Two-Year Follow-up of a Multimodal Intervention on Functional Capacity and Muscle Power in Frail Patients With Type 2 Diabetes

ObjectivesTo analyze the effects of a program composed of resistance training and nutritional interventions on functional capacity, maximal strength, and power output after 2 years of follow-up, including 2 periods of 16 weeks of intervention followed by several weeks of intervention cessation in frail patients with type 2 diabetes.DesignMIDPOW is a substudy of a multicenter, multimodal intervention composed of resistance training combined with a structured diabetes and nutritional education program in frail and prefrail older people with type 2 diabetes (MID-Frail).Setting and ParticipantsThis study recruited 52 participants (mean age: 79 ± 5.6, 63% women), with type 2 diabetes mellitus, frail or prefrail using Fried's frailty phenotype.MethodsPrimary outcomes of this substudy were Short Physical Performance Battery (SPPB) and maximal power output at 30% and 80% of 1RM.ResultsEach set of 16 weeks of intervention resulted in significant improvements in SPPB performance by a mean of 36.1% at week 18 (P < .001) and 10.2% at week 68 (P < .05). Maximal power output improvements at 30% and 80% of the 1RM ranged from 45.2% to 57.2% at week 18 (P < .01–.001); and no significant changes were observed after the second period of intervention. After 2 years of follow-up, the SPPB and maximal power values observed remained significantly higher than the baseline.Conclusions and ImplicationsResistance training combined with nutritional program improved SPPB, maximal strength, and power output in older frail patients with diabetes. These improvements were maintained above the basal levels after several weeks of intervention cessation during a 2-year follow-up.     

Association between reproductive variables and metabolic syndrome in chinese community elderly women

ObjectiveThis study aimed to evaluate the association between reproductive variables and metabolic syndrome (MetS) among Chinese community elderly women.MethodsWe conducted a cross-sectional study in a Beijing urban district. A two-stage stratified clustering sampling method was used and 1251 elderly women were included.ResultsThe prevalence of MetS was 65.1% in this population. Women with MetS had younger menarche age, a greater number of years after menopause, higher gravidity and parity. The prevalence of MetS showed an increasing trend for tertiles of years after menopause (p = 0.002) and number of children (p < 0.001), while decreasing trend for menarche age (p = 0.021). Logistic regression showed ORs of age at menarche, years after menopause and number of children for MetS were 0.94, 1.40, and 1.36 for second and 0.63, 1.58, and 1.75 for last tertiles.ConclusionThere is strong association between reproductive variables and higher risk of MetS. Simple information on timing of menarche and menopause could help identify women who may have higher risk of getting MetS and take early action to prevent related chronic diseases.     

Efficacy of resistin and leptin in predicting persistent organ failure in patients with acute pancreatitis

BackgroundTo investigate the accuracy of resistin, leptin and adiponectin levels in predicting persistent organ failure in patients with acute pancreatitis (AP).MethodsData from 90 consecutive patients admitted to our hospital for AP were retrospectively collected from an ongoing prospective cohort study. The levels of adiponectin, leptin and resistin were measured and compared between patients with and without persistent organ failure. The accuracy of the adipokines in predicting persistent organ failure were compared with the patients' Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, and were separately investigated in overweight and non-overweight groups.ResultsPersistent organ failure occurred in 26.7% of the patients. The levels of resistin were significantly increased in AP patients with persistent organ failure, in both the overweight and the non-overweight subgroups. Resistin and APACHE-II score predicted persistent organ failure with comparable areas under the curve (AUC) of 0.72 and 0.75, respectively (p = 0.66). Resistin demonstrated similar accuracy with the APACHE-II score in predicting persistent organ failure in the overweight (0.69 vs. 0.66, p = 0.82) and non-overweight (0.76 vs. 0.87, p = 0.39) subgroups. There was no correlation between adiponectin and persistent organ failure, but a weak correlation between leptin and persistent organ failure was demonstrated.ConclusionsResistin and leptin levels, rather than adiponectin, correlate with persistent organ failure in patients with AP.     

Modifiable factors associated with anxiety in persons with dementia: An integrative review

ObjectivesThe purpose of this integrative review was to examine factors related to the presence of anxiety in person with dementia (PWD) and to identify potentially modifiable factors among them.MethodsAn integrative review was conducted using PsycINFO, CINAHL, AgeLine, PubMed, Embase, Web of Science, and Scopus. Among 1856 studies identified, 27 studies were included.ResultsA number of modifiable factors associated with anxiety were identified. Individual level factors included pain, physical health, physical functioning, fatigue, sleep disturbance, disclosure of diagnosis, embarrassment about memory problems, separation from caregivers, views about oneself and others, social rejection, social isolation, and interactions with others. Caregiver factors associated with anxiety in PWD included caregiver stress, caregiver's negative reactions towards the behavioral problems of PWD, and competence about caregiving.ConclusionThe results of this review can be used to identify potential targets for interventions to reduce for anxiety in persons with dementia.     

Effects of registered nurse staffing on quality of care and resident outcomes in nursing homes

Few studies focus on Registered Nurse (RN) staffing and resident health outcomes in Korean nursing homes. This study aimed to investigate the effects of RN staffing on quality of care and resident outcomes in South Korean nursing homes. The study was a secondary data analysis of 5679 participants from the National Health Insurance Service. A mixed-effect linear model and multinomial logistic regression model assessed resident outcomes and quality of care, respectively. The number of RNs significantly affected patient mortality. The overall evaluation rating for quality of care in nursing homes increased as the number of RNs increased. Level of RN staffing in nursing homes influenced health management and quality of care for residents. A variety of efforts are needed to strengthen the workforce of RNs in nursing homes, including enacting a law for safe RN staffing and converting the evaluation of nursing home quality into health outcomes.     

Diffusion tensor imaging MR Neurography detects polyneuropathy in type 2 diabetes

AimTo evaluate if diffusion-tensor-imaging MR-Neurography (DTI-MRN) can detect lesions of peripheral nerves due to polyneuropathy in patients with type 2 diabetes.MethodsTen patients with type 2 diabetes with polyneuropathy (DPN), 10 patients with type 2 diabetes without polyneuropathy (nDPN) as well as 20 healthy controls (HC) were included. DTI-MRN covered proximal (sciatic nerve) and distal regions (tibial nerve) of the lower extremity. Fractional-anisotropy (FA) and diffusivity (mean (MD), axial (AD) and radial (RD)) were calculated and compared to neuropathy severity. Conventional T2-relaxation-time and proton-spin-density data were obtained from a multi-echo SE sequence. Furthermore, we evaluated sensitivity and specificity of DTI-MRN from receiver operating characteristics (ROC).ResultsThe proximal and distal FA was lowest in patients with DPN compared with nDPN and HC (p < 0.01). Likewise, proximal and distal RD was highest in patients with DPN (p < 0.01). MD and AD were also significantly different though less pronounced. ROC curve analyses of DTI separated nDPN and DPN with area-under-the-curve values ranging from 0.65 to 0.98. T2-relaxation-time and proton-spin-density could not differentiate between nDPN and DPN.ConclusionDTI-MRN accurately detects DPN by lower nerve FA and higher RD. These alterations are likely to reflect both proximal and distal nerve fiber pathology in patients with type 2 diabetes.     

健康老龄化与老年流行病学研究进展

近年来我国正大力推进并努力实现健康老龄化社会的建设,而反映一个国家健康老龄化的核心指标就是老年人群躯体健康、心理健康、社会适应程度及生活质量的水平。本文综述了健康老龄化的概念及国内外的相关进展,并阐述了老年流行病学在该领域研究的引领作用和策划本期“关注老年人的功能与健康”栏目的初衷,即针对主要影响我国老年人群生活质量的诸如失能、共病和失智的基本患病情况及主要影响因素在有一定全国代表性的人群进行调查与分析,以期描述和了解我国不同地区影响老年人群生活质量的主要健康问题的严重程度及相关影响因素的差异性,为制定针对性的干预策略、探索实现健康老龄化社会的有效途径提供相关基础数据。     

肥胖相关遗传基因位点的研究进展

胖既是独立疾病?,又作为明确的危险因素与高血压、心脑血管疾病、糖尿病、多种癌症等非传染性慢性病的发生及死亡风险紧密相关[21],已成为全球范围内可预防性疾病负担主要来源之一。