Push and pull: Exposure of young Taiwanese women to sexually explicit materials

This study was designed to understand young Taiwanese women’s perception of sexually explicit materials (SEMs). Researchers conducted six focus group discussions with 38 young women between the ages of 18 and 22 in Taiwan in 2009–2010 and used content analysis to analyze the data based on the push-pull theory. The results showed that the exposure of young women to SEMs was a sexual exploration process from no sexual activity to future sexual activity. This process was affected by the interactions of three powers: push power, pull power, and personal factors. The push power included factors, such as parents and social values, which failed to satisfy their sexual curiosity and provide them with autonomy. The pull power included SEMs and peer influence, which increased sexual arousal stimuli and curiosity to try sexual activity. The most important personal factors were young women’s growth, including sexual curiosity, cognition of SEMs, and gender equity in freedom to make sexual decisions. Understanding this push-pull process regarding SEM can help health-care providers with their own discourses in addressing sex and influence young women’s participation in desired, protected, and enjoyable sex when sufficiently ready.     

Improved coronary artery blood flow following the correction of systolic dyssynchrony with cardiac resynchronization therapy

Background

Coronary blood flow (CBF) is improved by cardiac resynchronization therapy (CRT) and impaired by right ventricular apical (RVA) pacing in patients with heart failure. However, the underlying mechanism remains unclear.

Methods

Twenty-nine non-ischemic heart failure patients who responded to CRT underwent transthoracic echocardiography examination including both left anterior descending (LAD) CBF and tissue Doppler imaging in 3 pacing modes: intrinsic conduction, RVA pacing and biventricular (BiV) pacing. LAD velocity-temporal integral (LAD-VTI) and duration were measured. Systolic dyssynchrony was assessed with the standard deviation of a 12-left ventricular segmental model (Ts-SD).

Results

BiV pacing improved while RVA pacing reduced CBF compared to intrinsic conduction (all p < 0.05). Both Ts-SD and ventricular septal velocity deteriorated during RVA pacing but improved during BiV pacing (all p < 0.05). When systolic dyssynchrony was induced, lower LAD-VTI (9.5 ± 3.4 versus 12.7 ± 5.1 cm, p = 0.001) and shorter LAD diastolic duration (483 ± 92 versus 542 ± 106 ms, p = 0.010) were detected than synchronous status. Systolic dyssynchrony was inversely related to septal velocity (r = − 0.41), p<0.001 and LAD-VTI (r = − 0.30, p = 0.007), with the latter found to be moderately correlated to septal velocity (r = 0.30, p = 0.007).

Conclusion

Regional LAD flow was improved in patients subjected to BiV but worsened in those treated with RVA pacing in non-ischemic heart failure CRT responders. Systolic dyssynchrony was more commonly observed in patients subjected to RVA pacing. Reduction of septal velocity with dyssynchrony may directly lead to reduced LAD flow. Improvement of septal velocity by CRT and hence LAD flow may be an important mechanism in determining the response to CRT.     

Extracorporeal Membrane Oxygenation Use,Expenditure, and Outcomes in Taiwan From 2000 to 2010

Background

No study to date has systematically examined use, expenditure, and outcomes associated with extracorporeal membrane oxygenation (ECMO) use in Taiwan. The aim of this study was to examine ECMO use, expenditure, and outcomes during an 11-year period in Taiwan.

Methods

Claims data were collected from the Taiwan National Health Insurance Research Database for patients who received ≥1 ECMO treatment between January 2000 and December 2010. Measurements included demographics, indications for ECMO use, length of hospital stay, outcome, and expenditure.

Results

A total of 3969 patients received ECMO during the study period (median age: 54.6 years). The number of patients receiving ECMO increased from 52 in 2000 to 1045 in 2010. The major indication for ECMO was cardiovascular disease (68.7%), followed by respiratory disease (17.9%). Median length of hospital stay was 13 days in 2000 and 17 days in 2010. Median expenditure (New Taiwan dollars) was $604 317 in 2000 and $673 888 in 2010. Some variables significantly differed by age, sex, hospital setting, calendar year, and indication for ECMO, and were associated with in-hospital and after-discharge mortality.

Conclusions

ECMO use has increased dramatically in Taiwan over the last decade. The high mortality rate of ECMO users suggested that ECMO may be being used in Taiwan for situations in which it provides no added benefit. This situation may be a reflection of the current reimbursement criteria for National Health Insurance in Taiwan. Refinement of the indications for use of ECMO is suggested.Key words: cost, extracorporeal membrane oxygenation, survival, Taiwan     

Serotonin transporter availability in the midbrain and perceived social support in healthy volunteers

Objective

Serotonin modulates human behavior and emotion. Recent evidence implies that a higher level of serotonergic activity could be associated with a higher level of perceived social support. This study aimed to examine the correlation between serotonin transporter (SERT) availability and perceived social support scores in healthy volunteers.

Methods

111 healthy participants, 50 males and 61 females, were enrolled from the community and completed the Measurement of Support Function questionnaire. Single photon emission computed tomography (SPECT) with [¹²³I] ADAM was performed to examine SERT availability.

Results

Perceived social support was positively correlated with SERT availability (Spearman's ρ = 0.29, p < 0.01; χ² = 7.57, p < 0.01), particularly in males (Spearman's ρ = 0.37, p < 0 .01; χ² = 11.77, p < 0.01). Censored regressions indicated that these associations are not influenced by a ceiling effect and remained significant after controlling the effect of age.

Conclusions

This result confirmed the correlation between perceived social support and central serotonergic activity. However, this correlation was present only in males.     

Association of Clinical Symptomatic Hypoglycemia With Cardiovascular Events and Total Mortality in Type 2 Diabetes: A nationwide population-based study

OBJECTIVE

Hypoglycemia is associated with serious health outcomes for patients treated for diabetes. However, the outcome of outpatients with type 2 diabetes who have experienced hypoglycemia episodes is largely unknown.

RESEARCH DESIGN AND METHODS

The study population, derived from the National Health Insurance Research Database released by the Taiwan National Health Research Institutes during 1998–2009, comprised 77,611 patients with newly diagnosed type 2 diabetes. We designed a prospective study consisting of randomly selected hypoglycemic type 2 diabetic patients and matched type 2 diabetic patients without hypoglycemia. We investigated the relationships of hypoglycemia with total mortality and cardiovascular events, including stroke, coronary heart disease, cardiovascular diseases, and all-cause hospitalization.

RESULTS

There were 1,844 hypoglycemic events (500 inpatients and 1,344 outpatients) among the 77,611 patients. Both mild (outpatient) and severe (inpatient) hypoglycemia cases had a higher percentage of comorbidities, including hypertension, renal diseases, cancer, stroke, and heart disease. In multivariate Cox regression models, including diabetes treatment adjustment, diabetic patients with hypoglycemia had a significantly higher risk of cardiovascular events during clinical treatment periods. After constructing a model adjusted with propensity scores, mild and severe hypoglycemia still demonstrated higher hazard ratios (HRs) for cardiovascular diseases (HR 2.09 [95% CI 1.63–2.67]), all-cause hospitalization (2.51 [2.00–3.16]), and total mortality (2.48 [1.41–4.38]).

CONCLUSIONS

Symptomatic hypoglycemia, whether clinically mild or severe, is associated with an increased risk of cardiovascular events, all-cause hospitalization, and all-cause mortality. More attention may be needed for diabetic patients with hypoglycemic episodes.Hypoglycemia is a major side effect of glucose-lowering therapy in patients with type 1 or type 2 diabetes. Patients with type 2 diabetes are usually believed to have less frequent hypoglycemia episodes than type 1 diabetic patients (1). Prodromal symptoms of hypoglycemia, including tremor, diaphoresis, tachycardia, and anxiety, are sometimes noticed by the patient; consequently, severe complications can be avoided. If left untreated, however, neuroglycopenia may develop, resulting in neurologic damage (2,3).Hypoglycemia has also been associated with adverse cardiovascular events in type 2 diabetic patients beyond hypoglycemic episodes themselves (4). The surge of sympathetic activity during hypoglycemic episodes has been suggested to be the underlying mechanism leading to destabilization of atherosclerotic plaques (5), increased arrhythmia attributable to increased corrected QT interval (6), and induction of cardiac and cerebral ischemia. Studies including epidemiological cohort studies and clinical trials (7–10) have already suggested that hypoglycemia also is a risk factor for cardiovascular outcomes. However, some patients in these studies had comorbidities on admission, such as unstable angina and acute myocardial infarction (11–14). Recently, the ADVANCE study suggested that hypoglycemia is associated with increased risks of a range of adverse clinical outcomes, and it is considered to be a marker for vulnerability to such events for type 2 diabetic patients (15).Whether hypoglycemia is a risk factor or a marker, it is important to evaluate the possible correlates to both hypoglycemia and serious health conditions, including hepatic disease, malignancy, renal disease, and use of various medications. Furthermore, in real-world clinical practice, it is intriguing to identify hypoglycemic events based solely on symptoms or a physician’s diagnosis rather than on glucose levels, as most previous studies have. Moreover, patient selection bias, especially the Berkson bias, in hospital-based observational or case-control studies probably confounds and casts doubt on the associations between hypoglycemia and clinical outcomes. Finally, the clinical impact of mild self-reported hypoglycemic episodes is largely unknown. We therefore conducted this nationwide random-sampling cohort study of type 2 diabetic patients to characterize their comorbidities and evaluate the influences of mild and severe hypoglycemia and their outcomes.     

Survival of motor neuron protein downregulates miR-9 expression in patients with spinal muscular atrophy

Spinal muscular atrophy (SMA) is a lethal hereditary disease caused by homozygous absence of the survival of the motor neuron (SMN) 1 gene (SMN1), and it is the leading genetic cause of infant mortality. The severity of SMA is directly correlated with SMN protein levels in affected patients; however, the cellular regulatory mechanisms for SMN protein expression are not completely understood. In this study, we investigated the regulatory effects between SMN expression and miR-9a, a downstream noncoding small RNA. Using an inducible SMN short hairpin RNA interference (shRNAi) system in NSC 34 and human skin fibroblast cells, cellular miR-9 levels and SMN protein repression were time-dependently upregulated. Conversely, cellular miR-9 levels decreased when HeLa cells were transfected with SMN protein fused with green fluorescent protein. In SMA-like mice spinal cords and human primary skin fibroblasts isolated from patients with different degrees of SMA, human SMN exhibited a disease severity-dependent decrease, whereas cellular miR-9 levels increased. These results clearly suggested that cellular SMN proteins regulated miR-9 expression and that miR-9 expression was related to SMA severity. Thus, miR-9 may be a marker for SMA prognosis.