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Hwang A.-W.,Chang Gung University | Liao H.-F.,The School and Graduate Institute of Physical Therapy | Chen P.-C.,Institute of Occupational Medicine and Industrial Hygiene | Hsieh W.-S.,National Taiwan University Hospital | And 3 more authors.
Journal of the Formosan Medical Association | Year: 2014

Background/Purpose: Previous cohort studies for the general pediatric population had a limited focus on either environmental or biological influences, or a specific theoretical framework. The child's development, however, is a composite of physical, mental, social, environmental, and personal factors. The framework of the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) provides a comprehensive model for investigating the influential factors of child development within a biopsychosocial perspective. Methods: A birth cohort study followed up 122 child-parent dyads at birth and when the children were 4 months, 6 months, and 2.5 years old. Structural equation modeling was conducted based on the concept and the definitions of ICF-CY. Results: The path coefficients linking exposures and outcome variables were significant except for the paths from birth weight to general development of infants and toddlers. Home environment explained 59% of variance of infant developmental outcomes. Conclusion: The proposed model based on ICF-CY showed acceptable fit to the data and provides support for the importance of the home environment on general development of infants and toddlers. © 2012.


Wang Y.,U.S. National Institutes of Health | Rogan W.J.,U.S. National Institutes of Health | Chen P.-C.,Institute of Occupational Medicine and Industrial Hygiene | Chen P.-C.,National Taiwan University | And 8 more authors.
Environmental Health Perspectives | Year: 2014

Background: Perfluoroalkyl substances (PFASs) are synthetic compounds that are widely used in industry and are often detectable in humans. In pregnant rats and their pups, PFASs can interfere with thyroid hormone homeostasis. In humans, maternal thyroid hormones supply the fetus throughout pregnancy, and thyroid hormones play a critical role in fetal growth and neurodevelopment. Objectives: We investigated the association between maternal PFAS exposure and thyroid hormone status in pregnant women and neonates. Methods: In a study of environmental exposure and health in Taiwan, we measured serum concentrations of nine PFASs and four thyroid hormones for 285 pregnant women in their third trimester, and also measured cord serum thyroid hormones for 116 neonates. Associations between maternal PFASs and maternal and cord thyroid hormones were examined in multiple linear regression models. Results: Perfluorohexanesulfonic acid concentrations were positively associated with maternal thyroid-stimulating hormone (TSH) levels. Pregnant women with higher levels of perfluorononanoic acid (PFNA), perfluoroundecanoic acid (PFUnDA), and perfluorododecanoic acid (PFDoDA) had lower free thyroxine (T4) and total T4 levels. For example, we estimated that maternal free T4 levels decreased 0.019 ng/dL (95% CI: -0.028, -0.009) with each nanogram per milliliter increase in maternal PFNA. Finally, maternal PFNA, PFUnDA, and PFDoDA levels were associated with lower cord total triiodothyronine (T3) and total T4 levels, and maternal perfluorodecanoic acid (PFDeA) was associated with lower cord total T3. Conclusions: Our results suggest that exposure to some PFASs during pregnancy may interfere with thyroid hormone homeostasis in pregnant women and fetuses.


Chen C.-H.,National Taiwan University Hospital | Chen C.-H.,Institute of Occupational Medicine and Industrial Hygiene | Chao H.J.,Taipei Medical University | Shen W.-C.,National Taiwan University | And 5 more authors.
Aerobiologia | Year: 2015

The prevalence of asthma in Taiwan is one of the highest in Asia. Mold exposures have been linked to the development and exacerbation of asthma. A pilot study of mold populations in homes in Taipei, Taiwan, was conducted in the spring of 2014. Dust and air samples were collected from five homes with an asthmatic child and five from control homes. A combined, settled-dust sample was collected in the living room and bedroom in each home using a Swiffer™ cloth. The dust (5 mg) was analyzed for 36 molds using a DNA-based analysis, mold-specific quantitative PCR, and mold contamination was estimated using the Environmental Relative Moldiness Index (ERMI) metric. The ERMI values were significantly (p = 0.03) greater in the homes of asthmatic children compared to the control homes, average 26.2 versus 17.4, respectively. Aspergillusochraceus was found in significantly greater numbers in homes of asthmatic children compared to control homes. Air samples were collected in each home for 2 min (total 63 l of air) using the Burkard portable air sampler for agar plates fitted with malt extract agar plates. The plates were incubated at 25 °C for 5 days, and the resulting mold colonies were enumerated. Significantly higher total numbers of molds were cultured from the air in homes of asthmatics compared to control homes. Although this is a pilot study, it suggests that asthmatic children in Taipei, Taiwan, live in homes with significantly greater exposures to molds. © 2014, Springer Science+Business Media Dordrecht.


Hung Y.-J.,National Taiwan University | Hung Y.-J.,Chung Hwa University of Medical Technology | Hwang Y.-H.,Institute of Occupational Medicine and Industrial Hygiene | Liou S.-H.,National Defense Medical Center | And 3 more authors.
Physical Therapy | Year: 2014

Background. Lumbar disk degeneration (LDD) has been related to heavy physical loading. However, the quantification of the exposure has been controversial, and the dose-response relationship with the LDD has not been established.Objective. The purpose of this study was to investigate the dose-response relationship between lifetime cumulative lifting load and LDD.Design. This was a cross-sectional study.Methods. Every participant received assessments with a questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disk dehydration, annulus tear, disk height narrowing, bulging, protrusion, extrusion, sequestration, degenerative and spondylolytic spondylolisthesis, foramina narrowing, and nerve root compression on each lumbar disk level. The compression load was predicted using a biomechanical software system.Results. A total of 553 participants were recruited in this study and categorized into tertiles by cumulative lifting load (ie, <4.0 ˟ 105, 4.0 ˟ 105 to 8.9 ˟ 106, and ≥8.9 ˟ 106 N h). The risk of LDD increased with cumulative lifting load. The best dose-response relationships were found at the L5–S1 disk level, in which high cumulative lifting load was associated with elevated odds ratios of 2.5 (95% confidence interval [95% CI]=1.5, 4.1) for dehydration and 4.1 (95% CI=1.9, 10.1) for disk height narrowing compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 2.1 (95% CI=1.3, 3.3) for bulging compared with low lifting load. The tests for trend were significant.Limitations. There is no “gold standard” assessment tool for measuring the lumbar compression load.Conclusions. The results suggest a dose-response relationship between cumulative lifting load and LDD. © 2014 A merican Physical Therapy Association.


Chen B.-Y.,National Taiwan University Hospital | Jasmine Chao H.,Taipei Medical University | Wu C.-F.,Institute of Occupational Medicine and Industrial Hygiene | Kim H.,Seoul National University | And 3 more authors.
Science of the Total Environment | Year: 2014

Background: In our previous longitudinal study, we found that exposure to current levels of ambient total fungal spores was related to a reduction of childhood lung function. However, the biological properties of various taxa of fungal spores varied greatly, as well as their health effects. In this study, we aimed to determine whether any specific fungal spores were responsible for observed changes in lung function. Methods: Measurement of lung function was conducted for 100 elementary and middle-school students on 5-10 occasions from October 2007 to November 2009 in New Taipei City, Taiwan. During the week of each lung function measurement, continuous daily concentrations of fungal spores were measured from Sunday to Saturday. The counts of fungal spores belonging to specific taxa were identified. A mixed-effect model with repeated measurements was used to analyze the association of lung function and exposure to each specific taxon of fungal spores. Forward stepwise regression was applied to determine which specific fungal spores were the most closely related to lung function changes. The non-linear relationship was examined using a generalized additive model. The piecewise linear regression was then applied to determine the threshold value. Results: A total of 824 measurements were obtained from 100 participants. Among all the species of fungal spores, only Cladosporium spores were found to be negatively associated with forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) one day later. This association was stronger than the one between the total spore counts and lung function. The threshold of exposure where lung function effect became observable was approximately 1500spores/m3. Conclusion: This study showed that ambient Cladosporium was most strongly associated with the observed lung function changes among schoolchildren. Replication of these preliminary findings in other geographic areas with different populations would be warranted. © 2014 Elsevier B.V.


Wu C.-F.,National Taiwan University | Wu C.-F.,Institute of Occupational Medicine and Industrial Hygiene | Li Y.-R.,National Taiwan University | Kuo I.-C.,National Taiwan University | And 3 more authors.
Science of the Total Environment | Year: 2012

Background: Few studies included information on components and sources when exploring the cardiovascular health effects from personal exposure to particulate matters (PM). We previously reported that exposure to PM between 1.0 and 2.5μm (PM2.5-1) was associated with increased cardio-ankle vascular index (CAVI, an arterial stiffness index), while exposure to PM smaller than 0.25μm (PM0.25) decreased the heart rate variability (HRV) indices. The purpose of this study was to investigate the association between PM elements and cardiovascular health effects and identify responsible sources. Methods: In a panel study of seventeen mail carriers, the subjects were followed for 5-6days while delivering mail outdoors. Personal filter samples of PM2.5-1 and PM0.25 were analyzed for their elemental concentrations. The source-specific exposures were further estimated by using absolute principal factor analysis. We analyzed the component- and source-specific health effects on HRV indices and CAVI using mixed models. Results: Several elements in PM2.5-1 (e.g., cadmium and strontium) were associated with the CAVI. Subsequent analyses showed that an interquartile range increase in exposure to PM from regional sources was significantly associated with a 3.28% increase in CAVI (95% confidence interval (CI), 1.47%-5.13%). This significant effect remained (3.35%, CI: 1.62%-5.11%) after controlling for the ozone exposures. For exposures to PM0.25, manganese, calcium, nickel, and chromium were associated with the CAVI and/or the HRV indices. Conclusions: Our study suggests that PM2.5-1 and PM0.25 components may be associated with different cardiovascular effects. Health risks from exposure to PM from sources other than vehicle exhaust should not be underappreciated. © 2012 Elsevier B.V..


PubMed | P.A. College, National Health Research Institute, Institute of Occupational Medicine and Industrial Hygiene, China Medical University at Taichung and Chung Hwa University of Medical Technology
Type: Journal Article | Journal: Physical therapy | Year: 2014

Lumbar disk degeneration (LDD) has been related to heavy physical loading. However, the quantification of the exposure has been controversial, and the dose-response relationship with the LDD has not been established.The purpose of this study was to investigate the dose-response relationship between lifetime cumulative lifting load and LDD.This was a cross-sectional study.Every participant received assessments with a questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disk dehydration, annulus tear, disk height narrowing, bulging, protrusion, extrusion, sequestration, degenerative and spondylolytic spondylolisthesis, foramina narrowing, and nerve root compression on each lumbar disk level. The compression load was predicted using a biomechanical software system.A total of 553 participants were recruited in this study and categorized into tertiles by cumulative lifting load (ie, <4.0 10(5), 4.0 10(5) to 8.9 10(6), and 8.9 10(6) Nh). The risk of LDD increased with cumulative lifting load. The best dose-response relationships were found at the L5-S1 disk level, in which high cumulative lifting load was associated with elevated odds ratios of 2.5 (95% confidence interval [95% CI]=1.5, 4.1) for dehydration and 4.1 (95% CI=1.9, 10.1) for disk height narrowing compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 2.1 (95% CI=1.3, 3.3) for bulging compared with low lifting load. The tests for trend were significant.There is no gold standard assessment tool for measuring the lumbar compression load.The results suggest a dose-response relationship between cumulative lifting load and LDD.


PubMed | Chang Gung University, National Taiwan University Hospital, The School and Graduate Institute of Physical Therapy, National Taiwan University and 2 more.
Type: Journal Article | Journal: Journal of the Formosan Medical Association = Taiwan yi zhi | Year: 2014

Previous cohort studies for the general pediatric population had a limited focus on either environmental or biological influences, or a specific theoretical framework. The childs development, however, is a composite of physical, mental, social, environmental, and personal factors. The framework of the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) provides a comprehensive model for investigating the influential factors of child development within a biopsychosocial perspective.A birth cohort study followed up 122 child-parent dyads at birth and when the children were 4 months, 6 months, and 2.5 years old. Structural equation modeling was conducted based on the concept and the definitions of ICF-CY.The path coefficients linking exposures and outcome variables were significant except for the paths from birth weight to general development of infants and toddlers. Home environment explained 59% of variance of infant developmental outcomes.The proposed model based on ICF-CY showed acceptable fit to the data and provides support for the importance of the home environment on general development of infants and toddlers.


Wu C.-F.,National Taiwan University | Wu C.-F.,Institute of Occupational Medicine and Industrial Hygiene | Kuo I.-C.,National Taiwan University | Su T.-C.,National Taiwan University | And 4 more authors.
American Journal of Epidemiology | Year: 2010

The effects on heart rate variability (HRV) and arterial stiffness from exposure to ambient particulate matter and ozone have not been studied simultaneously. The aim of this study was to analyze these effects with refined exposure estimates from personal measurements of ozone and size-resolved particulate matter mass concentrations. The authors recruited 17 mail carriers in a panel study in Taipei County, Taiwan, during February-March, 2007, and each subject was followed for 5-6 days. Personal ozone and size-fractionated particulate matter exposures were monitored during working hours while carriers delivered mail outdoors. Cardiovascular effects were evaluated with heart rate variability (HRV) indices and an arterial stiffness index, the cardio-ankle vascular index (CAVI). The authors used linear mixed models to examine the association between personal exposure data and the HRV index and CAVI. They found that an interquartile range increase in personal exposure to ozone and particulate matter of between 1.0 and 2.5 μm was associated with a 4.8% and 2.5% increase in CAVI, respectively, in the single-pollutant models. In contrast, the personal exposure data showed no significant effects on HRV. In 2-pollutant models, personal ozone exposure remained significantly associated with the CAVI measurements. The study results indicate that vascular function may be more sensitive to air pollutants than the autonomic balance. © 2010 The Author.


Tsai F.-J.,Taipei Medical University | Tseng E.,Thomas Jefferson University | Chan C.-C.,Institute of Occupational Medicine and Industrial Hygiene | Chan C.-C.,National Taiwan University | And 3 more authors.
Globalization and Health | Year: 2013

Background: This study aims to evaluate the length of time elapsed between reports of the same incidents related to avian flu and H1N1 outbreaks published by the WHO and ProMED-mail, the two major global health surveillance systems, before and after the amendment of the International Health Regulations in 2005 (IHR 2005) and to explore the association between country transparency and this timeliness gap.Methods: We recorded the initial release dates of each report related to avian flu or H1N1 listed on the WHO Disease Outbreak News site and the matching outbreak report from ProMED-mail, a non-governmental program for monitoring emerging diseases, from 2003 to the end of June 2009. The timeliness gap was calculated as the difference in days between the report release dates of the matching outbreaks in the WHO and ProMED-mail systems. Civil liberties scores were collected as indicators of the transparency of each country. The Human Development Index and data indicating the density of physicians and nurses were collected to reflect countries' development and health workforce statuses. Then, logistic regression was performed to determine the correlation between the timeliness gap and civil liberties, human development, and health workforce status, controlling for year.Results: The reporting timeliness gap for avian flu and H1N1 outbreaks significantly decreased after 2003. On average, reports were posted 4.09 (SD = 7.99) days earlier by ProMED-mail than by the WHO. Countries with partly free (OR = 5.77) and free civil liberties scores (OR = 10.57) had significantly higher likelihoods of longer timeliness gaps than non-free countries. Similarly, countries with very high human development status had significantly higher likelihoods of longer timeliness gaps than countries with middle or low human development status (OR = 5.30). However, no association between the timeliness gap and health workforce density was found.Conclusion: The study found that the adoption of IHR 2005, which contributed to countries' awareness of the importance of timely reporting, had a significant impact in improving the reporting timeliness gap. In addition, the greater the civil liberties in a country (e.g., importance of freedom of the media), the longer the timeliness gap. © 2013 Tsai et al.; licensee BioMed Central Ltd.

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