New-onset atrial fibrillation (NeOAF) is a common type of tachyarrhythmia in critically ill patients and is associated with increased mortality in patients with sepsis. However, the prognostic impact of restored sinus rhythm (SR) in septic patients with NeOAF remains unclear. A total of 791 patients with sepsis, who were admitted to a medical intensive care unit from January 2011 to January 2014, were screened. NeOAF was detected by continuous electrocardiographic monitoring. Patients were categorized into three groups: no NeOAF, NeOAF with restored SR (NeOAF to SR), and NeOAF with failure to restore SR (NeOAF to atrial fibrillation (AF)). The endpoint of this study was in-hospital mortality. Patients with pre-existing AF were excluded. We reviewed the data of 503 eligible patients, including 263 patients with no NeOAF and 240 patients with NeOAF. Of these 240 patients, SR was restored in 165 patients, and SR could not be restored in 75 patients. The NeOAF to AF group had the highest in-hospital mortality rate of 61.3% compared with the NeOAF to SR and no NeOAF groups (26.1% and 17.5%, respectively). Moreover, multivariate logistic regression analysis revealed that failure of restored SR was independently associated with increased in-hospital mortality in patients with sepsis and NeOAF. Failure to restore a sinus rhythm in patients with new-onset atrial fibrillation may be associated with increased in-hospital mortality in patients with sepsis. Further prospective studies are needed to clarify the effects of restoration of sinus rhythm on survival in patients with sepsis and new-onset atrial fibrillation.

Studies related to air pollution exposure and neurocognitive disorders, specifically cognitive impairment, among older adults are limited. We investigated the association between short-term and long-term exposure to ambient air pollution (i.e., particulate matter with an aerodynamic diameter of <10 μm and ozone) and the effects of their interaction on cognitive function in a community-dwelling, free-living elderly population. Study participants were in a multiple-wave representative sample, namely the Taiwan Longitudinal Study on Aging (n = 2241). In four surveys between 1996 and 2007, their cognitive function was assessed using the Short Portable Mental Status Questionnaire (SPMSQ). We estimated air pollution from 1993 to 2007, including daily concentrations of PM₁₀ and O₃ from air quality monitoring stations, based on the administrative zone of each participant’s residence. Generalized linear mixed models were used to examine these associations after adjusting for covariates. We found that long-term exposure to PM₁₀ and O₃ was significantly associated with cognitive impairment (OR = 1.094, 95% CI: 1.020, 1.174 for PM₁₀; OR = 1.878, 95% CI: 1.363, 2.560 for O₃). The joint effect of exposure to PM₁₀ and O₃ was associated with cognitive impairment (p < 0.001). Co-exposure to ambient PM₁₀ and O₃ may deteriorate cognitive function in older adults.

Phthalate exposure was shown to alter thyroid function, however it is unclear, whether oxidative and nitrosative stress explains the intermediate biological mechanism. This study aimed to investigate the associations between phthalate exposure, oxidative/nitrosative stress, and thyroid function in adults, and to examine the mediating role of oxidative/nitrosative stress in the associations between phthalate exposure and thyroid function. Levels of eleven urinary phthalate metabolites, three urinary biomarkers of oxidative/nitrosative stress (malondialdehyde [MDA], 8-OHdG, and 8-NO2Gua) and five serum thyroid hormones (thyroxine [T4], free T4, triiodothyronine, thyroid-stimulating hormone, and thyroxine-binding globulin) were measured in 266 Taiwanese adults. Cross-sectional associations between phthalate metabolites, biomarkers of oxidative/ nitrosative stress and thyroid hormones were analyzed using multivariate regression models. Mediation analysis was conducted to assess the role of oxidative/nitrosative stress in the associations between phthalate metabolites and thyroid hormone levels. Sum of di-(2-ethylhexyl) phthalate (DEHP) metabolites was positively associated with MDA (βT1-T2 = 0.253, 95%CI [0.060, 0.447]; β ≧ T2 = 0.317, 95% CI [0.098, 0.536]; Ptrend = 0.005) and 8-NO2Gua (βT1-T2 = -0.010, 95%CI [-0.138, 0.118]; β ≧ T2 = 0.144, 95% CI [-0.001, 0.289]; Ptrend = 0.045). Mono-n-butyl phthalate (MnBP) was positively associated with 8-NO2Gua (βT1-T2 = 0.201, 95% CI [0.078, -0.324]; β ≧ T2 = 0.161, 95% CI [0.031, -0.292]; Ptrend = 0.018). T4 was negatively associated with MDA (βT1-T2 = -0.027, 95% CI [-0.088, 0.0034]; β≧T2 = -0.094, 95% CI [-0.161, -0.028]; Ptrend = 0.005) and 8-NO2Gua (βT1-T2 = -0.068, 95% CI [-0.127, -0.010]; β≧T2 = -0.125, 95% CI [-0.184, -0.066]; Ptrend < 0.001). Free T4 was positively associated with MDA (Ptrend = 0.047) and with 8-NO2Gua (Ptrend < 0.001). 8-NO2Gua mediated 11% of the association between the sum of DEHP metabolites and T4, and 17% of the association between MnBP and free T4. These results suggest that phthalate exposure may influence thyroid hormone levels through induced oxidative/nitrosative stress.

Objectives Evidence on the associations between short-term and long-term air temperature exposure and cognitive function in older adults, particularly those in Asia, is limited. We explored the relationships of short-term and long-term air temperature exposure with cognitive function in Taiwanese older adults through a repeated measures survey. Design and setting We used data the ongoing Taiwan Longitudinal Study on Aging, a multiple-wave nationwide survey. Participants We identified 1956, 1700, 1248 and 876 older adults in 1996, 1999, 2003 and 2007, respectively. Primary and secondary outcome measures Participants’ cognitive function assessment was based on the Short Portable Mental Status Questionnaire. We calculated the temperature moving average (TMA) for temperature exposure windows between 1993 and 2007 using data from air quality monitoring stations, depending on the administrative zone of each participant’s residence. Generalised linear mixed models were used to examine the effects of short-term and long-term temperature changes on cognitive function. Results Short-term and long-term temperature exposure was significantly and positively associated with moderate-to-severe cognitive impairment, with the greatest increase in ORs found for 3-year TMAs (OR 1.247; 95% CI 1.107 to 1.404). The higher the quintiles of temperature exposure were, the higher were the ORs. The strongest association found was in long-term TMA exposure (OR 3.674; 95% CI 2.103 to 6.417) after covariates were controlled for. Conclusions The risk of mild cognitive impairment increased with ambient temperature in community-dwelling older adults in Taiwan.

Background: Few studies have evaluated the linkage between food cost and mortality among older adults. This study considers the hypothesis that greater food expenditure in general, and particularly on more nutritious plant and animal-derived foods, decreases mortality in older adults. Methods: This study uses the 1999–2000 Elderly Nutrition and Health Survey in Taiwan and follows the cohort until 2008, collecting 24-hr dietary recall data for 1781 participants (874 men and 907 women) aged 65 y or older. Using monthly mean national food prices and 24-hr recall, this study presents an estimate of daily expenditures for vegetable, fruit, animal-derived, and grain food categories. Participants were linked to the national death registry. Results: Of the 1781 original participants, 625 died during the 10-y follow-up period. Among the 4 food categories, the fourth and fifth expenditure quintiles for vegetables and for fruits had the highest survival rates. After adjusting for co-variates, higher (Q4) vegetable and higher fruit (Q4) food expenditures referent to Q1 were significantly predictive of reduced mortality (HR = 0.55, 95% CI: 0.39-0.78 and HR = 0.64, 95% CI: 0.42–0.99, respectively) and the risk decreased by 12% and 10% for every NT$15 (US$0.50) increase in their daily expenditures. Animal-derived and grain food spending was not predictive of mortality. Conclusion: Greater and more achievable vegetable and fruit affordability may improve food security and longevity for older adults.