Epidemiological trends of childhood tuberculosis in Taiwan, 1998-2005.

SETTING: Understanding tuberculosis (TB) epidemiology among children is critical to overall TB control. OBJECTIVE: To investigate the trends and epidemiological and clinical characteristics of TB in children aged 0-14 years in Taipei City, Taiwan. DESIGN: Data on all childhood TB cases in Taipei City from 1998 to 2005 were obtained from the National Tuberculosis Registry Database. RESULTS: TB incidence rates increased significantly in both adults and children aged 0-14 years during the study period. The age-specific rate in children was highest in 10-14-year-olds and lowest in the 5-9 years age group. Of the 163 childhood TB cases, 52 cases (31.9%) were extra-pulmonary, with the highest proportional rate, of 39.6%, in the 0- 4 years age group. The most common site of extra-pulmonary involvement was the lymph nodes, followed by the bones and joints and the pleura. Bone and joint involvement occurred significantly more often in children aged 0- 4 years, while pleural disease was significantly more frequent in children aged 10-14 years. Only two cases of TB meningitis were identified. CONCLUSIONS: The increase in childhood TB may be associated with the increase in the incidence of the disease in adults. Identifying and treating infectious sources, usually adults, can reduce the risk of TB exposure in children.

Epidemiology and control of tuberculosis in Taipei.

OBJECTIVES: This retrospective study evaluated epidemiological trends in tuberculosis and the performance of a TB control program in Taipei. METHODS: Data of all recorded tuberculosis cases from 1994 through 2000 obtained from the Tuberculosis Registry Center was used to analyze the trend of incidence. Tuberculin skin tests were also performed to estimate the prevalence and annual risk of tuberculosis infection in second-grade schoolchildren during the period 1996-1999. The management cards for all tuberculosis patients from 1992 to 1996 obtained from Taipei Municipal Chronic Disease Hospital were also reviewed. RESULTS: The results show that incidence of tuberculosis had an increasing trend during the study periods with an average annual increase of 7.73% and 9.93% for males and females, respectively. Age-specific incidence showed a similar trend with a clear predominance of cases occurring in patients aged 25-34 and 65+ years. This bimodal pattern became more apparent in 2000. In second-grade schoolchildren, the annual risk of tuberculosis infection was approximately 0.68% with a decreasing trend over the study period. The relatively low cure rate of TB, averaging 47.2%, did not change significantly during the study period. Cure rate was significantly associated with patient's age, patient status as a new or recurrent case, and the development of side effects due to treatment with antituberculosis drugs. CONCLUSIONS: Because of the low overall cure rate of 47.2%, this region of Taipei remains high TB rates. The inefficiency of the existing tuberculosis control program is largely to blame for the alarmingly high rates. The high percentage of recurrent cases and of cases in individuals aged 25-34 and older than 65 present a severe challenge to effective management and form a chronic pool of infectious cases. Our findings suggest that in order to achieve the WHO target of cure in 85% of TB cases, focusing effort on the identification and treatment of these groups is mandatory.

Coronary heart disease risk factors in urban bus drivers.

The purpose of this study was to determine the risk factors for coronary heart disease (CHD) in 2297 bus drivers and skilled workers from the Taipei Municipal Bus Administrative Bureau. Data for this study were compiled from the medical records of annual physical examinations for bus drivers and skilled workers conducted at Taipei Municipal Chronic Disease Hospital during the period from July 1998 to June 1999. The results showed that, after adjustment for age, hypertension rates for bus drivers (56.0%, 986/1361) were significantly greater than for skilled workers (30.6%, 164/536). All age groups demonstrated a similar difference. Significant differences were also noted in body mass index, serum cholesterol, serum triglyceride and ischemic heart disease between bus drivers and skilled workers. Among bus drivers, the prevalence of obesity was 9.6%, hypercholesterolemia 34.0%, hypertriglyceridemia 69.4% and ischemic heart disease 1.7%. By contrast, among skilled workers, the prevalence of obesity was only 4.6%, hypercholesterolemia 29.9%, hypertriglyceridemia 30.6% and ischemic heart disease 0.9%. These findings suggest that exposure to the occupation of driving a bus may carry an increased risk of CHD and that drivers who develop signs of cardiovascular illness should be transferred to non-driving occupations within the company.

Continuous radiographic visualization of the mandibular nutrient canals.

The continuous radiographic appearance of the course of mandibular nutrient canals (NC), originating from the incisive branch of the inferior alveolar neurovascular bundle bilaterally, showing anastomoses and terminating in the interdental area of the anterior teeth, is reported for the first time.

Drug-resistant tuberculosis in Taipei, 1996-1999.

OBJECTIVES: To determine the trends, patterns, and risk factors associated with drug-resistant tuberculosis, we conducted a hospital-based retrospective study in Taipei. METHODS: Clinical and bacteriologic data were routinely collected from 453 patients with a diagnosis of tuberculosis who were treated at Taipei Municipal Chronic Disease Hospital from January 1996 through December 1999 for whom drug-susceptibility testing was done. RESULTS: Resistance to at least one drug was identified in 154 (34%) out of the 453 patients, and 34 (7.5%) patients were resistant to at least isoniazid and rifampin. Among the 199 patients with recurrent tuberculosis, 98 (49.2%) had isolates that showed resistance to at least one drug. Among the 254 new patients, 56 (22.0%) had isolates that were drug resistant. For all 453 patients, resistance to rifampin was most common (17.4%), followed by resistance to isoniazid (13.9%), streptomycin (13.7%), ethambutol (8.2%), and kanamycin (3.5%). A history of previous tuberculosis therapy (odds ratio = 9.4; 95% CI, 2.9-28) and being born outside of Taiwan (odds ratio 3.3; 95% CI, 1.1-34) were significant risk factors for multidrug resistance. CONCLUSIONS: Our data suggest that the Taipei tuberculosis control program should be rapidly strengthened by expanded use of directly observed therapy and more careful bacteriologic and clinical follow-up, particularly in cases of recurrence and in persons born outside of Taiwan in tuberculosis endemic areas. Our results also indicate that the regular measuring of rates of drug resistance and the monitoring and guiding of tuberculosis treatment programs could increase the therapeutic response rate and prevent the appearance of newly acquired resistance in patients with tuberculosis. In addition, with high rifampin resistance (17.4%), the regulated market for rifampin is essential in Taiwan.

Tuberculosis transmission in the family.

OBJECTIVE: To evaluate the risk of tuberculosis (TB) transmission from family members with infectious TB to other family members, and to examine whether household contact investigations had an impact on tuberculosis patterns. DESIGN: Under the direction of the Taipei Municipal Chronic Disease Hospital, 12 full-time public health nurses recruited the household contacts of TB patients. Chest X-ray examination was recommended for adult contacts. Child contacts received the Mantoux tuberculin skin test, and radiography was recommended if the results were positive. SETTING: Family contacts of all TB index patients who attended one of 29 hospitals in Taipei, from July 1993 through June 1996. The medical records of index patients were obtained from the National Tuberculosis Registry. RESULTS: During the study period, the families of 3903 index patients, comprising 11873 contacts, were investigated. Among these, 4595 received radiography, for a response rate of 38.7%. Of these, 284 had active pulmonary disease: 188 (66.3%) had minimal disease, 79 (27.8%) had moderately advanced disease, and only 17 (5.9%) had far advanced disease. Overall, the index patients had more advanced TB: only 1261 (32.3%) had minimal disease, while 2022 (51.8%) had moderately advanced disease and 620 (15.9%) had far advanced disease. CONCLUSIONS: These data show a relatively high risk of intrafamily TB transmission. Our findings also show that family contact investigations may help to diagnose TB in earlier stages. Such an approach should greatly reduce the number of new TB cases and speed eradication of the disease.

Two-step tuberculin testing of passengers and crew on a commercial airplane.

OBJECTIVES: We investigated the risk of tuberculosis transmission from a person with highly infectious pulmonary tuberculosis to fellow passengers and crew members on a 14-hour commercial flight. The 2-step tuberculin testing was used to minimize the effects of the booster phenomenon. METHODS: Passengers and flight crew members identified from airline records were contacted by letter, telephone, or both to notify them of their potential exposure to Mycobacterium tuberculosis. The subjects were advised to undergo Mantoux tuberculin skin testing within the required time period to assess a conversion. In addition, information regarding tuberculosis history and other sources of potential exposure was solicited by means of a questionnaire. RESULTS: Of the 277 passengers and crew members on the aircraft, 225 (81.2%) responded. Of these, 173 (76.9%) had positive tuberculin results on the first test (induration > 10 mm). Thirteen subjects with negative results refused further testing; 11 (28%) of the remaining 39 exhibited the booster phenomenon on the second test. Subjects who exhibited the booster phenomenon were significantly more likely to have received previous BCG vaccination. Nine contacts with negative results on the initial test had positive results on a third test administered at 12 weeks after the flight exposure Of these, 6 contacts had previous BCG vaccination, old tuberculosis, or a family member with tuberculosis; the remaining 3 reported on other risk factors for positive reactions. None of these 3 contacts had sat in the same section of the plan as the index patient. CONCLUSIONS: The 2-step tuberculin testing procedure is an effective tool for minimization of the booster effect, thus allowing accurate monitoring of subsequent tuberculin conversion rates. Moreover, the clustering of tuberculin skin test conversions among passengers in this study demonstrates the possible risk of M tuberculosis transmission during air travel.

Bilateral mandibular accessory foramina and canals: a case report and review of the literature.

OBJECTIVES: To present a case of bilateral mandibular accessory canals and foramina observed on CT and review the relevant literature. RESULTS: Based on the literature, accessory canals and foramina are prevalent in the posterior mandible and the area of the symphysis and more frequently on the internal than the external surface of the mandible. Bilateral symmetry is common. Variations exist in size and number. Occurrence may change with age and racial origin. Nerves, neurovascular bundles, arterioles and venules have been found to occupy the accessory canals and foramina. No gender differences have been described. CONCLUSION: CT has advantages over two-dimensional radiography in identification of anatomical variations in the mandible.

Perinatal mortality in Taiwan.

Information on perinatal deaths was obtained from 310 women by collecting detailed obstetric histories dating from marriage to the start of the survey. These histories were compared to those of 688 age matched controls. Potential risk factors, levels and time trends of perinatal mortality in Taiwan were examined and factors underlying stillbirths and early neonatal deaths were also compared using conditional logistic regression analyses. A nearly 56% decline of the perinatal mortality rate during the 35 y, approximately, prior to the survey was observed. Risk of stillbirths was increased among those who had abused illegal drugs during pregnancy, those who reported that the pregnancy was unwanted and those with Thalassemia trait. Body mass index was log-linearly related with stillbirths, with higher body mass associated with higher risk. For early neonatal deaths, those mothers aged 19 y or less, those giving birth to either their first children or to their fifth or later child, those who had their first prenatal care visit after the first three months of pregnancy were associated with increased risk in the logistic model. Those with a birth interval of less than two years and those with less education were associated with increased risk in both perinatal death groups. While some of these factors have already been associated with perinatal deaths, others have not; the new associations provide clues to mechanisms by which the risk of death increases before or after delivery.

PIP: Each year in Taiwan, there are approximately 320,000 live births and more than 6400 deaths during the perinatal period. In many cases, the cause of death is unknown. To determine whether there are subgroups of the Taiwanese population which are at increased risk of perinatal death and to attempt to provide appropriate preventive measures, the authors conducted a randomized case-control study to compare the similarities and differences in the underlying causes of stillbirths and neonatal deaths. Findings are based upon data obtained for women attending family planning services in Taipei between July 1991 and December 1992. Data on perinatal mortality were obtained from 310 women by collecting detailed obstetric histories dating from marriage to the start of the survey. Those histories were then compared to those of 688 age-matched controls. Potential risk factors, levels, and time trends of perinatal mortality in Taiwan were examined, and factors underlying stillbirths and early neonatal deaths compared using conditional logistic regression analyses. When all perinatal deaths were considered, maternal age of 19 years or less, birth interval of less than 2 years, maternal attitude toward unwanted pregnancy, being a mother with Thalassemia trait, and high body mass all appeared to increase the risk of perinatal mortality. Illegal drug use during pregnancy was suggestive of increased perinatal death risk. A relatively higher educational status and maternal age of 30 years or higher, however, had protective effects.

Age-period-cohort analysis of cervical cancer mortality in Taiwan, 1974-1992.

OBJECTIVES: To develop a hypothesis about the carcinogenesis of cervical cancer from a descriptive analysis. METHODS: The mortality data of cervical cancer were analyzed over the period from 1974 to 1992 among Taiwanese women using a log-linear Poisson model modified from the method of Osmond and Gardner to examine the effects of age, calendar period of death, and birth cohort on cervical cancer mortality. RESULTS: This age-period-cohort model provides a summary guide for interpretation of cancer mortality trends. According to this model, age was found to be the strongest factor predicting cervical cancer mortality. Women in 50-54 age group have 89.3-fold risk of cervical cancer compared to those in the 30-34 age group. The cohort effect is also of particular interest because the generation at greatest risk for cervical cancer is the one born between 1893 and 1938, and a dramatically declining trend is observed thereafter for 1938-1963 birth cohort. Interest has emerged about the increasing trend in recent cohorts (after 1963 birth cohort). However calendar time only has a slight effect in the APC analysis. The model also identified a possible role of female sex hormones as the age effect, promiscuous sexual activity as the period effect (promoter) and the change in reproductive behavior as the cohort effect (initiator). CONCLUSIONS: These results may help to develop a hypothesis of carcinogenesis of cervical cancer in Taiwan.

Epidemiology of cervical cancer in Taiwan.

Because the prevalence of several risk factors for cervical cancer, including sexual behavior, reproductive patterns, contraceptive use, and cigarette smoking, has changed significantly over time among Taiwanese women, it is of interest to analyze the impact of these trends on the incidence and mortality rates for this cancer during the decades between 1970 and 1990. The number of deaths from cervical cancer was obtained from the Taiwan Provincial Department of Health during the period from 1974 to 1992. Data of all incident cervical cancer cases from 1979 through 1990 obtained from the Taiwan Cancer Registry were also used for the analyses. The trends in the age-adjusted and age-specific rates were examined. Age, period, and cohort effects on the incidence and mortality rates were also examined, using age-period-cohort (APC) models. The age-adjusted mortality rate has been increasing since the 1970s, particularly in both the youngest group (20-29 years) and the oldest group (65 years and over). While the age-adjusted incidence rate decreased from 1979 to 1990, and decreases were apparent across all broad age groups, nevertheless, the incidence of adenocarcinoma was moderating during the same time period. The APC models disclosed a decreasing cohort effect for the mortality and incidence rates among women born after 1936. Decreasing incidence rates after menopause were more consistent with a hormonal effect than a cohort effect. Declining trends in cervical cancer incidence may be related to the screening practices which may have counteracted the increasing prevalence of several risk factors, although poor survival influenced the incidence/mortality differentials for cervical cancer. Continued surveillance is warranted; however, attention might be directed to the trends in cervical adenocarcinoma.

Risk factors for cervical intraepithelial neoplasia in Taiwan.

A population-based case-control study was conducted in Taiwan between July 1991 and June 1994 to evaluate the significance between risk factors for cervical intraepithelial neoplasia (CIN) among Taiwanese women. Personal interviews were compiled with 288 histologically confirmed CIN who were matched by age to 576 randomly selected controls with normal cervical smears. Using logistic regression models to simultaneously evaluate the effects of multiple factors as predictors of CIN, we found that the strongest risk was associate with HPV infection (OR = 5.02). Other significant risks included husband's visiting prostitutes (OR = 2.56), four or more vaginal deliveries (OR = 2.01), two or more induced abortions (OR = 1.96), and multiple sex partners (OR = 1.87). A protective effect was also noted with the use of condoms (OR = 0.38). These data support the hypothesis that CIN is sexually transmitted in Taiwan's population and may have a viral etiology. Furthermore the results indicate the important role of the husband's visiting prostitutes and the nonuse of condoms as contributing factors in the high incidence rate for CIN in a population.

Sociodemographic factors of Pap smear screening in Taiwan.

Substantial evidence exists that regular screening is effective in preventing cervical cancer. However, the existing services are underused by many women in Taiwan. To examine the effects of sociodemographic characteristics on the underuse of Papanicolaou (Pap) smear screening, from September to December 1993 we conducted a questionnaire interview on a sample of 4,400 women aged 20 years and older in Taipei city using multistage sampling with probability proportional to size. Our results indicate that 40% of the women sampled have never had a Pap smear and 86% have not had one in the past year. Age is the strongest factor affecting Pap smear use, particularly for women below age 30 and over the age of 65. In addition, women with lower levels of education, women who are not employed, never-married women and women who live outside the city tend to underuse Pap smear screening. These findings help indicate priority groups which should be targeted to increase screening and consequently reduce cervical cancer. Our data also provides a good baseline for comparison of rates of Pap smear screening by various sociodemographic factors in the future.

PIP: This study determined the extent of Pap smear screening and identified the determinants of Pap smear screening among a probability sample of women in the greater Taipei area of northern Taiwan. The sample includes 3564 women interviewed during September-December 1993. Findings show that about 40% of women aged 20 years and older reported never having had a Pap smear. 86% did not have a Pap smear within the last year before the survey. Almost 30% of women aged under 20 years had never been screened compared to 18% among women aged 40-49 years. Other significant determinants of a lack of screening were residence in the southern part of the urban area, a lower level of education, unemployment status, and an unmarried status. Sociodemographic characteristics varied between women who had never had a Pap smear and women who had not had one in the past year. Women aged 65 years and older were 13 times more likely not to have had a Pap smear in the past year compared to women aged under 30 years. Not having a recent Pap smear was associated with women who were descended from mainlanders only in the bivariate model. A higher level of education was related negatively to never having had a Pap smear. Unemployment was more strongly related to the lack of a recent smear. An illiterate woman had the greatest risk of never having been screened in the multivariate model. Age was the most important factor in determining Pap smear use. Findings differ from the findings of Hayward et al. particularly for women in the younger age group and confirm the findings of Swan et al. Findings were consistent with other studies showing that women aged 65 years and older were a risk group that needed targeting.

Epidemiologic differences between candidial and trichomonal infections as detected in cytologic smears in Taiwan.

The epidemiologic differences between cytology-detected candidial and trichomonal infections were assessed in 15,933 women attending the 12 district health centres in the Taipei area and a consecutive 1114 patients, visiting venereal disease clinics, whose smears were screened for cervical cancer between July 1991 and December 1992 in Taipei. The Pap smears were examined for the presence of specific organisms, such as trichomonas vaginalis, vaginal candida, herpes simplex virus, human papillomavirus, actinomyces, leptothrix, aspergillu, gardnerella and others. More emphasis was placed on the candidial and trichomonal infection in inflammatory Pap smears. The overall prevalence of candidial and trichomonal infections was 3.40% and 1.88%, respectively. There were striking differences in the prevalence of trichomoniasis ranging from 1.74% in the district health centre population to 3.77% in the venereal disease clinic patients; however, the prevalence of candidial infection remained the same (3.40%) in these two distinct population groups. Indices of socioeconomic status--education and personal hygiene--showed an inverse association with the prevalence of trichomoniasis but a positive correlation with candidiasis. Among participants, younger age (< 20 years old) was independently associated with candidial (OR = 1.95) and trichomonal (OR = 3.87) infections. No sexual behavioural factors were associated with candidial infection in this study; however, having multiple sexual partners (OR = 5.07) was associated with a significantly elevated risk of trichomoniasis, while using condoms was associated with a diminished risk (OR = 0.38). The presence of candidiasis and trichomoniasis was highly associated with abnormal cytologic findings, particularly those indicative of inflammation. There was little evidence that findings suggestive of cervical cancer could be attributed to either candidial or trichomonal infections. These data suggest that trichomoniasis is consistent with venereal transmission of the disease, but transmission by contaminated objects cannot be ruled out because there is an increased relation between trichomoniasis infection and socioeconomic conditions and personal hygiene. Elucidation of such differences may be helpful in designing different strategies to control these infections. Furthermore, the findings can provide a good baseline of prevalence for investigating the relationship between these two pathogens and cervical dysplasia.

PIP: During July 1991-December 1992, in Taiwan, health workers collected cervical smears from 15,933 women attending 12 district health centers and from 1114 consecutive patients visiting a sexually transmitted disease (STD) clinic in the Taipei region. Researchers focused on the 320 women with trichomoniasis (1.88%) and the 580 women with candidiasis (3.4%) to examine the epidemiologic differences of the two infections, particularly their socioeconomic and sexual behavior factors. The prevalence of candidiasis was the same for both the district health centers and the STD clinics (3.4%), while trichomoniasis was more prevalent at the STD clinics than the district health centers (3.77% vs. 1.74%; p 0.001). The multivariate logistic regression revealed that adolescence was a significant independent risk factor for both candidiasis (odds ratio [OR] = 1.95) and trichomoniasis (OR = 3.87) (p 0.05 and 0.01, respectively). There were no other significant independent risk factors for candidiasis. Other significant independent risk factors for trichomoniasis were: more than one sexual partner (OR = 5.07; p 0.01); primary education or illiteracy (OR = 1.86; p 0.05); and poor genital hygiene (OR = 1.46; p 0.05). Condom use had a protective effect for trichomoniasis (OR = 3.8; p 0.05). Candidial and trichomonal infections were both greatly associated with cervical inflammation (28.41% and 16.59%, respectively) but not with cervical cancer (0 cases). These findings suggest that sexual transmission contributes to trichomoniasis but not to candidiasis and that socioeconomic conditions and poor personal hygiene also contribute to trichomoniasis.

Prevalence of goiter in school children in the Wan-Hwa district of Taipei.

Salt has been iodized in Taiwan since 1967. To understand goiter status after salt iodization, we studied the prevalence of goiter in school children in rural areas where tap water or underground water are used. To further elucidate the prevalence of goiter in urban areas where tap water is used, we studied school children from the Tong-Yuan and Lao-Song elementary schools located in the Wan-Hwa District of Taipei. Thyroid enlargement was examined by palpation as recommended by the World Health Organization. Thyroid antibodies and hormones were determined in school children with goiter and in age- and sex-matched normal control children using particle agglutination methods and radioimmunoassay. A total of 4,623 school children were examined. Of these, 129 children (2.8%) had goiters of grade I or above, or nodular goiters. The prevalence of goiter was similar to that of Putai and Peimen in southern Taiwan where tap water is used, but less than that of Tachia and Chingshuei in middle Taiwan where underground water is used. The prevalence of goiter was much lower than recent studies in Tung-Lo, an oil-bearing area in middle Taiwan, where there was a 12.9% prevalence in school children residing in hill districts who relied on underground water for drinking purposes, and 8.2% in school children residing on lower plains, who depended upon tap water for drinking purposes. The prevalence of goiter is highly related to the quality of drinking water.(ABSTRACT TRUNCATED AT 250 WORDS)

Induced abortion in Taiwan.

Induced abortion is widely practised in Taiwan; however, it had been illegal until 1985. It was of interest to investigate induced abortion practices in Taiwan after its legalization in 1985 in order to calculate the prevalence rate and ratio of induced abortion to live births and to pregnancies in Taiwan. A study using questionnaires through personal interviews was conducted on more than seventeen thousand women who attended a family planning service in Taipei metropolitan areas between 1991 and 1992. The reproductive history and sexual behaviour of the subjects were especially focused on during the interviews. Preliminary findings showed that 46% of the women had a history of having had an induced abortion. Among them, 54.8% had had one abortion, 29.7% had had two, and 15.5% had had three or more. The abortion ratio was 379 induced abortions per 1,000 live births and 255 per 1,000 pregnancies. The abortion ratio was highest for women younger than 20 years of age, for aboriginal women and for nulliparous women. When logistic regression was used to control for confounding variables, we found that the number of previous live births is the strongest predictor relating to women seeking induced abortion. In addition, a significant positive association exists between increasing number of induced abortions and cervical dysplasia.

PIP: Induced abortion practices were investigated in Taiwan the 1985 legalization of abortion in order to calculate the prevalence rate and ratio of induced abortion to live births and to pregnancies. This study used questionnaires through personal interview that were administered on 17,047 consecutive women who attended a family planning service at one of 12 local health centers in the metropolitan area of Taipei between July 1991 and December 1992. Cross-tabulations were performed using a SAS package. In addition, the Mantel-Haenszel Chi-square test for trends and a logistic regression test were used when applicable. Preliminary findings showed that 46% of the women had a history of an induced abortion. Among them, 54.8% had had 1 abortion, 29.7% had had 2, and 15.5% had had 3 or more. The abortion ratio was 379 induced abortions per 1000 live births and 255 per 1000 pregnancies. The abortion ratio was highest for women 19 years or younger (539.68/1000 live births) compared with 463.99/1000 for those 20-24. Ethnic specific abortion ratios were the highest (599.06) for the aboriginal group and the lowest (369.67) for the Taiwanese group (p 0.0001). The ratio was also high for nulliparous women. Age-specific induced abortion ratios showed an inverse relationship between induced abortions and age. The ratios for employed and unemployed were 440.50 and 347.79 respectively (p 0.01). Women with higher sexual activity faced a greater chance to have an induced abortion (p 0.001). Illiterate women had the lowest abortion ratio, while women who had completed senior high school had a greater tendency to have induced abortions. Women who worked outside the home were much more likely to have an induced abortion than those who did not. There was a significant relationship between the increasing number of induced abortions and cervical dysplasia (p 0.01). Logistic regression indicated that the odds ratio was the strongest (14.38) for having had an induced abortion between women with 1 or fewer live births vs. those with 2 or more.

Sexual activity of women in Taiwan.

In this paper, we calculate a base line of statistical data on the frequency of sexual activity at various ages of Taiwanese women. A cross-sectional study using questionnaires administered during personal interviews was conducted on more than seventeen thousand women who attended family planning clinics in the Taipei metropolitan area in 1991 and 1992. Of the women surveyed, 2.8 per cent were sexually inactive in the previous month, 83.67 per cent had intercourse one to nine times in the previous month, and 13.56 per cent had intercourse ten times or more. The mean frequency of sexual activity was 6.8 times a month. Age-specific mean coital frequencies for the age groups of less than 25 years, of 25-34 years, and of 35-44 years were 10.3, 7.3, and 6.6 times per month, respectively. Increased sexual frequency was associated with the following factors: young age, unmarried, lower educational level, fewer years of marriage and being on the pill. When logistic regression was used to control for confounding variables, we found that a woman's age is the most significant factor in predicting her sexual frequency.

PIP: Between July 1991 and December 1992 in Taiwan, public health nurses interviewed 17,047 women aged 16-92 years attending family planning clinics at 12 local health centers in metropolitan Taipei to gather baseline data on frequency of sexual intercourse among Taiwanese women and to describe social and demographic characteristics associated with coital frequency. The mean number of acts of sexual intercourse was 6.8/month. The age-specific mean of coital acts/month was 10.3 for women aged less than 25, 7.3 for women aged 25-34, and 6.6 for women aged 35-44. 2.8% of the women had not had sexual intercourse in the last month. 83.64% had had sexual intercourse 1-9 times in the last month. 13.56% had had intercourse at least 10 times. Sexual activity in the last month decreased with age (99.65% for age 25 years; 98.94% for age 35-39; 94.75% for age 45-49; 68.15% for age 55-59; 58.6% for age 60-64; and 40% for age 65 or older; p 0.0001). Unmarried women engaged in sexual intercourse more frequently in the last month than married women (14.2 vs. 6.4; p 0.0001). Married women were much less likely to have intercourse at least 10 times in the last month than unmarried women and divorced/separated women (9.88% vs. 54.15% vs. 38.91%; p 0.0001). The higher the educational status, the greater sexual activity was in the last month (p 0.01). Women with at least a college education were more likely to be sexually active in the last month than those with no education (98.86% vs. 83.46%; p 0.0001). As the years of marriage increased, the mean coital frequency decreased (7.8 for 1 year, 6.9 for 5 years, 6.4 for 11-15 years, 3.7 for 26 or more years; p 0.001). Oral contraceptive users were more likely to have sexual intercourse often than women using no or other family planning methods (9.4 vs. 5.8-7.3 acts/month; p 0.0001). When researchers controlled for confounding variables, age was the most significant predictor of frequency of sexual intercourse (regression coefficient for age 35-49 = -1.5808; odds ratio = 0.21; p 0.0001).

Ridge augmentation using a subepithelial connective tissue pedicle graft.

The deficient labial ridge can present aesthetic problems for the patient and technical problems for the restorative dentist. The learning objective of this report is a technique for obtaining connective tissue from an adjacent donor site in the form of a pedicle and positioning it beneath a partial thickness flap. The technique offers advantages over previous methods in terms of patient comfort, vascularization of the graft, and specific placement of the grafted connective tissue.

Drug metabolising N-acetyltransferase activity in human cell lines.

Many arylamine and hydrazine drugs and xenobiotics are acetylated by N-acetyltransferase (NAT), a cytosolic enzymic activity which has a wide tissue distribution. Humans can be classified as either fast or slow acetylators on the basis of their ability to metabolise isoniazid or sulphamethazine. These are termed polymorphic substrates. The acetylation of other compounds does not vary amongst individuals, e.g., p-aminobenzoic acid, and are termed monomorphic substrates. NAT from human hepatic and non-hepatic tissues, viz., (i) liver, (ii) the hepatoma cell line HepG2, (iii) tonsil lymphocytes and (iv) the monocytic cell line U937 have been compared with respect to substrate specificity towards polymorphic and monomorphic substrates. The chromatographic and centrifugation behaviour of NAT from these sources has also been investigated. NAT from liver shows 2-fold greater activity towards sulphamethazine than towards p-aminobenzoic acid as substrate. All other cell types tested show at least 70-fold greater activity with p-aminobenzoic as substrate compared to sulphamethazine. NAT from HepG2 cells, U937 cells and tonsil lymphocytes migrates as a single peak during ion-exchange chromatography, whereas the liver NAT activity is separated into two peaks. NAT in HepG2 cells resembles extra-hepatic tissue NAT rather than NAT in liver. HepG2 cells do not therefore represent a good in vitro model for investigation of human metabolism of arylamines or hydrazines. The molecular weight of NAT from U937 cells has been determined by a combination of sucrose density gradient centrifugation and gel filtration to be 31,600 +/- 1200 daltons.