Taiwanese School Children Research Articles

Efficacy of Multifocal Soft Contact Lenses in Reducing Myopia Progression Among Taiwanese Schoolchildren: A Randomized Paired-Eye Clinical Trial.

To evaluate the efficacy and safety of myopia control using a multifocal soft contact lens designed with high peripheral add power in schoolchildren. This 1-year multi-center, prospective, randomized, double-blind, controlled study enrolled myopic schoolchildren aged 6-15years with refractive errors between - 1.0 D and - 10.0 D. Each participant was randomly allocated to wear a daily disposable multifocal soft contact lens as the treatment in one eye and a single-vision soft contact lens as the control in the other eye. The primary endpoints were changes in the cycloplegic spherical equivalent (SE) and axial length at 1year. Fifty-two of the 59 participants (88.1%) completed the study protocol. The mean change in SE was - 0.73 ± 0.40 D in the treatment group. and - 0.85 ± 0.51 D in the control group (mean difference: - 0.12 ± 0.34 D, p = 0.012). The mean change in axial length was 0.25 ± 0.14mm in the treatment group, and 0.33 ± 0.17mm in the control group (mean difference: 0.08 ± 0.10mm, p < 0.001). The treatment was well tolerated, and no serious adverse events were observed. Treatment with multifocal soft contact lenses with high peripheral add power was effective in controlling the progression of myopia and axial length elongation in myopic schoolchildren.

Association of exposure to environmental vanadium and manganese with lung function among young children: A population-based study

Exposure to environmental metals has been associated with health outcomes including respiratory health. Little is known about the impact of exposure to environmental metals on lung function among young children in general population. This study aimed to investigate the associations of exposure to metals with lung function among young children in a population-based cohort. A total of 1488 children aged 5–8 years attended a follow-up visit as part of the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort. We measured urinary samples of vanadium (median: 1.21 ng/mL; interquartile range (IQR): 0.73–1.98), manganese (median: 0.23 ng/mL; IQR: 0.13–0.47), arsenic (median: 40.51 ng/mL; IQR: 21.66–70.49), nickel (median: 1.09 ng/mL; IQR: 0.31–3.60), and cadmium (median: 0.26 ng/mL; IQR: 0.11–0.43) and performed lung function tests. Urinary vanadium concentrations were inversely associated with FVC (β coefficient for the highest quartile versus the other quartiles: −33.40, p = 0.001), FEV1 (β: −41.31, p < 0.001), FEV1/FVC ratio (β: −1.00, p = 0.009), PEF (β: −92.12, p = 0.004), and FEF25–75 (β: −82.85, p < 0.001), after adjusting for relevant confounders. Urinary manganese concentrations were inversely associated with FVC (β: −26.60, p = 0.007), FEV1 (β: −31.62, p = 0.001), PEF (β: −84.86, p = 0.009), and FEF25–75 (β: −69.21, p = 0.002). Stratification analyses found inverse associations of urinary vanadium and manganese concentrations with lung function parameters predominantly among children exposed to environmental tobacco smoke. We did not find significant associations of urinary arsenic, nickel, and cadmium concentrations with lung function parameters. In conclusion, this study adds new evidence showing inverse associations of vanadium and manganese exposure with lung function among young children in the general population. Children with environmental tobacco smoke exposure are particularly vulnerable to adverse impact of vanadium and manganese exposure on lung function.

Risk factors for anisometropia in schoolchildren: A population-based, longitudinal cohort study.

To investigate the incidence rate and risk factors for anisometropia among young schoolchildren. A population-based cohort study, the Myopia Investigation Study in Taipei, was conducted in primary schools in Taipei City. Children were recruited for biannual comprehensive eye examinations over 2 years. Cycloplegic autorefraction and slit lamp examinations were performed biannually. Data on demographic information, parental history, lifestyle and near-work activities were collected using parent-administered questionnaires at the first and final visits. Anisometropia was defined as ≥1 D difference in the spherical equivalent (SE) refractive error. A total of 7035 8-year-old children completed the 2-year follow-up evaluations. The average annual incidence of anisometropia was 3.8%. Multivariable logistic regression analysis revealed that baseline SE (odds ratio [OR]: 0.87 95% CI: 0.80-0.95) and female sex (OR: 1.24, 95% confidence interval [CI]: 1.02-1.50) were significantly associated with incident anisometropia. Among lifestyle risk factors, spending <1 h per day in after-school outdoor activities on weekdays (OR: 1.38, 95% CI: 1.08-1.76) and performing near work at a distance <30 cm (OR: 1.33, 95% CI: 1.08-1.64) were significantly associated with an increased risk of incident anisometropia. In the multiple linear regression analysis, the inter-eye difference in SE increased significantly in children performing near work at distances <30 cm (adjusted β = 0.03; p = 0.02). This study indicated the annual incidence of anisometropia in Taiwanese schoolchildren. Less time spent outdoors and shorter eye-to-object distances during near work increased the risk of incident anisometropia.

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.

Early-life weight gain is associated with non-atopic asthma in childhood

BackgroundPrevious studies suggest the association between early-life weight gain and asthma. It remains unclear whether early-life weight gain is associated with atopic or non-atopic asthma. This study aimed to investigate whether early-life weight gain is associated with atopic or non-atopic asthma. MethodsIncluded in this study were 1343 singleton-birth children (761 boys, 57%) born between January 2010 and December 2011 participating in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort were evaluated by a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and interviewed by pediatricians between July 1, 2016 and May 31, 2018 at the mean age of 6.4 years. Weight gain z-scores during the first 6, 12, and 18 months of life were classified into 4 groups: slow (below −0.67), on track (−0.67 to 0.67), rapid (0.67 to 1.28), and extremely rapid (above 1.28). The main outcomes were atopic and non-atopic asthma. Asthma was defined as having physician-diagnosed asthma and the presence of wheeze or asthma exacerbations in the last 12 months. Atopy was determined by Phadiatop Infant. ResultsThe extremely rapid weight gain group of children during the first 6, 12, and 18 months of life was significantly associated with an increased risk of non-atopic asthma (adjusted odd ratio [AOR], 2.14, 95% confidence interval [CI], 1.01–4.53 for the first 6 months; AOR, 2.86, 95% CI, 1.34–6.14 for the first 12 months; AOR, 3.26, 95% CI 1.49–7.15 for the first 18 months) compared with the on track group. No significant association was found in atopic asthma. A sex-stratified analysis revealed the association of early-life weight gain with non-atopic asthma was statistically significant only in boys (AOR, 4.24, 95% CI, 1.44–12.50). ConclusionExtremely rapid weight gain during the first 6–18 months of life was significantly associated with 2.1- to 3.3-fold increased risk of non-atopic asthma, with a more pronounced risk found in boys.

Association of advanced paternal age with lung function at school age

BackgroundEpidemiological studies suggest that advanced paternal age impact offspring health, but its impact on respiratory health is unclear. This study aimed to investigate the association of paternal age with lung function and fraction of exhaled nitric oxide (FeNO) in children.MethodsWe analyzed data from 1330 single-born children (576 girls, 43.3%; mean age, 6.4 years), who participated in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort and received measurements of lung function and FeNO at 6-year follow-up visits. Covariate-adjusted regression analyses were applied.ResultsEvery 5-year increase in paternal age at birth was associated with 0.51% decrease in FEV1/FVC ratio (95% CI − 0.86 to − 0.15; p = 0.005) and 19.86 mL/s decrease in FEF75 (95% CI: − 34.07 to − 5.65; p = 0.006). Stratified analyses revealed that increasing paternal age at birth was associated with decreasing FEV1/FVC ratio and FEF75 only among children with prenatal exposure to environmental tobacco smoke (ETS) or not being breastfed. Sensitivity analyses using paternal age as a categorical variable found decreasing FEV1/FVC ratio and FEF75 in the groups of paternal age 35–39 and ≥ 40 years. There was no association of paternal age at birth with FeNO.ConclusionOur findings provide novel evidence linking advanced paternal age at birth with decreasing lung function in children at school age. Children with prenatal exposure to ETS or not being breastfed are more vulnerable to the adverse effect of advanced paternal age on childhood lung function. Further studies are warranted to confirm this novel adverse effect of advanced paternal age.

The Impact of Clinical Atropine Use in Taiwanese Schoolchildren: Changes in Physiological Characteristics and Visual Functions.

Taiwan is commonly noted for its high prevalence of myopia, as well as a long history of more than 20 years of using atropine to control myopia. However, the clinical implications are rarely discussed. This is a cross-sectional study investigating the influence of topical atropine instillation on ocular physiology, visual function, and visual discomfort in children. Aged 7 to 12 years, 212 schoolchildren were recruited and divided into the atropine group and the non-atropine group. Physiological characteristics such as pupil size and intraocular pressure were measured, and a variety of visual functions was also evaluated. A questionnaire was used to investigate the side effects and visual complaints caused by atropine treatment. There was a significant difference in pupil size (OD: 5.40 ± 0.90 vs. 6.60 ± 1.01 mm; OS: 5.42 ± 0.87 vs. 6.64 ± 1.00 mm, p < 0.001) between the two groups. Reductions in near visual acuity, accommodation, convergence ability, and stereopsis were observed in the atropine group. The horizontal pupil diameter enlarged, and visual functions were greatly affected after administration of topical atropine. The changes in visual function during atropine therapy need to be carefully monitored by clinicians, while patient compliance is usually the key to success.

Positive Association between Endothelium-Platelet Microparticles and Urinary Concentration of Lead and Cadmium in Adolescents and Young Adults.

(1) Background: In previous research, higher levels of urine heavy metals, especially lead and cadmium, have been associated with increased cardiovascular risk. However, there is no information linking exposure to heavy metal to endothelial and platelet microparticles (EMPs and PMPs), particularly in the younger population, which are novel biomarkers of endothelial dysfunction. (2) Methods: From a nationwide database, which was incepted in 1992–2000, screening for renal health among Taiwanese school children, a total of 789 subjects were recruited. Cross-sectional analysis was performed to evaluate the association between serum EMPs/PMPs and urine iron, nickel, copper, cadmium, lead, chromium, manganese, and zinc levels in the adolescent and young adult population. (3) Results: After we adjusted the conventional cardiovascular risk factors, CD31+/CD42a− and CD31+/CD42a+ counts, in subjects’ serum, respective markers of EMP and PMP displayed a significant positive dose-response relationship with urinary lead and cadmium levels. Higher quartiles of urine lead and cadmium levels were associated with an increased risk of higher EMPs/PMPs (≥75th percentile) in a multivariate logistic regression model. (4) Conclusion: Higher urinary lead and cadmium concentrations are strongly associated with endothelium–platelet microparticles in this adolescent and young adult population, which could help explain, in part, the mechanism through which heavy metal exposure results in cardiotoxicity.

Association between sugary drinks consumption and dental caries incidence among Taiwanese schoolchildren with mixed dentition.

Dental caries is a multifactorial disease, and a sugary diet can generate an acidic plaque environment that advances its development. However, the specific effect of sugary drinks on the subsequent oral health of schoolchildren with mixed dentition is unclear. In this study, we investigated the association between the consumption of sugary drinks and 1year incidence rate of caries in permanent teeth among Taiwanese schoolchildren with mixed dentition. A longitudinal 1year follow-up study was conducted among Taiwanese schoolchildren aged 8-9years. A questionnaire collected information regarding the parents' oral health status and their children's demographic background, oral health-related behaviours and consumption habits of sugary drinks, including handmade drinks (specifically bubble tea and pearl milk tea) and carbonated drinks. Dental caries was recorded through standardized oral examinations. The number of dental services received was retrieved from the Taiwan National Health Insurance Research Database. Multivariate Cox proportional hazards models and zero-inflated negative binomial models were used to estimate the association between the consumption of sugary drinks and the incidence rate of caries in permanent teeth after 1year. The study involved 494 children. During the 1year follow-up period, 117 children developed new dental caries in their permanent teeth, yielding a caries incidence rate of 0.183 per person-year. After adjustments for confounding factors, children who preferred having sugar-rich beverages were associated with having a 4.3 times higher (95% confidence interval [CI]=1.2-15.7) risk of developing caries than did those who preferred nonsugary drinks (P<.05). Additionally, children who often consumed handmade drinks were associated with having a 1.7 times higher (95% CI=1.1-2.9) risk of developing caries than those who seldom consumed (P<.05). The findings suggest that the consumption of sugary drinks during the mixed dentition stage might be a major etiological factor for caries in permanent teeth. These findings could be valuable to paediatricians, dentists, nutritionists and policymakers.

Evolution of the Prevalence of Myopia among Taiwanese Schoolchildren: A Review of Survey Data from 1983 through 2017

The aim of this study was to evaluate the changes in the prevalence of myopia in Taiwanese schoolchildren over the past few decades and to analyze the risk factors for myopia. Analysis of 8 consecutive population-based myopia surveys conducted from 1983 through2017. An average of 8917 (5019-11 656) schoolchildren 3 to 18 years of age were selected using stratified systematic cluster sampling or by probability proportional to size sampling. All participants underwent complete ophthalmic evaluations. Three drops of 0.5% tropicamide were used to obtain the cycloplegic refractive status of each participant. Questionnaires were used to acquire participant data from the 1995, 2005, 2010, and 2016 surveys. Prevalence of myopia (spherical equivalence of ≤-0.25 diopter [D]) and high myopia (≤-6.0 D) was assessed. Multivariate analyses of risk factors were conducted. The prevalence of myopia among all age groups increased steadily. From 1983 through 2017, the weighted prevalence increased from 5.37% (95% confidence interval [CI], 3.50%-7.23%) to 25.41% (95% CI, 21.27%-29.55%) for 7-year-olds (P= 0.001 for trend) and from 30.66% (95% CI, 26.89%-34.43%) to 76.67% (95% CI, 72.94%-80.40%) for 12-year-olds (P= 0.001 for trend). The prevalence of high myopia also increased from 1.39% (95% CI, 0.43%-2.35%) to 4.26% (95% CI, 3.35%-5.17%) for 12-year-olds (P= 0.008 for trend) and from 4.37% (95% CI, 2.91%-5.82%) to 15.36% (95% CI, 13.78%-16.94%) for 15-year-olds (P= 0.039 for trend). In both the 2005 and 2016 survey samples, children who spent less than 180 minutes daily on near-work activities showed significantly lower risks for myopia developing (<60 minutes: odds ratio [OR], 0.48 and 0.56; 60-180 minutes: OR, 0.69 and 0.67). In the 2016 survey, spending more than 60 minutes daily on electronic devices was associated significantly with both myopia and high myopia (OR, 2.43 and 2.31). The prevalence of myopia among schoolchildren increased rapidly from 1983 through 2017 in Taiwan. The major risk factors are older age and time spent on near-work activities. Use of electronic devices increased the amount of time spent on near-work and may increase the risk of developing myopia.

Association between maternal age at delivery and allergic rhinitis in schoolchildren: A population-based study

BackgroundSome studies have shown associations of maternal age at delivery with asthma and food allergy in offspring. However, the relationship between maternal age at delivery and allergic rhinitis is largely unclear. This study aimed to investigate the association between maternal age at delivery and allergic rhinitis in a population sample of Asian children, and to explore potential effect modifiers. MethodsA total of 1344 singleton-birth children (763 boys, 56.8%; mean age, 6.4 years) participating in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort were evaluated by a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and interviewed by pediatricians. Allergic sensitization was determined by using Phadiatop Infant. Multiple logistic regression models with covariates adjustment were performed to investigate the association of maternal age at delivery with allergic rhinitis and allergic sensitization in offspring. ResultsAmong 1344 study children, 793 (59%) had physician-diagnosed allergic rhinitis. Advanced maternal age at delivery (≥40 years) was significantly associated with increased odds of allergic rhinitis (adjusted odds ratio [AOR] = 4.58, 95% confidence interval [CI]: 1.90–11.03) and allergic sensitization (AOR = 2.86, 95% CI: 1.13–7.22) in offspring. A sex-stratified analysis revealed that the association of advanced maternal age with allergic rhinitis was statistically significant only in female offspring (AOR = 7.02, 95% CI: 1.89–26.14). Stratified analyses by birth order or environmental tobacco smoke exposure during pregnancy did not reveal any significant differences. ConclusionAdvanced maternal age at delivery was associated with increased risk of allergic rhinitis in Asian children, probably more pronounced among girls.

Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students

To investigate the change in the prevalence of reduced visual acuity (VA) in Taiwanese school children after a policy intervention promoting increased time outdoors. Prospective cohort study based on the Taiwan School Student Visual Acuity Screen (TSVAS) by the Ministry of Education in Taiwan. All school children from grades 1 through 6 were enrolled in the TSVAS from 2001 through2015. The TSVAS requires each school in Taiwan to perform measurements of uncorrected VA (UCVA) on all students in grades 1 through 6 every half year using a Tumbling E chart. Reduced VA was defined as UCVA of 20/25 or less. Data from 1.2 to 1.9 million primary school children each year were collected from 2001 through 2015. A policy program named Tian-Tian 120 encouraged schools to take students outdoors for 120 minutes every day for myopia prevention. It was instituted in September 2010. To investigate the impact of the intervention, a segmented regression analysis of interrupted time series was performed. Prevalence of reduced VA. From 2001 to 2011, the prevalence of reduced VA of school children from grades 1 through 6 increased from 34.8% (95% confidence interval [CI], 34.7%-34.9%) to 50.0% (95% CI, 49.9%-50.1%). After the implementation of the Tian-Tian 120 outdoor program, the prevalence decreased continuously from 49.4% (95% CI, 49.3%-49.5%) in 2012 to 46.1% (95% CI, 46.0%-46.2%) in 2015, reversing the previous long-term trend. For the segmented regression analysis controlling for gender and grade, a significant constant upward trend before the intervention in the mean annual change of prevalence was found (+1.58%; standard error [SE], 0.08; P < 0.001). After the intervention, the trend changed significantly, with a constant decrease by -2.34% annually (SE, 0.23; P < 0.001). Policy intervention to promote increased time outdoors in schools was followed by a reversal of the long-term trend toward increased low VA in school children in Taiwan. Because randomized trials have demonstrated outdoor exposure slowing myopia onset, interventions to promote increased time outdoors may be useful in other areas affected by an epidemic of myopia.

A Nationwide Study of Myopia in Taiwanese School Children: Family, Activity, and School-Related Factors

The purpose of the study was to explore how fixed and modifiable family, activity, and school factors affect a student's myopia risk and severity. We used national cross-sectional data from Taiwanese children in Grades 4-6. Bivariate and multivariate analyses, including logistic and ordinary least squares regression, examined factors related to children's myopia status and severity. Age, parent myopia, and school district were associated with risk of myopia. One hour or more per day of near work (OR = 1.26) increased the odds of myopia. The same amount of time in outdoor activities (OR = 0.85) or moderate or vigorous physical activities (OR = 0.82) was associated with lower risk. Near work (β = 0.06), outdoor activity (β = -0.04), and outdoor recess (β = -0.03) predicted myopia severity. To promote healthy vision, nurses should advocate for and implement interventions that increase school children's time outdoors and in physical activities and reduce their time on near work.

Myopia Development Among Young Schoolchildren: The Myopia Investigation Study in Taipei.

To investigate the annual incidence of myopia and associated factors among young schoolchildren in Taipei City. The Myopia Investigation Study in Taipei was a citywide, population-based cohort study. During the fall 2013 semester (baseline), a total of 11,590 grade 2 schoolchildren completed ocular examination and were included for further analysis. A parent-completed questionnaire was administered to collect data on risk factors for myopia development. Follow-up visits were arranged biannually over 3 years. The first-year results are reported here. Schoolchildren who were emmetropic/hyperopic at baseline and had myopia (spherical equivalent ≤ -0.5 diopters) in either eye at follow-up were identified as having incident myopia. Among 7376 baseline nonmyopic participants, 6794 (92.1%) were examined during the first-year follow-up, and 1856 (25.2%) with incident myopia were identified. The incidence density of myopia was 31.7 (95% confidence interval [CI]: 30.6-32.8) per 100 person-years. Cox hazard proportional regression analysis revealed that participants who were emmetropic at baseline (hazards ratio [HR]: 19.37; 95% CI: 4.84-77.57), who had two myopic parents (HR: 1.21; 95% CI: 1.04-1.42), and who spent ≥5 hours every week on after-school tutoring programs (HR: 1.12; 95% CI: 1.02-1.22) had greater risk for incident myopia. By contrast, protective factors included suburban area of residence (HR: 0.91; 95% CI: 0.83-1.00) and spending ≥30 minutes outdoors after school every weekday (HR: 0.90; 95% CI: 0.82-0.99). This study provides population-based data on the annual incidence of myopia among Taiwanese schoolchildren, and found that baseline refractive status, parental myopia, area of residence, time outdoors after school on weekdays, and time spent on after-school tutoring programs are associated with risk of new-onset myopia.

Phthalate Metabolites in Urine Samples from School Children in Taipei, Taiwan.

In 2011, Taiwan authorities reported that two phthalates, including di-(2-ethylhexyl) phthalate and di-iso-nonyl phthalate, were intentionally introduced into a variety of foods and beverages during the course of 15years. However, little is known about body burdens of phthalate contaminations in local residents, especially children recently living in Taiwan. In the present study, five target phthalate metabolite analytes-including mono-methyl phthalate, mono-ethyl phthalate, mono-n-butyl phthalate (MBP), mono-benzyl phthalate (MBzP), and mono-(2-ethylhexyl) phthalate (MEHP)-in spot urine samples were analyzed by way of high performance liquid chromatography-tandem mass spectrometry-mass spectrometry. All of the urine samples were collected from 225 healthy school children between 12 and 15years of age (average 13.6) in the Taipei area, Taiwan, between 2009 and 2010. As the dominant urinary phthalate metabolites in Taiwanese school children, MEHP and MBP contributed 61 and 29% of all of the target analytes, respectively. MEHP had the highest median of 29.8μg/g creatinine (range of 13.1-72.8), which was greater than those reported for school children in the other countries during the same period, whereas MBP had a median of 14.3μg/g creatinine (range 7.91-27.8). Statistically, urinary concentrations of MBP, MBzP, and MEHP were determined to have significantly positive correlations with the ages of Taiwanese school children (p<0.05). Furthermore, urinary levels of MBzP in male children were considerably greater than those in female children (p=0.006).

Epidemiologic features of mumps in Taiwan from 2006 to 2011: a new challenge for public health policy.

The adoption of a second dose of the measles-mumps-rubella (MMR) vaccine among Taiwanese school children began in 2001. However, during that time, mumps cases continued to occur. The purpose of the present study was to assess the epidemiology and vaccination policy for mumps in Taiwan. We examined the data on mumps cases collected by the Taiwan Centers for Disease Control (Taiwan CDC) between 2006 and 2011. During the 6-year study period, a total of 6612 cases of mumps were reported to the Taiwan CDC. Of the patients with known vaccination status, 62% received one dose of the MMR vaccine or no vaccine. The incidence of mumps ranged from 4.18 to 5.28 per 100 000 population and peaked in 2007. Males had a higher incidence of mumps than females (5.9 vs. 3.7 per 100 000 population; P=0.024). Children between 5 and 6 years of age had the highest incidence of mumps, and those 20 years and older had the lowest incidence. Compared to those who received two doses of the MMR vaccine, patients who were not vaccinated or received a single dose of the vaccine had a higher risk of suffering from complications and/or hospitalization. In Taiwan, more than 60% of mumps cases received either no dose or one dose of the MMR vaccine. Monitoring mumps through biological testing and instituting a second dose of the MMR vaccine for children is needed for the elimination of mumps in Taiwan.

Biological correlates of psychological states among young children: a cross-sectional examination of roles of aspartate transaminase/alanine aminotransferase, insulin, and cytokines

Compared to data on adolescents and adults, limited research has been conducted on biological correlates among young children with possible psychological difficulties, especially in Asian countries. By focusing on various peripheral biochemical indicators, we investigated potential biological correlates of psychological states in a community sample of Taiwanese school children aged 6–10 years. In total, 307 students (159 obese children and 148 normal-weight children) were selected from first- and fourth-grade school children in eight elementary schools in the Taipei metropolitan area in 2009. These children underwent a comprehensive health examination, including a physical examination, blood sample analysis, and questionnaire administration in a hospital. Differences in anthropometric and serum biochemical readings were compared between children with average and worse levels on each of the five psychological domains. We found that interleukin (IL)-1β [β = 1.29, 95 % confidence interval (CI) 0.50–2.09], IL-10 (β = 1.61, 95 % CI <0.01–3.24), fasting blood glucose (β = 0.08, 95 % CI 0.01–0.15), homocysteine (β = 0.63, 95 % CI 0.09–1.18), and aspartate transaminase (AST) (β = 0.15, 95 % CI <0.01–0.31) were significantly positively associated with anxiety. In addition, IL-1β, insulin, AST, and alanine aminotransaminase (ALT) were significantly positively associated with depression. Anger and disruptive behaviors were also related to specific biological correlates. Specific biological correlates, including AST/ALT, cardiovascular disease-related variables, and specific cytokines, were linked to particular psychological states among young children in this Asian population. These might provide a route for better understanding the biological aspects of children’s mental health and might contribute to research on diagnostic or predictive biomarkers for psychiatric diseases in young children.

Bidirectionality and gender differences in emotional disturbance associations with obesity among Taiwanese schoolchildren

Childhood obesity is associated with psychological problems, but little is known about its association with emotional disturbance (ED) in the educational setting, especially by gender. In the population representative Elementary School Children's Nutrition and Health Survey in Taiwan 2001-2002 of children aged 6-13 (n=2283), we have considered whether ED is associated with obesity by gender. Schoolchildren were assessed with the modified scale for assessing emotional disturbance questionnaires. For some subscales, boys and girls had ED associations with obesity which were bidirectional. With normal weight as referent and relevant adjustments, the significant ED subscales predictable by obesity were relationship problems (RP) in boys (odds ratio, OR=1.89 with 95% CI: 1.08-3.30) and inappropriate behavior (IB) in girls (OR=2.88: 95% CI: 1.47-5.61). Conversely, with 'no-specific-ED' as referent, obesity was predictable by fully-adjusted specific-EDs in the same subscales, namely RP in boys (OR=1.88 with 95% CI: 1.13-3.13) and IB in girls (OR=3.03: 95% CI: 1.57-5.85). Child obesity prevalence showed no trend with school grade from 1 to 6, but for aggregate ED and most of its subscales the prevalence increased with grade (P for trend <0.01). Thus, there is some dissociation of obesity and ED as judged by their trend presence with school grade. Where obesity and ED occurred together (for inability-to-learn and unhappiness or depression), there were upward trends with grade (P<0.01). There are probably some selected bidirectional pathogenicities for obesity-ED associations with different expression in boys and girls and during elementary education. This provides some policy direction while mechanisms and causality require elucidation.

Roles of pollution in the prevalence and exacerbations of allergic diseases in Asia

The prevalence of asthma and allergic diseases has been found to be increasingly rapidly, especially in developing countries. Environmental factors have been found to be important contributors to the manifestations of allergic diseases. Air pollution has been extensively studied in different regions of the world. The levels of ambient air pollutants in many Asian countries are very high when compared with those in developed Western countries. However, the prevalence of asthma was relatively low across many Asian countries. Many studies have clearly documented that environmental air pollution is an important factor resulting in exacerbations of asthma. In particular, levels of traffic-related pollutants are increasing rapidly across many Asian countries in parallel with the level of urbanization and economic development. The loss of protective factors associated with a rural environment will further contribute to the adverse effect on patients with allergic diseases such as asthma. In this review the roles of air pollution were examined in relation to the inception and exacerbations of allergic diseases in Asia.

The Relation Between Home Dampness and Molds, Interleukin-4 Promoter, and Atopic Asthma among Taiwanese School Children

ISEE-0257 Background and Objective: The weather is warm and wet in Taiwan. Children exposure to mold or mold odor in dwellings are quite common. The objective of study was to assess whether or not exposure to mold or mold older in dwellings and IL-4 promoter were related to atopic asthma. Method: We conducted a population-based case-control study among Taiwanese school children in northern Taiwan. The study population consisted of 113 atopic asthma children and 376 controls. The PCR amplification followed by Bsm F1 restriction digestion were used to determine genotype at the IL-4 promoter C-589T locus. Results: In the logistic regression adjusting for confounding, the risk of childhood atopic asthma was positively associated with visible mold (adjusted odds ratio (aOR) = 2.45, 95% confidence interval (CI) = 1.43–4.19) and mold odor (aOR = 2.30, 95%CI = 1.40–3.80). The adjusted odds ratio for atopic asthma was slightly more elevated in CT genotype (aOR = 1.17, 95%CI = 0.72–1.91) than reference (TT genotype). The joint effect of CT genotype and exposure to visible mold (aOR = 3.32, 95%CI = 1.52–7.25) or mold odor (aOR = 3.86, 95%CI = 1.65–9.06) was a significantly increased risk of atopic asthma than the TT genotype without any dampness and mold problem. Conclusion: The presence of visible mold and mold odor in the home may be an important environmental factor of atopic asthma and its effect may also be modified by IL-4 promoter.