No abstract

Sewer construction in Taiwan lags other developed nations, and the authorities are undertaking major sewerage system construction projects in several cities. In Kaohsiung City, sewerage networks pass through residential, commercial and industrial areas. The composition of sewage thus is highly complicated. Eight target monitoring positions are chosen to analyze the compounds and concentrations of hazardous air pollutants. Pollutant concentrations are used to evaluate the cancer risk increment based on inhalation intake for sewer workers under using exhaust ventilation and wearing personal gas filtering equipment. GC/MS analysis confirmed that concentrations of benzene and trichloromethane compounds in sewer air for all the monitoring positions exceeded the minimum risk levels (MRLs) of 0.009 ppm benzene and 0.1 ppm trichloromethane, and the maximum concentrations reached 148.4 and 327.3 ppm, respectively. The cancer risks of benzene and trichloromethane for workers without personal protection approached 2.77-3.98 × 10 -3 and 29.74-42.70 × 10 -3 , respectively. Through ventilation for 15 minutes and the wearing of gas filtering equipment, the cancer risks for benzene and trichloromethane were reduced to 0.0003-0.0004 × 10 -3 and 0.0029-0.0041 × 10 -3 , respectively. The authorities thus must order all workers to follow a strict code of practice for sewer entry before entering sewer systems. This code of practice should include a minimum time for general exhaust ventilation and the use of personal protection equipment.

According to the 2004 US Renal Data System's annual report, the incidence rate of chronic renal failure in Taiwan increased from 120 to 352 per million populations between 1990 and 2003. This incidence rate is the highest in the world. The prevalence rate, which ranks number two in the world (Japan ranks number one), also increased from 384 to 1630 per million populations. Based on 2005 Taiwan national statistics, there were 52,958 end-stage renal disease (ESRD) patients receiving routine dialysis treatment. This number, which comprised less than 0.2% of the total population and consumed $2.6 billion New Taiwan dollars, was more than 6.12% of the total annual spending of national health insurance during 2005. Dialysis expenditures for patients with ESRD rank the highest among all major injuries (traumas) and diseases. This article identifies and discusses the risk factors associated with consumption of medical resources during dialysis. Instead of using reimbursement data to estimate cost, as seen in previous studies, this study uses cost data within organizations and focuses on evaluating and predicting the resource consumption pattern for dialysis patients with different risk factors. Multiple regression analysis was used to identify 23 risk factors for routine dialysis patients. Of these risk factors, six were associated with the increase of dialysis cost: age (i.e. 75 years old and older), liver function disorder, hypertension, bile-duct disorder, cancer and high blood lipids. Patients with liver function disorder incurred much higher costs for injection medication and supplies. Hypertensive patients incurred higher costs for injection medication, supplies and oral medication. Patients with bile-duct disorder incurred a significant difference in check-up costs (i.e. costs were higher for those aged 75 years and older than those who were younger than 30 years of age). Cancer patients also incurred significant differences in cost of medical supplies. Patients with high blood lipids incurred significant differences in cost of oral medication. This study identified the relationship between cost and risk factors of dialysis procedures for ESRD patients based on average variable costs for each dialysis treatment. The results show that certain risk factors (e.g. aged 75 and older, hypertension, bile-duct disease, cancer and high blood lipids) are associated with higher cost. The results from this study could enable health policy makers and the National Health Insurance Bureau to design a fairer and more convincible reimbursement system for dialysis procedures. This study also provides a better understanding of what risk factors play more influential roles in affecting ESRD patients to receive haemodialysis treatment. It will help policy makers and health-care providers in better control or even prevent the disease and manage the distribution of the treatment. In addition, with the results from the analysis of cost information, we can tell which risk factors have more impacts on the dialysis cost. It will further hel...

A health risk assessment for the Lin-Yuan Petrochemical Industrial Complex (LYPIC) in southern Taiwan was conducted in this study. The main aims of the study were to develop an emission inventory for the 21 processing plants in the LYPIC, conduct hazard identification based on the emission inventory, perform an exposure assessment by applying air dispersion modeling to obtain the annual average concentration of hazardous air pollutants near the LYPIC, and estimate the lifetime risk of cancer associated with volatile organic compound exposure for residents living in the vicinity of the LYPIC. Comparing with the reported monitoring data from several petrochemical and refinery plants in the world, the estimated exposure concentrations in this study were within reasonable range. The results of cancer risk assessment showed that the cumulative excess lifetime cancer risk (ELCR) at four representative residential sites surrounding the LYPIC were in the range of 9.3 × 10 -5 to 1.7 × 10 -4. From a risk management perspective, in order to protect human health, greater emphasis on the reduction of emissions of benzene, 1,3-butadiene, acrylonitrile, and vinyl chloride is recommended. This study provides a feasible risk assessment procedure to identify the key carcinogenic chemicals emitted from a petrochemical industrial complex.

In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.