Selenium status is independently related to bone mineral density, FRAX score, and bone fracture history: NHANES, 2013 to 2014.

Selenium is an essential trace mineral element for humans. Although previous in vitro and animal studies have reported the vital role of selenium in bone, the results of the relationship between the selenium status and bone health were inconsistent in epidemiological studies. The risk of selenium deficiency is negligible for U.S. general population, however, the relationship between selenium status and bone health has never been surveyed in a nationally representative sample. In this study, we analyzed the data of 2983 adults (aged ≥40 years) in the National Health and Nutrition Examination Survey (NHANES) 2013-2014 to investigate the association among three markers of the selenium status (measured from whole blood, serum, and dietary intake), total spine and femur bone mineral density (BMD), and FRAX scores, and history of bone fractures. We found a one-unit increase in the ln-whole-blood selenium level was correlated with an increase in the total femur BMD of 0.064 g/cm2 (S.E. = 0.025; P = 0.022) in all participants and 0.086 g/cm2 (S.E. = 0.031; P = 0.013) in menopausal women. Additionally, a one-unit increase in the ln-selenium intake amount was associated with an increase in the total femur BMD of 0.014 g/cm2 (S.E. = 0.007; P = 0.043) in all participants. We also found that the dietary and whole-blood selenium statuses were negatively associated with the FRAX score, while levels of all the three selenium biomarkers were negatively associated with a history of bone fractures. In conclusion, increased selenium status is correlated with an increased total femur BMD, decreased FRAX scores, and a reduced incidence of previous bone fractures in the U.S. representative survey of adults. Further study is warranted to clarify the causal inference.

Legionnaires' disease caused by Legionella longbeachae in Taiwan, 2006-2010.

The aim of the present study was to investigate the epidemiology of Legionnaires' disease (LD) caused by Legionella longbeachae in Taiwan during 2006-2010. A total of six cases were identified prospectively, accounting for 1.6% of all laboratory-confirmed LD cases and 4.4% of culture-positive LD cases. All six cases occurred between April and August. The male to female ratio was 0.5. These six LD patients had a higher median age than those with LD due to Legionella pneumophila. Four of the six patients presented with pleural effusion and five survived the infection episode. Only two patients had a potential soil contact history prior to LD onset. The patients resided in divergent geographical areas without a common exposure history. The individual genomic DNA banding patterns of the six L. longbeachae isolates analyzed by pulsed-field gel electrophoresis (PFGE) were unique, supporting the hypothesis that the L. longbeachae infections occurred sporadically.

Efficacy of narrowband ultraviolet phototherapy on renal pruritus.

AIMS AND OBJECTIVES: To test the efficacy of narrowband ultraviolet B phototherapy in reducing renal pruritus. BACKGROUND: Renal pruritus is a disabling symptom affecting approximately 50% of patients undergoing maintenance haemodialysis. Managing refractory pruritus can be a great challenge for healthcare providers and patients as well. For patients who do not respond to conventional treatments, ultraviolet B phototherapy is considered the treatment of choice. Few investigators, however, have studied the efficacy of narrowband ultraviolet B phototherapy in this condition. DESIGN: The study was based on a quasi-experimental design with repeated measures. METHODS: A convenience sample of 42 haemodialysis patients with pruritus was recruited from haemodialysis units of a general hospital in Taipei, Taiwan. Two groups were created according to the dates of haemodialysis. The intervention participants received narrowband ultraviolet B phototherapy three times a week for two weeks. The control participants were maintained on their prior pruritus treatment. The pruritus intensity was measured with a numerical rating scale at baseline and on alternating days for seven times. Data were collected during the year 2008. RESULTS: The generalised estimating equation showed statistically significant group-by-time interactions in pruritus intensity. Using the control group as the reference group and baseline as the reference time, the intervention group had significantly lower pruritus intensity than the control group: 3·14 (p < 0·001) at time seven, 1·71 (p < 0·001) at time six and 1·24 at time five (p < 0·001). The group-by-time interactions were statistically significant after four sessions of narrowband-UVB irradiation. CONCLUSION: The study findings support the efficacy of narrowband ultraviolet B phototherapy in alleviating renal pruritus. RELEVANCE TO CLINICAL PRACTICE: Clinicians may consider prescribing phototherapy for haemodialysis patients who have intractable renal pruritus and do not respond to conventional treatments.

Impact of spiritual and religious activity on quality of sleep in hemodialysis patients.

BACKGROUND: Sleep disorders are common in hemodialysis (HD) patients. This study examined the relationship between quality of sleep (QoS) and religious/spiritual activity in HD patients. METHODS: The study subjects were 861 HD patients from 14 dialysis clinics in Taiwan. QoS and religious/spiritual activity were evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Royal Free Questionnaire respectively. RESULTS: There was no difference in clinical parameters between the good and poor sleepers. Although total scores of religious and spiritual activity did not correlate with global PSQI score, patients who held strong 'spiritual' beliefs reported more problems in 'sleep disturbances', while those who exercised religious beliefs more strongly reported less trouble in 'daytime dysfunction'. CONCLUSION: There is no significant correlation between QoS and religious/spiritual activity globally. However, the spiritual and religious activity did associate with different components of QoS.

Sexual dysfunction in peritoneal dialysis patients.

BACKGROUND/AIMS: Sexual dysfunction in patients undergoing peritoneal dialysis (PD) is highly prevalent, but studies addressing this issue are scarce. This cross-sectional study aims to evaluate sexual dysfunction and the determinants among PD patients. METHODS: All chronic PD patients in 8 PD centers were asked to complete a self-reported questionnaire - the International Index of Erectile Function (IIEF) for men and the Index of Female Sexual Function (IFSF) for women - so that sexual function could be assessed. They also answered the Beck Depression Inventory (BDI) to measure depressive symptoms. RESULTS: Among 294 patients invited for study, 54 men (mean age 48.8 +/- 10.8 years) and 45 women (mean age 43.6 +/- 7.4 years) were willing to and completed the sexual function questionnaires. The median IIEF score in the men was 56.25. The prevalence of erectile dysfunction, identified by the score in erectile domain of IIEF

Impact of near-death experiences on dialysis patients: a multicenter collaborative study.

BACKGROUND: People who have come close to death may report an unusual experience known as a near-death experience (NDE). This study aims to investigate NDEs and their aftereffects in dialysis patients. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 710 dialysis patients at 7 centers in Taipei, Taiwan. PREDICTOR: Demographic characteristics, life-threatening experience, depression, and religiosity. OUTCOMES: NDE and self-perceived changes in attitudes or behaviors. MEASUREMENTS: Greyson's NDE scale, Royal Free Questionnaire, 10-Question Survey, Ring's Weighted Core Experience Index, and Beck Depression Inventory. RESULTS: 45 patients had 51 NDEs. Mean NDE score was 11.9 (95% confidence interval, 11.0 to 12.9). Out-of-body experience was found in 51.0% of NDEs. Purported precognitive visions, awareness of being dead, and "tunnel experience" were uncommon (<10%). Compared with the no-NDE group, subjects in the NDE group were more likely to be women and younger at life-threatening events. Both frequency of participation in religious ceremonies and pious religious activity correlated significantly with NDE score in patients with NDEs (P < 0.01 and P = 0.01, respectively). The NDE group reported being kinder to others (P = 0.04) and more motivated (P = 0.02) after their life-threatening events than the no-NDE group. LIMITATIONS: Determining the incidence of NDEs is dependent on self-reporting. Many NDEs occurred before the patient began long-term dialysis therapy. Causality between NDE and aftereffects cannot be inferred. CONCLUSIONS: NDE is not uncommon in the dialysis population and is associated with positive aftereffects. Nephrology care providers should be aware of the occurrence and aftereffects of NDEs. The high occurrence of life-threatening events, availability of medical records, and accessibility and cooperativeness of patients make the dialysis population very suitable for NDE research.

The association of higher depressive symptoms and sexual dysfunction in male haemodialysis patients.

BACKGROUND: The prevalence of sexual dysfunction among male haemodialysis patients is high. Sexual dysfunction is composed of both physiological and psychological factors. However, the role of psychological depression is still obscure. METHODS: A multicentre cross-sectional study of 411 male haemodialysis patients was conducted to define the determinants of sexual dysfunction. Mid-week pre-dialytic biochemical and haematological parameters were obtained. All patients were required to complete three questionnaires by themselves: (i) the International Index of Erectile Function (IIEF, Chinese version); (ii) the Beck Depression Inventory (BDI, Chinese version) and (iii) the 36-item Short Form Health Survey Questionnaire (SF-36, Taiwan Standard Version 1.0). RESULTS: In total, 154 male patients completed the IIEF questionnaire. Their mean age was 50.2 +/- 10.7 years. A linear multivariable regression analysis demonstrated advanced age, diabetes and the presence of depressive symptoms to be independently associated with sexual dysfunction. Subjects with sexual dysfunction had significantly lower quality of life scores. CONCLUSIONS: The presence of depressive symptoms, highly prevalent in haemodialysis patients, is an independent factor of sexual dysfunction in male haemodialysis patients. In a comprehensive approach to the management of sexual dysfunction, a thorough evaluation of psychological depression must be included.

Sexual dysfunction in female hemodialysis patients: a multicenter study.

BACKGROUND: Sexual function is one aspect of physical functioning. Sexual dysfunction, no matter the etiology, could cause distress. In female hemodialysis patients, sexual problems have often been neglected in clinical performance and research. METHODS: We conducted this study by use of self-reported questionnaires. A total of 578 female hemodialysis patients in northern Taiwan were included in this study. Demographic data, comorbid diseases, medications in use, biochemical, and hematologic parameters were analyzed. All patients were asked to complete by themselves three questionnaires: (1) the Index of Female Sexual Function (IFSF) to assess sexual function; (2) the Beck Depression Inventory (BDI) (Chinese version) to rate the severity of depressive symptoms; and (3) the 36-item Short Form Health Survey Questionnaire (SF-36, Taiwan Standard Version 1.0) to survey their quality of life. RESULTS: A total of 138 female patients were enrolled into further analysis. The mean age was 48.7 +/- 11.2 years old. The mean IFSF score was 24.5 +/- 9.3. Age, BDI score, and serum triglyceride levels were the independent factors of dysfunction in each sexual functional dimension. Patients with higher IFSF scores had significantly higher scores in physical functioning and mental health (P= 0.007 and 0.018, respectively). Patients with higher intercourse satisfaction had significantly higher general health scores (P= 0.001). CONCLUSION: Sexual dysfunction is frequent in the female hemodialysis population. It is strongly associated with increasing age, dyslipidemia, and depression. The subjects with sexual dysfunction had poorer quality of life. The diagnosis and treatment of sexual dysfunction should be included in the clinical assessment.