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Asian Dust Storm Elevates Children’s Respiratory Health Risks: A Spatiotemporal Analysis of Children’s Clinic Visits across Taipei (Taiwan)  [PDF]
Hwa-Lung Yu, Lung-Chang Chien, Chiang-Hsing Yang
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0041317
Abstract: Concerns have been raised about the adverse impact of Asian dust storms (ADS) on human health; however, few studies have examined the effect of these events on children’s health. Using databases from the Taiwan National Health Insurance and Taiwan Environmental Protection Agency, this study investigates the documented daily visits of children to respiratory clinics during and after ADS that occurred from 1997 to 2007 among 12 districts across Taipei City by applying a Bayesian structural additive regressive model controlled for spatial and temporal patterns. This study finds that the significantly impact of elevated children’s respiratory clinic visits happened after ADS. Five of the seven lagged days had increasing percentages of relative rate, which was consecutively elevated from a 2-day to a 5-day lag by 0.63%~2.19% for preschool children (i.e., 0~6 years of age) and 0.72%~3.17% for school children (i.e., 7~14 years of age). The spatial pattern of clinic visits indicated that geographical heterogeneity was possibly associated with the clinic’s location and accessibility. Moreover, day-of-week effects were elevated on Monday, Friday, and Saturday. We concluded that ADS may significantly increase the risks of respiratory diseases consecutively in the week after exposure, especially in school children.
Comparison of the Effects of Air Pollution on Outpatient and Inpatient Visits for Asthma: A Population-Based Study in Taiwan  [PDF]
Hui-Hsien Pan, Chun-Tzu Chen, Hai-Lun Sun, Min-Sho Ku, Pei-Fen Liao, Ko-Hsiu Lu, Ji-Nan Sheu, Jing-Yang Huang, Jar-Yuan Pai, Ko-Huang Lue
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0096190
Abstract: Background A nationwide asthma survey on the effects of air pollution is lacking in Taiwan. The purpose of this study was to evaluate the time trend and the relationship between air pollution and health care services for asthma in Taiwan. Methods Health care services for asthma and ambient air pollution data were obtained from the National Health Insurance Research database and Environmental Protection Administration from 2000 through 2009, respectively. Health care services, including those related to the outpatient and inpatient visits were compared according to the concentration of air pollutants. Results The number of asthma-patient visits to health-care facilities continue to increase in Taiwan. Relative to the respective lowest quartile of air pollutants, the adjusted relative risks (RRs) of the outpatient visits in the highest quartile were 1.10 (P-trend = 0.013) for carbon monoxide (CO), 1.10 (P-trend = 0.015) for nitrogen dioxide (NO2), and 1.20 (P-trend <0.0001) for particulate matter with an aerodynamic diameter ≦10μm (PM10) in the child group (aged 0–18). For adults aged 19–44, the RRs of outpatient visits were 1.13 (P-trend = 0.078) for CO, 1.17 (P-trend = 0.002) for NO2, and 1.13 (P-trend <0.0001) for PM10. For adults aged 45–64, the RRs of outpatient visits were 1.15 (P-trend = 0.003) for CO, 1.19 (P-trend = 0.0002) for NO2, and 1.10 (P-trend = 0.001) for PM10. For the elderly (aged≥ 65), the RRs of outpatient visits in were 1.12 (P-trend = 0.003) for NO2 and 1.10 (P-trend = 0.006) for PM10. For inpatient visits, the RRs across quartiles of CO level were 1.00, 1.70, 1.92, and 1.86 (P-trend = 0.0001) in the child group. There were no significant linear associations between inpatient visits and air pollutants in other groups. Conclusions There were positive associations between CO levels and childhood inpatient visits as well as NO2, CO and PM10 and outpatient visits.
Association between Temperature and Emergency Room Visits for Cardiorespiratory Diseases, Metabolic Syndrome-Related Diseases, and Accidents in Metropolitan Taipei  [PDF]
Yu-Chun Wang, Yu-Kai Lin
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0099599
Abstract: Objective This study evaluated risks of the emergency room visits (ERV) for cerebrovascular diseases, heart diseases, ischemic heart disease, hypertensive diseases, chronic renal failure (CRF), diabetes mellitus (DM), asthma, chronic airway obstruction not elsewhere classified (CAO), and accidents associated with the ambient temperature from 2000 to 2009 in metropolitan Taipei. Methods The distributed lag non-linear model was used to estimate the cumulative relative risk (RR) and confidence interval (CI) of cause-specific ERV associated with daily temperature from lag 0 to lag 3 after controlling for potential confounders. Results This study identified that temperatures related to the lowest risk of ERV was 26 °C for cerebrovascular diseases, 18 °C for CRF, DM, and accidents, and 30 °C for hypertensive diseases, asthma, and CAO. These temperatures were used as the reference temperatures to measure RR for the corresponding diseases. A low temperature (14°C) increased the ERV risk for cerebrovascular diseases, hypertensive diseases, and asthma, with respective cumulative 4-day RRs of 1.56 (95% CI: 1.23, 1.97), 1.78 (95% CI: 1.37, 2.34), and 2.93 (95% CI: 1.26, 6.79). The effects were greater on, or after, lag one. At 32°C, the cumulative 4-day RR for ERV was significant for CRF (RR = 2.36; 95% CI: 1.33, 4.19) and accidents (RR = 1.23; 95% CI: 1.14, 1.33) and the highest RR was seen on lag 0 for CRF (RR = 1.69; 95% CI: 1.01, 3.58), DM (RR = 1.69; 95% CI: 1.09, 2.61), and accidents (RR = 1.19; 95% CI: 1.11, 1.27). Conclusions Higher temperatures are associated with the increased ERV risks for CRF, DM, and accidents and lower temperatures with the increased ERV risks for cerebrovascular diseases, hypertensive diseases, and asthma in the subtropical metropolitan.
A new species of Orobdella (Hirudinida, Arhynchobdellida, Orobdellidae) from Taipei, Taiwan  [cached]
Takafumi Nakano,Yi-Te Lai
ZooKeys , 2012, DOI: 10.3897/zookeys.207.3334
Abstract: A new quadrannulate species of Orobdella, Orobdella ketagalan sp. n., from Taipei, Taiwan, is described. This is the first record of Orobdella and the family Orobdellidae from Taiwan. This new species possesses small, paired sperm duct bulbs in the male reproductive system. In addition to these bulbs, the following combination of characters distinguishes this new species from other quadrannulate species: somite IV uniannulate, male gonopore at XI b6, female gonopore at XIII a1, 1/2 + 4 + 1/2 between gonopores, simple tubular gastroporal duct, lacking epididymides, and undeveloped atrial cornua. Phylogenetic analyses using nuclear 18S rDNA and histone H3 as well as mitochondrial COI, 12S rDNA, tRNAVal, and 16S rDNA markers showed that O. ketagalan is related to the two Ryukyu Archipelago species Orobdella dolichopharynx Nakano, 2011 and Orobdella shimadae Nakano, 2011.
Improved Consistency in Dosing Anti-Tuberculosis Drugs in Taipei, Taiwan  [PDF]
Chen-Yuan Chiang, Ming-Chih Yu, Hsiu-Chen Shih, Muh-Yong Yen, Yu-Ling Hsu, Shiang-Lin Yang, Tao-Ping Lin, Kuan-Jen Bai
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0044133
Abstract: Background It was reported that 35.5% of tuberculosis (TB) cases reported in 2003 in Taipei City had no recorded pre-treatment body weight and that among those who had, inconsistent dosing of anti-TB drugs was frequent. Taiwan Centers for Disease Control (CDC) have taken actions to strengthen dosing of anti-TB drugs among general practitioners. Prescribing practices of anti-TB drugs in Taipei City in 2007–2010 were investigated to assess whether interventions on dosing were effective. Methodology/Principal Findings Lists of all notified culture positive TB cases in 2007–2010 were obtained from National TB Registry at Taiwan CDC. A medical audit of TB case management files was performed to collect pretreatment body weight and regimens prescribed at commencement of treatment. Dosages prescribed were compared with dosages recommended. The proportion of patients with recorded pre-treatment body weight was 64.5% in 2003, which increased to 96.5% in 2007–2010 (p<0.001). The proportion of patients treated with consistent dosing of a 3-drug fixed-dose combination (FDC) increased from 73.9% in 2003 to 87.7% in 2007–2010 (p<0.001), and that for 2-drug FDC from 76.0% to 86.1% (p = 0.024), for rifampicin (RMP) from 62.8% to 85.5% (p<0.001), and for isoniazid from 87.8% to 95.3% (p<0.001). In 2007–2010, among 2917 patients treated with either FDCs or RMP in single-drug preparation, the dosage of RMP was adequate (8–12 mg/kg) in 2571(88.1%) patients, too high in 282(9.7%), too low in 64(2.2%). In multinomial logistic regression models, factors significantly associated with adequate dosage of RMP were body weight and preparations of RMP. Patients weighting <40kg (relative risk ratio (rrr) 6010.5, 95% CI 781.1–46249.7) and patients weighting 40–49 kg (rrr 1495.3, 95% CI 200.6–11144.6) were more likely to receive higher-than-recommended dose of RMP. Conclusions/Significance Prescribing practice in the treatment of TB in Taipei City has remarkably improved after health authorities implemented a series of interventions.
The Association between Cold Spells and Pediatric Outpatient Visits for Asthma in Shanghai, China  [PDF]
Yuming Guo, Fan Jiang, Li Peng, Jun Zhang, Fuhai Geng, Jianming Xu, Canming Zhen, Xiaoming Shen, Shilu Tong
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0042232
Abstract: Background Asthma is a serious global health problem. However, few studies have investigated the relationship between cold spells and pediatric outpatient visits for asthma. Objective To examine the association between cold spells and pediatric outpatient visits for asthma in Shanghai, China. Methods We collected daily data on pediatric outpatient visits for asthma, mean temperature, relative humidity, and ozone from Shanghai between 1 January 2007 and 31 December 2009. We defined cold spells as four or more consecutive days with temperature below the 5th percentile of temperature during 2007–2009. We used a Poisson regression model to examine the impact of temperature on pediatric outpatient visits for asthma in cold seasons during 2007 and 2009. We examined the effect of cold spells on asthma compared with non-cold spell days. Results There was a significant relationship between cold temperatures and pediatric outpatient visits for asthma. The cold effects on children's asthma were observed at different lags. The lower the temperatures, the higher the risk for asthma attacks among children. Conclusion Cold temperatures, particularly cold spells, significantly increase the risk of pediatric outpatient visits for asthma. The findings suggest that asthma children need to be better protected from cold effects in winter.
ANT Analysis on the River Management of Urban Taiwan: A Case Study of Keelung River in Taipei Basin  [PDF]
Tsu-Lung Chou
Advances in Applied Sociology (AASoci) , 2012, DOI: 10.4236/aasoci.2012.23027
Abstract: This article provides a historical investigation on river management in urban Taiwan. It demonstrates the application of actor network theory (ANT) on the long-term development and evolution of river management network through a case study of the Keelung River in Taipei Basin. The study considers the formation of the actors’ world of the Keelung River and the way the actors have affected flood drainage and the supply of land in the region. River management and induced disasters in the Basin are explored. Strengths and weaknesses of the ANT are also discussed.
Estimation of Fine Particulate Matter in Taipei Using Landuse Regression and Bayesian Maximum Entropy Methods  [PDF]
Hwa-Lung Yu,Chih-Hsih Wang,Ming-Che Liu,Yi-Ming Kuo
International Journal of Environmental Research and Public Health , 2011, DOI: 10.3390/ijerph8062153
Abstract: Fine airborne particulate matter (PM 2.5) has adverse effects on human health. Assessing the long-term effects of PM 2.5 exposure on human health and ecology is often limited by a lack of reliable PM 2.5 measurements. In Taipei, PM 2.5 levels were not systematically measured until August, 2005. Due to the popularity of geographic information systems (GIS), the landuse regression method has been widely used in the spatial estimation of PM concentrations. This method accounts for the potential contributing factors of the local environment, such as traffic volume. Geostatistical methods, on other hand, account for the spatiotemporal dependence among the observations of ambient pollutants. This study assesses the performance of the landuse regression model for the spatiotemporal estimation of PM 2.5 in the Taipei area. Specifically, this study integrates the landuse regression model with the geostatistical approach within the framework of the Bayesian maximum entropy (BME) method. The resulting epistemic framework can assimilate knowledge bases including: (a) empirical-based spatial trends of PM concentration based on landuse regression, (b) the spatio-temporal dependence among PM observation information, and (c) site-specific PM observations. The proposed approach performs the spatiotemporal estimation of PM 2.5 levels in the Taipei area (Taiwan) from 2005–2007.
Factors associated with patient visits to the emergency department for asthma therapy
Hamdan AL-Jahdali, Ahmed Anwar, Abdullah AL-Harbi, Salim Baharoon, Rabih Halwani, Abdulllah Al Shimemeri, Saleh Al-Muhsen
BMC Pulmonary Medicine , 2012, DOI: 10.1186/1471-2466-12-80
Abstract: A cross-sectional survey of all the patients who visited the emergency room with bronchial asthma attacks over a 9-month period was undertaken at two major academic hospitals. The following data were collected: demographic data, asthma control in the preceding month, where and by whom the patients were treated, whether the patient received education about asthma or its medication and the patients’ reasons for visiting the ED.Four hundred fifty (N?=?450) patients were recruited, 39.1% of whom were males with a mean age of 42.3?±?16.7. The mean duration of asthma was 155.90?±?127.13 weeks. Approximately half of the patients did not receive any information about bronchial asthma as a disease, and 40.7% did not receive any education regarding how to use asthma medication. Asthma was not controlled or partially controlled in the majority (97.7%) of the patients preceding the admission to ED. The majority of the patients visited the ED to receive a bronchodilator by nebuliser (86.7%) and to obtain oxygen (75.1%). Moreover, 20.9% of the patients believed that the ED managed them faster than the clinic, and 21.1% claimed that their symptoms were severe enough that they could not wait for a clinic visit. No education about asthma and uncontrolled asthma are the major factors leading to frequent ED visits (three or more visits/year), p-value?=?0.0145 and p-value?=?0.0003, respectively. Asthma control also exhibited a significant relationship with inhaled corticosteroid ICS use (p-value =0.0401) and education about asthma (p-value =0.0117).This study demonstrates that many avoidable risk factors lead to uncontrolled asthma and frequent ED visits.Asthma is a common condition that affects 5-10% of the population. The incidence and prevalence of asthma have increased during the past 20 years [1,2]. The prevalence of bronchial asthma among Saudi patients is approximately 20-25% [2,3]. Poor asthma control remains a frequent cause of emergency department (ED) presentation and hospit
Application of Frequent Itemsets Mining to Analyze Patterns of One-Stop Visits in Taiwan  [PDF]
Chun-Yi Tu,Tzeng-Ji Chen,Li-Fang Chou
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014824
Abstract: The free choice of health care facilities without limitations on frequency of visits within the National Health Insurance in Taiwan gives rise to not only a high number of annual ambulatory visits per capita but also a unique “one-stop shopping”phenomenon, which refers to a patient' visits to several specialties of the same healthcare facility in one day. The visits to multiple physicians would increase the potential risk of polypharmacy. The aim of this study was to analyze the frequency and patterns of one-stop visits in Taiwan.
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