The islet autoantibody titres: their clinical relevance in latent autoimmune diabetes in adults (LADA) and the classification of diabetes mellitus

Latent autoimmune diabetes in the adult (LADA) is a slowly progressive form of autoimmune diabetes, characterized by diabetes‐associated autoantibody positivity. A recent hypothesis proposes that LADA consists of a heterogeneous population, wherein several subgroups can be identified based on their autoimmune status. A systematic review of the literature was carried out to appraise whether the clinical characteristics of LADA patients correlate with the titre and numbers of diabetes‐associated autoantibodies. We found that the simultaneous presence of multiple autoantibodies and/or a high‐titre anti‐glutamic acid decarboxylase (GAD)—compared with single and low‐titre autoantibody—is associated with an early age of onset, low fasting C‐peptide values as a marker of reduced pancreatic B‐cell function, a high predictive value for future insulin requirement, the presence of other autoimmune disorders, a low prevalence of markers of the metabolic syndrome including high body mass index, hypertension and dyslipidaemia, and a high prevalence of the genotype known to increase the risk of Type 1 diabetes. We propose a more continuous classification of diabetes mellitus, based on the finding that the clinical characteristics gradually change from classic Type 1 diabetes to LADA and finally to Type 2 diabetes. Future studies should focus on determining optimal cut‐off points of anti‐GAD for differentiating clinically relevant diabetes mellitus subgroups.     

Self‐worth therapy for depressive symptoms in older nursing home residents

Title. Self‐worth therapy for depressive symptoms in older nursing home residents. Aim. The aim of this study is to report the effects of self‐worth therapy on depressive symptoms of older nursing home residents. Background. Depression in older people has become a serious healthcare issue worldwide. Pharmacological and non‐pharmacological therapies have been shown to have inconsistent effects, and drug treatment can have important side‐effects. Method. A quasi‐experimental design was used. Older people were sampled by convenience from residents of a nursing home in northern Taiwan between 2005 and 2006. To be included in the study participants had to: (i) have no severe cognitive deficits; (ii) test positive for depressive status and (iii) take the same anti‐depressant medication in the previous 3 months and throughout the study. Participants in the experimental group (n = 31) received 30 minutes of one‐to‐one self‐worth therapy on 1 day a week for 4 weeks. Control group participants (n = 32) received no therapy, but were individually visited by the same research assistant, who chatted with them for 30 minutes on 1 day/week for 4 weeks. Depressive status, cognitive status and functional status were measured at baseline, immediately after the intervention and 2 months later. Data were analysed by mean, standard deviations, t‐test, chi‐squared test and univariate anova . Findings. Self‐worth therapy immediately decreased depressive symptoms relative to baseline, but not relative to control treatment. However, 2 months later, depressive symptoms were statistically significantly reduced relative to control. Conclusion. Self‐worth therapy is an easily‐administered, effective, non‐pharmacological treatment with potential for decreasing depressive symptoms in older nursing home residents.     

鼻咽癌高发区健康成人六项EB病毒抗体检测结果的分析

背景与目的：鼻咽癌有明显地域倾向性，而鼻咽癌发病又与EBV密切相关。本研究通过检测来自不同地域的人群抗EBV抗体的水平和阳性率．以探讨EBV感染与鼻咽癌的地域倾向性之间的关系。方法：从鼻咽癌高发区广东省中山市的健康成人中收集303例中山原住居民的血清和92例来自非NPC高发区的外省移民的血清，用ELISA法检测血清中的EBNA1-IgA、EBNA1-IgG、VCA-p18-IgA、VCA-p18-IgG、Zta—IgA和Zta—IgG等六种抗体水平，以校正相对吸光度（ArA）值表示，逐一比较两个人群样本六项抗EBV抗体水平及阳性率的差别。结果：中山原住居民的Zta—IgA（0．84±0．03）和VCA—p18-IgA的ArA（0．96±0．05）明显高于外省移民（0．42±0．04和0．40±0．05，P〈0．05）。另外，中山原住居民30-年龄段组和50～年龄段组的Zta—IgA阳性率分别是29．27％和48．28％，均明显高于外省移民同一年龄段组的3．03％和6．67％（P〈0．05）。中山原住居民30～年龄段组和50-年龄段组的VCA—p18．IgA分别是28．46％和43．10％，均明显高于外省移民同一年龄段组的9．09％和13．33％（P〈0．05）。结论：中山原住居民针对EBV溶解期的抗体Zta-IgA和VCA—p18-IgA的水平和阳性率偏高．反映其感染的EBV更多地处于再激活状态，这提示NPC高发区中山的原住居民罹患鼻咽癌的风险比来自非NPC高发区的外省移民更高。     

中国9省市中老年人群体重指数与健康相关生命质量的关系

Objective To study the association between body mass index (BMI) and the health-related quality of life (HRQOL) in the middle-aged and older Chinese people. Methods Data of 9539 middle-aged and older adults was collected from a cross-sectional survey performed in 9 provinces of China (Jiangsu, Anhui, Gansu, Qinghai, Fujian, Beijing, Jilin, Jiangxi and Henan province). MO SSF-36 was used to measure HRQOL. BMI classification was in accordance with the criteria recommended by the Ministry of Health of China. Rank sum test was used to compare HRQOL between subjects with normal weight and those with different BMI classification. Multiple logistic regression analysis was used to assess the association of HRQOL with BMI after adjusted for sex, age, marital, education, physical activity status and chronic diseases. Results When compared with middle-aged and older adults at normal weight range (18.5≤BMI<24) , data on physical domain (P<0.001) , mental domain (P< 0.01) and 8 dimensions of HRQOL (physical functioning, mental health, P<0.05; role-physical, bodily pain, general health, vitality, social functioning, role-emotional, P<0.01)among subjects with underweight (BMI<18.5) were significantly lower while mental component summary (P<0.05) of overweight subjects (24≤BMI<28) was significantly higher. Obese subjects (BMI≥28) had worse physical function (physical functioning, P<0.01) but better mental health (mental health, P<0.01; mental component summary, P<0.05). After adjusting for other factors, and compared to middle aged and older adults with normal weight, data on odds ratios (ORs) of impaired HRQOL in physical domain (OR=1.67, 95% CI: 1.35-2.06), mental domain (OR=1.39, 95%CI: 1.13-1.70) and 8 dimensions increased among underweight subjects while ORs of impaired HRQOL in mental domain (0R=0.86,95% CI: 0.78-0.95) and role-physical, vitality, social functioning, role-emotional and mental health dimensions decreased among overweight subjects. ORs increased (OR=1.51,95% CI: 1.27-1.80) in impaired HRQOL in physical functioning dimension but decreased in mental domain (OR=0.71,95%CI: 0.60-0.85) as well as vitality, role-emotional and mental health dimensions among obese subjects. Conclusion HRQOL of each domain were different among middle aged and older adults with different BM1 classification. Underweight people had poor HRQOL in both physical domain and psychological domain, and obese people had poor physical function but good mental health condition.     

Evidence-Based Psychotherapies for Depression in Older Adults

We conducted an evidence-based review of psychological treatments for geriatric depression using coding criteria, and we identified six treatments to be beneficial: behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychody-namic therapy, and reminiscence therapy. Other interventions were found to be promising but were lacking replication. These findings suggest that (a) there are several treatment choices for consumers and practitioners across a relatively broad range of theoretical orientations and modalities, (b) there needs to be a recognition of the viability of psychological treatments for depressed elders by other disciplines, and (c) there is an opportunity to provide training in evidence-based treatments for present and future providers to the growing number of older adults.     

Erosion by the amplatzer septal occluder: Experienced operator opinions at odds with manufacturer recommendations?

Background: Device erosion is a very rare but potentially fatal complication of ASD occlusion by the Amplatzer Septal Occluder (ASO). After reviewing cases of device erosion, recommendations for ASD sizing and device selection were revised by a small group of “experts” and adopted by the device manufacturer in 2004. These revisions, which recommend use of smaller devices, which do not straddle the aorta, remain controversial. Objective: The aim of our study is to help define an expanded expert consensus with respect to the causes and preventive strategies for erosions. Methods: We report a case of device erosion in which the 2004 revisions were carefully followed; and a survey of the members of the Congenital Cardiovascular Interventional Study Consortium (CCISC) soliciting experiences with and opinions about device erosion. Results: In our case, the device disk appeared to protrude into the aortic root but not straddle, and had motion independent of cardiac movement. Of 57 survey responders having a total experience of 12,006 ASO implants, 12 members reported 14 erosions among 3,010 implants. Ninety percent of erosions occurred in patients with deficit aortic rim. Of 53 patients, 38 (71.7%) responded that devices, which are undersized and do not straddle the aorta are at highest risk of erosion. Of 52 patients, 44 (84%) responded that motion of the device relative to the heart may cause erosion. Conclusion: Both the survey results and our single case experience suggest that operator opinions (and perhaps also device sizing practices) are at odds with the 2004 revisions. Further study and focus on this issue is needed. © 2009 Wiley‐Liss, Inc.     

Social Problem Solving as a Mediator of the Link Between Stress and Psychological Well-being in Middle-Adulthood

This study had two major objectives: (1) to examine the relationship between stress, social problem solving, and psychological well-being (PWB) in a sample of middle-aged adults (M 46.3 years) and (2) to examine the role of social problem solving as a potential mediator of the link between stress and PWB in this group. Correlational analyses indicated that both stress and social problem solving were significantly involved in PWB. Moreover, results from conducting a path analysis indicated that social problem solving partially mediated the link between stress and PWB. Although stress and negative problem orientation were found to be unique predictors of different dimensions of PWB, other social problem-solving dimensions also emerged as important predictors. Some implications of these findings for enhancing positive psychological functioning in middle-aged adults are discussed.     

Ethnic Variation in Attitudes toward Hypertension in Adults Ages 75 and Older

Background. Although critical to the management of hypertension, the attitudes of geriatric patients and possible ethnic group differences in attitudes concerning the disease are poorly understood.Methods. Data from a 1995–1996 population-based survey of 507 Hispanic American, African American, and non-Hispanic white adults ages 75 and older were used to assess ethnic differences in perceptions regarding the cause, prevention, and treatment of hypertension, as well as associations between perceptions and use of preventive health services.Results. African Americans were more likely to attribute hypertension to health behaviors and stress. In contrast, Hispanic Americans were more likely consider the disease a normal part of aging, whereas non-Hispanic whites were more likely to attribute hypertension to heredity or mechanistic causes. Non-Hispanic whites were less likely to perceive hypertension as preventable, whereas Hispanic Americans were less likely to feel that hypertension was treatable. The odds of having a primary care physician, blood pressure checked, or glaucoma checked were lower among older African Americans and Hispanic Americans than older non-Hispanic whites. The odds of having had a recent physical and of emergency room use were higher among African Americans and lower among Hispanic Americans, in relation to non-Hispanic whites.Conclusion. Ethnic differences regarding hypertension were clearly evident in this sample of older adults. In addition, attitudes regarding the cause and treatment of hypertension were found to be associated with both the use and the underuse of preventive health services in all three ethnic groups.     

Predictive Values of Body Mass Index and Waist Circumference for Risk Factors of Certain Related Diseases in Chinese Adults - Study on Optimal Cut-off Points of Body Mass Index and Waist Circumference in Chinese Adults

The body mass index of Chinese population is lower than that of the Westerncountries, however, the trends of mean body mass index and prevalence of overweight inadults have increased significantly in recent 15 years[1]. Overweight and obesity areclosely r…     

New directions in mental health practice with older people: Canadian strategies for mental health reform

Aim and objective.  The purpose of this article is to draw attention to problems in the Canadian health system that must be overcome if Canada is to ensure that older people can access the services they need.
Background.  Projections suggest that 20% of Canadians will be aged 65+ by 2021. If current prevalence rates for mental illness continue, this will result in a significant increase in the number of older Canadians with or at risk for mental illness and mental health problems.
Design.  Findings of the final report of the Standing Committee on Social Affairs, Science and Technology are summarized and related to the intended role and primary strategy of the proposed Canadian Mental Health Commission.
Methods.  The relevance of the Interprofessional Education for Collaborative Patient-Centred Practice initiative launched by Health Canada is then considered in light of the intention that the Commission adopt collaboration with relevant stakeholders as its primary strategy for achieving mental health reform.
Conclusions.  Fragmentation in service delivery must be overcome if older Canadians are to receive age appropriate mental health services when and where they need them. Yet there is little evidence that the degree of interprofessional collaboration required can be achieved.
Relevance to clinical practice The reforms advocated by the Senate Committee are widely embraced but evidence is needed on how mental health and other professionals can best learn to work together in the interests of older people and other mental health consumers.