Association between sodium-glucose co-transporter 2 inhibitors and risk of bullous pemphigoid in patients with type 2 diabetes: a nationwide population-based cohort study.

BACKGROUND: Certain anti-diabetic agents have been linked to the development of bullous pemphigoid (BP). However, the relationship between BP and sodium-glucose co-transporter 2 inhibitors (SGLT2is) remains inconclusive. OBJECTIVE: To investigate the association between SGLT2i usage and BP. METHODS: Participants were recruited from the Taiwan National Health Insurance Database between 2007 and 2018. A total of 149 060 patients with diabetes receiving SGLT2i were matched 1 : 2 with diabetic patients without SGLT2i usage. Factors such as age, sex, duration of diabetes condition, DPP4i usage, insulin usage and selected comorbidities were included in the multivariate analysis. RESULTS: Compared with the control, the 2-year-cumulative incidence was significantly low in patients using SGLT2i after adjustment for competing mortality. Patients with diabetes receiving SGLT2i had a low risk [adjusted hazard ratio (HR) 0.56, 95% confidence interval (CI), 0.33-0.96] for BP after adjustment for potential confounders. Age (HR, 1.06), renal disease (HR, 1.79), cerebrovascular disease (HR, 3.23), epilepsy (HR, 3.07), DPP4i users (HR: 2.55) and insulin users (HR: 2.56) were significant risk factors for BP. CONCLUSIONS: The risk of BP did not increase in patients receiving SGLT2i. Thus, SGLT2i could be a safe choice for patients with diabetes having additional risk factors or a history of BP.

Post-acute Use of Opioids and Psychotropics in Patients after Hip Fracture: Unintended Consequences of Implementing Diagnosis-Related Grouping Payment.

OBJECTIVE: How implementing diagnostic-related grouping (DRG) payment affected the use of opioids and psychotropics by hip fracture patients following hospitalization remained unknown. DESIGN: A retrospective, pre-post design, cohort study of data excerpted from Taiwan's National Health Insurance Research database (NHIRD). SETTING AND PARTICIPANTS: Adults aged ≥ 65 years first admitted for hip fracture surgery from 2007 to 2012 were identified and divided into two 1:1 propensity-score matched groups: pre-DRG (2007-2009); DRG (2010-2012). MEASUREMENTS: The outcome measures were use of opioid and/or psychotropic drugs within 30 days, 90 days, 180 days, and 365 days after discharge. RESULTS: Data of 16,522 subjects were excerpted, and 8,261 propensity-score matched subjects each classified into the pre-DRG and DRG groups. After adjustment, the DRG group was significantly more likely than the pre-DRG group to have used antipsychotics after discharge from hip fracture surgery (≤30 days, ≤90 days, ≤180 days and ≤365 days). The DRG group also had significantly higher prescription rates of benzodiazepines and antipsychotics during the observation period. Moreover, the DRG group was less likely to use non-steroidal anti-inflammatory drugs (≤30 days, ≤90 days, ≤180 days and ≤365 days) and more likely to use acetaminophen (≤30 days, ≤180 days, and ≤365 days). CONCLUSIONS: In conclusion, DRG implementation in Taiwan substantially increased post-acute prescription of antipsychotic and psychotropic agents for hip fracture patients, and changed use of analgesics, which may result in suboptimal quality and safety for these patients. Further research is needed to evaluate the long-term outcomes of DRG implementation, and the potential benefits of appropriate post-acute care bundled with DRG payment.

Cigarette smoking and risk of rosacea: a nationwide population-based cohort study.

BACKGROUND: Most evidence regarding the relationship between cigarette smoking and risk of rosacea is obtained from cross-sectional or case-control studies. OBJECTIVE: To examine the association between smoking and risk of developing rosacea. METHODS: Participants were collected from four rounds (2001, 2005, 2009 and 2013) of the Taiwan National Health Interview Survey. Incident cases of rosacea were identified from the National Health Insurance database. Cox proportional hazard model was used for the analyses. RESULTS: Of the 59 973 participants, 379 developed rosacea during a mean follow-up of 10.8 years. After adjustment for potential confounders, current smokers had a lower risk of rosacea than never smokers [adjusted hazard ratio (aHR) 0.60; 95% confidence interval (CI) 0.39-0.92]. An increase in smoking intensity was associated with a decreased risk of rosacea among current smokers (Ptrend  = 0.0101). Compared with never smokers, current smokers of >15 cigarettes/day had an aHR of 0.51 (95% CI: 0.26-0.99) for rosacea. For incident rosacea, the aHRs (95% CIs) of current smokers of ≤10 years of smoking and ≤10 pack-years of smoking were 0.44 (0.22-0.88) and 0.51 (0.29-0.89), respectively. Former smoking was not associated with rosacea risk. CONCLUSION: Current smoking was significantly associated with a decreased risk of rosacea.

Antiretroviral treatment attrition in Swaziland: a population-based study.

Swaziland has the highest prevalence of human immunodeficiency virus (HIV) in the world. Attrition (loss to follow-up and mortality) in people living with HIV/AIDS (PLWHA) already on treatment is a major challenge, undermining achievements of the antiretroviral treatment (ART) programme in Swaziland. The contributing factors to attrition in the Swazi context are unclear. This study aims to (1) estimate attrition from the ART programme 12 months after ART initiation in Swaziland, and (2) determine the predictors of attrition in PLWHA treated with ART in Swaziland. A retrospective cohort study using national baseline data was conducted. A competing-risk Cox proportional hazard regression was used to determine the predictors of attrition. We estimated 10·3% (95% confidence interval 10·1-10·6) attrition in 16 423 participants that initiated ART in 2012. Attrition was significantly associated with sex, age, district, treatment supporter at initiation, co-infection of HIV and TB, functional status, WHO clinical stage, and ownership of facility. Our study can form a base of policies, plans, and service delivery strategies for preventing and controlling attrition in Swaziland.

Increased risk of tuberculosis in patients with end-stage renal disease: a population-based cohort study in Taiwan, a country of high incidence of end-stage renal disease.

This nationwide population-based cohort study investigated the risk of tuberculosis (TB) in patients with end-stage renal disease (ESRD) and receiving dialysis. The evaluations included 4131 incident ESRD patients receiving dialysis and 16,524 age- and gender-matched controls, recruited between 1998 and 2009. We used Cox proportional hazards regression analysis to measure the association between TB and ESRD. Compared to the controls, the ESRD cohort had a significantly higher risk of TB within 1 year [incident rate ratio (IRR) 4.13], and 1-2 years (IRR 2.12), of occurrence of ESRD. The Cox proportional hazards model revealed that ESRD [hazard ratio (HR) 2.40], age >65 years (HR 2.41), male sex (HR 1.94), diabetes mellitus (HR 1.36), silicosis (HR 7.70) and chronic obstructive pulmonary disease (HR 1.61) are independent risk factors for TB. Patients with ESRD are associated with an increased risk of TB, and should thus be monitored more carefully for TB, especially within 2 years of onset of ESRD.

Prescription of atropine eye drops among children diagnosed with myopia in Taiwan from 2000 to 2007: a nationwide study.

PURPOSE: This study was conducted to examine the atropine eye drop prescription trend for children diagnosed with myopia, and to determine the factors associated with the prescription of atropine eye drops. DESIGN: This was a population-based cross-sectional study. METHODS: This study was conducted using a national representative sample from the National Health Insurance (NHI) claims data. All school children between 4 and 18 years of age who had visited an ophthalmologist and were diagnosed with myopia between 2000 and 2007 were included herein. The main outcome measure was the proportion of subjects who were prescribed atropine eye drops in each year. Logistic regression was used to identify the factors associated with atropine eye drops being prescribed. RESULTS: The prescription of atropine eye drops for children diagnosed with myopia increased significantly from the school years 2000 (36.9%) to 2007 (49.5%). There was also a shift from prescribing high concentrations (0.5 and 1%) of atropine eye drops to lower concentration ones (0.3, 0.25, and 0.1%) within this period. Atropine eye drops were more frequently prescribed to 9-12-year-old children (OR=1.26-1.42, compared with those 7-8 years old), and to children from families with a high socioeconomic status (OR=1.19-1.25); however, they were less prescribed to those living in mid to low urbanized areas (OR=0.65-0.84). CONCLUSIONS: This study revealed an increasing trend of atropine eye drop prescription for children with myopia in Taiwan. Our study provides eye-care professionals worldwide a reference for the potential integration of atropine eye drops into their clinical practice toward children with myopia.

Aerodigestive tract, lung and haematological cancers are risk factors for tuberculosis: an 8-year population-based study.

SETTING: The deterioration of immunity in cancer patients may be associated with a higher incidence of tuberculosis (TB). OBJECTIVE: Despite several previous studies on cancer and TB, no population-based investigation has been published. We performed a nationwide population-based study to investigate the incidence of active TB among cancer patients, and the cancer-type specific risk factors related to TB. DESIGNS: This nationwide population-based retrospective cohort study was based on data obtained from the Taiwan National Health Insurance Database. A total of 16,487 cancer patients and 65,948 controls matched for age and sex were recruited. RESULTS: The incidence of TB per 100,000 person-years was 339 in the cancer patients and 202 in the controls, which gives a crude incidence rate ratio of 1.68 (95%CI 1.42-1.98). The hazard ratio (HR) was 1.67 (95%CI 1.42-1.96) after adjusting for age, sex and comorbidity. Cox regression showed that cancers of the aerodigestive tract, including oral, nasopharyngeal and oesophageal and lung cancer (HR 3.09, 95%CI 2.42-3.94) and haematological cancers, including non-Hodgkin's lymphoma and leukaemia (HR 3.22, 95%CI 1.98-5.22), were significant risk factors for TB. CONCLUSION: Cancer patients have a higher incidence of TB than controls. Patients with aerodigestive tract, lung and haematological cancers are especially vulnerable to TB.

Comparison of the perforation rate for acute appendicitis between nationals and migrants in Taiwan, 1996-2001.

OBJECTIVE: Immigrant populations have grown rapidly in recent years in many countries. Immigrant-related healthcare issues have thus become more and more important. The aim of this study was to assess any possible disparity in access to care between migrants and nationals under the national health insurance (NHI) system in Taiwan. STUDY DESIGN: Retrospective population-based observational study. METHODS: National population-based data on patients aged ≥20 years in Taiwan under the NHI programme were studied. The frequency of use and expenditure on ambulatory care, inpatient care and emergency care were analysed separately. Ruptured appendicitis was also analysed as an outcome indicator for access to care. Logistic regression and two-part models were applied. RESULTS: Overall, migrants had a lower rate of healthcare utilization than nationals, and this gap remained consistent from 1996 to 2001. However, using ruptured appendicitis as the outcome indicator, no significant overall difference in access to care was found between nationals and migrants under the NHI programme in Taiwan (odds ratio 1.01, 95% confidence interval 0.93∼1.11). CONCLUSION: This study found that although migrants had a lower rate of healthcare utilization than nationals, their rate of adverse outcome was similar to nationals when they faced an acute, non-selective emergency condition such as appendicitis. The findings suggest that the use of more dimensional indicators may help to avoid possible misleading inferences on the variation in access to health care in Taiwan.

Association between obesity and injury among Taiwanese adults.

BACKGROUND: The prevalence of obesity and injury has increased in Asian countries, but the relationship between obesity and injury is less well established. The aim of this study is to evaluate the relationship between body mass index (BMI), the occurrence of injury, and the injury-related expenditure among Taiwanese adults. DESIGN: Retrospective cohort study. METHODS: Our study sample consisted of 12 520 adults aged 18 years or older from the 2001 National Health Interview Survey, who had consented to the linking of their survey responses with their National Health Insurance claims records. Cox proportional hazards regression and a two-part model were used for analysis. RESULTS: The results show that there was a positive association between BMI and injury. Relative to normal-weight adults, the hazard ratio (HR) of injury were 1.21 (95% confidence interval (CI): 1.08-1.36) for obese class II adults and 1.11 (95% CI: 1.05-1.18) for obese class I adults, after adjusting for confounding factors. The HR of sustained strain/sprain rose to statistical significance (P<0.001) among persons with a higher BMI. For obese class II and I adults, the adjusted injury-related expenditure levels were 33.4 and 15.6%, respectively, greater than those of normal-weight adults. CONCLUSIONS: There was a strong positive relationship between high BMI and increased risk of injury as well as higher injury-related expenditure. Specifically, a high BMI was associated with an increased risk of strain/sprain. Low-intensity flexibility, strength, and balance training programs should be considered in addition to weight reduction programs to prevent strain/sprain for obese adults.

Patterns of combined prescriptions of aspirin-Ginkgo biloba in Taiwan: a population-based study.

BACKGROUND AND OBJECTIVES: Although interactions between aspirin and Ginkgo biloba extract (GBE) have been documented, the extent to which these two drugs are used in combination remains unclear. The aim of this study was to estimate the extent and utilization patterns of combined prescriptions of aspirin and GBE in Taiwan based on an analysis of a nationwide database. METHODS: A representative nationwide sample of 200 000 National Health Insurance (NHI) beneficiaries in Taiwan was used. The prescription details of ambulatory care claims for this sample of beneficiaries for the period 1997-2003 were analysed. The prevalence of aspirin and GBE prescriptions was evaluated. The extent of co-prescription of the two drugs was assessed together with the associated patient characteristics. RESULTS: There was an increase in the number of aspirin prescriptions (from 29 986 out of 2 454 879 (1.2%) in 1997, to 50 614 out of 2 499 605 (2.0%) in 2003). Aspirin was mostly prescribed to patients over 50 years old. The percentage of prescriptions with aspirin increased rapidly from 57% to 84%, among those over 50 years old. The number of prescriptions with GBE also increased from 3039 to 6171 and 78-84% was prescribed to those 50 years or older. During the study period, combined prescriptions of aspirin and GBE dramatically increased four times. Most prescriptions were longer than 14 days and 42.4% of combined prescriptions were found to be at the same ambulatory care visit. CONCLUSION: The findings of this study suggest that there is an increasing trend in co-prescription of aspirin and GBE for Taiwan's elderly population during 1997-2003. This trend is of concern and worthy of note.

Comparison of clinical outcomes and spectral Doppler indices of uterine and ovarian stromal arteries in women undergoing myomectomy with or without hypogastric arterial ligation.

OBJECTIVE: To compare clinical outcomes and hemodynamic alterations of uterine and ovarian stromal arteries between patients with symptomatic myomas undergoing myomectomy preceded by arterial ligation and those undergoing myomectomy alone. METHODS: In this prospective, non-randomized comparative study, myomectomy was performed on 69 women with symptomatic myomas. Myomectomy alone was performed in 31 patients (Group I) and myomectomy with concomitant bilateral hypogastric arterial ligation was performed in 38 patients (Group II). In both groups, surgical results and clinical outcomes were evaluated by peripheral hemoglobin levels, a pictorial blood-loss assessment chart, and visual analog scales. Spectral Doppler indices of uterine and ovarian stromal arteries, including peak systolic velocity, end-diastolic velocity, pulsatility index and resistance index were performed preoperatively, and 1 day and 1 or more months postoperatively. RESULTS: Twenty-two patients in Group I and 31 patients in Group II received regular follow-up examinations for a mean follow-up period of 10.1 months. Menstrual flow, dysmenorrhea and hemoglobin levels improved significantly after surgery in both groups. Blood loss during surgery was less in Group II than it was in Group I (P=0.02). Doppler indices of uterine and ovarian stromal arteries from preoperation to mean follow-up point were not significantly different between the groups, except for a significantly lower uterine artery pulsatility index in Group II (P=0.01). CONCLUSIONS: Myomectomy with hypogastric arterial ligation for symptomatic myomas is as efficient as is myomectomy alone and reduces blood loss during surgery. Serial Doppler studies showed that hypogastric ligation does not block uterine and ovarian perfusion, and even reduces the impedance of the uterine arteries. The long-term recurrence rate after myomectomy with hypogastric arterial ligation remains to be determined.

Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the National Health Insurance in Taiwan.

OBJECTIVES: Rural-urban disparities in health remain a major focus of concern. This population-based study examined the performance of Taiwan's universal healthcare system in reducing rural-urban disparities in health, through better accessibility. Changes in the rates of ruptured appendicitis were compared between residents of remote and non-remote areas in Taiwan, under the National Health Insurance (NHI) programme. METHODS: We identified all 128,930 patients undergoing appendectomy in Taiwan between 1996 and 2001. The NHI inpatient files, enrolment files, major disease files, hospital registry and the household registry were linked to provide comprehensive individual and hospital information. Probit regression analyses were used to obtain adjusted estimates. RESULTS: During the first 3 years, although the differences between the remote and non-remote areas were apparent, they were seen to be narrowing. This downward trend continued, and, since 1999, few discernible differences have been observed. After adjusting for individual and hospital characteristics, over time, the ruptured appendix rate among remote area residents was seen to be decreasing significantly faster (1.1%) than among non-remote area residents. More specifically, the children showed a substantially steeper narrowing trend (3.3%) in rural-urban disparities, than did adults. CONCLUSIONS: Our findings have shown a significant narrowing of health disparities between remote and non-remote populations, resulting from free access to care and more healthcare provision in remote areas under the NHI programme; particular success has been observed in rural children. Although certain disparities still exist, Taiwan's universal healthcare system has effectively reduced rural-urban disparities in access to care and in ultimate health outcomes.

Comparison of perforation risk among physicians, other medical professionals and general adults with acute appendicitis in Taiwan.

BACKGROUND: This study aimed to compare the risk of appendiceal perforation among physicians, other medical professionals and general adults, when hospitalized for acute appendicitis. METHODS: National population-based data for 92 143 patients with acute appendicitis, aged 20 years or more, who underwent appendicectomy or drainage of an appendiceal abscess in Taiwan from 1996 to 2001 were analysed retrospectively. The outcome measure was appendiceal perforation. Patients were categorized as physicians (Western medical doctors), other medical professionals (such as dentists or nurses) or general adults (not medical professionals). Adjusted odds ratios and 95 per cent confidence intervals (c.i.) were estimated by multiple logistic regression. RESULTS: Multivariable analysis showed that appendiceal perforation was 0.67 (95 per cent c.i. 0.46 to 0.96) and 0.78 (95 per cent c.i. 0.62 to 0.99) times less likely in physicians and other medical professionals respectively than in general adults, after adjusting for patient and admitting hospital characteristics, and for calendar year. CONCLUSION: The risk of perforation was significantly lower among physicians and other medical professionals than in general adults. Medical knowledge, familiarity with the healthcare system and better patient-doctor communication may have been contributory factors.

Microbial kinetic analysis of three different types of EBNR process.

The disadvantages of developed biological nutrient removal (BNR) processes (additional energy for liquid circulation and addition of external carbon substrate for denitrification in anoxic zones) were improved by reconfiguring the process into (1) an anaerobic zone followed by multiple stages of aerobic-anoxic zones (TNCU3 process) or (2) anaerobic, oxic, anoxic, oxic zones in sequence (TNCU2 process). These two pilot plants were operated at a recycling sludge ratio of 0.5 without internal recycle of nitrified supernatant. The sludge retention time was maintained at 10 d. The main objective of this study is to analyze the kinetics of different microorganisms in these two processes and A2O process by using the Activated Sludge Model No. 2d. The effective removal efficiency of carbon, total phosphorus and total nitrogen at 87-98%, 92-100% and 63-80%, respectively, were achieved in the testing runs. According to model simulations, the microbial kinetics in the TNCU3 and TNCU2 processes would be affected by different operations. When the step feeding strategy was adopted, the HRT was longer due to the less influent flowrate in the front stages and the microbes would grow in quantities by about 6% in the aerobic reactors. In the followed anoxic reactors, the microbes would decrease in quantities by about 12% due to the dilution effect. The dilution effects in TNCU3 and TNCU2 processes did not take place in A2O process because the recycling mixed liquid from the aerobic reactor to the anoxic reactor still contained particulate components. The XH, XPAO, and XAUT concentrations in the effluent of the last tank were lower when the step-feeding mode was adopted. The TNCU3 and TNCU2 processes could be operated efficiently without nitrified liquid circulation and addition of external carbon substrate for denitrification.

Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan's experience.

In many Asian countries, physicians both prescribe and dispense drugs. This practice is hypothesized to have caused high drug expenditure and widespread prescription of antibiotics in Asia. Recently, Taiwan implemented the separation policy on an experimental basis. This paper's objective is to empirically evaluate the impact of Taiwan's reform to separate drug prescribing and dispensing on drug expenditure and total health expenditure. The research design consists of a pre/post comparison of the experimental with the control sites (difference-in-difference). Separation policy was implemented in Kaohsung and Taipei in March 1997, and expanded to Chia-yi and Taichung in March 1998. Changes in drug prescription behaviour before and after implementation in these two pairs of experimental cities were compared to Hsin-chu and Tainan (control), where separation policy was not implemented during the study period. To reduce resistance, providers in experimental sites were allowed to hire on-site pharmacists and dispense drugs through them if they chose to do so. Our study sample consists of all outpatient visits to clinics in the study sites between December 1996 and June 1998, with a total of 55.23 million claim records. The drug prescription rate, drug expenditure and total health expenditure per visit were the main outcome measures. We found that the probability of prescription and drug expenditure per visit were, respectively, 17-34% and 12-36% less among visits to clinics without on-site pharmacists, compared with the control sites. However, no difference in total health expenditure was found between these two types of visits. Hence, the separation policy could be effective in reducing drug expenditure and affecting prescription behaviour, but is less certain as a policy for reducing total health expenditure. We also found that the policy has practically no effect on clinics that have on-site pharmacists.

Health insurance and female labor supply in Taiwan.

We examine whether the availability of subsidized health insurance to the non-working population in Taiwan affected the labor force participation of married women. Our empirical identification exploits the fact that such insurance was first made available to wives of government employees, before being made universally available in Taiwan in 1995. We find that the availability of insurance for non-workers was associated with a 4 percentage point decline in labor force participation among married women, with larger declines among women from low income households. Countries considering universal health insurance as in Taiwan should anticipate similar declines in labor force participation.

Toxicity of nitromusks in early lifestages of South African clawed frog (Xenopus laevis) and zebrafish (Danio rerio).

Musk xylene (MX), musk ketone (MK) and musk moskene (MM) are synthetic nitro-containing fragrances. Due to their inherent lipophilicity and environmental persistence, they are frequently detected in environmental samples and especially in aquatic ecosystems. Despite this, the current environmental toxicity database of nitromusks is limited. Although nitromusks have been shown to accumulate in aquatic organisms, little is known about their potential developmental effects in the respective aquatic species. To investigate the developmental toxicity of these compounds to amphibians and fish, early lifestages of xenopus (Xenopus laevis) and zebrafish (Danio rerio) were exposed to three nitromusks for 96 h to examine the developmental effects of these compounds in the two species. Nitromusk body concentration measurements were carried out in parallel for correlation with potential developmental effects. No increased mortality, malformation or growth inhibition was observed in either species following 96-h exposure to 400 microg/l MX, MK and MM. However, an approximately 20% reduced viability was observed in xenopus larvae when exposed to 400 microg/l MX, MK and MM for 11 days. Xenopus and zebrafish exposed to 10, 153, 871 and 1637 microg/l 14C-MX for 96 h resulted in whole-body concentrations of 0.7 +/- 0.1, 11.1 +/- 1.1, 38.7 +/- 1.9 and 76.3 +/- 18.3 microg/g, and 4.3 +/- 0.6, 73.3 +/- 11.8, 440.0 +/- 72.7 and 664.0 +/- 47.7 microg/g wet body weight, respectively. Exposure of xenopus larvae to 400 microg/l MX, MK and MM for 11 days, resulted in whole body concentrations (extrapolated from gas chromatographic determinations) of 4700 +/- 5000, 1300 + 300 and 4600 + 4800 microg/g wet weight for MX, MK and MM, respectively. The latter toxicity results, in conjunction with the fact that the concentrations used for the above experiments were between 400- and 10000-fold higher than those detected in the environment, suggest that environmental concentrations of nitromusks are not hazardous for early lifestages of fish and amphibians.

Interactions of nitromusk parent compounds and their amino-metabolites with the estrogen receptors of rainbow trout (Oncorhynchus mykiss) and the South African clawed frog (Xenopus laevis).

Nitromusks, musk xylene (MX), musk ketone (MK) and musk moskene (MM) are synthetic fragrances. 4-Amino-MX (4X), 2-amino-MX (2X) and 2-amino-MK (2K) are nitromusk metabolites formed during the sewage treatment process and have been detected in effluent and surface water at concentrations four to 40 times higher than their parent compounds. To date, data to the aquatic toxicity of nitromusk compounds are limited to the parent compounds and the determination of acute and subacute effects in aquatic organisms. No data are available regarding the potential endocrine modulating effects of these compounds and/or their metabolites in aquatic organisms. Therefore, the competitive binding capability of nitromusks and their metabolites to the estrogen receptors (ER) in rainbow trout and xenopus was investigated. No binding of MX, MK and MM to the ER of either species was observed. In contrast, binding to the ER was observed for 4X, 2X and 2K in both species. The IC50 (competitive binding at the ER) of 2X in rainbow trout was 1.3 +/- 1.1 mM. In contrast, 4X, 2X and 2K bound to the xenopus ER with an IC50 of 30.8 +/- 28.5, 12.9 +/- 10.3 and 70.1 +/- 88.3 microM, respectively.

Mortality trends in the past 20 years in Pu-Li, Taiwan.

This study was based on a survey of the death certificates of Pu-Li Town in Taiwan, issued over the past 20 years from 1966 to 1985. Age-adjusted mortality trends as well as cause-specific mortality trends were analyzed and compared with nationwide Taiwan data. As a whole, Pu-Li had a higher age-adjusted mortality than that of the overall Taiwan area. This finding may result from a higher mortality from tuberculosis in Pu-Li. Based on these data, the five leading causes of death in Pu-Li were cerebro-vascular disease, accident, heart disease, cancer and tuberculosis. Hypertension and diabetes were the 5th and 6th leading causes of death in 1985 and ranked 12th and 13th, respectively, in 1966. This data point out the increasing importance of hypertension and diabetes rates in Pu-Li. Tuberculosis and pneumonia had been controlled, ranking from the 1st and 3rd in 1966 to the 10th and 12th, respectively, in 1985. Suicide, cancer, and accident were usually coded as the single cause of death without other co-existent causes of death noted, so that there was in most instances not much difference between analyses based on the underlying cause of death and multiple causes of death. However, this was not true for hypertension and diabetes. If multiple causes of death were analyzed, only 34.5% of hypertension and 66% of diabetes were coded as the underlying cause of death. 37.2% of cerebro-vascular diseases co-existed with hypertension, and 20.3% of diabetes co-existed with hypertension.

Techniques for virus detection in aquatic sediments.

Laboratory experiments have been undertaken to study the adsorption-desorption of poliovirus to and from marine and freshwater sediments. It was observed that marine sediments retained 99% of added virus, whereas, freshwater sediments adsorbed approximately 40% of the added virus. Ten eluents were investigated for their ability to desorb viruses from a marine sediment. It was found that virus elution from the marine sediment was relatively low and ranged from less than 1% to 44%. Two eluents, urea-lysine and TCA-glycine at pH 9.0, were found to be the most efficient among the eluents tested. Viruses were more easily released from freshwater than from marine sediments. When urea-lysine, beef extract and purified casein were used as eluents, the overall virus recovery ranged from 8% to 22% for the marine sediment and from 23% to 59% for the freshwater sediments. The urea-lysine methods was used for the detection of indigenous enteroviruses in sediments from a closed shellfish bed. Enteroviruses were recovered with concentrations up to 708 TCID50/50 g of sediment.