Clinical activity of Occupational Medicine in Taiwan

Yue Leon Guo 대한직업환경의학회 2009 대한직업환경의학회 학술대회 논문집 Vol.43 No.-

Mortality risk attributable to high and low ambient temperature: a multicountry observational study

Gasparrini, Antonio,Guo, Yuming,Hashizume, Masahiro,Lavigne, Eric,Zanobetti, Antonella,Schwartz, Joel,Tobias, Aurelio,Tong, Shilu,Rocklö,v, Joacim,Forsberg, Bertil,Leone, Michela,De Sario, Manuela Elsevier 2015 The Lancet Vol.386 No.9991

<P><B>Summary</B></P><P><B>Background</B></P><P>Although studies have provided estimates of premature deaths attributable to either heat or cold in selected countries, none has so far offered a systematic assessment across the whole temperature range in populations exposed to different climates. We aimed to quantify the total mortality burden attributable to non-optimum ambient temperature, and the relative contributions from heat and cold and from moderate and extreme temperatures.</P><P><B>Methods</B></P><P>We collected data for 384 locations in Australia, Brazil, Canada, China, Italy, Japan, South Korea, Spain, Sweden, Taiwan, Thailand, UK, and USA. We fitted a standard time-series Poisson model for each location, controlling for trends and day of the week. We estimated temperature–mortality associations with a distributed lag non-linear model with 21 days of lag, and then pooled them in a multivariate metaregression that included country indicators and temperature average and range. We calculated attributable deaths for heat and cold, defined as temperatures above and below the optimum temperature, which corresponded to the point of minimum mortality, and for moderate and extreme temperatures, defined using cutoffs at the 2·5th and 97·5th temperature percentiles.</P><P><B>Findings</B></P><P>We analysed 74 225 200 deaths in various periods between 1985 and 2012. In total, 7·71% (95% empirical CI 7·43–7·91) of mortality was attributable to non-optimum temperature in the selected countries within the study period, with substantial differences between countries, ranging from 3·37% (3·06 to 3·63) in Thailand to 11·00% (9·29 to 12·47) in China. The temperature percentile of minimum mortality varied from roughly the 60th percentile in tropical areas to about the 80–90th percentile in temperate regions. More temperature-attributable deaths were caused by cold (7·29%, 7·02–7·49) than by heat (0·42%, 0·39–0·44). Extreme cold and hot temperatures were responsible for 0·86% (0·84–0·87) of total mortality.</P><P><B>Interpretation</B></P><P>Most of the temperature-related mortality burden was attributable to the contribution of cold. The effect of days of extreme temperature was substantially less than that attributable to milder but non-optimum weather. This evidence has important implications for the planning of public-health interventions to minimise the health consequences of adverse temperatures, and for predictions of future effect in climate-change scenarios.</P><P><B>Funding</B></P><P>UK Medical Research Council.</P>

Pretherapy 18F-FDG PET/CT in Predicting Disease Relapse in Patients With Immunoglobulin G4-Related Disease: A Prospective Study

Cheng Mei-Fang,Guo Yue Leon,Yen Ruoh-Fang,Wu Yen-Wen,Wang Hsiu-Po 대한영상의학회 2023 Korean Journal of Radiology Vol.24 No.6

Objective: To investigate whether the levels of inflammation detected by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) can predict disease relapse in immunoglobulin G4-related disease (IgG4-RD) patients receiving standard induction steroid therapy. Materials and Methods: This prospective study analyzed pretherapy FDG PET/CT images from 48 patients (mean age, 63 ± 12.9 years; 45 males and 3 females) diagnosed with IgG4-RD between September 2008 and February 2018, who subsequently received standard induction steroid therapy as the first-line treatment. Multivariable Cox proportional hazards models were used to identify the potential prognostic factors associated with relapse-free survival (RFS). Results: The median follow-up time for the entire cohort was 1913 days (interquartile range [IQR], 803–2929 days). Relapse occurred in 81.3% (39/48) patients during the follow-up period. The median time to relapse was 210 days (IQR, 140–308 days) after completion of standardized induction steroid therapy. Among the 17 parameters analyzed, Cox proportional hazard analysis identified whole-body total lesion glycolysis (WTLG) > 600 on FDG-PET as an independent risk factor for disease relapse (median RFS, 175 vs. 308 days; adjusted hazard ratio, 2.196 [95% confidence interval: 1.080–4.374]; P = 0.030). Conclusion: WTLG on pretherapy FDG PET/CT was the only significant factor associated with RFS in IgG-RD patients receiving standard steroid induction therapy.

Mortality Related to Extreme Temperature for 15 Cities in Northeast Asia

Chung, Yeonseung,Lim, Youn-Hee,Honda, Yasushi,Guo, Yue-Liang Leon,Hashizume, Masahiro,Bell, Michelle L.,Chen, Bing-Yu,Kim, Ho Wolters Kluwer Health, Inc. All rights reserved. 2015 Epidemiology Vol.26 No.2

BACKGROUND:: Multisite time-series studies for temperature-related mortality have been conducted mainly in the United States and Europe, but are lacking in Asia. This multisite time-series study examined mortality related to extreme temperatures (both cold and hot) in Northeast Asia, focusing on 15 cities of 3 high-income countries. METHODS:: This study includes 3 cities in Taiwan for 1994–2007, 6 cities in Korea for 1992–2010, and 6 cities in Japan for 1972–2009. We used 2-stage Bayesian hierarchical Poisson semiparametric regression to model the nonlinear relationship between temperature and mortality, providing city-specific and country-wide estimates for cold and heat effects. Various exposure time frames, age groups, and causes of death were considered. RESULTS:: Cold effects had longer time lags (5–11 days) than heat effects, which were immediate (1–3 days). Cold effects were larger for cities in Taiwan, whereas heat effects were larger for cities in Korea and Japan. Patterns of increasing effects with age were observed in both cold and heat effects. Both cold and heat effects were larger for cardiorespiratory mortality than for other causes of death. Several city characteristics related to weather or air pollution were associated with both cold and heat effects. CONCLUSIONS:: Mortality increased with either cold or hot temperature in urban populations of high-income countries in Northeast Asia, with spatial variations of effects among cities and countries. Findings suggest that climate factors are major contributors to the spatial heterogeneity of effects in this region, although further research is merited to identify other factors as determinants of variability.

Temporal changes in mortality attributed to heat extremes for 57 cities in Northeast Asia

Lee, Whanhee,Choi, Hayon Michelle,Kim, Dahye,Honda, Yasushi,Guo, Yue-Liang Leon,Kim, Ho Elsevier 2018 Science of the Total Environment Vol.616 No.-

<P><B>Abstract</B></P> <P>Recent studies have reported that heat-related mortality decreased by adaptation during decades. However, since the frequency of extreme heat events is increasing, it is difficult to conclude with certainty that the heat mortality burden is decreasing. To examine temporal changes in mortality attributed to heat extremes in Northeast Asia, we collected temperature and mortality data covering the years 1972–2012 from 57 cities of 3 countries (Taiwan, Korea, and Japan) in Northeast Asia. Poisson regression curves were fitted to the data from each city. The temporal changes in heat-mortality association were estimated with a time-varying distributed lag non-linear model. Heat extremes were defined as temperatures greater than the 97.5th percentiles of city-specific average temperatures. Attributable deaths were calculated considering temporal variations in exposure and relative risk. The estimates were then pooled through meta-analysis. The results show that the mortality risk on extreme heat days declined during the study period in all countries. However, as summer temperatures in Japan have shown more heat extremes over time, the mortality risk attributed to heat increased during 2003–2012 (0.32%) compared with 1972–1981 (0.19%). Thus, to assess the total health burden due to heat extremes related to climate change, public health strategies should focus on the temporal variation in heat-mortality association as well as changes in the distribution of heat extremes overtime.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Heat-related mortality has declined for all three countries. </LI> <LI> In Japan, a positive shift of heat extremes was observed during study period. </LI> <LI> The attributable risk fraction (ARF) of heat extremes increased overtime in Japan. </LI> <LI> The ARF heat extremes temporally declined in Korea and Taiwan. </LI> <LI> We suggest that the ARF of heat extremes will not reduce in climate change. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

Longer-Term Impact of High and Low Temperature on Mortality: An International Study to Clarify Length of Mortality Displacement

Armstrong, Ben,Bell, Michelle L.,de Sousa Zanotti Stagliorio Coelho, Micheline,Leon Guo, Yue-Liang,Guo, Yuming,Goodman, Patrick,Hashizume, Masahiro,Honda, Yasushi,Kim, Ho,Lavigne, Eric,Michelozzi, Pao U.S. Dept. of Health, Education, and Welfare, Publ 2017 Environmental health perspectives Vol.125 No.10

<P><B>Background:</B></P><P>In many places, daily mortality has been shown to increase after days with particularly high or low temperatures, but such daily time-series studies cannot identify whether such increases reflect substantial life shortening or short-term displacement of deaths (harvesting).</P><P><B>Objectives:</B></P><P>To clarify this issue, we estimated the association between annual mortality and annual summaries of heat and cold in 278 locations from 12 countries.</P><P><B>Methods:</B></P><P>Indices of annual heat and cold were used as predictors in regressions of annual mortality in each location, allowing for trends over time and clustering of annual count anomalies by country and pooling estimates using meta-regression. We used two indices of annual heat and cold based on preliminary standard daily analyses: <I>a</I>) mean annual degrees above/below minimum mortality temperature (MMT), and <I>b</I>) estimated fractions of deaths attributed to heat and cold. The first index was simpler and matched previous related research; the second was added because it allowed the interpretation that coefficients equal to 0 and 1 are consistent with none (0) or all (1) of the deaths attributable in daily analyses being displaced by at least 1 y.</P><P><B>Results:</B></P><P>On average, regression coefficients of annual mortality on heat and cold mean degrees were 1.7% [95% confidence interval (CI): 0.3, 3.1] and 1.1% (95% CI: 0.6, 1.6) per degree, respectively, and daily attributable fractions were 0.8 (95% CI: 0.2, 1.3) and 1.1 (95% CI: 0.9, 1.4). The proximity of the latter coefficients to 1.0 provides evidence that most deaths found attributable to heat and cold in daily analyses were brought forward by at least 1 y. Estimates were broadly robust to alternative model assumptions.</P><P><B>Conclusions:</B></P><P>These results provide strong evidence that most deaths associated in daily analyses with heat and cold are displaced by at least 1 y. https://doi.org/10.1289/EHP1756</P>

Heat-related mortality risk model for climate change impact projection.

Honda, Yasushi,Kondo, Masahide,McGregor, Glenn,Kim, Ho,Guo, Yue-Leon,Hijioka, Yasuaki,Yoshikawa, Minoru,Oka, Kazutaka,Takano, Saneyuki,Hales, Simon,Kovats, R Sari Japanese Society for Hygiene 2014 Environmental health and preventive medicine.['97. Vol.19 No.1

<P>We previously developed a model for projection of heat-related mortality attributable to climate change. The objective of this paper is to improve the fit and precision of and examine the robustness of the model.</P>

Ozone and Daily Mortality Rate in 21 Cities of East Asia: How Does Season Modify the Association?

Chen, Renjie,Cai, Jing,Meng, Xia,Kim, Ho,Honda, Yasushi,Guo, Yue Leon,Samoli, Evangelia,Yang, Xin,Kan, Haidong Oxford University Press 2014 American Journal of Epidemiology Vol.180 No.7

<P>Previous studies in East Asia have revealed that the short-term associations between tropospheric ozone and daily mortality rate were strongest in winter, which is opposite to the findings in North America and Western Europe. Therefore, we investigated the season-varying association between ozone and daily mortality rate in 21 cities of East Asia from 1979 to 2010. Time-series Poisson regression models were used to analyze the association between ozone and daily nonaccidental mortality rate in each city, testing for different temperature lags. The best-fitting model was obtained after adjustment for temperature in the previous 2 weeks. Bayesian hierarchical models were applied to pool the city-specific estimates. An interquartile-range increase of the moving average concentrations of same-day and previous-day ozone was associated with an increase of 1.44% (95% posterior interval (PI): 1.08%, 1.80%) in daily total mortality rate after adjustment for temperature in the previous 2 weeks. The corresponding increases were 0.62% (95% PI: 0.08%, 1.16%) in winter, 1.46% (95% PI: 0.89%, 2.03%) in spring, 1.60% (95% PI: 1.03%, 2.17%) in summer, and 1.12% (95% PI: 0.73%, 1.51%) in fall. We found significant associations between short-term exposure to ozone and higher mortality rate in East Asia that varied considerably from season to season with a significant trough in winter.</P>

Air Pollution and Suicide in 10 Cities in Northeast Asia: A Time-Stratified Case-Crossover Analysis

Kim, Yoonhee,Ng, Chris Fook Sheng,Chung, Yeonseung,Kim, Ho,Honda, Yasushi,Guo, Yue Leon,Lim, Youn-Hee,Chen, Bing-Yu,Page, Lisa A.,Hashizume, Masahiro Environmental Health Perspectives 2018 Environmental health perspectives Vol.126 No.3

<P><B>Background:</B></P><P>There is growing evidence suggesting an association between air pollution and suicide. However, previous findings varied depending on the type of air pollutant and study location.</P><P><B>Objectives:</B></P><P>We examined the association between air pollutants and suicide in 10 large cities in South Korea, Japan, and Taiwan.</P><P><B>Methods:</B></P><P>We used a two-stage meta-analysis. First, we conducted a time-stratified case-crossover analysis to estimate the short-term association between nitrogen dioxide ([FORMULA OMISSION]), sulfur dioxide ([FORMULA OMISSION]), and particulate matter [aerodynamic diameter [FORMULA OMISSION] ([FORMULA OMISSION]), aerodynamic diameter [FORMULA OMISSION] ([FORMULA OMISSION]), and [FORMULA OMISSION]] and suicide, adjusted for weather factors, day-of-week, long-term time trends, and season. Then, we conducted a meta-analysis to combine the city-specific effect estimates for [FORMULA OMISSION], [FORMULA OMISSION], and [FORMULA OMISSION] across 10 cities and for [FORMULA OMISSION] and [FORMULA OMISSION] across 3 cities. We first fitted single-pollutant models, followed by two-pollutant models to examine the robustness of the associations.</P><P><B>Results:</B></P><P>Higher risk of suicide was associated with higher levels of [FORMULA OMISSION], [FORMULA OMISSION], [FORMULA OMISSION], and [FORMULA OMISSION] over multiple days. The combined relative risks (RRs) were 1.019 for [FORMULA OMISSION] (95% confidence interval [CI]: 0.999, 1.039), 1.020 for [FORMULA OMISSION] (95% CI: 1.005, 1.036), 1.016 for [FORMULA OMISSION] (95% CI: 1.004, 1.029), and 1.019 for [FORMULA OMISSION] (95% CI: 1.005, 1.033) per interquartile range (IQR) increase in the 0–1 d average level of each pollutant. We found no evidence of an association for [FORMULA OMISSION]. Some of the associations, particularly for [FORMULA OMISSION] and [FORMULA OMISSION], were attenuated after adjusting for a second pollutant.</P><P><B>Conclusions:</B></P><P>Our findings suggest that higher levels of air pollution may be associated with suicide, and further research is merited to understand the underlying mechanisms. https://doi.org/10.1289/EHP2223</P>

Aspergillus sensitization associated with current asthma in children: NHANES 2005-2006

Wen Hui-Ju,Wang Shu-Li,Li Ming-Chieh,Guo Yue Leon 한국역학회 2022 Epidemiology and Health Vol.44 No.-

OBJECTIVES: To investigate the association between allergen sensitization and current asthma in children from the National Health and Nutrition Examination Survey (NHANES) 2005-2006. METHODS: Children from the NHANES 2005-2006, aged 6 to 19 years, were included in this study. A structured questionnaire was used to assess asthma status, including without asthma, asthma in remission, and current asthma. Nineteen specific IgE (sIgE) levels were measured using the Pharmacia Diagnostics ImmunoCAP 1000 System (Kalamazoo, Michigan, USA). A machine-learning method was applied to select important sIgEs related to childhood asthma. Multivariate regression analysis was used to test this hypothesis. RESULTS: A total of 2,875 children were recruited. The prevalence of ever having asthma and current asthma was, 16.5% and 5.6%, respectively. Six specific IgE levels were found to contribute to asthma using bootstrap forest selection. After adjusting for child’s sex, age, and family income, children with the double of sIgE levels of Dermatophagoides farinae, dog, and Aspergillus were related to current asthma, as compared to children without asthma [odds ratio (95% confident interval)= 1.11 (1.04-1.19), 1.30 (1.16-1.46), and 1.54 (1.38-1.72), respectively]. CONCLUSIONS: Our findings suggested that allergen sensitization, especially to Aspergillus, is associated with current asthma in children. Strategies to reduce sensitization may help prevent and manage asthma.