Biomedical subjects

Mei-Chih Huang

Publications and source records attributed to Mei-Chih Huang.

10 recordsLinked to original sources

PubMed2006

Long-term cognitive and motor deficits after enterovirus 71 brainstem encephalitis in children.

OBJECTIVES: Several large outbreaks of enterovirus 71 infections have occurred in Taiwan during the past decade. Brainstem encephalitis was the most common neurologic complication. This study was designed to determine the long-term cognitive and motor outcomes of children with enterovirus 71 brainstem encephalitis. METHODS: We conducted a prospective follow-up study of children who met the case definition for enterovirus 71 brainstem encephalitis. Subjects were stratified into isolated brainstem encephalitis (stage II), autonomic nervous system dysregulation (stage IIIa), and pulmonary edema (stage IIIb). The subjects and their parents or guardians were interviewed using structured questionnaires and received comprehensive cognitive and neurologic examinations. Motor coordination, visual-motor skill, and intellectual ability were evaluated. RESULTS: Follow-up studies were conducted in 63 previously healthy children with enterovirus 71 brainstem encephalitis (49 stage II, 7 stage IIIa, and 7 stage IIIb). The mean time to follow-up was 2.8 +/- 1.0 years (range: 1.4-4.9 years). Boys outnumbered girls by 3 to 2. The mean age at diagnosis was 2.4 +/- 1.4 years (range: 0.3-7.1 years). The most common abnormal neurologic findings on admission were altered consciousness (47.6%), followed by abnormal activities of daily living (52.4%), cerebellar dysfunction (17.5%), and cranial nerve palsy (15.9%). At follow-up, 51 of 63 children had no detectable deficits. Among the remaining 12 children, 3 died during the follow-up. The remaining 9 children (14.3%) had residual deficits. Two of these with stage IIIb disease continued to have severe motor and respiratory failure. CONCLUSIONS: Residual defects were still present in a significant proportion of children with enterovirus 71 brainstem encephalitis at >2 years after their hospitalization. Children with stage II disease were most likely to have residual cerebellar defects. Those with stage IIIb disease continued to have severe respiratory and motor impairment. Long-term follow-up of this cohort is needed to determine the ultimate prognosis.

Brain Stem↗

PubMed2006

Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-associated brainstem encephalitis.

BACKGROUND: Several epidemics of enterovirus 71 (EV71) infections occurred in Taiwan since 1998. OBJECTIVES: We performed the study to determine the changes in cytokine profiles associated with administration of intravenous immunoglobulin (IVIG) in patients with EV71-associated brainstem encephalitis complicated by autonomic nervous system (ANS) dysfunction and pulmonary edema. STUDY DESIGN: Plasma cytokine concentrations (IL-1beta, IL-6, IL-8, IFN-gamma, TNF-alpha, IL-2, IL-4, IL-5, IL-10, and IL-13) were monitored on admission and within 12-24h after administration of IVIG in a cohort of children (n=22) with virologically confirmed EV71 infection, from March 2000 through April 2004. RESULT: Plasma levels of IFN-gamma, IL-6, IL-8, IL-10, and IL-13 levels significantly decreased in patients with pulmonary edema after administration of IVIG, P<0.05. Plasma levels of IL-6 and IL-8 were significantly decreased in patients with ANS dysregulation after administration of IVIG, P<0.05. Administration of IVIG was not associated with significant changes in plasma concentration of IL-1beta, IL-2, IL-4, IL-5 IL-10, IL-13 and TNF-alpha in patients with ANS dysregulation. CONCLUSIONS: These findings suggest that IVIG might be considered to have a therapeutic role in EV71-associated brainstem encephalitis. A clinical trial is needed to support this hypothesis.

Brain Stem↗

PubMed2006

Febrile convulsions: development and validation of a questionnaire to measure parental knowledge, attitudes, concerns and practices.

BACKGROUND: The best medicine for febrile convulsions (FCs) is not prescription medications but effective communication of related information to parents. Therefore, a quick assessment tool for obtaining information about parental responses to FCs is essential for educating parents, clinical practice and research. This paper describes the development and psychometric testing of a questionnaire on parental knowledge, attitudes, concerns and practices (KACP) toward FC. METHODS: Questionnaire items were created via literature review, interview, and expert consultation. Ten parents were interviewed to develop the questionnaire contents. Nine experts and seven parents were consulted to review the content and face validity of the questionnaire. Of the 326 parents of children with FC visiting 11 emergency departments in southern Taiwan, 216 parents completed the questionnaire, and 64 completed the questionnaire again 2 weeks later. Content validity, internal consistency, test-retest reliability, and item analysis were evaluated. RESULTS: Cronbach's alpha exceeded 0.72 for the knowledge, attitudes and concerns domains. The item-total correlations in the knowledge and concerns domains ranged from 0.40 to 0.73, but were lower in the attitudes domain (only 4 in 10 items were within 0.40-0.70). The intraclass correlation coefficients (ICC) for the test-retest reliability of the knowledge, attitudes and concerns domains were 0.65, 0.68 and 0.58, respectively. The correlation coefficients between KACP domains were tested and significantly supported the theoretical basis of the questionnaire. CONCLUSION: For research purposes, the KACP questionnaire measures parental responses with a moderate level of reliability and validity. Cross-cultural investigation of the questionnaire is needed to facilitate its use in other countries.

Adult↗

PubMed2006

[Peripheral I.V. therapy and nursing].

Peripheral intra vein (I.V.) therapy is common and important in clinical practice, and the arguments about I.V. therapy are still being put forward. Reviewing the relevant literature, this article identifies the points for attention and evaluation prior to I.V. therapy, methods to prevent and manage peripheral extravasation, and important points about legal aspects of I.V. therapy. These include tips on assessing patient needs, scholars views on preventing disease combinations caused by I.V. therapy, methods for verifying the efficacy of the therapy, important points about record-keeping and I.V therapy and advice on dealing with an I.V. therapy lawsuit. The recommendations should be useful to nurses in clinical practice.

Humans↗

PubMed2005

Therapeutic efficacy of milrinone in the management of enterovirus 71-induced pulmonary edema.

Hand, foot, and mouth disease and herpangina are the major clinical manifestations of enterovirus 71 (EV71) infections. Brain-stem encephalitis and pulmonary edema are severe complications that can lead to death. This study was designed to evaluate the potential therapeutic effect of milrinone, a phosphodiesterase (PDE) inhibitor, in the treatment of patients with EV71-induced pulmonary edema. We conducted a historically controlled trial of 24 children with severe EV71-induced pulmonary edema from April 1998-June 2003 in southern Taiwan. Patients were divided into groups treated before and after the introduction of milrinone therapy. Etiological diagnosis was established by viral cultures and confirmed by specific immunofluorescence and neutralization tests. All 24 patients were below 5 years of age. The mortality was lower in the milrinone-treated vs. nontreated group (36.4% vs. 92.3%, P=0.005). Sympathetic tachycardia was decreased in patients treated with milrinone compared to controls (144 +/- 17/min vs. 206 +/- 26/min, P=0.004). A marked decrease in IL-13 (77 +/- 9 pg/ml vs. 162 +/- 88 pg/ml, P=0.001) was observed in milrinone-treated patients compared to controls. There was a significant reduction in white blood cell (10,838 +/- 4,537/mm3 vs. 19,475 +/- 7,798/mm3, P=0.009) and platelet (257 +/- 45 x 10(3)/mm3 vs. 400 +/- 87 x 10(3)/mm3, P=0.001) counts in milrinone-treated patients compared to controls. These results were associated with improvement in sympathetic regulation and decrease in IL-13 production. Milrinone therapy may provide a useful therapeutic approach for this highly lethal disorder.

Biomarkers↗

PubMed2004

[Effects of fever education on changing parental concepts and management of fever in childhood].

"Fever phobia" has been found to decrease parents' ability to assess and manage febrile children appropriately, increase the utilization of emergency health care services, and add to the burden of family finances. Educational intervention is an important means of changing parents' knowledge, attitudes, and practices in order to counteract their misconceptions and over-anxiety, and improve the children's health. Parent-oriented education programs can be conducted in various ways, both inside and outside the clinic. However, evidence of the efficacy of given interventions from systematic evaluation of the literature is required to convince pediatric experts what content to teach and what methods to employ daily. The relevant literature from 1980 to 2004 were collected and reorganized to present the theories, contents, methods, effects, and influencing factors of various fever educational interventions. Accordingly, this article could provide healthcare professionals more information about the efficacy, accurate and reliable of various fever education programs. Thus, impel healthcare professionals provide more information to parents for improving parents' actions and decision making on fever management.

Child↗

PubMed2003

Lack of evidence for fecal-oral transmission of Helicobacter pylori infection in Taiwanese.

BACKGROUND AND PURPOSE: Helicobacter pylori infection is primarily acquired in early childhood and its transmission routes are debated. The aims of this study were to determine the seroprevalence of anti-H. pylori immunoglobulin G (IgG) in Taiwanese and to investigate whether a common mode of transmission could be shared between H. pylori and hepatitis A virus (HAV). METHODS: An enzyme-linked immunosorbent assay (ELISA) was used to investigate the prevalence of H. pylori among 924 healthy volunteers aged less than 40 years, and radioimmunoassay for HAV infection was conducted in 500 subjects from the same population. The kappa statistic was used to measure the difference in positivity for the 2 infections in a subgroup of 500 subjects who had their sera simultaneously tested for anti-H. pylori and anti-HAV antibodies. RESULTS: The seroprevalence of anti-H. pylori IgG was 16.7% in subjects aged < 16 years and 38.3% at ages >or= 16 years. Most children (99%) under the age of 16 were seronegative for HAV. The prevalence of H. pylori infection increased rapidly with age, at 1%/year and 0.8%/year for children and adults, respectively. The rate of H. pylori infection was higher in male (21%) than in female (12%) children (p < 0.01; OR, 2.0; 95% confidence interval, 1.2 to 3.0). No significant difference in seroprevalence between genders was noted in subjects aged >or= 16 years. The agreement in the trend of seropositivity between both infections in the age groups 1 to 10 years and 10 to 20 years was worse than chance (kappa = -0.56) and little better than chance (kappa = 0.01), respectively. CONCLUSIONS: Acquisition of H. pylori infection occurs at a young age, and male children are more likely to develop the infection. The main transmission route of HAV, the fecal-oral route, did not seem to be responsible for H. pylori transmission in this Taiwanese cohort.

Adolescent↗

PubMed2002

Effects of educational intervention on changing parental practices for recurrent febrile convulsions in Taiwan.

PURPOSE: To evaluate the effects of educational interventions on parental practices for recurrent febrile convulsions (FC). METHODS: A 2-year follow-up, nonequivalent comparison group design was used to evaluate the intervention effects. Two educational interventions were provided for FC parents in southern Taiwan. The 326 parents voluntarily chose either to receive a mailed pamphlet (n=196) or to attend a 2-h educational program (n=130). Five telephone interviews focused on investigating FC episodes and parental practices for seizures were conducted at months 3, 6, 12, 18, and 24 after the interventions. RESULTS: Of the 326 FC children, 78 (23.9%) had recurrent FCs within the 2-year follow-up. Parents who only received pamphlets did not show significant improvements. Parents who attended the educational program demonstrated significant improvements in the recommended practices, particularly in protecting the convulsing child (8.3 vs. 36.1%; p=0.02 by McNemar) and placing the child on his or her side (19.4 vs. 47.2%; p=0.01). Nonrecommended practices including rushing the convulsing child to the hospital (88.9 vs. 30.6%; p < 0.01) and putting protective devices in the child's mouth (38.9 vs. 8.3%; p < 0.01) significantly decreased. By generalized estimating equation analyses, the types of interventions are the single significant factor influencing parental practice changes from initial to recurrent FCs. CONCLUSIONS: Most parents used inappropriate practices for their child's initial FC. Compared with the mailed pamphlet, the educational program had significant improvements in recommended and nonrecommended practices from initial to recurrent FCs.

Adult↗

PubMedDate not supplied

Newborn screening: should explicit parental consent be required?

Newborn screening, the first population-based metabolic screening program has been universally conducted for several decades. With the advent of genetic technologies, many genetic/metabolic disorders can be detected pre-symptomatically but might be untreatable. Since the benefits and risks of screening tests on newborns are not fully known, newborn screening programs confront both legal and ethical challenges. This article aims to explore the following questions: (1) Is explicit parental consent required? (2) What level of consent should be sought? and (3) Is screening in the absence of explicit consent legally defensible? This article considers: (1) the introduction of newborn screening, (2) the conditions under which it is conducted (voluntary vs. mandatory), (3) the argument over whether explicit parental consent is required, (4) the conditions under which implied consent may be assumed, and (5) the principles of informing parents. This article concludes that implied consent is not acceptable except for traditional routine screening. Healthcare professionals should provide information about the known benefits and risks of testing and recognize the parental right of refusal. Finally, since the absence of explicit parental consent to newborn screening is not legally defensible, children's advocates should lobby for legislation permitting it in the absence of explicit consent in specific circumstances.

Humans↗

PubMedDate not supplied

A survey of parental consent process for newborn screening in Taiwan.

Recent technological developments in newborn screening (NBS) allow many genetic/metabolic disorders to be detected pre-symptomatically even though they may be untreatable. Thus, current NBS faces ethical, legal, and social challenges. Obtaining parental consent for NBS demonstrates respect for and educates parents. The purpose of this study was to explore current practices in obtaining parental consent to conduct NBS in Taiwan. A self-administered questionnaire was mailed to obstetric clinicslhospitals (N=339) and 204 questionnaires were returned for a response rate of 60.2%. Parental consent processes for NBS were divided into three categories-informed consent, informed refusal, and no informedlconsent. Between 66.7-67.6% clinics/hospitals used an "informed consent" model for all NBS items. Although most clinics/hospitals frequently informed parents before screening was conducted, the information given was often incomplete. Moreover, a "no informedl consent" model was used for congenital adrenal hyperplasia (CAH) and rare geneticlmetabolic disorders in between 22.5% and 25.1% of the clinics/hospitals, respectively. A total of 23.1% of clinics/hospitals chose an "informed refusal" model for the five traditional genetic/metabolic disorders. Using logistic regression analysis, the parental consent process for the five traditional disorders was found to have significant associations with the classification of the hospitals and the contracted NBS center (p < 0.01). Regional hospitals less frequently used the "informed consent" model than local clinics, and the clinics/hospitals that contracted with National Taiwan University Hospital were more likely to follow an "informed consent" model rather than those contracted with Taipei Institute Pathology. Establishing specific guidelines to regulate the parental consent process and educate medical personnel is crucial.

Adult↗