Comparison of stress experienced by family members of patients treated in hospital at home with that of those receiving traditional acute hospital care

OBJECTIVES: To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care.
DESIGN: Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model.
SETTING: Three Medicare managed care health systems and a Veterans Affairs Medical Center.
PARTICIPANTS: Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis.
INTERVENTION: Treatment in a substitutive HaH model.
MEASUREMENTS: Fifteen-question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care.
RESULTS: The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean ± standard deviation 1.7 ± 1.8 vs 4.3 ± 3.1, P <.001; median 1 vs 4, P <.001). HaH care was associated with lower odds of developing mean levels of family member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05–0.30).
CONCLUSION: HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.     

血清瘦素对慢性阻塞性肺疾病患者营养状态影响的初步研究

目的 探讨血清瘦素及肿瘤坏死因子α（ＴＮＦ－α）的慢性阻塞性肺疾病（ＣＯＰＤ）患者营养不良发生中的意义。方法 测定３１例ＣＯＰＤ患者（分为营养不良组１２例,非营养不良组１９例）及１１名正常人的血清瘦素、ＴＮＦ－α浓度、体重指数（ＢＭＩ）、理想体重百分比（ＮＷ％）、三头肌皮皱厚度（ＴＳＦ）、肩胛下皮皱厚度（ＳＳＦ）、上臂中部臂围（ＭＡＣ）,血清白蛋白（ＡＬＢ）、总淋巴细胞计数（ＬＹＭ）等指标。瘦素与     

Serum total and bioavailable testosterone levels, central obesity, and muscle strength changes with aging in healthy Chinese men

OBJECTIVES: To investigate the effects of the changes in serum bioavailable and total testosterone (TT) levels with aging on visceral body fat distribution and muscle strength in Chinese men.
DESIGN: Cross-sectional study.
SETTING: Ambulatory care.
PARTICIPANTS: Four hundred seventy-five healthy ambulatory Chinese men (aged 18–89, body mass index (BMI) 16.4–40.0 kg/m²).
MEASUREMENTS: Morning serum total and bioavailable testosterone levels, waist circumference (WC), waist-hip ratio (WHR), and right handgrip strength.
RESULTS: Mean serum TT levels fell mildly but significantly with aging ( P =.02, linear trend; one-way analysis of variance (ANOVA)), whereas mean serum bioavailable testosterone (BT) levels fell greatly with aging ( P <.001, linear trend, one-way ANOVA). The rates of decline in serum TT and BT levels were 0.2% and 1.14% per year, respectively. [Correction added after online publication 14-May-2008: BT levels have been corrected from 1.44% to 1.14%.] After adjustment for adiposity according to BMI, multiple linear regression analyses showed that age remained significantly related to serum TT and BT levels. Handgrip strength decreased with age (correlation coefficient ( r )=−0.394, P <.001) and was greater with higher serum BT levels ( r =0.239, P <.001) but not with higher TT levels. WHR, before and after adjustment for BMI, was inversely related to serum TT ( r =−0.34 and −0.197 respectively, P <.001) and BT levels ( r =−0.104, P <.05 and −0.161, P <.001, respectively).
CONCLUSION: In Chinese men, serum BT levels decreased with aging and may contribute to central obesity and poorer muscle strength in aging men.     

Leptin serum levels in cachectic heart failure patients. Relationship with tumor necrosis factor-alpha system

Cachexia is a strong predictor for mortality in patients with congestive heart failure. To investigate the role of leptin and regulators of apoptosis in cardiac cachexia we compared leptin concentrations and their relation to the TNF system, interleukin 1-beta (IL-1b), and soluble Fas in patients with heart failure with and without cachexia. Patients with cardiac cachexia have increased levels of interleukin-1b compared to non-cachectic heart failure patients [mean(S.E.)=1.11(0.62) vs. 0.02(0.02), P=0.01] and decreased concentrations of leptin [10.79(3.93) vs. 23.24 (8.35), P=0.1]. Leptin levels correlate with TNF-RI in cachectic heart failure patients (r=0.58, P=0.018). The TNF-RI levels were also correlated with Fas, both in all the patients taken together (r=0.5, P=0.006) and in those with cachexia (r=0.52, P=0.036). Our data indicate that more prospective studies are needed to clarify the role of leptin in the pathophysiology of heart failure cachexia.     

武汉市某医院老年慢性阻塞性肺疾病住院患者发生衰弱现状及其影响因素分析

摘要：目的 调查武汉市某医院老年慢性阻塞性肺疾病（COPD）住院患者发生衰弱现状，并分析其影响因素。方法 采用便利抽样法选取2021年1月-2022年12月我院住院的260例老年COPD住院患者。采用自制一般资料问卷对患者开展调查；使用临床衰弱量表（Fried）对患者的衰弱状况进行评估；采用全自动血液分析仪对血红蛋白的水平进行检测；采用化学发光免疫法对25-羟基维生素D（25-OH-D）的水平进行检测；采用噶庖呶椒ǘ园紫赴樗�-6（IL-6）的水平进行检测；单因素及多因素Logistic回归分析影响老年COPD住院患者发生衰弱的因素。结果 本研究对武汉市某医院老年COPD住院患者一共发出260份调查问券，收回260份，有效率为100.00%。260例患者中，发生衰弱的有67例，发生率为25.77%（67/260）；其中性别、年龄、吸烟、锻炼习惯、营养状态比较均有统计学意义（P<0.05）；衰弱组患者的血红蛋白、25-OH-D水平显著低于未衰弱组，IL-6水平显著高于为衰弱组（P＜0.05）；根据Logistic回归分析得知性别（OR=3.174，95%CI：1.415-7.117）、年龄（OR=1.556，95%CI：1.049-2.307）、吸烟（OR=3.162，95%CI：1.337-7.476）、锻炼习惯（OR=1.735，95%CI：1.103-2.729）、血红蛋白低表达（OR=1.314，95%CI：1.014-1.701）、25-OH-D低表达（OR=1.974，95%CI：1.073-3.631）、IL-6高表达（OR=2.173，95%CI：1.198-3.943）是老年COPD住院患者发生衰弱的危险因素（P＜0.05）。结论 武汉市某医院老年COPD住院患者发生衰弱的发生率较高，性别、年龄、吸烟、锻炼习惯、营养状态、血红蛋白、25-OH-D、IL-6水平均有影响，临床上应进行合理的干预，从而减少衰弱的发生。     

Large differences in serum leptin levels between nonwesternized and westernized populations: the Kitava study

OBJECTIVES: To compare serum leptin between nonwesternized and westernized populations. SETTING: (i) The tropical island of Kitava, Trobriand Islands, Papua New Guinea and (ii) the Northern Sweden MONICA study population. Design. Cross-sectional survey. METHODS: Fasting levels of serum leptin were analysed in 163 randomly selected Kitavans aged 20-86 years and in 224 Swedes aged 25-74. MAIN OUTCOME MEASURE: Mean and determinants of serum leptin. RESULTS: Geometric mean of serum leptin in Kitavan males and females were 1.5 and 4.0 vs. 4.9 and 13.8 ng mL-1 in Swedish male and females (P < 0.0001 for both sexes). In Kitavans, observed geometric mean were close to predicted levels (1.8 ng mL(-1) for males and 4.5 ng mL-1 for females) based on multiple linear regression equations including body mass index (BMI), triceps skinfolds (TSF) and age from the Swedish population-based sample. In Kitavans serum leptin was positively related to TSF amongst both sexes and, amongst females, to BMI. In Kitavans leptin was not related to fasting serum insulin. TSF explained 55% of the variation of leptin amongst females. There was a slight age-related increase of leptin amongst males. In Kitava leptin was not related to fasting serum insulin which was substantially lower than in Sweden. CONCLUSION: The low concentrations of serum leptin amongst Kitavans probably relates to the absence of overweight and hyperinsulinaemia. At a population level serum leptin can apparently be predicted from simple measures of adiposity.     

Lower plasma adiponectin is a marker of increased intima-media thickness associated with type 2 diabetes mellitus and with male gender

OBJECTIVE: We tested the extent to which altered plasma adipokine levels may contribute to the increased carotid artery intima-media thickness (IMT) associated with type 2 diabetes mellitus and with male gender, independently of conventional cardiovascular risk factors, insulin resistance, and plasma C-reactive protein (CRP). DESIGN: IMT (mean of three segments of both carotid arteries by ultrasonography), insulin resistance (homeostasis model assessment; HOMA(ir)), plasma CRP, lipids, adiponectin, leptin, resistin, and tumor necrosis factor-alpha (TNF-alpha) were measured in 84 type 2 diabetic patients and 85 control subjects. RESULTS: In diabetic patients, IMT (P<0.001), mean arterial pressure (P<0.001), HOMA(ir) (P<0.001), plasma CRP (P=0.003), triglycerides (P=0.037), leptin (P=0.023), resistin (P=0.003), and TNF-alpha (P=0.003) levels were higher, whereas high-density lipoproteins (HDL) cholesterol (P<0.001) and adiponectin (P<0.001) levels were lower compared with control subjects. Plasma adiponectin (P<0.001) and leptin (P<0.001) were substantially lower in men than in women. IMT was positively and independently associated with age (P<0.001), diabetes (P=0.049), and male gender (P=0.002) in a multivariate regression model, not including other variables. Further analyses showed that IMT was positively related to age (P<0.001) and plasma triglycerides (P=0.038) and negatively to adiponectin (P<0.001), without independent effects of diabetes, gender, and HOMA(ir). CONCLUSIONS: Increased IMT in type 2 diabetes may in part be explained by lower plasma adiponectin and higher triglycerides, but not by leptin, resistin, and TNF-alpha. The gender effect on IMT is related to lower plasma adiponectin.     

Sleep–Wake Disturbances and Frailty in Community-Living Older Persons

OBJECTIVES: To evaluate the association between sleep–wake disturbances and frailty.
DESIGN: Cross-sectional.
SETTING: New Haven, Connecticut.
PARTICIPANTS: Three hundred seventy-four community-living persons aged 78 and older.
MEASUREMENTS: Frailty was based on the Fried phenotype, and sleep–wake disturbances were defined as daytime drowsiness, based on an Epworth Sleepiness Scale (ESS) score of 10 or greater, and as subthreshold and clinical insomnia, based on Insomnia Severity Index (ISI) scores of 8 to 14 and greater than 14, respectively.
RESULTS: Mean age was 84.3; 87 (23.8%) participants were drowsy, 122 (32.8%) had subthreshold insomnia, 38 (10.2%) had clinical insomnia, and 154 (41.2%) were frail. There was a significant association between drowsiness and frailty, with unadjusted and adjusted odds ratios (ORs) of 3.79 (95% confidence interval (CI)=2.29–6.29) and 3.67 (95% CI=2.03–6.61), respectively. In contrast, clinical insomnia was significantly associated with frailty in the unadjusted analysis (OR=2.77, 95% CI=1.36–5.67) but not the adjusted analysis (OR=1.93, 95% CI=0.81–4.61)), and subthreshold insomnia was not associated with frailty in the unadjusted or adjusted analysis.
CONCLUSION: In older persons, sleep–wake disturbances that present with daytime drowsiness, but not insomnia, are independently associated with frailty. Because drowsiness is potentially remediable, future studies should determine whether there is a temporal relationship between drowsiness and frailty, with the ultimate goal of informing interventions to reverse or prevent the progression of frailty.     

Continuous noninvasive orthostatic blood pressure measurements and their relationship with orthostatic intolerance, falls, and frailty in older people

OBJECTIVES: To identify morphological orthostatic blood pressure (BP) phenotypes in older people and assess their correlation with orthostatic intolerance (OI), falls, and frailty and to compare the discriminatory performance of a morphological classification with two established orthostatic hypotension (OH) definitions: consensus (COH) and initial (IOH). DESIGN: Cross‐sectional. SETTING: Geriatric research clinic. PARTICIPANTS: Four hundred forty‐two participants (mean age 72, 72% female) without dementia or risk factors for autonomic neuropathy. MEASUREMENTS: Active lying‐to‐standing test monitored using a continuous noninvasive BP monitor. For the morphological classification, four orthostatic systolic BP variables were extracted (delta (baseline – nadir) and maximum percentage of baseline recovered by 30 seconds and 1 and 2 minutes) using the 5‐second averages method and entered in K‐means cluster analysis (three clusters). Main outcomes were OI, falls (≥1 in past 6 months), and frailty (modified Fried criteria). RESULTS: The morphological clusters were small drop, fast overrecovery (n=112); medium drop, slow recovery (n=238); and large drop, nonrecovery (n=92). Their characterization revealed an increasing OI gradient (17.9%, 27.5%, and 44.6% respectively, P<.001) but no significant gradients in falls or frailty. The COH definition failed to reveal clinical differences between COH+ (n=416) and COH? (n=26) participants. The IOH definition resulted in a clinically meaningful separation between IOH+ (n=85) and IOH? (n=357) subgroups, as assessed according to OI (100% vs 11.5%, P<.001), falls (24.7% vs 10.4%, P<.001), and frailty (14.1% vs 5.4%, P=.005). CONCLUSION: It is recommended that the IOH definition be applied when taking continuous noninvasive orthostatic BP measurements in older people.     

尿毒症血液透析患者血浆瘦素水平与营养状态的研究

目的　研究尿毒症维持性血液透析（血透）患者血浆瘦素水平及其与营养状态的关系。方法　选择维持性血透患者及健康人各30例,于空腹取血,应用放射免疫分析法测定血浆中瘦素水平;同时检测肾功能、血浆白蛋白、转铁蛋白、前白蛋白和胰岛素水平等。结果　血透患者的血浆瘦素浓度明显高于正常对照组（P＜0.01）;血浆白蛋白、转铁蛋白及前白蛋白含量两组间差异均有显著性（P＜0.01）。血透组患者血浆瘦素浓度与体重指数（BMI,体重/身高2）、肱三头肌皮褶厚度（TSF）和胰岛素水平呈明显正相关（r值分别为0.53、0.66、0.57,P＜0.01）,而与血尿素氮（BUN）、肌酐（Scr）、甘油三脂（TG）、总胆固醇、高密度脂蛋白、低密度脂蛋白、白蛋白、转铁蛋白、前白蛋白、标准化蛋白分解率等则无明显相关关系。结论　尿毒症维持性血透患者血浆瘦素浓度明显升高,其浓度与BMI、TSF及胰岛素水平呈正相关,未发现瘦素浓度与常用的评价营养指标、尿素氮、血肌酐和血脂有相关关系。