Religious activities and attitudes of older adults in a geriatric assessment clinic

Few studies have examined the prevalence, salience, and impact of religious beliefs, activities, and commitment among medical patients in later life. Surveys of the U.S. population aged 65 years and over reveal a high frequency of such beliefs and activities, which are reported to play a significant role in their lives. In this study, the religious beliefs, activities, and motivations of 106 consecutive patients (mean age 74.4 years) attending a geriatric outpatient clinic were examined. A high prevalence of orthodox Christian beliefs, religious community activity, private devotional activity, and intrinsic religious orientation was found. Levels of religious activity and intrinsic orientation were lower among patients with cancer, chronic anxiety, depressive symptoms, and those who smoked cigarettes or consumed moderate to large amounts of alcohol. Intrinsic religiosity was lower among men with hypertension. Patients with mild to moderate dementia tended to have higher levels of intrinsic religious orientation. The results of this study suggest that religion is a powerful cultural force in the lives of older medical patients and is integrally related to both mental and physical health.     

CD4+ and CD8+ lymphocytes and HIV RNA in HIV infection: high baseline counts and in particular rapid decrease of CD8+ lymphocytes predict AIDS

OBJECTIVE: To study the progression of HIV infection in relation to immunological and virological variables with emphasis on the role of CD8+ lymphocytes. DESIGN: Prospective follow-up from October 1991 of patients observed for at least 18 months allowing nucleoside analogue monotherapy. Peripheral CD4+ and CD8+ lymphocyte counts, HIV RNA, and soluble CD8 were analysed by statistics allowing the evaluation of serial data, avoiding time points with concurrent infections. SETTING: Tertiary university clinic. PATIENTS: Forty-nine patients were followed for 52.6 months, baseline CD4+ count of 300 x 10(6)/l, sample interval of 5.9 months (medians). MAIN OUTCOME MEASURES: AIDS, death, and CDC groups B- or C-related events. RESULTS: AIDS developed in 28% of patients. Baseline CD8+ counts above the median were significantly associated with AIDS development; the best Cox model included CD8+ cells and the log10RNA/CD4 ratio. A decline in CD8+ counts relative to baseline most significantly predicted AIDS, along with higher baseline RNA and actual CD4+ counts of less than 200 x 10(6)/l. Levels of soluble CD8 in the blood relative to total CD8+ cells significantly increased in patients developing AIDS. Death occurred in 16% of the patients, and was only predicted by high CD8+ cell counts at baseline. CDC B- and C-related events occurred in 35% of the patients and were best predicted by high baseline CD8+ counts and high RNA levels. CONCLUSIONS: The serial quantitation of CD8+ lymphocytes gave highly significant predictive information on the natural progression of HIV infection in patients with moderate to severe immune deficiency. Our data suggest that the hyperactivation of CD8+ lymphocytes is an important factor leading to a numerical decrease of CD8+ lymphocytes in progressive HIV infection.     

Smoking and lung cancer survival: the role of comorbidity and treatment

STUDY OBJECTIVE: Numerous studies indicate that smoking is associated with poorer outcomes in patients with cancer. The aim of this study was to determine whether smoking independently predicts survival in patients with lung cancer or whether an existent effect is mediated through comorbidity and/or treatment. DESIGN AND SETTING: Cox proportional hazards analysis was used to study a cohort of 1,155 patients with lung cancer diagnosed at the Henry Ford Health System between 1995 and 1998, inclusive. RESULTS: Adjusted for the baseline covariates, age, gender, illicit drug use, adverse symptoms, histology, and stage, the hazard ratio (HR) for smoking (current vs former/never) was 1.37 (95% confidence interval [CI], 1.18 to 1.59; p < 0.001). Adjusted for the baseline covariates and for 18 deleterious comorbidities, the HR for smoking was 1.38 (95% CI, 1.18 to 1.60; p < 0.001), indicating that the hazardous effect of smoking was not mediated through comorbidity. Current smoking was inversely associated with treatment (any surgery and/or chemotherapy and/or radiation therapy vs none) [odds ratio, 0.73; 95% CI, 0.55 to 0.98 (p = 0.03)]. Adjusted for baseline covariates, comorbidities and treatment, the HR for current smoker vs former/never was 1.26 (95% CI, 1.08 to 1.47; p = 0.003), a decline of 30.7% explained by treatment (HR for any treatment vs none, 0.40; 95% CI, 0.33 to 0.48; p < 0.001). CONCLUSIONS: Current smoking at diagnosis is an important independent predictor of shortened lung cancer survival. That this effect was not explained by sociodemographic/exposure factors, adverse symptoms, histology, stage, comorbidity, and treatment suggests that it may be mediated through direct biological effects.