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Biomedical subjects

Y C Ko

Publications and source records attributed to Y C Ko.

At least 73 records · Page 4Linked to original sources

[Operation directions by comparing financial ratio of 22 provincial hospitals].

Even more restrictive regulations and reimbursement limits seem to be a very heavy burden and stress for most provincial hospitals, especially after the National Health Insurance System has been introduced. The purpose of this project to find a better, universal direction for these hospitals through three steps: 1) Using different financial and accounting ratio indexes to evaluate the general business performance of each hospital. 2) Taking a comprehensive questionnaire with senior managers of each hospital to know their concepts and attitudes concerning external environment and internal operation. 3) Comparing data's correlation and differentiation to ascertain better trends for future operation for all hospitals. The database for this project comes from two resources: 1) Government finance and budget reports of 22 provincial hospitals for the 1994 accounting calendar year. 2) The results of questionnaires returned by 274 senior managers of hospitals, and analysis of these by chi-square test. Through statistical comparison, a number of conclusions can be made: 1) Most hospitals have better operation efficiency if any professional hospital administrator is working for them. 2) The hospital with more comprehensive personnel system shows better business performance. 3) The hospital with routine and formal financial analysis reports always has better business performance. 4) The hospital with poor operational efficiency tends to get rid of restriction or limitation from government's system. 5) The hospital with good operational efficiency has more confidence and desire to improve and change. 6) The hospital with poor operational efficiency is more dependent on outside support from government. 7) The hospital with better business performance has more concern about the impact of malpractice around the hospital. In short, a hospital with poor business efficiency always has more pessimistic attitude and tends to rely on outside resource support. On the other hand, a hospital with more confidence, flexibility and readiness for internal improvement always demonstrates greater business efficiency.

Economics, Hospital↗

Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan.

A hospital-based case-control study of matched pairs was conducted to explore (a) the relationship between the use of betel quid chewing, cigarette smoking, alcohol drinking and oral cancer and (b) synergism between these factors. The case group consisted of 104 male and 3 female oral cancer patients and these were compared with 194 male and 6 female matched controls. We found by univariate analysis that alcohol consumption, smoking, betel quid chewing, educational level and occupation were associated with oral cancer. The adjusted odds ratios were to be found elevated in patients who were smoking and betel quid chewing. After adjusting for education and occupation covariates, the incidence of oral cancer was computed to be 123-fold higher in patients who smoked, drank alcohol and chewed betel quid than in abstainers. The synergistic effects of alcohol, tobacco smoke and betel quid in oral cancer were clearly demonstrated, but there was a statistically significant association between oral cancer and betel quid chewing alone. Swallowing betel quid juice (saliva extract of betel quid produced by chewing) or including unripened betel fruit in the quid both seemed to enhance the risks of contracting oral cancer.

Adolescent↗

Specific increase in interleukin-8 concentrations in dialysis fluid of patients with peritonitis receiving continuous ambulatory peritoneal dialysis.

AIMS: To evaluate the influence of interleukin-8 (IL-8) and other inflammatory cytokines (IL-6, IL-1 beta and tumour necrosis factor alpha (TNF alpha)) on the occurrence of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). METHODS: The study population comprised 12 patients with peritonitis, 33 without peritonitis, all undergoing CAPD, and five patients undergoing peritoneal catheter implantation. Cytokine concentrations in dialysis fluid were determined by immunoassay and their values compared. RESULTS: Concentrations of both IL-8 (median 147 pg/ml, range 20-2273 pg/ml; n = 12) and IL-6 (median 1120 pg/ml, range 96-10,600 pg/ml) were substantially elevated, while the IL-1 beta concentration was lower and TNF alpha was not detectable in patients at diagnosis. The IL-6 concentration was also elevated in patients undergoing catheter implantation as well as in those with peritonitis. The IL-8 concentration, however, was elevated only upon infection. Intraperitoneal production of IL-8 was evident on determination of paired serum and dialysis fluid cytokine concentrations, and immunostaining of peritoneal cells with monoclonal anti-IL-8 antibody. CONCLUSIONS: These results suggest that determination of the IL-8 concentration in dialysis fluid maybe useful as a specific marker for following patients with peritonitis receiving CAPD.

Adult↗

Assessment of interlaboratory performance on the measurement of blood lead levels in Taiwanese adults.

The purpose of this proficiency study was to assess the accuracy and consistency of blood lead level (BLLs) measurements in a study of Taiwanese adults. Three methods, including a certified blood accuracy test, an interlaboratory precision test and an intertime repeated measurement test, were applied to the six participating laboratories. Accuracy tests showed that most of the blood lead measurements were within the acceptable criteria proposed by United States Center for Disease Control and Prevention (U.S. CDC). However, an average of 11% underestimation was found at BLLs below 15 micrograms/dl. Coefficients of variation (CVs) were high in the first 3 months. After technical improvements, the CVs were reduced to acceptable limits of around 15% at low target lead values and 7% at high lead values. Interlaboratory variations of measurements in blood from ten normal healthy donors showed that the standard deviations were less than 2 micrograms/dl, which is within the acceptable criteria of +/- 4 micrograms/dl, in 8 out of 10 samples. Repeated measurements of BLLs in 54 blood samples over two months showed that most of the differences were within the acceptable range with a few exceptions. The mean BLLs measured in the baseline (pre-test) and two months later (post-test) were nearly identical. This proficiency test provides comparable and reliable results of BLL estimations in this multilaboratory study. However, the accuracy and consistency at low BLLs need to be improved.

Adult↗

Comparison of the genetic variation in type 1 dengue virus isolates in Taiwan, 1987-1992.

In this study, the genetic variation of eight dengue-1 strains isolated in Taiwan from 1987 to 1992 (including two imported strains) were studied. A fragment of 490 nucleotides from the E/NS1 junction was amplified and studied by reverse transcription-polymerase chain reaction (RT-PCR) and vector cloning. By comparing the nucleotide sequences of these strains, it was found that local strains in Taiwan shared geographic similarity. The nucleotide differences among local strains were less (0.61% to 2.24%) than the differences between imported strains and other strains (2.04% to 4.29%). The differences of nucleotide sequences between local strains and the prototype remain constant (5.10%-5.29%). However, the differences in nucleotide sequences between imported strains and the prototype ranged from 3.89% to 7.14%. Since the point mutations occurred in the wobble position of the codon, only conserved changes resulted in the amino acid among the isolates.

Amino Acids↗

Body mass index and hyperuricemia differences between aboriginal and non-aboriginal children in Taiwan.

To explore the relationship between the body mass index (BMI) and uric acid in different races before growing up into adulthood, we selected a total of 1236 five to 14 year-old children in the period from March to December 1994. The children originated from three Aboriginal tribes (the Bunun, and the Paiwan tribes--classified as South-Aborigines and Atayal tribe as North-Aborigines) and two non-Aboriginal tribes (Fukein-Taiwanese and Hakka), all of whom are from the following four countries: Chien-Shih, Sandimen, Gaushuh and Sanmin. The results showed that the percentage of hyperuricemia (> or = 7.5 mg/dl) was 28.5% (352/1236) and of obesity (BMI > or = 22 kg/m2) was 9.5% (118/1236). Increased uric acid concentration was found to be related to age, sex, BMI, race, triglyceride (TG) and cholesterol levels in both the primary analysis and after the adjusted logistic regression model. Obesity did not vary with sex (OR = 1.0; 95% CI = 0.7-1.5), or with Aborigines in north Taiwan as compared with non-Aborigines (OR = 1.0, 95% CI = 0.6-1.6), but the logistic regression model adjusted for age indicated large BMI values for children with high serum uric acid concentration, triglyceride levels and the Aborigines who originated from south Taiwan. It was concluded from this study that both of the North-Aborigines and South-Aborigines made an important influence on serum uric acid concentration in children, especially the South-Aborigines made difference to BMI as compared with non-Aborigines and North-Aborigines.

Adolescent↗

[Interleukin-8].

Interleukin 8 (IL-8) is one of the most widely studied chemoattractants for leukocytes. It belongs to the newly classified CXC family of chemokine which possesses biological activities mainly on neutrophils. The potential role of IL-8 in inflammation is substantiated by the growing evidences of clinical relevance of IL-8 in various diseases such as infection, ischemia and autoimmune disorders. The common characteristic pathological feature of these events is neutrophil infiltration. Although little is known about the mechanism of neutrophil recruitment into the urine, urinary tract infections (UTI) are accompanied by pyuria. Elevated urinary IL-8 levels were found in patients with UTI. Bioactive, multiple forms of IL-8 were produced locally within the urinary tract, and implied that IL-8 participated in the induction of neutrophil migration into the inflammatory site. Similar findings were observed in the peritoneal dialysate of patients on continuous ambulatory peritoneal dialysis with peritonitis. The notion of involvement of IL-8 in local infection was reinforced by the findings obtained on the rabbit UTI model. Finally, the clinical usefulness, as well as the problems of IL-8 level determination in various body fluids are discussed.

Humans↗

[Risk factors related to alcohol use among adolescents of fathers with alcoholism].

The purposes of this study were: 1) to investigate the risk factors related to alcohol use among adolescents of fathers with alcoholism. 2) to compare their drinking behaviors with the adolescents whose fathers were non-alcoholics. Sixty-one adolescents, including 29 males and 32 females, aged from 12 to 22 whose fathers were alcoholics formed the case group. 122 age and sex matched adolescents in a ratio of 1:2 whose fathers were non-alcoholics were recruited as the comparison group (normal/control). Data were collected by interview during home visits or by mailing questionnaires to patients. The prevalence rates of drinking, smoking and betel-nut chewing among the adolescents of fathers with alcoholism were 67.2%, 19.7%, 18%. There was no significant difference in drinking behavior between the two groups. Beer was the most popular drink in adolescents' drinking habits. The most popular motivation of drinking was the peer pressure by friends. The significant risk factors of alcohol use among the adolescents included male poor mental health status adolescents with behavioral problems and alcohol use amongst classmates or friends.

Adolescent↗

Blood lead levels in the general population of Taiwan, Republic of China.

The purpose of this study was to investigate the environmental lead exposure of the general population in Taiwan. A total of 2919 residents of Taiwan were selected by multistage sampling methods. The participants were characterized by questionnaires and 10 ml venous blood was collected for blood lead measurement. A quality assurance/quality control program was designed during the analysis of blood lead levels. The mean blood lead level of 2719 residents without occupational lead exposure was 8.29 +/- 5.92 micrograms/dl. After adjustment for age and sex distribution to the Taiwan general population, the mean blood lead level was 8.10 micrograms/dl. Adjusted for an 11% underestimation of blood lead levels among the six laboratories, the mean blood lead level was estimated to be 8.99 micrograms/dl. This study also found that blood lead levels were associated with personal characteristics, i.e., gender, ethnic group, education level; lifestyle factors, i.e., smoking, alcohol consumption, sources of drinking water; and residential location, i.e., levels of urbanization, distance of house from the road. However, age, floor of residence, milk consumption, betel nut consumption, and Chinese herbal drug consumption were not found to be associated with blood lead levels. These results show that blood lead levels in Taiwan residents were not higher than in most developed and developing countries. Environmental lead pollution does not seem to be a serious problem in Taiwan.

Adolescent↗

Excess cancer mortality among children and adolescents in residential districts polluted by petrochemical manufacturing plants in Taiwan.

We have collected data on the cancer deaths of children and adolescents 0-19 yr old living in a residential area near 3 large petroleum and petrochemical complexes in and near Kaohsiung city (petrochemical industrial districts, PIDs) in the period of 1971-1990 and compared these with the cancer deaths of children and adolescents 0-19 yr old among the entire population of Taiwan (national reference) and among the residents of 26 administrative districts, comprising all of Kaohsiung city and Kaohsiung county (local reference), except for 8 sparsely populated, rural districts. Having scrutinized all cancer death certificates, we have identified various statistically significant excess deaths, as compared with the national and local reference, due to cancers at all sites. Cancer of the bone, brain, and bladder in boys and girls 0-9 yr and 10-19 yr of age in the 1981-1990 decade that followed the establishment of petrochemical production in the PIDs was studied. However, excess cancer deaths seemed to have clustered in the 10-19 yr age group, who had been potentially exposed to the petrochemical pollutants for the longest period of time from the youngest age. Almost all bone, brain, and bladder cancer deaths registered were within 3 km of the 3 complexes. Bone and brain cancers in particular occurred in girls in the PIDs more frequently than in boys, even though these are believed to occur more in males than females elsewhere.

Adolescent↗

Protection against lethal bacterial infection in mice by monocyte-chemotactic and -activating factor.

Chemotactic factors regulate the recruitment of neutrophils, lymphocytes, or monocytes-macrophages to infectious and inflammatory sites. The purpose of this study was to determine whether monocyte-chemotactic and -activating factor (MCAF [MCP-1], a JE gene product) also influences the host defense mechanism against microbial infection. We evaluated the effect of recombinant human MCAF on the survival rate of mice systemically infected with Pseudomonas aeruginosa or Salmonella typhimurium. The administration of 2.5 micrograms of MCAF 6 h before infection completely protected the mice from lethal infection. Mice with cyclophosphamide-induced leukopenia exhibiting increased susceptibility to P. aeruginosa were also endowed with resistance by the same dose of MCAF. Administration of MCAF at -6 h was critical, since MCAF given either earlier or later than -6 h failed to rescue mice from lethal infection. The in vivo effect on the survival of mice paralleled the reduced recovery of viable P. aeruginosa or S. typhimurium from the peritoneal cavity, i.e., the number of recovered bacteria from the MCAF (2.5 micrograms per mouse)-treated mice was reduced to less than 2% of control mice for P. aeruginosa and 4% of control mice for S. typhimurium at 24 h. Since MCAF exhibited chemotaxis on murine macrophages as well as enhanced phagocytosis and killing of bacteria in vitro, the activation of macrophages, followed by the recruitment into the peritoneal cavity, is responsible for eliminating bacteria and thus enhancing the survival rate.

Animals↗

[Issues on aboriginal health in Taiwan].

In recent years health professionals have been concerned about the health of aborigines which has been neglected for a long time. Health disparities are known to exist among aborigines and non-aborigines in the United States or other countries. In Taiwan, there are nine main aboriginal tribes consisting of approximately 330,000 people. In general, their health status, evaluated by life expectancy, mortality rates and the prevalence and incidence of various diseases amongst them, is worse than amongst the rest of the Taiwanese (general) population. Current investigations indicate that life expectancy for aborigines is on average 10 years less than that of the general population; 12.5 years less for men, 6 years less for women; approaching a standardized mortality ratio of 2 fold, that is 2.1 fold in men, 1.7 fold in women. Accidental injures, suicide, tuberculosis, liver cirrhosis, alcoholism, pneumonia, bronchitis, parasite infections are the most important sources of diseases. Hypertension, heart disease, some selected sites of cancer, nutrition and lack of adaptation are gradually becoming important new sources of disorders. Although aboriginal health has improved over the decades, the author estimates that their overall health status is 25-30 years behind that of the general population or of off-shore islanders. The extent of their development varies with tribes. It is necessary to study the cause of why aborigines die so young. It may be due to insufficient medical care for heart disease whose prevalence is relatively low among aborigines but resultant mortality is nevertheless high. However, insufficient medical care cannot explain the high incidence of a number of cancers and resultant mortality. All factors relating to the environment, agents, hosts and diseases should be taken into consideration, such culture, transportation, life style, health behavior etc, and compared to those of non-aborigines. A series of studies are proposed to address the specific, multi-dimensional health demands of the aborigines. The author suggests the development of prevention and intervention strategies designed to overcome difficulties and barriers to eliminate these disparities among the people of Taiwan.

Adolescent↗

[Leading causes of death in the aborigines in Taiwan].

Leading causes of death were analyzed among Aboriginal tribes in Taiwan in the decades of 1971-80 and 1981-90. Sex and tribe specific standardized mortality ratios were calculated from death certificate data and compared with the number of expected deaths derived from the mortality of the total population in Taiwan. In all, 35,221 cases of death in Aborigines were contrasted with 1,695,479 cases of death in the total population in Taiwan. Generally speaking during the two decades the SMR increased considerably suggesting more attention should be paid to the aborigines. Mortality due to accidents was statistically significantly higher than expected among Atayal, Bunun, Paiwan and Rukai men and among Atayal, Bunun and Paiwan women, as was mortality from tuberculosis among Atayal, Bunun, Paiwan and Rukai men and women, mortality due to liver cirrhosis as well as pneumonia among the Atayal, Bunun and Paiwan men and women, mortality from suicide among Atayal, Bunun, and Paiwan men, and among Atayal and Bunun women, mortality due to cancer among Bunun and Paiwan men and women, and mortality due to cardiovascular diseases among Atayal, Bunun and Paiwan men in 1981-90 decade. The SMR for ill-defined conditions was on average twice as high as expected; but among the Yami tribe in particular it was elevated 12 fold, indicating insufficient medical care. Factors relating to the cause of increased deaths need to be further studied.

Cause of Death↗

[Mortality patterns of Taiwan aborigines due to accidents].

The purpose of this investigation was to study ethnic differences in mortality patterns due to accidents in the various aboriginal areas of Taiwan. Mortality data was collected from the National Health Department. To compare the accident mortality of aborigines with that of the general population of Taiwan, and then calculated standardized mortality ratios for accidents in the various aboriginal groups by using the cause specific accident mortality of the general population as standardized mortality and found that mortality in Taiwan between 1971 and 1990 was 60.1 per hundred thousand due all causes of injuries 72.2 (102.2 for males and 39.5 for females). The same figures for the aborigines were 194.9 (274.1 for males and 98.7 for females), respectively. The leading causes of accidental death among the aborigines were motor vehicle accidents, suicide, drowning, accidental falls for males and suicide, motor vehicle accidents and non-drug poisoning for females. Our investigations show that the standardized mortality ratio due to accidents in the aboriginal areas is two to three times higher than that in the general population of Taiwan. These figures were differences among the aboriginal tribes, despite similarities in medical care, environmental and economic circumstances. Mortality due to accidents, especially due to suicide and poisoning, in the Atayal and Bunun tribes were particularly higher than in other tribes. Thus, the risk of an accident in these regions may be associated not only with the environment and the lack of medical resources, but with some socio-cultural factors.

Accidents↗

[Cancer mortality analysis among aborigines in Taiwan].

Mortality among Aborigines tribes in Taiwan from malignant neoplasms in the 1971-80 and 1981-90 decades were analyzed. Sex and tribe specific standardized mortality ratios were calculated from death certificate data and compared with the number of expected deaths derived from the cancer mortality of the entire population of Taiwan. Mortality due to oral cancer was statistically significantly higher than expected among Paiwan men in the 1971-80 decade and among Paiwan women from 1971-80 and 1981-90; as was mortality from nasopharyngeal cancer among Bunun, Paiwan and Rukai men from 1981-90 and among Bunun and Paiwan women from 1971-80 and 1981-90; mortality due to stomach cancer among the Atayal, Bunun and Paiwan people from 1971-80 and 1981-90, among Rukai men from 1971-80 and among the Tsou and mixed group women from 1981-90; mortality from liver cancer among Atayal and Bunun men in 1971-80, among Bunun women from 1971-80 and 1981-90 and among Paiwan women in 1981-90; mortality due to nasal cavity, middle ear and paranasal sinuses cancer among Rukai men from 1981-90; and mortality due to bone cancer among Tsou men and Atayal women from 1981-90. Mortality due to colorectal cancer was statistically significantly lower than expected among mixed group men from 1971-80 and in Atayal women from 1981-90; as was mortality from lung cancer among Atayal men and Paiwan women from 1971-80 and among Paiwan and mixed group men in the 1981-90 decade. Overall, the standardized mortality ratio of all cancers in aborigines was a little higher than in the general population of Taiwan. However, differences for ratio or site existed in different tribes.

Female↗

[Standardized incidence ratios for cancers in Taiwan aborigines, 1981-1987].

Standardized incidence ratios (SIR) of malignant neoplasms in Taiwanese Aborigines were analyzed. In all, 995 cases of cancers had been reported in 30 Taiwanese Aboriginal communities between 1981 and 1987. In the same time period, 137, 159 cases were registered in Taiwan and carefully categorized according to race, gender, site and frequency of occurrence. Sex and tribe-specific standardized incidence ratios with 95% confidence interval were calculated. We found that the standardized incidence ratios of all cancers in Aborigines was lower than that in the general population of Taiwan for both Aboriginal men (0.72, 95% CI:0.67-0.78) and women (0.66, 95% CI:0.59-0.72). Of selected malignant neoplasms, SIR for nasopharyngeal carcinoma was slightly elevated in men, especially in the Bunun and Rukai tribes and significantly elevated in Paiwan women (2.95, 95% CI:1.65-4.87). The SIR for gastric cancer was significantly elevated for both men (SIR = 1.22, 95% CI:1.03-1.44) and women (1.48, 95% CI:1.14-1.92), especially in Atayal and Bunun men and Atayal women. There was a higher than expected level of incidence of penis cancer and other male genital cancers, especially in Paiwan people, with the SIR as large as 6.24 (95% CI:2.02-14.53). The SIR of lymph node cancer was significantly increased in Bunun (4.21, 95% CI:1.36-9.81) and Yamei women (CI:1.50-44.89), but not for all Aboriginal men. Colon, rectum, lung, bladder and oral cancers in aboriginal men and colon, rectum, lung, breast and cervical cancer in women occurred significantly less frequently than in the general population. The SIR of colon and rectum carcinoma was significant lower for both men (0.45, 95% CI:0.32-0.61) and women (0.25, 95% CI:0.13-0.42), particularly in the Atayal and Paiwan tribes. The SIR of lung cancer was 0.52 (95% CI:0.41-0.66) in Atayal, Bunun, Paiwan men and 0.58 (95% CI:0.38-0.86) in Paiwan women. There were significantly lower than expected levels of incidence of bladder (0.18, 95% CI:0.02-0.65) and oral cancer (0.29, 95% CI:0.08-0.74) for Atayal men. Aboriginal women had significantly lower SIR of cervical cancer (0.46) especially in Atayal, Bunun, Paiwan women and of breast cancer (0.38) especially in the Atayal and Paiwan women. But cancer of esophagus, liver, gallbladder, pancreas, and prostate occurred among Aboriginal people at the same rate as in the general Taiwan.

Adolescent↗

[Prevalence of smoking, drinking and betel quid chewing and related factors among aborigines in Wufeng District].

This study surveyed the prevalence of smoking, drinking, betel quid chewing and related factors among adult Aborigines in Wufeng District, Hsinchu county, Northern Taiwan, as determined in a cross-sectional study (N = 504), based on random sampling. In house to house survey, 420 residents were interviewed in their homes by a structured questionnaire (with a response rate of 83.3%) and a complete set of data was collected for 360 Atayal and Saisiat Aborigines. The survey only included adults (N = 302), as the number of children were few. The life-time prevalence rate of smoking, drinking and betel quid chewing was 71.1%, 85.5%, 49.7% in men and 25.2%, 58.0%, 6.3% in women, respectively. In contrast, the one year prevalence rates were 61.0%, 65.4%, 27.0% in men and 16.8%, 25.97%, 1.4% in women, respectively. The result of multiple logistic regression were that (1) the male drinker and betel quid chewer was the highest risk group for smoking; (2) the male smoker was the highest risk group for drinking and (3) the married male smoker was the highest risk group for betel quid chewer.

Adolescent↗

[The analysis of factors affecting the sexual behavior and antibody against syphilis of deep sea fishermen].

Prostitutes may be regarded as the reservoir of sexual transmitted diseases and their customers as the transmitters. The use of condom for sexual intercourse with prostitutes is an effective way of preventing sexually transmitted infections. Deep sea fishermen usually spend a long period of time sailing the oceans, and many have contacts with prostitutes when their boat stays in harbor. This is a study of the factors which affect the fishermen who are customers of prostitutes and condom using. In all 859 Taiwanese deep sea fishermen were interviewed and samples of their blood serum were collected between January and June of 1991. Of the interviewees, 628 (73.1%) used at one time the services of a prostitute; 84% of aborigines from reserved areas and 68% of aborigines from non-reserved areas. The factors which were found to be related to a sailor's tendency to become the customer of a prostitute after adjustments in logistic regressions were marital status, educational level, tobacco smoking and alcohol consumption. Of the 628 men 100 claimed to use condoms always, 110 sometimes and the remaining 414 men never. The vast majority of aborigines from reserved areas (113/124; 91.1%) never used condoms as compared with 84.0% of aborigines from non-reserved areas and 81.8% of non-aborigines (included Hakka). As might be expected, the lesser educate as well as the aborigines from reserved areas use condoms the least frequently.

Adult↗