Tube Feeding among Elder in Long-Term Care Facilities: A Systematic Review and Meta-Analysis.

OBJECTIVE: The use of tube feeding for elderly patients with poor nutritional intake is a ubiquitous method of feeding. This systematic review and meta-analysis were carried out to compare nutritional benefits of enteral feeding versus oral feeding in long-term care facilities. SETTING: Databases including the Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science and Google Scholar through April 2014 using keywords including enteral feeding, tube feeding or oral feeding combined with long term care facilities or nursing home. PARTICIPANTS: Eight articles, with 841 participants were included in meta-analysis and 13 articles were included in systematic review. The elderly had to live in long-term care institutions and could not be on any mechanically assisted ventilation systems or be in any type of post-operative status. MEASUREMENTS: The three investigators extracted and appraised data using the same study design, baseline characteristics, and outcomes, independently. RESULTS: Following a systematic review, 13 articles out of 8218 original research articles were selected for this analysis. Meta-analysis of tube-fed patients found lower levels of hemoglobin (Weighted Mean Difference (WMD -0.21g/dl; 95% CI -0.42 to -0.01; p=0.04) and creatinine (WMD -0.08g/dl; 95% CI -0.17 to 0.00, p=0.05). Moreover, the results showed that there were no benefits regarding body mass index (BMI), albumin, dietary intake of proteins, total calories and fat. CONCLUSIONS: The results show that tube feeding does not increase patients' nutrients absorption to improve nutritional status. Instead, these results indicate that oral feeding is better regarding some nutritional biochemical parameters.

Oral health disparities of children among Southeast Asian immigrant women in arranged transnational marriages in Taiwan.

This study assessed the oral health disparities and oral health care needs of children whose parents are Southeast Asian immigrant women in arranged transnational marriages. We used the baseline data of the Lay Health Advisor Approach to Promote Oral Health Program (LHA-POHP) to explore the disparities in oral health between immigrant and native children, and the factors associated with their oral health. A cross-sectional community-based study was conducted to collect data from mothers and their preschool children in Southern Taiwan in 2011. A total of 590 (440 natives, 150 immigrants) children aged 4-6 years and their mothers completed the questionnaire and oral examination. Multiple regression models were used to analyze the association between children's oral health and their related factors. The caries index was 6.05 in immigrant children and 3.88 in native children (p < 0.001). The caries prevalence of maxillary anterior teeth in the labial surfaces was higher among immigrants, ranging from 14.7 to 22%. The factor associated with children's caries index was maternal tooth brushing frequency (adjusted odds ratio [aOR] = 8.95, 95% confidence interval [CI] 1.95-41.05). When the mothers did not direct children to brush teeth after eating sweets, their children were more likely to have decayed teeth (aOR = 3.54, 95% CI 1.04-12.03). Children's filled teeth were related to their dental regular check-ups (aOR = 2.28, 95% CI 1.26-4.10). Disparities in oral health among immigrant and native children were observed. The findings suggest that culturally adequate oral health promotion intervention programs should be implemented for immigrants.

Prevalence and subtypes of dementia in southern Taiwan: impact of age, sex, education, and urbanization.

To determine the prevalence and subtypes of dementia in southern Taiwan, a two-phase study consisting of a phase I screening survey using the Mini-Mental Status Examination (MMSE) and a phase II diagnostic examination using the CERAD neuropsychological battery and the neurobehavioral examination was conducted. According to the household records, stratified random sampling by the degree of urbanization of the community was used, and 2915 inhabitants aged 65 and over participated in this study. The ICD-10NA criteria for dementia, NINCDS-ADRDA guidelines for Alzheimer's disease (AD), and NINDS-AIREN criteria for vascular dementia (VaD) were employed. Three hundred and ninety-eight persons who had MMSE scores below the cutoff values were recruited into the phase II study, of whom 108 had dementia. The prevalence rate (PR) of dementia was 3.7%, increasing from 1.3% in people 65-69 years old to 16.5% in people 85 years old and older. The age-standardized PR (ASPR) was 4.0%. AD (58 cases, 53.7%, PR=2.0%, ASPR=2.3%) was the most common cause of dementia, followed by VaD (25 cases, 23.1%, PR=0.9%, ASPR=0.9%), and mixed dementia (eight cases, 7.4%). After adjusting for age, sex and education using logistic regression analysis, aging was a significant risk factor for AD, VaD and total dementia. Female sex and illiteracy were significant risk factors for AD only. We concluded that the prevalence of dementia in Taiwan is lower than in the developed countries, which could be due to a relatively young elderly population and a high mortality from dementia in Taiwan. AD is the leading cause of dementia in Taiwan. Considering the high stroke prevalence, the relatively lower prevalence of VaD in Taiwan deserves further investigation.

Incidence and subtypes of dementia in southern Taiwan: impact of socio-demographic factors.

OBJECTIVE: To determine the incidence rate (IR) and subtypes of dementia in southern Taiwan. METHODS: From a cohort of 2,915 community inhabitants aged 65 years and over, 2,507 and 2,175 subjects participated in the first- and second-year follow-up surveys, respectively. A two-phase study used the Mini-Mental State Examination in phase I and the Consortium to Establish a Registry of Alzheimer's Disease (CERAD) neuropsychological battery and the neurobehavioral examination in phase II. We applied International Classification of Diseases (ICD)-10NA criteria for dementia, National Institute of Neurological and Communication Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) guidelines for Alzheimer's disease (AD), and National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria for vascular dementia (VaD). RESULTS: The annual IR for total dementia was 1.28%, which increased with age from 0.77% for 65- to 74-year-olds to 6.19% for persons aged 85 years or older. AD (25 cases, 41.7%, IR=0.54%) was the most common cause of dementia, followed by VaD (19 cases, 31.7%, IR=0.41%) and mixed dementia (9 cases, 15.0%). After adjusting for sex, increasing age was significantly associated with total dementia and AD (p < 0.01). Illiteracy was associated with a marginally increased risk for total dementia (aRR=1.59, p < 0.1) as was being female for AD (aRR = 1.92, p < 0.1). The 2-year mortality rate was high among the demented (48% in total dementia, 38% in AD, and 60% in VaD). CONCLUSIONS: The age-specific incidence of dementia in Taiwan is approaching that of developed countries and the low prevalence of dementia (especially VaD) may be mainly due to the high mortality. Age was the major risk factor for total dementia and AD. Being female was probably a risk factor for AD, as was illiteracy for total dementia.

A cohort study on mortality and exposure to polychlorinated biphenyls.

In 1979, an outbreak of food poisoning ("Yu-Cheng") occurred in Central Taiwan, ROC, involving more than 2000 people. The event was caused by ingestion of rice oil contaminated with polychlorinated derivatives of biphenyls, dibenzofurans, and quaterphenyls. A retrospective cohort study on mortality was undertaken, and possible long-term health effects in the affected individuals were studied. The mortality experience of 1940 victims (929 males, 1011 females) between 1980 and 1991 was compared with the expected numbers, which were calculated from national and local mortality rates. By the end of 1991, 102 deaths were identified, thus producing a standardized mortality ratio (SMR) of overall mortality of 0.99 for males and 1.34 for females. Total cancer mortality was lower than in each comparison group. Mortality from liver diseases was elevated significantly (SMR = 3.22), especially during the first 3 y after the food-poisoning event (SMR = 10.76). Increased clinical severity of polychlorinated biphenyl intoxication was associated with increased mortality from all causes and from liver diseases. In summary, there was a positive association between mortality and intoxication dose, and severe polychlorinated biphenyl poisoning acutely affected mainly the liver. A continued follow-up of this cohort would be valuable in the study of long-term health effects of polychlorinated biphenyl poisoning.

Prevalence of dementia in an urban area in taiwan.

This two-stage epidemiologic study was to investigate the prevalence and types of dementia among elderly people in the Saa-Min district of Kaohsiung City in Taiwan. In stage one, the Chinese Mini-Mental Status Examination (CMMSE) and Blessed Dementia Rating Scale were employed. In stage two, a comprehensive neurobehavioral examination and neuropsychologic tests were administered by neurologists and neuropsychologists. Dementia was defined by DSM-III-R criteria. The National Institute of Neurological and Communication Disorders and Stroke-Alzheimer's Disease and Related Disorders Association guidelines for Alzheimer's disease (AD) and the National Institute of Neurological Disorder and Stroke-Association international pour la Recherche et l'Enseignement en Neurosciences criteria for vascular dementia (VaD) were applied. A total of 1,016 randomly selected elderly people participated in phase one: 131 people with CMMSE below cutoff values participated in phase two, of whom 45 were confirmed to have a form of dementia. The prevalence of dementia in this sample was 4.4% (3.2% in men and 5.8% in women): 2.0% for those 65 to 74 years old, 8.3% for those 75 to 84 and 24.4% for those > or = 85 years old; 6.0% for those who were illiterate, 3.3% for those who attended grade-school; and 2.8% for those who finished junior-high-school. AD (22 cases, 48.9%) was the most common cause of dementia, followed by VaD (11 cases, 24.4%) and mixed dementia (MIX: 5 cases, 11.1%). Old age and being female were significant high risk factors for AD. Medical history indicated that stroke and hypertension were significant risk factors for VaD. A relatively high prevalence of dementia was observed in this study, probably because we assessed neurobehavior in great detail. Although AD was the leading cause of dementia in the present population sample. VaD and MIX also comprised an important proportion, reflecting the high prevalence of stroke in Taiwan. Older women had high risk for AD, not for VaD; and those with a history of stroke and hypertension had high risk for VaD, not for AD.

A case-control study of oral cancer in Changhua County, Taiwan.

Forty oral cancer patients identified consecutively in Changhua Christian Hospital between 1990 and 1992 were compared with 160 population-based controls, matched for sex, age, area of residence, and educational background. Betel quid chewing was positively associated with the risk of oral cancer with adjusted odds ratio of 58.4 (95% CI: 7.6-447.6). The greater the number of years of chewing betel quid, the higher the risk of oral cancer; the adjusted odds rations were 12.9, 93.7 and 397.5 for < 21, 21-40, and > 40 years of betel chewing as compared with the non-users. The risk also increased with the quantity chewed per day; the odds ratios for those chewing < 10, 10-20 and > 20 quids/day were 26.4, 51.2 and 275.6, respectively. These odds ratio estimates were all statistically significantly different from the null value of unity.

Birth weight and handedness in boys and girls.

The association between selected demographic variables and birth weight on the one hand and a composite hand preference score based on seven hand tasks (each performed twice) on the other was investigated in a sample of 1387 male and female schoolchildren aged 5 to 10 years old. In multiple regression models left-handedness was significantly more common among boys and among children of better educated mothers and tended to decrease with age. No association was found with respect to urban or rural residence or birth order. Increased birth weight was associated with right-handedness in boys but with left-handedness in girls, and the birth weight by sex interaction term was statistically significant (p = 0.037). The demographic associations in the present study are compatible with those reported previously. The different associations of birth weight with hand preference in boys and girls indicate that the prenatal hormonal factors that affect brain lateralization and handedness are qualitatively or quantitatively different in the two sexes and may be differentially associated with birth weight.

Prevalence and characteristics of areca nut chewers among junior high school students in Changhua county, Taiwan.

Some studies indicate that betel quid and its ingredients chewing can produce cell mutagenicity and tumorigenicity. In Taiwan studies, betel quid chewing is the main cause of submucous fibrosis and oral cancer. Understanding the distribution and characteristics of the areca nut chewing population is one of the first steps in the effort to prevent these oral diseases. A stratified cluster random sample of 2442 junior high school students in Changhua county, Taiwan, were surveyed for the habit of areca nut chewing. Significantly more male students chewed areca nut than female students (9.2% vs 0.9%). The proportion of students who were chewing areca nuts increased with increasing (seventh to ninth) grades. Areca nut was used by junior high school students at a higher rate in village (rural) areas as compared to town (semi-urban) and city (urban) areas (6.4%, 3.7% and 3.0%, respectively). More students in the ordinary achievement classes were chewing areca nuts than those in the high achievement classes (8.4% vs 1.6%). Areca nut chewing students tended to have users in their families. Cigarette smoking and alcohol drinking were positively associated with areca nut chewing. More than half (53.6%) of the areca nut chewing students first experimented with this habit with a family member, most often the father or grandfather.

Breast-feeding and maternal smoking in the etiology of Crohn's disease and ulcerative colitis in childhood.

Medical records concerning pediatric or adolescent patients first diagnosed with Crohn's disease or ulcerative colitis in two New York hospitals during a 5-year period (1986 to 1990) were abstracted, and information concerning sex, age, race, birthplace, sibship size, birth order, maternal age at birth, month of birth, duration of breast-feeding, and maternal smoking was recorded. Medical records of patients presenting at the respective pediatric gastroenterology departments immediately before or after the patients with inflammatory bowel disease were seen were also abstracted in order to generate a control series. Data concerning 68 patients with Crohn's disease, 39 patients with ulcerative colitis, and 202 control patients were analyzed through multiple logistic regression. Breast-feeding was negatively associated with Crohn's disease (P approximately 0.04) and ulcerative colitis (P approximately 0.07), with relative risk point estimates around 0.5 and with evidence of duration-dependent trends in both instances. There was no evidence of association of either disease with maternal age at birth, birth order, maternal smoking, or season of birth.

Breast-feeding and breast cancer in the offspring.

The causation of breast cancer in certain strains of mice by a virus that can be transmitted vertically, through the milk produced during lactation, has led to the hypothesis that a similar phenomenon could exist in humans. There have been laboratory-based studies in humans suggesting that a virus may be involved in the etiology of female breast cancer although other investigations did not support this hypothesis. Descriptive data and epidemiologic evidence of ecologic nature do not indicate a role of lactation in the causation of human breast cancer, but the hypothesis has not been adequately assessed in analytic epidemiologic studies. A nested case-control study undertaken in Sweden to examine the role of prenatal factors on breast cancer risk in the offspring, allowed the evaluation of the importance of breast-feeding in the causation of this disease. Standardised records concerning women born at the Uppsala University Hospital from 1874 to 1954 were linked with invasive breast cancer incident cases, identified through their unique national registration number in the Swedish Cancer Registry during 1958-1990. For each case with breast cancer, the females born to the first three mothers admitted after the case's mother were selected as potential matching controls. Only controls living in Sweden and free from breast cancer until the time of diagnosis of breast cancer in the corresponding case were eventually included in the study. The analysis was based on 458 cases of breast cancer born in singleton pregnancies and 1,197 singleton age- and birth date-matched controls. Breast-feeding was not a significant or suggestive risk factor for breast cancer in the offspring; compared to women who at discharge were wholly or partly breastfed, women who as newborn were not breastfed had a relative risk of breast cancer of 0.97 with 95% confidence interval 0.44-2.17 (P = 0.95).

Strategies for blood screening for the hepatitis C virus and for the human immunodeficiency virus in high risk groups.

For many infectious agents, seroprevalence rate is low but has serious consequences and must therefore be kept out of donated blood supplies. However, screening to ensure the safety of blood supplies has an associated very high cost. For example, in blood banks, detection of all the harmful items in a large number of samples is an expensive and tedious process. The laboratory and statistical approaches to obtain significant savings by the pooling method were discussed from 1943, recently, there have been further discussions of pooling sera as a means to determining the HIV seroprevalence rate in the general population or the weed out all HIV-positive individuals in blood screening. Here we describe a simple mathematical method to weed out all HIV, and HCV seropositive units. The method is designed to maximize possible savings. Two examples illustrate the application of this method in determining the number to be pooled in each stage, and the resulting savings. When the prevalence rate is lower than 2 percent. our method offers savings of over 80 percent.

Successful use of pooled sera to estimate HIV antibody seroprevalence and eliminate all positive cases.

Pooling specimens when testing them in large numbers can save scarce resources and several earlier reports have indicated this to be a feasible strategy. In an HIV antibody mass screening test carried out in our laboratory, we used Dorfman's two-stage model. We sought to establish the optimal number of specimens in a pool, and to achieve maximum efficiency while maintaining both sensitivity and specificity. Before testing for HIV antibody, five positive samples were placed in a set of 1012 sera in a double blind manner, one positive sample into a second set of 1012 sera and none in a third set. The positive rate was assumed to be 0.2% for each set of 1012 sera. As indicated by our model, 22 individual serum samples were placed into each of 46 pools which, when tested by particle agglutination assays, lead to the identification of all positive samples. We concluded that the prevalence rate can be estimated in the first stage, 95% confidence intervals were given, and the efficiency rate could be calculated for the identification of all infected specimens in a large number of samples showing low prevalence rates.

[Risk factors related to the use of amphetamines in adolescent students].

The prevalence of amphetamine abuse among school children was studied by asking 3548 adolescent students (aged 12-15, response rate 98.6%) to complete a questionnaire anonymously, which was developed and evaluated by the authors. A complete set of data was collected for 3200 (90.2%) students. Eighty-five (2.7%) of them who admitted that they had used amphetamines constituted the case group. Non-users with negative urine tests formed the control group. Six independent factors were found to be related to amphetamine use when the answers were analyzed by stepwise logistic regression. The prevalence odds ratio estimation was elevated in: males compared females, students who did not live with both parents compared to those who lived with both parents, students with amphetamine-user friends compared to those with no-user friends, smokers compared to non-smoker, betel nut chewers compared non-chewers, and in students with positive attitudes compared to those with negative attitudes. The average starting age for smoking was 12.5 +/- 0.1 years; later this was followed by alcohol abuse, chewing of betel-nuts, and use of amphetamines. The average age of starting to use amphetamines was 13.5 +/- 0.2 years; a common reason given for using amphetamines was curiosity (65.4%). Many students (54.2%) obtained the amphetamine from their friends and most of them (85.2%) used it six months before responding to the questionnaire.

[The prevalence of amphetamine use in adolescent students: self-reported and urine analysis].

The prevalence of amphetamine use was studied using an anonymous questionnaire given to 3548 adolescent students aged 12--15, with a response rate of 98.6%. This questionnaire was developed and evaluated by the authors. A complete set of data was collected on 3200 subjects, making up 90.2% of all students surveyed. Eighty-five (2.7%) students admitted that they had used amphetamines; that is, 64 of the 1,584 male (4.0%), and 21 of the 1,616 female (1.3%) respondents. The life-time prevalence odds ratio estimation was elevated in male (POR = 3.2, 95% CI 1.9--5.3), as compared to female students. The life-time prevalence rates increased with age only among male students (P trend = 0.01). Seven hundred and twenty four male students were randomly tested for the presence of amphetamines in their urine using thin layer chromatography and fluorescence polarization immunoassay. Of six students who tested positive, five asserted that they had not used amphetamines. The point prevalence rate of amphetamine use based on the urine tests was 0.9% among the 652 students who had completed questionnaires. This rate was higher than on self-reported use of amphetamines (rate difference 0.9%, 95% CI 0.2--1.6%). In this group, 27 (4.1%) admitted that they had used amphetamines. The estimated overall life-time prevalence rate was at least 4.9% (32/652), with 95% CI between 3.2% and 6.6%.

[The study of Apgar score and infant birth weight in the central Taiwan].

The objective of this study was to assess the relationship between birth weight and the Apgar Score. We collected data on the birth weights and the 1 min and 5 min Apgar Score of new born infants between 1982 and 1987 at a teaching hospital in Central Taiwan. Compared to babies with normal Apgar Score, infants with low Apgar Scores were found to born with low and very low birth weights. In the 1 min of life test, the relative risks of low birth weights among infants with Apgar Scores of 0 to 3 and 4 to 6 were 115.0 and 5.9 times higher than those of normal infants, respectively. In the very low birth weight category, the relative risks of the above score were 252.5 and 51.1, in this order. In the 5 min of life test, the relative risks of the above scores were 16.2 and 12.1 in the low birth weight category, respectively. However, among babies of very low birth weight, the relative risks of the same scores were 121.2 and 84.9, in this order. In conclusion, the 5 min Apgar Score might be a useful prognostic index for the relationship between health and birth weight of new born infants.

Horizontal transmission of hepatitis B virus from siblings and intramuscular injection among preschool children in a familial cohort.

The authors followed 147 children from 113 families who were susceptible to hepatitis B virus infection for a total of 275 person-years. Among these children, 19 became infected with the hepatitis B virus and thus became new subclinical cases. In this cohort study, parents played a minor role in hepatitis B virus horizontal transmission. On the other hand, the estimated incidence rate ratio of hepatitis B virus infection for siblings of a hepatitis B e antigen (HBeAg) carrier was 2.8 (95% confidence interval 1.1-7.4) when compared with those children without a HBeAg sibling carrier as analyzed by multiple logistic regression. The adjusted incidence rate ratio among siblings increased with increased number of HBeAg carriers. In addition, intramuscular injections played an important role in hepatitis B virus transmission in children. It was found that 61.8% (170/275 person-years) of the children had received intramuscular injections. Most of the injections were administered at private clinics over a 2-year period. Hepatitis B virus infection showed a correlation with injection (adjusted incidence rate ratio = 3.3, 95% confidence interval 1.1-9.5) and with frequency of injections. The authors concluded that HBeAg was a valuable marker for infectivity in hepatitis B virus horizontal transmission. Furthermore, the authors found that hepatitis B virus infection is independently transmitted from sibling to sibling, and by iatrogenic injections because improperly sterilized syringes were shared in areas where hepatitis B is prevalent and intramuscular injection is common.

[A study of weight and weight/birth at birth by gestational week].

A study of 35,919 live neonates was conducted from 1976 to 1987 (excluding 1980) at a teaching hospital in Central Taiwan. Our goal was to determine the proportions of low birth weight (LBW) and very low birth weight (VLBW) and birth weight/birth length ratios by gestational week. The results showed that LBW and VLBW neonates were 6.3% and 1.1%, respectively. In LBW neonates groups, there was a rapid decline after the 33rd gestational week, then as low as 6.9% by the 38th gestational week. After the 28th gestational week, there was a rapid decline in VLBW proportion, then a further decline to 9.3% at the 32nd gestational week. Birth weight/birth length ratios were 2.94 and 6.25 at the 28th and 39th gestational weeks, respectively. There were no differences in birth weight/birth length ratios between male and female babies. Based on the above findings, we tried to set a norm from birth weight/birth length ratios by gestational week.

Efficiency gains from the use of sample pooling technique: a theoretical example of dengue virus detection in vector.

Testing large numbers of specimens for viral antigens, antibodies, requires a great deal of manpower, time and money. Therefore it would be useful if testing could be performed with the specimens pooled. However, how to establish the optimal number of specimens to be pooled to achieve the maximum efficiency while maintaining both sensitivity and specificity is a question that needs to be answered. In this study, we developed a mathematical model and procedure to resolve this problem. We estimated a saving rate of over 98% for an assumed infection rate of 1/10000 by testing the sample in pools of 100-101 specimens. The saving rate decreases with increasing infection rates, until there is probably no efficiency gain achieved for infection rates greater than 30%. Tests of infection in pooled mosquitoes were assumed to be free of viruses other than the dengue virus to interfere with detection. Heads of Aedes mosquitoes were first pooled and squashed, and the extract obtained was injected by intrathoracic inoculation into Toxorhynchites amboinensis, a biological amplifier of dengue antigen. Sensitivity was not reduced. Therefore, this pooling technique is useful for determining the optimal number of specimens in a pool, calculating an exact infection rate, and for identifying specific infected specimens in tests of a large number of samples showing low rates of infection in our theoretical example.