臺灣博碩士論文加值系統

背景: 隨著科技進步時代推演，智慧型手機功能增加，手機逐漸成為生活中不可或缺之物，已嚴重影響生活型態。然而，手機輻射及手機使用型態對於身體健康造成不可逆的後果，甚至會提高罹患乳癌的機率。由於，化學療法是治療乳癌最有效的方法，然而化學療法最常見且致命的副作用為骨髓抑制。
目的: 本論文包含三個子研究，子研究一:深入探究智慧型手機發出的射頻輻射對於乳癌發生率的影響。子研究二:台灣婦女手機使用型態與乳癌危險性。子研究三:探討針灸療法用於乳癌病人接受化學治療引起白血球減少症之療效。
研究方法: 子研究一，利用系統性文獻搜尋及統合分析探查手機發出的射頻輻射與罹患乳癌的發生率。子研究二，為病例對照研究，利用中文匹茲堡睡眠量表、手機成癮問卷，評估睡眠型態、手機成癮、手機使用型態及方式與乳癌發生率之相關因子。子研究三，運用系統性文獻查證並進行統合分析，針灸用於乳癌病患接受化學療法引起骨髓抑制之療效。
結果: 子研究一，暴露於射頻輻射環境下與乳癌發生率存在顯著相關性。亞組分析進一步表明，年齡≥ 50歲，以及暴露電子產品環境下:手機顯著增加了乳癌發生率。子研究二，智慧型手機成癮者與未成癮者相比，罹患乳癌的風險明顯提高1.43倍。習慣於睡前使用智慧型手機大於4.5分鐘者與少於4.5分鐘者相比，罹患乳癌的風險顯著增加了5.27倍。此外，使用智慧型手機姿勢:低頭滑手機與將手機放於桌面上相比，罹患乳癌風險顯著增加1.59倍。平常攜帶智慧型手機方式: 與在腰部以下相比，攜帶位置在胸部或腰腹部罹患乳腺癌的風險，分別顯著增加了5.03倍與4.06倍。進一步分析發現，睡前使用智慧型手機大於4.5分鐘者，與手機成癮者具有增加乳癌發生率的協同作用。子研究三，綜合了8項相關研究統合分析發現，針灸可改善乳癌病人接受化學治療引起之骨髓抑制，其中白血球達顯著性增加。此外，不管使用哪一種針灸方法，白血球都能被顯著的提升。
結論: 暴露於射頻輻射環境下與乳癌發生率存在顯著相關性。由其是年齡≥ 50歲，以及手機暴露環境下顯著增加了乳癌發生率。攜帶或使用手機時手機置放位置與乳房越近者，大量使用手機者及習慣睡前使用手機大於4.5分鐘者，有更高的風險罹患乳癌。於是，針灸可緩解乳癌化學治療所引起之白血球減少症。

Background: With the advancement of science and technology, the functions of smartphones have increased greatly, and it has gradually become an indispensable thing in life, which has affected the lifestyle seriously. However, smartphone radiation and use behavior have irreversible consequences for health, even increase the risk of breast cancer. Because chemotherapy is the most effective therapeutic to treat breast cancer, but the most common and fatal side effect of leukopenia.
Aims: This dissertation comprises of three sub-studies. Sub-study one: to deeply explore the impact of radiofrequency radiation emitted by smartphones on the incidence of breast cancer. Sub-study two: the behavior for smartphone use of Taiwanese women and the risk of breast cancer. Sub-study three: to evaluate the effectiveness of acupuncture relieving chemotherapy-induced leukopenia in patients with breast cancer.
Methods: Sub-study one, detecting radiofrequency radiation emitted by smartphones and the incidence of breast cancer by systematic literature review and meta-analysis. The second sub-study is a case-control study, using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) and the Smartphone Addiction Inventory Short Form (SPAI-SF) to assess the factors related to sleep patterns, smartphone addiction, the behavior of smartphone use, and the incidence of breast cancer. Sub-study three, a systematic literature review and meta-analysis to evaluate the effect of acupuncture for chemotherapy-induced leukopenia in breast cancer patients.
Results: Sub-study one, there is a significant correlation between exposure to radiofrequency radiation and the incidence of breast cancer. Further, subgroup analysis showed that age ≥50 years old, and exposure to mobile phone significantly increased the incidence of breast cancer. Sub-study two: Compared with non-addicts, smartphone addicts have a significantly increased risk of breast cancer by 1.43-fold. Those who are accustomed to using a smartphone for more than 4.5 minutes before going to bed have a significantly increased risk of breast cancer by 5.27-fold compared with those who are less than or equal to 4.5 minutes. In addition, using the smart phone posture: using the phone with the head down compared to putting the phone on the table, the risk of breast cancer is significantly increased by 1.59-fold. In the carrying way of smartphones: Compared with carrying it below the waist, the risk of breast cancer in the chest or waist and abdomen is significantly increased by 5.03 times and 4.06 times, respectively. Moreover, the combination of smartphone addiction and use of smartphone >4.5 min before bedtime synergistically increased the breast cancer risk. Sub-study three, after a comprehensive systematic review and meta-analysis, found out that acupuncture can improve chemotherapy-induced bone marrow suppression in breast cancer patients, with a significant increase in white blood cells. In addition, subgroup analysis revealed, no matter what acupuncture manners be applied, white blood cells can be significantly improved.
Conclusion: There is a significant correlation between exposure to radiofrequency radiation and the incidence of breast cancer, among which age ≥50 years old and exposures to smartphones. The closer distances between the smartphone and the breasts when carrying or using smartphones, those who use smartphones massively, and those who are used to using smartphones more than 4.5 minutes before night sleep have a higher risk of breast cancer. Therefore, acupuncture can relieve leukopenia caused by chemotherapy of breast cancer, and the white blood cells can be improved significantly.

Acknowledgements ......................................... I
Chinese abstract ......................................... II
Abstract ......................................... IV
Table of Content ......................................... VII
List of Figures and Tables ......................................... IX
List of Figures ......................................... IX
List of Tables ......................................... XI
Chapter I Introduction ......................................... 1
1.1 Aim of studies ......................................... 5
1.2 Conceptual framework ......................................... 6
Chapter II Literature Review ......................................... 7
2.1 Epidemiology & Etiology of Breast Cancer......................................... 7
2.2 Electromagnetic Radiation ......................................... 8
2.3 The relationship between radiofrequency and
breast cancer ......................................... 9
2.4 Smartphone causes cancer ......................................... 10
2.5 Chemotherapy-induced myelosuppression
and leukopenia ......................................... 10
2.6 Acupuncture of relieving chemotherapy-related symptoms and others......................................... 12
2.7 The mechanism of Acupuncture relieving chemotherapy-induced
bone marrow suppression and leukopenia......................................... 13
Chapter III Methodology ......................................... 16
3.1 Part one ......................................... 16
3.2 Part two ......................................... 21
3.3 Part three ......................................... 26
Chapter IV Results ......................................... 31
4.1 Part one ......................................... 31
4.2 Part two ......................................... 45
4.3 Part three ......................................... 53
Chapter V Discussions ......................................... 66
5.1 Part one ......................................... 66
5.2 Part two ......................................... 71
5.3 Part three ......................................... 77
Chapter VI Conclusions ......................................... 81
Conclusions ......................................... 81
References ......................................... 82

List of Figures
Figure 1. Conceptual framework of the dissertation.......................................... 6
Figure 2. The PRISMA flow diagram of the review
process.......................................... 32
Figure 3. The overall risk ratio between radiofrequency exposure and breast cancer development.......................................... 37
Figure 4. The subgroup analyses were based on age groups. The risk ratio between radiofrequency exposure and breast cancer in aged ≥50 years............................................ 39
Figure 5. The subgroup analyses were based on age groups. The risk ratio between radiofrequency exposure and breast cancer in aged <50 years.......................................... 40
Figure 6. The subgroup analyses: Smartphone/computer exposure significantly
increased the risk of breast cancer..........................................41
Figure 7. Meta-analysis of radiofrequency exposure in occupational environments and the breast cancer
risk..........................................42
Figure 8. Meta-analysis of radiofrequency exposure to transmitters and the breast cancer risk.......................................... 43
Figure 9. Funnel plot of the radiofrequency exposure papers included in the meta-analysis.......................................... 44
Figure 10. The review process of the flow diagram.......................................... 54
Figure 11. Forest plot of the overall effect sizes for studies measuring white blood cell (WBC) counts and acupuncture..........................................61
Figure 12. Forest plot of the effective response of platelet counts. ......................................... 61
Figure 13. Forest plot of the effective response of natural killer (NK)-cell counts.......................................... 62
Figure 14. The mixed-effects model for different types of acupuncture. ......................................... 62
Figure 15. Meta-regression analyses performed by different total treatment doses (min) for white blood cell (WBC) counts..........................................63
Figure 16. Funnel plot of the meta-analysis of included papers that examined white blood cell (WBC) counts..........................................64
Figure 17. Trial sequential analysis of the effects of WBCs and acupuncture. ......................................... 65

List of Tables
Table 1. Characteristics of the included studies.......................................... 34
Table 2. Assessment of the included studies quality
using the Newcastle-Ottawa Scale..........................................36
Table 3. The characteristics between controls and
cases.......................................... 46
Table 4. Adjusted odd ratio (AOR) and 95% confidence interval (CI) of smartphone use behaviors and breast cancer risk..........................................49
Table 5. Adjusted odd ratio (AOR) and 95% confidence interval (CI) of the synergistic effect between people with smartphone addiction and the time spent on smartphone use before night sleep on the breast cancer risk..........................................52
Table 6. Characteristics of the included studies.......................................... 56
Table 7. Risk of methodological bias of the included
studies.......................................... 60

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