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Chin CY, Chen CA, Fu CM, Hsu JY, Lin HC, Chiu SN, Chang YM, Lu CW, Chou HW, Huang SC, Chen YS, Wu MH, Wang JK, Lin MT. Risk Factors of Long-Term Sequelae After Transcatheter Closure of Perimembranous Ventricular Septal Defect in Young Children. Circ J 2024; 88:663-671. [PMID: 38325819 DOI: 10.1253/circj.cj-23-0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Complications arising from transcatheter closure of perimembranous ventricular septal defects (pmVSD) in children, such as residual shunts and aortic regurgitation (AR), have been observed. However, the associated risk factors remain unclear. This study identified risk factors linked with residual shunts and AR following transcatheter closure of pmVSD in children aged 2-12 years.Methods and Results: The medical records of 63 children with pmVSD and a pulmonary-to-systemic blood flow ratio <2.0 who underwent transcatheter closure between 2011 and 2018 were analyzed with a minimum 3-year follow-up. The success rate of transcatheter closure was 98.4%, with no emergency surgery, permanent high-degree atrioventricular block, or mortality. Defects ≥4.5 mm had significantly higher odds of persistent residual shunt (odds ratio [OR] 6.85; P=0.03). The use of an oversize device (≥1.5 mm) showed a trend towards reducing residual shunts (OR 0.23; P=0.06). Age <4 years (OR 27.38; 95% confidence interval [CI] 2.33-321.68) and perimembranous outlet-type VSD (OR 11.94, 95% CI 1.10-129.81) were independent risk factors for AR progression after closure. CONCLUSIONS Careful attention is crucial for pmVSDs ≥4.5 mm to prevent persistent residual shunts in transcatheter closure. Assessing AR risk, particularly in children aged <4 years, is essential while considering the benefits of pmVSD closure.
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Affiliation(s)
- Chia-Yi Chin
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Jui-Yu Hsu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Hsin-Chia Lin
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Ya-Mei Chang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Heng-Wen Chou
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Shu-Chien Huang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University
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Yang MC, Wu KL, Huang CN, Liu YC, Chien YH, Fu CM, Lim HK, Chin CY, Wu JR, Liu HM, Sun LC, Lee CY, Su YH, Wang YF, Lin MT. Kawasaki disease in children with Bacillus Calmette-Guérin scar reactivity: Focus on coronary outcomes. J Formos Med Assoc 2023; 122:1001-1007. [PMID: 37142476 DOI: 10.1016/j.jfma.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/19/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND /Purpose: Reactivity at the Bacillus Calmette-Guérin (BCG) scar is a pathognomonic feature of Kawasaki disease (KD). However, its value in predicting KD outcomes has not been emphasized. This study explored the clinical significance of BCG scar redness with respect to coronary artery outcomes. METHODS This retrospective study collected data on children with KD from 13 hospitals in Taiwan during 2019-2021. Children with KD were categorized into four groups based on the KD type and BCG scar reactivity. Risk factors of coronary artery abnormalities (CAA) were analyzed in all groups. RESULTS BCG scar redness occurred in 49% of 388 children with KD. BCG scar redness was associated with younger age, early intravenous immunoglobulin (IVIG) treatment, hypoalbuminemia, and CAA at the first echocardiogram (p < 0.01). BCG scar redness (RR 0.56) and pyuria (RR 2.61) were independent predictors of any CAA within 1 month (p < 0.05). Moreover, pyuria (RR 5.85, p < 0.05) in children with complete KD plus BCG scar redness was associated with CAA at 2-3 months; first IVIG resistance (RR 15.2) and neutrophil levels ≥80% (RR 8.37) in children with complete KD plus BCG scar non-redness were associated with CAA at 2-3 months (p < 0.05). We failed to detect any significant risk factors of CAA at 2-3 months in children with incomplete KD. CONCLUSION BCG scar reactivity contributes to diverse clinical features in KD. It can be effectively applied to determine the risk factors of any CAA within 1 month and CAA at 2-3 months.
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Affiliation(s)
- Ming-Chun Yang
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kun-Lang Wu
- Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Chi-Nan Huang
- Department of Pediatrics, Taipei City Hospital, Taipei, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Hing-Ka Lim
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Chia-Yi Chin
- Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hsin-Ming Liu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Li-Chen Sun
- Department of Pediatrics, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Chee-Yew Lee
- Department of Pediatrics, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Yi-Hsuan Su
- Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Fang Wang
- Department of Pediatrics, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.
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Lin TY, Lee YL, Wu KL, Yang MC, Huang CN, Fu CM, Huang LM, Chang LY, Lin MT, Liu HH. Cross-protective humoral immunity to coronaviruses from SARS coronavirus 2-naïve sera of children with Kawasaki disease. Clin Microbiol Infect 2023; 29:257.e1-257.e5. [PMID: 36191846 PMCID: PMC9525189 DOI: 10.1016/j.cmi.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES SARS coronavirus 2 (SARS-CoV-2)-associated multi-system inflammatory syndrome in children indicates that viruses can trigger a Kawasaki disease (KD)-like hyperinflammation. A plausible hypothesis was that coronavirus-specific 'holes' in humoral immunity could cause both diseases. METHODS To determine whether SARS-CoV-2-naïve patients with KD have inferior humoral immunity for the novel coronavirus, sera of children with KD and control children from year 2015 to 2021 were subjected to ELISA, microwestern, and neutralization assays to evaluate the capabilities in recognizing the receptor-binding domain of SARS-CoV-2, spotting spike proteins of three respiratory syndromic coronaviruses, and blocking SARS-CoV-2 from binding to angiotensin-converting enzyme 2 receptors in vitro, respectively. RESULTS 29 patients with KD before 2019, 74 patients with KD in 2019 or 2020, 54 non-febrile controls, and 24 febrile controls were included in the study. SARS-CoV-2 was recognized on ELISA for both patients with KD in 2016 and those with KD in 2020. Microwestern demonstrated cross-reactive IgG in an all-or-none manner towards three spike proteins of syndromic coronaviruses regardless of sample year or KD status. The ratio between the sera that recognized all spike proteins and those that recognized none (51 vs. 47) was significantly higher from patients with KD than from non-febrile controls (17 vs. 32; p 0.047) but not from febrile controls (13 vs. 11; p 0.85). Most positive sera (12 of 17 controls, 5 of 8 patients with KD before 2019, and 28 of 33 patients with KD in 2019 or 2020) offered protection comparable to low-titre sera from the WHO reference panel. DISCUSSION Humoral immunity of SARS-CoV-2-naïve children with KD was not inferior to that of controls in offering cross-protection against the novel coronavirus.
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Affiliation(s)
- Tzu-Yi Lin
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan
| | - Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Kun-Lang Wu
- Pediatric Cardiology, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Ming-Chun Yang
- Department of Paediatrics, E-DA Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chi-Nan Huang
- Department of Paediatrics, Heping-Fuyou Branch, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Min Fu
- Department of Paediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Li-Ming Huang
- Department of Paediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Paediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Paediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hong-Hsing Liu
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan Town, Miaoli County, Taiwan; Paediatrics, En Chu Kong Hospital, Sanxia District, New Taipei City, Taiwan.
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Lue HC, Wu MH, Wang JK, Lin MT, Lu CW, Chiu SN, Chen CA, Wu ET, Wang CC, Fu CM, Tseng WC, Chang WH, Lee MC. Normal ECG standards and percentile charts for infants, children and adolescents. Pediatr Neonatol 2022; 64:256-273. [PMID: 36464585 DOI: 10.1016/j.pedneo.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/19/2022] [Accepted: 07/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Normal ECG standards in newborns, infants, children and adolescents have been collected and published by many authors. Only those by Davignon et al., Rijinbeek et al. and our two studies covered all ages from birth to adolescence. The standards reflecting the growth and development of the heart in infants, children and adolescents remained to be studied and explored. METHODS We selected from our ECG database, after discussions and consultation, 15 key ECG parameters and analyzed for their age- and sex-specific mean, standard deviation and 2nd to 98th percentiles and their percentile charts were constructed. RESULTS The ranges and distributions of the normal ECG standards, means and 2nd to 98th percentiles of 15 key parameters were established. CONCLUSION A complete set of normal ECG standards of 15 key parameters from birth to adolescents is available for clinicians and researchers.
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Affiliation(s)
- Hung-Chi Lue
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan.
| | - Mei-Hwan Wu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - En-Ting Wu
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ching-Chia Wang
- Department of Cardiology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Wei-Chieh Tseng
- National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Wei-Hsuan Chang
- National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Meng-Chang Lee
- National Taiwan University Children's Hospital, Taipei, Taiwan
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Su PY, Tan BF, Fu CM, Chen CN, Chou AK, Kung PJ, Liao LC, Li MJ. Concurrence of imatinib-induced massive pleural/pericardial effusion and Campylobacter bacteremia in an adolescent with chronic myeloid leukemia. J Infect Chemother 2021; 28:103-107. [PMID: 34649758 DOI: 10.1016/j.jiac.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 01/22/2023]
Abstract
Imatinib is a crucial therapeutic strategy against chronic myeloid leukemia. Though superficial edema is a common adverse effect of imatinib, massive fluid retention is rarely reported. Here, we report the case of an adolescent who had tolerated imatinib for a long time, and then presented with massive pleural/pericardial effusion during an episode of Campylobacter jejuni bacteremia. A stepwise and comprehensive survey excluded all other plausible causes of disease. The Naranjo scale was used to assess the probability of an adverse effect of medication, and the score turned out to be 9, indicating severe fluid retention to be a definite reaction to imatinib. Drug discontinuation, antibiotic administration, and invasive procedures improved this condition. After this episode, the patient could tolerate imatinib again, illustrating the transient and reversible nature of this reaction. Since prolonged imatinib usage is crucial for chronic myeloid leukemia control, alertness to drug-related adverse effects is recommended, even if the subject has previously shown a good tolerance to the drug due to various physical conditions, especially physiological stressors, like infection or inflammation.
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Affiliation(s)
- Po-Yu Su
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Boon Fatt Tan
- Department of Pediatrics, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Chi-Nien Chen
- Department of Pediatrics, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - An-Kuo Chou
- Department of Pediatrics, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Po-Jung Kung
- Department of Pediatrics, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Ling-Chun Liao
- Department of Pharmacy, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Meng-Ju Li
- Department of Pediatrics, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan.
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6
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Wang PY, Tseng WC, Fu CM, Wu MH, Wang JK, Chen YS, Chou NK, Wang SS, Chiu SN, Lin MT, Lu CW, Chen CA. Long-Term Outcomes and Prognosticators of Pediatric Primary Dilated Cardiomyopathy in an Asian Cohort. Front Pediatr 2021; 9:771283. [PMID: 34796157 PMCID: PMC8593174 DOI: 10.3389/fped.2021.771283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Dilated cardiomyopathy (DCM) is the most common childhood cardiomyopathy. The epidemiological profiles and prognosticators of clinical outcomes in Asian populations are not well elucidated. Methods: Data of 104 children aged <18 years with a diagnosis of primary DCM from January 1990 to December 2019 in our institutional database were retrospectively investigated. Relevant demographic, echocardiographic, and clinical variables were recorded for analysis. A P <0.05 was considered statistically significant. Results: The median age at diagnosis was 1.4 years (interquartile range = 0.3-9.1 years), and 52.9% were males. During a median follow-up duration of 4.8 years, 48 patients (46.2%) were placed on the transplantation waitlist, and 52.1% of them eventually received heart transplants. An exceptionally high overall waitlist mortality rate was noted (27.1%), which was even higher (43.5%) if the diagnostic age was <3 years. The 1-, 5-, and 10-year transplant-free were 61.1, 48.0, and 42.8%. Age at diagnosis >3 years and severe mitral regurgitation at initial diagnosis were independent risk factors for death or transplantation (hazard ratios = 2.93 and 3.31, respectively; for both, P <0.001). In total, 11 patients (10.6%) experienced ventricular function recovery after a median follow-up of 2.5 (interquartile range = 1.65-5) years. Younger age at diagnosis was associated a higher probability of ventricular function recovery. Conclusions: Despite donor shortage for heart transplantation and subsequently high waitlist mortality, our data from an Asian cohort indicated that transplant-free long-term survival was comparable with that noted in reports from Western populations. Although younger patients had exceptionally higher waitlist mortality, lower diagnostic age was associated with better long-term survival and higher likelihood of ventricular function recovery.
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Affiliation(s)
- Po-Yuan Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan.,Department of Pediatrics, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Kuan Chou
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shoei-Shen Wang
- Department of Cardiovascular Surgery, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
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Yang WC, Fu CM, Su BW, Ouyang CM, Yang KC. Child Growth Curves in High-Altitude Ladakh: Results from a Cohort Study. Int J Environ Res Public Health 2020; 17:ijerph17103652. [PMID: 32455978 PMCID: PMC7277569 DOI: 10.3390/ijerph17103652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/21/2022]
Abstract
High prevalence of child underweight and stunting in high-altitude areas has often been reported. However, most previous studies on this topic were cross-sectional. Another critical concern is that using the World Health Organization (WHO) Child Growth Standards to evaluate child growth in high-altitude areas may lead to overestimations of underweight and stunting. Our study aimed to evaluate the long-term growth pattern of children (3 to 18 years) above the altitude of 3500 m in Ladakh, India. The participants’ body weight (BW), body height (BH), and body mass index (BMI) were measured annually according to the WHO Child Growth Standards for children under 5 years old and the WHO reference data for children aged 5 to 19 years. The generalized estimating equation (GEE) was used to estimate the means and z-scores of BW, BH, and BMI at different ages. A total of 401 children were enrolled from 2012 to 2018. Their mean z-scores of BW, BH, and BMI were −1.47, −1.44, and −0.85 in 2012 and increased to −0.74, −0.92, and −0.63 in 2018. This population’s specific growth curve was also depicted, which generally fell below the 85th percentile of the WHO standards. This is the first cohort study about long-term child growth patterns in a high-altitude area. The detailed underlying mechanisms of our findings need future research on more representative data of high-altitude populations.
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Affiliation(s)
- Wen-Chien Yang
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 30059, Taiwan; (W.-C.Y.); (C.-M.F.)
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 30059, Taiwan; (W.-C.Y.); (C.-M.F.)
| | - Bo-Wei Su
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan;
| | - Chung-Mei Ouyang
- Department of Dietetics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 30059, Taiwan;
| | - Kuen-Cheh Yang
- Department of Family Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei 108206, Taiwan
- Correspondence: ; Tel.: +886-928-778-355
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Chiang JY, Fu CM, Lin YC, Ku BW, Hsu SU, Wu CK, Lin LY, Lin JL, Chiang FT, Juang JM. P1880Entropy-based algorithm for atrial fibrillation detection using photoplethysomgraphic signal recorded by a smart watch. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most common arrhythmia, and its paroxysmal and short duration nature makes its detection challenging. The most important limitation of current smartwatches is that patients need to touch to the sensor of the watch to record signals when patients feel discomfort. We developed a wearable smart watch and evaluated its accuracy to differentiate AF from sinus rhythm, which can continuously detecting heart rhythm without hand touching the device.
Methods and results
A wearable smart watch with PPG sensor and electrocardiogram (ECG) recording function was used for signal acquisition. A total 399 patients with a mean age of 67 years old were enrolled in the study, of whom 237 (81.5%) were male, and 101 have been diagnosed with AF. Pulse wave extracted from the green light spectrum of the signal and ECG were recorded for about 10 minutes for each patient. Pulse-to-pulse intervals (PPI) were automatically identified. All ECG signals were verified by two cardiologists. The correlation between R-to-R interval on ECG and PPI were excellent, with a correlation coefficient R >0.99 (p<0.05). An entropy-based algorithm which combined Shannon entropy of successive difference of PPI and sample entropy of PPI was used to discriminate between AF and sinus rhythm. This method had high sensitivity and specificity (96% and 98%, respectively), the area under receiver operating characteristic curve reached 0.98.
Conclusions
We developed an entropy-based algorithm for AF detection with PPG signal recorded by a wearable smart watch. This algorithm discriminates AF from sinus rhythm accurately. This advance in technology overcomes an important clinical obstacle and can increase the AF detection rate tremendously.
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Affiliation(s)
- J Y Chiang
- National Taiwan University Hospital, Internal medicine, Taipei, Taiwan
| | - C M Fu
- MediaTek Inc, Taipei, Taiwan
| | - Y C Lin
- MediaTek Inc, Taipei, Taiwan
| | - B W Ku
- MediaTek Inc, Taipei, Taiwan
| | - S U Hsu
- MediaTek Inc, Taipei, Taiwan
| | - C K Wu
- MediaTek Inc, Taipei, Taiwan
| | - L Y Lin
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan
| | - J L Lin
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan
| | - F T Chiang
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan
| | - J M Juang
- National Taiwan University Hospital, Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan
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9
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Kuo YT, Luo CM, Li MJ, Fu CM. Pulmonary embolism and deep vein thrombosis in a child: Successfully treated with catheter-directed thrombolysis. J Formos Med Assoc 2019; 119:660-661. [PMID: 31405711 DOI: 10.1016/j.jfma.2019.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/30/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yi-Ting Kuo
- Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Chien-Ming Luo
- Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Meng-Ju Li
- Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.
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10
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Li MJ, Chang HH, Yang YL, Lu MY, Shao PL, Fu CM, Chou AK, Liu YL, Lin KH, Huang LM, Lin DT, Jou ST. Infectious complications in children with acute lymphoblastic leukemia treated with the Taiwan Pediatric Oncology Group protocol: A 16-year tertiary single-institution experience. Pediatr Blood Cancer 2017; 64. [PMID: 28371256 DOI: 10.1002/pbc.26535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/07/2017] [Accepted: 02/16/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infection is a major complication in pediatric patients with acute lymphoblastic leukemia during chemotherapy. In this study, the infection characteristics were determined and risk factors analyzed based on the Taiwan Pediatric Oncology Group (TPOG) acute lymphoblastic leukemia (ALL) protocol. PROCEDURE We retrospectively reviewed fever events during chemotherapy in 252 patients treated during two consecutive clinical trials at a single institution between 1997 and 2012. Patients were classified as standard, high, and very high risk by treatment regimen according to the TPOG definitions. We analyzed the characteristics and risk factors for infection. RESULTS Fever occurred in 219 patients (86.9%) with a mean of 2.74 episodes per person. The fever events comprised 64% febrile neutropenia, 39% clinically documented infections, and 44% microbiologically documented infections. The microbiologically documented infections were mostly noted during the induction phase and increased in very high risk patients (89 vs. 24% and 46% in standard-risk and high-risk patients, respectively). Younger age and higher risk (high-risk and very high risk groups) were risk factors for fever and microbiologic and bloodstream infections. Female gender and obesity were additive risk factors for urinary tract infection (odds ratios = 3.52 and 3.24, P < 0.001 and P = 0.004, respectively). CONCLUSIONS Infections developed primarily during the induction phase, for which younger age and higher risk by treatment regimen were risk factors. Female gender and obesity were additive risk factors for urinary tract infection.
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Affiliation(s)
- Meng-Ju Li
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.,Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiu-Hao Chang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yung-Li Yang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Yao Lu
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Lan Shao
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - An-Kuo Chou
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yen-Lin Liu
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kai-Hsin Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Dong-Tsamn Lin
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shiann-Tarng Jou
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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11
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Lin BY, Genden K, Shen W, Wu PS, Yang WC, Hung HF, Fu CM, Yang KC. The prevalence of obesity and metabolic syndrome in Tibetan immigrants living in high altitude areas in Ladakh, India. Obes Res Clin Pract 2017; 12:365-371. [PMID: 28411022 DOI: 10.1016/j.orcp.2017.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/22/2017] [Accepted: 03/08/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the prevalence of obesity and related cardiovascular disease risk factors among Tibetan immigrants living in high altitude areas. RESEARCH METHODS & PROCEDURES A total of 149 Tibetan immigrants aged 20 years and over were recruited in 2016 in Ladakh, India. Anthropometric indices and biochemical factors were measured. Using the provided Asia-Pacific criteria from the World Health Organization, overweight and obese status were determined. Metabolic syndrome (MetS) was defined according to the American Heart Association. RESULTS In general, men were older, taller, and had a greater amount of fasting glucose, and uric acid when compared to women. The prevalence of overweight, general obesity, and central obesity was 23.4, 42.6, and 42.6% in men and 7.8, 64.7, and 69.6% in women, respectively. The prevalence of MetS was 10.6% in men and 33.3% in women, respectively. In older subjects, the prevalence of obesity and MetS was found to be greater. In both genders, the prevalence of hypertension, central obesity, and MetS was significantly different among these body mass index (BMI) groups. Compared to the non-central obesity group, the central obesity group has higher weight, BMI, body fat, hip circumference, systolic and diastolic BP, and prevalence of hypertension. No relationship was found between the prevalence of diabetes and fasting glucose and BMI groups or central obesity groups in both genders. CONCLUSIONS Among this group of Tibetan immigrants living in high altitude areas, women have a higher prevalence of obesity and MetS than men. No relationship was found between diabetes and obesity.
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Affiliation(s)
| | - Karma Genden
- Tibetan Primary Health Care Center, Choglamsar, Leh, Ladakh, India
| | - Wei Shen
- Obesity Research Center, Department of Medicine & The Institute of Human Nutrition, Columbia University, New York, United States
| | - Po-Shu Wu
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chien Yang
- Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hui-Fang Hung
- Department of Community and Family Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Min Fu
- Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan
| | - Kuen-Cheh Yang
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
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12
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Fu CM, Wang JK, Lu CW, Chiu SN, Lin MT, Chen CA, Chang CI, Chen YS, Chiu IS, Wu MH. Total anomalous pulmonary venous connection: 15 years' experience of a tertiary care center in Taiwan. Pediatr Neonatol 2012; 53:164-70. [PMID: 22770104 DOI: 10.1016/j.pedneo.2012.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/16/2011] [Accepted: 06/27/2011] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease in which the connection between the pulmonary vein (PV) and left atrium needs to be surgically created. This study investigated the spectrum and outcome of a Taiwanese cohort. METHODS Isolated TAPVC cases were identified from our institutional database between 1995 and 2009. We reviewed the medical chart and conducted telephone interviews with those lost to follow-up. RESULTS There were 78 patients (52% male). The anomalous drainage sites were mainly supracardiac type (42.3%) and cardiac type (39.8%). Before operation, PV stenosis was found in 100% of infracardiac type, and in 69.7% of supracardiac type. Among the 75 patients undergoing operation, the surgical mortality was 9% (7/75). Perioperative arrhythmias (mainly of atrial origin) occurred in 35% of the patients. Of the 68 patients who survived the first operation, 28 (41%) developed pulmonary vein restenosis. Half of them progressed to severe PV stenosis, which required reintervention or resulted in mortality. Preoperative PV stenosis was the most significant predictor for postoperative PV restenosis and PV re-intervention. For the cohort, the 1-year and 5-year survivals were 78.9% and 74.2%, respectively, and the predictor for survival was again preoperative PV stenosis. CONCLUSION The surgical mortality of isolated TAPVC is now low. Preoperative PV stenosis not only increased the risk of late PV restenosis and its reintervention, but also the overall mortality. The spectrum of PV drainage, per se, was not associated with worse outcome. PV restenosis remained the most important issue after correction of TAPVC.
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Affiliation(s)
- Chun-Min Fu
- Department of Pediatrics, Hsichu General Hospital, No. 25, Lane 442, Section 1, Jingguo Road, Hsinchu, Taiwan
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13
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Lien TH, Fu CM, Hsu CJ, Lu L, Peng SSF, Chang LY. Recurrent bacterial meningitis associated with Mondini dysplasia. Pediatr Neonatol 2011; 52:294-6. [PMID: 22036227 DOI: 10.1016/j.pedneo.2011.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/05/2010] [Accepted: 12/03/2010] [Indexed: 10/17/2022] Open
Abstract
We reported two cases of recurrent meningitis and both of them had Mondini dysplasia, which provides a link between the brain and inner ear and is associated with cerebrospinal fluid, otorrhea/rhinorrhea, hearing impairment, and recurrent meningitis. Patients who have hearing impairment and recurrent meningitis should be evaluated for the possibility of this congenital dysplasia, and early diagnosis and prompt surgical intervention may prevent further episodes.
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Affiliation(s)
- Tien-Hau Lien
- Division of Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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14
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Tsai HE, Huang SC, Chen SJ, Fu CM, Chiu IS. Left Pulmonary Artery Coarctoplasty by Using the Right Pulmonary Artery Flap Near the Arterial Duct. Ann Thorac Surg 2011; 92:1135-7. [DOI: 10.1016/j.athoracsur.2011.03.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/07/2011] [Accepted: 03/17/2011] [Indexed: 11/28/2022]
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15
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Li P, Li SP, Lao SC, Fu CM, Kan KKW, Wang YT. Optimization of pressurized liquid extraction for Z-ligustilide, Z-butylidenephthalide and ferulic acid in Angelica sinensis. J Pharm Biomed Anal 2006; 40:1073-9. [PMID: 16242882 DOI: 10.1016/j.jpba.2005.08.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 08/25/2005] [Accepted: 08/31/2005] [Indexed: 11/27/2022]
Abstract
Pressurized liquid extraction, one of the most promising and recent sample preparation techniques, offers the advantages of reducing solvent consumption and allowing for automated sample handling. It is being exploited in diverse areas because of its distinct advantages. However, because the extraction is performed at elevated temperatures using PLE, thermal degradation could be a concern. Z-ligustilide, one of the biologically active components in Angelica sinensis, is an unstable compound, which decomposes rapidly at high temperature. In this study, we carried out a comparative study to evaluate PLE as a possible alternative to current extraction methods like Soxhlet and sonication for simultaneous extraction of Z-ligustilide, Z-butylidenephthalide and ferulic acid in A. sinensis. The operating parameters for PLE including extraction solvent, particle size, pressure, temperature, static extraction time, flush volume and numbers of extraction were optimized by using univariate approach coupled with central composite design (CCD) in order to obtain the highest extraction efficiency. Determination of Z-ligustilide, Z-butylidenephthalide and ferulic acid were carried out by means of high performance liquid chromatography with diode-array detector. The results showed that PLE was a simple, high efficient and automated method with lower solvent consumption compared to conventional extraction methods such as Soxhlet and sonication. PLE could be used for simultaneous extraction of Z-ligustilide, Z-butylidenephthalide and ferulic acid in A. sinensis.
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Affiliation(s)
- P Li
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau, China
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16
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Huang XR, Zhang YS, Fu CM, Liu WN, Zhang ZH, Song WS, Huang J, Wang SX. [Determination of naoning pian by multi-wavelength linear regression method]. Guang Pu Xue Yu Guang Pu Fen Xi 2001; 21:840-842. [PMID: 12958910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Assay of naoning pian was reported by multi-wavelength linear regression method in this paper. The program was edited by BASIC. The recoveries and RSD of pyramidon and caffeine were 98.03%-100.9%, 1.0% and 97.77%-99.39%, 0.61%, respectively. This method could be used for the determination of two components in naoning pian without separation. The method was simple, rapid, and results were satisfactory.
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Affiliation(s)
- X R Huang
- College of Pharmacy, Hebei Medical University, Shijiazhuang 050017, China
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17
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Clark K, Fu CM, Burnett C. Accuracy of birth certificate data regarding the amount, timing, and adequacy of prenatal care using prenatal clinic medical records as referents. Am J Epidemiol 1997; 145:68-71. [PMID: 8982024 DOI: 10.1093/oxfordjournals.aje.a009033] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This study compared birth certificate data on the amount, timing, and adequacy of prenatal care with the same data abstracted from the prenatal clinic records of 2,032 women who attended a health department prenatal clinic in northeast Georgia from 1980 to 1988. Overall accuracy was poor. Only 14.3% (n = 291) of the records completely agreed on the total number of visits, while approximately 36% (n = 738) and 53% (n = 1,081) agreed within one visit and two visits, respectively. Complete agreement for month and trimester prenatal care began was 31.1% (n = 632) and 50.6% (n = 1,202), respectively. Because of the small geographic region included in the current study, the generalizability of these findings to other populations may be limited.
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Affiliation(s)
- K Clark
- College of Nursing, University of Iowa, Iowa City 52242-1121, USA
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Abstract
A proportionate mortality study of a cohort of golf course superintendents was conducted using death certificates for 686 deceased members of the Golf Course Superintendents Association of America who died from 1970 to 1992. White males were included in the study population from all 50 states. The study objective was to compare mortality from this cohort to the general U.S. white male population. The proportionate mortality ratio (PMR) for all types of cancer was 136 (CI: 121, 152). Significant excess mortality from smoking-related diseases was observed. The PMR for arteriosclerotic heart disease was 140, which was significantly elevated (CI: 127, 155). In addition, the PMR for all respiratory diseases was 176 (CI: 135,230), while the PMR for emphysema was 186 (CI: 101,342). The PMR for lung cancer was 117 (CI: 93, 148). Mortality for four cancer types--brain, lymphoma (non-Hodgkin's lymphoma, NHL), prostate, and large intestine--occurred at elevated levels within this cohort: brain cancer PMR = 234 (CI: 121,454), non-Hodgkin's lymphoma (NHL) PMR = 237 (CI: 137,410), prostate cancer PMR = 293 (CI: 187,460), and large intestine cancer PMR = 175 (CI: 125,245). The PMR for diseases of the nervous system was 202 (CI: 123,333). A similar pattern of elevated NHL, brain, and prostate cancer mortality along with excess deaths from diseases of the nervous system has been noted among other occupational cohorts exposed to pesticides.
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Affiliation(s)
- B C Kross
- Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City 52242, USA
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Fu CM, Zhang BD, Bo CY. [Care of hypertension of pregnancy syndrome during parturition]. Zhonghua Hu Li Za Zhi 1995; 30:716-8. [PMID: 8716650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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