Assessing the impact of specific PM2.5-Bound metallic elements on asthma emergency department visits: A case-crossover study in Taiwan.

OBJECTIVES: This study aims to assess the specific PM2.5-bound metallic elements that contribute to asthma emergency department visits by using a case-crossover study design. METHODS: This study analyzed data from 11,410 asthma emergency department visits as case group and 22,820 non-asthma onset dates occurring one week and two weeks preceding the case day as controls from 2017 to 2020. PM2.5 monitoring data and 35 PM.2.5-bound metallic elements from six different regions in Taiwan were collected. Conditional logistic regression models were used to assess the relationship between asthma and PM2.5-bound metallic elements. RESULTS: Our investigation revealed a statistically significant risk of asthma emergency department visits associated with PM2.5 exposure at lag 0, 1, 2, and 3 during autumn. Additionally, PM2.5-bound hafnium (Hf), thallium (Tl), rubidium (Rb), and aluminum (Al) exhibited a consistently significant positive correlation with asthma emergency department visits at lags 1, 2, and 3. In stratified analyses by area, age, and sex, PM2.5-bound Hf showed a significant and consistent correlation. CONCLUSIONS: This study provides evidence of PM2.5-bound metallic elements effects in asthma exacerbations, particularly for Hf. It emphasizes the importance of understanding the origins of these metallic elements and pursuing emission reductions to mitigate regional health risks.

Assessing the effectiveness of mitigating pesticide-related disease risk among pesticide-spraying drone operators in Taiwan.

OBJECTIVES: The purpose of this study was to evaluate the risk of pesticide poisoning, liver and renal failure, dermatitis, respiratory problems, hypersensitivity pneumonitis, keratitis, and epilepsy among pesticide-spraying personnel and to assess the effectiveness of a new method of aerial pesticide application in reducing this risk. METHODS: A total of 2268 pesticide spraying operators (1651 ground-based field crop operators and 617 aerial pesticide spraying drone operators) who passed the national certification examination between 2010 and 2020 in Taiwan were included. Ground-based operators served as the positive control group, while 2463 farmer controls were matched from the Farmers' Health Insurance database as the negative control group. Data from the National Health Insurance Research Database were used to track possible pesticide-related disease cases. Logistic regression was employed to calculate odds ratios and 95% confidence intervals (95% CI). RESULTS: Drone operators had significantly reduced risks of dermatitis, asthma and chronic bronchitis compared to ground-based operators. This was observed in allergic contact dermatitis (OR = 0.40, 95% CI: 0.24-0.68), unspecified contact dermatitis (OR = 0.58, 95% CI: 0.35-0.97), asthma (OR = 0.27, 95% CI: 0.12-0.60), and chronic bronchitis (OR = 0.24, 95% CI: 0.06-0.93), after adjusting for age, sex, working areas, and licensing years. However, no significant differences were found when comparing drone operators to matching farmers. CONCLUSIONS: Aerial pesticide spraying using drones may contribute to a decreased risk of dermatitis, asthma and chronic bronchitis, suggesting potential health benefits for operators. Further field pesticide exposure surveys are recommended to validate these findings and assess health risk indicators.

Polycystic kidney disease increases the stoke incidence in Taiwan: A retrospective population-based cohort study using National Health Insurance Database.

BACKGROUND: Few studies documented incidence rates of different types of stroke among patients with polycystic kidney disease (PKD). METHODS: We conducted a retrospective cohort study based on the National Health Insurance (NHI) Database of Taiwan. The PKD cohort comprised patients aged≥20 years diagnosed with PKD using inpatient claims from 1998 to 2011, excluding prior stroke. The reference cohort was established by inpatients without PKD using 1:4 frequency-matched with age, gender, and baseline comorbidities. The two cohorts were followed-up until stroke hospitalization, death, withdrawal from the NHI program, or the end of 2012. To account for competing risks of death, we used multivariable competing risks regression models to estimate sub-distribution hazard ratio (SHR) adjusted for age, gender, baseline comorbidities and end stage renal disease. RESULTS: 7837 PKD patients and 31,211 reference subjects were followed up through 2012. A total of 955 cases of stroke were identified in the PKD cohort, including 441 ischemic stroke (IS), 289 intracranial hemorrhage (ICH), 73 subarachnoid hemorrhage (SAH) and 232 other stroke. The incidence rates of overall stroke, IS, ICH, and SAH were 21.3, 10.2, 6.8, and 1.7 per 1000 person-years, respectively. The SHR for overall stroke was 1.39 [95% confidence interval (CI) 1.28-1.50]. SAH had the highest SHR, 4.55 [95% CI 3.26-6.37], followed by ICH (1.84), other stroke (1.24), and IS (1.22). CONCLUSION: This study illustrated the incidence rates of stroke among inpatient of PKD. The PKD patients had a significantly increased risk of all kinds of stroke after adjusting baseline comorbidities.

Increased Risk of Gastric Cancer in Asbestos-Exposed Workers: A Retrospective Cohort Study Based on Taiwan Cancer Registry 1980-2015.

Asbestos has been recognized as a human carcinogen associated with malignant mesothelioma, cancers of lung, larynx, and ovary. However, a putative association between gastric cancer and asbestos exposure remains controversial. In this study, we aimed to explore gastric cancer risk of workers potentially exposed to asbestos in Taiwan. The asbestos occupational cohort was established from 1950 to 2015 based on the Taiwan Labor Insurance Database, and Taiwan Environmental Protection Agency regulatory datasets, followed by the Taiwan Cancer Registry for the period 1980-2015. Standardized incidence ratios (SIRs) for cancer were computed for the whole cohort using reference rates of the general population, and also reference labor population. Compared with the general population, SIR of the asbestos occupational cohort for the gastric cancer increased both in males (1.05, 95% confidence interval (CI): 1.02-1.09) and females (1.10, 95% CI: 1.01-1.18). A total of 123 worksites were identified to have cases of malignant mesothelioma, where increased risk for gastric cancer was found with a relative risk of 1.76 (95% CI: 1.63-1.90). This 35-year retrospective cohort study of asbestos-exposed workers in Taiwan may provide support for an association between occupational exposure to asbestos and gastric cancer.

Upcoming epidemic of asbestos-related malignant pleural mesothelioma in Taiwan: A prediction of incidence in the next 30 years.

BACKGROUND/PURPOSE: Globally, asbestos-related diseases (ARDs) keep rising over the coming decades. The epidemic of ARDs will be a burden on public health. We aimed to predict the malignant pleural mesothelioma (MPM) incidence in the next 30 years for Taiwan based on historical asbestos consumption. METHODS: We collected annual data on local asbestos consumption during 1939-2015 and sex-specific incidence of pleural cancer as a proxy for MPM during 1979-2013. We applied Poisson log-linear models to predict future MPM numbers under the assumption that latency periods between asbestos exposure and MPM incidence were between 25 and 45 years. RESULTS: Asbestos consumption reached a peak in the 1980s, with a total of 668 thousand metric tons during 1939-2015. The observed number of MPM incidence increased by 9- and 6-fold in males and females during 1979-2013, with a cumulative number of 907. Given a latency period of 31 years, MPM incidences were expected to peak around 2012-2016 for males and 2016-2020 for females. In 2017-2046, the predicted total number of new MPM might reach 659 cases (95% confidence interval = 579-749); and the male to female ratios ranged from 1.8 to 2.8. CONCLUSION: The MPM epidemic in Taiwan will likely peak in 2012-2020 as a result of local asbestos consumption. Approximately 659 new MPM cases in the next 30 years warrant an urgent need to implement a total asbestos ban and put more resources on a comprehensive surveillance, diagnosis, and follow-up health care system for ARDs.

Clustering of malignant pleural mesothelioma in asbestos factories: a subgroup analysis in a 29-year follow-up study to identify high-risk industries in Taiwan.

OBJECTIVE: Exposure to asbestos is the major cause for malignant pleural mesothelioma (MPM), but the causal link of individual cases is difficult to establish for lack of exposure information and long disease latency. METHODS: We established a retrospective cohort of workers employed in asbestos industries during the period of 1950-1989 and the occurrence of MPM during the period of 1980-2009 was examined with the Taiwan Cancer Registry. Estimated rate ratios (eRRs) were computed for each factory where any case of MPM was diagnosed by assuming Poisson distribution with a minimal latency of 20 years. RESULTS: A total of 18 MPM (17 males, 1 female) in eight factories were found. The incidence rate of MPM for the eight factories was 18.0 per million, ranging from 6.2 per million (military factory) to 268.2 per million (asbestos cement). We observed significantly increased risks for MPM in asbestos cement, thermal insulation and shipbuilding industries, with eRR (genders combined) of 113.6, 87.5 and 15.8, respectively. The sensitivity analyses considering latency showed similar findings in latency ≥30 years, and the shipbuilding industry presented a significant eRR given a latency ≥40 years. The gender-specific eRR showed similar results in men, but high eRR of 729.6 was observed in an asbestos cement factory where a female MPM was diagnosed. CONCLUSIONS: This nationwide study in Taiwan comprehensively shows that different asbestos manufacturing processes, including asbestos cement, thermal insulation and shipbuilding industries, were at significantly increased risks for MPM. We recommend to establish a medical screening programme for workers previously exposed to asbestos to identify MPM and other asbestos-related diseases at an earlier stage.

Characterization of genes encoding proteins containing HD-related output domain in Xanthomonas campestris pv. campestris.

The Gram-negative plant pathogen Xanthomonas campestris pv. campestris (Xcc) is the causative agent of black rot in crucifers. The production of Xcc virulence factors is regulated by Clp and RpfF. HD-related output domain (HDOD) is a protein domain of unknown biochemical function. The genome of Xcc encodes three proteins (GsmR, HdpA, and HdpB) with an HDOD. The GsmR has been reported to play a role in the general stress response and cell motility and its expression is positively regulated by Clp. Here, the function and transcription of hdpA and hdpB were characterized. Mutation of hdpA resulted in enhanced bacterial attachment. In addition, the expression of hdpA was positively regulated by RpfF but not by Clp, subject to catabolite repression and affected by several stress conditions. However, mutational analysis and reporter assay showed that hdpB had no effect on the production of a range of virulence factors and its expression was independent of Clp and RpfF. The results shown here not only extend the previous work on RpfF regulation to show that it influences the expression of hdpA in Xcc, but also expand knowledge of the function of the HDOD containing proteins in bacteria.

Estimating quality weights for EQ-5D (EuroQol-5 dimensions) health states with the time trade-off method in Taiwan.

BACKGROUND/PURPOSE: EQ-5D (EuroQol-5 dimensions) is a preference-based measure of health, which is widely used in cost-utility analyses. It has been suggested that each country should develop its own value set. We therefore sought to develop the quality weights of the EQ-5D health states with the time trade-off (TTO) method in Taiwan. METHODS: A total of 745 respondents consisting of employees and volunteers in 17 different hospitals were recruited and interviewed. Each of them valued 13 of 73 EQ-5D health states using the TTO method. Based on the three exclusion criteria for valuation data, only 456 (61.21%) respondents were considered eligible for data analysis. The quality weights for all EQ-5D health states were modeled by generalized estimating equations (GEEs). RESULTS: Over half of the responses were given negative values, and the medical personnel seemed to have a significantly higher TTO value (+0.1) than others after controlling for other predictors. The N3 model (level 3 occurred within at least 1 dimension) yielded an acceptable fit for the observed OTT data [mean absolute error (MAE) = 0.056, R(2) = 0.35]. The magnitude of mean absolute differences (MADs) between Taiwan data and those from the UK, Japan, and South Korea ranged from 0.146 to 0.592, but the rank correlation coefficients were all above 0.811. CONCLUSION: This study reaffirms the differences in health-related preference values across countries. The high proportion of negative values might indicate that we have also partially measured the intensity of fear in addition to the utility of different health states.

Lifetime costs for peritoneal dialysis and hemodialysis in patients in Taiwan.

BACKGROUND: This study compared the lifetime costs for peritoneal dialysis (PD) and hemodialysis (HD) patients in Taiwan. METHODS: Using the National Health Insurance (NHI) database of all end-stage renal disease patients on maintenance dialysis registered from July 1997 to December 2005, we matched eligible PD patients with eligible HD patients on age, sex, and diabetes status. The matched patients were followed until 31 December 2006. Patients were excluded if they were less than 18 years of age, had been diagnosed with cancer before dialysis, or had been dialyzed at centers or clinics other than hospitals. Outcomes-including life expectancy, total lifetime costs, and costs per life-year paid by the NHI-were estimated and compared. RESULTS: The 3136 pairs of matched PD and HD patients had a mean age of 53.2 ± 15.4 years. The total lifetime cost for PD patients (US$139 360 ± US$8 336) was significantly lower than that for HD patients (US$185 235 ± US$9 623, p < 0.001). Except for patients with diabetes (who had a short life expectancy), the total lifetime cost was significantly lower for PD patients than for HD patients regardless of sex and age (p < 0.01). CONCLUSION: In Taiwan, the total lifetime costs paid by the NHI were lower for PD than for HD patients.

Monascin improves diabetes and dyslipidemia by regulating PPARγ and inhibiting lipogenesis in fructose-rich diet-induced C57BL/6 mice.

Monascin (MS) is a yellow compound isolated from Monascus-fermented products that has pancreatic protective, anti-inflammatory, anti-oxidative, and hypolipidemic activity. We recently found that MS also acts as a peroxisome proliferator-activated receptor-gamma (PPARγ) agonist, thereby promoting insulin sensitivity in C2C12 cells. However, the attenuation of hyperglycemia by MS treatment in vivo remains uncertain. In the present study, both MS and pioglitazone significantly down-regulated blood glucose and hyperinsulinemia in fructose-rich diet (FRD)-induced C57BL/6 mice (8 weeks). In addition, inhibitions of inflammatory factor production, serum dyslipidemia, and hepatic fatty acid accumulation by MS and pioglitazone were attenuated by GW9662 (PPARγ antagonist). These results were mediated by MS-suppressing FRD-elevated lipogenic transcription factors, including sterol regulatory element-binding protein-1c (SREBP-1c), carbohydrate response element-binding protein (ChREBP), PPARγ coactivator-1α (PGC-1α), and PPARγ coactivator-1ß (PGC-1ß). Taken together, de novo lipogenesis results in hyperlipidemia and hyperglycemia by fructose induction thereby leading to diabetes development; we found that MS may inhibit lipogenesis in FRD-induced mice. These findings suggest that MS acts as an antidiabetic agent and thus may have therapeutic potential for prevention of diabetes.

Exposure to multiple low-level chemicals in relation to reproductive hormones in premenopausal women involved in liquid crystal display manufacture.

BACKGROUND: Liquid crystal display (LCD) manufacturing involves three fabrication processes: array, panel and module processes, which result in different levels of volatile organic compound (VOC) exposure. The aim of this study was to assess the potential reproductive endocrine effects of occupational exposures during LCD manufacturing predictive of menstrual cycles as subclinical markers of female reproductive dysfunction effects of low-dose exposures. METHODS: A total of 94 fabrication workers were followed for one complete menstrual cycle using daily urine samples: 23 were from the array, 53 from the panel, and 18 from the module work areas. The menstrual cycle characteristics of the study population were measured using a self-administered questionnaire. Urine samples were collected during the first urination in the morning for at least one complete menstrual cycle. The urine was then analyzed to determine the urinary concentrations of follicular stimulating hormone (FSH), estrone conjugates (E1C), and pregnanediol-3-glucuronide (PdG). The results of this analysis were used to assess the potential effects of chemical exposure as determined by handheld volatile organic compound (VOC) monitors and 24 h canisters. RESULTS: The concentration of total VOCs was much higher in the module making area (ND-21,000 ppb) than in panel (ND-766 ppb) and array (58-1,472 ppb) making areas. The concentrations of ethanol and acetone were much higher in the module (1,974.9 and 2,283.2 ppb, respectively) and panel (2256.9 and 592.2 ppb, respectively) making areas. Compared to those in the array making area, we found that E1C (12.55, 95% confidence interval (CI): 8.49, 16.61 µg/mg Cr) and PdG (0.53, 95% CI: 0.29, 0.77 µg/mg Cr) levels in the module group were significantly higher in the early follicular phase; E1C (11.93, 95% CI: 6.21, 17.65 µg/mg Cr) and PdG (0.53, 95% CI: 0.29, 0.77 µg/mg Cr) levels were significantly higher in the periovulatory phase; and all the hormone levels, FSH (1.48, 95% CI: 0.81, 2.15 µg/mg Cr), E1C (9.29, 95% CI: 4.92, 13.66 µg/mg Cr), and PdG (1.01, 95% CI: 0.42, 1.60 µg/mg Cr) were also significantly higher in the luteal phase. In addition, the FSH (0.89, 95% CI: 0.07, 1.71 µg/mg Cr) level in the panel group was significantly higher but E1C (-4.49, 95% CI: -7.90, -1.08 µg/mg Cr) was lower in the early follicular phase; and E1C (-5.16, 95% CI: -9.61, -0.71 µg/mg Cr) level was significantly lower in the periovulatory phase. CONCLUSIONS: Our findings add to the evidence that exposure to multiple low-level chemicals is associated with modest changes in reproductive hormone urinary concentrations in healthy premenopausal women. In addition, the FSH (0.89, 95% CI: 0.07, 1.71 µg/mg Cr) level in the panel group was significantly higher but E1C (-4.49, 95% CI: -7.90, -1.08 µg/mg Cr) lower in the early follicular phase; and E1C (-5.16, 95% CI: -9.61, -0.71 µg/mg Cr) level was significantly lower in the periovulatory phase.

Estimation of expected life-years saved from successful prevention of end-stage renal disease in elderly patients with diabetes: a nationwide study from Taiwan.

OBJECTIVE: Because of the increasing incidence and prevalence of diabetes as a leading cause of end-stage renal disease (ESRD) in the aging population, we estimated the expected life-years (LYs) saved from successful prevention of ESRD in elderly patients with diabetes. RESEARCH DESIGN AND METHODS: We conducted a population-based cohort study using the National Health Insurance Research Database. We identified all incidences of ESRD in the individuals >65 years of age who were receiving maintenance hemodialysis (N = 24,243) from the registry files of catastrophic illnesses in Taiwan from 1 July 1997 to 31 December 2005. We then retrospectively searched the database to determine whether there had been a diagnosis of diabetes in these cases. After the exclusion of individuals with malignancy (n = 3,423), we extrapolated the survival rates through the end of 2006 using the Monte Carlo method. Using the data of preventable ESRD cases due to diabetes and expected years of life lost (EYLL) in each age stratum, we further estimated the expected LYs saved from successful prevention of ESRD in elderly patients with diabetes. RESULTS: The estimated average EYLL was 10.6-5.8 and 12.3-7.3 years for diabetic males and females, respectively, aged 65-79 years. In total, 5,430.1 LYs and 10,177 LYs could be saved by the successful prevention of ESRD in male and female elderly patients with diabetes, respectively, in a single year. CONCLUSIONS: The LYs saved by successful prevention of ESRD in elderly patients with diabetes in a single year are substantial and deserve special attention, especially in elderly females.

Estimation of benefit of prevention of occupational cancer for comparative risk assessment: methods and examples.

OBJECTIVES: To quantify the life years gained and financial savings by preventing a case of occupational cancer. METHODS: The authors retrieved data from the Taiwan Cancer Registry and linked them with the National Mortality Registry to estimate the survival functions for major occupational cancers: lung, pleural mesothelioma, urinary bladder and leukaemia. Assuming a constant excess hazard for each type of cancer, the authors extrapolated lifetime survival functions by the Monte Carlo method. For each patient with cancer, the authors simulated an age- and gender-matched person without cancer based on vital statistics of Taiwan to estimate life expectancy and expected years of life lost (EYLL). By using the reimbursement data from the National Health Insurance Research Database, the authors calculated the average monthly healthcare expenditures, which were summed to estimate the lifetime healthcare expenditures after adjusting for the corresponding monthly survival probability. RESULTS: A total of 51,408, 136, 12,891 and 5285 new cases of lung, pleural mesothelioma, bladder and leukaemia cancers, respectively, were identified during 1997-2005 and followed until the end of 2007. The EYLL was predicted to be 13.7±0.1, 18.9±0.7, 4.7±0.3 and 19.4±0.5 years for these cancers, respectively, and the lifetime healthcare expenditures with a 3% annual discount were predicted to be US$22,359, US$14,900, US$51,987 and US$59,741, respectively. CONCLUSIONS: The burden of these occupational cancers, in terms of EYLL and lifetime healthcare expenditures, was substantial. Such estimates may provide useful empirical evidence for comparative risk assessment that can be applied in health policy-making and clinical decision-making.

Estimation of life expectancies and loss-of-life expectancies for workers with permanent occupational disabilities of the extremities--a 21-year follow-up study.

OBJECTIVES: This study aims to estimate the life expectancies and loss-of-life expectancies of workers with permanent occupational disabilities of the upper and lower limbs in Taiwan. METHODS: We collected all cases of permanent occupational disability in the upper and lower limbs from the Bureau of Labor Insurance database of compensation claims between 1986-2006; these data were linked with the national mortality registry to obtain a survival function. Workers were divided into eight groups according to their injury types, three of which fulfilled the condition of constant excess hazard and the survival functions were extrapolated to 50 years using a semi-parametric method. RESULTS: Of the subjects involved in the study, 1016 with toe amputations, 995 with foot or leg amputations, and 4339 with foot or leg non-amputations showed a life expectancy of 1.8 [95% confidence interval (95% CI) -1.3- -4.9], 4.9 (95% CI 2.2- -7.6), and 4.5 (95% CI 2.1- -6.9) years, respectively. The above method was validated by extrapolating partial cohorts based on the first 10 years of follow-up data to 21-year and comparing actual survival rates using the Kaplan Meier method. The relative bias of three groups was <8%. CONCLUSIONS: The semi-parametric extrapolation method is a feasible and accurate approach for projecting life expectancy and expected years of life lost for groups with occupational amputations of the lower extremities. The value of life lost among these groups should be considered when determining compensation for these workers and assessing the cost-effectiveness of preventive occupational health services.

Health impact of pneumoconiosis in Mongolia: estimation of losses in life expectancy and quality adjusted life expectancy.

OBJECTIVE: To estimate the life expectancy (LE), quality-adjusted life expectancy (QALE), and their losses, in patients with pneumoconiosis in Mongolia. METHODS AND MATERIALS: All patients (n = 432) diagnosed with occupational pneumoconiosis during 1986-2006 were recruited from the registry of the National Research Center of Occupational Diseases, which was linked to the National Mortality Registry of Mongolia to obtain the survival function. We simulated age and gender matched referents group based on the life table in 2000. The survival ratio between patients and referents was used to extrapolate and calculate the LE. The average expected years of life loss (EYLL) of pneumoconiosis were calculated as the mean survival difference between patients and referents. We adopted utility values for workers with pneumoconiosis and multiplied them with the survival function to estimate the QALE, which was then used to calculate the loss of QALE. RESULTS: The life expectancy and EYLL of a patient with pneumoconiosis were 18.1 and 9.5 years respectively. QALE and loss of QALE were 15.1 and 12.5 QALYs (quality-adjusted life years), respectively, indicating a health gap of 45%. CONCLUSION: The health inequality suffered by miners in Mongolia must be addressed through prevention, including exposure monitoring and control, early diagnosis and case management and rehabilitation of pneumoconiosis.

Comparison of the quality of life between patients with non-small-cell lung cancer and healthy controls.

PURPOSE: We explored covariates of the quality of life (QOL) in non-small-cell lung cancer (NSCLC) patients and made a comparison with healthy controls. METHODS: We assessed the QOL of 220 consecutive NSCLC patients at a university hospital. The QOL data were measured by the brief version of the World Health Organization's Quality of Life and by utility using the standard gamble method. We selected demographically matched healthy controls from the 2001 National Health Interview Survey for comparison. Multiple linear regression models were constructed to explore significant factors of QOL after controlling for covariates. RESULTS: Patients with more advanced stages of NSCLC had poorer scores than did the healthy controls in the physical and psychological domains. Patients with disease duration of longer than 1 year tended to report higher physical and environment QOL than did those with NSCLC diagnosed for less than 1 year. Insight into one's own illness was associated with a higher utility, better social support, and improved financial resources. CONCLUSIONS: QOL was significantly associated with staging and duration of NSCLC. Disease insight appears to be a positive factor for operable NSCLC patients of the Taiwanese culture, which implies that clinicians should respect patient autonomy in diagnosis disclosure.

Mortality from liver cancer and leukaemia among polyvinyl chloride workers in Taiwan: an updated study.

OBJECTIVES: To investigate types of cancer caused by occupational exposure to vinyl chloride monomer (VCM) and the temporal mortality trends of these cancers in workers from polyvinyl chloride (PVC) manufacturing factories in Taiwan, with follow-up of the cohort extended by 15 years, from 1980 to 2007. Methods A retrospective cohort study of workers from six PVC factories in Taiwan was conducted. 3336 male PVC workers were enrolled and further linked with the National Mortality Registry and National Household Registry databases. Standardised mortality ratios (SMR) with 95% CIs were calculated and compared to the general Taiwanese male population. Cause-specific mortality between two study periods, 1980-1997 and 1998-2007, was compared. Six-year moving averages of the SMRs were calculated to examine mortality trends. RESULTS: Liver cancer mortality increased during 1989-1994 (SMR 1.90, 95% CI 1.01 to 3.25), reached a peak during 1991-1996 (SMR 2.31, 95% CI 1.39 to 3.61) and became non-significant during 1994-1999 (SMR 1.42, 95% CI 0.80 to 2.34). Leukaemia mortality significantly increased during 1984-1989 (SMR 6.06, 95% CI 1.24 to 17.53), reached a peak during 1985-1990 (SMR 7.56, 95% CI 2.06 to 19.35) and became non-significant during 1991-1996 (SMR 3.24, 95% CI 0.39 to 11.69). The mortality trend for haemolymphopoietic cancer showed a similar pattern to that of leukaemia. CONCLUSIONS: VCM may increase the risk of liver cancer and leukaemia. When VCM exposure was controlled at worksites, mortality from these cancers returned to background levels.

Working the night shift causes increased vascular stress and delayed recovery in young women.

Shiftwork has been associated with elevated blood pressure (BP) and decreased heart-rate variability (HRV), factors that may increase the long-term risk of cardiovascular-related mortality and morbidity. This study explored the effect of shiftwork on dynamic changes in autonomic control of HRV (cardiac stress), systolic BP and diastolic BP, i.e., SBP and DBP (vascular stress), and recovery in the same subjects working different shifts. By studying the same subjects, the authors could reduce the effect of possible contribution of between-subject variation from genetic predisposition and environmental factors. The authors recruited 16 young female nurses working rotating shifts--day (08:00-16:00 h), evening (16:00-00:00 h), and night (00:00-08:00 h)--and 6 others working the regular day shift. Each nurse received simultaneous and repeated 48-h ambulatory electrocardiography and BP monitoring during their work day and the following off-duty day. Using a linear mixed-effect model to adjust for day shift, the results of the repeated-measurements and self-comparisons found significant shift differences in vascular stress. While working the night shift, the nurses showed significant increases in vascular stress, with increased SBP of 9.7 mm Hg. The changes of SBP and DBP seemed to peak during waking time at the same time on the day off as they did on the working day. Whereas HRV profiles usually returned to baseline level after each shift, the SBP and DBP of night-shift workers did not completely return to baseline levels the following off-duty day (p < .001). The authors concluded that although the nurses may recover from cardiac stress the first day off following a night shift, they do not completely recover from increases in vascular stress on that day.

Life expectancy, expected years of life lost and survival of hemodialysis and peritoneal dialysis patients.

BACKGROUND: Expected years of life lost (EYLL) in dialysis patients are rarely discussed. This study compared life expectancy, EYLL and survival between hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS: Adults who underwent maintenance dialysis at National Taiwan University Hospital from 1995 to 2006 were followed up until December 2007. Kaplan-Meier analysis and a constant excess hazard model were used to estimate and project long-term survival. EYLL was calculated by subtracting the life expectancy of patients from that of age- and sex-matched referents. HD patients were then matched with PD patients on age, sex and diabetes mellitus (DM). Life expectancy, EYLL and survival between the 2 groups were compared. Mortality risks were determined by the Cox model. RESULTS: Before matching, the 305 HD patients were older than the 428 PD patients (62.4 ± 13.7 vs. 53.1 ± 16.7 years; p<0.0001). More HD patients had DM (HD vs. PD, 29.2% vs. 20.6%; p=0.0072). Life expectancy and EYLL of HD patients were 8.8 and 11.5 years, compared with those of PD patients (19.9 and 7.4 years). After matching, life expectancy (p=0.790) and EYLL (p=0.793) of both groups (236 patients each) were similar. Age (adjusted hazard ratio [AHR] = 1.07; 95% confidence interval [95% CI], 1.05-1.09) and DM (AHR=3.81; 95% CI, 2.28-6.36) were independent mortality predictors. For diabetic patients who underwent HD, a better survival rate was observed (AHR=0.24; 95% CI, 0.11-0.53). CONCLUSIONS: After matching, HD and PD patients had similar life expectancy and EYLL. Survival was better for diabetic patients if they received HD.

Increased mortality risk for workers with a compensated, permanent occupational disability of the upper or lower extremities: a 21-year follow-up study.

This 1986-2006 study sought to determine whether specific causes led to increased mortality risks for Taiwanese workers with an approved compensation claim for permanent occupational disability (ACCPOD) of the upper or lower extremities. All cases of ACCPOD between 1986 and 2006 were collected from the database of compensation claims at the Bureau of Labor Insurance. Standardized mortality ratios and 95% confidence intervals were calculated for different causes of death among workers with an ACCPOD of the upper or lower extremities. A total of 800,047 person-years were accrued for 71,001 workers with a single type of disability. Standardized mortality ratios were significantly increased for all causes, including liver cirrhosis, injuries, and intentional self-harm. Standardized mortality ratios for workers with amputations of the lower extremities increased to 7.66 (95% confidence interval (CI): 5.36, 10.61), 2.40 (95% CI: 1.44, 3.75), 2.07 (95% CI: 1.03, 3.70), and 5.09 (95% CI: 2.20, 10.03) for those with diabetes mellitus, cerebrovascular disease, liver cirrhosis, and chronic renal failure, respectively. The authors concluded that workers with occupational disabilities involving an upper or lower extremity should be assisted to prevent further injuries or intentional self-harm, whereas those with lower limb amputations should be provided care related to proactive control of diabetes mellitus and associated complications during rehabilitation.