Department Of Health In Taiwan Research Articles

Intussusception associated with rotavirus vaccination in a 2-month-old infant: A case report

Abstract Intussusception is an intestinal disease usually occurring within 2 years of age. Most cases are idiopathic or caused by intestinal lymphadenopathy after viral infection. The rotavirus vaccine is a kind of oral live attenuated vaccine approved by the Department of Health in Taiwan since 2006. This vaccine reportedly increases the risk of intussusception, especially after the first dose. Herein, we report a case of intussusception after the first dose of oral rotavirus vaccination with surgical findings that could clarify the pathogenesis of rotavirus vaccine-induced intussusception.

An HPLC method for the simultaneous determination of marker compounds of aloe and scutellariae radix in cosmetics

The Department of Health in Taiwan has announced mandatory labeling of the whole composition of cosmetics since May 5, 2002. Chinese herbal extracts are commonly added to cosmetics to attract consumers. To follow the earlier-mentioned regulation, it is important to develop a quantitative method to examine the contents of products to which Chinese herbal extracts have been added. This study attempted to establish a quantitative method for aloe and Scutellariae Radix (SR) in cosmetics. An HPLC/UV method using gradient elution was established to analyze marker compounds in herbal extracts and spiked blank cosmetic bases. The calibration curves of the marker compounds were linear (r > 0.99) in the range of 1.6 to 50.0 μg/mL. The analytical method was validated and commercial products were assayed. The results indicated that aloin, aloe-emodin and chrysophanol were not detected in all four aloe extracts. Baicalin and wogonin were detected in the two SR extracts. However, marker compounds of these two herbs were not detectable in the 26 commercial product samples.

Plant Based Diet, Lifestyle, and Medical Cost - A Matched Cohort Study

Background: Plant based diet and lifestyle have been shown to reduce many chronic non-communicable diseases, which now accounts for major global burden of diseases. We tried to determine the contribution of a plant based diet and lifestyle to actual direct medical cost in a population-based study. Methods: Through linkage to the National Health Insurance Database of Taiwan, we compared health care utilization and medical expenditure of 2166 vegetarians and 4332 age, sex matched non-vegetarians recruited from the Buddhist Tzu Chi Foundation. Diet and lifestyle questionnaires were self-administered and prospectively collected. General linear model was used to estimate the 5-year average medical cost in vegetarians versus non-vegetarians while adjusting for age, sex, education, exercise habits, smoking, and alcohol drinking. Medical expenses related to non-diet associated lifestyle factors (smoking, alcohol drinking, active community activities and religious emotional support) were estimated by comparing with published population medical cost data standardized to match the age and sex characteristics of the cohort. Findings: Tzu Chi vegetarians have significant lower outpatient visits, inpatient admissions. This translates to 13% lower outpatient (P=0·007) and 15% total medical expenditure (P=0·008) compared with Tzu Chi non-vegetarians, who have additionally 8% lower medical expenditure compared with the general population. No difference in dental visits and expenses were found between diet groups. Interpretation: Plant based diet and healthy lifestyle are associated with significantly lower medical care utilization and expenditure and should be the first choice of strategies to alleviate the current medical-economic burden. Funding: This work was supported by a grant from the Department of Health in Taiwan (grant number: DOH94-TD-F-113-044) for cohort establishment, and by grants (grant numbers: TCMMPSP104-08-02, TCMMP105-13-05, TCMMP106-04-01) from the Buddhist Tzu Chi Medical Foundation for cohort follow-ups and linkage to the National Health Insurance Database. Declaration of Interest: None. Ethical Approval: The study was approved by the Institutional Reviewer Board at the Dalin Tzu Chi Hospital and signed informed consents were obtained from all study participants.

The Risk of Erectile Dysfunction Following Pelvic Angiographic Embolization in Pelvic Fracture Patients: A Nationwide Population-Based Cohort Study in Taiwan.

Pelvic fracture with hypovolemic shock is a known crucial injury in trauma patients. Pelvic fracture with vessel injury often leads to hemodynamic complications; in a trauma scenario, evidence of other systems being affected is often absent. Bleeding cessation and resuscitation are important for these types of trauma patients. For this purpose, pelvic angiographic embolization is frequently used. Multiple studies have reported that angiographic embolization may cause erectile dysfunction (ED) in hemodynamically stable patients with pelvic fracture. However, no study has evaluated a large patient cohort with a long-term follow-up. We hypothesized that angiographic embolization to control bleeding may compromise blood supply to the genitourinary organs or cause secondary neurogenic injury that increases the risk of ED. Our goal was to evaluate the risk of ED following pelvic fractures in male patients treated with pelvic angiographic embolization. We used data from the National Health Insurance Research Database (NHIRD) from 1997 to 2010 provided by the Bureau of National Health Insurance of the Department of Health in Taiwan. We collected disease histories from inpatient files. The disease diagnoses were based on the International Classification of Diseases (ICD), Ninth Revision, Clinical Modification. These data were all deidentified, and we did not contact the patients. As such, informed consent was not needed. Eighty-five and 82,802 patients were included in the case and control cohorts, respectively. All patients were aged 15-45, and the proportion of pelvic fracture locations was equal between the groups. After investigating the causes of ED among male patients aged 15-45 with pelvic fractures using logistic regression analysis in a generalized estimating equations model and after adjusting for the influence of confounders, we found that these patients had high risks (odds ratio (OR): 32.637; 95% confidence interval: 14.137-75.346; P < 0.001) of developing ED post-angiographic embolization. Male patients in Taiwan with pelvic fractures who undergo angiographic embolization to control bleeding have a higher risk of ED than those who do not undergo the procedure. Physicians should practice caution and inform patients of this connection before the procedure.

Risk of infertility following pelvic angiographic embolization in female patients with pelvic fractures: A nationwide population-based cohort study in Taiwan.

Pelvic angiographic embolization is an effective procedure to provide haemostasis in patients with pelvic fractures. However, management with repeated follow-up radiographs may result in infertility. The study aimed to evaluate the risk of infertility following pelvic fracture treated with pelvic angiographic embolization in female patients. We used data from the National Health Insurance Research Database (NHIRD) provided by the Bureau of National Health Insurance of the Department of Health in Taiwan from the period of 1997–2010. A total of 36 and 18,029 patients were included in the case and control cohorts, respectively. The risk estimations for the case and control cohorts were compared using a Cox’s proportional hazards regression model. The significance level was set at <0.05. After adjusting for possible confounding factors, the incidence of infertility in the case cohort was nearly 30.7-fold higher than that in the control cohort (adjust hazard ratio [HR] = 30.7, 95% confidence interval [CI] = 10.643–70.109). Patients between 15–35 years of age had a much higher incidence of infertility in the case cohort than in the control cohort (adjusted HR = 49.9, 95% CI = 15.177–64.099). Taken together, pelvic fractures in female patients treated with arterioembolization for haemostasis might be associated with a higher risk of infertility in Taiwan. Physicians should be aware of the link and inform patients of this risk prior to arterioembolization.

Impact of hypoalphalipoproteinemia on quality of life in Taiwanese women with central obesity

To investigate the relationship between health-related quality of life (HRQoL) and different cutoff value of low level of high-density lipoprotein cholesterol (HDL-C) in Taiwanese women with different definition of obesity. Prospective observational study in women with central obesity was conducted in Taipei City Hospital. A total of 572 women were screened at our clinic, and 227 of them with a body mass index ≧27 kg/m2 defined by the Department of Health in Taiwan and weight circumference ≧80 cm were eligible for the study. We defined two groups as group A-low HDL (HDL-C < 40 mg/dL) and group B-high HDL (HDL-C < 50 mg/dL) according to different definition of hypoalphalipoproteinemia in obese women. Significantly reduced HRQoL score was noted in group A-low HDL compared to group A-high HDL (HDL-C ≧ 40 mg/dL), but not between group B-low HDL and group B-high HDL (HDL-C ≧ 50 mg/dL). Positively correlation was noted between HDL-C level and physical domain of HRQoL score. HDL-C contributes independently to physical domain of HRQoL score after controlling for other factors. Decreased leptin and adiponectin level were noted in hypoalphalipoproteinemia groups. Taiwanese obese women with hypoalphalipoproteinemia have adverse impact on HRQoL, especially when the HDL-C level is lower than 40 mg/dL. Both hypoalphalipoproteinemia and hypertension accounted for a great variance to lower scores of physical domain of HRQoL with positively correlation with HDL-C level observed. Decreased leptin and adiponectin were also observed in hypoalphalipoproteinemia group, which implied increased cardiovascular risk. HDL-C level may deem as another indicator for HRQoL in women with central obesity.

Investigation on the trend of food-borne disease outbreaks in Taiwan (1991–2010)

This article summarizes the results of 20 years (1991–2010) of investigation on food-borne disease outbreaks (FBDOs) collected by the Food and Drug Administration of the Department of Health in Taiwan. Among the 4284 FBDOs (82,342 cases) reported, the average annual number of 285 outbreaks during 2001–2010 was substantially greater than the average annual number of 143 outbreaks reported during 1991–2000. The average number of 15.5 cases per outbreak in 2001–2010 was lower than that in 1991–2000, which is 28.5 cases per outbreak. Small-scale FBDOs increased during 2001–2010. Good hygiene practices should be carried out at food service establishments and school kitchens that provide compound cooking food or meal boxes. The three most common bacterial etiology agents involved were Vibrio parahaemolyticus, Staphylococcus aureus, and Bacillus cereus. FBDOs resulting from B. cereus and Salmonella spp. exhibited an increasing trend during 2001–2010. Increased botulism FBDOs in 2001–2010 had been effectively controlled and reduced after governmental policy intervention. However, natural toxin-associated FBDOs are of concern as they can be fatal, especially the outbreaks associated with eating pufferfish by mistake.

The effects of strategic hospital alliances on hospital efficiency

This study examines the effects of strategic alliances on the efficiency of hospitals controlled by the Department of Health in Taiwan. Overall, it is found that the efficiency of the hospitals improved after they formed strategic hospital alliances (SHAs). The results also indicate that smaller hospitals located in competitive areas are more efficient, as exemplified by shorter patient stays, higher occupancy rates, and lower mortality rates. Based on Taiwan's experience, it is inferred that SHAs do improve the performance of the participating hospitals. It is hoped that the results of this study will encourage health policy officials and healthcare organizations in other countries to consider implementing similar strategies for their hospitals.

Rapid onset of rhabdomyolysis after switching to a raltegravir-based antiretroviral regimen

Raltegravir is the first integrase inhibitor antiretroviral agent that has been demonstrated to have antiviral efficacy and safety. However, the US Food and Drug Administration has recommended use with caution in patients with risk factors for rhabdomyolysis, based on four case reports of rhabdomyolysis in patients with identifiable risk factors. We present a 32-year-old Asian man with human immunodeficiency virus (HIV), but without other underlying diseases, who developed rapid-onset, raltegravir-associated rhabdomyolysis and hyperlactatemia. Our patient lacked predisposing factors for rhabdomyolysis, and the rapid onset time of 4 days was the shortest reported. Therefore, clinicians should exercise caution when using raltegravir and closely monitor all patients for the symptoms of muscle pain and weakness. This case has been reported to the National Adverse Drug Reactions Reporting System of the Department of Health in Taiwan.

Population-Based Study of Birth Prevalence and Factors Associated with Cleft Lip and/or Palate in Taiwan 2002–2009

BackgroundFacial cleft deformities, including cleft lip with or without cleft palate (CL/P) and cleft palate (CP), are common congenital birth anomalies, especially in Asia. This study aimed to analyze the prevalence of CL/P and CP and to identify associated factors in Taiwan.MethodsThis population-based epidemiological study retrospectively analyzed birth data obtained from the Department of Health in Taiwan for years 2002–2009. Frequency distribution, percentages and related predictors were investigated, and findings were presented by types of cleft deformities. Logistic regression analysis was performed to identify factors associated with cleft deformities.ResultsOverall prevalence of cleft deformities among 1,705,192 births was 0.1% for CL/P and 0.04% for CP over the 8-year study period. Higher prevalence of CL/P or CP was observed with multiple pregnancies, being male for CL/P, being female for CP, gestational age ≤37 weeks and lower birth weight (<1.5 kg). Both CL/P and CP were significantly associated with gestational age <37 weeks and birth weight<1.5 kg (all P <0.0001). CL/P was significantly associated with multiple parities (P = 0.0004–0.002). Male newborns and female newborns were significantly associated with CL/P and CP, respectively (both P<0.0001).ConclusionsOverall prevalence for congenital cleft deformities in study subjects was 0.1%, in keeping with high rates in Asia. Results suggest the need for awareness and early identification of those at high risk for cleft deformities, including newborns with gestational age <37 weeks, weighing <1.5 kg at birth and women with multiple parities, as a potential strategy to counter long-term adverse effects on speech and language in this population.

The association between self‐reported sleep quality and overweight in a Chinese population

Sleep quality and obesity are associated with type 2 diabetes, hypertension, and metabolic syndrome. However, there is limited research on the association between sleep quality and obesity, and thus the aim of this study is to investigate this relationship in a Chinese population. Subjects were recruited from the Prevention Health Center of National Cheng Kung University Hospital. Anthropometric data and metabolic parameters were measured. Being overweight or obese was defined according to the recommendations of the Department of Health in Taiwan. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Of the total 2,803 subjects, 1,059 were classified as normal weight, 1,127 were overweight, and 617 were obese. The global PSQI score were 6.30 ± 2.56, 6.61 ± 2.96, and 7.02 ± 2.95 in subjects who were normal weight, overweight, and obese, respectively (test for trend, P < 0.001). Of the variables tested in the multivariate linear regression model, female gender, being overweight, obesity, sleep duration, and alcohol drinking were significantly associated with global PSQI scores, and in the multivariate logistic regression model, female gender, being overweight, obesity, and sleep duration were independent predictors of poor sleepers after controlling for age, gender, BMI or different weight statuses, sleep duration, alcohol drinking, smoking, habitual exercise, hypertension, newly diagnosed diabetes, total cholesterol, high-density lipoprotein, triglyceride, estimated glomerular filtration rate, and alanine aminotransferase. In conclusion, female gender, being overweight, obesity, and sleep duration were associated with poor sleep quality independent of cardiometabolic risk factors. In clinical practice, subjects who are obese, or even only overweight, should be evaluated for the presence of sleep disturbance.

Association of the C825T polymorphism in the GNB3 gene with obesity and metabolic phenotypes in a Taiwanese population

The relationship between obesity and a single nucleotide polymorphism (SNP), rs5443 (C825T), in the guanine nucleotide binding protein beta polypeptide 3 (GNB3) gene is currently inconsistent. In this study, we aimed to reassess whether the GNB3 rs5443 SNP could influence obesity and obesity-related metabolic traits in a Taiwanese population. A total of 983 Taiwanese subjects with general health examinations were genotyped. Based on the criteria defined by the Department of Health in Taiwan, the terms "overweight" and "obesity" are defined as 24 ≦ BMI<27 and BMI ≧ 27, respectively. Compared to the carrier of the combined CT+TT genotypes of the GNB3 rs5443 polymorphism, triglyceride was significantly higher for the carrier of CC genotype in the complete sample population (128.2±93.2 vs. 114.3±79.1mg/dl; P=0.041). In addition, the carriers of CC variant had a higher total cholesterol than those with the combined CT+TT variants (194.5±36.8 vs. 187.9±33.0mg/dl; P=0.019) in the complete sample population. In the normal controls, both triglyceride (P=0.018) and total cholesterol (P=0.011) were also significantly higher in the CC homozygotes than in the combined CT+TT genotypes. However, the GNB3 rs5443 SNP did not exhibit any significant association with obesity or overweight among the subjects. Our study indicates that the CC genotype of the GNB3 rs5443 SNP may predict higher obesity-related metabolic traits such as triglyceride and total cholesterol in non-obese Taiwanese subjects (but not in obese subjects).

More medical resources do not imply better quality of life : A population- based study in Taiwan

Studies regarding medical resources input-output (I/O) efficiencies gained increasing importance in recent years. Most of published studies measure medical resources I/O efficiencies of hospitals or clinics, however, very limited number of studies investigating nation-wide medical resources I/O efficiencies. Besides, there was also very limited number of studies using population data of quality of life (QOL) as an outcome variable. The aim of this study was to investigate nation-wide medical resources I/O efficiencies of Taiwan, by using national medical service volumes statistics as input variables and population QOL as outcome variables. The population QOL data were from 2005 National Health Interview Survey (NHIS) and the national medical service volumes statistics were from 2005 National Statistics of Health Care Providers and Medical Services, which were issued by Department of Health in Taiwan. The population QOL was measured by SF-36. The data envelopment analysis (DEA) method was used to investigate the medical resources I/O efficiencies. Twenty three cities and counties of Taiwan were regarded as decision making units (DMUs). The results showed that 40% of cities and counties achieved efficiency regarding health care resources allocation. The results showed that the Tai-Nan city (an emerging high-tech city) and the Taiwan capital, Taipei City, were the two lowest QOL DMU. In summary, cities with high tech development and with more medical resources are not necessarily the cities with better quality of life.

The contribution of depression to mortality among elderly with self-reported hypertension

Previous research has suggested that hypertension and depression are two of the important causes of mortality among the elderly. This study aims to test the contribution of depression to mortality among elderly with self-reported hypertension. This research used data from the Survey of Health and Living Status of the Middle Age and Elderly (SHLS) conducted by the Bureau of Health Promotion, Department of Health in Taiwan. The 1989, 1996, 1999, 2003, and 2007 waves were used. In total, 3736 respondents aged 60 or above were analyzed. Participants were grouped by status of hypertension and depression. The contribution of depression to mortality among elderly with self-reported hypertension was estimated using Cox proportional hazard model. Analyses were separated into younger elderly individuals (<70 years) and older elderly individuals (≥ 70 years). In the full model, the hazard ratios for mortality for the groups of not hypertensive/depressed, hypertensive/not depressed, and hypertensive/depressed were 1.12 [95% confidence interval (CI) 0.98-1.28], 1.32 (95% CI 1.19-1.46), and 1.54 (95% CI 1.29-1.83), respectively, compared with the reference group of not hypertensive/not depressed. The pattern remained the similar after separating the participants into the two age groups. However, much higher hazard ratios were observed for the older cohort. Depression contributes significantly to the hypertension-mortality relationship for the elderly. For the elderly, hypertension should be tackled along with depression in order to reduce the mortality associated with hypertension.

Evaluation of the Determinants for Acceptance of Antenatal Clinical Breast Examination in Taiwan

Antenatal clinical breast examinations (ANCBEs) performed by physicians or nurses during prenatal care visits are recommended by the Department of Health in Taiwan. This study aimed to assess the level of acceptance of ANCBE in Taiwan and the determinants associated with behavior toward them. This was a clinic-based study conducted from 30 November 2008 to 30 April 2009 by using a structured questionnaire for 492 pregnant women. Only 2.8% of the patients received ANCBE, and 95.9% were not aware of the availability of ANCBE. History of breast surgery and awareness of ANCBE availability were significantly associated with receiving ANCBE (P < .001). Furthermore, multiparity was statistically different for the awareness of ANCBE availability (P = .04). Acceptance of ANCBE was determined by personal history of breast surgery and awareness of ANCBE availability.

Associations of the thymidylate synthase 3¡¦UTR polymorphisms with one carbon status, lymphocytic p53 oxidative lesions and hepatocellular carcinoma progression

The aims of the study were to investigate relationships between thymidylate synthase (TS) 3'UTR polymorphisms. Genotypes in a 6‐bp deletion/insertion in the 3’‐untranslated region (TS 3'UTR), blood folate and homocysteine (Hcy) levels were determined on 232 HCC patients. The frequencies of TS 3’‐UTR genotype of the study HCC patients were 52% (del6/del6), 43% in del6/ins6, and 5% in ins6/ins6. Increased frequencies of one 6‐bp insertion in the TS genotypes were associated with decreased Hcy levels (r = −0.154, P = 0.04). Compared with the (del6/del6) variant, HCC patients with at least one 6‐bp insertion variants had lower levels of AFP tumour marker (P = 0.05). Among individuals with low serum folate levels (&lt; 14 nM), the TS del6/ins6 and ins6/ins6 variants had significantly lower levels of p53 promoter oxidative damage than the del6/del6 variant. After adjustment for multiple factors including life‐style, clinical factors and serum folate status, the odds ratios for developing large tumour (size &gt; 3 cm) were 0.24 (95% CI: 0.07–0.08) for combined MTHR C677T mutant variants (CT+TT genotypes) and TS 3'UTR mutant variants (del6/ins6 + ins6/ins6) compared with wild type variants. This protective effect against developing large tumour was negated after further adjustment of lymphocytic p53 oxidative lesions. Taken together, our data suggested that HCC patients carrying combined genotypes with at least one mutant allele in MTHFR C677T and TS 3'UTR 6 bp‐insertion variants have reduced risks of developing large tumour, which may be mediated by amelioration of p53 oxidative lesions.Grant Funding Source: Department of Health in Taiwan

When does poor subjective financial position hurt the elderly? Testing the interaction with educational attainment using a national representative longitudinal survey.

BackgroundSeveral studies have demonstrated that perceived financial status has a significant impact on health status among the elderly. However, little is known about whether such a subjective perception interacts with objective socioeconomic status (SES) measures such as education that affect the individual's health.MethodsThis research used data from the Survey of Health and Living Status of the Middle Age and Elderly in Taiwan (SHLS) conducted by the Bureau of Health Promotion, Department of Health in Taiwan. Waves 1996, 1999 and 2003 were used. The sample consisted of 2,387 elderly persons. The interactive effects of self-rated satisfaction with financial position and educational attainment were estimated. Self-rated health (SRH), depressive symptom (measured by CES-D) and mortality were used to measure health outcomes.ResultsSignificant interaction effect was found for depressive symptoms. Among those who were dissatisfied with their financial position, those who were illiterate had an odds ratio (OR) of 8.3 (95% CI 4.9 to 14.0) for having depressive symptoms compared with those who were very satisfied with their financial position. The corresponding OR for those with college or above was only 2.7 (95% CI 1.0 to 7.3). No significant interaction effect was found for SRH and mortality.ConclusionsAlthough poor financial satisfaction was found to be related to poorer health, the strongest association for this effect was observed among those with low educational attainment, and this is especially true for depressive symptoms. Subjective financial status among the elderly should be explored in conjunction with traditional measures of SES.

Cross-Cultural Comparisons of Health-Related Quality of Life Between Taiwanese Women and Transnational Marriage Vietnamese Women in Taiwan

According to the Ministry of the Interior, Department of Statistics, Taiwan, ROC (2010), Taiwan is home to 131,000 Southeast Asian female spouses holding valid resident permits. More than two thirds (68%) of this number is from Vietnam. An understanding of health-related quality of life (HRQL) among female Vietnamese spouses is essential to develop appropriate health policies and interventions for this population. The purpose of this study was to compare HRQL values between the general Taiwan female spouse population and the female Vietnamese spouses living in Taiwan. This study was conducted in a community-based health center in southern Taiwan and targeted households with Vietnamese wives in the Tainan, Kaohsiung, and Pingtung areas. A total of 203 female Vietnamese spouses were included in this study, with data collected using questionnaires between June 2007 and July 2008. Research instruments included the Demographic Inventory Scale and the 36-Item Short Form Version 2. The general population norm was based on the findings of the Center for Population and Health Survey Research, Bureau of Health Promotion, Department of Health in Taiwan (2001) using the 36-Item Short Form Version 2, with norm scoring based on 18,142 subjects aged 12 years and older. Cross-cultural comparisons indicate that Vietnamese immigrant women have a generally lower HRQL mean score than Taiwanese women in terms of seven dimensions, including physical functioning, role limitations due to physical health, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health. Only one domain, bodily pain, showed a slightly higher level among Vietnamese spouse respondents. This result is consistent with previous studies that indicate immigrant health status is generally lower than that of the people in the host society. High bodily pain, low vitality, somatization, social isolation, and mental health issues were discussed and should of concern to future policymakers. This study can inform the government regarding which references to use to make appropriate health policies for immigrant women and their families.

Mortality Among Ship-breaking Workers—-A Retrospective Cohort Study

PP-30-161 Abstract: Background/Aims: Taiwan was ever a ship-breaking kingdom. From the late 1960s to the late 1980s, the port city of Kaohsiung witnessed one of the most thriving ship demolition industries in the world. The OSHA agency stated that ship breaking also posed the following dangers: (1) Exposure of hazardous substances as the demolition sometimes released toxic or explosive substances such as asbestos, PCBs, heavy metals, and waste fuel; (2) hazard work activities; and (3) hazard work condition. Among these, there is a need for long-term follow-up study to examine the health risks of exposure of hazardous substances. Hence, the aim of this study was to study the cause of death and standardized mortality ratios in ship-breaking cohort. Methods: The national mortality data during the years from 1985 to 2008 were obtained from the Office of Statistics of the Department of Health in Taiwan. The death record is defined according to the International Classification of Disease, Injury, and Causes of Death (9th revision). Standardized mortality rates (SMR) for various diseases were calculated on the basis of Taiwan standard population mortality. Results: The results showed that cause of death of ship-breaking cohort among all cause (SMR = 1.50, 95% CI = 1.41–1.60), cancer (SMR = 1.43, 95% CI = 1.27–1.61), liver cirrhosis (SMR = 10.77, 95% CI = 8.35–13.68), all accidents (SMR = 2.45, 95% CI = 2.09–2.85), and special region cancers as oral and nasopharyngeal (SMR = 2.90, 95% CI = 2.20–3.76), esophagus (SMR = 2.47, 95% CI = 1.44–3.95), liver (SMR = 5.31, 95% CI = 4.12–6.73), and lung (SMR = 1.60, 95% CI = 1.20–2.09) were significantly higher mortality than general Taiwan population. Conclusion: The studies are providing the reference of health care policy for alive ship-breaking worker in Taiwan and still precede ship-breaking industry in development countries.

Larger Body Mass Index and Waist Circumference Are Associated with Lower Mortality in Chinese Long‐Term Care Facility Residents

To investigate the association between body mass index (BMI) and waist circumference (WC) and all-cause mortality of Chinese residents in long-term care facilities in Taiwan. Prospective cohort study. Eight long-term care facilities in Taiwan. Three hundred fifty-four residents aged 60 and older (median 78.4, range 60-101; 156 men, 198 women) were recruited during the study period. Anthropometrics and metabolic parameters were measured at baseline. Mean BMI was 21.7 ± 4.2 kg/m(2) (range 11.6-35.3 kg/m(2) , and mean WC was 82.4 ± 10.9 cm (range 55.0-124.0 cm). Mortality data were from the Department of Health in Taiwan. There were 219 deaths during the 5 years of follow-up. After adjusting for age, sex, albumin, Karnofsky performance status scale, hypertension, and diabetes mellitus, subjects in the highest quartile of BMI (27.3 ± 2.8 kg/m(2) ) and WC (96.7 ± 7.4 cm) had a significantly lower mortality rate than did subjects in the lowest quartile (BMI, 16.7 ± 1.7 kg/m(2) ; WC, 69.6 ± 4.2 cm). After further stratification according to central obesity status, the subjects in the two highest BMI quartiles had a lower mortality rate than those in the lowest BMI quartile but only in the central obesity group (≥ 90 cm in men or ≥ 80 cm in women). The adjusted relative risk for all-cause mortality in the highest versus lowest BMI quartile was 0.17 (95% confidence interval = 0.05-0.57). BMI and WC were negative predictors for all-cause mortality in older Chinese adults living in long-term care facilities. Participants with higher WC and BMI had lower all-cause mortality.