Taiwanese Children Research Articles

Seasonal and source characteristics of organophosphorus flame retardants in air and house dust in Taiwan residential microenvironments: Implications for young children's exposure and risk assessment using a probabilistic approach

Organophosphate flame retardants (OPFRs) are prevalent in multiple industries. They have gradually replaced brominated flame retardants in recent years. Eleven OPFRs were collected from indoor air and house dust in two primary activity spaces––bedrooms and living rooms. The aim of the present study was to explore the potential sources of, and health risks associated with, OPFR exposure in young children using integrated and probabilistic approaches. The level of 11 indoor air OPFRs (466 ng/m3) in the bedroom was greater than that measured in the living room (379 ng/m3), and these values contrasted with those detected in dust. The air OPFRs in the warmer season were higher than those measured in the cold season; the inverse was true for those detected in house dust. In both activity spaces, the composition profiles indicated that tris(1-chloro-2-propyl)phosphate in indoor air (39%) and tris(2-butoxyethyl)phosphate in house dust (67%) were the dominant congeners. The average daily exposure dose (ADD) of OPFRs via air inhalation and dust ingestion did not differ significantly between preschool and school-aged children or based on sex. The Monte-Carlo-simulated 95th percentile ADD of the OPFRs in dust ingested by preschool children was 1.4 times higher. The OPFR exposure from air inhalation and dust ingestion in Taiwanese children is currently an acceptable non-carcinogenic risk and a negligible carcinogenic risk to Taiwan residents.

Trends in the prevalence of intellectual disability among children in Taiwan.

Intellectual disability (ID) is a major developmental disability. However, data on changes in the prevalence over time at the national level are limited. Using data from the national disability registry, we conducted an ecological study to evaluate the time trends of ID among children in Taiwan. We calculated the prevalence of ID by age, sex and severity, from 2000 to 2011, and assessed the time trends. During the study period, the overall prevalence of ID in children aged 3-17years increased from 3.60 to 5.91 per 1000 (β=0.22, P<0.001, r2 =0.97). The prevalence of mild ID (MID, intelligence quotient: 50-69) increased from 1.30 to 3.60 per 1000 (β=0.21, P<0.001, r2 =0.98). However, the prevalence of severe ID (SID, intelligence quotient: <50) was relatively constant, between 2.22 and 2.38 per 1000 (β=0.01, P=0.076, r2 =0.96). Boys had a higher prevalence than girls, and the average boy-to-girl prevalence ratio was 1.42 for MID and 1.31 for SID. The boy-to-girl prevalence ratios of MID and SID decreased over time (β=-0.01, P<0.001, r2 =0.99 for MID; β=-0.01, P<0.001, r2 =1.00 for SID). The prevalence of ID in Taiwanese children increased from 2000 to 2011 and was largely attributable to increases in MID. Boys had a higher prevalence of ID and were more likely to have MID.

Decline in dental caries experience among schoolchildren in Taiwan, 2012-2020.

This study investigated the association between the decline of the decayed, missing, and filled teeth (DMFT) index and several family-level and individual-level factors among 6- to 18-year-old Taiwanese children from 2012 to 2020. This study used data from the 2012 and 2020 Taiwan National Oral Health Survey of Children and Adolescents. Both surveys used similar methods and were performed in the same study age group. A structured questionnaire was used to collect data on parents' sociodemographic background; the number of children in the family; oral health-related knowledge, attitudes, and behaviours; and children's dietary habits. Dental caries was recorded through standardized oral examinations. Multivariable multilevel zero-inflated negative binomial regression models were used to determine the association between family-level and individual-level factors and the DMFT index from 2012 to 2020. A total of 10217 and 10436 schoolchildren completed the oral examinations and questionnaires in the 2012 and 2020 surveys, respectively. The adjusted mean DMFT index of 12-year-old Taiwanese schoolchildren in 2020 was 2.01, denoting a significant decline from 2.50 in 2012 (adjusted mean ratio=0.20, 95% confidence interval [CI]=0.17, 0.23, p < .0001). Furthermore, children who often consumed sugar-rich drinks had a significantly higher risk (mean ratio=1.05, 95% CI=1.01, 1.10) of having DMFT than those who seldom consumed such drinks (p=.017). In the period of 2012-2020, the DMFT index among Taiwanese children significantly declined. Children who often consumed sugar-rich drinks had a higher DMFT index than those who seldom consumed such drinks. Our findings are valuable to paediatricians, dentists, nutritionists, and public health policymakers.

Results from the Chinese Taipei (Taiwan) 2022 report card on physical activity for children and youth

Background /ObjectiveIn Taiwan, physical inactivity is highly prevalent among children and adolescents. Chinese Taipei (Taiwan) joined the Global Matrix 3.0 in 2018 to share local data on childhood physical activity and related factors with the international community. This study reports the grades for 10 indicators endorsed by the Global Matrix 4.0 and 1 additional indicator. MethodsLocal data for school-aged children and adolescents (approximately 5–17 years old) from 2017 to 2022 were used to determine the grades. The data were obtained from online academic databases and websites of government agencies. The highest priority was given to national surveys, followed by studies using nationally representative samples. ResultsThe data revealed very poor Overall Physical Activity, Organized Sport Participation, and Active Play (F, D−, and F, respectively). Active Transportation, Sedentary Behavior, and Family and Peers were also below average (C−, D+, and D−, respectively). Taiwan's central and local governments have recognized the importance of physical activity by implementing related policy and improving public sports facilities. Accordingly, School and Community and the Built Environment both received a grade of A−, and Government Strategies and Investments received a B+. Physical Fitness received an INC for lack of data. An additional indicator, body mass index, received a grade of B−. ConclusionsDespite great effort by governments and schools, physical activity levels are low and sedentary behavior is prevalent among Taiwanese children and adolescents.

Identification of serum metabolic signatures of environmental-leveled phthalate in the Taiwanese child population using NMR-based metabolomics

Phthalates have become important environmental pollutants due to their high exposure frequency in daily life; thus, phthalates are prevalent in humans. Although several epidemiologic surveys have linked phthalates with several adverse health effects in humans, the molecular events underlying phthalate exposure have not been fully elucidated. The purpose of this study was to reveal associations between phthalate exposure and the serum metabolome in Taiwanese children using a metabolomic approach. A total of 256 Taiwanese children (8–10 years old) from two cohorts were enrolled in this study. Twelve urinary phthalate metabolites were analyzed by high-performance liquid chromatography/tandem mass spectrometry, while a nuclear magnetic resonance-based metabolomic approach was used to record serum metabolic profiles. The associations between metabolic profiles and phthalate levels were assessed by partial least squares analysis coupled with multiple linear regression analysis. Our results revealed that unique phthalate exposures, such as mono-isobutyl phthalate, mono-n-butyl phthalate, and mono (2-ethyl-5-oxohexyl) phthalate, were associated with distinct serum metabolite profiles. These phthalate-mediated metabolite changes may be associated with perturbed energy mechanisms, increased oxidative stress, and lipid metabolism. In conclusion, this study suggests that metabolomics is a valid approach to examine the effects of environmental-level phthalate on the serum metabolome. This study also highlighted potentially important phthalates and their possible effects on children.

Prevalence of Dental Anomalies in Taiwanese Children with Cleft Lip and Cleft Palate

The aim of this study was to investigate the prevalence of tooth agenesis, tooth malformation, and eruption patterns of upper canines/first premolars in Taiwanese children. A total of 132 cleft lip and cleft palate (CLCP) patients (82 boys and 50 girls) underwent alveolar bone grafting (ABG) between 2012 and 2022. The patients’ dental records and X-ray images were inspected. We examined dental anomalies, including congenital missing teeth, microdontia, and transposition from the upper canines to the upper first premolars in these CLCP patients. Additionally, we investigated the mean ABG operation age (9.27 ± 0.76 years) of our patient; 40.9% of them received pre-ABG orthodontic treatment at 8.72 ± 0.70 years. Among the 132 cleft subjects, the prevalence of tooth agenesis is 73.5% (97/132). The most frequently missing teeth are the maxillary lateral incisors (right side: 46.2%; left side: 47.0%). In this study, microdontia are found in all the upper incisors, of which the highest percentage (18.9%) is observed in the upper left lateral incisors. The prevalence of upper canine and first premolar transposition is 10.6%. The pattern of tooth agenesis and microdontia of the upper lateral incisors shows a strong correlation with the cleft sites of these CLCP patients in our study. These results may support the idea that the patterns of dental anomalies in CLCP patients are region-specific.

Unpacking leader responsiveness effects of emotional cultivation groups: Using the variance partitioning method.

Theoretically, group leaders can play a significant role in contributing to the effectiveness of group counseling intervention. However, very few studies have examined the group leader's effects on the client-rated group counseling outcomes. We hypothesized that responsive group leaders who were caring, understanding, and respectful could serve as safe havens and secure bases to facilitate their group members' social and emotional cultivation. The current investigation examined the effects of leader responsiveness on group members' social-emotional cultivation (SEC). A total of 307 Taiwanese children and adolescent clients across 53 groups participated in an eight-session emotional cultivation group intervention. There were five time points of data collection (i.e., preintervention, third group session, sixth group session, postintervention, and a 4-week follow-up), and the variance partitioning method was used to partition longitudinal data into within-member, within-group, and between-group variance components. The results of hierarchical linear modeling revealed that the group leader's responsiveness significantly predicted group members' SEC at each of the three levels of analysis: Individual members had greater change in SEC when (a) they perceived higher leader responsiveness in a time period compared to the average rating of leader responsiveness across all time periods, (b) they perceived higher leader responsiveness compared to the average rating of leader responsiveness across all members in the same group, and (c) the group-as-a-whole perceived higher leader responsiveness than the average rating of leader responsiveness across all groups. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sex differences in the associations between psychological symptoms and tumor necrosis factor-alpha levels among obese and nonobese children aged 6–13 in Taiwan

BackgroundEvidence of associations between psychological symptoms and tumor necrosis factor (TNF)-α level is scant, as is evidence on sex differences in associations for children and adolescents with obesity. This study examined sex differences in associations between psychological symptoms (self-concept, anxiety, depression, anger, and disruptive behavior) and TNF-α level in Taiwanese children and adolescents with healthy weight, overweight, or obesity. MethodsIn 2010, 564 first, fourth, and seventh graders—comprising 250 children with overweight or obesity (44.3 %), 330 adolescents (58.5 %), and 303 males (53.7 %)—underwent a health examination and blood sampling and completed a questionnaire. ResultsA significantly higher TNF-α level was found in children and adolescents with healthy weight than in those with overweight or obesity (median: 14.5 vs. 4.1 (pg/mL); p < 0.001). In multiple linear regression models, anxiety was significantly positively associated with TNF-α level in female participants with healthy weight (β = 0.11 per 10 increments in anxiety, 95 % confidence interval = 0.01–0.22). LimitationsGiven the cross-sectional nature of the study, no inferences of causal relationships among TNF-α level, obesity, and psychological symptoms could be made. ConclusionsThe findings enrich the literature on the TNF-α–psychological symptom association. Sex differences were found in children and adolescents without obesity rather than in those without obesity, and a higher TNF-α level was associated with increased anxiety in girls without obesity. The role of sex differences in the complex associations among psychological symptoms, TNF-α level, and overweight or obesity requires further investigation.

Adult height of children with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

Congenital adrenal hyperplasia attributable to 21-hydroxylase deficiency (21-OHD) is a disorder of adrenal steroidogenesis. Achievement of optimal growth by such patients is challenging. We evaluated the adult height of Taiwanese children with 21-OHD and the effect of a gonadotropin-releasing hormone analogue (GnRHa) in patients with central precocious puberty (CPP) complicating 21-OHD. Among 116 patients with 21-OHD in Taiwan, 90 who had attained adult height were subjected to an analysis of height outcomes. Nine with progressive CPP were treated with GnRHa and the effects of this therapy on adult height were further analyzed. In the pre-screening era, the percentage of boys with 21-OHD was lower than expected. Although neonatal screening can prevent mortality caused by adrenal crisis, some cases may be missed. The pooled mean adult height of the 78 patients treated with conventional therapy were -1.1 SD and -0.5 SD adjusting for the genetic potential. The disease features affecting height outcomes are the genetic height potential and in boys the simple virilizing type. Nine patients with CPP were treated with GnRHa in addition to conventional therapy; the mean adult height increased from the predicted -4.1 SD to -1.0 SD after 6.0±2.5 years of treatment. Patients with 21-OHD had poorer mean adult height. A high caregiver's index of suspicion is required for the early diagnosis of patients with 21-OHD missed on neonatal screening. Adjuvant therapy with GnRHa can improve the adult height of patients with CPP complicating 21-OHD.

Efficacy of machine learning assisted dental age assessment in local population

IntroductionAlthough the dental age assessment is commonly applied in forensic and maturity evaluation, the long-standing dilemma from population differences has limited its application. ObjectivesThis study aimed to verify the efficacy of the machine learning (ML) to build up the dental age standard of a local population. MethodsWe retrospectively studied 2052 panoramic films retrieved from healthy Taiwanese children aged 2.6–17.7 years with comparable sizes in each age-group. The recently reported Han population-based standard (H method) served as the control condition. To develop and validate ML models, random divisions of the sample in an 80%–20% ratio repeated 20 times. The model performances were compared with the H method, Demirjian’s method, and Willems’s method. ResultsThe ML-assisted models provided more accurate age prediction than those non-ML-assisted methods. The range of errors was effectively reduced to less than one per year in the ML models. Furthermore, the consistent agreements among the age groups from preschool to adolescence were reported for the first time. The Gaussian process regression was the best ML model; of the non-ML modalities, the H method was the most efficacious, followed by the Demirjian’s method and Willems’s methods. ConclusionThe ML-assisted dental age assessment is helpful to provide customized standards to a local population with more accurate estimations in preschool and adolescent age groups than do studied conventional methods. In addition, the earlier complete tooth developments were also observed in present study. To construct more reliable dental maturity models in the future, additional environment-related factors should be taken into account.

Sex-specific associations between prenatal exposure to phthalates and neurocognitive development in Taiwanese children: Application of environmental mixture methods to small study sample

BACKGROUND AND AIM: Few studies have examined the sex-specific effect of phthalates as a mixture by applying multiple mixture methods to a small study sample. This study, therefore, examined sex-specific associations of prenatal exposure to urinary phthalates with neurocognitive development in Taiwanese children aged two to three years old. METHODS: The study included 127 children who were followed up at the ages two-three years in the Taiwanese Maternal and Infant Cohort Study. The Mental Development Index (MDI) and Psychomotor Development Index (MDI) were measured in children using the Bayley Scales of Infant Development-II (BSID-II). The monomethyl phthalate, monoethyl phthalate, mono-butyl phthalate (MBP), mono-benzyl phthalate, mono-2-ethylhexyl phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate, mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) were measured in urine samples collected from mothers during pregnancy. Multivariable linear regression (MLR), Weighted Quantile Sum (WQS) regression, quantile g-computation (qgcom), Bayesian Kernel Machine Regression (BKMR), the Super Learner with g-computation were applied and compared to examine the sex-specific effects of the phthalate mixture on MDI and PDI. RESULTS: The mediation MDI and PDI were 94.0 and 99.0, respectively. The spearman correlation ranged between -0.01 and 0.74. None of these methods could detect any sex-specific associations between phthalates and MDI. Results suggest that WQS and qgcomp were able to detect inverse associations between phthalates and PDI with a stronger effect in boys. BKMR and Super Learner with g-computation were unable to detect any precise associations of phthalates with PDI. However, mixture methods detected mixtures&amp;#x27; negative directionality and linear dose-response effects on neurocognitive development. MBP, MEHP, and MEOHP dominated these associations with PDI. CONCLUSIONS: Mixture methods outperformed MLR. However, flexible approaches like BKMR and Super Learner with g-computation may perform better with larger samples. Therefore, the study recommends using multiple mixtures methods for getting comprehensive results from mixture studies. KEYWORDS: Mixture; Neurodevelopment; WQS; BKMR; G-computation

Health risk assessment of phthalates exposure through lipid peroxidation in children with asthma

Background: Global prevalence of asthma in children has dramatically increased in the past decades. Recent studies revealed that Taiwanese children are still exposed to considerable amounts of phthalates after the 2011 incident of phthalates-tainted food products. Up-to-date findings indicated that phthalates may increase malondialdehyde (MDA), a lipid peroxidation marker, in asthma patients. The role of phthalates in the increased occurrence of childhood asthma through lipid peroxidation remains unclear. We want to assess the association between phthalates exposure and MDA in children with asthma. Methods: We recruited 125 children with clinically-diagnosed asthma and around 98 controls from Taipei Hospital since January 2019. Participants provided urine specimen and questionnaire. Eleven phthalate metabolites and MDA were analyzed by liquid chromatography tandem-mass spectrometry (LC-MS/MS) and ELISA, respectively. Pearson correlation and related statistical method were used to analyze the relationship of urinary phthalate metabolites or MDA in asthma children. Results: BMI in asthma children was significantly higher than that in control (p=0.005) whereas no similar phenomena was observed for other demographic factors. Mother ever had cigarette smoking in pregnancy and current burn incense at home in the case group were marginally significantly higher than those in control. Meanwhile, the median levels of urinary MEHP (72.18 v.s 68.81 ng/mL), MiNP (28.75 v.s 23.51 ng/mL), and MDA (6.87 v.s. 5.86) in asthma children were higher than those in control, though failed to reach statistical significance. Age was positively correlated with urinary MDA (r=0.159, p=0.018) and MEP (r=0.13, p=0.058). Urinary MEP was highly correlated with the other phthalate metabolites which indicated a common exposure source. Conclusion. Certain phthalates may increase lipid peroxidation markers in asthma children. Keyword: Phthalate metabolites; lipid peroxidation; asthma.

Seasonal attack patterns in childhood atopic dermatitis are related to different environmental factors

BACKGROUND AND AIM: Atopic dermatitis (AD) is a prevalent childhood condition involving many people. The attack pattern has been quite diverse. Few studies have classified AD children into subgroups according to seasonal attack pattern. This study explores the methods to group AD children into seasonal attack patterns, and examines hereditary and environmental factors on each subgroup in children with AD. METHODS: In Taiwanese children from one elementary and one middle schools in each of the 22 cities/counties, allergic status, hereditary and living environmental factors were surveyed in 2016, as well as air pollutants by air monitoring stations. Among those with current AD, principal component analyses on weighted moving average of monthly attack score was applied to categorize AD attack subtypes. Generalized Estimating Equation was used to study the effects of environmental exposure on each AD attack subgroups. RESULTS: A total of 11,585 children were surveyed, and 17.6% of children reportedly had AD attack in the past 1 year. Among them, four attack patterns were identified: spring, summer/fall, winter and perennial. Parental atopic diseases and higher education, and molds in residence are important factors for AD. Among seasonal attack patterns, lower temperature, higher humidity, and PM2.5 were related to spring-attack; higher temperature to summer-fall-attack; lower humidity to winter-attack; and traffic-related air pollutants to perennial-attack AD. CONCLUSIONS: Distinguished attack patterns are identified in children with current AD. Depending on individual attack subtypes, environmental factors can be different. KEYWORDS seasonal attack pattern; atopic dermatitis; environmental factors; GEE

Prevalence, clinical presentation, and associated atopic diseases of pediatric fruit and vegetable allergy: A population-based study.

In children, fruit and vegetable allergies are often overlooked compared with well-known allergies such as those to eggs, milk, and shellfish. Therefore, this study aimed to analyze fruit and vegetable allergies in children, including prevalence, types of food allergens, clinical presentation, management, and associated comorbid atopic diseases. In 2012, a nationwide, cross-sectional, random sampling questionnaire-based survey for common fruit and vegetable allergies was conducted in Taiwan. Information regarding these plant food allergies was collected. Physicians diagnosed food allergies according to the descriptions of convincing symptoms. Enrolled questionnaires were reviewed by expert pediatricians. A total of 9,982 valid questionnaires were analyzed. The overall prevalence of fruit and vegetable allergies was 5.6% (n=560) and 3.0% (n=304), respectively. The most common fruit allergen was mango, followed by kiwifruit, whereas taro and bamboo shoot were the most common vegetable allergens. Meanwhile, most allergic symptoms were of the mucocutaneous tissue, followed by the upper airway and gastrointestinal tract. Most only required avoidance of allergens and not medical treatment. Children with fruit or vegetable allergies had a higher percentage of comorbid atopic dermatitis, allergic rhinitis, and asthma than those without food allergies; additionally, the proportion of comorbid atopic diseases was similar between fruit and vegetable allergies and shellfish allergy. One child developed anaphylaxis due to a corn allergy. Fruits and vegetables are common food allergens in Taiwanese children who present with diverse and potentially severe symptoms. Children with plant food allergies had a percentage of comorbid atopic diseases similar to that of shellfish allergy, the most common allergen. These findings indicate the importance of considering fruit and vegetable allergies in children.

Exploring Taiwanese preschool children’s perspectives on the value of caring

ABSTRACTThe current study explores Taiwanese preschool children’s understanding of the value of caring in school. This study offers researchers and practitioners opportunities to study children’s perspectives in a particular cultural setting and discuss the connectedness of culture and children’s views on caring. Participatory research and qualitative methods were used, encompassing the collecting of children’s speech, photography, and drawings. The findings regarding the understanding of caring indicated the following: (1) Children interpret caring among peers and from school surroundings; (2) children perceive teacher care in daily classroom routines; (3) children learn about values when outdoors, in learning areas, and during transition times; and (4) children exhibit the ability to distinguish non-caring behaviour. This study shows that for children caring was most frequently defined as helping others in need and as teacher care in daily routines. The children’s views on caring were influenced by culture, and they created meanings for caring.

Functional Independence of Taiwanese Children with Osteogenesis Imperfecta.

Osteogenesis imperfecta (OI) is a group of rare genetic disorders that affect bone formation. Patients with OI present mainly with increased bone fragility and bone deformities. Twenty-seven Taiwanese children between 2 and 21 years of age with OI and their parents were recruited at MacKay Memorial Hospital from January 2013 to December 2019. We used the Functional Independence Measure for Children (WeeFIM) questionnaire to assess the functional independence of the children and describe any functional limitations or additional burden of daily care. Out of a potential score of 126, the mean total WeeFIM score was 113.7. There was a statistically significant difference between the scores of type I, type III and type IV OI (121.88 [SD 7.01] vs. 80.8 [SD 26.25] vs. 119.17 [SD 10.89]; p < 0.001). There were no statistically significant differences between the scores in different age groups, the male and female participants, and patients with pathogenic variants in COL1A1 and COL1A2. The mean scores for the self-care, mobility, and cognition domains were 48.78 (maximum 56, mean quotient 91.14%), 30.44 (maximum 35, mean quotient 87.12%), and 34.44 (maximum 35, mean quotient 99.05%), respectively. The best performance was in the cognition domain (mean quotient 99.05%), and the worst was in the mobility domain (mean quotient 87.12%). There were no statistically significant correlations between WeeFIM scores and age, or age when symptoms began. The total WeeFIM score and 13 subscores for the self-care and mobility domains were all positively correlated with body height (p < 0.01). The correlation was lowest for bowel and walking/wheelchair tasks, and the highest for bathing and dressing-upper tasks. For tasks in bathing, over 40% of the patients needed help. For tasks in the cognition domain, most patients required no help. For the Taiwanese children with OI, some support and supervision were required for self-care and mobility tasks, and the functional independence in these two domains was correlated with body height and disease types. The WeeFIM questionnaire may be a useful tool to assess the functional strengths and weaknesses of children with OI.

Differences in Cardiopulmonary Fitness Between Boy and Girls With Repaired Tetralogy of Fallot.

ObjectiveMany studies have demonstrated that patients with repaired tetralogy of Fallot (rTOF) have generally poorer cardiopulmonary fitness (CPF). However, little is known about how the disease results in different CPF in each sex. Therefore, this study aimed to investigate whether sex (and gender) differences affect CPF in children and adolescents with rTOF.MethodsThis retrospective study recruited adolescents and children (aged 10–18) with rTOF following an acute stage of tetralogy of Fallot (TOF) who received cardiopulmonary exercise testing (CPET) in the past 10 years. CPF was determined by symptom-limited CPET with a treadmill under ramped Bruce protocol. Boys and girls were categorized into groups based on body mass index (BMI) and fat mass index (FMI). The BMI was grouped by Taiwanese obesity cutoff points. The FMI was categorized by the body fat percentage. Excess adiposity was defined as (1) “overweight” and “obese” by BMI and (2) greater than the sex- and age-specific 75th percentile of whole subjects by FMI.ResultsA total of 185 participants (104 boys and 81 girls) with rTOF were recruited for the final analysis. Within the BMI category, 76 boys and 63 girls were in the normal group, whereas 28 boys and 18 girls were in the excessive adiposity group. Within the FMI category, 77 boys and 60 girls were in the normal group, whereas 27 boys and 21 girls were in the excessive adiposity group. The analysis of the body composition of rTOF subjects showed that there was no statistically significant difference between the subgroups of the two sexes, but both showed a smaller body size than normal Taiwanese children. When comparing the CPF within different BMI and FMI groups, the children in the excessive adiposity group had significantly lower values in metabolic equivalents (MET) at anaerobic threshold, peak MET, and measured peak oxygen consumption (VO2) to predicted peak VO2, regardless of sex. Moreover, boys (60.90%) presented poorer CPF than girls (74.22%, p < 0.001).ConclusionIn Taiwan, patients with rTOF had poorer CPF than healthy peers. This study found that girls with rTOF had better CPF than boys with rTOF. The effect of gender stereotypes on sports participation and self-efficacy might be one of the contributing factors; however, further investigations are warranted to determine the causal effect.

Classification-Based Approaches to Myopia Control in a Taiwanese Cohort.

PurposeMyopia is a disorder of growing prevalence in school-aged children worldwide, especially in Asia. Although low-dose atropine is recognized as an effective treatment to slow myopia progression, different studies have reported varying efficacies of treatment, and the optimal concentration of low-dose atropine remains an open question.MethodsA two-stage approach was conducted in this study. First, an observational study was conducted to plot the axial length growth curve for Taiwanese children. Second, an interventional 2-year study was performed in which different concentrations of low-dose atropine were applied based upon the risk-level status from the first stage.ResultsA total of 4,091 subjects, consisting of 2,105 boys (51.5%) and 1,986 girls (48.5%), were enrolled in the first stage to plot the axial growth curve for Taiwanese children aged between 3 and 16 years. The percentage of children with myopia increased from 2.3% in 4-year-olds to 88.0% in 16-year-olds. At the second stage, a total of 886 subjects [307 (34.65%) at low risk, 358 (40.41%) at moderate risk and 221 (24.94%) at high risk] were enrolled to receive low-dose atropine based upon the risk level (0.02, 0.03, and 0.05%, respectively). With this approach, the mean annual myopia progression was −0.33, −0.57, and −0.82 D in the low-risk, moderate-risk and high-risk groups, respectively. Applying annual myopic progression < -1.0 D as a criterion for responder, the responder rates were 95.77, 83.52, and 70.59% in the low-risk, moderate-risk, and high-risk groups, respectively.ConclusionsWe proposed a classification-based approach involving different concentrations of low-dose atropine based upon an individual's risk-level status. With this approach, myopic progression can be effectively controlled in patients without exposure to atropine side effects due to exposure to a higher dose than actually needed.

Differences in health-related quality of life in children with chronic kidney disease as reported by children and parent proxies.

Correlation between reports of children and parent for health-related quality of life (HRQOL) is not well studied. This study aims to assess the degree of agreement between child self- and parent proxy-rated HRQOL and to identify factors associated with discordance at baseline and during follow-up in Taiwanese children with chronic kidney disease (CKD). This study includes pediatric patients aged 5-18years with confirmed CKD. Participants completed the generic version of the Pediatric Quality of Life Inventory (PedsQL) at baseline and every 6months during follow-up. Child-parent agreement on HRQOL reports was assessed using intraclass correlation coefficient (ICC). Multivariate regression models were used to determine factors associated with child-parent discordance. Of the 112 child-parent dyads included in the analysis, 97 dyads with 640 patient visits were assessed in 4.5years. Children reported higher total scores on the physical and psychosocial domains as compared to their parent proxies. ICC was low (< 0.5) for the psychosocial domain and moderate for the physical health domain at initial assessment and slightly increased for the physical health (0.62) and for school functioning (0.51) during follow-up. Development of mineral bone disorder/anemia (β, 11.75 [3.77-19.72]) and proteinuria (β, 8.48 [1.15-15.81]) in the follow-up were associated with increased discordance in school functioning, and fathers with chronic disease were associated with increased discordance in social functioning (β, 4.21 [0.68-7.74]). Parent proxy consistently estimated lower PedsQL score compared to self-reports of children. Child self-rated psychosocial health domains should be evaluated whenever possible to better elucidate treatment outcome over time. A higher resolution version of the Graphical abstract is available as Supplementary information.

Genetic variants of NTCP gene and hepatitis B vaccine failure in Taiwanese children of hepatitis B e antigen positive mothers.

Hepatitis B virus (HBV) vaccine failure remains a hurdle to the global elimination of HBV infections in the vaccination era. We aimed to elucidate the relationships between HBV entry receptor sodium taurocholate co-transporting polypeptide (NTCP) and vaccine failure in children born to highly infectious mothers. The genetic variants rs7154439, rs4646285, rs4646287, and rs2296651 were genotyped in 170 children with chronic HBV infections and 138 control children of mothers positive for hepatitis B e antigen (HBeAg). All children received hepatitis B immunoglobulin and complete HBV vaccination. Total RNAs from 82 adult non-tumor liver tissues were quantified for NTCP, type I interferons and interferon-induced transmembrane protein 3 (IFITM3) levels. A higher rate of the GA/AA genotype (28.3% vs. 15.3%, p = 0.006) of the genetic variant rs4646287 in intron 1 of the NTCP gene was detected in control children compared to the carrier children. The rs4646287 G > A genotype was associated with younger ages at which spontaneous HBeAg seroconversion occurred (10.8 ± 8.4 vs. 14.6 ± 8.7years, p = 0.003) in chronic HBV-infected children. Unique correlation patterns of NTCP and innate immunity-related genes (type I interferons and IFITM3) were found in HBV-infected liver tissues with the rs4646287 G > A genotype. The rs4646287 G > A genotype of the NTCP gene may be associated with lower risk for HBV vaccine failure in children born to highly infectious mothers. The protective effect of rs4646287 G > A was also present in carrier children, evidenced by earlier spontaneous HBeAg seroconversion.