Incident edentulism and number of comorbidities among middle-aged and older Americans

BACKGROUNDS

Certain chronic non-communicable diseases have been associated with the loss of all natural permanent teeth, referred to as edentulism. It has been suggested that edentulism, a chronic dental state, involving the loss of all teeth and poorer masticatory efficiency, could be associated with multiple chronic conditions as people age. In this study, we describe the association between the number of comorbidities and incident edentulism in a representative sample of older Americans.

METHODS

We took data from the Health and Retirement Study (HRS). Dentate participants aged 50 or older at the baseline of 2006 (N = 13 221) and 2012 (N = 13 938) were linked to their dentate and survival status at the follow-up interviews in 2012 and 2018, respectively. The association between the number of comorbidities and incident edentulism was investigated by using multinomial logistic regression models.

RESULTS

Over the two observation periods, the number of selected chronic conditions was predictive of edentulism 6 years later. A 10% higher chance of becoming edentulous by 2012 (OR = 1.10, 95% CI = 1.01, 1.20) was found for every additional comorbid condition to those who remained dentate in 2012. A similar association was identified for the 2012-2018 period.

CONCLUSION

Among older adults, the number of comorbidities was predictive of incident edentulism, and the same association pattern was found across two longitudinal study periods. Older adults with an increase in the number of comorbidities may experience a higher chance of tooth loss later in time.

Use of Advance Directives in US Veterans and Non-Veterans: Findings from the Decedents of the Health and Retirement Study 1992-2014

Evidence shows that older patients with advance directives such as a living will, or durable power of attorney for healthcare, are more likely to receive care consistent with their preferences at the end of life. Less is known about the use of advance directives between veteran and non-veteran older Americans. Using data from the decedents of a longitudinal survey, we explore whether there is a difference in having an established advance directive between the veteran and non-veteran decedents. Data were taken from the Harmonized End of Life data sets, a linked collection of variables derived from the Health and Retirement Study (HRS) Exit Interview. Only male decedents were included in the current analysis (N = 4828). The dependent variable, having an established advance directive, was measured by asking the proxy, "whether the deceased respondent ever provided written instructions about the treatment or care he/she wanted to receive during the final days of his/her life" and "whether the deceased respondent had a Durable Power of Attorney for healthcare?" A "yes" to either of the two items was counted as having an advance directive. The independent variable, veteran status, was determined by asking participants, "Have you ever served in the active military of the United States?" at their first HRS core interview. Logistic regression was used to predict the likelihood of having an established advance directive. While there was no difference in having an advance directive between male veteran and non-veteran decedents during the earlier follow-up period (from 1992 to 2003), male veterans who died during the second half of the study period (from 2004 to 2014) were more likely to have an established advance directive than their non-veteran counterparts (OR = 1.24, p < 0.05). Other factors positively associated with having an established advance directive include dying at older ages, higher educational attainment, needing assistance in activities of daily living and being bedridden three months before death, while Black decedents and those who were married were less likely to have an advance directive in place. Our findings suggest male veterans were more likely to have an established advance directive, an indicator for better end-of-life care, than their non-veteran counterparts. This observed difference coincides with a time when the Veterans Health Administration (VHA) increased its investment in end-of-life care. More studies are needed to confirm if this higher utilization of advance directives and care planning among veterans can be attributed to the improved access and quality of end-of-life care in the VHA system.

Evaluation of feasibility and acceptability of a web-based diabetes prevention program (DPP) for diabetes risk reduction in Chinese Americans in New York City

Introduction

Intensive lifestyle intervention remains an effective modality to reduce diabetes incidence and delay the progression to type 2 diabetes. The primary aim of this study was to pilot-test the feasibility and acceptability of a culturally and linguistically tailored web-based DPP intervention among Chinese Americans with prediabetes living in New York City.

Methods

Thirteen Chinese American participants with prediabetes were recruited to complete a 1-year web-based Diabetes Prevention Program (DPP) lifestyle intervention. Quantitative and qualitative measures such as retention rate and data collected from web-based questionnaires and focus groups were collected and analyzed to assess study feasibility and acceptability.

Results and Discussion

Participants were receptive to the program through high engagement, retention and satisfaction. Retention rate was 85%. 92% of participants completed at least 16 sessions out of 22 sessions. Post-trial surveys indicated high satisfaction of 27.2/32 based on Client Satisfaction Questionnaire (CSQ-8) score. Participants expressed the program increased their knowledge and methods to prevent onset of type 2 diabetes such as incorporating healthy eating habits and increasing physical activities. Although not a primary outcome, there was a significant weight reduction of 2.3% at the end of month 8 of the program (p < 0.05). The culturally and linguistically adapted DPP via online platform successfully demonstrated feasibility and acceptability among Chinese Americans with prediabetes. Further evaluation of the web-based Chinese Diabetes Prevention Program in a larger trial is warranted.

Exploring Sources of Information and Religious Beliefs in Regard to HPV and Vaccination Among Hispanic/Latino College Students in the USA

We identified (a) sources of and communication about HPV information and (b) factors (e.g., religious affiliations) related to information sources and communication regarding HPV among Hispanic/Latino college students attending US institutions. Applying a cross-sectional design, we recruited 209 participants from US colleges. Most participants used healthcare professionals for their sources and communication about HPV-related information. Respondents who were practicing Catholics tended to use the Internet and healthcare professionals as their sources for HPV-related information. Healthcare professionals, TV, schoolteachers, same-sex friends, and family members affected participants' HPV vaccination, knowledge, and attitudes. Religious faith may influence information-seeking behaviors and requires more research.

Development of a Web-Based Diabetes Prevention Program (DPP) for Chinese Americans: A Formative Evaluation Approach

Increasing evidence demonstrates that an online Diabetes Prevention Program (DPP) can delay the onset of type 2 diabetes. However, little has been done for Chinese Americans. This study, using Community-Based Participatory Research and Intervention Mapping approaches, describes a formative research process in the development of a culturally and linguistically tailored online DPP program among Chinese Americans with prediabetes living in New York City. Using a triangulation approach, data were collected to inform the development of an online DPP curriculum through (1) a literature review, (2) three focus groups (n = 24), and (3) a community advisory board meeting among 10 key informants knowledgeable in community needs, diabetes care, and lifestyle interventions. Participants indicated online DPPs would be very useful and easily accessible. However, key barriers including low computer skills/literacy and technology self-efficacy were identified. In addition, taking meal photos and tracking pedometer steps daily were found to be acceptable self-motoring tools for sustaining a healthy lifestyle. Furthermore, the integration of features such as text message reminders and the creation of social support groups into the online DPP curriculum was proposed to minimize attrition. This theory-based formative research to develop a culturally and linguistically appropriate web-based DPP curriculum was well-received by Chinese Americans and warrants testing in future intervention studies.

Evidence for high gene flow, nonrandom mating, and genetic bottlenecks of Ganoderma boninense infecting oil palm (Elaeis guineensis Jacq.) plantations in Malaysia and Indonesia

Ganoderma boninense, the causal agent of basal stem rot (BSR) disease, has been recognized as a major economic threat to commercial plantings of oil palm (Elaeis guineensis Jacq.) in Southeast Asia, which supplies 86% of the world's palm oil. High genetic diversity and gene flow among regional populations of 417 G. boninense isolates collected from Sabah, Sarawak, and Peninsular Malaysia (Malaysia) and Sumatra (Indonesia) were demonstrated using 16 microsatellite loci. Three genetic clusters and different admixed populations of G. boninense across regions were detected, and they appeared to follow the spread of the fungus from the oldest (Peninsular Malaysia and Sumatra) to younger generations of oil palm plantings (Sabah and Sarawak). Low spatial genetic differentiation of G. boninense (F_ST = 0.05) among the sampling regions revealed geographically nonrestricted gene dispersal, but isolation by distance was still evident. Analysis of molecular variance (AMOVA) confirmed the little to no genetic differentiation among the pathogen populations and the three genetic clusters defined by STRUCTURE and minimum spanning network. Despite G. boninense being highly outcrossing and spread by sexual spores, linkage disequilibrium was detected in 7 of the 14 populations. Linkage disequilibrium indicated that the reproduction of the fungus was not entirely by random mating and genetic drift could be an important structuring factor. Furthermore, evidence of population bottleneck was indicated in the oldest oil palm plantations as detected in genetic clusters 2 and 3, which consisted mainly of Peninsular Malaysia and Sumatra isolates. The population bottleneck or founding event could have arisen from either new planting or replanting after the removal of large number of palm hosts. The present study also demonstrated that migration and nonrandom mating of G. boninense could be important for survival and adaptation to new palm hosts.

Adaptation of diabetes prevention program for Chinese Americans - a qualitative study

BACKGROUND

Studies have demonstrated that a culturally and linguistically tailored Diabetes Prevention Program (DPP) can be effective in reducing diabetes risk in Chinese Americans. The purpose of this study was to explore the cultural and linguistic acceptability of the Centers for Disease Control and Prevention's Prevent T2 curriculum in an online format in the Chinese American community in New York City (NYC).

METHODS

Three focus groups among a total of 24 Chinese Americans with prediabetes and one community advisory board (CAB) meeting with 10 key stakeholders with expertise in diabetes care and lifestyle interventions were conducted. Each focus group lasted approximately 1 to 1.5 h. All groups were moderated by a bilingual moderator in Chinese. The sessions were audiotaped, transcribed and translated to English for analysis. Using Atlas.ti software and open coding techniques, two researchers analyzed transcripts for thematic analysis.

RESULTS

Five key themes were identified: barriers to behavioral changes, feedback on curriculum content and suggestions, web-based intervention acceptability, web-based intervention feasibility, and web-based intervention implementation and modifications. Participants with prediabetes were found to have high acceptability of web-based DPP interventions. Suggestions for the curriculum included incorporating Chinese American cultural foods and replacing photos of non-Asians with photos of Asians. Barriers included lack of access to the internet, different learning styles and low technology self-efficacy for older adults.

CONCLUSION

Although the acceptability of web-based DPP in the Chinese American community in NYC is high, our focus group findings indicated that the major concern is lack of internet access and technical support. Providing support, such as creating an orientation manual for easy online program access for future participants, is important.

Genetic diversity and gene flow amongst admixed populations of Ganoderma boninense, causal agent of basal stem rot in African oil palm (Elaeis guineensis Jacq.) in Sarawak (Malaysia), Peninsular Malaysia, and Sumatra (Indonesia)

In 1911 and 1917, the first commercial plantings of African oil palm (Elaeis guineensis Jacq.) were made in Indonesia and Malaysia in Southeast Asia. In less than 15 years, basal stem rot (BSR) was reported in Malaysia. It took nearly another seven decades to identify the main causal agent of BSR as the fungus, Ganoderma boninense. Since then, research efforts have focused on understanding G. boninense disease epidemiology, biology, and etiology, but limited progress was made to characterize pathogen genetic diversity, spatial structure, pathogenicity, and virulence. This study describes pathogen variability, gene flow, population differentiation, and genetic structure of G. boninense in Sarawak (Malaysia), Peninsular Malaysia, and Sumatra (Indonesia) inferred by 16 highly polymorphic cDNA-SSR (simple sequence repeat) markers. Marker-inferred genotypic diversity indicated a high level of pathogen variability among individuals within a population and among different populations. This genetic variability is clearly the result of outcrossing between basidiospores to produce recombinant genotypes. Although our results indicated high gene flow among the populations, there was no significant genetic differentiation among G. boninense populations on a regional scale. It suggested that G. boninense genetic makeup is similar across a wide region. Furthermore, our results revealed the existence of three admixed genetic clusters of G. boninense associated with BSR-diseased oil palms sampled throughout Sarawak, Peninsular Malaysia, and Sumatra. We postulate that the population structure is likely a reflection of the high genetic variability of G. boninense populations. This, in turn, could be explained by highly successful outcrossing between basidiospores of G. boninense from Southeast Asia and introduced genetic sources from various regions of the world, as well as regional adaptation of various pathogen genotypes to different palm hosts. Pathogen variability and population structure could be employed to deduce the epidemiology of G. boninense, as well as the implications of plantation cultural practices on BSR disease control in different regions.

Protective Effect of Seasonal Influenza Vaccination in Elderly Individuals with Disability in Taiwan: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study

This is the first and largest population-based cohort study to demonstrate that influenza vaccination reduced all-cause mortality and influenza-related hospitalization in elderly individuals with a disability.

PURPOSE

To estimate the protective effect of influenza vaccination in elderly individuals with a disability by conducting a propensity score-matched (PSM), nationwide, population-based cohort study.

METHODS

Data from Taiwan's National Health Insurance Research Database were used in this study. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. The GEE logit was used to estimate the relative risks of death and hospitalization after influenza vaccination. Adjusted odds ratios (aORs) were used to estimate relative risk.

RESULTS

The matching process yielded a final cohort of 272 896 elderly individuals with a disability (136 448 individuals in each cohort). In multivariate GEE analyses, aOR (vaccinated vs. unvaccinated) and 95% confidence interval (CI) of death were 0.70 (0.68-0.72). The aORs (95% CIs) of hospitalization for influenza and pneumonia, respiratory diseases, respiratory failure, heart disease, hemorrhagic stroke, and ischemic stroke were 0.98 (0.95-1.01), 0.96 (0.94-0.99), 0.85 (0.82-0.89), 0.96 (0.93-0.99), 0.85 (0.75-0.97), and 0.89 (0.84-0.95), respectively. The length of stay and medical expenditure exhibited greater reduction in vaccinated elderly individuals with a severe and very severe disability than in unvaccinated elderly individuals.

CONCLUSIONS

Influenza vaccination reduced all-cause mortality, influenza-related hospitalization, length of stay, and medical expenditure in elderly individuals with a disability. The decrease in the length of stay and medical expenditure because of influenza vaccination was proportional to the severity of disability.

Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Elderly Individuals with and without Disabilities: A Nationwide, Population-Based Cohort Study

Purpose: The effects of influenza vaccines are unclear for elderly individuals with disabilities. We use a population-based cohort study to estimate the effects of influenza vaccines in elderly individuals with and without disabilities. Methods: Data were taken from the National Health Insurance Research Database and Disabled Population Profile of Taiwan. A total of 2,741,403 adults aged 65 or older were identified and 394,490 were people with a disability. These two groups were further divided into those who had or had not received an influenza vaccine. Generalized estimating equations (GEE) were used to compare the relative risks (RRs) of death and hospitalization across the four groups. Results: 30.78% elderly individuals without a disability and 34.59% elderly individuals with a disability had vaccinated for influenza. Compared to the unvaccinated elderly without a disability, the vaccinated elderly without a disability had significantly lower risks in all-cause mortality (RR = 0.64) and hospitalization for any of the influenza-related diseases (RR = 0.91). Both the unvaccinated and vaccinated elderly with a disability had significantly higher risks in all-cause mortality (RR = 1.81 and 1.18, respectively) and hospitalization for any of the influenza-related diseases (RR = 1.73 and 1.59, respectively). Conclusions: The elderly with a disability had higher risks in mortality and hospitalization than those without a disability; however, receiving influenza vaccinations could still generate more protection to the disabled elderly.

Associations among knowledge, attitudes, and practices toward palliative care consultation service in healthcare staffs: A cross-sectional study

Background

The palliative care consultation service (PCCS) of the National Health Insurance payments has been promoted in Taiwan since 2011, although few studies have been conducted on healthcare staffs’ knowledge, attitudes, and practices regarding PCCS in Taiwan; consequently, the main objective of this study was to explore any correlations regarding the above by cross-sectional design using convenience sampling.

Methods

A total of 210 healthcare staff members were enrolled from a regional hospital from June 1, 2018, to September 30, 2018. Questionnaire items on the Palliative Care Consultation Service Inventory (KAP-PCCSI) were used to measure healthcare staff’s knowledge, attitudes, and practices of PCCS. The collected data were analyzed by using descriptive statistics, independent samples t-test, Pearson’s correlation coefficient analysis, and multiple linear regression analysis.

Results

The results revealed that the mean scores for knowledge of and attitudes of KAP-PCCSI were 58.7 ± 8.9 (perfect score: 75) and 42.7 ± 4.7 (perfect score: 50) respectively, while the mean score for practices of KAP-PCCSI was 36.3 ± 8.1 (perfect score: 50); moreover, the healthcare staff’s knowledge and attitudes were positively correlated with their practices (p < 0.01). The results also showed that knowledge, attitudes, experience of having a family member(s) or friend(s) passing away, and being a medical personnel constituted the major predictors of practices (p < 0.001). These factors explained 43.2% of the overall variance for practices of KAP-PCCSI.

Conclusions

The findings can help healthcare staff understand factors influencing practices of KAP-PCCSI and can serve as a reference for the development of strategies for palliative care education and training while improving the care quality of patients undergoing such palliative care with terminal life considerations in the hospitals, thereby fulfilling the goal of achieving holistic care.

Combined effect of eating alone and a poor nutritional status on cognitive decline among older adults in Taiwan

BACKGROUND AND OBJECTIVES

Nutritional status is not only associated with older individuals' physical health but also has an impact on their cognitive functioning. Evidence indicates that a socially integrated lifestyle in the later stages of life protects against cognitive decline and dementia. This study tested the combined effect of two hazards, the risk of malnutrition and eating meals alone, on the cognitive changes among a representative sample of older Taiwanese individuals over an 8-year period.

METHODS AND STUDY DESIGN

Data were taken from the Taiwan Longitudinal Survey on Aging. In 1999, 2584 respondents aged >=65 years were surveyed, and follow-up surveys were performed in 2003 and 2007. The Short Portable Mental Status Questionnaire (SPMSQ) and Mini Nutritional Assessment were used to evaluate participants' cognitive functioning and nutritional status, respectively. Nutritional status and eating alone data assessed at baseline were combined to predict changes in SPMSQ scores longitudinally. Generalized estimating equations were used to evaluate the longitudinal changes from baseline to 2007.

RESULTS

Findings suggest that nutritional status was a salient predictor for cognitive decline among the older Taiwanese adults over the 8-year period. Female respondents who had a compromised nutritional status at baseline and who were eating their meals alone exhibited a greater decrease in SPMSQ scores compared with those who had a normal nutritional status and who were eating their meals with others.

CONCLUSION

Nutritional programs for the elderly should focus on what they eat as well as who they eat their meals with to prevent social isolation, especially among older women.

Evaluation of a successful aging promotion intervention program for middle-aged adults in Taiwan

PURPOSE

This study was to implement and evaluate a successful aging intervention program for middle-aged private insurance beneficiaries.

METHODS

The participants were recruited from the staff and middle-aged clients for the experimental and control groups of a private insurance company. The two client (experimental and control) groups were matched by comparable age groups, gender, education, and purchased insurance types. The intervention program provided for the staff and the experimental group consisted of a series of educational courses on the topics about successful aging and preparation for 4 months. In total, there were 40 staff members, in addition to the 74 members of the experimental group and 60 members of the control group participating in the study.

RESULTS

After the intervention, the rate of physical activity and exercise significantly improved for the staff and for the intervention group. There were significant improvements in behaviors associated with doing exercise and living a less sedentary lifestyle and in the utilization of health examinations, and improvements in fitness and blood pressure.

CONCLUSION

The successful aging intervention program significantly improved awareness of successful aging, exercise behavior and fitness.

Ehnicity and Health Disparities Among the Elderly in Taiwan

Two measures of health, an index of functional and disability status and global selfrated health, and their transitions over a seven-year period were compared across two ethnic groups of elders in Taiwan: Mainlanders and Taiwanese. This ethnic division is considered a salient dimension of social stratification, shaping the two groups of elders'pathways through life. The results showed that Taiwanese elders experience a disproportionate burden on the two measures of health in part because of their lower socioeconomic status (SES). Also, Taiwanese elders are more likely to develop adverse health transitions than their Mainlander counterparts, and variations in perceptions of chronic illnesses may exist across ethnicity. The results suggest that both ethnicity and SES play important roles in linking social status to health status among this cohort of elders. Ethnicity and SES affect health collectively, and different components of SES may not confer the same health benefits across ethnic groups.

Use of Seasonal Influenza Vaccination and Its Associated Factors among Elderly People with Disabilities in Taiwan: A Population-Based Study

Background

Influenza immunization among elderly people with disabilities is a critical public health concern; however, few studies have examined the factors associated with vaccination rates in non-Western societies.

Methods

By linking the National Disability Registration System and health service claims dataset from the National Health Insurance program, this population-based study investigated the seasonal influenza vaccination rate among elderly people with disabilities in Taiwan (N = 283,172) in 2008. A multivariate logistic regression analysis was conducted to adjust for covariates.

Results

Nationally, only 32.7% of Taiwanese elderly people with disabilities received influenza vaccination. The strongest predictor for getting vaccinated among older Taiwanese people with disabilities was their experience of receiving an influenza vaccination in the previous year (adjusted odds ratio [AOR] = 6.80, 95% confidence interval [CI]: 6.67–6.93). Frequent OPD use (AOR = 1.85, 95% CI: 1.81–1.89) and undergoing health examinations in the previous year (AOR = 1.66, 95% CI: 1.62–1.69) also showed a moderate and significant association with receiving an influenza vaccination.

Conclusions

Although free influenza vaccination has been provided in Taiwan since 2001, influenza immunization rates among elderly people with disabilities remain low. Policy initiatives are required to address the identified factors for improving influenza immunization rates among elderly people with disabilities.

Non-mass-like breast lesions at ultrasonography: feature analysis and BI-RADS assessment

OBJECTIVE

To analyze the features of non-mass-like (NML) breast lesions on ultrasound (US) and determine their corresponding malignancy rate and to stratify these lesion patterns according to US BI-RADS categories.

MATERIALS AND METHODS

One hundred sixty-four consecutive lesions were retrospectively classified into four types according to the US features, the corresponding positive predictive values (PPVs) were obtained. Clinical, imaging, and histopathological findings were reviewed.

RESULTS

Among the 164 lesions, 39 (24%) were classified as type Ia, 14 (8%) as type Ib, 39 (24%) as type IIa, 19 (12%) as type IIb, 19 (12%) as type III, and 34 (21%) as type IV. The PPVs for malignancy were 21% for type Ia, 79% for type Ib, 10% for type IIa, 58% for type IIb, 16% for type III, and 21% for type IV. All NML lesions were classified as BI-RADS category 4a (type IIa), 4b (type Ia, III and IV) and 4c (type Ib and IIb) according to their PPVs. There was a significantly higher frequency of malignancy among lesions of type Ib and type IIb compared with the other types (P<0.01 for each). Lesions with associated calcifications, presence of abnormal axillary nodes, or a mammographic finding of suspected malignancy had a higher probability of malignancy (P<0.05 for each).

CONCLUSION

US is useful in clarifying the indication for biopsy of NML lesions. The types of US classifications used in our study establish reliable references for the NML patterns when stratified according to the BI-RADS categories.

The effect of menu labeling with calories and exercise equivalents on food selection and consumption

BACKGROUND

Better techniques are needed to help consumers make lower calorie food choices. This pilot study examined the effect of menu labeling with caloric information and exercise equivalents (EE) on food selection. Participants, 62 females, ages 18-34, recruited for this study, ordered a fast food meal with menus that contained the names of the food (Lunch 1 (L1), control meal). One week later (Lunch 2 (L2), experiment meal), participants ordered a meal from one of three menus with the same items as the previous week: no calorie information, calorie information only, or calorie information and EE.

RESULTS

There were no absolute differences between groups in calories ordered from L1 to L2. However, it is noteworthy that calorie only and calorie plus exercise equivalents ordered about 16% (206 kcal) and 14% (162 kcal) fewer calories from Lunch 1 to Lunch 2, respectively; whereas, the no information group ordered only 2% (25 kcal) fewer.

CONCLUSIONS

Menu labeling alone may be insufficient to reduce calories; however, further research is needed in finding the most effective ways of presenting the menu labels for general public.

Parenting style and child-feeding behaviour in predicting children's weight status change in Taiwan

OBJECTIVE

The prevalence of overweight and obesity among children is on the rise worldwide. Prior studies find that parents' child-feeding practices are associated with child weight status and the efficacy of specific parental child-feeding practices can be moderated by parenting styles. In the current longitudinal study, we examined the associations between child-feeding practices and weight status changes over 1 year among a sample of school-aged children in Taiwan.

DESIGN

In autumn 2008, a child-feeding questionnaire and parenting-style questionnaire were administered to parents of the second and fourth graders in an elementary school in Taiwan. The weight and height of the students were measured by a trained school nurse in 2008 and again in 2009.

SETTING

An elementary school in central Taiwan.

SUBJECTS

A total of 465 parent-child pairs were included in the analysis.

RESULTS

Using a gender- and age-adjusted BMI classification scheme issued by the Taiwan Department of Health, 29·2 % of the students were considered overweight at the 2009 measurement. Controlling for 2008 weight status revealed moderating effects of parenting style on the relationship between child-feeding practices and child weight status. Both authoritative and authoritarian mothers might monitor their children's dietary intake; however, the effectiveness of this practice was better, in terms of weight status control, among the authoritative mothers.

CONCLUSIONS

Findings suggest that parenting styles have a moderating effect on specific parental child-feeding practices. Parenting styles and parent's feeding practices could be an important focus for future public health interventions addressing the rising childhood obesity epidemic.

Underestimation of invasive lesions in patients with ductal carcinoma in situ of the breast diagnosed by ultrasound-guided biopsy: a comparison between patients with and without HER2/neu overexpression

PURPOSE

To determine the rate of underestimation of ductal carcinoma in situ (DCIS) diagnosed at imaging-guided biopsy and to analyze its association with HER2/neu oncogene, an important biomarker in assessing the tumour aggressiveness and guiding hormone therapy for breast cancer.

METHODS

We retrospectively reviewed 162 patients with DCIS diagnosed by imaging-guided core needle biopsy between January 2008 and March 2013. All of these patients received surgical excision, and in 25, the diagnosis was upgraded to invasive breast cancer. In this study, we examined the ultrasound, mammographic features and histopathological results for each patient, and compared these parameters between those with and without HER2/neu overexpression.

RESULTS

Of the 162 DCIS lesions, 110 (67.9%) overexpressed HER2/neu. Nineteen patients with HER2/neu overexpressing DCIS (n=19/110, 17.3%) were upgraded after surgery to a diagnosis of invasive breast cancer. In this group, the upgrade rate was highest in patients with a dilated mammary duct pattern (42.1%, n=8/19, p=0.02) and the presence of abnormal axillary nodes (40.0%, n=12/30, p<0.01) at ultrasound and was significantly associated with comedo tumour type on pathology.

CONCLUSIONS

Biopsy may underestimate the invasive component in DCIS patients. Sonographic findings of dilated mammary ducts and presence of abnormal axillary lymph nodes may help predicting the invasive components and possibly driving more targeted biopsy procedures.

Outpatient physical therapy utilization for children and adolescents with intellectual disabilities in Taiwan: a population-based nationwide study

This study analyzed the utilization and utilization determinants of outpatient physical therapy (PT) among children and adolescents with intellectual disabilities (ID) in Taiwan. A cross-sectional study was conducted to analyze 2007 national health insurance (NHI) claim data from 35,802 eighteen-year-old and younger persons with intellectual disabilities. A total of 3944 (11.02%) claimants received outpatient physical therapy. Variables that affected PT utilization included age, residence urbanization level, ID level, copayment status and major co-morbidity. The average annual PT visit frequency was 25.4 ± 33.0; pre-school children, claimants suffering from catastrophic disease and ID co-occurring with cerebral palsy had a higher mean cost per visit. Age, ID level, copayment status and co-morbidity were factors that influenced expenditure. Pre-school children, males, individuals who resided in the lowest urbanization areas and individuals with a catastrophic disease tended to use hospital services. The point prevalence of epilepsy and cerebral palsy were 12.10% and 19.80%, respectively. Despite the NHI program and government regulations to provide special services, the use of physical therapy for children and adolescents with intellectual disabilities was low, and the utilization decreased as the subjects aged.

Trends in the use of psychotropic drugs in people with intellectual disability in Taiwan: a nationwide outpatient service study, 1997-2007

This study aims to examine trends in outpatient psychotropic drug use among people with intellectual disabilities in Taiwan. The NHI outpatient medication records between January 1, 1997 and December 31, 2007 for people with intellectual disabilities were analyzed to observe the percent change, prevalence and prescription trends in psychotropic drugs. The overall prevalence of psychotropic medication increased from 17.82% to 23.22% during the study period. Results from stepwise logistic analysis demonstrated that females, the elderly, and individuals suffering from catastrophic disease were more prone to receive psychotropic drugs and that those with mild intellectual disability were less likely to receive psychotropic drugs. The percentage change in prescription rates of antipsychotics, hypnotics/sedatives, and antidepressants were 85.30%, 127.25%, and 167.50%, respectively, and the trends were statistically significant (p<0.05). Taiwan's NHI program and off-label use of psychotropic drugs might have attributed to this trend.

Healthcare utilization and expenditure analysis between individuals with intellectual disabilities and the general population in Taiwan: a population-based nationwide child and adolescent study

This study examines differences in outpatient-visit frequency and medical expenditures between (1) children and adolescents in Taiwan with intellectual disabilities and (2) children and adolescents in Taiwan's general population. A cross-sectional study was conducted to analyze data from 2007 provided by Taiwan's National Health Insurance program. A total of 236,045 beneficiaries younger than 19 years made use of outpatient services; among them, 35,802 had a principal diagnosis of mental retardation (intellectual disability). The average number of ambulatory visits was 14.9 ± 12.4, which is much higher than in the United States and other developed countries. The mean number of annual visits of the individuals with intellectual disabilities was significantly higher than that of the general population in Taiwan (20.1 ± 20.0 vs. 14.0 ± 12.2); age, gender, urbanization level of residential area, and copayment status affected outpatient visit frequency. The mean annual outpatient costs were NTD6371.3 ± NTD11989.1 for the general population and NTD19724.9 ± NTD40469.9 for those with intellectual disabilities (US $1 equals approximately NTD30). Age, gender, urbanization level of residential area, and copayment status were the determinants that accounted for this difference in cost. Children and adolescents with intellectual disabilities had higher use rates of rehabilitative and psychiatric services than the general population. We conclude that individuals with intellectual disabilities had higher demands than the general population for healthcare services, especially for rehabilitative and psychiatric services.

Comparison of outpatient services between elderly people with intellectual disabilities and the general elderly population in Taiwan

This study aims to analyze the ambulatory visit frequency and medical expenditures of the general elderly population versus the elderly with intellectual disabilities in Taiwan, while examining the effects of age, gender, urbanization and copayment status on ambulatory utilization. A cross-sectional study was conducted to analyze data from 103,183 national health insurance claimants aged 65 or older. A total of 1469 had a principal diagnosis of mental retardation (intellectual disability) and claimed medical outpatient services in 2007. The average number of ambulatory visits was 30.1 ± 23.1, which is much higher than in the United States and other developed countries, and the mean annual visits of the elderly with intellectual disabilities was significantly higher than the general population in Taiwan (35.2 ± 28.7 vs. 30.0 ± 23.1). Age and copayment status affected outpatient visit frequency. The mean medical expenditure per visit and the mean annual outpatient cost were 1146.5 ± 4497.7 NT$ and 34,533.7 ± 115,891.7 NT$, respectively. Male beneficiaries tended to have higher average annual medical expenses and mean medical expenses per visit than female beneficiaries. The three most frequent principal diagnoses at ambulatory visits were circulatory system diseases, musculoskeletal system and connective tissue diseases and digestive system diseases. We conclude that the elderly with intellectual disabilities had higher demand than the general population for healthcare services, and the NHI program lowers the barrier to care for populations with special needs.

Transarterial treatment of acute gastrointestinal bleeding: prediction of treatment failure by clinical and angiographic parameters

BACKGROUND

Acute gastrointestinal bleeding (GIB) is a life-threatening abdominal emergency and can be treated by transarterial embolization (TAE). Rehemorrhage and poor outcome are associated with several clinical factors. This study investigated the clinical and angiographic parameters associated with treatment failure for patients with acute GIB undergoing TAE.

METHODS

Sixty-seven patients who had angiographic evidence of contrast extravasation and who received subsequent TAE were included in this study. Treatment failure was defined as continuous or recurrent bleeding that required surgery within 7 days after the bleeding episode and/or death within 1 month. Univariate and multivariate logistic regression was applied to analyze the clinical and angiographic parameters affecting treatment failure.

RESULTS

Patients were divided into two groups: success (n = 35, 52.3%) and failure (n = 32, 47.7%). In the failure group, 22 patients (68.9%) re-bled and then received surgery. With the aid of angiographic localization, 68.2% (15 of 22 patients) survived after surgery. The other 10 patients who did not receive surgery died within 30 days. Several clinical and angiographic parameters analyzed by multivariate analysis were associated with treatment failure (p < 0.05), including presence of coagulopathy [odds ratio (OR), 14.7], number of supplying arteries >1 (OR, 13.2), and a distance of >5 cm (OR, 6.3) during TAE.

CONCLUSION

Angiographic parameters associated with treatment failure in patients undergoing TAE are established when the number of supplying arteries is >1, and a distance of >5 cm. Patients with these risk factors should be watched carefully for recurrence in the post-procedural period.

Effects of health literacy to self-efficacy and preventive care utilization among older adults

AIM

This study examined the relationships between health literacy, self-efficacy and preventive care utilization among older adults in Taiwan.

METHODS

The data were from a longitudinal survey, "Taiwan Longitudinal Study in Aging" in 2003 and 2007. A total of 3479 participants who completed both two waves were included for analysis. Health literacy first was constructed through education, cognitive function and disease knowledge through structural equation modeling (SEM); then, the associations of health literacy to later self-efficacy and preventive care were examined.

RESULTS

The model fit of SEM was good, indicating that the construct of health literacy was appropriate. Healthy literacy showed a moderate positive effect on self-efficacy and a small positive effect on preventive care utilization.

CONCLUSIONS

Health literacy increases self-efficacy and utilization of preventive care. Promoting people's health knowledge and health literacy is suggested.

Interactive effects of family socioeconomic status and body mass index on depression in school-aged children

Depression is an important health problem in children and the onset of depression is occurring at a younger age than previously suggested. The associations of being overweight and low socioeconomic status in childhood depression have been well documented; nevertheless few studies have addressed the combined effects of socioeconomic status and body weight, with depression in school-age children. We intended to examine if the relationship between socioeconomic status and childhood depression could be modified by abnormal body weight. A cross-sectional study was performed with a total of 559 subjects from 29 elementary schools in Taiwan. A depression scale was used to determine the depression status. Children receiving governmental monetary assistance for after-school class were categorized as being in the lower socioeconomic group. Data for depression-related demographic characteristics, family and school variables were collected. Children in the lower socioeconomic status group have a higher prevalence of depression (23.5%) than those in higher socioeconomic status groups(16.4%). Being overweight demonstrates the opposite effect on depression risk in the different socioeconomic groups. In lower socioeconomic families, the risk of depression in overweight children is three times higher than that for normal weight children; whereas in higher socioeconomic families, overweight children have a lower risk for depression than normal weight children. We concluded that a qualitative interactive effect existed between being overweight and socioeconomic status with childhood depression. More attention should be paid to overweight children from lower socioeconomic status families to prevent depression in school-age children.

Interactive influences of family and school ecologies on the depression status among children in marital immigrant families

The incidence of transnational marriage has increased significantly in Taiwan in recent years. Children born in immigrant families are predisposed to acculturation and learning problems. We aimed to determine if the children of marital immigrants are more depressed than children from native families, and examine the individual and joint effects of various factors on their depression risk. A cross-sectional study was performed to investigate the depression status of elementary school children in MiaoLi County, Taiwan. A total of 676 participants, including 157 children from families in which the mother was an immigrant and the father native to Taiwan, were recruited from 29 schools. A modified depression scale "Depression Screen Scale for Children and Adolescents" for domestic school children was used to determine depression status. Data which might relate to depression, including demographic, family and school variables, were collected with a structured questionnaire and analyzed with multivariate and stratification methods. The results show that 20.4% of children from immigrant mother families and 17.1% of children from native families exhibited depressive symptoms. The child-parent relationship, peer relationship and academic performance in school were found by logistic regression to be the main predictors of depression in immigrant family children. With further stratification analysis, synergistic effects in immigrant families were found between child-parent relationship and family climate and between peer relationship and academic performance, raising the risk of depression in children of marital immigrants by 7.26- and 7.71-fold, respectively. This synergistic effect was not observed in native families. This study provides significant evidence of synergistic effects between family variables and school variables which increase, up to more than 7-fold, the risk of depression in children of marital immigrants. The results provide hints to parents and teachers for improving the mental health of children in immigrant families by reducing the occurrence of depression.

Interactive effects of delayed bedtime and family-associated factors on depression in elementary school children

Shorter sleep time was reported to be associated with psychological functioning in children. We intended to examine the relationship between nocturnal sleep duration and depression status by investigating if delayed bedtime could be one of the enhancement factors for depression in children. A cross-sectional study was performed to investigate the depression status in elementary school children in middle Taiwan. Total 676 participants from 29 schools, in grades 3-6 were recruited to participate in the study. A modified depression scale for domestic school children was used to determine the depression status. Data of depression-related demographic characteristics, family, school variables and bedtime data were collected with a structured questionnaire. The results showed that almost one in five children (18%) had depression status. Delayed bedtime, child-parent relationship, family climate, and peer relationship were found to be the main predictors of childhood depression. Further stratification analysis showed that delayed bedtime significantly interacted with family climate and peer relationship on childhood depression. The risk of depression for children with a delayed bedtime of 10 PM and either in a non-harmonious family life or without a close parent-child relationship was 4.35 and 4.73 times greater than the reference group respectively. This study provides evidence for interactive effects between delayed bedtime and family concern factors which synergistically elevated the risk of childhood depression. This information may serve as a practical guide for parents and school teachers by recognizing that an adequate bedtime schedule could serve as a preventive measure against depression in children.

Intra-arterial treatment in patients with acute massive gastrointestinal bleeding after endoscopic failure: comparisons between positive versus negative contrast extravasation groups

Objective

To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure.

Materials and Methods

From January 2007 to December 2009, patients that experienced a first attack of acute gastrointestinal bleeding after failure of initial endoscopy were referred to our interventional department for intra-arterial treatment. We enrolled 79 patients and divided them into two groups: positive and negative extravasation. For positive extravasation, patients were treated by coil embolization; and in negative extravasation, patients were treated with intra-arterial vasopressin infusion. The two groups were compared for clinical parameters, hemodynamics, laboratory findings, endoscopic characteristics, and mortality rates.

Results

Forty-eight patients had detectable contrast extravasation (positive extravasation), while 31 patients did not (negative extravasation). Fifty-six patients survived from this bleeding episode (overall clinical success rate, 71%). An elevation of hemoglobin level was observed in the both two groups; significantly greater in the positive extravasation group compared to the negative extravasation group. Although these patients were all at high risk of dying, the 90-day mortality rate was significantly lower in the positive extravasation than in the negative extravasation (20% versus 42%, p < 0.05). A multivariate analysis suggested that successful hemostasis (odds ratio [OR] = 28.66) is the most important predictor affecting the mortality in the two groups of patients.

Conclusion

Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.

Using multidetector-row CT for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction

PURPOSE

To assess the clinical manifestations and multidetector-row computed tomography (MDCT) findings of afferent loop syndrome (ALS) and to determine the role of MDCT on treatment decisions.

MATERIALS AND METHODS

From January 2004 to December 2008, 1,100 patients had undergone gastroenterostomy reconstruction in our institution. Of these, 22 (2%) patients were diagnosed as ALS after surgery that included Roux-en-Y gastroenterotomy (n=9), Billroth-II gastrojejunostomy (n=7), and Whipple's operation (n=6). Clinical manifestations and MDCT features of these patients were recorded and statistically analyzed. The presumed etiologies of obstruction shown on the MDCT were correlated with clinical information and confirmed by surgery or endoscopic biopsy.

RESULTS

The most common clinical symptom was acute abdominal pain, presenting in 18 patients (82%). We found that a fluid-filled C-shaped afferent loop in combination with valvulae conniventes projecting into the lumen was the most common MDCT features of ALS. Malignant causes of ALS, such as local recurrence and carcinomatosis, are the most common etiologies of obstruction. These etiologies and associated complications can be predicted 100% by MDCT.

CONCLUSION

Our results suggest that MDCT is a reliable modality for assessing the etiologies of ALS and guiding treatment decisions.

What makes you good and happy? Effects of internal and external resources to adaptation and psychological well-being for the disabled elderly in Taiwan

AIM

This study explored the effect of internal adaptation and external resources to psychological well-being for the disabled elderly.

METHODS

Data were collected by face-to-face interviews with physically disabled elderly people, including the institutional and community-based long-term care service users in middle Taiwan. The number of persons interviewed was 563, of whom 505 completed the survey and met the disability criteria. Path analysis was applied. Internal resources (coping strategies and self-management of health) and external resources (social support and environmental support) were hypothesized to be related to difficulty in adapting to disability, and had a further impact on depressive symptoms and life satisfaction.

RESULTS

Acceptance-action coping strategies were beneficial in the adaptation process and in psychological well-being, and self-management of health was positively related to successful adaptation. Social support and environmental support were beneficial to adaptation and psychological well-being, although the effects were modest. In general, the effect of internal resources was larger than the external resources to adaptation and psychological well-being.

CONCLUSION

Positive coping and self-management as well as the use of external resources are positive indicators of successful adaptation to disability. The disabled elderly should be encouraged to take a positive attitude toward disability, and external resources should also be built up to support them.

The value of multidetector-row computed tomography for localization of obscure acute gastrointestinal bleeding

PURPOSE

There are no simple guidelines on when to perform multidetector-row computed tomography (MDCT) for diagnosis of obscure acute gastrointestinal bleeding (AGIB). We used a risk scoring system to evaluate the diagnostic power of MDCT for patients with obscure AGIB.

MATERIALS AND METHODS

Ninety-two patients with obscure AGIB who were referred for an MDCT scan after unsuccessful endoscopic treatment at presentation were studied. We recorded clinical data and calculated Blatchford score for each patient. Patients who required transfusion more than 500mL of blood to maintain the vital signs were classified as high-risk patients. Two radiologists independently reviewed and categorized MDCT signs of obscure AGIB. Discordant findings were resolved by consensus. One-way ANOVA was used to compare clinical data between two groups; kappa statistics were used to estimate agreement on MDCT findings between radiologists.

RESULTS

Of the 92 patients, 62 (67.4%) were classified as high-risk patients. Blatchford scores of high-risk patients were significantly greater than those of low-risk patients. Sensitivity for MDCT diagnosing obscure AGIB was 81% in high-risk patients, as compared with 50% in the low-risk. When used in conjunction with selection of the cut-off value of 13 in Blatchford scoring system, the sensitivity and specificity of MDCT were 70.9% and 73.7%, respectively. Contrast extravasation was the most specific sign of AGIB (k=.87), recognition of which would have improved diagnostic accuracy.

CONCLUSIONS

With the aid of Blatchford scoring system for evaluating the disease severity, MDCT can localize the bleeders of obscure AGIB more efficiently.

Reduced Acetylated Histone H4 is Associated With Promoter Methylation of the Fragile Histidine Triad Gene in Resected Esophageal Squamous Cell Carcinoma

BACKGROUND

Promoter methylation inactivates expression of some important tumor suppressor genes and may be associated with histone modification. The fragile histidine triad (FHIT) gene is considered a tumor suppressor gene in different human epithelial cancers. We investigated whether FHIT methylation is associated with aberrant expression of Fhit protein and acetylated histone, and whether aberrant expression of Fhit protein and acetylated histone are related to prognosis after resection for esophageal squamous cell cancer.

METHODS

We analyzed FHIT methylation using methylation-specific polymerase chain reaction and Fhit protein and acetylated histone H4 using immunohistochemistry in 60 resected tumor specimens. Concordance analysis was performed between FHIT methylation and expression of Fhit as well as H4.

RESULTS

The FHIT methylation was observed in 33(55%) specimens, and the aberrant expression of Fhit and acetylated H4 was found in 42 (70%) and 40 (67%) specimens, respectively. Expression of aberrant Fhit correlated positively with tumor staging (p < 0.017) and nodal involvement (p = 0.004). Aberrant expression of acetylated H4 correlated positively with tumor staging (p < 0.001), nodal involvement (p < 0.001), and metastasis (p = 0.004). Concordance rates of 75% and 81.7% were present between promoter methylation of FHIT and expression of Fhit (p = 0.035) and acetylated H4 (p = 0.02).

CONCLUSIONS

Aberrant expression of Fhit and acetylated histone H4 are frequently associated with the presence of esophageal squamous cell carcinoma, and they are potential prognostic predictors for patients after resection of the tumor.

Pulmonary cryptococcosis: comparison of clinical and radiographic characteristics in immunocompetent and immunocompromised patients

STUDY OBJECTIVES

We compared the clinical characteristics and imaging findings between immunocompetent and immunocompromised patients in whom pulmonary cryptococcosis had been diagnosed to define the role of serum cryptococcal antigen (sCRAG) and radiographs during a follow-up period of up to 1 year.

DESIGN

Retrospective cohort study.

SETTING

University hospital.

PATIENTS

The clinical records, chest radiographs, and CT scan findings of 13 immunocompetent and 16 immunocompromised patients with a diagnosis based on cerebrospinal fluid (CSF) culture, sCRAG titers, and cytologic or histologic confirmation of the presence of pulmonary cryptococcosis were reviewed during the course of the study. Two thoracic radiologists reviewed chest radiographs and CT scans for morphologic characteristics and the distribution of parenchymal abnormalities, and a final reading was reached by consensus. The correlation between serial radiographs and sCRAG titers was examined in 9 immunocompetent and 10 immunocompromised patients.

MEASUREMENTS

Serum or CSF cryptococcal antigen.

RESULTS

The most common clinical symptom was cough, which was present in 24 patients (82.8%). Pulmonary nodules were the most frequent radiologic abnormality. Cavitation within nodules and parenchymal consolidation were significantly less common in immunocompetent patients compared to immunocompromised patients (p = 0.02 and p = 0.05, respectively). Immunocompromised patients tended to have a larger extent of pulmonary involvement than immunocompetent patients, the changes seen on their serial radiographs were more variable, and their corresponding sCRAG titers were higher (> 1:256). In the immunocompetent patients, the radiographic characteristics of lesions usually improved with a corresponding decrease in sCRAG titers over time.

CONCLUSIONS

Our study suggests that pulmonary cryptococcosis usually follows a benign clinical course in immunocompetent patients. Immunocompromised patients often undergo an evolution to cavitary lesions that represent a more aggressive disease nature. Serial radiographic changes and changes in sCRAG titers reliably reflect disease progression and the response to therapy.

Promoter methylation of the hMLH1 gene and protein expression of human mutL homolog 1 and human mutS homolog 2 in resected esophageal squamous cell carcinoma

OBJECTIVE

Aberrant expression of mismatch repair genes, such as human mutL homolog 1 (hMLH1) and human mutS homolog 2 (hMSH2), are common in some human cancers, and promoter methylation is believed to inactivate expression of hMLH1. We investigated whether promoter methylation is involved in loss of hMLH1 protein and whether aberrant expression of hMLH1 and hMSH2 protein is related to prognosis after resection for esophageal squamous cell cancer.

METHODS

We analyzed promoter methylation of hMLH1 using methylation-specific polymerase chain reaction and hMLH1 and hMSH2 protein by using immunohistochemistry in 60 resected tumor specimens. The Pearson chi2 test was used to compare expression of hMLH1 and hMSH2 protein among patients with different clinicopathologic parameters. Concordance analysis was performed between hMLH1 methylation and its protein expression.

RESULTS

Loss of hMLH1 and hMSH2 protein was found in 43 (72%) and 39 (65%, P = .06) of 60 resected specimens, respectively. hMLH1 protein correlated well with tumor staging (P < .0001), depth of tumor invasion (P = .008), and nodal involvement (P < .0001) but not with distant metastasis, whereas hMSH2 did not show correlation with any of these parameters. A concordance rate of 83.3% was present between expression of hMLH1 protein and its promoter methylation (P < .001).

CONCLUSIONS

Aberrant expression of hMLH1 and hMSH2 protein is frequently associated with the presence of esophageal squamous cell carcinoma, and expression of hMLH1 protein is a better prognostic predictor than is expression of hMSH2 protein. Promoter methylation is one of the mechanisms responsible for loss of hMLH1 protein in esophageal squamous cell cancer.

Ten-year follow-up of blood lead levels with medical removal protection of shipyard workers

This cases report compared the short-term changes of BLL with medical removal intervention and follow-up the long-term changes of BLL afterward. During a physical examination in October 1992, a 44-year old shipyard welder was discovered to have a blood lead level (BLL) of 54.1 microg/dl. It was recommended that the shipyard remove this worker from his workplace. In 1993 the BLLs checked for this worker were 36.7 microg/dl in March and 32.0 microg/dl in April. After six months of medical removal, he returned to initial welding work. In 2002, we collected two blood samples from this worker for analysis in May and October. The results were 30.4 microg/dl and 31.6 microg/dl, respectively. Meanwhile, two other welding workers (case 2 and case 3) with BLLs over 40 microg/dl in the survey conducted at the same shipyard in 1992. It took 4 yr to let BLLs downed to less than 40 microg/dl. However, after the blood lead concentration drops to below 40 microg/dl, 10 yr long-term observation indicates that BLLs reduction level off and do not continue to go down in these three cases.

Zinc Chloride (Smoke Bomb) Inhalation Lung Injury

STUDY OBJECTIVES

Zinc chloride smoke inhalation injury (ZCSII) is uncommon and has been rarely described in previous studies. We hypothesized that structural changes of the lung might correlate with pulmonary function. To answer this question, we correlated findings from high-resolution CT (HRCT) scan and the results of pulmonary function tests (PFTs) in patients with ZCSII.

DESIGN

Retrospective cohort study.

SETTING

University hospital.

PATIENTS

Twenty patients who had been hospitalized with ZCSII-related conditions.

MEASUREMENTS

The study included HRCT scan scores (0 to 100), static and dynamic lung volumes, and diffusing capacity of the lung for carbon monoxide (D(LCO)).

RESULTS

HRCT scans and PFTs were performed initially after injury (range, 3 to 21 days) in all patients and during the follow-up period (range, 27 to 66 days) in 10 patients. The predominant CT scan findings were patchy or diffuse ground-glass opacities with or without consolidation. The majority of patients showed a significant reduction of FVC, FEV1, total lung capacity, and D(LCO), but normal FEV1/FVC ratio values. Changes of functional parameters correlated well with HRCT scan scores. Substantial improvements in CT scan abnormalities and pulmonary function were observed at follow-up.

CONCLUSIONS

The majority of our patients with ZCSII presented with a predominant parenchymal injury of the lung that was consistent with a restrictive type of functional impairment and a reduction in Dlco rather than with obstructive disease. Our results suggest that HRCT scanning and pulmonary function testing may reliably predict the severity of ZCSII.

Correlation of high-resolution CT, symptoms, and pulmonary function in patients during recovery from severe acute respiratory syndrome

Study objectives:

Little is known of the nature of the recovery period after severe acute respiratory syndrome (SARS) infection. We hypothesized that structural changes of the lung might correlate with symptoms and pulmonary function. To answer this question, we correlate findings of high-resolution CT (HRCT) with dyspnea scores and results of pulmonary function tests in patients during recovery from SARS.

Design:

Retrospective follow-up cohort study.

Setting:

University hospital.

Patients:

Nineteen patients who recovered from SARS-related hospitalization.

Measurements:

The study included HRCT scores (0 to 100), dyspnea scores (1 to 4), static and dynamic lung volumes, and diffusing capacity of the lung for carbon monoxide (Dlco).

Results:

The interval between hospital discharge and HRCT study or functional assessment was 31.2 ± 4.8 days (range, 25 to 38 days) [mean ± SD]. All patients had HRCT abnormalities and were assigned to two groups: ground-glass opacity (GGO) only (n = 7, 36.8%) and GGO with fibrosis (GGO+F) [n = 12, 63.2%]. Most patients (16 of 19, 84.2%) had no zonal predominance. HRCT scores correlated well with dyspnea scores (r = 0.78, p < 0.01) and with a variety of pulmonary functional variables, with Dlco being the most significant (r = − 0.923, p < 0.001). Compared with the GGO group, the GGO+F group showed significantly lower FEV₁, FVC, total lung capacity, residual volume, and Dlco.

Conclusions:

HRCT findings correlate well with functional studies and clinical symptoms during recovery from SARS. Longer-term follow-up studies in a larger cohort of patients should be performed to investigate the clinical outcome of recovered SARS patients.

Self-gain and self-loss among African American and white caregivers

OBJECTIVES

This study compared the effects of a traditional ideology of care and role conflict on the intrinsic rewards (self-gain) and consequences (self-loss) of caregiving among African Americans and Whites.

METHODS

Using a cross-sectional telephone survey of caregivers in North Carolina (n = 481), the authors performed a structural equation groups analysis to assess the equality of an a priori caregiving model for African Americans (n = 257) and Whites (n = 224).

RESULTS

Despite a stronger preference for family care among African Americans, traditional caregiving ideology was associated with more self-gain among Whites only; there was no relationship between preference for family care and self-loss for either group. Furthermore, role conflict was unrelated to self-gain but was related to more self-loss for both groups. Three additional relationships differed between African Americans and Whites: age and self-gain, gender and self-gain, and care recipient depression and role conflict. However, 12 proposed relationships were statistically significant and equivalent for African Americans and Whites.

DISCUSSION

The findings suggest that contextual elements that influence preference for family care and role conflict are almost identical for African Americans and Whites. Caregiver demographics are associated with caregiving ideology, whereas care recipient frailty is related to role conflict. However, there are differences between African American and White caregivers, which primarily stem from the role of age, gender, and preference for family care with self-gain.