Atypical work schedules are associated with poor sleep quality and mental health in Taiwan female nurses.

PURPOSE: To investigate the effects of shift work schedules on sleep quality and mental health in female nurses in south Taiwan. METHODS: This study recruited 1,360 female registered nurses in the Kaohsiung area for the first survey, and among them, 769 nurses had a rotation shift schedule. Among the 769 rotation shift work nurses, 407 completed another second survey 6-10 months later. Data collection included demographic variables, work status, shift work schedule, sleep quality (Pittsburgh Sleep Quality Index), and mental health (Chinese Health Questionnaire-12). RESULTS: Nurses on rotation shift had the poor sleep quality and mental health compared to nurses on day shift. The nurses on rotation shift had a relatively higher OR of reporting poor sleep quality and poor mental health (OR, 2.26; 95% CI, 1.57-3.28; and OR, 1.91; 95% CI, 1.39-2.63, respectively). Additionally, rotation shift nurses who had ≥2 days off after their most recent night shifts showed significantly improved sleep quality and mental health (PSQI decreased of 1.23 and CHQ-12 decreased of 0.86, respectively). Comparison of sleep quality between the first and second surveys showed aggravated sleep quality only in nurses who had an increased frequency of night shifts. CONCLUSION: Female nurses who have a rotation shift work schedule tend to experience poor sleep quality and mental health, but their sleep quality and mental health improve if they have ≥2 days off after their most recent night shifts. This empirical information is useful for optimizing work schedules for nurses.

Stability of miniplates and miniscrews used for orthodontic anchorage: experience with 492 temporary anchorage devices.

OBJECTIVES: The aim of this retrospective study was to evaluate systematically the potential factors that influence failure rates of temporary anchorage devices (TADs) used for orthodontic anchorage. MATERIALS AND METHODS: Data on 492 TADs (miniplates, pre-drilling miniscrews, and self-drilling miniscrews) in 194 patients were collected. The factors related to TAD failure were evaluated using univariate analysis and multivariate forward stepwise logistic regression analysis. RESULTS: There were no significant differences in failure rates among the TADs for the following variables: gender, type of malocclusion, facial divergency, implantation site (buccal, lingual, or crestal/midpalatal), location (anterior or posterior), method of force application (power chain or Ni-Ti coil spring), arch (upper or lower), type of soft tissue (attached gingiva or removable mucosa), and most of the cephalometric measurements that reflect dento-cranio-facial characteristics. An increased failure rate was noted for the self-drilling miniscrew type of TAD, TADs used for tooth uprighting, those inserted on bone with lower density, those associated with local inflammation of the surrounding soft tissue, those loaded within 3 weeks after insertion, and those placed in patients with greater mandibular retrusion. Failure rates of the self-drilling miniscrews installed by an oral surgeon and by an orthodontist did not differ significantly. CONCLUSIONS: Inflammation of soft tissue surrounding a TAD and early loading within 3 weeks after insertion were the most significant factors predicting TAD failure. Both orthodontists and oral surgeons who install orthodontic TADs must undergo sufficient training to achieve clinical excellence.

Hepatitis B virus infection among pregnant women in Taiwan: comparison between women born in Taiwan and other southeast countries.

BACKGROUND: Taiwan's national vaccination program has successfully decreased the prevalence of hepatitis B infection after twenty years of implementation and might be indirectly beneficial to the second generation. In this study, we compared the hepatitis B infection status of two groups: pregnant Taiwanese women and other Southeast Asian women, who because they had immigrated later in life to Taiwan by marriage to a Taiwanese man, had not been exposed to that vaccination program to evaluate the effect of hepatitis vaccination program on women of child-bearing age and further explored the potential impact of immigration on the hepatitis B public health policy in Taiwan. METHODS: Data was collected from 10,327 women born in Taiwan and 1,418 women born in other Southeast Asian countries, both groups receiving prenatal examinations at Fooyin University Hospital between 1996 and 2005. The results of serum hepatitis B s-Antigen (HBsAg) and hepatitis B e-Antigen (HBeAg) tests and other demographic data were obtained by medical chart review. RESULTS: The pregnant women from Taiwan had a higher HBsAg positive rate (15.5%) but lower HBeAg(+)/HBsAg(+) ratio (32.1%) than the women from other countries (8.9% and 52.4%). For those born before July, 1984, the period of no national vaccination program, Taiwanese women had a higher HBsAg positive rate than other Southeast Asian women (15.7% vs. 8.4%), but for women born after that day and before June 1986, the period of vaccination for high risk newborns, the HBsAg positive rates found to be slightly lower for Taiwanese women than for other Southeast Asian women (11.4% vs. 12.3%) and the difference was more significant (3.1% vs. 28.6%) after June 1986, the period of vaccination for all newborns. While the HBeAg(+)/HBsAg(+) ratios decreased with age in both groups, they were consistently higher in women from other Southeast Asian countries than in women born in Taiwan after age 20. CONCLUSION: In Taiwan, the neonatal vaccination program that was implemented in 1984 has successfully reduced hepatitis B infection among pregnant women in present day, and is likely to indirectly prevent hepatitis B infection in the next generation. However, the increasing number of pregnant women from other Southeast Asian countries without a national neonatal vaccination program or with a program that was introduced later than the one in Taiwan will likely lessen the positive impact of this program and should be further assessed.

Albumin and prealbumin may predict retinol status in patients with liver cirrhosis.

BACKGROUND/AIMS: Impaired retinol status may be associated with development of cirrhosis to hepatocellular carcinoma (HCC). Besides cirrhotic severity, retinol may be influenced by compromised nutrition status. This study investigated the interrelations among retinol, malnutrition, and severity of cirrhosis and further aimed to examine whether malnutrition proxies commonly measured in hospital would be useful to predict retinol concentrations in different cirrhosis stages. METHODOLOGY: Fifty patients with liver cirrhosis, but without HCC were classified into the three Child-Pugh stages. Nutrition assessment was performed and fasting plasma retinol was analyzed using high-pressure liquid chromatography. RESULTS: Plasma retinol concentrations were significantly reduced as cirrhotic stage progressed accordingly (p for trend < 0.05). Stratified by each Child-Pugh class, subjects having albumin < 3.5 g/dL, prealbumin < 15 mg/dL and transferrin < 200 mg/dL showed significantly lower retinol concentrations compared to their respective counterparts (p<0.05), except that all Child-Pugh C patients had prealbumin < 15 mg/dL or transferrin < 200 mg/dL. After adjusting for confounders, albumin < 3.5 g/dL (beta = -14.2, SE = 6.5, p=0.028) or prealbumin < 15 mg/dL, (beta = -34.0, SE = 7.6, p<0.001) was negatively associated with retinol levels; transferrin < 200 mg/dL however. was not related. CONCLUSIONS: Retinol status was independently associated with malnutrition defined by albumin and prealbumin in cirrhosis patients. These malnutrition indicators are routinely measured by laboratory devices available in hospitals and may be used for prediction of retinol status in patients in different stages.

Inadequate energy and excess protein intakes may be associated with worsening renal function in chronic kidney disease.

OBJECTIVES: Dietary energy and protein play important roles in chronic kidney disease (CKD). This study investigates the relationship between energy/protein intake status and renal function in CKD. DESIGN AND STUDY POPULATION: This cross-sectional study included 599 adult patients diagnosed with stage 3 to 5 CKD in nephrology and nutrition outpatient clinics in Taiwan. MAIN OUTCOME MEASURE: Energy and protein intakes were assessed using 24-h dietary recall. We recorded recommended calorie/protein amounts and renal function indices, glomerular filtration rate (GFR), creatinine, and blood urea nitrogen (BUN). Patients were categorized into three intake calorie/protein groups by a ratio of actual intake vs. recommended intake. High intake was defined as a ratio of actual intake/recommended intake > or = 110%, moderate intake as > or = 90% to <110%, and low intake as <90%. Data were analyzed by paired t test, one-way analysis of variance, least significant differences, and multiple linear regression. RESULTS: The energy and protein intakes in CKD patients were significantly higher and lower than recommended levels (P < .001). Low energy intake was significantly related to worsening GFR at increments of -4.41 mL/min/1.73 m(2), compared with moderate and high energy intake (P = .008); high protein intake was also associated with worsening GFR at increments of -3.50 mL/min/1.73m(2), compared with moderate and low protein intake (P < .001). Low energy intake and high protein intake were significantly positively correlated with elevations in creatinine and BUN. CONCLUSION: Lower energy and higher protein intakes than recommended may be associated with deteriorating renal function.

Validity of a Short Food Frequency Questionnaire Assessing Macronutrient and Fiber Intakes in Patients of Han Chinese Descent with Type 2 Diabetes.

Few food frequency questionnaires (FFQs) have been developed to assess diet in diabetes patients. This cross-sectional study examined the validity of a 45-item FFQ assessing the intake of macronutrients against three 24-h dietary recalls (24-HDRs) in Taiwan, and compared vegetable and fruit intakes with carotenoid biomarkers. We recruited 126 adults with type 2 diabetes who completed the FFQ and three 24-HDRs administered by a registered dietitian. We measured plasma carotenoids (α-carotene, ß-carotene and lutein) in 71 subjects. Partial Pearson correlation coefficients derived from the FFQs and three 24-HDRs and adjusted for energy were of 0.651, 0.587, 0.639 and 0.664 for protein, fat, carbohydrate and fiber, respectively. Cross-classification analysis revealed that 71.5⁻81% of the macronutrients and fiber were categorized into the same or adjacent quartiles by the FFQ and 24-HDRs. Bland⁻Altman plots revealed good agreement for energy/macronutrients/fiber across the range of intakes. Multiple linear regression of backward elimination revealed that tertile levels of dark- or light-colored vegetables obtained by the FFQ were significantly associated with plasma α-carotene and ß-carotene, but not lutein. Fruit consumption did not correlate with carotenoid biomarkers. In conclusion, this short FFQ provided a valid assessment of macronutrients and fiber intake in type 2 diabetes patients. Vegetable consumption estimated by the FFQ corresponded to plasma α-carotene and ß-carotene concentrations.

Admission time and outcomes of patients in a medical intensive care unit.

Studies have shown that weekend or night admissions to intensive care units (ICUs) are associated with increased mortality in critically ill patients. Our study aimed to evaluate the effects of admission time and day on patient outcomes in a medical ICU equipped with patient management guide-lines, and staffed by intensivists on call for 24 hours, who led the morning rounds on all days of the week but did not stay in-house overnight. The study enrolled 611 consecutive patients admitted to a 26-bed medical ICU in a university hospital during a 7-month period. We divided them into two groups, which we labeled as "office hours" (08:00-18:00 on weekdays) and "non-office hours" (18:00-08:00 on weekdays, and all times on weekends) according to their ICU admission times. The clinical outcomes were compared between the groups. The effects of admission on weekends, at night, and various days of the week on hospital mortality were also evaluated. Our results showed that there were no significant differences in ICU and hospital mortalities between patients admitted during office hours and those admitted during non-office hours (27.2% vs. 27.4%, p = 1.000; 38.9% vs. 37.6%, p = 0.798). The ICU length of stay, ICU-free time within 21 days, and length of stay in the hospital were also comparable in both groups. Among the 392 patients requiring mechanical ventilation, the ventilator outcomes were not significantly different between those in the office-hour group and the non-office-hour group. Multivariate logistic regression analyses showed that the adjusted odds of hospital mortality were not significantly higher for patients admitted to our ICU on weekends, at night, or on any days of the week. In conclusion, our results showed that non-office-hour admissions to our medical ICU were not associated with poorer ICU, hospital, and ventilator outcomes, compared with office-hour admissions. Neither were time of day and day of the week admissions to our ICU associated with significant differences in hospital mortality.

Correlations of dietary energy and protein intakes with renal function impairment in chronic kidney disease patients with or without diabetes.

Dietary energy and protein intake can affect progression of chronic kidney disease (CKD). CKD complicated with diabetes is often associated with a decline in renal function. We investigated the relative importance of dietary energy intake (DEI) and dietary protein intake (DPI) to renal function indicators in nondiabetic and diabetic CKD patients. A total of 539 Stage 3-5 CKD patients [estimated glomerular filtration rate (eGFR)<60 mL/min/1.73 m2 using the Modification of Diet in Renal Disease equation] with or without diabetes were recruited from outpatient clinics of Nephrology and Nutrition in a medical center in Taiwan. Appropriateness of DEI and DPI was used to subcategorize CKD patients into four groups:(1) kidney diet (KD) A (KD-A), the most appropriate diet, was characterized by low DPI and adequate DEI; (2) KD-B, low DPI and inadequate DEI; (3) KD-C, excess DPI and adequate DEI; and (4) KD-D, the least appropriate diet, excess DPI and inadequate DEI. Inadequate DEI was defined as a ratio of actual intake/recommended intake less than 90% and adequate DEI as over 90%. Low DPI was defined as less than 110% of recommended intake and excessive when over 110%. Outcome measured was eGFR. In both groups of CKD patients, DEI was significantly lower (p<0.001) and DPI higher (p=0.002) than recommended levels. However, only in the nondiabetic CKD patients were KD-C and KD-D significantly correlated with reduced eGFR compared with KD-A at increments of -5.63 mL/min/1.73 m2 (p = 0.029) and -7.72 mL/min/1.73 m2 (p=0.015). In conclusion, inadequate energy and excessive protein intakes appear to correlate with poorer renal function in nondiabetic CKD patients. Patients with advanced CKD are in need of counseling by dietitians to improve adherence to diets.

Pulpal inflammation and incidence of coronary heart disease.

Pulpal inflammation is primarily caused by coronal caries, and leads to root canal therapy (RCT). Chronic inflammation has been associated with various cardiovascular diseases. This study evaluates the association between pulpal inflammation (using RCT as a surrogate) and incident coronary heart disease (CHD). We report results among males from the Health Professionals Follow-Up Study (HPFS), excluding participants with prior cardiovascular disease or diabetes. We obtained RCT data from the HPFS cohort (n = 34,683). Compared to men without RCT, those with >/=1 RCT had a multivariate RR of 1.21 (95% CI 1.05-1.40) for CHD. The association was limited to dentists (RR = 1.38; 95% CI 1.14-1.67). There was no association among nondentists (RR = 1.03). Dental caries was not associated with CHD. The results suggest a possible modest association between pulpal inflammation and CHD.

Factors associated with quitting areca (betel) quid chewing.

OBJECTIVES: The purpose of this study was to provide useful data for a future abstinence project by identifying the factors related to quitting areca (betel) quid chewing. METHODS: The study was cross-sectional. Data on demographic variables, psychological factors and substance-use behaviors were collected via questionnaires from 326 participants. RESULTS: Multiple logistic regression analysis indicated that the areca/betel quid chewers who were less educated (OR = 0.58, 95% CI = 0.34-0.98) were least likely to try to give up. Among the chewers who tried to quit, those employed as full-time drivers (OR = 2.24, 95% CI = 1.14-4.39), who had drinking habits (OR = 2.41, 95% CI = 1.24-4.66), and who preferred to chew only betel quid wrapped with leaf (OR = 4.44, 95% CI = 1.99-9.90) were more likely to fail. Chewers who successfully quit had a higher internal health locus of control compared with those who failed to quit (one-point increments, OR = 0.94, 95% CI = 0.90-0.98). CONCLUSIONS: The results suggest that health educators and researchers can better influence people's chewing behavior if the importance of chewers' education level, job type, substance use (i.e. drinking habits, type of betel quid), and level of health locus of control are all taken into consideration when devising interventions.

Oral health and peripheral arterial disease.

BACKGROUND: Many studies have reported the association between poor oral health and coronary heart disease or stroke, but few of them evaluated peripheral arterial disease (PAD). Hence, in this study we examined the associations between oral health and PAD. METHODS AND RESULTS: In the prospective study of 45,136 eligible male health professionals free of cardiovascular diseases at baseline, we identified 342 cases of PAD during a 12-year follow-up period. We evaluated the association between different measures of oral diseases and the occurrence of PAD. Baseline number of teeth was not related to the risk of PAD, but cumulative incident tooth loss was significantly associated with elevated risk of subsequent occurrence of PAD. The relative risk for history of periodontal disease was 1.41 (95% CI, 1.12 to 1.77) and for any tooth loss during the follow-up period was 1.39 (95% CI, 1.07 to 1.82), controlling for traditional risk factors of cardiovascular disease. Among men with a history of periodontal diseases, the relative risk of tooth loss increased to 1.88 (95% CI, 1.27 to 2.77), whereas no association was found between tooth loss and PAD among those without periodontal diseases (RR, 0.92; 95% CI, 0.61 to 1.38). We further explored the potential induction period of tooth loss and found that tooth loss in the previous 2 to 6 years was most strongly associated with PAD. CONCLUSIONS: We found that incident tooth loss was significantly associated with PAD, especially among men with periodontal diseases. The results support a potential oral infection-inflammation pathway.

Survivin expression predicts poorer prognosis in patients with areca quid chewing-related oral squamous cell carcinoma in Taiwan.

Survivin, a recently characterized novel member of the inhibitor of apoptosis (IAP) family, is not detectable in most differentiated normal adult tissues but is expressed in a wide range of cancer tissues. Its expression in cancer has been correlated with poor prognosis, cancer progression and drug resistance. We immunohistochemically examined the expression of survivin in 62 cases of oral epithelial dysplasia (ED) and 96 cases of oral squamous cell carcinoma (SCC). Cytoplasmic survivin staining was detected in 60 of the 62 (97%) ED specimens and 94 of the 96 (98%) SCC specimens but not in adjacent normal oral mucosal tissues. The labeling index (LI) for survivin protein significantly increased from ED (32.3+/-16.3%) to SCC samples (49.4+/-28.5%) (p<0.001). In addition, the mean LI for ED cases with further malignant transformation into SCC (45.6+/-8.8%) was higher than those without malignant transformation (30.1+/-16.3%) (p=0.008). No significant correlation was found between the survivin expression and the patients' age, sex, oral habit, cancer location, or STNM status in SCC cases. Kaplan-Meier curves showed oral SCC patients with high survivin expression (LI>25%), advanced stage, larger tumor size, or positive lymph node metastasis had significantly shorter overall survival (p=0.014, 0.012, 0.005 and 0.011, respectively by log-rank test) than others. The associations remained significant after adjusting for age. These results indicate that survivin protein expression may be an important early event in oral carcinogenesis and predicts unfavorable prognosis for oral SCC. Furthermore, the unique expression of survivin in cancer cells but not in most normal adult tissues suggests that modulation of survivin protein expression may provide a novel strategy for the therapy of oral SCC.

The association between tooth loss and the self-reported intake of selected CVD-related nutrients and foods among US women.

OBJECTIVES: Many studies have reported associations between oral health and cardiovascular diseases; poor nutritional status due to impaired dentition status has been suggested as a mediator. Our objective is to evaluate the associations between tooth loss and the self-reported consumption of fruits and vegetables and selected CVD-related nutrients. METHODS: A total of 83,104 US women who completed a food frequency questionnaire (FFQ) in 1990 and 1994 and reported number of natural teeth in 1992, were included in a cross-sectional analysis relating dietary intake to number of natural teeth. A longitudinal analysis was also conducted to evaluate whether tooth loss in 1990-1992 was associated with change in diet between 1990 and 1994. RESULTS: After adjusting for age, total calorie intake, smoking and physical activity, edentulous women appeared to have dietary intake associated with increased risk for CVD, including significantly higher intake of saturated fat, trans fat, cholesterol and vitamin B12, and lower intake of polyunsaturated fat, fiber, carotene, vitamin C, vitamin E, vitamin B6, folate, potassium, vegetables, fruits, and fruits excluding juices compared with women with 25-32 teeth. In the longitudinal analyses, women who lost more teeth were more likely to change their diet in ways that would potentially increase risk for development of CVD. They also tended to avoid hard foods, such as raw carrot, fresh apple or pear. CONCLUSIONS: Women with fewer teeth have unhealthier diets such as decreased intake of fruits and vegetables, which could increase CVD risk. Diet may partially explain associations between oral health and cardiovascular disease.

The association between rotating shift work and increased occupational stress in nurses.

PURPOSE: The aim of this study was to investigate whether rotating shift work increases occupational stress in nurses. METHODS: This study measured shift work scheduling and occupational stress by using the Effort-Reward Imbalance model with self-reported questionnaires in a sample of 654 female nurses. RESULTS: Overcommitment risk was higher in nurses who worked rotating shifts than in those who worked day/non-night shifts (OR, 2.16; 95% CI, 1.03-4.66). However, an effort/reward imbalance was not directly associated with work schedules (OR, 1.88; 95% CI, 0.87-4.35). Among nurses working rotation rotating shifts, those who had 2 days off after their most recent night shifts showed an alleviated risk of overcommitment (OR, 0.52; 95% CI, 0.32-0.82), but those who had worked for at least one series of 7 consecutive work days per month had an increased risk of effort/reward imbalance (OR, 2.75; 95% CI, 1.69-4.48). Additionally, those who had little or no participation in planning working hours and shift scheduling and worked overtime at least three times per week during the preceding 2 months tended to have high stress. CONCLUSIONS: The nurses who worked rotating shifts tended to experience work-related stress, but their stress levels improved if they had at least 2 days off after their most recent night shift and if they were not scheduled to work 7 consecutive days. These empirical data can be used to optimize work schedules for nurses to alleviate work stress.

Periodontal disease, tooth loss, and incidence of ischemic stroke.

BACKGROUND AND PURPOSE: Periodontal and other infections have been suggested as potential risk factors for stroke. This study evaluates periodontal disease and tooth loss as risk factors for ischemic stroke. METHODS: The study population consisted of 41 380 men who were free of cardiovascular disease and diabetes at baseline. Periodontal disease history was assessed by mailed validated questionnaires. During 12 years of follow-up, stroke incidence was assessed and subclassified by use of medical history, medical records, and imaging reports. Hazard ratios (HRs) were adjusted for age, amount smoked, obesity, alcohol, exercise, family history of cardiovascular disease, multivitamin use, vitamin E use, profession, baseline reported hypertension, and hypercholesterolemia. Sex and socioeconomic status were inherently controlled for by restriction. Confounding variables were updated in the analyses for each 2-year follow-up interval. RESULTS: We documented 349 ischemic stroke cases during the follow-up period. Men who had < or =24 teeth at baseline were at a higher risk of stroke compared to men with > or =25 teeth (HR=1.57; 95% CI, 1.24 to 1.98). There was little evidence of an increased risk with recent tooth loss during follow-up. A modest association was seen between baseline periodontal disease history and ischemic stroke (HR=1.33; 95% CI, 1.03 to 1.70). Addition of dietary factors to the model changed the HR only slightly. CONCLUSIONS: Our results suggest that periodontal disease and fewer teeth may be associated with increased risk of ischemic stroke.

Lifestyle and psychosocial factors associated with chronic periodontitis in Taiwanese adults.

BACKGROUND: The development of chronic periodontitis (CP) is a multifactorial process and variation in severity cannot be explained by just a few risk factors. The aims of this study were: 1) to explore the lifestyle and psychosocial factors of CP patients and 2) to estimate the proportion of total CP cases attributable to one or more risk factors considered. METHODS: A case-control study of 250 cases of CP patients and 250 controls were matched by age (within 3 years) and gender. Complete dental examinations were performed based on the clinical criteria for CP for both groups. Structured questionnaires were conducted to collect lifestyle and psychosocial factors. Multivariate logistic regression was applied to assess the association between risk factors and chronic periodontitis. RESULTS: Conditional multivariable logistic regression analysis showed that toothbrushing frequency (odds ratio [OR]: 5.77, if rarely; OR: 3.50, if once a day), mental illness (OR: 5.32, if Chinese Health Questionnaire scores were > or = 6), and smoking (OR: 3.93, if pack years smoked was > 21) are significantly and independently associated with chronic periodontitis. In addition, all these variables reflected a dose-response effect (P trend = <0.001, 0.004, and 0.005, respectively). CONCLUSIONS: For Taiwanese adults, 36.10% of CP cases were presumably attributable to toothbrushing frequency, mental illness, and smoking. These three factors should be the first priorities in establishing a preventive program to improve the periodontal health status.

The association between tooth loss and coronary heart disease in men and women.

OBJECTIVES: This paper evaluates the relation of tooth loss to incidence of coronary heart disease in two large cohort studies. METHODS: Participants included 41,407 men and 58,974 women free of any cardiovascular diseases at baseline. We recorded 1,654 incident coronary heart disease events (562 fatal events) among men during 12 years of follow-up and 544 events (158 fatal events) among women during 6 years of follow-up. RESULTS: After controlling for important cardiovascular risk factors, compared to men with 25-32 teeth at baseline, men with 0-10 teeth had a significantly higher risk of coronary heart disease (relative risk [RR]= 1.36; 95 percent confidence interval [CI]=1.11, 1.67). The relative risk increased to 1.79 (95% CI=1.34, 2.40) when limited to fatal events. Women with 0-10 teeth were also at increased risk of coronary heart disease compared to women with 25-32 teeth (RR=1.64; 95% CI=1.31, 2.05). The association was similar for fatal events (RR= 1.65; 95% CI=1.11, 2.46). The association between number of teeth and incidence of coronary heart disease was similar between men with and without a history of periodontal disease, and there was no significant association between tooth loss during follow-up and coronary heart disease. CONCLUSIONS: This study showed a significant association between number of teeth at baseline and risk of coronary heart disease and the mechanisms to explain this association should be further clarified.

Tooth loss and dietary intake.

BACKGROUND: Several studies have reported that impaired dentition status is associated with poor nutritional intake. However, most of these studies are cross-sectional and thus are unable to clarify the temporal sequence. METHODS: We assessed the longitudinal relation between tooth loss and changes in consumption of fruits and vegetables and of nutrients important for general health among 31,813 eligible male health professionals. RESULTS: Subjects who lost five or more teeth had a significantly smaller reduction in consumption of dietary cholesterol and vitamin B12, greater reduction in consumption of polyunsaturated fat and smaller increase in consumption of dietary fiber and whole fruit than did subjects who had lost no teeth. Men who had lost teeth also were more likely to stop eating apples, pears and raw carrots. CONCLUSIONS: The results support the temporal association between tooth loss and detrimental changes in dietary intakes, which could contribute to increased risk of developing chronic diseases. PRACTICE IMPLICATIONS: Dietary evaluation and recommendations can be incorporated into dental visits to provide a greater benefit to patients.

Plasma polyunsaturated fatty acids and periodontal recovery in Taiwanese with periodontitis: a significant relationship.

BACKGROUND: Plasma levels of polyunsaturated fatty acids (PUFAs) are different before and after periodontal treatment. Asians and Westerners have significantly different baseline levels of plasma PUFAs. However, no Asian study has reported the effects of nonsurgical treatment on the correlation between periodontal condition and plasma levels of PUFAs. We analyzed whether recovery from periodontitis was correlated with the elevation of plasma fatty acids 3 months after the nonsurgical intervention and with no recommended supplements. DESIGN: Thirty-five Taiwanese patients with periodontitis were recruited. Probing pocket depths (PPDs) and clinical attachment levels (CALs) were measured at baseline and 3 months after the nonsurgical treatment. Plasma levels of fatty acids were determined using gas chromatography. Differences and correlations between plasma fatty acid composition and periodontitis severity at baseline and 3 months after treatment were determined. RESULTS: Twenty-six patients completed the study. At the baseline, PPDs were negatively correlated with plasma n-3 PUFAs (r=-0.52, p<0.01), but at 3 months post intervention, periodontitis severity had declined and the weight percentages of n-3 PUFAs, DPA, and DHA were significantly (p=0.019, 0.005, and 0.037, respectively) higher. The recovery percentages of CALs were positively and significantly correlated with plasma ΔPUFAs and the percentage of Δn-3 PUFAs in ΔPUFAs (r=0.42 and 0.45, respectively; p<0.05 for both). CONCLUSIONS: We conclude that a higher weight percentage of n-3 PUFAs in total PUFAs was related to the recovery of CALs 3 months after the nonsurgical periodontal treatment. However, no such relationship was found for PPDs.

Effects of marital status and shift work on family function among registered nurses.

This study aims to assess the interactive effect of marital status and shift work on family function. A population-based sample of 1,438 nurses between the ages of 20-45 yr was recruited from Taiwan during the period from July 2005 to April 2006 using a mailed questionnaire. The self-administered questionnaire contained information about demographic data, work status, shift work schedule, and the Family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve) Scale, to evaluate family function. Compared to day shift nurses, non-night and rotation shift nurses had 1.53- and 1.38-fold (95% CI=1.09-2.14 and 1.01-1.88) risk to have poor family function after adjusting for other covariates. Married nurses, by contrast, had a 0.44-fold (95% CI=0.29-0.66) risk to have poor family function compared to single nurses. In addition, married nurses who worked non-night or rotation shifts had a significantly higher percent of poor family function than those married nurses working day shifts; however, similar results were not replicated in single nurses. We concluded that shift work and marital status could influence family function.