Relationship between home hazards and falling among community-dwelling seniors using home-care services.

BACKGROUND: Evidence linking home hazards to falls has not been well established. The evidence-based approach to fall-risk assessment in longitudinal studies becomes difficult because of exposures that change during follow-up. We conducted a cohort study to determine the prevalence of hazards and to resolve whether they are linked to the risk of falls among 959 seniors receiving home-care services. METHODS: A home hazards assessment was completed at entry and every six months thereafter using a standardized form. The adjusted (for a number of confounding factors) relationship between home hazards and falls was estimated using a survival model taking into account updated time-varying exposures and multiple events. Falls leading to a medical consultation were examined as a secondary outcome, hypothesized as a measure of severity. FINDINGS: Home environmental hazards were found in 91% of homes, with a mean of 3.3 risks per individual. The bathroom was the most common place for hazards. The presence of hazards was significantly associated with all falls and fall-related medical consultations, and showed relatively constant effects from one fall to another. IMPLICATIONS: The current study is innovative in its approach and useful in its contribution to the understanding of the interaction between home environmental hazards and falls. Our results indicate that inattention to changes in exposure masks the statistical association between home hazards and falls. Each environmental hazard identified in the home increases the risk of falling by about 19%. These findings support the positive findings of trials that demonstrate the effectiveness of this home hazard reduction program, particularly for at-risk people.

Risk factors for falling among community-dwelling seniors using home-care services: an extended hazards model with time-dependent covariates and multiple events.

The identification of risk factors for falls in longitudinal studies becomes difficult because of exposures that change during the follow-up and also because individual subjects may experience an event more than once. These issues have been neglected and improper statistical techniques have been used. The typical approaches have been to report the proportion of fallers or the time to first fall. Both avoid the underlying assumption of independence between events and discard pertinent data. We review the existing methods and propose a Cox hazards extension. We exemplify it in the study of potential risk factors associated with all falls in 959 seniors. Finally, we compare the results of the proposed Wei, Lin, & Weissfeld (WLW) method with those of several other techniques. Stable exposure variables measured at baseline and updated time-varying exposures include socio-demographic characteristics, BMI, nutritional risk, alcohol consumption, home hazards, gait and balance, and medications. Results demonstrate that the usual methods of analyzing risk factors for falling are inappropriate, as they produce considerable biases relative to the WLW model using time-dependent covariates. Results also show that modeling for first events may be inefficient, given that the risk of occurrence varies between falls.

Evaluation of acute skin toxicity of breast radiotherapy using thermography: Results of a prospective single-centre trial.

PURPOSE: Radiotherapy is a common adjuvant treatment of breast cancer. Acute radiation-induced dermatitis is a frequent side effect. We hypothesized whether it is possible to capture the increase of local temperature as a surrogate of the inflammatory state induced by radiotherapy. We designed a prospective, observational, single-centre study to acquire data on temperature rise in the treated breast during the course of radiotherapy, establish a possible association with the occurrence of dermatitis and investigate the predictive value of temperature increase in future occurrences of radiation-induced dermatitis. PATIENTS AND METHODS: All patients presenting for neoadjuvant or adjuvant radiotherapy during the course of breast cancer treatment at the university hospital of Martinique were considered for inclusion. Every week, patients were examined by two trained investigators for the occurrence of radiation-induced dermatitis, graded based on Radiotherapy Oncology Group, Common Terminology Criteria for Adverse Events v.4.0 and Wright scales. A frontal thermal image of torso was taken in strictly controlled conditions, with a calibrated TE-Q1 camera (Thermal Expert, i3systems, Daejeon, Korea). We studied temperature differences between the irradiated breast or thoracic wall and the contralateral area. For each thermal picture, we measured the difference in maximum temperature as well as the difference in minimum temperature and the difference in the average temperature in the considered area. We studied the evolution of these parameters over time week after week, measuring the maximum recorded difference and its correlation to acute radiation dermatitis intensity. RESULTS: Sixty-four consecutive patients were included. For all patients, we noticed an increase of temperature during the course of radiotherapy. Difference in maximum, minimum and average temperature was higher between the two breasts of patients with a radiation-induced dermatitis grade 2 or above compared to patients with no or mild dermatitis. Higher temperatures were also significantly associated with an increased sensation of discomfort, as recorded by questionnaire (P<0.05). CONCLUSION: As expected from the inflammatory phenomena involved in radiation-induced dermatitis, a noticeable increase in temperature during the course of radiotherapy was seen in all patients. Furthermore, high-grade radiation-induced dermatitis was strongly associated with an additional increase in local temperature, which is probably linked to the intense inflammatory reaction. Lastly, with a 1.4°C threshold set beforehand, it is possible to anticipate the occurrence of radiation-induced dermatitis, with interesting positive and negative predictive values of 70% and 77%, respectively in our population. We note that these results need to be confirmed in a dedicated study.

Curative brachytherapy for prostate cancer in African-Caribbean patients: A retrospective analysis of 370 consecutive cases.

PURPOSE: Prostate cancer is the most frequent malignancy in African-Caribbean men, a population sharing common genetic traits with African-American (AA) but presenting also genomic and epidemiologic specificities. Despite socioeconomic disparities with French mainland, all patients were treated within the French state-financed equal-access health care system. In this study, we report biochemical outcomes of patients treated by brachytherapy in our department from 2005 to 2014 in an African-Caribbean population. METHODS AND MATERIALS: Three hundred seventy consecutive patients receiving 125I brachytherapy as a curative treatment for early-stage (localized) disease between 2005 and 2014 were recorded. Selected patients presented with low-risk disease: initial prostate-specific antigen (PSA) <10 ng/mL, clinical stage ≤ T2c, and Gleason score <7. Patients with intermediate risk of recurrence were also included on a case-to-case basis with prostate-specific antigen <15 or Gleason score 7 (3 + 4). Biochemical failure free-survival was defined according to the American Society for Radiation Oncology nadir+2 definition. RESULTS: The 3-year and 5-year biochemical failure free-survival for the entire cohort were 98.3% and 91.6%, respectively. For patients with low- and intermediate-risk disease, the 5-year BBFS rates were 92.1% and 90.8%, respectively. In univariate and multivariate analyses, only Gleason score (<7 vs. 7; p =  0.030 vs. p < 0.05) was a significant predictor of biochemical failure. The overall rate of late and acute Grade 2 or higher genitourinary toxicity was 12.6% and 10.3%. CONCLUSIONS: In this large single-center series, brachytherapy achieved excellent rates of medium-term biochemical control in both low and selected intermediate-risk localized prostate cancer in African-Caribbean patients. Brachytherapy seems to be an excellent choice of treatment, with excellent outcomes and limited morbidity for African-Caribbean populations.

Variations in sucrose and ABA concentrations are concomitant with heteroblastic leaf shape changes in a rhythmically growing species (Quercus robur).

In rhythmically growing woody species such as common oak (Quercus robur L.), stem growth is discontinuous and a bud forms at regular intervals at the shoot apex. These buds are composed of different types of leaves: laminate, aborted lamina and scale. The change in heteroblastic leaf shape from laminate to aborted lamina leaves is regarded as one of the events marking shoot growth arrest. To better understand the determinism of heteroblastic leaf shape change and thus, of rhythmicity, we studied morphogenetic events during the early days of the second flush of growth in oak, as well as changes in sucrose metabolism and abscisic acid (ABA) concentrations in control plants expressing the heteroblastic leaf shape change and in defoliated plants showing no heteroblastic leaf shape change and producing only laminate leaves. In control plants, the leaf shape change was underway on Day 5 of the second flush with the differentiation of the first two aborted lamina leaves. Sucrose concentration in the apices of control plants decreased between Days 3 and 5 during differentiation of the aborted lamina leaves. An inverse pattern was observed in defoliated plants, suggesting that sucrose acts as a signal triggering heteroblastic leaf shape changes. During the same period, acid cell wall invertase activity was high in young stem and laminate leaves of control plants, whereas the activity remained constant and low in the apices. If the laminate leaves were removed, the increase in apical sucrose concentration was proportionally higher than the decrease in apical acid vacuolar invertase activity, suggesting that, in the absence of young leaves, sucrose is imported to the apex. The sucrose concentration in the apex is therefore likely to be affected by trophic competition with the expanding laminate leaves. The decrease in apex sucrose concentration may be one of the mechanisms driving heteroblastic leaf shape change. Differentiation of aborted lamina leaves was followed by a decrease in the organogenic activity of the shoot apical meristem (SAM) between Days 7 and 9. High concentrations of ABA are associated with differentiation of aborted lamina and scale leaves and with low SAM organogenic activity. Shoot apical meristem organogenic activity remained high and ABA concentration in the apex remained low in defoliated plants producing only photosynthetic leaves. These results suggest that (1) ABA is involved in the gradual conversion of embryonic leaves to abnormal leaves, thereby regulating heteroblastic leaf shape changes and (2) changes in ABA concentration influence the intensity of SAM organogenic activity. Heteroblastic development and therefore rhythmic growth could be the result of competition between apices and laminate leaves, with competition first involving sucrose and thereafter ABA.

Prostate-specific antigen bounce after curative brachytherapy for early-stage prostate cancer: A study of 274 African-Caribbean patients.

BACKGROUND: Prostate cancer incidence in the African-Caribbean population ranks among the highest worldwide. We aim to evaluate the prostate-specific antigen (PSA) kinetics after brachytherapy, which so far remains unknown in this population. METHODS AND MATERIALS: From 2005 to 2013, 371 patients received (125)I brachytherapy of 145 Gy for early-stage prostate cancer. Eligibility criteria were cTNM ≤T2c, Gleason score ≤7, and initial PSA ≤15 ng/mL. Pretreatment androgen deprivation therapy was allowed. PSA bounce was defined as an increase of ≥0.4 ng/mL, lasting ≥6 months, followed by a decrease without any anticancer therapy. We examined PSA kinetics during followup. RESULTS: For the 274 patients with at least 24 months followup, median age was 62 years old (range, 45-76). Initial PSA was <10 ng/mL in 244 and 10-15 ng/mL in 30 patients; 40 received androgen deprivation therapy. With a median followup of 50 months (range, 24-125), PSA declined continuously in 168 (61%) patients, bounced in 87 (31%), and initially declined and then rose in 22 (8%) patients. Among these latter patients, 18 presented clinical recurrence. Mean bounce intensity was 2.0 ng/mL (median, 1.2; range, 0.4-12.4). Bounces occurred in average 12 months after brachytherapy. Patients with bounce were significantly younger: mean age 59 vs. 63 years old in patients without bounce, p <0.001. Bounce was also significantly associated with the immediate post-brachytherapy PSA, mean 4.0 among bounce cases vs. 2.9 among non-bounce cases, p < 0.001. Bounce was not associated with recurrence. CONCLUSIONS: PSA bounce in our African-Caribbean population seemed earlier and was more intense than described in other populations. Early increase of PSA should not be ascribed to treatment failure.

Anthropometric characteristics of Mohawk children aged 6 to 11 years: a population perspective.

OBJECTIVE: Recent studies have concluded that Native North American children have higher proportions of overweight and obesity than children from the general North American population. This study presents anthropometric data on a representative sample of children from the Mohawk Nation that can be used for comparison with other Native American populations. DESIGN: This is a cross-sectional study comparing distributions of anthropometric characteristics of Mohawk children to the corresponding age and gender data from the Second National Health and Nutrition Examination Survey (NHANES II). Weight, height, triceps and subscapular skinfold thickness, and waist and hip circumferences were measured in 527 children. SUBJECTS/SETTING: All children in grades 1 to 6 (aged 6 to 11 years) in the 3 elementary schools of 2 Mohawk communities in Canada, for whom parental consent was obtained, were enrolled in the present study. There were no exclusion criteria. With a participation rate of 83%, the 527 children enrolled in this study represent an unbiased sample of the population from 2 Mohawk territories. RESULTS: Compared with children studied in NHANES II, Mohawk children were similar in height and triceps skinfolds but were generally heavier, had thicker subscapular skinfolds, and had greater waist and hip circumferences. These differences were greater in older children. Mohawk children who had extreme-high weight values compared with their population means were heavier than their NHANES II counterparts. APPLICATIONS/CONCLUSIONS: Results indicated that, on average, Mohawk children seem to be slightly heavier than children in NHANES II. Except for those with extreme overweight values, Mohawk children show less variation of weight and body mass index than children in NHANES II. Finally, overweight Mohawk children seem to be more likely to carry their excess body fat truncally, compared with overweight children from NHANES II. Health practitioners working with Native American populations should be careful when assessing childhood obesity. Simple comparisons of weight or body mass index with NHANES standards may lead to inappropriate risk assessments.

Organizational and environmental determinants of the performance of public health units.

In the wake of the reform of the Quebec health care system in the early 1970s, thirty-two public health units (DSCs) were created. They were administratively and geographically integrated into short-term care hospitals throughout the province. This study aimed at determining: (1) the influence of environmental and organizational factors on the way in which those public health units carried out their mandate; (2) the influence of these same factors on their performance in terms of level of innovation and in terms of the fulfillment of their mandate as assessed by their main clients; and (3) the influence of their activities on their performance. Our results show that the most innovative units appear to be those that have directed a large part of their efforts toward research and that have maintained close ties with other institutions and agencies. The public health units main clients differ however on their perception of the DSCs' performance.

[Innovation in the Quebec's community health departments]. / L'innovation dans les départements de santé communautaire du Québec.

Following the reform of the health care system in Quebec at the beginning of the 1970s, 32 Community Health Departments (départements de santé communautaire or DSC) were created; these new organizations were administratively and physically integrated into 32 acute care hospitals throughout the province. Our study investigates to what extent variations in the implementation of DSCs and in the way they have fulfilled their mandate influence the degree of innovation of their practices. The results show that DSCs devoting greater efforts to research activities and to their relationships with other health care establishments and agencies achieve a higher level of innovation in their practices.

[Prior use of a telephone-nursing triage service by patients of emergency services]. / Le recours préalable à un service de triage téléphonique infirmier chez les usagers des services d'urgence.

OBJECTIVES: A province-wide telephone-nursing triage service was implemented in Quebec, Canada, in order, among other objectives, to decrease overcrowding in hospital emergency rooms. This study analyses prior use of Info-Sante CLSC telephone service by patients of emergency services. METHODS: Structured interviews were conducted with 850 patients of a general hospital emergency room and of walk-in medical clinics. Patients were recruited while waiting to see the physician between 8h and 23 h, 7 days a week, from November 1997 to June 1998. Information was collected on knowledge and use of the telephone-nursing triage service, health problem and perceived health status, information-seeking behaviour on health services, utilisation habits, social support, and socio-demographic characteristics. Interval estimates and multiple logistic regressions were performed. RESULTS: Of the patients who were aware of this service, 17,4% (CI(95)=0,14 - 0,20) had used it prior to their medical visit. Among these, 85,1% had received a recommendation to consult a doctor. Among the users who were at the hospital emergency room at the time of the study, 56,4% were advised to consult a walk-in clinic or a CLSC, 28,2% their family doctor and only 12,8% a hospital emergency room. The probability of prior recourse to the telephone nursing service is influenced significantly by the duration of the health problem (2-4 days versus<2 days: OR(adjusted)=2,03), new health problem (OR(adjusted)=1,98) and by the frequenting of walk-in clinics rather than hospital emergency rooms (OR(adjusted)=0,31). CONCLUSION: Despite a heightened awareness of the telephone-nursing triage service, few users of emergency services make use of it and, when they do, follow rather loosely the recommendation towards the type of service judged appropriate for their needs.

[Health promotion for immigrant women in Quebec]. / Promotion de la santé en faveur des femmes immigrant au Québec.

Over the past fifteen years, the Canadian population has undergone increasing cultural diversification. Many researchers have investigated the role of culture with respect to social and health services. Most studies confirm the fact that increased cultural diversification related to immigration challenges the public health system in many ways. Certain groups, such as economically challenged immigrant women, may pose even greater problems to the health system. While these individuals are in relatively good health upon arrival to Canada, there is a need to ensure that adequate health promotion as well as disease prevention strategies are instituted. It is important to examine the concepts of health promotion and disease prevention through a cultural perspective. Little research has been done in this area. Concepts of promotion and prevention as they are understood by immigrants may not always coincide with North American or European definitions. Therefore, it is essential to consider life conditions that surround potential health promotion and prevention behaviors of immigrants. Empowerment, economic integration and acculturation are among the many factors that need to be taken into account when studying immigrants' health promotion behavior. Here, we present a critical analysis of current knowledge in this field. This is followed by research recommendations aimed at facilitating the development of health promotion and prevention strategies that are appropriate to the needs of Canadian, and more specifically of immigrant women in Québec.

Content and methods of studies on the prevention and treatment of mental disorders in selected psychiatric journals.

Studies on psychiatric treatments published in 1986 were reviewed in five major psychiatric journals (Am. J. Psychiatry, Can. J. Psychiatry, Arch. Gen. Psychiatry, Am. J. Orthopsychiatry and Am. Acad. Child Psychiatry). Articles on prevention and treatment represent only 27% of the total of titles (194 out of 731 articles). The studies reviewed focus mostly on the treatment of adults, on psychoses, on the short term effect of treatment and on the effect of treatment rather than its process. Almost no information is published on the evaluation of the process or on the cost of treatment. Studies are for the most part original, but they tend to be studies without controls rather than randomized or non-randomized controlled trials. Interpretation of results rely essentially on statistical significance and almost no attention is paid to the evaluation of impact, in epidemiological terms, of the cause-effect relationship and to the clinical relevance of observed differences. Psychiatrists who read only a few major journals of psychiatry should get more information on therapeutic and preventive interventions in comparison to other components of clinical work and to clinical course of disease.

[Emigration of Quebec physicians: motivation for departure and return]. / L'émigration des médecins québécois: motifs de départ et de retour.

Since the 80's, outmigration of physicians from Quebec is steadily increasing. About 46 percent of outmigrating doctors explain their move by factors related to their occupational life (higher income, greater opportunity in the academic career, larger amount of resources devoted to the health care system). Nearly 40 percent relate their decision to personal factors (greater job opportunity for their wife/husband, quality of family life...). The factors linked to the context of the receiving place (political climate, linguistic regulations, income tax level...) play a minor role on the migration decision. As concerns the returning physicians, 80 percent explain their decision by personal factors. The factors linked to the occupational life have a lower role. It appears therefore that doctor outmigration from Quebec is not directly determined by manpower policies adopted by the Province during the last two decades, except the policies directly linked to the income level of professionals.

[Beyond the statistics: why are Quebec physicians emigrating?]. / Au-delà des statistiques: qu'en est-il de l'émigration des médecins québécois?

During the period 1986-1999, about 16% of the annual average number of active physicians in Quebec have left for the US or an other Canadian province. The absolute number was 2367. During the same period, 661 would have returned to Quebec. The majority of the outmigrating doctors were graduated from the anglophone university of the Province (although 44 percent are francophone) whereas the majority of the returning doctors were graduated from the 3 francophone universities of the Province. As a matter of fact, 78 percent of the returning doctors are francophone. The migration decision is equally linked to post-graduate training and occupational opportunities and job satisfaction. This feature should be related to an other: those who have returned to Quebec have had a geographic and occupational mobility level far lower than those who have not returned. Finally, it is noteworthy that there are significant differences between the doctors emigrating to the US and their colleagues going to an other Canadian province.

Blue light effects on rose photosynthesis and photomorphogenesis.

Through its impact on photosynthesis and morphogenesis, light is the environmental factor that most affects plant architecture. Using light rather than chemicals to manage plant architecture could reduce the impact on the environment. However, the understanding of how light modulates plant architecture is still poor and further research is needed. To address this question, we examined the development of two rose cultivars, Rosa hybrida'Radrazz' and Rosa chinensis'Old Blush', cultivated under two light qualities. Plants were grown from one-node cuttings for 6 weeks under white or blue light at equal photosynthetic efficiencies. While plant development was totally inhibited in darkness, blue light could sustain full development from bud burst until flowering. Blue light reduced the net CO(2) assimilation rate of fully expanded leaves in both cultivars, despite increasing stomatal conductance and intercellular CO(2) concentrations. In 'Radrazz', the reduction in CO(2) assimilation under blue light was related to a decrease in photosynthetic pigment content, while in both cultivars, the chl a/b ratio increased. Surprisingly, blue light could induce the same organogenetic activity of the shoot apical meristem, growth of the metamers and flower development as white light. The normal development of rose plants under blue light reveals the strong adaptive properties of rose plants to their light environment. It also indicates that photomorphogenetic processes can all be triggered by blue wavelengths and that despite a lower assimilation rate, blue light can provide sufficient energy via photosynthesis to sustain normal growth and development in roses.

Genetics in health care: an overview of current and emerging models.

BACKGROUND: With advances in genetic and genomic medicine, the optimal integration of genetic services into the health care system remains of major concern in many countries. OBJECTIVES: To review the current organisation of genetic services, mostly in Europe, North America and Australia, explore emerging service delivery models, and probe challenges inherent in the transition process. METHODS: We conducted a literature review of genetics in clinical practice: testing, diagnosis, counselling, and treatment. We examined the basic structures of genetic services, examples of integrated networks, and existing professional resources. We investigated services belonging traditionally in medical genetics as well as those developed for more common diseases. RESULTS: Multidisciplinary specialist clinics and coordinated services appeared to be key to delivering proper care in rare genetic disorders. For oncogenetics, neurogenetics and cardiogenetics, interprofessional collaboration between geneticists and other specialists seemed to be favoured. On the other hand, there was also a tendency toward the integration of genetic services directly into primary care. Among the most pressing challenges was the morphing of paediatric care into adult care. CONCLUSION: The coordination of activities between professionals in first-, second-, and third-line medical care is a primary objective calling for the reconfiguration of professional roles and responsibilities. This entails the forging of new relationships as well as an enhanced sharing of expertise and genetic information, including information regarding services. Barriers to overcome include the redistribution of roles, sharing of data and databases, and the lack of preparedness of non-genetics professionals and of the health care system in general.

Methods for non-stigmatic pollination in Trifolium repens (Papilionaceae): seed set with self- and cross-pollinations in vitro.

The stigma and style of Trifolium repens L. was successfully by-passed, and viable seed was obtained by placing pollen on a perforation made in either the ovary wall or in the base of the style. The application of pollen to the stump of the style also succeeded in producing viable seed. The presence of the calyx and corolla facilitated seed set in cultured florets. An incision made along the entire length of the ovary to permit pollen entry resulted in necrosis of the floret. Perforation of the ovary did not affect the yield of seeds obtained from stigmatic pollinations. Growth of pollen tubes was observed on wounded tissues and also within the style and cavity of the ovary. A mean yield of 20 embryos was obtained per 100 florets in non-stigmatic pollinations, whereas with stigmatic pollinations in vitro the yield was 148. Nonstigmatic pollinations also gave seeds when T. repens was self pollinated, which showed that the gametophytic system of self-incompatibility (SI) could be by-passed. With one genotype, self-pollination via the stigma failed, whereas embryos were obtained via non-stigmatic pollinations.

Pollination in vitro: effects on the growth of pollen tubes, seed set and gametophytic self-incompatibility in Trifolium pratense L. and T. repens L.

Growth of pollen tubes and seed set were compared after hand pollination in situ and in vitro in two self-incompatible species, Trifolium pratense and Trifolium repens. Adhesion of pollen grains to the stigma was greater in vitro for both species. After cross-pollination, in vitro culture gave a significant increase in the cumulative growth of pollen tubes in pistils of T. pratense compared to in situ conditions. After selfing in T. repens, pollen tube growth was significantly increased by in vitro culture of florets. Seed set after crossing in situ and in vitro was similar for both species. Seed set after selfing in vitro was not increased in T. pratense. Several genotypes of T. repens were classified as very good, good and poor selfers based on their capacity for seed set following selfing in situ. In vitro pollination increased self seed formation by 1.7-, 18.0- and 31.0-fold for each class, respectively. Ovules located nearest to the style were fertilized more often after selfing than after crossing.

What factors determine whether individuals found to have hypercholesterolaemia at mass screening accept advice to visit their physician.

OBJECTIVE: This study aims to identify the determinants of compliance with the recommendation to visit a physician for advice which was given to individuals whose cholesterolemia was > 6.2 mmol/l at mass screening for risk factors of cardiovascular diseases. METHODS: Data were collected from 1144 adults found to be hypercholesterolemic during a screening programme in 54 work sites and 29 public areas and contacted by phone two to six months later. Based on the Health Belief Model, perceived seriousness, perceived self-efficacy, and cues to action were measured. Potential determinants of compliance to the recommendation were examined using multivariate analyses. RESULTS: Mean compliance was 58.6%. For the perceived seriousness dimension of the Health Belief Model, personal history of CVD or risk factors, and prior awareness of cholesterol levels were important determinants. Those already treated for hypercholesterolemia comply twice as much as those who were aware and untreated. Among cues to action, higher cholesterol levels and hypertension are associated with greater compliance; however, smokers were less likely to comply. The dimension of perceived self-efficacy, as measured by ease of access to health services and prior success in eating habit modification, is also associated with compliance to the recommendation. Compliance increases significantly with age. For those previously aware of their elevated cholesterol level, variables representing perceived self-efficacy were no longer determinants. For those previously unaware of their elevated cholesterol level, variables representing CVD perceived threat do not influence compliance. CONCLUSION: The Health Belief Model appears to be an appropriate framework to the determinants of compliance with the recommendation to visit a doctor during mass screening.

Nutritional deficiencies and gastrointestinal disorders in the edentulous elderly: a literature review.

Many factors influence the food selection and nutritional status of elderly individuals. In this brief review, it is hypothesized that the functional status of dental prostheses is a prime determinant in the food selection, dietary fibre intake and prevalence of gastrointestinal disorders in edentulous elderly subjects.