Health-related quality of life and help seeking among American Indians with diabetes and hypertension

Objective  To evaluate the Health-Related Quality of Life (HRQoL) of American Indians with diabetes, hypertension, or both conditions using the SF36; and to explore how the HRQoL is associated with help seeking among American Indians with and without these chronic conditions. Methods  We analyzed data obtained from respondents with diabetes and/or hypertension who participated in a large epidemiological study of two culturally distinct American Indian tribes. Comparison data were provided by an age, gender, and tribe matched sample from the same study who did not report either condition. Results  The respondents with both diabetes and hypertension had the lowest HRQoL on all eight subscales of SF36. Confirmatory factor analysis (CFA) showed that the assumption of equivalent factor loadings for participants with and without diabetes and/or hypertension was not satisfied. Biomedical service use was significantly associated with the SF36 physical health factor in those with hypertension only. Help seeking from traditional healers was significantly negatively related to physical factor scores for all the respondents except those with diabetes only. Conclusions  Participants with comorbid diabetes and hypertension had worse HRQoL. The relationships between HRQoL and different types of help seeking varied depending on the comorbidity status of the respondents. Members of the AI-SUPERPFP Team are listed in the appendix.     

Practical model description of peripheral neural excitation in cochlear implant recipients: 2. Spread of the effective stimulation field (ESF), from ECAP and FEA

This second paper of the series considers the spread of the “effective stimulation field” (ESF) produced by monopolar biphasic stimulation of an electrode within scala tympani, in subjects implanted with the Nucleus^® 24 cochlear implant system (three with straight and two with Contour™ electrode arrays). A novel measure of the ECAP was employed, using the Neural Response Telemetry™ (NRT™) system. The ESF provides a patient-specific measure of the “ability” of the stimulation field to excite neurons at differing locations around the cochlea. The results were interpreted with the aid of simple finite element computational models of the electric field. The finite element models were used to generate template field spread functions that differed with radial distance of the stimulated electrode from the modiolus. Relative to a template field function for the appropriate radial distance, the ESF spread on average approximately twice as broadly (a scaling factor of two). The magnitude of this scaling factor was considered to be indicative of the site of excitation on the neural fibers. The relationship between two ECAP measures, the spread of ESF and the “spread of excitation” (SOE), is discussed.     

TM4SF与整合素共同调节肿瘤转移

转移是恶性肿瘤死亡的主要原因,TM4SF(跨膜四超蛋白家族)与整合素结合形成跨膜复合体,通过调节细胞的黏附和移动,对肿瘤的侵袭及转移过程起着重要作用.文中对近年来关于TM4SF的结构、与整合素结合的形式和特点,以及与肿瘤转移的有关机制进行了综述.     

Understanding the pathophysiological mechanisms in the pediatric non-alcoholic fatty liver disease: The role of genetics

Classically, the non-alcoholic fatty liver disease(NAFLD) physiopathology and progression has been summarized in the two hits hypothesis. The first hit is represented by the action of hyperinsulinemia and insulin resistance, accompanying obesity, that leads to liver steatosis increasing the absolute non esterified fatty acids uptake in the liver and the esterification to form triacylglycerol. The oxidative stress is involved in the second hit leading to the progression to nonalcoholic steatohepatitis(NASH) because of its harmful action on steatosic hepatocytes. However, at the present time, the two hits hypothesis needs to be updated because of the discover of genetic polymorphisms involved both in the liver fat accumulation and progression to NASH that make more intriguing understanding the NAFLD pathophysiological mechanisms. In this editorial, we want to underline the role of PNPLA3 I148 M, GPR120 R270 H and TM6SF2 E167 K in the pediatric NAFLD development because they add new pieces to the comprehension of the NAFLD pathophysiological puzzle. The PNPLA3 I148 M polymorphism encodes for an abnormal protein which predisposes to intrahepatic triglycerides accumulation both for a loss-of-function of its triglyceride hydrolase activity and for a gain-of-function of its lipogenic activity.Therefore, it is involved in the first hit, such as TM6SF2 E167 K polymorphisms that lead to intrahepatic fat accumulation through a reduced very low density lipoprotein secretion. On the other hand, the GPR120 R270 H variant, reducing the anti-inflammatory action of the GPR120 receptor expressed by Kuppfer cells, is involved in the second hit leading to the liver injury.     

初发急性脑卒中患者生活质量的调查分析

目的:了解初发急性脑卒中患者的生活质量情况及其相关因素.方法:采用横断面、多中心研究方法,应用健康测量量表SF-36对11所医院的121例初发急性脑卒中患者进行调查,用非参数检验及多元逐步回归方法分析影响生活质量的相关因素.结果:生活质量与患者是否合并有高血压、性别、家人对患者的关心程度有关.合并高血压者生活质量降低,女性患者的生活质量明显低于男性,家人对患者的关心程度与患者的生活质量呈正相关.结论:积极治疗高血压,重视女性患者生活质量尤其是精神健康的维护,提供给患者足够的家庭支持是提高脑卒中患者生活质量的重要保证.     

Persistent neuropsychiatric impairment in HCV patients despite clearance of the virus?!

One of the most disabling symptoms of hepatitis C virus (HCV) infection is chronic fatigue. While this is accepted for HCV polymerase chain reaction (PCR)‐positive patients, a relationship between HCV infection and chronic fatigue is questioned after successful virus eradication. As fatigue is a subjective criterion, we aimed to evaluate in addition mood alterations and cognitive function in HCV‐exposed patients with only mild liver disease and to assess a) possible interrelationships between these factors and health‐related quality of life and b) the impact of viremia and former interferon treatment. One hundred and fifty‐nine anti‐HCV‐positive individuals without advanced liver disease answered health‐related quality of life (HRQoL), fatigue and depression questionnaires and underwent a battery of attention and memory tests. Accompanying diseases which could distort the results of the study such as HIV co‐infection or drug addiction were exclusion criteria. The patients were subdivided into four groups according to their viremia status and interferon treatment history. Patients' data were evaluated with respect to norms given in the respective test manuals and in addition compared to those of 33 age‐matched healthy controls. Eighty‐five per cent of the patients had chronic fatigue, 50‐60% mild depression or anxiety, 45% memory deficits and 30% attention deficits, irrespective of their HCV viremia status or treatment history. HRQoL correlated negatively with chronic fatigue (P<.001), while cognitive deficits—especially memory function—were independent from fatigue and depression. HCV infection may cause long‐standing cerebral dysfunction that significantly impairs HRQoL and may even persist after clearance of the virus.     

Changes in leisure‐time physical activity and physical and mental health functioning: a follow‐up study

Functioning will be an increasingly important issue in Finland over the coming decades as the proportion of the population aged 65 and older is growing significantly. However, the associations between changes in physical activity and subsequent health functioning are poorly understood. The aim of this study was to examine how changes in physical activity relate to concurrent and prospective levels of health functioning. Cohort data from the Helsinki Health Study were used. Phase 1 (n = 8960, response rate 67%, 80% women) was conducted among 40‐ to 60‐year‐old employees of the City of Helsinki in 2000–2002, phase 2 in 2007 (n = 7332, response rate 83%), and phase 3 in 2012 (n = 6814, response rate 79%). Linear mixed models were used as the main statistical method. Increasing physical activity was associated with higher concurrent and prospective levels of physical health functioning, whereas decreasing activity was associated with lower levels of physical health functioning. The associations were stronger with physical than with mental health functioning. Promoting physical activity among aging people may help to maintain their level of health functioning.