Role of hepatic HCV-RNA level on the severity of chronic hepatitis C and response to antiviral therapy

Background

Correlation between hepatic HCV-RNA and serum HCV-RNA, severity of liver disease and response to therapy is poorly known.

Objectives

To assess the influence of hepatic HCV-RNA level on severity of liver disease and response to therapy in a large cohort of chronic hepatitis C (CHC) patients.

Study Design

HCV-RNA was measured in frozen liver biopsies and serum samples from 130 CHC patients the day of liver biopsy prior to treatment. Liver fibrosis was assessed by Ishaq scoring. A Sustained Virological Response (SVR) was observed in 52% of the patients, non-response (NR) in 34%.

Results

Mean ± standard deviation hepatic HCV-RNA level was 7.69 ± 0.67 log₁₀ copies/mg of liver. Mean serum HCV-RNA level was 6.21 ± 0.72 log₁₀ copies/ml. There was a correlation between hepatic and serum HCV-RNA in genotype 1 and 4 (p = 0.008 and p = 0.03) and age (p = 0.006). Mean hepatic HCV-RNA was 7.70 ± 0.69 vs 7.67 ± 0.68 log₁₀ copies/mg of liver, in patients with significant fibrosis vs those with mild fibrosis, respectively (p = 0.7); 8.04 ± 0.68; 7.44 ± 0.47; 7.43 ± 0.49 and 7.44 ± 0.71 log₁₀ copies/mg of liver in genotypes 1, 2, 3 and 4, respectively (p = 0.0001); higher in women than in men (p = 0.04); 7.60 ± 0.63, 7.71 ± 0.54 and 7.96 ± 0.73 log₁₀ copies/mg in SVR, relapsers and NR, respectively (p = 0.1). Multivariate analysis showed that high hepatic HCV-RNA level was independently associated with genotype and response to therapy was associated with genotype independently from hepatic HCV-RNA level.

Conclusions

Hepatic HCV-RNA level was not associated with severity of liver disease. High level was strongly associated with HCV genotype independently from response to therapy.     

Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital

Objective

Determine treatment adherence in patients with multiple chronic conditions (MCC).

Methods

A random patient sample ≥15 years, discharged from hospital with ≥1 chronic conditions (CC) was interviewed after 6-12 months. Analysis included variables in 5 dimensions (WHO): socio-demographics, disease, treatment, patient and health system characteristics. Morisky-Green adherence questionnaire was used. High chronic treatment complexity was defined as: >3 pills/day, >6 inhalations/day, >1 injection/day, pharmacological treatment plus diet or self-monitoring techniques.

Results

301 patients were interviewed (62 ± 15 years, 59% males). Despite good treatment information perception (79%), only 3% followed the patient education programme. Poor adherents (82%) were older (64 ± 14 years vs. 55 ± 16 years), had more CC (3.25 ± 2.02 vs. 2.62 ± 2.72), a higher frequency of hypertension (44% vs. 15%), ischaemic heart diseases: (21% vs. 4%), hyperlipidaemia (19% vs. 6%), more pills/day (5.78 ± 4.14 vs. 3.20 ± 4.70) and more complex treatments (95% vs. 70%) (p < 0.05). On multivariate analysis number of CC [3.68 (0.75-18.15)], pills/day [2.23 (1.02-4.84)], treatment complexity [4.00 (1.45-11.04)], and hypertension [2.57 (1.06-6.25)] were predictive of poor adherence (OR 95% CI p < 0.05).

Conclusion

The WHO conceptual framework allows the construction of poor adherence risk profiles in patients with MCC after hospital discharge.

Practice implications

Predictive variables of poor adherence could help clinicians detect patients with MCC most likely to present poor adherence.     

Cyclic alternating pattern and sleep quality in healthy subjects—Is there a first-night effect on different approaches of sleep quality?

Objective

Cyclic alternating pattern (CAP) is defined as periodic EEG activity during NREM sleep that reflects unstable sleep and represents a marker of instability of the sleep process. The aim of the present investigation was to analyze sleep quality of 28 healthy subjects (mean age 53.3 ± 21.3 years) over two consecutive nights and determine potential differences between them (“first-night effect”).

Methods

Evaluations comprised objective and subjective sleep variables as well as macrostructural and microstructural variables of sleep.

Results

Macrostructural analysis showed significant differences between the first and the second sleep laboratory night in REM latency (122.39 ± 60.46 min vs. 95.43 ± 36.60 min; T = 3.431; p = 0.002) and the amount of sleep stage 1 (42.60 ± 21.80 min vs. 39.70 ± 18.95 min; T = 2.223; p = 0.035). Microstructural analysis revealed a significant decrease in the CAP rate (1st night: 33.29%; 2nd night: 26.34%; T = 3.288; p = 0.003) and in the amount of subtype A2 (74.79 ± 43.47 vs. 58.50 ± 23.22; T = 2.185; p = 0.038). Subjective variables also demonstrated a significant increase of drive (T = 2.564; p = 0.016).

Conclusion

Healthy subjects show hardly any macrostructural differences between the first and the second night in the sleep laboratory. On the microstructural level differences in CAP variables were found.

Significance

Microstructural analysis can be seen as a further approach to the classification of sleep and CAP turned out to be sensitive to environmental influences on sleep.     

Disease-specific education in the primary care setting increases the knowledge of people with chronic obstructive pulmonary disease: A randomized controlled trial

Objective

To examine the effect of brief disease-specific education delivered in primary care on objective measures of knowledge in individuals recently diagnosed with chronic obstructive pulmonary disease (COPD).

Methods

A randomized control trial was undertaken during which an experimental group received 2 h of education delivered by a certified COPD educator and a control group received usual care. The Bristol COPD Knowledge Questionnaire (BCKQ) was self-administered at the time of randomization and approximately three months later.

Results

Of the 93 individuals that completed the study, 50 (forced expiratory volume in 1 s [FEV₁] = 60.0 ± 14.3% predicted; 22 males) and 43 (FEV₁ = 58.2 ± 14.4% predicted; 20 males) participants were randomized to the experimental and control groups, respectively. The BCKQ increased from 27.6 ± 8.7 to 36.5 ± 7.7 points (p < 0.001) in the experimental group, which was greater than any seen in the control group (between-group difference 8.3, 95% confidence interval 5.5-11.2 points).

Conclusion

As little as 2 h of education delivered in primary care was effective at increasing objective measures of disease-specific knowledge.

Practice implications

A program of brief education delivered in the primary care setting, represents an important approach for many individuals with COPD who are unlikely to access pulmonary rehabilitation.     

Circulating vascular endothelial growth factor is independently and negatively associated with trait anxiety and depressive mood in healthy Japanese university students

Objective

Anxiety and depressive mood are sometimes accompanied by modulation of neuroendocrine and immune functions. The aim of this study was to identify circulating immune mediators reflecting anxiety and depressive mood in healthy young adults.

Methods

Anxiety and depressive mood in 209 healthy medical students (125 males and 84 females, aged 20.7 ± 2.7 years (mean ± SD)) were assessed by the Spielberger state-trait anxiety inventory (STAI) and the Zung self-rating depression scale (Zung-SDS), respectively. Cortisol and chromogranin A (CgA) levels in saliva were measured using enzyme immunoassay kits, and 50 different mediators in sera were measured by a multiplex-suspension array system. The level of statistical significance was set at α = 0.05.

Results

Forty-four mediators were measurable in sera, and each mediator showed substantial individual variations. After determining Pearson correlation coefficients, we selected candidate cytokines whose levels were associated with STAI-state (2 cytokines), STAI-trait (8 cytokines), or SDS scores (8 cytokines). The candidate cytokines plus interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and macrophage migration inhibitory factor were then subjected to multiple regression analysis adjusted for gender, BMI, and salivary concentrations of cortisol and CgA. Vascular endothelial growth factor (VEGF) was independently and negatively associated with both trait anxiety (p < 0.05) and depressive mood (p < 0.01). IL-1β showed independently positive association with depressive mood (p < 0.05). Interactions between these two cytokines and gender or BMI were not observed.

Conclusion

Besides IL-1β, circulating VEGF may be a potential biomarker for negative mood states in healthy young adults.     

The profession of public health informatics: Still emerging?

Purpose

Although public health informatics (PHI) was defined in 1995, both then and still now it is an “emerging” profession. An emergent profession lacks a base of “technical specialized knowledge.” Therefore, we analyzed MEDLINE bibliographic citation records of the PHI literature to determine if a base of technical, specialized PHI literature exists, which could lead to the conclusion that PHI has emerged from its embryonic state.

Method

A MEDLINE search for PHI literature published from 1980-2006 returned 16,942 records. Record screening by two subject matter experts netted 2493 PHI records that were analyzed by the intervals of previous PHI CBMs 96-4 and 2001-2 for 1980-1995 (I₁₉₈₀) and 1996-2000 (I₁₉₉₆), respectively, and a new, third interval of 2001-2006 (I₂₀₀₁).

Results

The distribution of records was 676 (I₁₉₈₀), 839 (I₁₉₉₆) and 978 (I₂₀₀₁). Annual publication rates were 42 (I₁₉₈₀), 168 (I₁₉₉₆), and 163 (I₂₀₀₁). Cumulative publications were accelerating. A subset of 19 (2.5%) journals accounted for 730 (29.3%) of the records. The journal subset average (±SD) annual publication rates of 0.7 ± 0.6 (I₁₉₈₀), 2.9 ± 1.9 (I₁₉₉₆), and 3.1 ± 2.7 (I₂₀₀₁) were different, F(3, 64) = 7.12, p < .05. Only I₁₉₈₀ was different (p < .05) from I₁₉₉₆ or I₂₀₀₁. Average (±SE) annual rate of increase for all journals (8.4 ± 0.8 publications per year) was different from the subset of 19 (2.7 ± 0.3), t(36) = 5.74, p < .05. MeSH first time-to-indexing narrowed from 7.3 (±4.3) years to the year (0.5 ± 0.8) the term was introduced, t(30) = 7.03, p < .05.

Conclusion

A core set of journals, the proliferation of PHI articles in varied and numerous journals, and rapid uptake of MeSH suggest PHI is acquiring professional authority and now should not be tagged as an “emerging” profession.     

Impact of patient level factors on the improvement of the ABCs of diabetes

Objective

To determine which patient factors contribute to improvements in the ABCs of diabetes following a multi-faceted diabetes care intervention.

Methods

A multi-level, cluster design, randomized controlled trial examined the effectiveness of a Chronic Care Model (CCM) intervention in an underserved community (n = 119).

Results

Improvements in glycemic control were experienced among older subjects (p = 0.02), those with higher scores on the WHO-10 Quality of Well-Being Subscale 1 (p = 0.05), and those in the CCM group (p = 0.04). Insulin use was associated with greater improvements in SBP and DBP. Those taking insulin (p = 0.07), and those more satisfied with their diabetes care and ready to make a behavior change (p = 0.08) experienced larger improvements in Non-HDLc. Medication treatment intensification (TI) did not significantly impact the ABCs.

Conclusion

Psychosocial and sociodemographic factors explained more of the variation in the ABCs than TI, and are important contributors to clinical improvement.

Practice Implications

Providers may be able to identify and intervene on patients who are at risk for developing diabetes complications and improve the consistency, quality, and effectiveness of patient care.     

Effectiveness of small-group interactive education vs. lecture-based information-only programs on motivation to change and lifestyle behaviours. A prospective controlled trial of rehabilitation inpatients

Objective

Although patient education may promote motivation to change health behaviours, the most effective method has not yet been determined.

Methods

This prospective, controlled trial compared an interactive, patient-oriented group program with lectures providing only information. We evaluated motivational stages of change and self-reported behaviours in three domains (sports, diet, relaxation) at four times up to one year (60% complete data) among 753 German rehabilitation inpatients (mean age 50 years, 52% male) with orthopaedic (59%) or cardiologic disorders (10%) or diabetes mellitus (31%).

Results

We found improvements between baseline and follow up regarding each outcome (p < .001) in both groups. At the end of rehabilitation, participants of the interactive group, as compared to the lectures, showed more advanced motivation regarding diet (p < .10) and sports (p = .006). Interactive group patients reported healthier diets both after 3 months (p = 0.013) and 12 months (p = 0.047), more relaxation behaviours (p = .029) after 3 months and higher motivation for sports after 12 months (p = .08).

Conclusions

The superior effectiveness of the interactive group was only partly confirmed.

Practice implications

This short, 5-session interactive program may not be superior to lectures to induce major sustainable changes in motivation.     

Innovative program to increase physical activity following an acute coronary syndrome: randomized controlled trial

Objective

To evaluate the impact of a socio-cognitive intervention associated with a pedometer-based program on physical activity, cardiovascular risk factors and self-efficacy expectation during one year following an acute coronary syndrome.

Methods

Sixty-five subjects were randomized during hospitalization in an experimental or a usual care group. Average steps/day was measured every 3 months until one year following discharge. Other dependent variables were measured at baseline, 6 and 12 months follow-up.

Results

There were 32 patients in the experimental group and 33 patients in the usual care group. Group characteristics were comparable. At baseline, averages steps/day were similar between groups (5845 ± 3246 vs. 6097 ± 3055 steps/day; p = 0.812). At 3-month follow-up, both groups increased their averages steps/day (p < 0.05). This increase was higher in the experimental group (3388 ± 844 vs. 1934 ± 889 steps/day; p < 0.001). At 12-month, interaction effects (group × time) in physical activity and waist circumference were different between groups (p < 0.05), whereas self-efficacy expectation increased in both groups similarly (p < 0.05).

Conclusion

The intervention is useful to improve average steps/day and waist circumference during the first year following an acute coronary syndrome.

Practice implications

This study supports development of the home-based cardiac rehabilitation program using socio-cognitive intervention associated with a pedometer after an acute coronary syndrome.     

Computerized self-monitoring and technology-assisted feedback for weight loss with and without an enhanced behavioral component

Objective

The purpose of this study was to develop and evaluate a 12-week weight management intervention involving computerized self-monitoring and technology-assisted feedback with and without an enhanced behavioral component.

Methods

120 overweight (30.5 ± 2.6 kg/m²) adults (45.0 ± 10.3 years) were randomized to one of three groups: computerized self-monitoring with Basic feedback (n = 45), Enhanced behavioral feedback (n = 45), or wait-list control (n = 30). Intervention participants used a computer software program to record dietary and physical activity information. Weekly e-mail feedback was based on computer-generated reports, and participants attended monthly measurement visits.

Results

The Basic and Enhanced groups experienced significant weight reduction (−2.7 ± 3.3 kg and −2.5 ± 3.1 kg) in comparison to the Control group (0.3 ± 2.2; p < 0.05). Waist circumference and systolic blood pressure also decreased in intervention groups compared to Control (p < 0.01).

Conclusions

A program using computerized self-monitoring, technology-assisted feedback, and monthly measurement visits produced significant weight loss after 12 weeks. However, the addition of an enhanced behavioral component did not improve the effectiveness of the program.

Practice implications

This study suggests that healthcare professionals can effectively deliver a weight management intervention using technology-assisted strategies in a format that may complement and reduce face-to-face sessions.     

Predictors of weight loss communication in primary care encounters

Objective

Evidence suggests that physicians’ use of motivational interviewing (MI) techniques helps patients lose weight. We assessed patient, physician, relationship, and systems predictors of length of weight-loss discussions and whether physicians’ used MI techniques.

Methods

Forty primary care physicians and 461 of their overweight or obese patients were audio recorded and surveyed.

Results

Weight-related topics were commonly discussed (nutrition 78%, physical activity 82%, and BMI/weight 72%). Use of MI techniques was low. A multivariable linear mixed model was fit to time spent discussing weight, adjusting for patient clustering within physician. More time was spent with obese patients (p = .0002), by African American physicians (p = .03), family physicians (p = .02), and physicians who believed patients were embarrassed to discuss weight (p = .05). Female physicians were more likely to use MI techniques (p = .02); African American physicians were more likely to use MI-inconsistent techniques (p < .001).

Conclusion

Primary care physicians routinely counsel about weight and are likely to spend more time with obese than with overweight patients. Internists spend less time on weight. Patient and systems factors do not seem to influence physicians’ use MI techniques.

Practice implications

All physicians, particularly, male and African American physicians, could increase their use of MI techniques to promote more weight loss among patients.     

Asthma disease management-Australian pharmacists' interventions improve patients' asthma knowledge and this is sustained

Objective

To assess any improvements in knowledge of asthma patients after a tailored education program delivered by pharmacists and measure the sustainability of any improvements. To ascertain patients’ perceptions about any changes in their knowledge.

Methods

Ninety-six specially trained pharmacists recruited patients based on their risk of poor asthma control. A tailored intervention was delivered to patients based on individual needs and goals, and was conducted at three or four time points over six months. Asthma knowledge was assessed at the beginning and end of the service, and six and 12 months after it had ended. Patients’ perceptions of the impact of the service on their knowledge were explored qualitatively in interviews.

Results

The 96 pharmacists recruited 570 patients, 398 (70%) finished. Asthma knowledge significantly improved as a result of the service (7.65 ± 2.36, n = 561, to 8.78 ± 2.14, n = 393). This improvement was retained for at least 12 months after the service. Patients reported how the knowledge and skills gained had led to a change in the way they managed their asthma.

Conclusion

Improvements in knowledge are achievable and sustainable if pharmacists used targeted educational interventions.

Practice implications

Pharmacist educational interventions are an efficient way to improve asthma knowledge in the community.     

Phenotypic characterization of the infiltrating immune cells in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma

Background

Immune cell infiltrate is a constant feature in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma. This study elaborates on the cells of the immune system present in normal prostate, benign nodular prostatic hyperplasia and prostatic adenocarcinoma.

Hypothesis

Here, we hypothesized that “the development of benign nodular prostatic hyperplasia and prostatic adenocarcinoma is associated with numeric alterations of the immune cell infiltrate”.

Materials and methods

A total of 50 transurethral prostatic resection specimens, each entailing normal prostate, benign nodular prostatic hyperplasia and high grade prostatic adenocarcinoma were evaluated for the density and phenotype of the immune cells using immunohistological methods and mouse monoclonal antibodies decorating T cells (CD3), histiocytes (CD68) and B lymphocytes (CD20).

Results

Immune cell infiltrate was composed of T cells, histiocytes and B-lymphocytes. CD⁺3 T lymphocytes and CD68⁺ cells were the predominant cell populations. We observed variations in the density of the immune cells among the normal prostate, benign nodular prostatic hyperplasia and high grade prostatic adenocarcinoma. Compared with normal prostate, benign nodular prostatic hyperplasia had a statistically significant high density of immune cells (3.4 ± 0.4versus 13.5 ± 1.0, P < 0.00). In contrast, a significant decrease in the counts of these cells was observed in high-grade prostatic adenocarcinoma compared to benign nodular prostatic hyperplasia (13.5 ± 1.0 versus 5.2 ± 0.3, P < 0.01).

Conclusions

The increased density of immune cells (predominantly CD⁺3 T cells) in benign nodular prostatic hyperplasia suggests that the initial response to cellular damage is mediated by cell-mediated immunity. The decreased density of immune cells in high-grade prostatic adenocarcinoma may reflect immunosuppression. The underlying mechanisms of these numeric variations are open for further investigations.     

Communication skills instruction: An analysis of self, peer-group, student instructors and faculty assessment

Objective

To explore the correlation of student and faculty assessments of, second-year dental students’ (D2s) communicative skills during simulated patient interviews.

Methods

Eighty-two D2s, 14 student instructors and 8 faculty used a 5-point scale, (1 = poor-5 = excellent) to assess 12 specific communicative skills of D2s generating assessment sources of self, peer-group, student instructor, and faculty. Mean scores and comparisons between assessment sources were calculated. Spearman correlations evaluated relationships between specific skills and assessment sources.

Results

Mean assessment score and standard error for peer-group (4.14 ± 0.04), was higher than self (3.86 ± 0.06, p < 0.05) yet slightly higher than student instructor (4.07 ± 0.04) and faculty (3.93 ± 0.10). Regarding assessment sources, the degree of correlation from highest to lowest was peer-group and student instructor (ρ = 0.46, p < 0.0001), self and student instructor (ρ = 0.35, p < 0.002), self and peer-group (ρ = 0.28, p < 0.02). The correlations between student instructor and faculty, faculty and self, and faculty and peer-group were nonsignificant.

Conclusion

Student assessments were different from faculty by mean score and correlation index. Future studies are needed to determine the nature of the differences found between student and faculty assessments.

Practice implications

Peer, student instructor and faculty assessments of dental students’ communicative skills are not necessarily interchangeable but may offer uniquely different and valuable feedback to students.     

Perception of empathy in the therapeutic encounter: effects on the common cold

Objective

To evaluate the effects of patient-practitioner interaction on the severity and duration of the common cold.

Methods

We conducted a randomized controlled trial of 719 patients with new cold onset. Participants were randomized to three groups: no patient-practitioner interaction, “standard” interaction or an “enhanced” interaction. Cold severity was assessed twice daily. Patients randomized to practitioner visits used the Consultation and Relational Empathy (CARE) measure to rate clinician empathy. Interleukin-8 (IL-8) and neutrophil counts were obtained from nasal wash at baseline and 48 h later.

Results

Patients’ perceptions of the clinical encounter were associated with reduced cold severity and duration. Encounters rated perfect on the CARE score had reduced severity (perfect: 223, sub-perfect: 271, p = 0.04) and duration (perfect: 5.89 days, sub-perfect: 7.00 days, p = 0.003). CARE scores were also associated with a more significant change in IL-8 (perfect: mean IL-8 change 1586, sub-perfect: 72, p = 0.02) and neutrophil count (perfect: 49, sub-perfect: 12, p = 0.09).

Conclusions

When patients perceive clinicians as empathetic, rating them perfect on the CARE tool, the severity, duration and objective measures (IL-8 and neutrophils) of the common cold significantly change.

Practice implications

This study helps us to understand the importance of the perception of empathy in a therapeutic encounter.     

HCV core antigen testing in HIV- and HBV-coinfected patients, and in HCV-infected patients on hemodialysis

Background

A quantitative HCV core antigen (HCVcoreAg) immunoassay has been developed for the confirmation of viremia in patients with hepatitis C.

Objectives

We evaluated the correlation of HCV RNA and HCVcoreAg in different patient populations without HCV-specific treatment: HIV/HCV-coinfection, HBV/HCV-coinfection, and patients with end-stage renal disease.

Study design

HCVcoreAg was quantified by a fully-automated immunoassay. Correlation of HCVcoreAg with HCV RNA was studied cross-sectionally in HIV/HCV- and HBV/HCV-coinfected patients, as well as before and after hemodialysis in patients with end-stage renal disease.

Results

A concordant positive or negative test result for both HCV RNA and HCVcoreAg was observed in 68 of 71 (96%), 55 of 57 (96%), and in 109 of 109 (100%) samples of patients with HIV- or HBV/HCV-coinfection, and patients undergoing hemodialysis, respectively. HCVcoreAg showed high correlation with HCV RNA in samples from HIV/HCV-coinfected patients and HCV-infected patients undergoing hemodialysis (r = 0.97 and r = 0.94, p < 0.001). There was no overall correlation between HCVcoreAg and HCV RNA in HBV/HCV-coinfected individuals (r = 0.04, p = 0.822). Excluding patients with HCV RNA to HCVcoreAg ratios below 100 and above 10,000 kIU/fmol led to improved correlation (r = 0.53; p = 0.02), but remained worse than for the other cohorts. Overall, HCV RNA to HCVcoreAg ratios did not differ significantly between the different patient populations, though variation tended to be higher in HBV/HCV-coinfected patients. Patients with lower HCV RNA levels tend to have lower HCV RNA/HCVcoreAg ratios.

Conclusions

HCVcoreAg represents a reliable marker of viral replication showing a good correlation with HCV RNA in various patient populations, with some limitations in HBV/HCV-coinfection.     

Intensive exercise: a remedy for childhood obesity?

Background

Acute exercise can affect the energy intake regulation, which is of major interest in terms of obesity intervention and weight loss.

Objective

To test the hypothesis that intensive exercise can affect the subsequent energy intake and balance in obese adolescents.

Design

The study was conducted in 2009 and enrolled 12 obese pubertal adolescents ages 14.4 ± 1.5 years old. Two exercise and one sedentary sessions were completed. The first exercise (EX₁) and sedentary session (SED) were randomly conducted 1 week apart. The second exercise session (EX₂) was conducted following 6 weeks of diet modification and physical activity (3 × 90 min/week) to produce weight loss. Energy intake was recorded, subjective appetite sensation was evaluated using Visual Analogue Scales and energy expenditure was measured using ActiHerats during EX₁, EX₂ and SED.

Results

Total energy intake over the awakened period was significantly reduced by 31% and 18% during the EX₁ and EX₂ sessions compared with the SED session, respectively (p < 0.01). Energy balance over the awakened period was negative during EX₁, neutral during EX₂ and positive during SED. There was no significant difference in terms of subjective appetite rates between sessions during the awakened hours.

Conclusions

Intensive exercise favors a negative energy balance by dually affecting energy expenditure and energy intake without changes in appetite sensations, suggesting that adolescents are not at risk of food frustration.     

Increased plasma d-lactic acid associated with impaired memory in rats

Aim

d-Lactic acidosis is associated with memory impairment in humans. Recent research indicates that d-lactic acid may inhibit the supply of energy from astrocytes to neurons involved with memory formation. However, little is known about the effects of increased hind-gut fermentation due to changes in diet on circulating lactic acid concentrations and memory.

Method

Thirty-six male Wistar rats were fed three dietary treatments: a commercial rat and mouse chow, a soluble carbohydrate based diet or a fermentable carbohydrate based diet. The parameters estimating memory were examined by employing the object recognition test. Physical parameters of fermentation including hind-gut and plasma lactic acid concentrations were examined after sacrifice, either 3 or 21 h after feeding.

Results

Increased fermentation in the hind-gut of rats, indicated by lower caecum pH, was associated with increased plasma l-lactic acid (r = −0.41, p = 0.020) and d-lactic acid (r = −0.33, p = 0.087). Memory, being able to discriminate between a familiar and a novel object during the object recognition test, was reduced with increasing plasma d-lactic acid (r = −0.51, p = 0.021).

Conclusions

Memory impairment was associated with alterations in plasma d-lactic acid following the fermentation of carbohydrate in the hind-gut. Further work is still required to determine whether these effects are mediated centrally or via direct connections through the enteric nervous system.     

Effects of sleep restriction on adiponectin levels in healthy men and women

Objective

Population studies have consistently found that shorter sleep durations are associated with obesity and cardiovascular disease, particularly among women. Adiponectin is an adipocyte-derived, anti-inflammatory hormone that is related to cardiovascular disease risk. We hypothesized that sleep restriction would reduce adiponectin levels in healthy young adults.

Methods

74 healthy adults (57% men, 63% African American, mean age 29.9 years) completed 2 nights of baseline sleep at 10 h time in bed (TIB) per night followed by 5 nights of sleep restricted to 4 h TIB per night. An additional 8 participants were randomized to a control group that received 10 h TIB per night throughout the study. Plasma adiponectin levels were measured following the second night of baseline sleep and the fifth night of sleep restriction or control sleep.

Results

Sleep restriction resulted in a decrease in plasma adiponectin levels among Caucasian women (Z = −2.19, p = 0.028), but an increase among African American women (Z = −2.73, p = 0.006). No significant effects of sleep restriction on adiponectin levels were found among men. A 2 × 2 between-group analysis of covariance on adiponectin change scores controlling for BMI confirmed significant interactions between sleep restriction and race/ethnicity [F(1,66) = 13.73, p < 0.001], as well as among sleep restriction, race/ethnicity and sex [F(1,66) = 4.27, p = 0.043)].

Conclusions

Inflammatory responses to sleep loss appear to be moderated by sex and race/ethnicity; observed decreases in adiponectin following sleep restriction may be one avenue by which reduced sleep duration promotes cardiovascular risk in Caucasian women.     

Perspectives and expectations for telemedicine opportunities from families of nursing home residents and caregivers in nursing homes

Background

This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan.

Methods

A total of 116 interviews were conducted with family members (n = 37) and caregivers (n = 79) using an original, four-part questionnaire devised to assess the expectations and concerns related to prospective telemedicine opportunities, including consumer attitude, knowledge of and interest in medicine, concerns and worries about telemedicine, and anticipated benefits of telemedicine.

Results

Statistical significance between the two groups was observed in sex, age, and educational level (all p < 0.001). Most respondents had heard about telemedicine before participation and showed some interest in telemedicine implementation. More than 70.0% of subjects in both groups had perceptions of telemonitoring of patients, notifications of health abnormalities, teleconferencing between physicians and family members, obtaining test/exam results and face-to-face consultation through telenetworks. Both groups hoped for information and education through telemedicine. More caregivers were concerned about increased costs (p = 0.020), poor hardware quality (p < 0.001), poor security, confidentiality, and reliability (p = 0.036), inconvenience to patients (p = 0.006), associated moral and ethical issues (p = 0.006), and uncertainty about responsibility (p = 0.022). The two groups did not differ in expectations concerning benefits of telemedicine. More than 60% of family members or caregivers expected improved efficiency and quality of hospital and nursing home health care, greater rapport between nursing homes and either staff or patients, reduced overall medical costs of caregiving, and reduced staff/caregiver working hours. The acceptable cost was anything up to $15.30 USD per month.

Conclusions

Nursing home caregivers and families of nursing home patients are highly interested in telemedicine; however, they are only willing to pay a slightly higher cost of nursing care for this service. The challenge for the future in this industry is to balance peoples’ demands and telemedicine's associated costs. Results of this study suggest that caregivers and families of nursing home residents favour telemedicine implementation to provide enhanced care coordination in nursing homes when economic circumstances are favourable.