Previous studies utilizing data from the Nevada Cancer Registry suggested a transient increase in non-Hodgkin’s lymphoma (NHL) and brain cancer in northern Nevada following an outbreak of Chronic Fatigue Syndrome (CFS) in that area which was not seen in southern Nevada which had no reported CFS outbreaks. A subsequent study from the National Cancer Institute (NCI) using data from the NCI’s Surveillance, Epidemiology and End Results(SEER) Program and Medicare documented the association between CFS and NHL on a national basis but no other cancer association was seen. Since brain cancer has a younger age distribution than NHL, we returned to the Nevada Cancer Registry and used ten more years of data and additional analyses to determine if there was an association between CFS and brain cancer by age. This study confirmed the increased incidence of brain cancer following the outbreak in northern Nevada but not southern Nevada with the increase limited to the under 65 age group, thus explaining why the SEER-Medicare analysis only analyzing data in the 65 and above age group did not detect this association.

Purpose: To explore sex variations in the prevalence and factors of high serum alanine aminotransferase (ALT) level among the working population in Taipei, Taiwan.

Methods: This study included 8,351 healthy adults (5,247 men and 3,104 women) who admitted to a teaching hospital voluntarily for a physical examination in 2009. The definitions of occupations include computer and mathematical occupations, architecture and engineering occupations, community and social service occupations, sales and related occupations, office and administrative support occupations, and production occupations. The age distribution of ≤ 29 yrs, 30-39 yrs, 40-49 yrs, and ≥ 50 yrs were 22.5%, 36.8%, 23.5%, and 17.2%, respectively. Fasting blood samples were drawn using venipuncture and participants were interviewed with a structured questionnaire.

Results: The overall prevalence of high serum ALT level (≥ 40 U/L) was 17.1%. After stratified the data according to age into four age groups (≤ 29 yrs, 30-39 yrs, 40-49 yrs, and ≥ 50 yrs), the men participants revealed a higher prevalence of high serum ALT levels for all age groups than the women participants. Bases on multiple logistic regression models, for the men, the significant factors were associated with high serum ALT level and included age (OR = 0.96, 95% CI: 0.95-097), BMI [no matter whether overweight (OR = 2.45, 95% CI: 1.99-3.02) or obese (OR = 4.02, 95% CI: 3.22-5.03)], hypercholesterolemia (yes vs. no, OR = 1.25, 95% CI: 1.05-1.48), hypertriglyceridemia (OR = 1.25, 95% CI: 1.04-1.50), high FPG levels (OR = 1.48, 95% CI: 1.05-2.09), high AST levels (OR = 26.71, 95% CI: 19.00-37.54), hyperuricemia (OR = 1.48, 95% CI: 1.25-1.76), high ALP levels (OR = 1.20, 95% CI: 1.00-1.45), and high glutamic acid transaminase levels (OR = 4.31, 95% CI: 3.61-5.14). For the women subjects, the statistically significant factors that were associated with high serum ALT level included BMI [no matter whether overweight (OR = 3.53, 95% CI: 1.87-6.67) or obese (OR = 4.32, 95% CI: 2.26-8.23)], high AST levels (yes vs. no, OR = 38.49, 95% CI: 21.45-49.28), high BUN levels (yes vs. no, OR = 1.66, 95% CI: 1.03-2.29), and high glutamic acid transaminase levels (yes vs. no, OR = 9.87, 95% CI: 5.79-16.83).

Conclusion: In conclusion, the clinical problem of elevated serum ALT level is important in the working population. Many subjects are asymptomatic and the diagnosis of high serum ALT level should be considered with sex, age, hyperuricemia, high AST levels, high ALP levels, high glutamic acid transaminase levels, and metabolic risk factors in mind.

Henoch-Schönleinpurpura (HSP), a self-limiting systematic vasculitic disease, occurs almost sporadically, and spatial-clustering series cases have rarely been reported. Herein, we report a case series of HSP that is strictly confined to a street of Zheng village in Xianyang City of Shaanxi Province, northwest of China.

Purpose: To assess the association between continuity of care and severity of diabetes-related complications for geriatric diabetic patients.

Methods: A retrospective study using 2009-2013 Taiwan’s National Health Insurance Research Database one million beneficiary version were conducted. Utilization data of 3,885 geriatric patients who newly had type 2 diabetes were studied. Five-year Continuity of Care Index (COCI) and the adapted Diabetes Complications Severity Index (aDCSI) of each subject were calculated. A Group-based trajectory modeling (GBTM) was used to distinguish patients with similar five-year COCI into different trajectories. A general estimating equation(GEE) was used to assess the association between COCI trajectories and aDCSI.

Results: The ratio of male to female in this study was 2:3. At the time of inclusion, the average age was 71.79 (4.65) years old. GBTM subjects can be divided into four different trajectories according to their COCI: low-level continuity of care trajectories, increasing continuity of care trajectories, decreasing continuity of care trajectory, and high-level continuity of care trajectory. After GEE analysis, the high continuity of care trajectories were associated with a significant decrease in aDCSI score.

Conclusion: The results of this study suggested better continuity of care was associated with less severity of diabetes-related complications for geriatric patients.

Objective: The Southern region of the United States (US) experiences higher HIV related disparities, majority of new HIV infections are transmitted by individuals who are unaware of their status. African Americans constitute 44% of HIV diagnosis in the US, and African American gay and bisexual men accounted for the largest number of new HIV diagnosis in 2016.

Methods: Data from nine southern states in the Behavioral Risk Factor Surveillance System (BRFSS) 2016 was analyzed using logistic regression.

Results: We found Individuals less likely to test for HIV included: heterosexuals, married individuals, living in a non-Metropolitan Statistical Area (MSA), others (retirees, students and homemakers), older than 65 years and/or with less than high school education.

Conclusion: Amid finite resources, interventions for HIV testing among African Americans should focus more on these individuals who are less likely to be aware of their HIV status, further contributing to new HIV infections.

This review of over 80 articles published in the last 30 years shows that estimates of the prevalence of chronic constipation in community-dwelling adults varied widely from 2.4% to 39.6% in general adult populations and from 4% to 25.8% in older adult populations. Estimates of the prevalence of any constipation (including both chronic and sporadic constipation) also varied widely from 2.6% to 31.0% in general adult populations and from 4.4% to 44.5% in older adult populations. Apart from any country or regional differences, this wide range of estimated prevalence may be attributed to different definitions used for both chronic and any constipation as well as different data collection methods and sampling differences. Sampling issues include sample size, representativeness and age range of populations sampled. Further research is required to examine the impact of different definitions on prevalence estimates to help determine the best definitions for use in future epidemiological studies. If standard definitions can be universally agreed and used, along with appropriate sampling and data collection methods, more precise estimates of constipation prevalence should be attained. This would allow more meaningful comparisons between countries and may also provide the ability to pool results.

Objectives: Increased C. difficile infection rates were observed during the last decade, as well as the onset of complicated forms of the disease. The primary objective of this study was to report the first outbreak of C. difficile in a Serbian hospital, aiming to determine clinical and environmental factors associated with the outbreak. The secondary objective was to describe outbreak control measures taken.

Design: The retrospective cohort study conducted from 18 April to 22 May 2013 in Serbian healthcare. Ninety-five patients hospitalized at the Department for orthopedic surgery during the CDI outbreak.

Results: Prophylactic antibiotic therapy was identified among 93.3% patients with and 87.9% without C. difficile infection. The multivariate logistic regression analysis has shown that the independent risk factors for C. difficile infection incidence are the age beyond 70 (OR = 4.5; 95%CI = 1.1-18.2; p =.031) and the length of antibiotic therapy (OR = 1.5; 95%CI = 1.1-2.1; p =.017).

Conclusion: The length of antibiotic prophylaxis is linked with the incidence. Orthopedic departments have a risk of C. difficile infection. Infection control measure, antimicrobial stewardship programs and compliance to guidelines for the prescribing of antibiotics play important role in the prevention of C. difficile infection burden.

Objectives: In today’s aging societies, subjective well-being is an important determinant of quality of life among older persons. The association between better health and better subjective well-being is well known. However, the kinds of social activities associated with subjective well-being are largely unknown. This study aimed to assess such relationships, taking into account the type of social activities involved among community living older persons aged 65 and over.

Method: We used self-administered questionnaire data (N = 2,652) from the Japan Gerontological Evaluation Project (JAGES) 2016. We conducted a poisson regression analyses stratified by age group to elucidate the association between social activities and better subjective well-being.

Results: After adjusting for sex, family composition, household income, number of illnesses and depression, we found that activities to teach skills or passing on experiences to others were significantly related to higher subjective well-being both among the young-old (65-74) and the old-old (75 and over) population.

Conclusion: Altruistic activities such as teaching skills or conveying knowledge to others appear to be related to higher subjective well-being. Promoting social activities has the potential to enhance subjective well-being among the elderly population.