Association of SDF-1 and CXCR4 Polymorphisms With Susceptibility to Oral and Pharyngeal Squamous Cell Carcinoma.

BACKGROUND/AIM: Long-term exposure to betel quid (BQ)-, cigarette-, and alcohol-induced chronic inflammation is a crucial risk factor for oral and pharyngeal squamous cell carcinoma (OPSCC) progression. We analyzed the genotypes of stromal-cell-derived factor-1 (SDF-1) and CXC-chemokine receptor-4 (CXCR4) and determined the association between their polymorphisms and the risk of OPSCC. MATERIALS AND METHODS: This study consisted of 452 patients with pathologically proved OPSCC and 424 sex- and age-matched cancer-free controls. The genotypes of SDF-1 and CXCR4 were detected through the TaqMan real-time polymerase chain reaction (PCR) method. RESULTS: Our data indicated that the C allele and C/C genotypes of CXCR4 were significantly associated with OPSCC [adjusted odds ratio (AOR)=1.41, 95% confidence interval (CI):1.02-1.96, p=0.037 and AOR=1.51, 95% CI:1.05-2.17, p=0.028, respectively] and OSCC (AOR=1.41, 95%CI:1.00-2.00, p=0.049 and AOR=1.49, 95%CI:1.01-2.20, p=0.044, respectively) risk. Patients with genetic polymorphisms of the genotype combination SDF-1/CXCR4 had a higher risk of OSCC (p trend=0.033). We analyzed the effects of CXCR4 genetic variants on susceptibility to OPSCC in patients with different risk habits of BQ chewing, tobacco smoking and alcohol consumption, and revealed that C/T+T/T genotypes exerted an increased risk only in patients with one (AOR=2.68, p=0.036) or two risk habits (AOR=2.02, p=0.027) compared to patients with the C/C genotype. CONCLUSION: We concluded that CXCR4 C>T can be used as a genetic marker of susceptibility to OPSCC, particularly in OPSCC patients with one or two types of risk habits with a synergistic effect.

Differential clinical significance of COL5A1 and COL5A2 in tongue squamous cell carcinoma.

BACKGROUND: Type V collagen (COL5), in the functional heterotrimer [α1(V)2 α2(V)] isoform, participates in the malignancies of various cancers. However, its role in tongue squamous cell carcinoma (TSCC) remains unclear. MATERIALS AND METHODS: The expression levels of COL5A1 and COL5A2 polypeptide chains were examined using the tissue microarray from 245 TSCC patients with immunohistochemistry. Paired t test and Wilcoxon signed-rank test were performed for comparisons among the groups. Survival rates were estimated by using the Kaplan-Meier method and compared with log-rank tests. A Cox proportional hazards model was used to evaluate the impact of protein expression level on survival rate. RESULTS: Expression level of COL5A1 was significantly increased in tumor tissues (P < 0.001) compared to that in corresponding adjacent normal tissues. High expression level of COL5A1 was associated with advanced pathological stage (III, IV, P = 0.015) and lymph node metastasis (P = 0.005) of TSCC patients. High expression level of COL5A1 was also correlated with poor disease-specific survival (DSS, P = 0.001) and disease-free survival (DFS, P = 0.003) in TSCC patients. However, high expression level of COL5A2 was correlated with better DFS in TSCC patients (P = 0.043). Moreover, co-expression level of high (COL5A1)2 /low (COL5A2) heterotrimer was correlated with worse DSS (P = 0.004) and DFS (P = 0.004). CONCLUSION: COL5A1 is an unfavorable factor for tumorigenesis, clinicopathological outcomes, and prognosis, whereas COL5A2 is only a favorable factor for prognosis in TSCC. The co-expression of high (COL5A1)2/low (COL5A2) heterotrimer is a more potential unfavorable factor for prognosis in TSCC.

[The internationalization of the nursing profession in Taiwan].

Globalization, nursing manpower migration, and the multinational nature of the medical industry have increased the level of internationalization in Taiwan's nursing profession. In nursing practice, competencies for the general nursing list (Taiwan version) and ICNP (International Classification for Nursing Practice) have been clinically tested and revised. In academic nursing, significant effort is invested toward achieving the three general objectives of internationalized teaching, internationalized campuses, and international academic exchanges. We should further test and revise Taiwan's competencies for the general nursing list, and the ICNP should be continually tested and revised. Additionally, nursing personnel should strengthen foreign language competencies, appreciate different nursing practice cultures, participate in international exchange activities, and place increasing emphasis on international cooperation in research and nursing education accreditation. Such should further enhance and strengthen international cooperation, which should further encourage internationalization in the domestic nursing profession.

Healthy behaviors and onset of functional disability in older adults: results of a national longitudinal study.

OBJECTIVES: To examine the combined effect of healthy behaviors on the development of functional disability in an elderly cohort. DESIGN: Prospective cohort study. SETTING: Taiwan Longitudinal Study in Aging from 1989, 1993, 1996, 1999, and 2003. PARTICIPANTS: A national sample of 1,940 men and 1,247 women aged 60 and older without functional disability at baseline. MEASUREMENTS: Functional disability was defined as difficulty with activities of daily living: taking a bath or walking 200 to 300 m. Time to functional disability was the age at midpoint between the first occurrence of disability onset in the survey year and prior survey year. Considering that the onset of disability is probably a precursor of death, for those who died without disability, time to disability onset was set at the midpoint between the last follow-up and death year. Four healthy behaviors were measured: not smoking, moderate alcohol consumption, regular exercise, and sleeping 6 to 8 hours per day. A Cox proportional hazards model with time-dependent covariates was used to analyze the association between age at the first functional disability and prior healthy behavior, after controlling for sex, time-varying disease status, marital status, and education. RESULTS: Healthy behaviors were linked to the onset of functional disability. Participants who performed one or more healthy behaviors were 15% to 75% less likely to be disabled than those who performed none. CONCLUSION: In the population studied, healthy behaviors were associated with lower incidence of functional disability. As the number of healthy behaviors increased, the likelihood of disability decreased.

Determinants of cognitive impairment over time among the elderly in Taiwan: results of the national longitudinal study.

This study aimed to identify the risk factors for cognitive impairment among the elderly population in Taiwan. Data were drawn from three waves of the "Survey of Health and Living Status of the Elderly in Taiwan", a national longitudinal study started in 1989. We included respondents without dementia or cognitive impairment at baseline in 1993 and followed them over a 10-year period. Cognitive function was measured by the nine-item Short Portable Mental Status Questionnaire in 1993, 1999, and 2003. Independent variables, including age, sex, marital status, education, ethnicity, ADLs, IADLs, physical function, social participation, chronic diseases, smoking, and alcohol drinking, were collected at baseline in 1993. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regression was used to evaluate the predictive factors for cognitive impairment. Of the eligible 1,626 respondents, 72 (4.43%) and 484 (29.77%) individuals did not complete follow-up in 1999 and 2003, respectively, mostly due to death. Our results showed that older age (OR = 2.60, 95% CI = 1.79-3.78), being female, lower educational level, IADL disability (OR = 2.06, 95% CI = 1.38-3.09), and having a history of diabetes (OR = 1.70, 95% CI = 1.06-2.74) or stroke (OR = 2.36, 95% CI = 1.06-5.26) were independent predictors for cognitive impairment in Taiwan.

The Chinese version of the Facts on Aging Quiz scale: reliability and validity assessment.

BACKGROUND: The use of health care services by older adults is increasing with the aging of the population. It is therefore essential that health care workers are current in their knowledge about gerontology; thus, educational programs regarding the care of elders are essential. Chinese-language assessments to measure knowledge about gerontology and aging and attitudes toward older adults are lacking. OBJECTIVE: This study was designed to measure the reliability and validity of a Chinese-language version of Palmore's facts on aging quiz (FAQ 1). METHOD: Cronbach's alpha, construct validity, content validity and convergent validity of the Chinese version of the FAQ 1 were assessed. A sample of 220 student nurses was recruited. Part of the sample (n=125; Group A) was comprised of experienced nurses who had returned to school for advanced degrees. The remaining 95 participants were first-year undergraduate students without prior work experience (Group B). The FAQ 1 was administered to all participants. The Chinese-language version of Kogan's Attitudes toward Older People (KAOP) was also administered to assess convergent validity of the FAQ 1. RESULTS: Cronbach's alpha of the FAQ was 0.68, content validity was 0.82, and construct validity and convergent validity were acceptable. Group A had more correct answers on each item than Group B, indicating that students with prior work experience with the elderly were more knowledgeable regarding older people and aging. CONCLUSIONS: Based on the results of the assessment, the Chinese version of FAQ 1 is a valid and reliable instrument for measuring students' or health care providers' knowledge about older people.

Evaluating outcomes of Taiwan's first gerontology certification program.

The elderly population will approach 20% within the next 20 years. This enhances the need for skilled and experienced health care providers. There is a critical need to strengthen gerontology curricula to prepare health-related professionals for a graying population. The purpose of this article is to investigate student satisfaction with the first National Project for Excellence in Gerontological Care Education (NPEGCE) in Taiwan. A cross-sectional design was used. A sample of 151 medical, nursing, and physical therapy students, who had enrolled in the NPEGCE and had taken at least one core course, completed a satisfaction questionnaire. To ensure content validity, a multidisciplinary, institutional committee of gerontology and geriatric faculty designed the content. Overall satisfaction scores varied between satisfied (4-points) and very satisfied (5-points). Medical students gave higher ratings than others. Two factors (Curriculum and Teaching) were extracted. A strong correlation was found between the subscales and overall satisfaction scores. Internal scale consistency reliability scores ranged from 0.92 to 0.96. Overall, this study demonstrates a moderate level of satisfaction with the NPEGCE. However, these results are from a single institution; they are not generalizable. This is also the first student satisfaction report from Taiwan. There are no similar programs or evaluation results to compare them with. Since the NPEGCE was well received by students and seemed to encourage a more nurturing attitude towards the elderly; it can be regarded as a catalyst for better elderly care in the future.

Cigarette smoking and cognitive impairment: a 10-year cohort study in Taiwan.

The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ> or =6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio=OR=0.31; 95% CI=0.18-0.53; p<0.001) and those who continued to smoke (OR=0.37; 95% CI=0.20-0.70; p<0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose-response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.

Taiwanese medical and nursing student interest levels in and attitudes towards geriatrics.

INTRODUCTION: To investigate the attitudes of medical and nursing student towards the older Chinese population. MATERIALS AND METHODS: A reliable and valid Chinese language version of Kogan's Attitudes toward Older People (KAOP) with 17 matched item pairs (34 items) was completed by 275 medical and nursing students. Descriptive data analysis was employed. RESULTS: Participants reported slightly to have a more positive attitudes (Mean, 144.30 +/- 17.89) than those reported from studies in other countries (Jordanian: Mean, 110.6 +/- 21.79). Students who were females (Mean, 148.27 +/- 18.97), younger (Mean, 146.01 +/- 18.59) and studying nursing (Mean, 156.86 +/- 17.56) were more likely to have a more positive attitudes than older (Mean, 140.04 +/- 15.31), males (Mean, 140.47 +/- 15.93), studying medicine (Mean, 138.77 +/- 15.04). DISCUSSION: Results show that students may have greater ambivalence attitudes on 10 out of 17 matched item pairs which provides useful information for faculty involved in aged care curriculum design. Working as a volunteer in the university hospital may increase students' interactions with the elderly and may positively influence attitudes towards the elderly.

A Chinese version of Kogan's Attitude Toward Older People Scale: reliability and validity assessment.

BACKGROUND: Taiwan is facing the dilemma of a rapidly growing elderly population and there is a perceived need for greater gerontological education. Several universities have recently started providing elective gerontological certification programs. In order to provide useful and sufficient information to increase students' knowledge and attitudes, to develop a reliable and valid instrument is essential and helpful for faculty as well as the program director to pinpoint students' strengths and weaknesses. OBJECTIVE: To assess the reliability and validity of a Chinese version of Kogan's Attitudes toward Older People (KAOP) among medical and nursing students at a medical university. METHOD: A two-phase data collection design was used. Two weeks following the first completion, another KAOP form, was given. Content validity, construct validity, internal consistency, and stability reliability were assessed. The final sample consisted of 275 students. RESULTS: Scores were between 34 and 238. The study sample reported slightly positive attitudes (144.3+/-17.89), with half of the subjects (50.1%) above average. All of the 34 items were found to have significant item-to-total correlations (p<.05). Two factors were extracted, Appreciation and Prejudice. The Prejudice and Appreciation contributed 33.6% and 21.1% to the variance. The Cronbach's alpha was .82 for the total scale (.83 for Prejudice, .81 for Appreciation). Stability was 0.86 for Prejudice and 0.91 for Appreciation. CONCLUSIONS: The Chinese version of the KAOP can be considered reliable and valid scale for assessing the attitudes toward older people.

Effect of dielectric responses on localization in one-dimensional random periodic-on-average layered systems.

Dielectric response effects on wave localization in random periodic-on-average layered systems are studied. Based on Monte Carlo simulations and products of random matrices, statistics of the Lyapunov exponent are determined efficiently for very long systems. An oscillatory behavior for Lyapunov exponent is found and explained for mildly strong scattering conditions. We also show the emergence of strongly localized states in metallic layered systems with intermediate disorder for frequencies above the plasma frequency omega(p) of metals, as is not shown in dielectrics. Furthermore, the violation of universal single parameter scaling behaviors in different regimes of multiple scattering is discussed.