Cefepime MIC as a predictor of the extended-spectrum beta-lactamase type in Klebsiella pneumoniae, Taiwan

To guide selection of carbapenems or fourth-generation cephalosporins as therapy, 110 Klebsiella pneumoniae isolates with extended-spectrum beta-lactamases from Taiwan were characterized by phenotypic (MICs), molecular, and chemical methods. MIC patterns of ceftazidime and cefepime clearly differentiate strains treatable by cefepime and those capable of efficiently hydrolyzing available cephalosporins (CTX-M series and SHV-types). Continued use of cefepime appears to be a treatment option in cases for which MIC results are available and interpreted by the criteria presented.     

台湾大学医学院百年史

台湾之有正规的医学教育始自日据时代初期,日本据台后首先在台北设立医院,两年后开办“台湾人医学讲习所”,是日本据台时期医学教育的雏型。1899年设立正式的医学教育机构－台湾总督府医学校,该校于1919年改称台湾总督府医学专门学校,1922年再改称台北医学专门学校,1936年北帝国大学设医学部,1945年太平洋战争结束台湾光复,台北帝大医学部改为台湾大学医学院,附属病院改为台湾大学医学院附设医院,杜聪明任首任院长,台大医学院是台湾光复当时唯一的医学教育机构,其后50余年间,台湾的医学教育有很大的改变和发展,到1990年台湾的医学院已增加到11年,光复前后台大医学院及附设医院的情况以及其医学教育蜕变的过程,可以反映出台大在医学教育,研究及医疗方面的成就。     

中国内地及港澳台地区药事管理研究动态介绍

为了解内地、台湾、香港和澳门药事管理研究动态，采用网络数据库检索的方法，对万方数据库、台湾博硕士论文数据库、香港各大学图书馆硕博论文数据库、澳门各大学图书馆硕博论文数据库中有关药事管理的研究文题进行分析。研究结果显示：内地与港澳台药事管理研究主题既有相同点，又各具特色；内地与港澳台药事管理研究方法差异较大；内地药事管理论文常常较宏观，而港澳台药事管理论文较微观。     

Identification of the spinocerebellar ataxia type 7 mutation in Taiwan: application of PCR-based Southern blot

Spinocerebellar ataxia (SCA) type 7 is an autosomal dominant disorder characterized by neural loss, mainly in the cerebellum and regions of the brainstem and particularly the inferior olivary complex. This neurodegeneration disease is associated with expansion of unstable CAG repeats within the 5'-translated region of the SCA7 gene, located on chromosome 3p. We conducted a local survey of the normal population and candidate patients for the analysis of the CAG repeats in the SCA7 gene. The distributions of the CAG repeat units of SCA7 gene in the normal population in Taiwan were established in this study by using the radioactive genomic polymerase chain reaction (PCR). The normal range of CAG repeats is from 6 to 17 repeats, with the more common being around 8-13 repeats. The range is narrower than that reported for other ethnic groups (7-35 CAGs). Meanwhile, by the use of a combination of PCR and Southern blot analysis, one SCA7 family was identified and is reported here. A marked instability of the CAG repeat number during transmission from father to son (41 vs. 100) was observed in the SCA7 family. Clinical anticipation is significant in this family including an infantile case, who was found to have nystagmus from the age of 1 month. To date, the SCA7 mutation has been detected in one of 73 families with autosomal dominant cerebellar ataxia phenotypes, which is about 1.4% of the ataxia families referred to us, compared to 1.4% SCA1, 9.6% SCA2, and 27.3% SCA3/Machado-Joseph disease in our collection. In addition, we demonstrate that the PCR-based Southern blot analysis, with the advantages of sensitivity of PCR and specificity of Southern blot, is a reliable diagnostic method for SCA7 mutation screening. The molecular analysis technique makes possible the quick and accurate diagnosis of SCA7 patients and in the future will hopefully be applied to prenatal screening for SCA7 families.     

Correlated risk factors for suicidal ideation in aboriginal Southern Taiwanese women of childbearing age

Suicide and non-accidental poisoning are two important causes of death of female aborigines in Taiwan. The purpose of this study was to estimate the prevalence of suicidal ideation and then to identify factors relating to this for female aborigines of childbearing age. Using stratified random sampling 212 female aborigines, aged between 20 and 49, were recruited into this study. Participants were interviewed at their homes by trained interviewers who used a structured questionnaire. The Suicidal Ideation Screening Questionnaire (SIS-Q) was used to help predict which participants would be more likely to have suicidal ideation. The prevalence rate of suicidal ideation within the previous 12 months was 20.3% (95% CI 14.9-25.7%). Significant related factors of suicidal ideation, which were analyzed by multiple logistic regression, revealed that women suffering depressive mood, living within a extended family, and perceiving poor health status were more likely to have suicidal ideation. Results generated from this study may be used, in primary care, for guidance as to how to prevent suicide. Outreach community programs incorporating a valid and sensitive screening instrument, such as the SIS-Q, should be implemented to help prevent suicides in aboriginal communities.     

Tuberculin reactivity in adults after 50 years of universal bacille Calmette-Guerin vaccination in Taiwan

We aimed to assess whether tuberculin reactivity in adults is affected by bacille Calmette-Guerin (BCG) vaccination after 50 years of universal BCG vaccination with 80-95% coverage. A community-based study on tuberculin reactivity in 619 participants was conducted in February 2000 in Keelung city, Taiwan. Information on BCG vaccination policies and annual risk of infection (ARI) in the underlying population was extracted from consecutive national prevalence surveys relating to the period 1952-1997. Compared with the expected ARI estimate, the standardized morbidity ratio of positive tuberculin response for vaccination in infancy was 2.2 (95% CI 0.3-15.5) for those aged <10 years. The corresponding figures for older age groups ranged from 3.6 (95% CI 2.2-5.9) for those aged 10-12 years to 0.7 (95% CI 0.5-0.9) for those aged 57-67 years. This suggests that the effect of BCG vaccination on positive tuberculin response in adults aged >30 years is probably negligible irrespective of age at vaccination or revaccination and that the tuberculin skin test can be used to diagnose TB in control programmes in countries with moderate or high incidence of TB.     

The Automated Classification of Medical Entities (ACME) system objectively assessed the appropriateness of underlying cause-of-death certification and assignment

BACKGROUND AND OBJECTIVES: To assess the feasibility of using the Automated Classification of Medical Entities (ACME) system to objectively define the appropriateness of tuberculosis (TB) related underlying cause of death (UCD) certification and the accuracy of UCD assignment. METHODS: All death certificates issued in 2002 in Taiwan in which TB was mentioned were extracted for analysis. Certification of the UCD was defined as inappropriate when ACME used Rule 1 or Rule 2 in assigning the UCD. The assignment of the UCD was defined as inaccurate when the UCD selected by coders was discordant with the UCD selected by ACME. RESULTS: Of the 2,129 death certificates mentioned TB, half (1,067 of 2,129) were inappropriately certified by physicians and 16.5% (351 of 2129) had an inaccurately assigned UCD by coders. The discrepancy rate in UCD assignment between coders and ACME increased when the number of diagnoses increased, TB was listed in Part II, and the certification of UCD was inappropriate. CONCLUSIONS: It is feasible to use the process information in ACME to objectively define the appropriateness of UCD certification and the accuracy of UCD assignment. Inappropriate certification of the UCD and TB being listed in Part II were the two most important factors associated incorrect interpretation of the World Health Organization Selection Rules by coders.     

Willingness to pay for low-lung-cancer-risk cigarettes in Taiwan

This study develops a conceptual framework based on the random utility model to estimate smokers' willingness to pay (WTP) for the hypothetical low-lung-cancer-risk cigarettes in Taiwan. Following the approach taken by Viscusi (J Polit Econ 1990; 98: 1253-1269), an individual's subjective risk perception on the probability of developing lung cancer from smoking cigarettes was measured and used in the estimation of demand for safer cigarettes. Other factors that may affect a smoker's purchase decision toward the hypothetically safer cigarettes are also identified. The average WTP for one pack of low-lung-cancer-risk cigarettes is estimated to be 44.15 NT dollars, which represents a 152% price increase over the average price of cigarettes currently sold in the market.     

Prevalent SLC26A4 mutations in patients with enlarged vestibular aqueduct and/or Mondini dysplasia: a unique spectrum of mutations in Taiwan, including a frequent founder mutation

OBJECTIVES/HYPOTHESIS: The purpose of the study is to elucidate the mutation spectrum of SLC26A4 among patients with enlarged vestibular aqueduct and/or Mondini dysplasia in Taiwan and to explore the origin of the most common mutation, IVS7-2A>G. The correlation between the genotypes and the phenotypes is also investigated, with special emphasis placed on comparison between the genotypes and hearing levels. STUDY DESIGN: A 3-year prospective clinical genetic study at a tertiary care university hospital. METHOD: Mutations on SLC26A4 were screened in 38 families that fulfilled the criteria of enrollment, and single nucleotide polymorphisms (SNPs) in the vicinity of IVS7-2A>G were typed. The presence of goiter, radiologic findings, and audiologic results of the probands were then compared according to the genotypes. RESULTS: A total of eight mutations were detected in 33 families, and IVS7-2A>G accounted for 84% (48/57) of the mutated alleles. SNP analysis confirmed the founder effect of IVS7-2A>G. Meanwhile, no obvious correlation was observed between SLC26A4 genotypes and phenotypes. CONCLUSION: The present study disclosed the unique SLC26A4 mutation spectrum in Taiwan, confirmed that IVS7-2A>G arose from a common ancestor, and demonstrated the lack of correlation between genotypes and phenotypes. High prevalence of certain SLC26A4 mutations in East Asians, as revealed here and previously, might largely facilitate mutation screening and genetic counseling in these areas.     

Substance initiation sequences among Taiwanese adolescents using methamphetamine

The aim of this study was to examine substance initiation sequences in Taiwanese adolescent methamphetamine (MAMP) users. Three hundred adolescent MAMP users were questioned about their use of cigarettes, alcohol, areca quid, benzodiazepine, glue, marijuana, MAMP and heroin. The sequences of substance use before MAMP use were determined in every subject according to their age at substance initiation. The sequences of substance initiation were compared between genders and between early-onset and late-onset MAMP users. The results revealed that the adolescents had used cigarettes, alcohol and areca quid before MAMP, and very few (4%) adolescents had started using MAMP before using other substances. Female MAMP users were more likely to use MAMP as their first substance and were less likely to use areca quid than males. Male early-onset MAMP users were more likely to drink alcohol and chew areca quid before MAMP use than were late-onset users. This study found that the sequences of substance initiation were different between genders and between the early-onset and late-onset MAMP users. There are several findings that are different from those in Western studies on the sequence of substance initiation in the adolescent population.