initial increase, followed by a decrease in concentration. Finally, the above inferences were further confirmed through the use of fixed-effect models to determine the influence of both CS and AF on the four exposure concentrations. These results provide a reference for industries to initiate appropriate control strategies to reduce the exposure levels encountered by workers.
Science of The Total Environment 08/2011; 409(17):3124-8. · 3.29 Impact Factor
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Day-Yu Chao,
Kuang-Fu Cheng,
Tsai-Chung Li, Trong-Neng Wu,
Chiu-Ying Chen,
Chen-An Tsai,
Jin-Hua Chen,
Hsien-Tsai Chiu,
Jang-Jih Lu,
Mei-Chi Su,
Yu-Hsin Liao,
Wei-Cheng Chan,
Ying-Hen Hsieh
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ABSTRACT: The focus of this study was to ascertain the factors associated with 2009 pandemic influenza H1N1 (pH1N1) infection during different phases of the epidemic.
In central Taiwan, 306 persons from households with schoolchildren were followed sequentially and serum samples were taken at three sampling time-points starting in the fall of 2008, shortly after influenza vaccination. Participants who seroconverted between two consecutive blood samplings were considered as having serological evidence of infection. A generalized estimation equation (GEE) with a logistic link to account for household correlations was applied to identify factors associated with pH1N1 infections during the pre-epidemic (April-June) and epidemic (September-October) periods.
The results showed that receiving an inactivated seasonal influenza vaccine (ISIV) and having a hemagglutination inhibition assay (HI) titer of 40 or higher resulted in a significantly lower likelihood of pH1N1 infection during the pre-epidemic period only, for both children and adults (adjusted odds ratio (OR) 0.3, 95% confidence interval (CI) 0.12-0.9). Having a previous infection by pH1N1 with a baseline titer of 20 or higher resulted in a significantly lower likelihood of infection by pH1N1 during the epidemic period (adjusted OR 0.06, 95% CI 0.02-0.16).
Our results provide the first serological evidence to suggest a protection effect from receiving an ISIV against pH1N1 infection only when the HI titer reaches 40 or higher during the pre-epidemic period. This study gives an important insight into the control and intervention measures required for preventing infections during future influenza epidemics.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 07/2011; 15(10):e695-701. · 2.17 Impact Factor
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ABSTRACT: The aim of this study was to investigate whether the use of statins was associated with pancreatic cancer risk.
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 50 years or older and had a first-time diagnosis of pancreatic cancer for the period between 2003 and 2008. The control subjects 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.
We examined 190 pancreatic cancer cases and 760 control subjects. The unadjusted OR for any statin prescription was 1.07 (95% CI, 0.72-2.06), and the adjusted OR was 0.87 (95% CI, 0.56-1.36). Compared with no use of statins, the adjusted ORs were 1.06 (95% CI, 0.61-1.85) for the group having been prescribed statins with cumulative defined daily doses less than 114.33 and 0.71 (95% CI, 0.39-1.30) for the group with cumulative statin use of 114.33 defined daily doses or more.
This study does not provide support for a beneficial association between usage of statin and pancreatic cancer.
Pancreas 07/2011; 40(5):669-72. · 2.39 Impact Factor
