【演講訊息】106學年度特聘教授「提升研究創新能量」系列講座－106/12/26(二)－邱弘毅特聘教授「我的研究歷程」(15:00-16:00)

(1)

邱弘毅

臺北醫學大學特聘教授

亞太公共衛生學術聯盟副理事長

台灣長照及高齡健康管理發展協會理事長

我的研究歷程

1

(2)



_{博士學位是學術生涯發展的重要歷練，但}

並非學術研究順利的充分必要因子



_{博士學位不過是在學術競賽取得參賽權}

2

(3)

ARSENIC AND CANCER

CHIEN-JEN CHEN, TSUNG-LI KUO, MEEI-MAAN WU

AGE-STANDARDISED MORTALITY(PER 100,000) FROM VARIOUS CANCERS

Cancer site

(ICD8 code)

Sex

Blackfoot disease-endemic area

General population

in Taiwan

0.60*

0.30-0.59*

<0.30*

All sites

(140-209)

M

F

434.7

369.4

258.9

182.6

154.0

113.3

128.1

85.5 Liver

(155)

M

F

68.8

31.8

42.7

18.8

32.6

14.2

28.0

8.9 Lung

(162)

M

F

87.9

83.8

64.7

40.9

35.1

26.5

19.4

9.5 Skin

(173)

M

F

28.0

15.1

10.7

10.0

1.6

0.8

0.8 Prostate

(185)

M

F

8.4

5.8

0.5

1.5 Bladder

(188)

M

F

89.1

91.5

37.8

35.1

15.7

16.7

3.1

1.4 Kidney

(189)

M

F

21.6

33.3

13.1

12.5

5.4

3.6

1.1

0.9

(4)

4 我自己的博士論文總共發表了三篇

期刊論文

1 Cancer Research

(

IF=9.122 Ranking 6.9

% (15/217) [2016]

)

2 Stroke (

IF=6.032 Ranking 7.9% (5/63)[2

016]

)

3 Mutation Research (

IF=5.5 Ranking 7.6%

(7/92) [2016]

)

(5)



_{263 patients with blackfoot disease}

_and

₂₂₉₃

_{healthy residents in the endemic}

area of arseniasis were recruited and

followed up for 7 years.



Consumption of high-arsenic artesian well water, sociodemographic

characteristics, life-style and dietary habits, and personal and family history of

cancers was obtained.



The occurrence of internal cancers determined

through annual health

examinations, home visit personal interviews, household registration data

checks, and national death certification and cancer registry profile linkages.

(6)

(7)



_{以博士論文為基礎，深化研究議題，探討一個重}

要的學術研究主題 ( 助理教授 )



_{接著再以此深化的學術主題或是累積的研究知識}

拓展新的研究主題。 ( 副教授 )



_{努力申請科技部計畫，失敗時要檢討原因，不可}

以氣餒



_{努力發表論文，論文被退是常態，有志者事竟成}



_{論文持續發表，建立學術社群的知名度}

學術成長期

_{: 助理教授 / 副教授}

7

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

Atherosclerosis

(17)

(18)

(Aposhian et al., 2004)

(As3MT, PNP)

14 (GSTM1,T,,P1, O1,O2)

(GSTM1,T,,P1, O1,O2)

(19)

(20)

(21)

(22)

(23)

(24)

(25)

(26)

(27)

A significant epistasis effect exists among estrogen

metabolic and signaling pathway genes and

gene-environment interactions on young ischemic stroke

subjects.

2012

(28)

(29)

• The PRS (8 SNPs of

MCP1, CCR2, E-selestin )

can be useful in

evaluating a high risk of

ischemic stroke among

patients, especially

those exposed to low

estradiol levels.

(30)



帶領研究團隊，探討重要的疾病機轉

(

科技部整合型計畫

)



取得大型研究計畫，解決重要健康問

題

(

衛福部

)



_{主導研究議題}

₍

_政策轉譯

_）

學術成熟期

_{: 教授}

30

(31)

Taiwan Stroke Registr

y

31 The first nationwide effort in

Taiwan to establish a reliable

national stroke database

(32)

Hospital Selection



Engages 39 academic and community hospitals.



TSR is representative of the national stroke figure.

-

Caring for 18% of all patients with stroke in the nation, which had conforme

d to the TSR criteria.

(33)

Stroke types and subtypes

(34)

(35)

(36)

(37)

37 I. 類鐸受體訊息傳遞途徑在中風

致病機轉及預後所扮演之角色

II. 中風後之認知功能障礙的機

制探討

科技部整合型計畫

參與團隊 : 雙和醫院，台大醫院，三軍總醫院，新光醫院

(38)

Study on the Mechanisms of

Post-stroke Vascular Cognitive impairment

PI

： Hung-Yi Chiou, PhD. Professor (TMU)

SP1 PI

： Hung-Yi Chiou, PhD. Professor (TMU)

SP2 PI

： Chaur-Jong Hu, MD. Professor (TMU)

(39)



_Importance

VCI increases the morbidity, disability, and healthcare

costs of the growing elderly population, and decreases

their quality of life and survival.



_Purpose

To evaluate mechanisms of post-stroke VCI, especial

ly in inflammatory aspects, including genomic effects

of inflammation (sub-proposal 1), accumulation of am

yloid on early/late-onset VCI (sub-proposal 2), TLRs

in amyloid accumulation (sub-proposal 3)

(40)

Hypothesis

Thiel A, et al: Amyloid burden, neuroinflammation, and links to cognitive decline after

ischemic stroke. Stroke 2014, 45(9):2825-2829.

Stroke

Vascular cognitive

impairment

Multiple

stroke

Inflammation?

Enhanced

A-beta or Tau

deposition?

Specific stroke

location

TLR/RAGE?

3 months

1 year

SP1: Inflammation-associated genes

SP2: Amyloid accumulation on VCI

SP3: TLRs in amyloid accumulation

(41)

Integrated figure of sub-proposals

SP1

Amyloid and inflammation

genes

Clinical Data

SP3

TLRs in amyloid

accumulation

Animal Model

SP2

Amyloid accumulation

on VCI

Clinical Data

Vascular cognitive

impairment (VCI)

SP3

TLR4 in amyloid

accumulation

Animal Model

P.4

(42)

(43)

(44)

Evaluation on

prevention for

metabolic syndrome

and diabetes

mellitus through

lifestyle

modification

intervention in

pre-diabetic subjects

(100-104)

(45)

Introduction-Prediab

etes



Prediabetes, defined as blood glucose concentrations higher than no

rmal, but lower than diabetes thresholds.



Prevention program: USA, Finland, and China.

Lifestyle intervention

70% T2D

40-70%

incidence of T2D

45

(Knowler et al., 2009; Lindstrom et al.,2006; Li et al., 2008; Knowler et al., 2002) (Tabak et al., 2012)

(46)

Methods



2-parallel groups’ randomized contro

lled trial

•

3-month lifestyle intervention

(intervention group)

•

regular prevention education

(control group)

Inclusion criteria:

• Middle-age (mean age

59.98.85)

• elevated fasting plasma glucose

concentrations (FPG: 100-125

mg/dl)

• glycated hemoglobin(HbA1C:

5.7-6.3%)

Exclusion criteria:

• diagnosis of diabetes or receiving

treatment for diabetes in 3 years;

• having a history of CVD, stroke, liver

disease, kidney disease,

cardiopulmonary disease, malignancy or

cancer and musculoskeletal impairment

• receiving corticosteroids, antrogens,

estrogen containing compounds;

• dietary problem

• pregnant women

• joined other health intervention study in

one year

.

(47)

physical

activity

150 min/ week

dietary

changes

modified by DASH Diet

Replacement:

•fat-free or low-fat milk, •whole grains,

•white meat and fish, •vegetable oil,

•having 5 vegetables ＆ 2 fruits

weight

loss

BMI  24 kg/m

2

_:

lose 0.5-1.0 kg/ wk

Methods-Intervention

47

(48)

HbA1C<5.7%:

追蹤點相較於基線時， HbA1c 改善至正常範圍的比例

48 3M

6M

12M

0.0

4.0

8.0

12.0

4.8 _3.4

6.9

8.7

10.2 _8.3

control group

intervention group

3M

6M

12M

0.0

4.0

8.0

12.0

5.0

8.9

14.1

14.7

10.7 control group

intervention group

Adherence to Protocol (ATP)

Intention to Treat (ITT)

（％）

P=0.01

₄

（％）

P=0.01

(49)

Metabolic syndrome indicators ：

追蹤點相較於基線時，代謝症候群異常數目減少的比例

49 Intention to Treat (ITT)

3 M

6 M

12 M

0

20

40

60

80

79.5

84.9

85.5

84.2 _76.7

80.8 control group intervention group

Adherence to Protocol (ATP)

3 M

6 M

12 M

0

20

40

60

80

73.3

81.2

71.3

83.1

83.6

77.4 control group

Ab no rm al n um be rs D ec re as e (% ) Ab no rm al n um be rs D ec re as e (% )

(50)

Methods-Procedures and measurements



Questionnaire-

_{Transtheoretical}

_{Model, TTM}

1)

Maintenance 維持期：

Have regular health behavior, and changed behavio

r more than 6 months ago.

2)

Action 行動期：

Have changed their behavior within the last 6 months.

3)

Preparation 準備期：

Have ready to start taking action or have changed

behavior but not routine.

4)

Contemplation 意圖期：

Intending to start the healthy behavior within

the next 6 months

5)

Precontemplatio 意圖前期：

do not intend to start the healthy behavior

in the near future (within 6 months).

1

2

3

4 Baseline 3

rd

_{month 6}

th

_{month 12}

th

month

progress

degenerate

(51)

intervention

　

control

　

mean

SD

　 mean

SD

p

1

_p

2

_p

3

stage of change progress or maintain

Fasting glucose

-0.93

8.94

0.82

9.54 _0.215

_0.171

_0.184

HbA1C

-0.12

0.25 -0.05

0.26 _0.060

_0.070

_0.029

Weight

-1.15

2.38 -0.51

2.02 _0.061

_0.057

_0.048

BMI

-0.41

0.94 -0.16

0.75 _0.059

_0.079

_0.077

Waist

-1.32

2.86 -0.60

3.63 _0.165

_0.111

_0.115

SBP

-3.41

16.62 -1.02

16.30 _0.344

_0.212

_0.705

DBP

-1.99

10.65 -1.19

9.78 _0.614

_0.538

_0.930

TC

-3.76

38.68

3.72

33.38 _0.184

_0.165

_0.093

TG

-13.28

56.72

4.75

65.98 _0.054

_0.069

_0.055

HDL-C

0.09

8.02 -1.06

7.62 _0.341

_0.555

_0.589

　

LDL-C

-2.53

34.56 _2.21

30.53 _0.350

_0.268

Table2. The difference of two group by stage of change status after

follow 12 months (ATP)

1:two sample t test; 2: unadjusted linear regression; 3: adjusted linear regression: linear regression function

change=baseline+treatment djust for age; gender; study sites

(52)

青少年世代健康行為長期追蹤

研究計畫

The Taiwan Adolescent to Ad

ult Longitudinal Study (TAA

LS)

Principal Investigator

Hung-Yi Chiou

臺北醫學大學公共衛生學系青少年世代健康行為長期追蹤研究團隊

(53)

Introduction

Adolescence

is the most important developmental period for pre-adul

t health. Many health problems and chronic diseases are highly corr

elated with

adolescent health behaviors.

Taiwan

lacks national-wide longitudinal surveys

for Adolescence.

53 Child and Adolescent

Behaviors

in Long-term Evolution

(CABLE)

Taiwan Longitudinal

Study in Aging (TLSA)

Taiwan Birth Cohort Study

(54)

Bronfenbrenner(1994) Social Ecology Model

Study Framework

Cross-Sectional

Survey

Ecological Model

54

(55)

Study Framework

Longitudinal Survey

(56)

Sample size

1. The Wave 1 of TAALS survey: March-June 2015.

2. 102 well-training interviewers , 173 sample schools with 1,473

classes.

Under 3% sampling

error,

Effective sample size

=12,600

Extend predetermine

sample, and finally

receive 20,092 informed

consents

40 % loss follow-up

50% refuse to response

due to IRB procedure.

Final sample

=18064

(57)

Survey team and interviewers training

57  We have held

several workshops

for interviewers

training.

 Each interviewer was asked to

follow a standard

protocol.

(58)

58

(59)

Total obs. Junior high school Senior high school Vocational school

p-value N=18064 N=6667 N=4689 N=6708

　 % after weighting % after weighting % after weighting

Part A. Health behaviors

Eating breakfast 　　　　 <0.001

Lower 1,320 5.73% 6.71% 9.84% 　

Higher 16,732 94.27% 93.29% 90.16% 　

Eating more than one and a half bowl of

vegetables 　　　　 <0.001

Lower 8,928 46.91% 42.75% 57.21% 　

Higher 9,064 53.09% 57.25% 42.79% 　

Eating more than two bowls of fruits 　　　　 <0.001

Lower 10,603 58.03% 47.81% 69.48% 　

Higher 7,414 41.97% 52.19% 30.52% 　

Drinking more than 1500mL of water 　　　　 <0.001

Lower 7,264 36.93% 34.12% 47.20% 　

Higher 10,712 63.07% 65.88% 52.80% 　

Medium intensity exercise days during past a

week 　　　　 <0.001 0 days 2,757 16.51% 10.28% 18.24% 　 1-3 days 9,648 56.78% 46.52% 56.46% 　 ≥4 days 5,571 26.71% 43.21% 25.30% 　

Main Findings(1/2)

59

(60)

Total obs. Junior high school Senior high school Vocational school p-value N=18064 N=6667 N=4689 N=6708

　 % after weighting % after weighting % after weighting

Part B. Unhealthy behaviors

Skipping meals 　　　　 <0.001

Lower 13,136 75.54% 77.26% 65.91% 　

Higher 4,890 24.46% 22.74% 34.09% 　

Fast food eating 　　　　 <0.001

Lower 16,783 94.61% 93.73% 91.51% 　

Higher 1,221 5.39% 6.27% 8.49% 　

Drinking sugar-containing beverages 　　　　 <0.001

Lower 10,116 54.96% 59.14% 51.80% 　

Higher 7,913 45.04% 40.86% 48.20% 　

Average time to use TV, PC, or cellphone screen within

a week. 　　　　 <0.001

< 2 hours 3,897 22.81% 32.21% 9.66% 　

≥ 2 hours 14,129 77.19% 67.79% 90.34% 　

Ever use e-cigarette 　　　　 <0.001

No 15,892 93.95% 92.21% 83.72% 　

Yes 1,875 6.05% 7.79% 16.28% 　

Current use e-cigarette 　　　　 <0.001

No 17,237 98.78% 97.90% 94.90% 　

Yes 530 1.22% 2.10% 5.10% 　

Main Findings(2/2)

(61)

Can Resilience Protect Victims of Bullying from

Developing Depression?

An Analysis among Adolescents

Yu-Ning Chien, Ping-Ling Chen, Yi-Hua Chen, Hsiu-Ju Chang,

Suh-Ching Yang, Yi Chun Chen, Hung-Yi Chiou*

Department of Public Health,

Taipei Medical University

(62)

Victim

Resilience

(63)

(64)

64 Thank you for

your Attention