CD4 T-cell activation and reduced regulatory T-cell populations are associated with early development of cataracts among HIV-infected adults in Uganda

Background

Cataracts contribute 12% of visual loss among HIV-infected adults in Uganda. Immuno-pathogenesis of cataracts may differ among HIV-infected individuals; thus the need for innovative therapeutic interventions among HIV-infected adults.

Methods

In a laboratory based case-control study, nested in a clinical/surgical community outreach camp, 50 adults with cataracts eligible for surgery were selected consecutively. HIV testing was done for individuals with unknown HIV sero-status. Peripheral Blood Mononuclear Cells (PBMC) were collected from all HIV-positive-adults-with-cataracts (cases) and HIV-negative-adults-with-cataracts (comparative group) and age-matched HIV-negative and HIV-positive-adults-without-cataracts (comparative group). Treg were measured as CD3 + CD4 + FoxP3 + CD25+^Bright and immune activation as CD3 + CD4 + CD38 + HALDR+ using a Facs Canto II flowcytometer. Mann Whitney test was used to compare expression among the four groups.

Results

Of 50 adults operated for cataracts, 24 (48%) were female, 25 (50%) were HIV-positive. HIV-positive-individuals had cataracts earlier [median; Inter-quartile Range (IQR); 49 (44–53) years] than HIV-negative [70 (IQR 59–75) years]; p = 0.0005. Treg were lower among individuals with cataracts irrespective of HIV status; p = 0.001; but comparable among younger HIV-positive and elderly HIV-negative with cataracts; p = 0.301. Immune activation levels were comparable among HIV-positive and HIV-negative individuals with cataracts. However, HIV-positive-individuals with cataracts expressed higher levels of immune activation than HIV-positive-individuals without cataracts; p = 0.012 and HIV-negative-individuals-with-cataracts expressed higher levels of immune activation that HIV-negative-without-cataracts; p < 0.0001.

Conclusion

CD4 T-cell activation and reduced regulatory T-cell populations were associated with cataracts among adults aging with HIV. We recommend studies on clinical relevance of immune modulation in the prevention of early development of cataracts among adults aging with HIV in Africa.     

Lymphocyte subpopulation reference ranges for monitoring human immunodeficiency virus-infected Chinese adults.

Two hundred eight healthy human immunodeficiency virus (HIV) type 1- and HIV type 2-seronegative Chinese adults (78 males and 130 females; mean age, 32 years; age range, 18 to 71 years) were analyzed for lymphocyte subsets by a standardized and quality-controlled flow cytometric immunophenotyping technique. While the leukocyte differential values were comparable to those found in studies of Caucasians, the means, medians, and 95% reference ranges of lymphocyte subsets were very different. The 95% reference ranges in absolute counts per microliter of whole blood (percentage of lymphocytes) for CD3+, CD3+ CD4+, CD3+ CD8+, CD3- CD19+ (B), and CD3- with CD16+ and/or CD56+ (NK) cells were 672 to 2,368 (54.8 to 83.0%), 292 to 1,366 (23.1 to 51.0%), 240 to 1,028 (17.9 to 47.5%), 82 to 560 (5.1 to 20.8%), and 130 to 938 (7.1 to 38.0%), respectively. CD3+ CD4+ cells showed significant sex difference (for males, mean of 702 [34.8%] and standard deviation of 258 [7.5%]; for females, mean of 728 [37.3%] and standard deviation of 254 [7.4%]) as well as an increase with age of 42 (1.6%) per decade. Investigations of the NK cell population did not show similar findings. Classification of HIV disease, treatment, and prophylactic regimens based on studies which relied heavily on estimations of lymphocyte subsets alone should be used with special caution for Chinese patients. Provided that adequate quality control measures are taken to ensure comparability of data, we recommend that these ranges be used on a day-to-day basis in laboratories that have not yet established their own reference ranges.     

Association between CTLA-4 polymorphisms and susceptibility to Celiac disease: A meta-analysis

Objective

The study explored whether cytotoxic T lymphocyte antigen-4 (CTLA-4) polymorphisms confer susceptibility to Celiac disease (CD).

Methods

A meta-analysis was conducted on the associations between the CTLA-4 CT60 A/G, +49 A/G, −318 C/T polymorphisms and CD using allele contrast, a recessive model, a dominant model, and homozygote contrast.

Results

Thirteen separate comparison studies were considered in the meta-analysis consisting of 5072 patients with CD and 13,462 controls. All subjects were Europeans. Meta-analysis of the CTLA-4 CT60 A/G polymorphism showed an association between CD and the CTLA-4 CT60 G allele in all subjects [Odds ratio (OR) = 1.160, 95% Confidence interval (CI) = 1.104–1.219, p < 1.0 × 10⁻⁹). Meta-analysis using the recessive model also revealed an association between CD and the CTLA-4CT60 GG genotype (OR = 1.331, 95% CI = 1.093–1.620, p = 0.004). Furthermore, analyses using the dominant model and homozygote contrast showed the same pattern as that shown by the CTLA-4CT60 G allele. Meta-analysis of the CTLA-4 +49 A/G polymorphism showed no association between CD and the CTLA-4 +49 G allele in all subjects (OR = 0.992, 95% CI = 0.872–1.129, p = 0.907). Meta-analysis using the recessive, dominant model, and homozygote contrast showed the same pattern as that shown by the CTLA-4 +49 Gallele. Meta-analysis of the CTLA-4 −318 C/T polymorphism showed no association between CD and the CTLA-4 −318 T allele in all subjects (OR = 1.018, 95% CI = 0.813–1.275, p = 0.877).

Conclusions

The CTLA-4 CT60 A/G polymorphism was associated with CD susceptibility, but no association was found between CTLA-4 +49 A/G and −318 C/T polymorphisms and CD in Europeans.     

Factors associated with menopausal symptom severity in middle-aged Brazilian women from the Brazilian Western Amazon

Objective

To determine the frequency and severity of menopausal symptoms and associated factors in middle-aged Brazilian women.

Methods

A cross-sectional study was carried out involving 1415 women aged 35–65 years attended at the Outpatient unit of the Clinicas Hospital of Rio Branco, Acre state, Brazil. The Menopause Rating Scale (MRS) was used to assess the severity of menopause symptoms. The Stata 10 statistical package was used for all data analysis whereas Pearson's x² nonparametric association test was used for bivariate analysis, adopting a level of statistical significance of 5%. On the multivariate analysis, independent variables positively associated with the dependent model were retained in the final model (p < 0.005).

Results

Overall, 54.1% of participants were premenopausal, 10.1% perimenopausal, and 35.8% postmenopausal. Irritability was the most frequent symptom (78.3%), followed by joint and muscular discomfort (74.8%), and anxiety (72.7%). Mean total MRS score was 15.6 + 8.8 (median 15). After adjusting for confounding factors, the logistic regression analysis found low educational level (OR:1.53; [95% CI:1.21–1.95]; p < 0.001); self-perceived poor/very poor health (OR:4.48; [95% CI: 3.53–5.69]; p < 0.001), and menopausal transition phase (OR:1.73; [95% CI:1.18–2.53]; p = 0.005) to be statistically significantly associated with more severe menopausal symptoms.

Conclusion

Among Brazilian women, atypical symptoms of the menopause were the most frequently reported. Severe menopausal symptoms were more likely in women with low educational level, self-perceived poor health and at the menopausal transition phase.     

Low serum testosterone and frailty in older men and women

Background

Frail older persons are at high risk of morbidity and mortality, and are characterized by body composition alterations. Serum testosterone, which regulates body composition, declines with age. We investigated the relation between serum testosterone level and physiological frailty in both older men and women.

Methods

This was a cross-sectional study of 108 adults 65 years old or older. Frailty status was determined by hand-grip strength, weight change, walking speed, exhaustion, and activity levels, and was classified as frail (3 or more deficits), pre-frail (1 or 2 deficits), or robust (no deficit) according to the Fried criteria. Serum total testosterone (TT) and sex-hormone-binding globulin were measured while free testosterone (FT) was estimated.

Results

Median (range) TT and FT were lower in frail than in pre-frail and robust men (TT: (frail) 15.7 [2.4–26.9] vs. (pre-frail) 19.4 [7.2–39.9] and (robust) 25.9 [13.2–35.2] nmol/L, P = 0.03; FT: 230.0 [35.9–299.0] vs. 272.0 [86.7–411.0] and 303.0 [267.0–396.0] pmol/L, P = 0.02) and women (TT: 0.31 [0.10–0.51] vs. 0.47 [0.14–1.55] and 0.45 [0.36–1.25] nmol/L, P = 0.02; FT: 4.59 [0.46–6.63] vs. 4.66 [1.57–15.10] and 6.65 [3.91–21.00] pmol/L, P = 0.03). After adjusting for age, comorbidities, body mass index, and serum albumin in ordinal logistic regression model, odds ratios of being frail were significantly higher for those participants whose TT and FT levels were in the lowest tertile compared to the highest tertile in men (TT: odds ratio [OR] 3.29, 95% confidence interval [CI] 1.14–9.50; FT: OR 3.44, 95% CI 1.05–11.22) and in women (TT: OR 6.69, 95% CI 1.84–24.31; FT: OR 4.86, 95% CI 1.31–18.08).

Conclusions

Low serum testosterone levels were independently associated with frailty in the elderly Taiwanese.     

CTLA-4 polymorphisms and susceptibility to inflammatory bowel disease: A meta-analysis

Objective

The aim of this study was to explore whether the cytotoxic T lymphocyte associated antigen-4 (CTLA-4) polymorphisms are associated with susceptibility to ulcerative colitis (UC) and Crohn’s disease (CD).

Methods

The authors conducted a meta-analysis on associations between CTLA-4 +49 A/G, −318 C/T, CT60 A/G polymorphisms, and (AT)n repeat in the 3′ untranslated region (UTR) and UC and CD susceptibility.

Results

A total of 15 comparison studies were considered in our meta-analysis. Meta-analysis revealed no association between UC and the CTLA-4 +49 G and CTLA-4 −318 T alleles in all subjects (OR = 0.982, 95% CI = 0.851–1.1339, p = 0.804; OR = 0.500, 95% CI = 0.223–1.124, p = 0.094). No association was found between UC and the CTLA-4 CT60 A/G polymorphism in Europeans. However, a significant association was observed between the longer allele (?118 bp) of the (AT)n and UC in Asian population (OR = 6.073, 95% CI = 4.246–8.684, p = 1.0 × 10⁻⁹). Meta-analysis of the CTLA-4 +49 A/G, −318 C/T, CT60 A/G polymorphisms showed no association with CD.

Conclusions

This meta-analysis demonstrates that the CTLA-4 (AT)n repeat in 3′ UTR may be associated with susceptibility to UC in Asians, while no association was found between the CTLA-4 +49 A/G, −318 C/T, and CD60 A/G polymorphism and susceptibility to UC and CD.     

Age-specific prevalence of,and factors associated with,different types of urinary incontinence in community-dwelling Australian women assessed with a validated questionnaire

Objective

The aim of this study was to document the age-specific prevalence of different types of urinary incontinence (UI) in women and to identify the risk factors associated with each type of UI.

Design

A detailed self-administered questionnaire was mailed to 542 community-dwelling women, aged 24–80 years. The questionnaire included a validated instrument, the Questionnaire for Urinary Incontinence Diagnosis (QUID), for the assessment of stress, urge and mixed UI.

Results

Five hundred and six of the 542 women provided data (93.4%). The overall prevalence of any UI was 41.7% [95% confidence interval (CI): 37.2–45.8%]. Of the 210 women reporting UI, 16% [95% CI: 12.9–19.3%] reported stress only; 7.5% [95% CI: 5.2–9.8%] reported urge only and 18% [95% CI: 14.7–21.5%] reported a mixed pattern. Stress incontinence was most common amongst middle-aged women (25.3% of women aged 35–44 years), while urge incontinence was most common in women over the age of 75 years (24.2%). In logistic regression analyses, obesity (p < 0.001) and being parous (p = 0.019) were found to be significantly associated with stress incontinence, increasing age (p = 0.002) with urge incontinence, and being overweight (p = 0.035) or obese (p < 0.001) and having had a hysterectomy (p = 0.021) with mixed incontinence.

Conclusions

UI is a highly prevalent condition in women living in the community. Stress, urge and mixed incontinence have different age distributions and risk factors. These data are important in understanding the etiology, management and possible prevention of these conditions.     

肝癌术后早期应用胸腺肽α 1对T淋巴细胞亚群的影响

目的：探讨肝癌患者术后早期应用胸腺肽α1对T淋巴细胞亚群的影响。方法： 46例肝癌手术患者, 随机分治疗组（23例）和对照组（23例）, 治疗组于术后1、3、5 d皮下注射胸腺肽α1 1.6 mg,观察2组术前后第1、4、7 d CD3+、CD4+、CD8+、CD4+/CD8+的变化情况。结果：（1）组内比较：对照组术后CD4+、CD4+/CD8+低于术前（P<0.05）,术后第1、4、7 d CD8+高于手术前（P<0.05）。治疗组CD3+、CD4+、 CD4+/CD8+术后与术前相比无显著差异;CD3+、CD4+/CD8+术后第1、7 d比较有显著差异（P<0.05）。（2）组间比较：CD4+、CD4+/CD8+治疗组高于对照组（术后第1、4、7 d均P<0.05）,治疗组CD8+细胞百分率低于对照组（术后第1、4、7 d均P<0.05）;治疗组CD3+细胞百分率高于对照组（术后第4、7 d P<0.05）。结论： 手术对肝癌患者术后T淋巴细胞免疫功能有抑制作用,胸腺肽α1对T淋巴细胞免疫功能有调节作用。     

Dietary patterns and functional disability in older Korean adults

Objectives

This study examined the relationship between dietary patterns and disability in the Korean elderly.

Study design

We used data from a cross-sectional study of 327 men and 460 women aged ≥65 years who completed the 2005 Korea National Health and Nutrition Examination Survey.

Main outcome measures

A single 24-h dietary recall method was used to assess dietary intake and dietary patterns were identified by cluster analysis. Functional disability was assessed by the activities of daily living (ADL) and instrumental ADL (IADL) scales. The association of dietary patterns with ADL and IADL disability was analyzed by logistic regression adjusting for age, marital status, education, household income, region, chronic conditions, body mass index, smoking, alcohol drinking, physical activity, and energy intake.

Results

Two dietary patterns were identified in both men and women: the modified traditional dietary pattern, characterized by a relatively lower consumption of white rice, but higher consumption of fruits, dairy products, and legumes, and the traditional dietary pattern, characterized by high consumption of white rice. After controlling for covariates, in men, those who engaged in modified traditional dietary pattern, compared with traditional dietary pattern, showed a lower likelihood of ADL disability (odds ratio [OR] = 0.17, 95% confidence interval [CI]: 0.05–0.56). In women, the modified traditional dietary pattern compared with the traditional pattern was associated with a significantly decreased risk of ADL (OR = 0.45, 95% CI: 0.23–0.90) and IADL disability (OR = 0.45, 95% CI: 0.28–0.72).

Conclusions

The modified traditional dietary pattern is associated with a decreased risk of functional disability in older Korean adults.     

大肠癌患者与正常健康人淋巴细胞表型差异分析

目的:分析大肠癌患者与正常健康人20项淋巴细胞亚群变化情况。方法:流式细胞术(FCM)检测168例大肠癌患者与102例正常健康人外周血20项淋巴细胞亚群,SPSS17.0软件进行统计学处理。结果:与正常健康人相比,大肠癌患者CD29+、45RA+、CD4+CD45RO+和CD8+CD28-细胞百分比例明显升高,而NKT、45RO+、CD4+CD45RA+、CD28+和CD8+CD28+细胞百分比例则明显降低(P<0.05)。Ⅳ期患者组CD8+CD28-细胞百分比例明显高于正常健康人组、Ⅰ+Ⅱ期患者组及Ⅲ期患者组(P<0.05)。结论:大肠癌患者的细胞免疫功能降低,体液免疫功能有所增强;传统指标难以准确评价患者的免疫功能,包括CD8+CD28+、CD8+CD28-在内的多项细胞亚群分析体系也许能更好的反映大肠癌患者的免疫状况。     

Association of CTLA-4 variants with susceptibility to inflammatory bowel disease: A meta-analysis

Objective

The aim of this study was to determine whether CTLA-4 gene variants were associated with susceptibility to inflammatory bowel disease (IBD).

Methods

Meta-analysis was conducted on the association between CTLA-4 variants and IBD using: (1) allelic contrast, (2) the recessive model, and (3) the dominant model.

Results

A total of 9 relevant studies including 1739 Crohn’s disease (CD) cases, 10 relevant studies containing 1017 ulcerative colitis (UC) cases and 2685 healthy controls were involved in this meta-analysis. Overall, CTLA-4+49A/G, −318C/T and CT60 variants were not associated with IBD susceptibility in all genetic models (P > 0.05). Stratification by ethnicity indicated a significant association between the CTLA-4+49A/G variant and CD in Caucasian group (GG vs. GA + AA: OR = 0.723, 95% CI = 0.564–0.926, P = 0.010). In Asian group, meta-analysis showed a significant association between the CTLA-4 CT60 variant and UC (AA vs. AG + GG: OR = 0.375, 95% CI = 0.163–0.861, P = 0.021).

Conclusions

Based on the published literature, this meta-analysis suggests that the CTLA-4+49A/G variant may be related to CD susceptibility in Caucasians, and the CTLA-4 CT60 variant may be associated with UC susceptibility in Asians.     

Psychological stress during exercise: Lymphocyte subset redistribution in firefighters

The purpose of this study examined the changes in heart rate (HR), catecholamines (NE, EPI) and percentages of blood lymphocyte subsets (CD3+ T cells, CD3+ CD4+ helper T cells, CD3+ CD8+ cytotoxic T cells, CD3− CD56+ NK cells, CD4/CD8 ratio, CD19+ B cells, and total lymphocytes [NK cells+ T cells+ B cells]) in firefighters exposed to a computerized firefighting strategies and tactics decision-making challenge while participating in moderate intensity exercise. Furthermore, this study also examined the possible relationships between catecholamines (NE and EPI) and blood lymphocyte subsets following combined mental and physical challenge. Ten professional male firefighters participated in two counterbalanced exercise conditions on a cycle ergometer: (1) 37 min of cycle ergometry at 60% VO_2max (exercise alone condition; EAC) and (2) 37 min of cycle ergometry at 60% VO_2max along with 20 min of a computerized firefighting strategies and tactics decision-making challenge (firefighting strategies condition; FSC). FSC elicited significantly greater HR, NE, and EPI when compared to EAC. Both EAC and FSC elicited increases in CD3− CD56+ NK cells. The percentages of CD3+ T cells, CD3+ CD4+ helper T cells, CD4/CD8 ratio, CD19+ B cells, and total lymphocytes were lower immediately following both conditions. Following dual challenge NE AUC was negatively correlated with percentage of CD19+ B cells immediately post challenge, and HR was negatively associated with the percent change in the CD4/CD8 ratio from pre to post challenge. These elevations in NE and heart rate simultaneously in response to the dual challenge suggest greater sympathetic activation that in turn would possibly explain the alteration in the distribution of lymphocyte subsets.     

Peripheral blood lymphocyte subsets (CD4+, CD8+ T cells), leptin level and weight loss after laparoscopic greater curvature plication in morbidly obese patients

Introduction

The aim of the study was to detect the effect of laparoscopic greater curvature plication (LGCP) on peripheral blood lymphocyte subsets (helper and cytotoxic T lymphocytes – CD4+ and CD8+ T cells respectively), leptin level and weight loss in morbidly obese patients.

Material and methods

Morbidly obese patients (n = 20, age range: 25–50 years, body mass index (BMI) range: 37–45 kg/m²) who underwent LGCP were enrolled in a prospective study to determine the percentages of their peripheral blood T cells (CD4+ and CD8+) before and 4 months postoperatively using flow cytometry. Also, the level of their leptin before and 4 months postoperatively was established using enzyme-linked immunosorbent assay (ELISA). The data are expressed as the percentage of total lymphocytes ± the standard error of the mean.

Results

A decrease in the BMI and loss of weight (31.20 ±1.2%) were confirmed 4 months postoperatively since BMI was 44.71 ±4.3 (range: 37–45) kg/m² preoperatively, and decreased to 31.80 ±1.1 (range: 24–33) kg/m² after surgery. The mean percentage of CD4+ and CD8+ T lymphocytes significantly decreased postoperatively (38.2 ±1.5 before and 29.3 ±2.6 after operation for CD4+, 17.3 ±1.8 preoperatively and 9.5 ±1.7 postoperatively for CD8+, p < 0.05). The mean leptin level was 43.01 ±22.01 preoperatively while postoperatively it was 24.8 ±11.1 (p < 0.05), so the leptin level substantially decreased compared to its preoperative values.

Conclusions

This study found that weight loss after LGCP in morbidly obese patients led to decreases in levels of leptin and circulating immune cells compared to their preoperative values.     

Moroccan lymphocyte subsets reference ranges: age,gender, ethnicity,and socio-economic factors dependent differences

ABSTRACT

Lymphocyte subsets reference ranges are helpful for a precise diagnosis and therapy of various diseases. We attempted in the current study to establish Moroccan lymphocyte reference range and reveal age, gender, ethnicity, income, and instructional levels dependent differences. Lymphocyte subsets percentage and absolute count were determined by 4-color flow cytometry in a population study of 145 adults Moroccan healthy volunteers. Analysis showed significant age-dependent changes. Age was associated with a decrease of naïve CD4+ and CD8+ T cells and an increase of memory CD4+ or CD8+ T cells. Activated CD4+ CD38+ and CD8+ CD38+ T cells, Treg as well as NK cell showed age-dependent alterations. In contrast, B cells remained unchanged. A higher percentage of CD3+ and CD4+ T cells was observed in females while CD8+, B and NK cells count were higher in men. Ethnicity, instructional levels, and personal income seem to not influence lymphocyte subsets reference values. This study provides reference ranges for lymphocyte subsets of healthy Moroccan adults. These results can be used for other North African (Maghrebian) countries considering their geographic, ethnic, economic, and cultural similarities.     

The association of health literacy with illness and medication beliefs among older adults with asthma

Objective

Suboptimal health literacy (HL) and asthma beliefs are associated with poor asthma self-management and outcomes. We tested the hypothesis that low HL is associated with inaccurate beliefs.

Methods

Asthmatics ≥60 were recruited from hospital and community practices in New York, NY and Chicago, IL (n = 420). HL was measured with the Short Test of Functional Health Literacy in Adults; validated instruments derived from the self regulation model were used to assess beliefs. The association of beliefs with HL was evaluated with multivariate models.

Results

Thirty-six percent of patients had low HL; 54% believed they only have asthma when symptoms are present, 29% believed they will not always have asthma and 20% believed that their doctor can cure asthma. HL was associated with beliefs of not having asthma all the time and that asthma can be cured (OR: 1.84, 95% CI: 1.2–2.82; OR: 2.22, 95% CI: 1.29–3.82, respectively). Patients with low HL were also more likely to be concerned about medication use (β = 0.92, p = .05), despite recognizing their necessity (β = −1.36, p = .01).

Conclusions

Older asthmatics with low HL endorse erroneous asthma beliefs.

Practice implications

Health communications for improving self-management behaviors in asthma should employ both health literacy-appropriate strategies and messages to counter illness-related misconceptions.     

Association of ADIPOQ polymorphisms with obesity risk: A meta-analysis

Background

The association between ADIPOQ polymorphisms and the risk of obesity remains controversial. We perform a comprehensive meta-analysis to clarify the current understanding of this association.

Methods

We searched for relevant studies in PubMed, Embase and Cochrane library before February 2014. The strengths of the association between ADIPOQ polymorphisms and obesity risk were estimated by odds ratios (OR) with 95% confidence intervals (CI).

Results

Eighteen case–control studies analyzing four SNPs (rs17300539, rs266729, rs1501299 and rs2241766) of ADIPOQ gene were eligible for the present meta-analysis. The pooling results showed that rs17300539 (2GG+GA vs. 2AA+GA: OR = 0.78, 95%CI = 0.69–0.89) and rs1501299 (2GG+GA vs. 2AA+GA: OR = 0.89, 95%CI = 0.80–0.98) were associated with obesity risk in Caucasian ethnicity. The rs266729 were associated with obesity risk in Asian ethnicity (2CC+CG vs. 2GG+GCG: OR = 0.77, 95%CI = 0.65–0.92). However, there were no associations between rs2241766 and the obesity risk (P > 0.05). No publication bias was found among these studies (all P > 0.05).

Conclusions

This study suggests that ADIPOQ rs17300539 and rs1501299 are associated with risk of obesity in Caucasian ethnicity, and the rs266729 is associated with obesity risk in Asian ethnicity. However, there is no association between rs2241766 and obesity risk.     

Building skill in heart failure self-care among community dwelling older adults: Results of a pilot study

Objective

Most of the day-to-day care for heart failure (HF) is done by the patient at home and requires skill in self-care. In this randomized controlled trial (RCT) we tested the efficacy of a community-based skill-building intervention on HF self-care, knowledge and health-related quality of life (HRQL) at 1- and 3-months.

Methods

An ethnically diverse sample (n = 75) of patients with HF (53% female; 32% Hispanic, 27% Black; mean age 69.9 ± 10 years) was randomized to the intervention group (IG) or a wait-list control group (CG). The protocol intervention focused on tactical and situational HF self-care skill development delivered by lay health educators in community senior centers. Data were analyzed using mixed (between–within subjects) ANOVA.

Results

There was a significant improvement in self-care maintenance [F(2, 47) = 3.42, p = .04, (Cohen's f = .38)], self-care management [F(2, 41) = 4.10, p = .02, (Cohen's f = .45) and HF knowledge [F(2, 53) = 8.00, p = .001 (Cohen's f = .54)] in the IG compared to the CG.

Conclusions

The skill-building intervention improved self-care and knowledge but not HRQL in this community-dwelling sample.

Practice implications

Delivering an intervention in a community setting using lay health educators provides an alternative to clinic- or home-based teaching that may be useful across diverse populations and geographically varied settings.     

Relationship between thyroid dysfunction and chronic kidney disease in community-dwelling older adults

Objectives

Renal function has been shown to be influenced by thyroid status in animal models and human studies. We aimed to assess the cross-sectional association between thyroid hormones and function with prevalence of chronic kidney diseases (CKD) in older adults.

Study design

1571 Blue Mountains Eye Study participants aged ≥60 years were analyzed in 2002–4. Thyroid dysfunction was defined using serum thyrotropin (TSH) screen, followed by serum free T4 (FT4) assessment. Baseline biochemistry including serum creatinine was measured. Moderate CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m².

Results

After adjusting for age, sex, receipt of pension payment, body mass index, smoking, hypertension and diabetes, persons with any thyroid dysfunction (hyperthyroidism or hypothyroidism) had 84% higher likelihood of having CKD, odds ratio, OR, 1.84 (95% confidence intervals, CI, 1.03–3.31). Participants in the highest versus lowest quartile (reference) of serum TSH and FT4 had a significantly greater odds of prevalent CKD, OR 1.82 (95% CI 1.22–2.71), and OR 1.64 (95% CI 1.10–2.45), respectively. Similarly, among participants not receiving treatment for their thyroid dysfunction (n = 1329), those in the third and fourth quartiles of serum TSH had significantly greater odds of having prevalent CKD, OR 1.83 (95% CI 1.15–2.92) and OR 1.96 (95% CI 1.23–3.13), respectively, P_trend = 0.001. Significant associations were not observed between type of thyroid dysfunction (hyperthyroidism or hypothyroidism) and prevalent CKD.

Conclusions

Increasing serum TSH was associated with a greater likelihood of prevalent CKD among older adults, independent of the influence of age, diabetes and hypertension.     

Communicating global cardiovascular risk: Are icon arrays better than numerical estimates in improving understanding,recall and perception of risk?

Objective

Experts recommend that adults have their global cardiovascular risk assessed. We investigated whether icon arrays increase understanding, recall, perception of CVR, and behavioral intent as compared with numerical information.

Methods

Male outpatient veterans, at an intermediate to high cardiovascular risk participated in a randomized controlled trial of a computer tutorial presenting individualized risk. Message format was presented in 3 formats: percentages, frequencies, and frequencies with icon arrays. We assessed understanding immediately (T1) and recall at 20 min (T2) and 2 weeks (T3) after the intervention. We assessed perceptions of importance/seriousness, intent to adhere, and self-efficacy at T1. Self-reported adherence was assessed at T3.

Results

One-hundred and twenty male veterans participated. Age, education, race, health literacy and numeracy were comparable at baseline. There were no differences in understanding at T1 [p = .31] and recall at T3 [p = .10]. Accuracy was inferior with frequencies with icon arrays than percentages or frequencies at T2 [p ≤ .001]. There were no differences in perception of seriousness and importance for heart disease, behavioral intent, self-efficacy, actual adherence and satisfaction.

Conclusion

Icon arrays may impair short-term recall of CVR.

Practice implications

Icon arrays will not necessarily result in better understanding and recall of medical risk in all patients.