Epidemiologic study of type 2 diabetes in Taiwan

Diabetes mellitus (DM) in adults is a global health problem, although its prevalence varies widely between different populations and the rate has generally increased worldwide. In Taiwan, the mortality rate from DM has almost doubled over the past 10 years. The prevalence of DM in Taiwan was established between 1985 and 1996 and the rates were between 4.9 and 9.2%. The prevalence of impaired glucose tolerance (IGT) was 15.5% (men 15% and women 15.9%). The prevalence of DM and IGT increased significantly with age for both genders. The significant factors associated with newly diagnosed DM were age, BMI, family history of DM, systolic blood pressure (hypertension), physical activity and serum triglyceride levels. The prevalence of large vessel disease (LVD) in DM and non-diabetic subjects were 20.0 and 12.9%, respectively. Among diabetics, 15.8% had ischemic heart disease (IHD), 1.7% leg vessel disease (leg VD), and 2.5% stroke. In non-diabetics, the prevalence of the aforementioned macroangiopathies were 11.5, 0.2 and 1.2%, respectively. The diabetics had a significantly higher prevalence of macrovascular disease than non-diabetic subjects. The most significantly associated with the LVD was serum cholesterol levels. Serum cholesterol and HbA1(c) were significantly associated with the development of IHD. Cigarette smoking and female gender were significantly associated with the leg VD. The prevalence of diabetic retinopathy (DR) was 35.0%. (background DR 30%, preproliferative DR 2.8% and proliferative DR 2.2%, respectively.) The prevalence of DR for previously and newly diagnosed diabetics were 45.2 and 28.3% (men 42.8 vs. 33.3% and women 47.5 vs. 24.8%), respectively. From multiple logistic regression analysis, duration of DM was the most important risk factor related to DR. Diabetic subjects treated with insulin had a higher risk of developing retinopathy than those treated with dietary control. The prevalence of nephropathy and neuropathy were 12.9 and 23.5%, respectively. For those patients with and those without nephropathy and neuropathy, the duration of DM, percentage of insulin treatment, percentage of hypertension, and fasting plasma glucose were significantly different. Diabetic duration, hypertension, insulin treatment and glycemic control consistently correlated with nephropathy and neuropathy. In conclusion, the prevalence of DM in Taiwan was between 4.9 and 9.2%, and the prevalence of IGT was 15.5%. The possible risk factors of newly diagnosed diabetes were age, family history of DM, BMI, SBP (hypertension), physical activity and triglyceride levels. Diabetes in Chinese subjects share many characteristics similar to other Asian populations. The burden imposed by the chronic complications of diabetes is massive. In Taiwan, the mortality rates from DM have increased greatly over the past 10 years. Reduction of the modificable risk factors such as BMI, hypertenion and dyslipidemia, and increase of physical activity and good glycemic control through public health efforts may help to reduce the risk of DM and its chronic complications.     

Case-control study on the prevention of occupational eye injuries

The risk factors for occupational eye injuries have never been published in Taiwan. We conducted a case-control study to analyze the differences among workers on their knowledge, attitude to and practice (KAP) of occupational accident prevention. In the study, a statistical model was also set up for predicting the occupational problem. Subjects, including 31 cases of work-related eye injuries and 62 controls, completed a structured questionnaire on KAP, which revealed that 80.6% and 62.7% of workers in the case and control groups, respectively, did not wear eye protection during work. Furthermore, we found that temporary employment (OR, 10.7; 95% CI, 3.03-36.16) and fewer than 10 years of education (OR, 4.44; 95% CI, 1.73-11.44) were the major risk factors for occupational eye injuries. In addition, we developed a logistic regression model with four predictors (temporary employment, education years less than 10, poor management of industrial health and safety in the workplace, and poor attitude towards accident prevention) for the occurrence of occupational eye injuries. In conclusion, in Taiwan, compulsory regulation of wearing eye protection during work, good education, management of work safety and hygiene and employee (especially temporary worker) commitment to safety and health are strongly recommended prevention strategies.     

Two clustering diffusion patterns identified from the 2001-2003 dengue epidemic, Kaohsiung, Taiwan

This study analyzed the spatio-temporal patterns of 4,587 (94% of the total) confirmed dengue cases in Kaohsiung and Fengshan Cities (a two-city area) that occurred in Taiwan from 2001 to 2003. The epidemic had two simultaneous distinct diffusion patterns. One was a contiguous pattern, mostly limited to 1 km from an initial cluster, reflecting that there was a rapid dispersal of infected Aedes aegypti and viremic persons. The second followed a relocation pattern, involving clusters of cases that diffused over 10 weeks starting from the southern and moving to the northern parts of the two-city area. The virus from one clustering site jumped to several distant areas where it rapidly dispersed through a series of human-mosquito transmission cycles to several localities. In both patterns, transmission of disease quickly enlarged the epidemic areas. Future dengue control efforts would benefit from a timely syndromic surveillance system plus extensive public education on how to avoid further transmission.     

黑龙江省巴彦县布鲁杆菌病流行病学分析

目的了解2003年8月～2005年12月巴彦地区布鲁杆菌病(布病)的流行动态及发展趋势,确定防治对策。方法按全国布病监测方案,对黑龙江省巴彦县人群进行连续监测,并对高发乡镇人群进行了布鲁杆菌素皮试,对阳性者和易感人群做琥红平板试验(RBPT)和试管凝集试验(SAT)。结果2003年8月～2005年12月巴彦县共发生布病79例,年平均发病率为3．9/10万,其中2004年最高,达8．4/10万,并有2名临床医生被感染。结论巴彦县布病疫情呈先升高后降低趋势,原因是病区牛羊大批私自屠宰和外卖,应切实采取有效措施控制疾病蔓延。     

Epidemiologic studies of eosinophilic meningitis in southern Taiwan.

A study of the epidemiologic characteristics of 125 cases of eosinophilic meningitis or meningoencephalitis, probably caused by Angiostrongylus cantonensis, which occurred in southern Taiwan in 1968 and 1969 revealed a close association of the disease with the rainy season. In contrast to findings in other geographic areas, most such cases in this study occurred among children. A higher attack rate was observed among aborigines than among descendants of mainland Chinese. Most patients had eaten the giant African snail, Achatina fulica, prior to their illness and this mollusc was commonly found infected with third-stage larvae of A. cantonensis. However, in almost all instances the snail was eaten after it had been thoroughly cooked and examination of cooked snail meat revealed only dead larvae. It is suspected that patients became infected by inadvertently ingesting A. cantonensis larvae liberated when the snails were prepared for consumption.     

Relationship between remaining teeth and self-rated chewing ability among population aged 45 years or older in Kaohsiung City, Taiwan

The purposes of this study were to (1) examine the relationship between the number of various types of healthy remaining natural teeth at different sites and self-rated chewing ability and (2) evaluate the relationship between the number of functional tooth units (FTUs), comprising functional natural teeth (FNT) or fixed prostheses, and self-rated chewing ability. A sample of 296 adults (122 men and 174 women), aged 45 years or older (average age, 56.6 ± 9.7), were recruited from seven dental clinics in Kaohsiung City. Dental information on the number and status of remaining teeth was obtained through examination by trained and calibrated dentists. Self-assessment of chewing ability (masticatory score) was evaluated with a self-administered questionnaire. Results showed that increased age is associated with a greater likelihood of difficulty in chewing. To avoid chewing difficulty, at least 24.7 FNT, 13.3 posterior-FNT, 8.1 units of natural tooth-FTUs, or 9.6 units of fixed tooth-FTUs must remain. Age and the number of healthy remaining teeth, including natural teeth and fixed prostheses, are key factors in chewing ability. Given that aging is unavoidable, the preservation of healthy remaining teeth plays a relatively important role in the maintenance of chewing ability among middle-aged and elderly people.     

老年代谢综合征患病情况及特点

目的　 调查老年干部代谢综合征的患病情况及特点。　 方法　通过体检的方法 ,测定血糖、血脂、血压、心电图、身高、体重、腰围、臀围、眼底等 ,并详细对受检人员询问病史。　 结果 　 1615名老年干部中发现代谢综合征 198例 ,发生率为 12 2 6% ;10 0 4名中年干部中发现 65例 ,发生率仅为 6 47% (P <0 0 1)。老年干部糖尿病、高血压的发生率分别为 2 1 67%、5 7 71% ,较中年干部的发生率 13 5 5 %、2 9 5 8%有明显增高 (P <0 0 1)。老年代谢综合征者冠心病、腹型肥胖、眼底动脉硬化的发生率分别为 5 4 0 4%、63 64%和 40 91% ;而非老年代谢综合征者为 2 6 15 %、44 61%和 2 9 2 3% ,明显低于老年代谢综合征者 (P <0 0 1)。　 结论　老年代谢综合征发病率较高 ,其主要原因是糖尿病和高血压的高发病率。老年代谢综合征伴有高冠心病、动脉硬化发病率 ,是威胁老年人身体健康的主要疾病     

A descriptive analysis of Canadian youth treated in emergency departments for work-related injuries

Because labour laws and regulations protect minors by preventing them from working, this population is often excluded from labour data. However, work is common among Canadian youth. Young teens, and especially pre-teens, have informal employment arrangements such as odd jobs, yard work, babysitting and deliveries. Work injuries occurring in these informal employment arrangements are surprisingly frequent and not usually captured by traditional occupational health and safety data sources (e.g. workers' compensation claims). We analyzed data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) and found 999 youths (5 to 17 years) who had suffered a work-related injury between 1995 and 1998. They were concentrated in two main areas: clerical/service and manual labour. Work-related injuries increased with age. Approximately one third of the youth experienced open wounds and 5.5 percent had animal bites. Collisions with someone or something were common, as were falls. Others or animals were frequently involved. For the majority of cases, the direct cause of injury corresponds to one of ten categories. Injuries and circumstances varied by occupation. Even informal work arrangements (e.g. delivering newspapers) contained hazards and these varied by workplace. The injuries of young workers have implications for future research, prevention efforts, health services policy and legislative and regulatory efforts.     

Community-based epidemiological study on hypertension in Pu-Li, Taiwan.

A community-based study was carried out by the Yang-Ming Crusade in 1987-1988 in Pu-Li Town, Taiwan. We interviewed 1738 out of 2573 registered residents more than 30 years old and their fasting blood samples were drawn and tested. The prevalences of definite hypertension (greater than or equal to 160/95 mm Hg) and borderline hypertension (140/90 to 160/95 mm Hg) were 18.7% and 16.0%, respectively. To study factors associated with hypertension, univariate analysis was applied first. Stratified analyses by age and sex were used for interaction assessment. Logistic regression was used for multivariate analysis. According to the final model, the significant factors related to definite hypertension were age (greater than or equal to 50 v less than 50 years of age, odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6 to 4.3), physical activity (frequent v infrequent, OR 0.4, 95% CI 0.2 to 0.6), alcohol intake (yes v no, OR 2.3, 95% CI 1.1 to 4.6), and cholesterol (greater than or equal to 240 v less than 240 mg/dL, OR 1.7, 95% CI 1.0 to 2.9). Significant factors related to borderline hypertension were age (only for those cholesterol greater than or equal to 240 mg/dL, greater than or equal to 50 v less than 50 years of age, OR 4.1, 95% CI 2.1 to 7.9), cholesterol (only for those age less than 50, greater than or equal to 240 v less than 240 mg/dL, OR 3.6, 95% CI 1.6 to 7.8), physical activity (frequent v infrequent, OR 0.4, 95% CI 0.2 to 0.7), and alcohol intake (yes v no, OR 2.3, 95% CI 1.1 to 4.6).(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidemiologic study of visceral leishmaniasis in Honduras, 1975-1983

Between 1975 and 1983, 53 patients with parasitologically proven visceral leishmaniasis (VL) and 16 patients with suspected VL were diagnosed in Honduras. The patients' ages ranged from 3 months to 10 years, but 95% were younger than 3 years old. Since 1978, when 16 patients were reported, the yearly incidence has declined, and in 1982 only 4 patients were reported. We located and interviewed the families of 57 of the 69 patients. At the onset of illness, all 57 patients lived in rural areas, and 55 lived in southern Honduras. All the patients who were discharged from the hospital alive were still living at the time of the interview. A case-control study, using age-matched neighbors as controls, showed that patients were significantly more likely to have lived in poorly constructed, wood-stick houses. We used an indirect immunofluorescence test to analyze blood samples for Leishmania antibodies from 218 family members of patients, 170 family members of controls, and 156 children living on the island of El Tigre, where 4 of the 5 most recently diagnosed patients lived. Although 15 specimens gave a positive reaction to L. donovani antigen, each gave a stronger reaction when tested against Trypanosoma cruzi antigen, suggesting that the reactions to L. donovani were false positives. A serosurvey of 279 dogs of cases and controls and from El Tigre showed that 24 had positive reactions to L. donovani antigen, but only 4 (1.4%) had higher titers to L. donovani than to T. cruzi.(ABSTRACT TRUNCATED AT 250 WORDS)     

Epidemiologic study of dwarfism in Niigata Prefecture

Epidemiologic study on dwarfism (height under "Mean-2.58 S.D") was performed in elementary schools and junior high schools in Niigata Prefecture. Results were as follows: Prevalences of dwarfism were 0.17% in elementary schools (age at 6-12 y.o.), 0.26% in junior high schools (12-15 y.o.), and 0.20% in all (690 dwarf students of 339,854 students). Prevalences in female was 1.3 times as high as that in male. 476 of 690 dwarf students were further examined. 50 (10.5%) of them had pituitary dwarfism and 2 (0.4%) had hypothyroidism. 24 of 50 cases with pituitary dwarfism and one of 2 cases with hypothyroidism were newly diagnosed in this study. One family who seemed to have autosomal-dominant inherited pituitary dwarfism was found in this study. The heights of brothers (11 y and 9 y 6 m) and their mother were under "Mean-4.0 S.D" and they were diagnosed as patients with isolated GH deficiency. The heights of their grandmother and aunt were also under "Mean-4.0 S.D", but they have not been examined. In both brothers and their mother, plasma GH levels didn't respond to iv bolus injection of GRF (1.0 micrograms/kg), and brain CT showed empty sella. Of 476 dwarf students, 249 (52.3%) had constitutional dwarfism, 118 (24.8%) had either constitutional dwarfism or delayed adolescence, 23 (4.8%) had Turner's syndrome (including Noonan's syndrome), and 13 (2.7%) had chondrodysplasia. Dwarf female whose ratios of the maximum response of plasma LH to LHRH/the maximum response of plasma FSH to LHRH were more than 2.0 and dwarf male whose plasma basal level of testosterone were more than 40 ng/ml were expected to become adolescent in the near future. Plasma IGF-I levels determined by RIA with unextracted samples did not clearly differentiate pituitary dwarfism from others.     

江苏社区人群甲状腺结节的流行病学研究

采用逐级分层整群抽样抽取江苏地区城乡6层样本,调查对象为20岁以上的常住(≥5年)居民6 128人进行甲状腺超声检查及甲状腺功能检测,应用7.5 MHz/50 mm探头B超诊断仪进行甲状腺超声检查,记录甲状腺结节部位、直径、数量、回声、边界、钙化等.采用固相化学发光酶免疫分析法(ICMA法)检测促甲状腺素(TSH),对于TSH在正常范围外的人群,检测游离三碘甲状腺原氨酸(FT3)和游离甲状腺激素(FT4).调查对象甲状腺结节的粗患病率为21.12%、标化患病率为15.69%;男性和女性的粗患病率为14.55%和25.24%,标化患病率为11.20%和20.40%(P＜0.05).以单发结节和直径＜1.0 cm的结节为主,不同年龄段甲状腺结节直径＜1.0 cm和≥1.0 cm构成比之间的差异无统计学意义(P＞0.05),而不同年龄段单发结节和多发结节构成比之间的差异有统计学意义(P＜0.05).江苏地区社区人群的甲状腺结节的患病率较高,加强对其随访和早期诊治有重要意义.

Abstract：

The residents who had lived for at least 5 years and aged over 20 years old were sampled from urban to rural districts of Jiangsu Province with a stratified cluster sampling technique. B mode ultrasonography and thyroid function determination were carried out in 6 128 persons. The location, diameter, number, boundary, and calcification in thyroid nodules were described by using 7.5 MHz/50 mm transducer of thyroid ultrasonography. TSH was measured by chemiluminescence immunoassay. Free triiodothyronine(FT3)and free thyroxin(FT4)were measured when TSH was abnormal. The crude prevalence of thyroid nodules was 21.12% in total population, 14.55% in male, and 25.24% in female. The standardized prevalence was 15.69%, 11.20%, and 20.40%, respectively. The prevalence was lower in male than in female, and increased with age(P＜0.05). Thyroid nodules in Jiangsu Province were highly prevalent and more attention should be paid to the follow-up, early diagnosis, and treatment.     

江苏地区甲状腺功能减退症流行现状调查

目的 研究江苏地区社区人群甲状腺功能减退症(甲减)的流行病学特点.方法 采用逐级分层整群抽样方法抽取江苏地区城乡6层样本,调查对象为≥20岁的常住(≥5年)居民,采集空腹静脉血标本7 122份,以固相化学发光酶免疫分析法(ICMA法)检测sTSH,对于sTSH在正常范围外的人群,检测FT33、FT4.结果 (1)江苏地区调查对象临床甲减粗患病率为0.66%,标化患病率为0.43%;亚临床甲减的粗患病率为7.53%,标化患病率为6.28%.(2)女性临床甲减和亚临床甲减的患病率均明显高于男性(均P<0.05).(3)随年龄增长,男性和女性亚临床甲减的患病率显著升高(P<0.05).结论 与临床甲减相比,江苏地区社区人群亚临床甲减的患病率明显升高,应加强对其随访和早期诊治.     

舟山海岛地区幽门螺杆菌耐药性流行病学研究

目的 探讨舟山海岛地区幽门螺杆菌(Hp)耐药性流行病学状况,指导临床合理用药.方法 收集2007年9月-2008年7月706例行胃镜检查患者,男457例,年龄13～85岁,平均43.8岁;女249例,年龄16～91岁,平均47.7岁.活检取胃黏膜进行Hp分离培养,用UreA基因PCR进行扩增鉴定.对Hp分离菌株进行药敏试验,并进行统计学分析.结果 706例标本中,281例Hp培养阳性,分离的281株Hp基因组均取得基因组DNA.281株Hp临床分离株对左氧氟沙星、甲硝唑、克拉霉素、氨卞青霉素、庆大霉素、呋喃唑酮的药敏耐药率分别为12.10%、100.00%、21.71%、0%、0%.结论 舟山海岛地区根除Hp药物,宜将阿莫西林、庆大霉素、呋喃唑酮作为首选,甲硝唑已不能作为根治药物.     

舟山海岛地区幽门螺杆菌耐药性流行病学研究

目的 探讨舟山海岛地区幽门螺杆菌(Hp)耐药性流行病学状况,指导临床合理用药.方法 收集2007年9月-2008年7月706例行胃镜检查患者,男457例,年龄13～85岁,平均43.8岁;女249例,年龄16～91岁,平均47.7岁.活检取胃黏膜进行Hp分离培养,用UreA基因PCR进行扩增鉴定.对Hp分离菌株进行药敏试验,并进行统计学分析.结果 706例标本中,281例Hp培养阳性,分离的281株Hp基因组均取得基因组DNA.281株Hp临床分离株对左氧氟沙星、甲硝唑、克拉霉素、氨卞青霉素、庆大霉素、呋喃唑酮的药敏耐药率分别为12.10%、100.00%、21.71%、0%、0%.结论 舟山海岛地区根除Hp药物,宜将阿莫西林、庆大霉素、呋喃唑酮作为首选,甲硝唑已不能作为根治药物.