Dietary questions in caries risk assessment and their relationship to caries.

OBJECTIVE: This retrospective chart review evaluated the relationship between specific dietary questions used in caries risk assessment and planned restorative treatment among patients attending a dental school's clinic. METHODS: Records for 6,218 adult patients attending the University of Iowa College of Dentistry who completed caries risk assessments and comprehensive oral examinations during 2018-2019 were included. The number of planned caries restorative treatments were compared between groups based on responses to specific dietary questions on the caries risk assessment. Analyses included chi-square and Wilcoxon rank-sum tests and logistic regression for factors associated with caries treatments. RESULTS: About 20% of subjects needed caries treatment, and regression analyses found that younger age, having unstructured meals, drinking sugared beverages daily, and drinking them for more than 30 min were significantly (p < 0.01) associated with having caries. CONCLUSIONS: Specific and focused questions on dietary practices are strongly associated with caries, and may be useful in improving caries risk assessments.

Erectile dysfunction as a holistic indicator of well-being: a narrative review.

INTRODUCTION: Erectile dysfunction (ED), affecting around 52% of men aged 40-70, is a significant marker of overall health and a potential warning sign of multiple conditions like cardiovascular diseases (CVDs), diabetes, and mental health disorders. Recognizing and addressing ED through a holistic approach involving nutrition, physical activity, sleep, and stress management can improve both erectile and overall health outcomes. AIMS: To provide a narrative review of the available literature on the relationship between ED and overall health, elaborate on the possible mechanisms explaining this association, and discuss the effects of lifestyle on ED. METHODS: A search of the medical literature was carried out in PubMed and Medline, focusing on original research and systematic reviews of original research on ED and overall health. RESULTS: Due to shared pathophysiological mechanisms like endothelial dysfunction, ED is a significant indicator of overall health, particularly related to CVD and diabetes mellitus. Multiple studies have shown that ED frequently precedes cardiovascular events and is associated with increased cardiovascular risk, especially in younger men and those with diabetes. It also has a profound, bidirectional relationship with mental health conditions like depression and anxiety, creating a vicious cycle where each exacerbates the other. The four health pillars of nutrition, physical activity, sleep, and stress management play significant roles in erectile function and overall sexual health. CONCLUSION: ED is not just a condition affecting sexual function but a critical indicator of broader health issues. By adopting an integrative approach that combines nutrition, physical activity, sleep, and stress management, healthcare providers can offer holistic and effective management strategies for this condition.

Social network, fair payment, subjective well-being, and general health: a moderation mediation analysis.

Objective: This research aimed to investigate whether subjective general health mediated the relationship between social networks and subjective well-being and whether the perception of fair payment moderated the mediating effect of subjective general health on subjective well-being. Methods: Data were drawn from round 9 of the European Social Survey (ESS), involving 3,843 respondents from 19 countries, with ages ranging from 65 to 90 years (Meanage = 73.88 ± 6.61 years). The participants completed self-reported measures assessing subjective well-being, social networks, subjective general health, and perception of fair payment. Results: Subjective general health played a mediating role in the relationship between social networks and subjective well-being. The perception of fair payment emerged as a moderator in the mediating effect of subjective general health on the association between social networks and subjective well-being. Conclusion: This study suggests that the impact of social networks on both subjective general health and subjective well-being is contingent upon individuals' perceptions of fair payment. These results highlight the significance of social networks in fostering social connections and promoting overall subjective well-being.

The effects of web-based education on health-promoting behaviors of first-year medical sciences students: A quasi-experimental study.

BACKGROUND: Students, as a representative of young adults, are at risk for engagement in unhealthy lifestyle behaviors such as unhealthy eating, unhealthy relationships, and drug abuse. Health-promoting lifestyle (HPL) largely depends on adequate knowledge of healthy behaviors and hence, education is a strategy with potential positive effects on lifestyle. This study aimed at evaluating the effects of web-based education (WBE) on HPL among first-year medical sciences students. MATERIALS AND METHODS: This quasi-experimental study was conducted in 2020 with a single-group pretest-posttest design. Participants were 185 first-year bachelor's and doctoral medical sciences students selected from Babol University of Medical Sciences, Babol, Iran, through multistage sampling. Study intervention was a three-week web-based educational program on HPL. Educational videos about the different components of HPL were sent to participants through WhatsApp. Data were collected before, one month after, and three months after the study intervention through the Health-Promoting Lifestyle Profile (HPLP2) and the General Health Questionnaire (GHQ). The STATA software (v. 16.0) was used for data analysis. RESULTS: Among 185 participants, 154 (83.69%) participants completed the study. The mean scores of HPL and its health responsibility and stress management subscales significantly increased by 4.58 (95% CI: 0.12, 9.04), 1.77 (95% CI: 0.39, 3.15), and 0.71 (95% CI: 0.13, 1.26), respectively. However, the mean scores of the nutrition, interpersonal relations, physical activity, and self-actualization subscales of HPL and the mean score of general health did not significantly change (P > 0.05). CONCLUSION: WBE has significant positive effects on HPL and its health responsibility and stress management subscales. Therefore, WBE through social media can be used to improve HPL among young adults, particularly students.

Factors related to parents' perceptions of oral health for children with Down syndrome in Japan.

AIMS: To evaluate the perceptions of parents on general health, oral health, and dental care for children with Down syndrome (DS), and to investigate factors related to parents' perceptions of oral health. METHODS AND RESULTS: An online questionnaire survey was conducted of parents of children with DS. Forty-three percent and 81% of the parents rated their child's oral health and general health as good, respectively. Parent-rated oral health was strongly associated with general health, followed by the parents' satisfaction with their child's dentist, halitosis, difficulty in dental examination, and the number of times they helped their child with toothbrushing. Seventy-seven percent of the parents were satisfied or rather satisfied with their child's dentist. The parents expected the dentist to reassure their child and to be specialized in the treatment of persons with disabilities. Seventy-three percent of the parents brushed their child's teeth at least once a day, and 92% brushed their own teeth at least twice a day. The number of times the parents brushed their own teeth was strongly associated with the frequency of brushing their child's teeth. CONCLUSION: General health, a trusting relationship with the dentist, and parental perceptions of oral hygiene affect parent-rated oral health of children with DS.

Self-reported hearing loss and health during a pandemic: Findings from a cross-sectional analysis using a 2021 household survey.

BACKGROUND: The COVID-19 pandemic differentially impacted individuals with hearing loss, likely in part due to increased communication difficulties from masking, a commonly implemented protective measure. OBJECTIVE: This study examines the association between self-reported hearing loss and health during the pandemic. METHODS: This study uses data from the COVID-19 Survey collected by the Survey of the Health of Wisconsin from February to March 2021. Hearing loss was defined as self-reported fair or poor hearing. The outcomes were self-reported symptoms of anxiety and depression, separately, and self-reported general health. Multivariable models adjusted for age, gender, and race/ethnicity were used to examine the associations between hearing loss with each outcome. Results are presented as prevalence ratios (PR) with corresponding 95 % confidence intervals (CI). RESULTS: There were 1857 participants (60.3 % female, 12.9 % non-white) with a mean age of 57.1 years in this cross-sectional study. In multivariable models, individuals with hearing loss (versus none) had higher prevalence of depression (PR: 1.22, 95 % CI: 1.06, 1.39), anxiety (PR: 1.13, 95 % CI: 1.02, 1.27), and self-reported fair or poor health (PR: 2.61, 95 % CI: 1.89, 3.61). CONCLUSION: Hearing loss was associated with poorer self-reported health during winter 2021 of the COVID-19 pandemic, when mask use in public was newly mandated and vaccines were not widely available to the general public. Further research on the impact of public health policies on vulnerable populations, including those with hearing loss, is warranted. Such research could inform policy decisions that accommodate these populations.

The midlife health of only children: chronic disease indicators and biomarkers by sibship size in three nationally representative UK cohorts.

BACKGROUND: Despite persistent concerns about only children's disadvantage relative to individuals with siblings, existing health-related evidence is inconsistent. Recent evidence from Nordic countries about only children having poorer health outcomes may not apply elsewhere because selection processes differ across contexts. We investigate the midlife health of only children in the UK where one-child families tend to be socio-economically advantaged relative to large families. METHODS: Using the 1946, 1958 and 1970 British birth cohort studies, we examine various biomarkers and self-reported measures of chronic disease by sibship size when respondents are aged in their mid-40s, mid-50s and mid-60s. We estimate separate linear probability models for each cohort, age and outcome, adjusting for childhood and early adulthood circumstances. RESULTS: We found no evidence of only children differing from those with one, two or three or more siblings, at any age, in any of the cohorts, on: heart problems, hypertension, high triglycerides, high glycated haemoglobin or high C-reactive protein. However, compared with only children, the probability for cancer (0.019, 95% confidence interval [CI]: 0.002, 0.035; age 46/1970) and poor general health (0.060, CI: 0.015, 0.127; age 55/1958; and 0.110, CI: 0.052, 0.168; age 63/1946) was higher among those with three or more siblings. CONCLUSIONS: There is no consistent pattern of only child health disadvantage for midlife chronic disease outcomes across ages or cohorts in the UK. Research should focus on better understanding how sibship size differentials are contingent on context.

The relationship between the duration of diabetes and dimensions of general health and quality of life associated with the health of diabetic patients.

Introduction: Diabetes is one of the most common chronic diseases in the world. Diabetes has a major impact on the quality of life of patients. The purpose of this study is the relationship between the duration of diabetes and dimensions of general health and quality of life associated with the health of diabetic patients. Materials and Methods: In this cross-sectional-analytical study, diabetic patients with more than 1-year history who were not suffering from other chronic diseases were included in the study. Then, using 15 questions for diabetes quality of life, questionnaires and GHQ28 general health were investigated in terms of quality of life and general health. The data were statistically analyzed using SPSS version 24 software. Results: The average age was equal to 42.8 ± 14.4 years (with a median of 40 years). The average duration of the disease in the patients was equal to 7.7 ± 7.2 years (with a median of 5 years). The average quality of life score of the patients was equal to 50.3 ± 7.8 (out of 75). A negative and significant correlation between age and quality of life of patients was observed (P < 0.001). The duration of the disease had a direct and significant relationship with the general health score. But a significant difference between the quality of life of married and single people was not observed (P = 0.613). A direct and significant relationship between duration of disease, age with physical symptoms (P < 0.001), anxiety and insomnia (P = 0.001), social activity failure (P = 0.013), and depression (P = 0.001) was observed and was also observed with the overall score of general health (P < 0.001). Discussion and Conclusion: The duration of diabetes disease affects the quality of life and general health of diabetic patients, and discomfort, depression, and anxiety are the main problems that affect the quality of life of diabetic patients.

Identifying Palliative Care Needs in Patients With Heart Failure Using Patient Reported Outcomes.

CONTEXT: Heart failure (HF) is considered a multifaceted and life-threatening syndrome characterized by high symptom-burden and significant mortality. OBJECTIVES: To describe the symptom-burden in patients with HF and identify their palliative care needs. In this respect, symptom burden related to sex, age and classification of HF using New York Heart Association Functional Classification (NYHA) were analyzed. METHODS: A cross-sectional questionnaire survey included adult HF patients according to NYHA II, III, and IV. Palliative care needs were assessed using validated patient reported outcomes measures; SF-36v1, HeartQoL, EORTC- QLQ-C15-PAL, MFI-20 and HADS. Patients were recruited from the Department of Cardiology, North Zealand Hospital, Denmark. RESULTS: In total, 314 patients (79%) completed the questionnaire (233 men). Mean age = 74 years (range 35-94 years). In all, 42% had NYHA III or IV and 53% self-rated their health to be fair or poor. In all, 19% NYHA II and 67% NYHA III/IV patients had ≥4 severe palliative symptoms according to EORTC-QLQ-C15-PAL. In addition, NYHA III/IV had a mean of 8.9 symptoms and a mean of 5.4 severe symptoms. Women, older patients, and those with NYHA III/IV had worse outcomes regarding health-related quality of life, functional capacity, and symptom burden. CONCLUSIONS: Patients with HF have a high prevalence of symptoms and, thus, potential palliative care needs. Predominantly, women, older patients, and those with higher severity of disease have the highest symptom burden. PROMs can help cardiologists address the palliative care needs and systematic assessment may be a prerequisite to integrate symptom-modifying and palliative care interventions.

Assessing Self-Rated Physical Health Scores Following Repeat Exposure to Anthropogenic and Natural Hazards in Houston, TX.

BACKGROUND: Research connects health outcomes to hazard exposures but often neglects the nature of the exposure or repeated events. METHODS: We undertook a cross-sectional study (N = 1,094) from a representative sample in the Houston Metropolitan Statistical Area (HMSA). Respondents were recruited using Qualtrics panels, targeting individuals reflecting the population of the HMSA. Physical composite scores (PCS) were calculated using the SF-12v2. RESULTS: Among the hazards (hurricanes, flooding, tornadoes, chemical spills, industrial fires), only chemical spills showed a dose-response: physical health scores declined significantly with repeated exposures. This decline persisted after multiple linear regression. Covariates including sex, race, age, education, and chemical exposure affected PCS, but chemical spill exposure remained the most significant, negatively affecting PCS even after adjusting for other factors (coef =-2.24, 95% CI, -3.33 to -1.15). CONCLUSION: Grasping the effects of hazards, especially repeated ones, can guide emergency management in mitigation, recovery, and preparedness efforts.

Navigating the disappointment of manuscript rejection: An author's dialogue with a reviewer and editor of tropical doctor (TD).

With the majority of medical journals having a rejection rate of >80% of submitted manuscripts, it does come as a shock and as grief to the author who great expectations before submission. Though the majority of literature available does mention how to overcome the lacunae in the manuscript before considering resubmission in another journal, none addresses the mental agony and setback the author faces and the way to overcome this setback. Every author should develop immunity and also be adequately mentally prepared to overcome this misery.

Changes in health-related quality of life in common variable immunodeficiency: an eight-year journey, including the COVID-19 pandemic.

BACKGROUND: Personalized medicine requires the assessment of the impact of health care interventions on Health-Related Quality of Life. RESEARCH DESIGN AND METHODS: We run an observational study of HRQoL in 140 CVID patients with biannual assessments over 8 years using a disease-specific tool, the CVID_QoL, and the GHQ questionnaires. Factors influencing changes in HRQoL scores were identified using multiple linear regression models with a stepwise procedure. RESULTS: Infections frequency, female gender, and chronic enteropathy were associated with worse global CVID_QoL scores. The presence of permanent organ damage and older age contributed to the perception of being at risk of health deterioration, while chronic enteropathy was associated with fatigue. The presence of permanent organ damage was also associated with perceived difficulties in usual activities. The frequency of infections was the main risk factor for difficulties in long-term planning and perceptions of vulnerability. Before COVID-19, improved HRQoL scores were associated with reduced respiratory infections and changes in immunoglobulin replacement route and setting. The COVID-19 pandemic caused a sudden deterioration in all HRQoL dimensions, and a further deterioration in the emotional dimension was observed during the pandemic period. Patients who died during the study had worse CVID_QoL scores at all time points, confirming that HRQoL performance is strongly related to patient outcome. CONCLUSIONS: Periodic HRQoL assessments are needed to capture relevant issues that change over time in patients affected by long-term chronic conditions such CVID, possibly identifying areas of intervention.

The Impact of Cost of Living on the Quality of Life of Cystic Fibrosis Patients: A Study in Greece.

Introduction Cystic fibrosis (CF) leads to the impairment of multiple essential organs and systems in the human body. The objective of this study was to analyze the financial consequences of having cystic fibrosis (CF) on patients, evaluate their general state of health, and specifically investigate the impact of living expenses on their quality of life. Methods The data were collected using three tools and a form for personal information entry. The first questionnaire was employed to quantify fluctuations in patients' cost of living. The Greek variant of the Short Form Questionnaire-36 (SF-36) and the Greek version of the Cystic Fibrosis Quality of Life (CFQoL) were implemented to assess quality of life. Statistical significance was set at p < 0.05, and analyses were conducted using SPSS statistical software. Results The study obtained a response rate of 93.2%, with 105 participants consenting to and effectively finishing the questionnaire. The mean age of the patients was 32.1 years, with 46.7% being female and 53.3% being male. Medication was being administered to 46.7% of the patients. The condition incurred an average cost of 767€ in the preceding semester. The maximum cost was 1007€. Patients with a higher monthly family income and those who were taking medication exhibited superior physical performance and functional capacity. Conclusion The research emphasizes that implementing causative treatment and minimizing hospitalizations can potentially enhance life satisfaction. The findings suggest possible approaches to enhance the quality of life in people with cystic fibrosis, in conjunction with the implementation of novel or enhanced treatment modalities.

Identification of risk groups for advanced liver fibrosis in the general population using the Fibrosis-3 index.

Background and Aim: We conducted a study using the Fibrosis-3 (FIB-3) index, which is the established age-independent index of fibrosis in nonviral liver disease and addresses the limitations of the FIB-4 index in older age group, to assess the liver fibrosis risk among diverse demographic groups in the general population. Methods: We analyzed 31 327 individuals who underwent health examinations between 2013 and 2020 and investigated the distribution of the FIB-3 index by age group. In addition, we examined the age distribution of the FIB-3 index stratified by background factors, such as sex, body mass index (BMI), alcohol consumption habits, and the presence or absence of fatty liver. Results: In terms of age-specific distribution, the FIB-3 index remained below 1.5 in >90% of cases until the age of 50 years but exceeded 1.5 beyond the age of 50 years, in approximately 30% among those aged 70 years. Notably, the FIB-3 index above 31 years old was significantly higher in men than in women. Among the different BMI categories, individuals with BMI < 18.5 exhibited the highest prevalence of fibrosis. Habitual drinkers had a higher proportion with FIB-3. index ≥1.5, and some had FIB-3 index ≥2.5, raising the suspicion of advanced hepatic fibrosis. No distinct association was identified between the FIB-3 index and the presence of fatty liver. Conclusions: The FIB-3 index was useful for identifying cases of advancing hepatic fibrosis in a health checkup population. Liver fibrosis progresses with age in the general population, especially among men, those with low BMI, and habitual drinkers.

Association between volatile organic compounds exposure and periodontitis: A representative cross-sectional study.

AIM: Periodontitis is one of the most common oral diseases and a major cause of tooth loss in adults. Environmental pollution is closely associated with the prevalence of periodontitis. However, few studies have focused on the association between volatile organic compounds (VOCs) and periodontitis. This cross-sectional study aims to examine whether exposure to VOCs is associated with periodontitis, based on data from the National Health and Nutrition Examination Survey (NHANES, 2011-2014). MATERIALS AND METHODS: We analysed data on blood VOC levels, periodontitis and related covariates from 2772 participants of the NHANES. The association between the blood VOCs and periodontitis was analysed using weighted logistic regression analysis, the restricted cubic spline (RCS) model and the weighted quantile sum (WQS) regression model. Interaction tests and mediation analysis were also conducted. RESULTS: After adjusting for covariates, for each natural constant-fold increase in 1,4-dichlorobenzene, the odds of having periodontitis increased by 16% (odds ratio = 1.16; 95% confidence interval: 1.08-1.24, p < .001). WQS regression model indicated that 1,4-dichlorobenzene contributed the most to the association between VOC co-exposure and periodontitis. Mediation analysis further revealed that total bilirubin levels mediated the association between 1,4-dichlorobenzene and the prevalence of periodontitis, accounting for 4.32%. In addition, the positive association between o-xylene and periodontitis was more pronounced in the <65-year-old group. CONCLUSIONS: This study has provided relatively little evidence to demonstrate a specific link between VOCs and periodontitis. Nonetheless, exposure to VOCs remains a non-negligible public health concern, and further research is required to investigate the association and potential mechanisms of action between VOCs and periodontitis.

Social support and physical activity: does general health matter?

BACKGROUND: Physical activity levels remain suboptimal in older adults. Exploration of potentially modifiable factors such as social support is needed to inform the development and implementation of patient-oriented physical activity interventions for older adults. The impact of general health on the relationship between social support and physical activity is not well understood. We aimed to determine the association between social support and self-reported physical activity in a study of community-dwelling older adults. In addition, we examined whether self-reported general health mediates the relationship between social support and self-reported physical activity. METHOD: This cross-sectional study analyzed baseline data collected as part of a randomized controlled trial comparing a digital physical activity intervention, which included social support features, with a tablet-based educational control. Adults ≥ 60 years of age were enrolled at 2 sites. Self-reported general health, social support, physical activity, and sociodemographic characteristics and comorbid conditions were assessed. Pearson and point-biserial correlations were computed to evaluate the relationship between physical activity and general health, social support, and sociodemographic features. Social support (exposure), general health (mediator), and physical activity (outcome) were incorporated into a mediation model. RESULTS: Among 181 participants (mean age of 70.1 years), significant correlations were found between physical activity and both general health and social support (r = -0.19 and r = 0.21, respectively; both p < 0.01). General health significantly mediated the relationship between social support and physical activity (unstandardized ß coefficient 416.9; 95% confidence interval 96.4, 842.0). CONCLUSIONS: Augmentation of social support, particularly when coupled with other modes of health promotion to improve personal wellbeing, may be a valuable component of physical activity promotion programs. Further longitudinal research is needed to clarify the potential mechanistic pathways linking social support, general health, and physical activity to inform development of evidence-based physical activity interventions for older adults and improve downstream health-related outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, ClinicalTrials.gov identifier NCT03538158 . Registered May 25, 2018.

Coming to Grips With Benign Prostate Enlargement or Prostate Cancer in Contemporary Japan: Readings From a Cancer-Self.

This article explores how a group of 35 Japanese men comprehend and verbalize the somatic experience embedded in dealing with benign prostate enlargement, or disquiet/discomfort of developing prostate cancer. Grounded in an adaptation of the sexual scripts theorizing, a set of in-depth, semistructured individual interviews were conducted through a LINE-app videocall from 2021 to 2023. Outcomes of interview were analyzed through a conversational approach, and presented by using three axes: the body, gender, and sexuality. An understanding of the Japanese-civilized-self has rendered somatic knowing problematic and pretended ignorance a strategy to deal with conversations about a condition involving the genitals and body waste. The body refers to a cancer-self who copes with ignorance of the prostate's anatomy and physiology, the-mechanics-of-urine, and medication/treatment side-effects. Gender is concerned with a cancer-self who grapples with an ailment that "emasculates the self," and the feminization of care as well as infantilization at medical facilities. Sexuality implies a cancer-self who bears scripts related to asexuality, medication/treatments that affect libido and penile erections, and a tarnished sexual reputation as a "heterosexual man" because prostate stimulation has been associate with homosexuality.

Exploring the association of self-rated oral health with self-rated general and mental health among older adults in a resource-poor context: Insights for advancing Sustainable Development Goal 3.

INTRODUCTION: Older adults in Ghana have been disproportionately affected by oral health issues such as caries and periodontitis. This situation calls for comprehensive attention within health and healthcare policies, due to the established connections between oral health and other aspects of health and well-being in high-income countries, including physical and mental health. However, there is a significant gap in the literature when it comes to exploring the association of oral health with physical and mental health in resource-constrained settings like Ghana. METHODS: To address this void, we collected a cross-sectional sample comprising older adults aged 60 and above (n = 1073) and analyzed self-rated health measures to investigate the relationship between oral health and general and mental health in Ghana. RESULTS: The results of our logistic regression analysis revealed a significant association: older adults who reported poor oral health were more likely to rate their general (OR = 5.10; p < .001) and mental health (OR = 4.78, p < .001) as poor, compared to those with good oral health, even after accounting for demographic and socioeconomic variables. CONCLUSIONS: Based on these findings, we discuss the policy implications of our findings, especially in the context of advancing Sustainable Development Goal 3 in Ghana and other resource-constrained settings.

Association of back pain with all-cause and cause-specific mortality among older men: a cohort study.

OBJECTIVE: We evaluated whether more severe back pain phenotypes-persistent, frequent, or disabling back pain-are associated with higher mortality rate among older men. METHODS: In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from 6 sites in the United States. The primary back pain measure used baseline and Year 5 back pain questionnaire data to characterize participants as having no back pain, nonpersistent back pain, infrequent persistent back pain, or frequent persistent back pain. Secondary measures of back pain from the Year 5 questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific death. RESULTS: After the Year 5 exam, during up to 18 years of follow-up (mean follow-up = 10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95% CI = 1.11-1.45). No association was evident after further adjustment for health-related factors, such as self-reported general health and comorbid chronic health conditions (fully adjusted HR = 1.00; 95% CI = 0.86-1.15). Results were similar for cardiovascular deaths and other deaths, but we observed no association of back pain with cancer deaths. Secondary back pain measures, including back-related disability, were associated with increased mortality risk that remained statistically significant in fully adjusted models. CONCLUSION: Although frequent persistent back pain was not independently associated with risk of death in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality rate. Future investigations should evaluate whether improvements in disabling back pain affect general health and well-being or risk of death.

Low energy intake and nutritional maladaptation in terminal stage IV periodontitis.

AIM: Impairment of masticatory function in elderly patients with terminal dentition due to stage IV periodontitis (TDS4P) may lead to lower nutritional intake. The study aimed to report the dietary intake and nutrition status of elderly patients with TDS4P and compare them with those of the elderly Chinese population and the Chinese Dietary Reference Intakes (DRIs). MATERIALS AND METHODS: Fifty-one consecutive subjects (≥55 years old) with TDS4P were enrolled. Average dietary intake was evaluated based on a 3-day 24-h dietary recall (24HR) and food frequency questionnaire (FFQ). The daily intake of fresh vegetables and fruits, dietary energy as well as macro and micronutrients were calculated and compared with matched national data and the Chinese DRIs. Nutritional status was assessed by Short-Form Mini-Nutritional assessment. RESULTS: Of the subjects, 19.6% (95% CI: 7.2%-28.1%) were at risk of malnutrition. The mean daily energy intake was 1517.4 kcal (95% CI: 1400.5-1634.3) for males and 1110.7 kcal (95% CI: 1001.5-1219.9) for females, which were very low compared with both the national data and the DRIs. Females derived a higher percentage of energy from fat. The mean daily intake of vegetables was 151.4 g (95% CI: 128.1-174.8) by FFQ and 130.9 g (95% CI: 104.6-157.3) by 24HR. Both results were significantly lower than the national reports (95% CI: 310.3-340.1) and the DRIs (300-450 g). Insufficient micronutrient intake, especially vitamins A, C and E, was also found. CONCLUSIONS: Elderly subjects with TDS4P had a lower daily energy intake, vegetable and fruit consumption and essential macro and micronutrient intake. More studies are needed to clarify the impact of periodontitis and tooth loss/replacement on nutrition and healthy ageing.