Cue-Responding Behaviors During Pharmacy Counseling Sessions With Patients With Asthma About Inhaled Corticosteroids: Potential Relations With Medication Beliefs and Self-Reported Adherence

The aim of this study was to examine cue-responding behavior at the pharmacy while counseling about inhaled corticosteroids (ICS) in relation to medication adherence and medication beliefs. Patients with asthma aged ≥18 years using ICS were recruited from 12 pharmacies. Counseling sessions were video-recorded. Patients’ emotional and informational cues and pharmacists’ and pharmacy technicians’ cue-responding behaviors were coded using an expanded version of the Medical Interview Aural Rating Scale. The Beliefs about Medicines Questionnaire assessed patients’ ICS concern and necessity beliefs. Self-reported ICS adherence was measured by four questions. During the 86 sessions, patients expressed on average 2.3, mostly informational, cues (70.8%). In 26.7% of the sessions, no cues were expressed. Pharmacists’ and technicians’ responses to emotional cues (59.3%) were mostly inadequate, and to informational cues mostly appropriate (63.6%). Providing inappropriate information (20.3%) was related to higher concerns post session (p < .05), and cue exploration to higher self-reported adherence at 3 months (p < .05). Apparently, providers’ responses to patients’ cues might have therapeutic value. In addition, patients might need to be encouraged to ask questions and express their concerns.     

Improving Adherence to Inhaled Corticosteroids in Children With Asthma: A Pilot of a Randomized Clinical Trial

This study examined the efficacy of an educational and behavioral intervention designed to improve adherence to inhaled corticosteroids in children with asthma. Fifteen children and their caregivers were randomly assigned to either a targeted educational and behavioral intervention (treatment group) or a broader psychoeducational condition (comparison group). Given the small sample size, data were analyzed using pooled time series analysis (PTSA), a unique statistical methodology that treats observations for each participant as a separate case and provides statistical power in small samples. Participants in the treatment group showed significant improvements in adherence (16.38%) during the intervention. Participants in both groups also made clinically meaningful improvements in pulmonary function. This study addressed various limitations of previous intervention research and demonstrated that a targeted intervention including educational and behavioral components was effective in improving adherence to inhaled corticosteroids in children with asthma. Implications for adherence interventions are discussed.     

Bone Density in Axial and Appendicular Skeleton in Patients with Lactose Intolerance: Influence of Calcium Intake and Vitamin D Status

Objective: To investigate policosanol absorption by brush border membrane (BBM), metabolism in CaCo-2 enterocytes, and transport of policosanol metabolites across the basolateral membrane (BLM). It was hypothesized that policosanol is partially oxidized into fatty acids and then is incorporated into other lipids.

Methods: Policosanol was emulsified with phosphatidylcholine in the culture medium. The viability of cells was assessed via an MTT (3-[4,5]dimethylthiazol-2-yl-2,5-diphenyltetrazolim) assay. Control cells received only the same amount of “vehicle” (phosphatidylcholine) without policosanol. CaCo-2 cell monolayer and medium were collected; lipid was extracted and analyzed by thin-layer chromatography (TLC) and gas liquid chromatography (GLC).

Results: Eighty-six percent of policosanol added to the cell culture medium was absorbed after 48 hours' incubation. The amount of cholesterol ester fatty acid was significantly increased both in the cells and in the basolateral medium, and was reduced in the apical medium. Policosanol increased the quantity of free fatty acids in the basolateral medium and reduced the free fatty acid content of CaCo-2 cells. Further evaluation of lipid profiles indicated that policosanol modulated the fatty acid profile of cholesterol ester in the basolateral medium.

Conclusion: It was concluded that policosanol or policosanol metabolites may modulate lipid metabolism and/or transport following absorption by the BBM, partial oxidation by the intestinal epithelium, and transport of policosanol metabolites across the BLM.     

Visual Acuity in Institutionalized Seniors With Moderate to Severe Dementia

ObjectiveThe evaluation of visual acuity (VA) in cognitively impaired older individuals may be limited by a reduced ability to cooperate or communicate. The objective of this research was to assess VA in older institutionalized individuals with cognitive impairment, including severe dementia, using various acuity charts.Design, setting, participants, and measurementsThree groups of 30 participants each were recruited: (1) young participants; (2) older participants with no history of cognitive or communication disorders; and (3) older participants with cognitive impairment, including severe dementia, residing in long term care facilities. The Mini-Mental State Examination was performed for each institutionalized subject. VA was measured using 6 validated charts [Snellen, Teller cards, Early Treatment Diabetic Retinopathy Study (ETDRS)-letters, -numbers, -Patty Pics, -Tumbling Es] presented in random order. Nonparametric tests were used to compare VA scores between charts, after Bonferroni-Holm corrections for multiple comparisons.ResultsParticipants in groups 1 and 2 responded to all charts. A large proportion of participants with dementia responded to all charts (n = 19), whereas only one did not respond to any chart. In group 3, VA charts with the lowest scores were the Teller cards (20/65) and Patty Pics (20/62), regardless of the level of dementia, whereas the highest VA scores were obtained with the Snellen (20/35) and ETDRS-letter (20/36) charts. Across all groups, the ETDRS-letter chart was the only one whose scores did not differ from those obtained with the standard Snellen chart.ConclusionsVisual acuity can be measured, and should at least be attempted, in older cognitively impaired individuals having a reduced ability to communicate.     

Dietary Intake Correlated to Waist-To-Hip Ratio in Patients on Maintenance Hemodialysis

ObjectiveIndividuals with end-stage kidney disease (ESKD) receiving maintenance hemodialysis (MHD) are at risk for protein-energy wasting (PEW). Inadequate dietary intake and altered anthropometrics are two criteria of the PEW diagnosis. This study explored whether individuals with ESKD on MHD meet the National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF-KDOQI) 2020 guidelines for nutritional adequacy on a dialysis treatment day (DD) and explored the relationship between dietary energy [DEI] and protein [DPI] intake and anthropometrics.MethodsThis was a secondary analysis of clinical and demographic data for 142 adults from the Rutgers Nutrition and Kidney Disease database. The study assessed the relationships between DEI, DPI, and anthropometrics, including body mass index (BMI), BMI category, waist circumference, and waist-to-hip ratio (WHR) using Pearson’s or Spearman’s correlation and one-way ANOVA.ResultsThe sample had a median age of 55.7 years; 58% were male, 83.8% were Black/African American, with a median dialysis vintage of 42.0 months (e.g., 3.5 years). Seventy-five percent of the data sample were overweight or obese. The WHR was 1.0 ± 0.8 cm for males and 0.9 ± 0.1 for females. DEI and DPI on a DD did not meet the NKF-KDOQI 2020 guidelines. Median DEI was 17.6 ± 8.4 kcal/kg and DPI was 0.7 ± 0.4 g/kg. In the total sample, significant positive correlations were found between DEI (r = 0.74, P = 0.03) and DPI (r = 0.18, P = 0.037) and WHR. In females, a significant positive correlation was identified between DPI and WHR (r = 0.26, P = 0.046).ConclusionsThese findings suggest that the nutritional intake of individuals with ESKD receiving MHD is inadequate to meet NKF-KDOQI 2020 guidelines on a DD. WHR may be a useful tool to assess alterations in anthropometrics related to DEI or DPI in this population, but more research is warranted.     

膳食碘摄入与碘代谢的研究进展

碘是人类必须的微量元素,是合成甲状腺激素的重要原料,目前已知碘的摄入量对甲状腺疾病的呈现具有双向性,碘缺乏和碘过量都会影响甲状腺的形态和功能。     

女性系统性红斑狼疮患者骨密度与骨代谢生化参数的相关性

目的 测定绝经前女性系统性红斑狼疮患者骨密度(BMD)与骨代谢的生化参数并探讨二者的相关性。方法 用双能量X线吸收测量仪测定30例SLE患者腰椎和股骨BMD；常规测定分别测定30例SLE患者和39名正常健康者校正后的血清钙、磷、碱性磷酸酶、肌酐和白蛋白，用ELISA法测定卵泡促激素、黄体生成素、甲状旁腺素、骨钙素、脱氧吡诺林的分泌，用RIA法测定雌二醇、孕酮、睾丸酮、25-OH维生素D、I型原胶原C端前肽、碱性磷酸酶骨特异性同工酶、交联的I型胶原端肽。结果 根据世界卫生组织的标准，在腰椎位点39％患者BMD正常，46％患者骨质减少，15％患者骨质疏松；在股骨颈位点，38．5％患者BMD正常，38．5％患者骨质减少，23％患者骨质疏松。狼疮患者骨钙素、血清磷显著性降低(P=0．03、P=0．002)，而患者校正后的血清钙则显著性升高(P=O．0001)；除了患者睾丸酮的血清水平降低和卵泡促激素血清水平升高外(P=0.001、P=0．42)，其它性激素水平没有显著性差异。结论 绝经前女性SLE患者腰椎和股骨颈的骨质疏松和骨质减少发生率高，至少部分因骨形成的减少所致。     

布地奈德混悬液吸入治疗中重度支气管哮喘的临床观察

目的评价中、重度支气管哮喘患者全身糖皮质激素治疗后吸人布地奈德混悬液减少全身糖皮质激素用量及时间。方法36例中、重度支气管哮喘患者为治疗组，给予吸人布地奈德混悬液2mgbid，对照组为同期收治的支气管哮喘患者33例。观察病情缓解和糖皮质激素减量的天数及肺功能变化。结果治疗组和对照组使用全身糖皮质激素天数分别为（7．6±2．7）、（12．8±3．7）d，症状缓解时间分别为（8．1±2．3）d和（12．5±3．1）d比较，差异均有统计学意义（P〈0．01）。结论中、重度支气管哮喘患者全身糖皮质激素治疗后吸人布地奈德混悬液减少全身糖皮质激素用量及时间，且不良反应少，无须再口服糖皮质激素。     

Caloric Intake in Renal Patients: Repercussions on Mineral Metabolism

The aim of this paper is to review current knowledge about how calorie intake influences mineral metabolism focussing on four aspects of major interest for the renal patient: (a) phosphate (P) handling, (b) fibroblast growth factor 23 (FGF23) and calcitriol synthesis and secretion, (c) metabolic bone disease, and (d) vascular calcification (VC). Caloric intake has been shown to modulate P balance in experimental models: high caloric intake promotes P retention, while caloric restriction decreases plasma P concentrations. Synthesis and secretion of the phosphaturic hormone FGF23 is directly influenced by energy intake; a direct correlation between caloric intake and FGF23 plasma concentrations has been shown in animals and humans. Moreover, in vitro, energy availability has been demonstrated to regulate FGF23 synthesis through mechanisms in which the molecular target of rapamycin (mTOR) signalling pathway is involved. Plasma calcitriol concentrations are inversely proportional to caloric intake due to modulation by FGF23 of the enzymes implicated in vitamin D metabolism. The effect of caloric intake on bone is controversial. High caloric intake has been reported to increase bone mass, but the associated changes in adipokines and cytokines may as well be deleterious for bone. Low caloric intake tends to reduce bone mass but also may provide indirect (through modulation of inflammation and insulin regulation) beneficial effects on bone. Finally, while VC has been shown to be exacerbated by diets with high caloric content, the opposite has not been demonstrated with low calorie intake. In conclusion, although prospective studies in humans are needed, when planning caloric intake for a renal patient, it is important to take into consideration the associated changes in mineral metabolism.     

Dietary Intake and Severe Early Childhood Caries in Low-Income,Young Children

Evidence suggests that risk for early childhood caries (ECCs), the most common chronic infectious disease in childhood, is increased by specific eating behaviors. To identify whether consumption of added sugars, sugar-sweetened beverages (SSBs), and 100% fruit juice, as well as eating frequency, are associated with severe ECCs, cross-sectional data collected from a sample of low-income, racially diverse children aged 2 to 6 years were used. Four hundred fifty-four children with severe ECCs and 429 caries-free children were recruited in 2004-2008 from three pediatric dental clinics in Columbus, OH; Cincinnati, OH; and Washington, DC. Dietary data were obtained from one parent-completed 24-hour recall and an interviewer-administered food frequency questionnaire (FFQ). Multivariate logistic regression analyses were conducted to assess associations between severe ECCs and dietary variables. On average, children with severe ECCs consumed 3.2-4.8 fl oz more SSBs (24-hour recall=1.80 vs 1.17; P< 0.001; FFQ=0.82 vs 0.39; P<0.001) and reported significantly more daily eating occasions (5.26 vs 4.72; P<0.0001) than caries-free children. After controlling for age, sex, race/ethnicity, maternal education, recruitment site, and family size, children with the highest SSB intake were 2.0 to 4.6 times more likely to have severe ECCs compared with those with the lowest intake, depending on dietary assessment method (24-hour recall odds ratio 2.02, 95% CI 1.33 to 3.06; FFQ odds ratio 4.63, 95% CI 2.86 to 7.49). The relationship between eating frequency and severe ECC status was no longer significant in multivariate analyses. Specific dietary guidance for parents of young children, particularly regarding SSB consumption, could help reduce severe ECC prevalence.     

2型糖尿病患者病程长短与骨密度和骨代谢指标关系的研究

目的研究病程长短对2型糖尿病患者骨密度及骨代谢生化指标的影响。方法随机选择2型糖尿病患者68例,按其病程分为三组,I组：病程〈5年,18例;Ⅱ组：病程5～10年,22例;Ⅲ组：病程〉10年,28例,并随机选择与糖尿病组年龄、体重指数相匹配的非糖尿病对照组18例。采用生化法测定所有研究对象血清总碱性磷酸酶、血钙、血磷、尿钙、尿磷等,应用DPX～L型双能X线法测定腰椎、股骨颈和全身的骨密度。结果不同病程长短的3组2型糖尿病患者性别比例相当,糖化血红蛋白水平和合并下肢血管病变差异无统计学意义。2型糖尿病组较对照组骨密度降低（RO．05）;Ⅲ组腰椎、股骨颈及全身的骨密度较对照组减低（P〈0．05）;I组股骨颈及全身的骨密度均高于Ⅲ组（P〈0．05）。I组、Ⅱ组血钙明显高于Ⅲ组（P〈0．05）,而I组与Ⅱ组血钙比较差异无统计学意义。结论病程大于10年的2型糖尿病患者骨质疏松发生的危险性增加。     

The Influence of Dietary Fat on Food Intake and Body Weight

Excessive intake of dietary fat is associated with a number of nutrition-related disorders, including obesity, heart disease, and cancer. The overconsumption of fat may be related to its palatability, high energy density, or physiological effects. This article reviews possible reasons why fat intake is high, examines the relationship between diet composition and body weight, and explores potential fat reduction strategies. It is concluded that low-fat or fat-free products could be useful in reducing the percentage of calories derived from fat, although this assertion needs to be further tested in controlled laboratory experiments and validated on a population basis.     

The Influence of Dietary Composition on Energy Intake and Body Weight

We review evidence regarding the influence of dietary fat, fiber, the glycemic index and sugar on energy intake and body weight. Although data from comprehensive long-term studies are lacking, published investigations suggest that the previous focus on lowering dietary fat as a means for promoting negative energy balance has led to an underestimation of the potential role of dietary composition in promoting reductions in energy intake and weight loss. More randomized clinical trials are needed to examine the relative utility of different putative dietary factors in the treatment of obesity.