Kerosene lighting contributes to household air pollution in rural Uganda.

The literature on the contribution of kerosene lighting to indoor air particulate concentrations is sparse. In rural Uganda, kitchens are almost universally located outside the main home, and kerosene is often used for lighting. In this study, we obtained longitudinal measures of particulate matter 2.5 microns or smaller in size (PM2.5 ) from living rooms and kitchens of 88 households in rural Uganda. Linear mixed-effects models with a random intercept for household were used to test the hypotheses that primary reported lighting source and kitchen location (indoor vs outdoor) are associated with PM2.5 levels. During initial testing, households reported using the following sources of lighting: open-wick kerosene (19.3%), hurricane kerosene (45.5%), battery-powered (33.0%), and solar (1.1%) lamps. During follow-up testing, these proportions changed to 29.5%, 35.2%, 18.2%, and 9.1%, respectively. Average ambient, living room, and kitchen PM2.5 levels were 20.2, 35.2, and 270.0 µg/m3 . Living rooms using open-wick kerosene lamps had the highest PM2.5 levels (55.3 µg/m3 ) compared to those using solar lighting (19.4 µg/m3 ; open wick vs solar, P=.01); 27.6% of homes using open-wick kerosene lamps met World Health Organization indoor air quality standards compared to 75.0% in homes using solar lighting.

Assessing the prevalence of malnutrition with the Mini Nutritional Assessment (MNA) in a nationally representative sample of elderly Taiwanese.

OBJECTIVE: The study was to determine whether the Mini Nutritional Assessment (MNA) could be used as a tool to effectively identify malnourished elderly in a non-Caucasian population. DESIGN: The study was a part of a population-based multistage random sample survey. SETTING: In-home face-to-face interviews. PARTICIPANTS: Randomly selected 1583 men and 1307 women, 65 years or older, in Taiwan. MEASUREMENTS: Assessing nutritional risk status of participants with the Mini Nutritional Assessment. RESULTS: The prevalence of malnutrition is 1.7% in elderly men and 2.4% in elderly women, 65 years or older. The proportion at risk of malnutrition is 13.1%. CONCLUSION: To the best of our knowledge, this is the first study to apply the MNA to estimate the prevalence of malnutrition in the elderly in a nationally representative sample. Results suggest that the MNA can identify malnourished elderly in a non-Caucasian population. However, it appears that the functionality of the instrument can be improved by adapting population-specific anthropometric cutoff standards.

Internalized HIV stigma, bullying, major depressive disorder, and high-risk suicidality among HIV-positive adolescents in rural Uganda.

BACKGROUND: Studies conducted in sub-Saharan Africa suggest a high prevalence of depression and suicidality among adolescents living with HIV (ALWH). This is an important public health issue because depression is known to compromise HIV treatment adherence. However, the drivers of depression and suicidality in this population are unclear. We conducted a cross-sectional study to estimate the associations between internalized stigma, bullying, major depressive disorder, and suicidality. METHODS: We conducted a cross-sectional survey between November 2016 and March 2017, enrolling a consecutive sample of 224 ALWH aged 13-17 years. We collected information on demographic characteristics, internalized HIV-related stigma (using the six-item Internalized AIDS-Related Stigma Scale), bullying victimization (using the nine-item Social and Health Assessment Peer Victimization Scale), major depressive disorder [using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)], and suicidality (also using the MINI-KID). We fitted multivariable logistic regression models to estimate the associations between stigma, bullying, major depressive disorder, and suicidality. RESULTS: Thirty-seven participants (16%) had major depressive disorder, 30 (13%) had suicidality, and nine (4%) had high-risk suicidality. Ninety-one participants (41%) had high levels of internalized stigma, while 97 (43%) reported two or more bullying events in the past year. In multivariable logistic regression models, major depressive disorder had a statistically significant association with bullying (AOR = 1.09; 95% CI 1.00-1.20; p = 0.04); while suicidality (low, moderate, high risk) had statistically significant associations with both bullying (AOR = 1.09; 95% CI 1.01-1.17; p = 0.02) and stigma (AOR = 1.30; 95% CI 1.03-1.30; p = 0.02). CONCLUSIONS: Among ALWH in rural Uganda, stigma and bullying are strongly associated with major depressive disorder and suicidality. There is a need to incorporate psychological interventions in the mainstream HIV care to address these challenges for optimal management of HIV among ALWH.

C1 Posterior Arch Flare Point: A Useful Landmark for Fluoroscopically Guided C1-2 Puncture.

BACKGROUND AND PURPOSE: The C1-2 intrathecal puncture is routinely performed when lumbar puncture is not feasible. Usage has steadily decreased in part because of the perceived high risk of injury to the cervical cord. Up to this point, vague fluoroscopic guidelines have been used, creating uncertainty about the actual needle location relative to the spinal cord. We present a novel osseous landmark to aid in C1-2 intrathecal puncture, corresponding to the posterior spinal cord margin on lateral fluoroscopic views. This landmark, which we have termed the "flare point," represents the triangular "flaring" of the posterior C1 arch at its junction with the anterior arch. MATERIALS AND METHODS: Cervical spine CT myelograms were reviewed. High-resolution axial images were reformatted into the sagittal plane, and maximum-intensity-projection images were created to simulate a lateral fluoroscopic view. Tangential lines were drawn along the superior cortices of the anterior and posterior C1 arches, with the point of intersection used to approximate the flare point. Chart review was performed for all C1-2 punctures using the flare point technique in the past 3 years. RESULTS: Forty-two cervical myelograms were reviewed. The average flare point was 0.2 ± 0.5 mm posterior to the dorsal spinal cord margin. In 37/42 subjects, the flare point was localized posterior to the spinal cord. Targeting by means of the flare point was used in 16 C1-2 punctures without complications. CONCLUSIONS: The C1 posterior arch flare point accurately approximates the dorsal spinal cord margin on myelography. Targeting between the flare point and the spinolaminar line, at the mid-C1-2 interspace, allows safe and optimal needle positioning.

Household water insecurity, missed schooling, and the mediating role of caregiver depression in rural Uganda.

BACKGROUND: School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children's water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations. METHOD: We conducted a population-based, cross-sectional study of female household heads (N = 257) and their children ages 5-17 (N = 551) in the rural regions surrounding the town of Mbarara, in southwestern Uganda. We used multivariable linear regressions to estimate the association between water insecurity and missed schooling. We then assessed the extent to which the association was mediated by caregiver depression. RESULTS: Among children, water insecurity had a statistically significant association with the number of missed school days (a standard deviation increase in water insecurity resulted in 0.30 more missed school days in the last week). The estimated association was partially mediated by caregiver depression. When stratified by sex, this mediating pathway remained significant for boys, but not among girls. CONCLUSIONS: Water insecurity is a risk factor for missed schooling among children in rural Uganda. Caregiver depression partially mediated this relationship. Also addressing caregiver mental health in water insecure families may more fully address the needs of sub-Saharan African families and promote educational participation among youth.

Effects of fat intake on body composition and hepatic lipogenic enzyme activities of hamsters shortly after exercise cessation.

Effects of fat intake on body composition and lipogenic enzyme activities were examined in hamsters. Forty-two female hamsters were randomly divided into two groups of 21 each. One group had access to voluntary disc running; the other group was sedentary. All were fed a low-fat, high-carbohydrate diet. After 30 d, seven hamsters from each group were killed and all running activity was discontinued. Remaining hamsters were separately assigned to two groups of seven and fed either a low-fat or high-fat diet for 7 d and then killed. Voluntary running increased food intake and weight gain and reduced body fat (52%). Cessation of exercise greatly enhanced body fat gain. High-fat diet enhanced weight gain. Increased energy intake during postexercise period appeared to cause enhanced body fat gain. The high-fat diet suppressed lipogenic enzyme activities. Serum triglyceride, total cholesterol, and HDL cholesterol levels were not affected by exercise or cessation of exercise.

Somatic, endocrine, and serum lipid changes during detraining in adult hamsters.

Effects of abrupt discontinuation of chronic exercise on body composition and serum lipid, insulin, and glucagon concentrations were examined in adult female hamsters. Thirty-six hamsters (100 to 120 g) were randomly allotted to two groups of 18 each for an 84-day study. One group served as controls and were sedentary throughout the experimental period; another group had access to voluntary running on horizontal discs during the first 42 days of the experimental period. Six hamsters from each group were killed at the end of the exercise period and at 12 and 42 days after retirement. Results showed that hamsters engaged in high levels of voluntary activity increased food intake by about 10 to 20% and this effect persisted for about 10 days after retirement. Voluntary running resulted in a 60% reduction in body fat content and a 30% decrease in serum triglyceride levels. Exercise was also associated with an increase in body cholesterol level, a decrease in glucagon concentration, and a suggestive increase in serum insulin level. Increased food consumption and changes in serum insulin and glucagon may reflect compensatory adjustments to increased energy expenditure of exercise. Discontinuation of exercise resulted in a reversal of exercise effects on body fat, body cholesterol, and serum triglyceride levels.

Metabolic alterations induced by voluntary exercise and discontinuation of exercise in hamsters.

A study was conducted to determine the possible biochemical mechanisms responsible for the rapid increase in body weight and body fat during the early phase of exercise-retirement. Thirty-two adult female hamsters were allotted to four groups of eight each. One group served as sedentary controls. Other groups had access to voluntary disc-running during a 35-day period of the 76-day experimental period and were retired from running for 0, 8, and 41 days, respectively, before the termination of the experiment. Disc-running reduced body fat and body weight. Discontinuation of running led to a fast gain of body fat and body weight. Disc-running decreased serum triacylglycerol levels but had no effect on serum cholesterol levels. Serum high-density lipoprotein-cholesterol concentration was significantly elevated at 8 days after retirement but was not changed during exercise or at 41 days after retirement. Exercise or discontinuation of exercise had no effect on serum T-3 or T-4 levels. The rate of fatty acid synthesis and the activities of malic enzyme and fatty acid synthetase in the liver were increased during running and during the early phase of retirement. Liver glucose-6-phosphate dehydrogenase activity was increased at 8 days after discontinuation of running. Disc-running enhanced food intake which was not reduced to the sedentary level until about 10 days after retirement, suggesting a delay in adaptation to reduced energy expenditure. Results of the present study suggest that both the delay in food intake adaptation and the enhanced lipogenic activity play a role in the rapid gain of body weight and body fat during the early phase of exercise-retirement.

Effects of soy polysaccharide on postprandial plasma glucose, insulin, glucagon, pancreatic polypeptide, somatostatin, and triglyceride in obese diabetic patients.

The effect of soy polysaccharide on postprandial plasma glucose levels was examined in a crossover experiment involving seven obese noninsulin dependent maturity-onset diabetic patients fed a standard meal without or with 10 g of this fiber source. Postprandial concentrations of plasma insulin, glucagon, pancreatic polypeptide, and somatostatin were measured to explore the mechanism of action. The effect on plasma triglyceride levels was also studied. Supplementation of soy polysaccharide significantly enhanced return of serum glucose levels towards fasting level during the latter half of the meal test. Addition of soy polysaccharide had no effect on plasma insulin levels but appeared (p greater than 0.05) to lessen postprandial increases in glucagon and pancreatic polypeptide levels while it raised somatostatin levels. Soy polysaccharide significantly reduced the rise of postprandial plasma triglyceride levels. The changes in plasma glucagon, pancreatic polypeptide, and somatostatin levels may have been instrumental in the observed postprandial glucose and triglyceride effects.

Effects of soy polysaccharide on gastrointestinal functions, nutrient balance, steroid excretions, glucose tolerance, serum lipids, and other parameters in humans.

A diet-controlled study with a cross-over design was conducted to determine the effect of soy polysaccharide on gastrointestinal functions, nutrient balance, steroid excretion, blood lipid levels, postprandial serum glucose response, and other blood parameters in healthy male human subjects. A total of 14 college students was selected to participate in the study on a voluntary basis and each served as his own control. The study had two 17-day feeding periods. During the first feeding period, half of the subjects served as controls, the other as experimentals. During the second feeding period, treatments were crossed. When serving as controls, subjects consumed a low-fiber basal diet; when serving as experimentals, the same diet was supplemented with 25 g/day of soy polysaccharide. Blood samples taken at the beginning (days -1 and 1) and at the end (days 17 and 18) of each period revealed no changes in serum lipid levels or other blood parameters by soy polysaccharide supplementation. Nutrient balance and fecal transit studies revealed a significant increase in fecal wet weight and fecal water content, but no changes in total dry weight, fecal neutral steroid, bile salt, protein, and mineral contents. Glucose tolerance tests conducted during each period revealed that addition of soy polysaccharide to the glucose solution significantly reduced the reactive hypoglycemia at 180 min. Results of the present study suggest that in healthy male subjects, supplementation of soy polysaccharide can result in an increase in wet fecal content and possibly some improvement in glucose tolerance response.

Morbidity and cost implications of inadequate hemodialysis.

American hemodialysis patients have short lifespans, frequent hospitalizations, and aggregate Medicare inpatient expenditures of $4 billion/year. Dose of dialysis, as quantified by the parameter, Kt/V, corresponds strongly with survival and is estimated to be inadequate (Kt/V <1.2) in one fourth of patients. However, little is known about the morbidity and cost implications of inadequate dialysis. We sought to determine the independent relationship between dose of dialysis and (1) number of hospitalizations, (2) hospital days, and (3) Medicare inpatient reimbursements. We randomly selected 674 patients from all 22 hemodialysis units in northeast Ohio and examined hospitalizations, hospital days, and Medicare inpatient reimbursements for a 6-month interval following a 90-day quantification of dialysis dose. Every 0.1 decrease in Kt/V was independently associated with more hospitalizations (rate ratio, 1.11; 95% confidence interval [CI], 1.07 to 1.15), increased hospital days (rate ratio, 1.12; 95% CI, 1.03 to 1.22), and higher Medicare inpatient expenditures ($940; 95% CI, $450 to $1,440) after adjustment for patient age, sex, race, cause of renal failure, number of years on dialysis, and number of comorbid conditions. We estimate that increasing dialysis doses to a Kt/V of 1.2 for all patients nationally may decrease Medicare inpatient expenditures by $150 million annually. In conclusion, inadequate dialysis dose is independently associated with increased hospitalizations, hospital days, and Medicare inpatient expenditures. Improving dialysis adequacy may both improve patient morbidity and lessen health care costs.

Outcomes of penetrating keratoplasty with imported donor corneas.

PURPOSE: To analyze factors influencing the surgical success of penetrating keratoplasty and long-term graft survival when using imported donor corneas. METHODS: Sixty-three donor corneas imported to Taipei from the Cincinnati Eye Bank from July 1992-June 1993 were used for penetrating keratoplasty. The corneal endothelium was examined using specular microscopy on arrival in Taiwan. The endothelial morphology and endothelial cell density (ECD) were compared with the photograph of the same cornea taken in the United States. The relationships of the surgical success rate with donor age, death to enucleation time, death to surgery time, and ECD were analyzed. The long-term graft survival and ECD of clear grafts were analyzed 4 years after surgery. RESULTS: On specular microscopic examination. the imported corneas showed diminished endothelial reflection, blurred cellular borders, and increased dark areas, which were markedly different from the pictures of the corneal endothelium taken in the United States. The average ECD before transportation was 2,525+/-267/mm2 and decreased to 1,934+/-250/mm2 after transportation (p < 0.001), with an average endothelial cell loss of 590+/-247/mm2. The overall surgical success rate was 89% and did not correlate with any of the donor factors tested except death to surgery time. The surgical success rate decreased when the time from death to surgery was >7 days (p = 0.05), mainly because of poor reepithelialization. Four years after surgery, 24 grafts remained clear. The ECD had decreased by 72+/-5% in the clear grafts. CONCLUSIONS: Our findings show that endothelial changes in imported donor corneas do occur after transportation, but the surgical success rate may not be influenced significantly if the penetrating keratoplasty is performed within 7 days after donor death. However, the ECD in the clear grafts 4 years after surgery is low.

Clinical evaluation of ciprofloxacin ophthalmic solution in the treatment of refractory bacterial keratitis.

Ciprofloxacin is a fluoroquinolone antimicrobial agent inhibiting bacterial DNA gyrase, with good in vitro and in vivo activity against many Gram-positive and Gram-negative ocular pathogens. It has low toxicity, low resistance rate and low minimum inhibitory concentration. The purpose of this study was to evaluate the efficacy of ciprofloxacin in treating bacterial keratitis refractory to conventional therapy. Thirty patients with smear-proven bacterial ulcers were treated by conventional therapy. Of these, cultures were positive in 28 (93.3%) patients. Pseudomonas aeruginosa was isolated in 13 (46.4%) patients, nontuberculous mycobacteria in nine (32.1%) and other bacteria in six (21.4%). Fifteen patients (50%) were cured with conventional therapy. Four patients (13.3%) underwent surgery due to impending corneal perforation. Eleven patients were shifted to ciprofloxacin therapy because of poor results with conventional treatment. Of these, eight (72.7%) patients were treated successfully. No adverse events were encountered except a white crystalline precipitate in two cases which resolved spontaneously after discontinuation of therapy. In view of its effectiveness and low toxicity, ciprofloxacin should be considered in treating bacterial keratitis which is refractory to conventional therapy.

Orally active microtubule-targeting agent, MPT0B271, for the treatment of human non-small cell lung cancer, alone and in combination with erlotinib.

Microtubule-binding agents, such as taxanes and vinca alkaloids, are used in the treatment of cancer. The limitations of these treatments, such as resistance to therapy and the need for intravenous administration, have encouraged the development of new agents. MPT0B271 (N-[1-(4-Methoxy-benzenesulfonyl)-2,3-dihydro-1H-indol-7-yl]-1-oxy-isonicotinamide), an orally active microtubule-targeting agent, is a completely synthetic compound that possesses potent anticancer effects in vitro and in vivo. Tubulin polymerization assay and immunofluorescence experiment showed that MPT0B271 caused depolymerization of tubulin at both molecular and cellular levels. MPT0B271 reduced cell growth and viability at nanomolar concentrations in numerous cancer cell lines, including a multidrug-resistant cancer cell line NCI/ADR-RES. Further studies indicated that MPT0B271 is not a substrate of P-glycoprotein (P-gp), as determined by flow cytometric analysis of rhodamine-123 (Rh-123) dye efflux and the calcein acetoxymethyl ester (calcein AM) assay. MPT0B271 also caused G2/M cell-cycle arrest, accompanied by the up-regulation of cyclin B1, p-Thr161 Cdc2/p34, serine/threonine kinases polo-like kinase 1, aurora kinase A and B and the downregulation of Cdc25C and p-Tyr15 Cdc2/p34 protein levels. The appearance of MPM2 and the nuclear translocation of cyclin B1 denoted M phase arrest in MPT0B271-treated cells. Moreover, MPT0B271 induced cell apoptosis in a concentration-dependent manner; it also reduced the expression of Bcl-2, Bcl-xL, and Mcl-1 and increased the cleavage of caspase-3 and -7 and poly (ADP-ribose) polymerase (PARP). Finally, this study demonstrated that MPT0B271 in combination with erlotinib significantly inhibits the growth of the human non-small cell lung cancer A549 cells as compared with erlotinib treatment alone, both in vitro and in vivo. These findings identify MPT0B271 as a promising new tubulin-binding compound for the treatment of various cancers.

The short-form mini-nutritional assessment is as effective as the full-mini nutritional assessment in predicting follow-up 4-year mortality in elderly Taiwanese.

OBJECTIVE: To compare the mortality-predictive ability of the full- and short-form (SF) Mini Nutritional Assessment (MNA). DESIGN: A prospective cohort study. SETTING: Population-representative sample. PARTICIPANTS: 2872 ≥65-year old men and women. MEASUREMENTS: The study analyzed 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging (TLSA). Subjects were graded for nutritional status with the full-MNA and MNA-SF of a Taiwanese-specific version (T2, containing calf circumference instead of BMI) at baseline (1999) and tracked their survival status for 4 years. Mortality-predictive abilities of the full-MNA and MNA-SF were compared using Cox regression analysis and Net Reclassification Improvement (NRI). RESULTS: The full-MNA and MNA-SF have comparable abilities in predicting follow-up 4-year mortality risk according to the hazard ratios (all p<0.001) and Akaike information criterion (AIC). It also showed a slight improvement (not significant) if the full-MNA in a predictive model was replaced by the MNA-SF (NRI=0.09%, p=0.956). CONCLUSION: The MNA-SF has at least comparable or even slightly better ability in predicting follow-up 4-year mortality risk of elderly Taiwanese. Results suggest that MNA-SF with calf circumference may possess some basic characteristics of a comprehensive and universal geriatric screening scale.

The effectiveness of IDF and ATP-III in identifying metabolic syndrome and the usefulness of these tools for health-promotion in older Taiwanese.

OBJECTIVES: The aim of this study was to compare the effectiveness of IDF (International Diabetes Federation) and ATP-III (National Cholesterol Education Program-Adult Treatment Panel III) for predicting metabolic syndrome, and to evaluate the usefulness of these definitions for health promotion. DESIGN: A cross-sectional study. SETTING: A national random sample. PARTICIPANTS: A population representative sample of 1021 54-91 year-old Taiwanese. MEASUREMENTS: Subjects were measured for anthropometric and biochemical indicators and rated for the presence of metabolic syndrome using the two definitions. We evaluated the effectiveness of the two definitions in predicting MetS among those who had specific metabolic disorders. Results were analyzed with Student t-test and McNemar's test. RESULTS: Among the 918 subjects who had one or more MetS-item disorders, ATP-III rated greater proportions of subjects as having MetS than IDF, but both definitions predicted less than 50% (37.7% and 45.4%, respectively) as having MetS. CONCLUSION: Compared to IDF, ATP-III rated a greater proportion of subjects as having MetS, but both definitions missed more than 50% of subjects who had metabolic disorder(s). Since those who are missed have as much need for lifestyle intervention, the definitions appear not appropriate for health promotion.

The HDAC inhibitor, MPT0E028, enhances erlotinib-induced cell death in EGFR-TKI-resistant NSCLC cells.

Epidermal growth factor receptor (EGFR), which promotes cell survival and division, is found at abnormally high levels on the surface of many cancer cell types, including many cases of non-small cell lung cancer. Erlotinib (Tarceva), an oral small-molecule tyrosine kinase inhibitor, is a so-called targeted drug that inhibits the tyrosine kinase domain of EGFR, and thus targets cancer cells with some specificity while doing less damage to normal cells. However, erlotinib resistance can occur, reducing the efficacy of this treatment. To develop more effective therapeutic interventions by overcoming this resistance problem, we combined the histone deacetylase inhibitor, MPT0E028, with erlotinib in an effort to increase their antitumor effects in erlotinib-resistant lung adenocarcinoma cells. This combined treatment yielded significant growth inhibition, induced the expression of apoptotic proteins (PARP, γH2AX, and caspase-3), increased the levels of acetylated histone H3, and showed synergistic effects in vitro and in vivo. These effects were independent of the mutation status of the genes encoding EGFR or K-Ras. MPT0E028 synergistically blocked key regulators of the EGFR/HER2 signaling pathways, attenuating multiple compensatory pathways (e.g., AKT, extracellular signal-regulated kinase, and c-MET). Our results indicate that this combination therapy might be a promising strategy for facilitating the effects of erlotinib monotherapy by activating various networks. Taken together, our data provide compelling evidence that MPT0E028 has the potential to improve the treatment of heterogeneous and drug-resistant tumors that cannot be controlled with single-target agents.

Functional impairment but not metabolic syndrome is associated with depression in older Taiwanese: results from the Social Environment and Biomarkers of Aging Study.

OBJECTIVES: This study examined the association of metabolic syndrome, metabolic disorders and functional impairment with depression in older (≥54 years) adults. DESIGN: A cross-sectional study. SETTING: Data of this study were from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan (2000). PARTICIPANTS: A national representative sample of persons 54 years of age or older in Taiwan (N = 1023). RESULTS: Results showed that the presence of any number of metabolic disorders without functional impairment was not associated with depression. However, the presence of functional impairment regardless of the number of metabolic disorder was associated with a significantly higher risk of depression after adjusting for confounding factors (OR = 5.13, 95% CI = 2.13-12.36) (p<0.05). The presence of a basic Activities of Daily Living (ADL) dependency was significantly associated with a 1.45 times higher likelihood of depression (OR = 1.45, 95% CI = 1.17-1.79) (p<0.05). CONCLUSIONS: Results suggest that functional impairment, but not metabolic syndrome or metabolic disorders, is associated with depression in older adults. Metabolic syndrome/disorders do not necessarily affect patient's psychological health unless it is accompanied with functional impairment.

Association of dental prosthetic condition with food consumption and the risk of malnutrition and follow-up 4-year mortality risk in elderly Taiwanese.

OBJECTIVE: To determine the impact of dental prosthetic condition on food consumption, risk of malnutrition and follow-up 4-year mortality risk in elderly Taiwanese. DESIGN AND SETTING: Analyzing the data sets of the 1999 and 2003 "Survey of Health and Living Status of the Elderly in Taiwan", a longitudinal cohort study. PARTICIPANTS: A national probability sample of 2766 men and women 65 years of age or older. MEASUREMENTS: Self-reported intake frequencies of major food categories, masticatory ability, food consumption, and the risk of malnutrition assessed with the Mini Nutritional Assessment (short-form) stratified by dental prosthetic condition. Cox regression was used to compare follow-up mortality risk. RESULTS: Non-denture wearers and removable-denture wearers had poorer masticatory ability and greater nutritional risk and consumed fruits and vegetable less often compared to fixed-denture wearers. Removable-denture wearers also had lower self-perceived nutritional status and BMI compared to fixed-denture wearers. Survival analysis showed that non-denture wearers and removable-denture wearers had lower follow-up 4-year survival. Cox regression analysis showed that removable-denture wearers had increased follow-up 4-year mortality risk compared to fixed-denture wearers adjusted for sociodemographic, lifestyle and health-related factors. CONCLUSIONS: Based on data of a national sample of a longitudinal cohort study, dental prosthetic condition is a significant factor of nutritional health in the elderly. It can affect food pattern and the risk of malnutrition and mortality of elderly persons. Dental care should be an important part of geriatric health promotion program and fixed-denture is a preferred choice over removable-denture.