Maternal-reported behavioral and emotional problems in Taiwanese preschool children

There has been limited epidemiologic information concerning preschoolers’ behavioral and emotional problems in Eastern societies. This study was therefore aimed to investigate behavioral and emotional problems in a large sample of Taiwanese preschoolers using the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). The CBCL/1.5-5 was scored by mothers of 645 Taiwanese preschoolers aged 24-71 months. Psychometric features of the scale as well as the raw scores and prevalence rates of behavioral problems of Taiwanese preschoolers were compared with those of American counterparts. Several demographic variables with the Total Problems and syndromes scores were also examined. The CBCL/1.5-5 was found to have good to excellent levels of reliability (internal consistency, test-retest reliability and inter-parent agreement) and an acceptable model fit of seven-syndrome factor structure (root mean square error of approximation = 0.055) when used with Taiwanese preschoolers. The prevalence rate of Total Problems, Internalizing syndrome and Externalizing syndrome score in the clinical range was 25.1%, 11.2% and 25.4%, respectively. Cross-cultural comparisons showed that Taiwanese preschoolers had higher scores in six narrow-band syndromes (effect size d = 0.17-0.43, all p's < 0.005) and prevalence rates of four Internalizing-related syndromes and Sleep Problems than American sample (odds ratio = 2.4-4.9, all p's < 0.005). Analyses of behavioral correlates revealed associations of first birth order with higher Internalizing, Externalizing and Total Problems scores (all p's < 0.05). Furthermore, younger ages (24-47 months) and male gender were associated with higher Externalizing and Total Problems scores (all p's < 0.05). Our data have provided important epidemiologic information to assist in clinical assessment and management of preschoolers’ behavioral and emotional problems in an Eastern society.     

Preoperative Plasma Vascular Endothelial Growth Factor But Not Nitrite Is a Useful Complementary Tumor Marker in Patients With Colorectal Cancer

Purpose Vascular endothelial growth factor and nitric oxide are both related to tumor progression. This study was designed to measure preoperative plasma vascular endothelial growth factor and nitrite levels in patients with colorectal cancer to evaluate their clinical applications as tumor markers. Methods In total, 279 patients with primary colorectal cancer and 20 patients with hemorrhoids (as a control) were included in this study. Plasma vascular endothelial growth factor was measured by quantitative, solid-phase, enzyme-linked immunosorbent assay (R&D Systems), whereas nitrite was measured by a high-performance liquid chromatographic method. Results The vascular endothelial growth factor (mean, 220.6 pg/ml, P < 0.005) and nitrite (mean, 29.4 μM, P = 0.043) levels of patients with cancer were significantly higher than those of controls (mean vascular endothelial growth factor, 67 pg/ml; mean nitrite, 23 μM). Preoperative plasma vascular endothelial growth factor levels were positively correlated with tumor stage, T class, M class, and tumor size (Spearman correlation, P < 0.01), but were not associated with gender, N class, tumor location, histology type, or grade. There were no statistical differences in nitrite levels among different groups of patients with cancer. Higher vascular endothelial growth factor levels also were correlated with leukocytosis, elevated carcinoembryonic antigen, and a higher platelet count. The positive rates of vascular endothelial growth factor elevation (>148.6 pg/ml) compared with carcinoembryonic antigen elevation were 36.9 to 14.6 percent in Stage I, 60.9 to 33 percent in Stage II, 62.9 to 48.7 percent in Stage III, and 86 to 70.2 percent in Stage IV, respectively. The overall positive rate of vascular endothelial growth factor elevation also was higher than that of carcinoembryonic antigen elevation (63 percent for vascular endothelial growth factor vs. 42.5 percent for carcinoembryonic antigen, P = 0.016). More than one-half of the patients without carcinoembryonic antigen elevation still had elevated vascular endothelial growth factor levels. The combined assessment using vascular endothelial growth factor and carcinoembryonic antigen was superior to individual assessment using vascular endothelial growth factor or carcinoembryonic antigen. In node-negative tumor, the patients with vascular endothelial growth factor elevation had worse disease-free survival than those without vascular endothelial growth factor elevation (P = 0.0367). There was no association of vascular endothelial growth factor elevation with survival in patients with node-positive tumor. Conclusions Plasma vascular endothelial growth factor is a useful complementary tumor marker; however, synchronous measurement of white blood cells, platelets, and carcinoembryonic antigen is suggested in the clinical application of vascular endothelial growth factor to colorectal cancer. Supported by the National Science Council of the Republic of China, Taiwan (NSC89-2314-B-182A-168); No. 106, HoPing E. Road, Sec.2, Taipei 106, Taiwan (R.O.C.). Presented in part at the congress of the Asian Federation of Coloproctology, Seoul, Korea, November 27 to 28, 2003.     

Abnormal gastroesophageal flap valve is highly associated with gastroesophageal reflux disease among subjects undergoing routine endoscopy in Taiwan

OBJECTIVE: Gastroesophageal flap valve (GEFV) grade predicts severe gastroesophageal reflux disease in Caucasians, but its role in other populations is unclear. This study evaluated the significance of endoscopic grading of the GEFV in Taiwanese subjects. METHODS: Five hundred and six consecutive patients undergoing routine check-ups at the National Taiwan University Hospital were enrolled. Symptoms of upper gastrointestinal disease and endoscopic severity of esophageal mucosal injury were correlated to GEFV grades according to the Hill classification. RESULTS: The frequency of abnormal valves (Hill grades III or IV) was 27.3%. Of these, 42.7% had erosive esophagitis (EE). The majority of patients with EE were classified as Los Angeles grades A and B (79.7 and 16.9%, respectively). The prevalence of EE, hiatal hernia and, to a lesser degree, non-erosive reflux disease, increased with altered GEFV. Patients with abnormal valves were younger and more likely to be male, overweight, and to have atypical and extraesophageal symptoms. CONCLUSIONS: Taiwanese patients with abnormal GEFVs share similar characteristics and risk factors with the patients who have EE. Endoscopic grading of the GEFV is highly associated with GERD, and in particular EE, in subjects undergoing routine endoscopy.     

Early serum (1→3)‐β‐D‐glucan levels in patients with burn injury

Serum (1→3)‐β‐D‐glucan (BG) is increasingly used as diagnostic marker for invasive fungal infections. Exposure to gauze may lead to false‐positive BG assays. The role of BG is unclear in thermally injured patients who frequently require extensive gauze coverage; therefore, we prospectively evaluated BG levels in burn‐injured patients. Serum BG levels were measured in 18 burn patients immediately before application of the first dressing and 12 h after. Patients were stratified by extent of total body surface area (TBSA) requiring gauze coverage: <20%, 20–39%, 40–60% and >60%. BG levels were obtained from patients with non‐burn trauma as controls. BG results were positive (>80 pg ml^?1) in 9/18 (50%) patients at baseline and in 8/18 (44%) 12 h after application of the first dressing. BG levels were positive in 1/5 (20%) of patients with <20% TBSA requiring gauze and in 10/13 (77%) with ≥20% (P < 0.05). None of the control patients had positive BG at any time point and none of the patients had candidemia at baseline. Mean serum BG levels decreased (19.44 pg ml^?1) after gauze placement. False‐positive serum BG elevations are common in this patient population. Positivity correlates with extent of TBSA injured, but is not impacted by the gauze itself.     

Hepatitis B and C virus infection as risk factors for hepatocellular carcinoma in Chinese: A case-control study

To assess whether hepatitis B and C virus infection were risk factors for hepatocellular carcinoma (HCC), antibody to hepatitis C virus (anti-HCV), hepatitis B surface antigen and e antigen (HBsAg and HBeAg) were tested in 150 HCC patients. Another 150 case-control pairs matched individually by sex and age were also enrolled. Univariate analysis demonstrated that both the anti-HCV and the carrier status of HBsAg and HBeAg were significantly associated with HCC. Multi-variate analysis revealed that both anti-HCV and HBsAg were risk factors for HCC. The population-attributable risk was estimated as 14.2% for anti-HCV alone, 59.4% for HBsAg alone and 8.0% for both anti-HCV and HBsAg in Taiwan. In conclusion, both hepatitis B and C virus infection are independent risk factors for HCC in Chinese in southern Taiwan.     

Empowering: the experiences of exercise among heart transplantation patients in Taiwan

AIM: To explore the experiences of exercise among Taiwanese heart transplant patients on the basis of a grounded theory. BACKGROUND: Although studies conducted around the world have proven how important exercise is to heart transplant patients, little information was found about heart transplant patients' exercise experience. In addition, because of different cultural backgrounds, people in Taiwan do not care about 'regular exercise' as much as Americans and Europeans do. Therefore, it is very important to find ways so that they can value 'regular exercise.' METHODS: In-depth interviews were undertaken with a purposive sample of eight heart transplant patients. Data was analysed by repeated verification. RESULTS: Eight valid cases were separately and thoroughly interviewed while they were exercising at a sports medical centre. The results revealed that 'empowering the new heart' is the core reason for their exercise. During the exercise training process, every participant felt that his or her new heart was filled with power or energy. The 'hardness and endurance' in terms of feeling discomfort in the body was identified at the beginning of post-surgical exercise training. Throughout the process of empowerment, patients experienced the following five interactive behaviour categories: 'self-protection', 'sharing', 'being watched and cared for', 'being aware of the benefits', and 'strengthening the new heart'. CONCLUSIONS: Exercise can empower the new heart. After the exercise training, all patients felt that their new hearts were empowered with energy and vigour, and thus were willing to continue exercising. They even expanded their regimen to include folk therapies such as Tai Chi and breathing exercises.     

Management of protozoal diarrhoea in HIV disease

Summary Since the first reported case of HIV infection in 1981, many HIV-seropositive patients have died as a result of diarrhoea induced by opportunistic protozoal infections: pathogens that would normally cause only a transient illness in immunocompetent individuals. The introduction of highly active antiretroviral therapy (HAART) in 1996 has been associated with a significant decline in incidence and mortality arising from infections such as cryptosporidia and microsporidia. Previously, there were no chemotherapeutic agents known to be effective in eradicating these parasites, but since the availability of HAART, the memory of the emaciated terminally ill patient with advanced AIDS suffering from refractory diarrhoea will hopefully be a thing of the past. Significant advances in the knowledge of the pathogenesis of HIV disease, earlier detection and thus treatment of the virus, and availability of improved diagnostic techniques and HAART have transformed the way HIV-associated diarrhoea is managed. In this review, we look specifically at the management of protozoa-induced diarrhoea.