Analysis of complex survey data--a solution using SAS.
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Cluster Analysis↗
Biomedical subjects
S T Wang
Publications and source records attributed to S T Wang.
The motion analysis system and goniometry of the finger joints.
The application of a video-based motion analysis system for goniometry of finger joints during measurement of the fingertip motion area has been assessed. The results indicate that the motion analysis system is reliable for angular measurements of finger joints that are comparable with those obtained by conventional goniometer. The advantages of using the motion analysis system is that it can record and show the changes in angle of all finger joints continuously during finger motion.
Adolescent↗
The motion analysis system and the fingertip motion area. Normal values in young adults.
The reliability of the motion analysis system and the normal value of the fingertip motion area have been studied in young adults. The results indicate that the motion analysis system is a reliable tool for the evaluation of fingertip motion. It was found that the fingertip motion area in young adults has a linear correlation with the square of the finger length. Therefore, the normal value of the fingertip motion area can be calculated from the finger length.
Adult↗
Risk factors analysis for early fatality in children with acute bacterial meningitis.
To identify the cause of early fatality and to delineate the clinical findings on admission associated with this early fatality, a retrospective study of 101 children with bacterial meningitis was performed in southern Taiwan. Risk factors for early fatality are compared between patients with and without acute death in the first 3 days after admission. The overall patient fatality is 27%. Eighty-five percent of them (23 patients) occur at an average of 16.5 hours after admission despite proper antibiotic treatment. The causes of early death are predominantly hemodynamic in 14 patients (61%) and predominantly neurologic in nine (39%). Analysis of clinical parameters available on admission indicated a significant risk of early death in patients who have tachycardia, tachypnea, hypothermia, poor skin perfusion, metabolic acidosis, leukopenia, thrombocytopenia, low cerebrospinal fluid leukocyte count, and high cerebrospinal fluid lactate level. Multivariate analysis demonstrates that metabolic acidosis, poor skin perfusion, and low cerebrospinal fluid leukocyte count are independently and significantly associated with early fatality. In conclusion, two thirds of early fatalities in children with bacterial meningitis are the result of septic shock. Close surveillance for signs of septic shock, as well as of brain herniation should be continued, especially within 3 days after antibiotic treatment.
Acute Disease↗
A SAS macro for a simulation study of imputation methods for missing values--an application of Bebbington's algorithm.
This paper presents a SAS macro for a simulation study of comparing a new variant of hot-deck imputation with mean imputation for missing values, in which a simple algorithm proposed by Bebbington (Applied Statistics, 1975) for carrying out simple random sampling without replacement was employed to draw repeated random samples efficiently. A simulated example of drawing repeated random samples from a regional survey of obesity in school children was used to demonstrate the SAS macro.
Algorithms↗
Acute symptomatic seizure disorders in young children--a population study in southern Taiwan.
PURPOSE: To determine the incidence, etiology, and prognosis of acute symptomatic seizures in children by age 3 years. METHODS: In a population-based birth cohort study of all 15,209 neonatal survivors born in Tainan City between October 1989 and December 1991, parents or caretakers of 13,493 children aged 3 years were surveyed by telephone regarding any provoked convulsive disorder, particularly acute symptomatic seizure, in the children; medical records were reviewed. RESULTS: Sixty-three children (39 boys, 24 girls) had acute symptomatic seizures (incidence 0.46 in 100). The leading causes of acute symptomatic seizures were acute gastroenteritis, encephalitis/encephalopathy, and bacterial meningitis. Age-specific incidence was highest in the group aged 1-12 months. Intracranial hemorrhage, bacterial meningitis, and metabolic disturbance were the major causes of acute symptomatic seizures in children aged 1-12 months. Acute gastroenteritis, encephalitis/encephalopathy, and bacterial meningitis accounted for 85% of the causes in children aged 13-24 months, and gastroenteritis and encephalitis/encephalopathy were the predominant causes in those aged 25-36 months. By age 5 years, subsequent unprovoked seizures developed in 14% of the survivors of acute symptomatic seizures. CONCLUSIONS: Many acute symptomatic seizures are preventable. The risk of subsequent unprovoked seizures is determined by underlying precipitating factors. Public education regarding the danger of shaken-baby syndrome and excessive water supplement, as well as and nationwide vaccination against bacterial meningitis in young children, is necessary.
Acute Disease↗
Minocycline and cefotaxime in the treatment of experimental murine Vibrio vulnificus infection.
We conducted an in vivo study with the mouse model of Vibrio vulnificus infection to evaluate the efficacies of therapy with minocycline or cefotaxime alone and in combination. V. vulnificus was introduced subcutaneously into the area over the right thigh. The inoculum size ranged from 1.0 x 10(3) to 1.2 x 10(8) CFU from experiment to experiment but was constant for all animals in the same experiment. Antibiotics were given intraperitoneally 2 h after the bacteria were inoculated. In experiments 1 to 4, the standard dose for humans was used to treat the infection, while in experiment 5, five times the standard dose for humans was used to treat the infection. In experiment 1, with a small inoculum of 5 x 10(3) CFU, all mice in the saline-treated control group and the cefotaxime-, minocycline-, and combined antibiotic-treated groups survived. In experiment 2, with a moderate inoculum of 1.2 x 10(5) CFU, all the mice in the three antibiotic-treated groups survived, while only two of nine mice in the control group survived. In experiment 3, with a large inoculum of 8.0 x 10(7) CFU, six of nine mice in the combined antibiotic-treated group survived, while only one of nine mice in the cefotaxime-treated group and none of the mice in the control and minocycline-treated groups survived. In experiment 4, with a large inoculum of 1.2 x 10(8) CFU, 8 of 20 mice in the combined antibiotic-treated group survived, while none of the 20 mice in the control group, the group treated with cefotaxime alone, and the group treated with minocycline alone survived. In experiment 5, in which mice were infected with a large inoculum of 6.6 x 10(7) CFU and treated with five times the standard human dose of antibiotics, 10 of 12 mice in the combined antibiotic-treated group survived, while only 4 of 12 mice in the minocycline-treated group, 1 of 12 mice in the cefotaxime-treated group, and none of the mice in the control group survived. In experiments 3 to 5, the difference in the survival rates between the combined antibiotic-treated and minocycline-treated groups was statistically significant (P < 0.05). These results indicate that combination therapy with cefotaxime and minocycline is distinctly more advantageous than therapy with the single antibiotic regimen for the treatment of severe experimental V. vulnificus infections.
Animals↗
Prevalence study of thyroid dysfunction in the elderly of Taiwan.
The present study was aimed at investigating the prevalence of thyroid dysfunction in the elderly, aged 65 years or older, in a community of southern Taiwan. By using the records of the local household registry, a sampling frame for the elderly population was constructed, and a sample of 1,400 subjects was drawn by simple random sampling. After the exclusion of nonresponse subjects, 917 subjects aged between 65 and 88 years (mean 71.9) were included in our survey. The serum thyrotropin levels of these participants were measured by monoclonal antibodies TSH immunoradiometric assays. A normal range, 0.45-4.65 microU/ml, was determined from the middle 95% of the TSH distribution of 140 'disease-free' subjects. By reference to the normal range, 23 (2.51%) participants had high (> 4.65 microU/ml), and 41 (4.47%) had low (< 0.46 microU/ml) TSH levels. The overall prevalence of thyroid dysfunction in the sample was 6.98%. Of the 23 participants with high TSH levels, 8 (34.8%) had low free T4 values (< 1.21 ng/dl), so-called overt hypothyroidism, and of the 41 participants with low TSH levels, only 1 (2.4%) had high T3 values, so-called T3 thyrotoxicosis. Antithyroid antibodies were found in 56.5% of those with high TSH levels but only 12.2% of those with low TSH levels (odds ratio = 8.53, 95% confidence limits = 2.55-28.50, p < 0.001). This result indicates that autoimmune disease is still the major cause of hypothyroidism in aged people. However, the prevalence of subclinical hyperthyroidism is higher than that of subclinical hypothyroidism and it might relate to nonautoimmune factors.
Aged↗
Clinical experience with pendimethalin (STOMP) poisoning in Taiwan.
The herbicide pendimethalin (STOMP) shares a similar chemical structure with nitro compounds such as dinitrobenzene, which was previously demonstrated to cause methemoglobinemia in mammals. However, reports on STOMP poisoning in humans are rare. We reviewed 71 STOMP poisoning cases (42 men and 29 women of mean age 43.9 +/- 2.5 y) reported to the Poison Control Center--Taiwan from September 1986 to September 1997 and summarized their clinical manifestations. Two incidences resulted from skin and eye contact. The rest were due to oral ingestion intentionally or accidentally. The average ingestion was 106.1 +/- 13.4 ml. Among them, 20 cases had no symptoms or signs, 38 had mild effects such as nausea, vomiting and sore throat, 7 had effects such as severe retching, hematemesis and seizures. Four patients expired due to also taking other herbicides (mainly organophosphates) and because of inadequate airway management. Adequate ventilation support was the major therapy in salvaging the poisoning cases.
Adult↗
Outcome of Graves' disease after antithyroid drug treatment in Taiwan.
The outcome of Graves' disease after treatment with antithyroid drugs (ATDs) varies widely among countries, and large-scale studies in Asia are rare. We investigated the associations of various clinical and laboratory features with the outcome of ATD therapy for Graves' disease in Taiwan. A total of 210 patients (177 women, 33 men; mean +/- SD age, 41.7 +/- 15.1 yr) treated with ATD in Taiwan were included. ATD therapy started with methimazole 30 mg daily or propylthiouracil 300 mg daily and was continued until a euthyroid state was achieved. Afterwards, 154 patients received a maintenance dose of ATD alone, while 56 patients received a combination of an ATD and thyroxine (L-T4). Patients were considered to be in remission if they remained in a euthyroid state for more than 2 years after drug withdrawal. The mean follow-up periods were 45.0 +/- 20.9 months for patients with remission and 30.4 +/- 19.8 months for those with relapse. Relapse occurred in 126 (60%) patients during the follow-up period, within 3 months after drug withdrawal in 47 (37%), and within 6 months in 60 (46%). The relapse rate was 100% among patients with two or more previous relapses. Patients with a second occurrence had a higher relapse rate than those with a first occurrence (84% vs 43%). Past history of recurrence, goiter size, thyroid-stimulating hormone level and thyrotropin-binding inhibition immunoglobulin activity at the end of ATD treatment were independently associated with relapse. Prolonged duration of treatment did not yield better results in patients with larger goiters or a history of recurrence, or both. Combination therapy with L-T4 yielded similar results to those achieved with ATD treatment alone. In conclusion, the relapse rate of Graves' disease after ATD treatment in Taiwanese patients was high, especially in those with a history of recurrence. The treatment duration and drug regimen did not affect the outcome.
Adolescent↗
Neurodevelopment of surviving infants at age two years, with a birthweight less than 2000 g and cared for in neonatal intensive care units (NICU)--results from a population based longitudinal study in Taiwan.
All surviving infants from nine neonatal intensive care units (NICU) in a southern city and county of Taiwan were followed up and assessed at 2 y of age if they had a birthweight of less than 2000 g and were born between February 1, 1993 and January 31, 1994. The assessments included: neurological, growth and general health. A comparison group of normal birthweight and full-term infants without congenital anomalies, matched by birth month and sex to the NICU survivors was also studied with respect to the same outcome measures. A developmental delay (either a severe neurological deficit or Mental Development Index < 68 or Psychomotor Development Index < 68) was present in 21 (15.4%) of the cases, compared to 3 (2.5%) of the controls (P < 0.0004). Significant correlates of developmental outcome for the cases were birthweight, gestational age, and maternal education. The very low birthweight (VLBW) children (< 1500 g) in our study cohort had a comparatively higher incidence of severe neurological deficits (and cerebral palsy) than that reported by other similar studies in developed countries. The incidence of abnormal neurodevelopmental outcome remained high in the graduates of NICU at 2 y of age, compared to that in normal controls. The findings have important implications in future health policy making regarding postnatal management of the surviving infants of NICU in developing countries such as Taiwan.
Case-Control Studies↗
Accuracy of three-dimensional ultrasonography in volume estimation of cervical carcinoma.
OBJECTIVE: To evaluate the accuracy of a three-dimensional (3D) ultrasound system in volume estimation of cervical carcinoma. STUDY DESIGN: Transvaginal 3D and two-dimensional (2D) scans on cervical carcinoma volumes were performed 1 day before surgery. The volume of cervical carcinoma measured from each surgical specimen was compared with the corresponding volume of the cervical tumor measured by a 3D ultrasound and with the conventional 2D ultrasound volume measurement calculated using the formula pi/6 x(R1 x R2 x R3), where R1, R2, and R3 were the maximal transverse, anteroposterior, and longitudinal length of tumor, respectively. Limits of agreement and 95% confidence intervals were calculated and systemic bias between the methods was analyzed. The Klotz test was also used to assess the statistical significance of the degree of dispersion. RESULTS: A total of 61 cases, 55 with exophytic tumors and 6 with endocervical tumors, were examined in this study. The limits of agreement between the volume measured from specimen and tumor volume determined by ultrasound were +6.68 to -6.10 mL for 3D measurements and +12.46 to -10.98 mL for 2D measurements. The Klotz test showed the discrepancy in the degree of dispersion between 3D and 2D ultrasound measurements was statistically significant (P = 0.01). CONCLUSION: The true volume of cervical carcinoma is measured more accurately by a 3D ultrasound system than 2D ultrasound.
Adult↗
Level of transforming growth factor beta 1 is elevated in cerebrospinal fluid of children with acute bacterial meningitis.
We investigated the levels of transforming growth factor beta 1 (TGF-beta 1) in cerebrospinal fluid (CSF) in children with meningitis, with a view to prognostic relevance. CSF TGF-beta 1 levels on admission were measured by a sandwich enzyme immunoassay in children with bacterial meningitis (n = 16), aseptic meningitis (n = 12), and control subjects without evidence of central nervous system (CNS) infection (n = 16). Patients were followed up for a mean duration of 13 months, and neurodevelopmental sequelae was determined for those with bacterial meningitis. On admission, CSF TGF-beta 1 levels were significantly higher in children with bacterial meningitis (mean, standard error, 32.92, 2.36 pg/ml) as opposed to those with aseptic meningitis (25.26, 1.72 pg/ml) (P = 0.0155), or control subjects (20.53, 1.05 pg/ml) (P < 0.0001). The CSF TGF-beta 1 levels in children with aseptic meningitis were higher than those in the control group, but without significance (P = 0.02). No apparent correlation existed between CSF TGF-beta 1 levels and CSF protein or cell counts in patients with bacterial meningitis. No significant difference in CSF TGF-beta 1 levels was found between patients with or without major sequelae following bacterial meningitis.
Acute Disease↗
Measurement error--"how much of a difference does it take to make a difference"?
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Female↗
Immunomodulation in women with endometriosis receiving GnRH agonist.
OBJECTIVE: To assess the changes in the subpopulations of lymphocytes and in lymphocyte mitogenic activity in women with endometriosis receiving GnRH-agonist treatment. METHODS: Twenty-six women with advanced endometriosis from the National Cheng Kung University Medical College were studied. Each received a total of six doses of GnRH agonist at 4-week intervals. Immunologic responses at various times after receiving GnRH-agonist treatment, including numbers of peripheral blood lymphocytes subsets and the lymphocyte proliferative activity, were analyzed using a repeated measures analysis of variance. Twenty-six healthy women who visited our gynecologic clinics for routine Papanicolaou smear examination at the time of the recruitment were enrolled as controls. The responses for each patient receiving GnRH agonist were normalized with respect to those of her matched control at each of the time points. The differences between post- and pretreatment data were estimated using generalized estimating equations. RESULTS: There was no significant difference in the sizes of lymphocyte subsets between patients and controls before treatment. After GnRH-agonist treatment, there was a trend in the rise of natural killer cell numbers early in the treatment period, with P values of .05 and .07 at 1-2 weeks and 2-3 weeks, respectively. This rise in natural killer cell numbers was not significant until 3-4 weeks and the second month after the treatment. There were no significant changes in the CD4+ and CD8+ T-cell subsets and B cells, although a slight increase in total T cells (ie, CD3+ T) was observed 1-2 weeks after receiving GnRH agonist. The T-cell mitogenic activities at the end of 2 and 4 months after GnRH-agonist treatment were 1.5 and 1.8 times, respectively, of those before treatment. CONCLUSION: The increase in natural killer cell numbers and the upregulation of T-lymphocyte mitogenic activity, which might be caused by a direct effect of GnRH agonist or a consequence resulting from the depression of estradiol by GnRH agonist, may have implications in the clinical treatment of endometriosis.
Adult↗
A study of the referral patterns of obstetric clinics and the performance of receiving neonatal intensive care units in Taiwan.
To study the referral patterns of obstetric clinics, and the performance of receiving intensive care units measured by the survival of transported neonates, transport records were collected prospectively between July, 1991 and June, 1992. Two hundred and fifty-four transported neonates born in 51 obstetric clinics (level I units) in Tainan City and County, in southern Taiwan, were enrolled in this study. Nineteen percent of the transported neonates were very low birthweight infants (< 1500 g). Nearly equal numbers of them were transported to eight district hospitals (level II units) and to a tertiary center (level III unit), but these infants were 1.5 times more likely to die in a level II unit than a level III unit. In addition, equal numbers of infants assisted by mechanical ventilators were transported to level II and III units, but these infants were three times more likely to die in a level II unit than a level III unit (P = 0.006). Seventy-seven percent of the normal birthweight infants (> or = 2500 g) were transported to level II units, and the mortality in this group was 12.3% compared with 0% in those transported to the level III unit. Approximately 56% of these normal birthweight infants in level II units died of severe birth asphyxia. The referral patterns of level 1 units had an unfavorable effect on the survival of neonates requiring mechanical ventilation. Enhancing the skills of the staff in level I units to recognize and stabilize such infants, elevating the capability of level II units in treating some of these cases, and increasing the hospital beds for level III care are necessary to increase their chance of survival.
Health Services Research↗
Risk factor of complications requiring neurosurgical intervention in infants with bacterial meningitis.
Among 50 consecutive cases of bacterial meningitis in infants aged 6 months or less, 9 (Group I) were confirmed to have complications requiring neurosurgery during the first 2 weeks of antibiotic treatment. Neurosurgery was performed in 40, 33, and 30% of cases caused by Streptococcus pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, respectively. There were 5 cases of subdural empyema, 1 case of brain abscess, 1 case of subdural empyema and brain abscess, and 2 cases of ventriculitis with severe hydrocephalus. All complications requiring neurosurgery were initially detected by cranial ultrasonography. The other 41 patients who did not undergo neurosurgery were classified as Group II. Comparison of clinical presentations and laboratory findings between the two groups showed that Group 1 contained more patients with a history of inadequate treatment, and longer duration of illness before diagnosis. Except for prolonged disturbance of consciousness, there was no difference between the two groups in clinical and laboratory data on admission or in clinical course during therapy. Due to the high incidence of complications requiring neurosurgical treatment, cost-effective cranial ultrasound is recommended for screening every young infant with bacterial meningitis, especially in cases caused by S. pneumoniae.
Anti-Bacterial Agents↗
Mouth care for nasopharyngeal cancer patients undergoing radiotherapy.
A randomised trial was undertaken to compare the effect of three oral care protocols in delaying the onset of stomatitis and reducing oral injury in nasopharyngeal cancer patients undergoing radiotherapy, 30 eligible patients with a mean age of 56.2 years were recruited and evenly allocated to one of the three groups using a randomly permuted blocks method. Patients allocated to group E1 and group E2 were given the same instructions on oral care at 1 day, and 1 week before radiotherapy, respectively, while those allocated to the control group were given no instructions. We use the Oral Assessment Guide to assess the oral physical conditions of these patients daily. Our findings revealed that the patients in the E2 group not only had later onset of stomatitis than those in the control and the E1 groups, but also had lesser degree of oral injury measured by the overall assessment score. We thereby recommend the use of the E2 protocol for delaying the onset of stomatitis and reducing oral injury in nasopharyngeal cancer patients undergoing radiotherapy.
Adult↗