Retrospective analysis of the association between tooth loss and dementia: a population-based matched case-control study.

OBJECTIVE: To clarify the association between multiple tooth loss and dementia. BASIC RESEARCH DESIGN: Case-control study based on the claims data from National Health Insurance Research Database (NHIRD). Patients were divided into two groups: the dementia groups and non-dementia group. For each case patient, one control patient was randomly selected and frequency matched by age (per 5 years) and sex. The case group comprised patients newly diagnosed with dementia, and the index date was the the date of dementia diagnosis, which became the baseline for comorbidity and age calculations. RESULTS: Among the 43,026 individuals, patients with dementia had a significantly higher extraction density at ages 60-69 (p ⟨ 0.0001) and 70-79 (p = 0.04) years compared with control patients. CONCLUSIONS: This population-based retrospective study demonstrated an association between tooth loss and dementia. Patients in Taiwan with more tooth extraction experience are likely to have an increased risk of dementia.

Argon plasma coagulation tonsillectomy versus coblation tonsillectomy: a comparison of efficacy and safety.

BACKGROUND: Tonsillectomy is one of the most common otolaryngological procedures. Nonetheless, there is still no universally approved 'gold standard' technique. OBJECTIVE: To compare the safety and efficacy of argon plasma coagulation and coblation techniques in tonsillectomy. METHODS: A multi-institutional, retrospective cohort study was conducted, comprising 283 patients who underwent bilateral tonsillectomies performed by a single surgeon between 2014 and 2017. The outcome measures included: operative time, intra-operative blood loss, post-operative pain and post-operative haemorrhage. RESULTS: In the argon plasma coagulation group, mean operative time and post-operative haemorrhage rate were significantly reduced, p = 0.0006 and p = 0.003 respectively. There was no statistically significant difference between the two groups in terms of post-operative pain and intra-operative blood loss. CONCLUSION: The argon plasma coagulation technique is easy, safe and efficacious. Argon plasma coagulation tonsillectomy seems cost-effective compared to coblation tonsillectomy: the single-use disposable electrode tip and wand used in this study cost AUD$76.50 and AUD$380 respectively. Argon plasma coagulation appears to be a favourable alternative to current modalities such as coblation.

Management of paediatric acute mastoiditis: systematic review.

BACKGROUND: Acute mastoiditis remains the commonest intratemporal complication of otitis media in the paediatric population. There has been a lack of consensus regarding the diagnosis and management of acute mastoiditis, resulting in considerable disparity in conservative and surgical management. OBJECTIVES: To review the current literature, proposing recommendations for the management of paediatric acute mastoiditis and appraising the treatment outcomes. METHOD: A systematic review was conducted using PubMed, Web of Science and Cochrane Library databases. RESULTS: Twenty-one studies were included, with a total of 564 patients. Cure rates of medical treatment, conservative surgery and mastoidectomy were 95.9 per cent, 96.3 per cent and 89.1 per cent, respectively. CONCLUSION: Mastoidectomy may be the most definitive treatment available; however, reviewed data suggest that conservative treatment alone has high efficacy as first-line treatment in uncomplicated cases of acute mastoiditis, and conservative therapy may be an appropriate first-line management when treating acute mastoiditis.

Temporomandibular disorder in otolaryngology: systematic review.

BACKGROUND: Temporomandibular disorder poses a diagnostic challenge to otolaryngologists as orofacial pain, headache and otology symptoms are very common in temporomandibular disorder, and mimic a number of otolaryngological conditions. Missed diagnosis of temporomandibular disorder can lead to unnecessary investigation and treatment, resulting in further patient suffering. OBJECTIVES: To review the current literature and propose management pathways for otolaryngologists to correctly differentiate temporomandibular disorder from other otolaryngological conditions, and to initiate effective treatment for temporomandibular disorder in collaboration with other health professionals. METHOD: A systematic review using PubMed and Medline databases was conducted, and data on temporomandibular disorder in conjunction with otolaryngological symptoms were collected for analysis. RESULTS: Of 4155 potential studies, 33 were retrieved for detailed evaluation and 12 met the study criteria. There are questionnaires, examination techniques and radiological investigations presented in the literature to assist with distinguishing between otolaryngological causes of symptoms and temporomandibular disorder. Simple treatment can be initiated by the otolaryngologist. CONCLUSION: Initial temporomandibular disorder treatment steps can be undertaken by the otolaryngologist, with consideration of referral to dentists, oral and maxillofacial surgeons, or physiotherapists if simple pharmacological treatment or temporomandibular disorder exercise fails.

Efficacy of low-dose intratympanic dexamethasone as a salvage treatment for idiopathic sudden sensorineural hearing loss: the Modbury Hospital experience.

OBJECTIVE: To evaluate the efficacy of low-dose intratympanic dexamethasone therapy in patients with idiopathic sudden sensorineural hearing loss whose hearing in the affected ear had failed to improve following a course of oral steroid therapy. METHODS: A prospective pilot study was undertaken of eight patients with idiopathic sudden sensorineural hearing loss whose hearing had failed to improve after a course of prednisolone. These patients subsequently received 8 mg intratympanic dexamethasone therapy, delivered via a ventilation tube on a weekly basis for 1 month. Clinical outcome was assessed weekly with pure tone audiography. RESULTS: At the end of the 1-month treatment period, no significant hearing improvement was observed on pure tone audiography in any of the patients (i.e. improvements were all less than 10 dB). CONCLUSION: The response to 8 mg of intratympanic dexamethasone used as a salvage therapy for idiopathic sudden sensorineural hearing loss was inadequate. A higher dosage of intratympanic dexamethasone might be required to achieve better outcomes.

Primary mastoid cyst.

OBJECTIVE: To report an unusual case of a primary mastoid cyst (congenital or developmental) in a patient without otological symptoms. METHOD: Case report and review of the English language literature. RESULTS: Primary mastoid cyst is a newly reported and very rare pathological entity. Mastoid cysts usually occur secondary to chronic infection, inflammation or trauma. Review of the medical literature highlights the rarity of this condition. CONCLUSION: This report describes the experience gained by the diagnosis and management of this patient. It emphasises the importance of clinical vigilance so that proper treatment may be instituted in a timely manner.

Intravenous immunoglobulins and haematopoietic growth factors in the prevention and treatment of neonatal sepsis: ground reality or glorified myths?

Neonatal sepsis is a significant cause of morbidity and mortality in the neonatal intensive care unit. The epidemiology of neonatal infections is complex; however, they are in large part secondary to developmentally immature host defence mechanisms. These immunodeficiencies, which are exaggerated in premature and sick neonates, include quantitative and qualitative deficits in phagocytes, complement components, cytokines and immunoglobulins. Therapies that modulate or augment host defences may attenuate the virulence of neonatal infections. In this paper, we have reviewed immunotherapies that modulate the immune system of the neonate, including intravenous immunoglobulins and myeloid haematopoietic growth factors. Future studies should focus on investigating other abnormalities of neonatal host defence and/or combined immunotherapy approaches in an attempt to circumvent the immaturity of host defence and potentially reduce both the incidence and severity of neonatal sepsis.

Neonatal sepsis bacterial isolates and antibiotic susceptibility patterns at a NICU in a tertiary care hospital in western Nepal: a retrospective analysis.

BACKGROUND: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. The neonatal intensive care units (NICUs) today face one common problem of tackling sepsis and neonatologists remain constantly baffled by the changing patterns of microbial flora and their sensitivity patterns. With the neonatal services coming of age in Nepal this retrospective analysis spread over a period of six years has become very pertinent. MATERIALS AND METHODS: We conducted a retrospective study over a period of six years to study the prevalence of different organisms causing septicaemia in the community and at our hospital and the antibiotic susceptibility pattern. In all 265 cases of suspected sepsis were screened using a panel consisting of CRP, ANC and I/T ratio and subsequently confirmed by cultures. The cases were early onset (n=44), late onset (n=56) and nosocomial groups (n=40). The data for the intramural (n=32) and extramural (n=68) cases was analysed separately. RESULTS: One hundred nineteen cultures out of the 131 positives were obtained from blood (44.92%) and the remaining were isolated from urine (6.11 %) and CSF (4.58 %). The most common organism to be isolated was staphylococcus aureus (42.75%) followed by klebsiella pneumoniae (18.32%)and escherechia coli (12.21%). Staphylococcus was isolated from 36.84%, 45.16% and 31.81% of the cultures obtained from neonates in the in-born, out-born and the nosocomial groups respectively while klebsiella pneumoniae [18.32 %] was seen in 21.05 %, 17.39 % and 36.36 % in each of the three groups. Pseudomonas aeruginosa [6.11 %] was isolated from 13.64 % of the nosocomial cultures compared to 8.7 % of the out-borns while it was not seen in the in-borns. Other organisms isolated were much less in number, included - pathogenic streptococci, acinetobacter and enterobacter species. Coagulase negative staphylococci (CoNS) was seen in 4.39 % [n=4] and 9.09 % [n=4] of the same groups respectively. The gram positive organisms displayed a high degree of resistance to most penicillins and cephalosporins but glycopeptides and monobactams were effective in them. There was a high incidence of resistance noted with most third generation cephalosporins and aminoglycosides amongst most gram negative organisms where-in cefepime and imepenem were effective in most cases. CONCLUSIONS: Staphylococcal sepsis is not only common in community acquired infections but also in nosocomial sepsis. There is an emerging resistance to cephalosposrins probably attributable to extended spectrum betalactamases. Further large-scale multicentre studies are required to generalise the data for the whole country.

Unusual mass in the parapharyngeal space: a Warthin's tumour.

Parapharyngeal space (PPS) tumours are uncommon and can be a diagnostic challenge as the presenting symptoms are often vague and non-specific. Most of the PPS tumours are salivary tumours (pleomorphic adenoma being the most frequent diagnosis), and are thought to originate from minor salivary glands or the deep lobe of the parotid gland. Warthin's tumour, another benign salivary tumour involving the PPS has been rarely reported. A case of bilateral, metachronous Warthin's tumour involving the PPS is reported here. PPS Warthin's tumour is a very rare condition that if undiagnosed may result in considerable morbidity.

Thyroid dysfunction in Down syndrome.

BACKGROUND: Down syndrome is associated with various forms of thyroid dysfunction, hypothyroidism being the most common. The additive effects of both co-morbid conditions lead to further amplification of the clinical problems in these children with Down syndrome. OBJECTIVE: The purpose of this prospective study was to know the prevalence of thyroid dysfunction in Down Syndrome children below the age of 14 years and to correlate the features of Down Syndrome with those of thyroid dysfunction. METHODS: In all 32 Down syndrome children were grouped as euthyroid, compensated and uncompensated hypothyroidism on the basis of their T3, T4 and TSH levels and the features of were compared using the student's t-test. RESULTS: Hypothyroidism was seen in 5 out of 32 cases (15.6%) of which 1 (3.1%) had uncompensated while the other 4 (12.5%) had a compensated hypothyroidism. Hyperthyroidism was not observed in any of the cases. The prevalence of hypothyroidism of 16.7% on the age group 0-1 year could well be a reflection of congenital hypothyroidism while 20% prevalence in the age group 9-12 could imply acquired hypothyroidism. The mean values of the developmental quotient (D.Q.) and the Rao's index in Down syndrome cases with hypothyroidism was 49 5.1 and 0.15 0.06 respectively while that of euthyroid Down syndrome patients were 52 5.54 and 0.17 0.04 respectively ('p' value > 0.05), the differences though obvious yet not statistically significant. CONCLUSION: It thus seems necessary to screen all Down syndrome children for thyroid dysfunction.

HLA-DRB1 genotyping in patients with juvenile idiopathic arthritis in Taiwan.

The object of this study was to investigate whether there is an association between HLA-DRB1 alleles and the development of juvenile idiopathic arthritis (JIA) in Taiwan. HLA-DRB1 alleles were studied in 60 patients with JIA and 200 healthy controls using polymerase chain reaction (PCR)/sequence-specific oligonucleotide probes (SSO). The frequency of HLA-DRB1*0405 in patients with JIA was found to be significantly higher than that in healthy controls [odds ratio (OR) 2.64, 95% confidence interval (CI) 1.01-6.91]. The DRB1*0405 allele was significantly associated with the development of both polyarthritis (OR 4.30, 95% CI 1.34-13.80) and oligoarthritis (OR 3.27, 95% CI 1.01-10.58). The frequency of HLA-DRB1*1502 was higher in Taiwanese JIA patients with systemic arthritis than in controls (OR 18.09, 95% CI 2.25-145.73). We conclude that, in Taiwan, HLA-DRB1*0405 is associated with the development of polyarthritis and oligoarthritis in children, and HLA-DRB1*1502 is associated with the development of systemic arthritis.

MCP-1 gene regulatory region polymorphism in Chinese children with mild, moderate and near-fatal asthma.

BACKGROUND: A polymorphism in the monocyte chemoattractant protein 1 (MCP-1) gene regulatory region has been associated with asthma in Caucasians. This polymorphism is possibly endemic to the Asian region, but its impact on Asian populations is unclear. In addition, the relationship of this marker with life-threatening asthma has not been clarified. The aim of this study was to test the genetic association between the MCP-1 -2518A/G polymorphism and asthma/atopy in a cohort of Chinese children, with particular emphasis on those patients who had experienced life-threatening asthma attacks. METHODS: Forty-eight children with near-fatal asthma, 134 mild-to-moderate asthmatics, 69 allergic-disorder cases without asthma, and 107 nonasthmatic, nonatopic control children were genotyped by a polymerase chain reaction-based assay. RESULTS: Comparison of the four groups of children (n = 358) revealed no detectable differences in genotype or allele frequencies of the MCP-1 -2518A/G polymorphism. There was no evidence of association between the polymorphism and any of the outcomes of interest including clinical severity, blood eosinophil count, atopy, total serum IgE levels, and degree of bronchial hyper-responsiveness. CONCLUSION: These results suggest that the MCP-1 -2518A/G polymorphism is not a risk factor for near-fatal asthma. Furthermore, this polymorphism seems to play no role in the development of asthma or atopy in Chinese subjects, possibly as a result of the genetic heterogeneity between Asian and Caucasian populations with respect to regulation of MCP-1 expression. Our results underscore the necessity of accounting for ethnic background in the investigation of asthma-predisposition genes.

Climate, traffic-related air pollutants and allergic rhinitis prevalence in middle-school children in Taiwan.

The prevalence of allergic rhinitis, a common respiratory disorder, may be rapidly increasing. Epidemiological studies, however, indicate little about its association with climatic factors and air pollution. The relationship between traffic-related air pollutants and allergic rhinitis in middle-school students was therefore investigated. In a nationwide survey of middle-school students in Taiwan conducted in 1995/1996, the lifetime prevalence of physician-diagnosed allergic rhinitis and typical symptoms of allergic rhinitis were compared with air-monitoring station data on temperature, relative humidity, sulphur dioxide (SO2), nitrogen oxides (NOx), ozone (O3), carbon monoxide (CO) and particulate matter with a 50% cut-off aerodynamic diameter of 10 microm (PM10). A total of 331,686 nonsmoking children attended schools located within 2 km of 55 stations. Mean (range) annual exposures were: CO 853 (381-1,610) parts per billion (ppb), NOx 35.1 (10.2-72.4) ppb, SO2 7.57 (0.88-21.2) ppb, PM10 69.2 (40.1-116.2) microg x m(-3), O3 21.3 (12.4-34.1) ppb, temperature 22.9 (19.6-25.1) degrees C, and relative humidity 76.2 (64.8-86.2)%. The prevalence of physician-diagnosed allergic rhinitis was 28.6 and 19.5% in males and females, respectively, with prevalence of questionnaire-determined allergic rhinitis 42.4 and 34.0%. After adjustment for age, parental education and history of atopic eczema, physician-diagnosed allergic rhinitis was found to be associated with higher nonsummer (September-May) warmth and traffic-related air pollutants, including CO, NOx and O3. Questionnaire-determined allergic rhinitis correlated only with traffic-related air pollutants. Nonsummer warmth and traffic-related air pollution, probably mediated through exposure to common allergens such as dust mites, are possible risk factors for allergic rhinitis in middle-school-aged children.

The association of HLA -A, -B, and -DRB1 genotypes with Graves' disease in Taiwanese people.

Graves' disease has been associated with different human leukocyte antigen (HLA) genes in different races. To evaluate the association of HLA type in Taiwanese with Graves' disease, the HLA-A, -B, and -DRB1 alleles in a total of 236 Taiwanese adults with Graves' disease and 533 racially matched normal control subjects were examined using the PCR-SSOP (sequence specific oligonucleotide probe) technique. The prevalence of HLA-A*0207, -B*2704, -B*4601, and -DRB1*0901 among patients with Graves' disease was found to be increased, with odds ratios (OR) of 2.21, 3.82, 1.76 and 1.62, respectively. However, after correction for multiple comparisons, the relative risk of HLA-A*0207 susceptibility to Graves' disease remained statistically significant and the haplotype HLA-A*3303 -B*5801 -DRB1*0301 had a significantly protective effect. None of the other 2- or 3-locus haplotypes showed any significantly increased risk. Although HLA-DRB1*1405 showed an increased relative risk in patients with GO (Graves' opthalmopathy) (OR 4.61) when compared with patients without GO, the relative risk after adjusting for the number of comparisons was not significant. Taiwanese patients with Graves' disease have HLA-associated susceptibility genes which are similar to those found in Chinese patients in Hong Kong and Singapore. However, the finding in this study of a higher frequency of HLA-A*0207 in Taiwanese with Graves' disease has not been documented in any other ethnic group.

Immunohistochemical localization of deleted-in-colon-cancer (DCC) protein in human epithelial, neural, and neuro-endocrine tissues in paraffin sections with antigen retrieval.

A gene called deleted in colon cancer (DCC) has been identified on a region of chromosome 18, which is deleted in 70% of colorectal cancers. The DCC gene encodes a protein belonging to the immunoglobulin superfamily with similarity to the N-CAM transmembrane proteins, and it is a putative tumor-suppressor gene. Alternative splicing of transcripts of transmembrane proteins, including N-CAM, is know to occur, resulting in different isoforms of the protein. Using a polyclonal antibody against the DCC gene product, we have demonstrated, by antigen retrieval immunostaining, the presence of a DCC protein isoform on the cell surface of goblet cells in the G-I tract, cytoplasm of squamous epithelium in the skin & esophagus and transitional epithelium in the urinary bladder, ductal glandular epithelium of endometrium, endocervix, prostate, gall bladder and breast, cytoplasm of neuron in the cerebral cortex and Purkinje cells in the cerebellum. In addition, we also demonstrated DCC protein expression in neuroendocrine cells including argentaffin cells of the stomach, small intestine, appendix and colon, C cells of thyroid gland, chromaffin cells of the adrenal gland, islets of Langerhans in the pancreas and neurons of the sympathetic ganglion. This restrictive distribution suggests the DCC gene products may be abundant expression in neuroendocrine cells of human tissue.

A study of the normal temporal healing pattern and the mucociliary transport after endoscopic partial and full-thickness removal of nasal mucosa in sheep.

The aim of this study was to assess the temporal healing process of nasal epithelium after full- thickness and partial thickness mucosal removal in sheep. Healing was assessed by histologically examining serial biopsies of the healing wounds. The histology assessed the regeneration of epithelium and return of cilia. Mucociliary clearance was measured before and after injury. On day 84 post injury partial thickness injuries had 80.7% (SEM = 10.25) normal epithelium and 68.35% (SEM = 19.2) reciliation. Full-thickness wounds had 64.98% (SEM = 19.17) normal epithelium and 32.96% (SEM = 17.46) reciliation. On day 84 the difference for epithelium regeneration was not significant (P > 0.05), but reciliation was significant (P < 0.05). The baseline mucociliary clearance was 0.84 mm per second (SEM = 0.2) and did not differ significantly from either the partial thickness wound transport rate (2.49 mm/s; SEM = 1.02) or the full-thickness transport rate (0.9 mm/s; SEM = 0.37) (paired t-test P > 0.05). The time period (84 days) for evaluation of reciliation was insufficient, as reciliation appeared to be continuing. The healing process took place over a longer time period than what had been previously reported in the literature and this may account for the symptoms seen in the postoperative period in patients after sinus surgery.

Prediction of bone fracture by bone mineral density in Taiwanese.

BACKGROUND AND PURPOSE: This study evaluated whether lumbar spine bone mineral density (BMDL) and the rate of change of BMDL could predict the risk of bone fracture in Taiwanese. METHODS: In 1989, a baseline survey was carried out in Lin-Kou Township. BMDL was measured using dual photon absorptiometry in 404 healthy volunteers. In 1994/95, a second survey was conducted to reexamine the BMDL and fracture history as well as the risk factors associated with fracture in these subjects. Fractures were classified according to the causes of the injury as severe or mild trauma. RESULTS: Of the 404 original examinees, 381 (79%) participated in the second survey. Twenty-six subjects had experienced a total of 32 fracture incidents during their lifetime and 10 subjects had experienced fracture during the observation period. After adjusting for the effect of body mass index, gender, and age, each standard deviation of decrease in BMDL was found to be associated with a significant 2.38-fold increase in the risk of mild trauma fracture, and a BMDL below the fracture threshold was associated with a 3.93-fold increase of fracture risk. Higher BMDL change rates were found in subjects with a history of fracture. CONCLUSION: This study indicates the importance of maintaining the BMDL above the fracture threshold (1 g/cm2). The strategy for fracture prevention should be directed at prevention of age-related bone loss.

Mutation analysis of the human NR4A2 gene, an essential gene for midbrain dopaminergic neurogenesis, in schizophrenic patients.

Recent studies have revealed that an orphan receptor gene of the steroid/thyroid hormone nuclear receptor superfamily, the Nurr1 gene, is essential for the neurogenesis and differentiation of dopaminergic neurons in the midbrain of mice. Transgenic mice lacking the Nurr1 gene soon die after birth and are devoid of dopaminergic neurons in the midbrain. Heterozygous mice survive postnatally without obvious locomotor deficits; however, they have increased vulnerability to dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). In view of the importance of dopamine neurotransmission in brain function, we were interested to know if the human homologous gene of murine Nurr1, the NR4A2 gene, may play a role in the pathogenesis of schizophrenia. We systematically sequenced all the exons of the human NR4A2 gene to search for molecular variants in a cohort of Chinese schizophrenic patients from Taiwan. Two molecular variants were identified: a G-insertion in intron 6 (designated IVS6 + 17 [see text] + 18insG), and a G-deletion in the untranslated exon 1 (designated c.-469delG). The IVS6 + 17 [see text] + 18insG is a polymorphic one; further case control study, however, did not reveal association of this polymorphism with schizophrenia. The c.-469delG is a rare variant found in two unrelated patients among 177 schizophrenic patients, but not in 130 nonpsychotic controls. The result suggests that the c.-469delG and possibly other variants of the NR4A2 gene may be of relevance to the complex factors involved in the pathogenesis of schizophrenia.

Multilocus linkage analysis of the German asthma data.

We analyzed data from the German Asthma Genetics Group with three methods that utilize pedigree-specific nonparametric linkage scores to facilitate the search for multiple independent and interacting susceptibility loci. The three methods included a conditional analysis, logistic regression, and neural networks. Although there were differences, the three methods identified many of the same susceptibility loci. The most consistent evidence was provided for loci on chromosomes 1, 2, 6, 9, and 15. Both the conditional and the logistic regression analyses suggested an epistatic relationship between loci on chromosomes 2 and 9. The logistic regression analysis further revealed evidence for locus heterogeneity between loci on chromosomes 6 and 15. Finally, the neural network analysis identified a potential locus on chromosome 17 that was not identified in the other analyses.

Role of urbanization and air pollution in adolescent asthma: a mass screening in Taiwan.

BACKGROUND AND PURPOSE: The prevalence of asthma in school children in Taiwan is increasing. This study used mass screening among middle school children in Taiwan to determine the prevalence of asthma and related factors. METHODS: Data were collected from parents using a self-reported questionnaire and from children using the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire. Six study teams conducted the survey nationwide in 1995-1996, with the assistance of middle school nurses and teachers. RESULTS: Among the 1,018,031 students at 795 middle schools who returned questionnaires, 8.5% had a history of asthma (ranging in prevalence from 4.2% to 13% in 25 areas). The prevalence of asthma was higher in boys than in girls (10.0% vs 7%) and was highest in more urbanized areas (11.2%), followed by moderately urbanized areas (7.4%) and less urbanized and rural areas (6.5%). Controlling for age, family smoking, family incense burning, and parental education level, multivariate logistic regression models indicated that children living in an area with heavy air pollution were more likely to have asthma than those in an area with no or light pollution (odds ratio, OR = 2.01 and 95% confidence interval, CI = 1.94-2.09 based on parental ranking of pollution level, or OR = 1.30 and 95% CI = 1.18-1.42 based on pollution level reported by the Environmental Protection Administration). CONCLUSIONS: Adolescent asthma in Taiwan is most prevalent in the most urbanized areas and decreases in prevalence in less urbanized areas. This study also found that higher parental education level and higher area air pollution were associated with higher adolescent asthma prevalence.