Energy and Protein Intake, Anthropometrics, and Disease Burden in Elderly Home-care Receivers--A Cross-sectional Study in Germany (ErnSIPP Study).

OBJECTIVE: To date, no study has examined the nutritional status and disease burden of elderly home-care receivers living in Germany. Aim of this cross-sectional study was, first, to assess disease burden and nutritional status, denoted in anthropometrics, and, second, to investigate associations between anthropometrics and disease burden. DESIGN: Cross-sectional multi-centre study. SETTING: Home-care receivers living in three urban areas of Germany in 2010. PARTICIPANTS: 353 elderly (>64 years) in home care (128 males aged 79.1 ±7.8 years, 225 females aged 82.0 ±7.5 years). MEASUREMENTS: Nutritional status was assessed by body mass index (BMI), mid upper arm circumference (MUAC) and calf circumference (CC). Medical conditions were assessed in personal interviews. A 3-day prospective nutrition diary was kept. Metric data are reported as mean±SD or median (interquartile range), p<0.05 was considered significant. RESULTS: Most participants were substantially (59%), and 11% severest in need of care. The seniors suffered from 5 (4-7) chronic diseases; dementia, depression, stroke, and respiratory illness were most prevalent (each 20-40%). More than one-third of participants had only moderate or poor appetite, nearly half were unable to eat independently. Chewing problems were reported for 52% of study participants, and more than one quarter of elderly had swallowing problems. Daily mean energy intake was 2017±528 kcal in men (n=123) and 1731±451 kcal in women (n=216; p<0.001). Mean protein intake amounted to 1.0 g/kg body weight. Mean BMI was 28.2±6.2 kg/m² (n=341), 14% of seniors had a BMI <22 kg/m² (including 4% with BMI <20 kg/m²). Critical MUAC (<22 cm) was indicated in 6% of subjects; and CC <31 cm in 11% of men, 21% of women (p<0.05). After adjusting for sex and age, BMI, MUAC and CC were negatively associated with high care level, hospitalization in the previous year, nausea/vomiting, prevalence of dementia, poor appetite, and eating difficulties like dependency, chewing and swallowing problems. CONCLUSION: We recommend to pay special attention to the nutritional status of elderly persons in home-care exhibiting named disease burden.

Vitamin D status and physical function in nursing home residents: a 1-year observational study.

OBJECTIVE: Low vitamin D blood levels are highly prevalent in elderly people, particularly in nursing home residents (NHR). A relation between vitamin D levels and physical function (PF) is described in several studies in older adults; however, data on NHR are scarce and there is presently no information on the time course of vitamin D levels and PF in this population. The aim of the present study was to describe the 25-hydroxyvitamin D [25(OH)D] status of NHR at baseline (t1) and after 1 year (t2) to examine whether 25(OH)D blood levels are related to PF at t1 and at t2, and whether changes in 25(OH)D levels over 1 year are related to changes in PF. METHODS: All NHR (≥ 65 years) without tube-feeding and severe acute or end-stage disease were asked to participate. At t1 and t2 fasting blood samples were taken for the analysis of 25(OH)D serum levels and PF was estimated by activities of daily living (Barthel ADL) and measured by handgrip strength (HGS) and timed 'up and go' test (TUG). RESULTS: In total, 115 residents, aged 87 (82-93) years (all data in median and 1st-3rd quartile), showed the following values for PF: ADL 50 (20-65) points, HGS 40 (30-50) kPa and TUG 26 (18-31) s. Vitamin D deficiency (< 50 nmol/l) was present in 93.9 % (70.4 % < 25 nmol/l) at t1 and in 71.2 % (57.3 % < 25 nmol/l) at t2. At t1 and at t2 a weak correlation between vitamin D level and PF (Spearman's correlation coefficient t1: ADL r = 0.367, HGS r = 0.313; t2: ADL: r = 0.247; all p < 0.01) was observed. There was no correlation between changes in vitamin D levels over 1 year and changes in PF. CONCLUSIONS: Almost all NHR included in the study showed vitamin D deficiency. 25(OH)D levels were weakly correlated to PF at baseline and at follow-up, and an increase in vitamin D levels was not associated with positive effects on PF in this study.

Institutional factors associated with the nutritional status of residents from 10 German nursing homes (ErnSTES study).

OBJECTIVES: In nursing homes malnutrition among residents is widespread. Because residents place part of their personal freedom of choice into institutional hands, institution-specific factors may influence nutritional status of residents. DESIGN: Multi-centre cross-sectional study. SETTING: 10 nation-wide German nursing homes. PARTICIPANTS: 714 exclusively orally fed residents (aged 65 years and older, not in final weeks of life). MEASUREMENTS: Participants' characteristics (e. g. gender, age, level of care, dementia diagnosis), body mass index (BMI), mini nutritional assessment (MNA), energy intake (3-day dietary record, BLS II.3), and selected institution-specific factors (size of institution, daily rate for food supply, number of residents per care staff member). Metric data are given as median (P25, P75). RESULTS: 11 % of residents (81 % female, 85 (81, 91) years) had a BMI <20 kg/m2 (n=658). According to MNA, 10 % of the residents were malnourished (n=650). Capacity of institutions was 116 (56, 139) beds, care staff ratio was 4.1 (3.5, 4.2) residents per care person (mean over all care levels), and daily food budget was 4.45 (4.10, 4.71) Euro/d. Low daily food budget was associated with a higher risk for a BMI <20 kg/m2 (OR 3.30 [95 %CI 1.70-6.42]). Higher food budget also decreased malnutrition risk (OR 0.66 [0.46-0.95]) according to MNA. Residents' mean energy intake was 6.1 (5.2, 7.1; n=565) MJ/day in women and 7.1 (6.2, 8.2; n=132) MJ/day in men. Intake was higher with small facility size, higher food budget, and lower care staff ratio (P <0.05). CONCLUSION: The institutional environment affects the nutritional status of nursing home residents as an independent risk factor. The results suggest promotion of small facilities and the provision of more care staff and more financial resources for food in the structural design of residential homes.

Malnutrition is related to functional impairment in older adults receiving home care.

OBJECTIVES: The aims of this work were (a) to provide a detailed description of the association between nutritional (Mini Nutritional Assessment; MNA®) and functional status in a sample of older adults receiving home care, using both questionnaire- and performance-based functional methods, and (b) to investigate the impact of different MNA subscales on this association. DESIGN: Multi-centre, cross-sectional. SETTING: Home care. PARTICIPANTS: 296 persons ≥65 years in need of care (80.7±7.7 y). MEASUREMENTS: Nutritional status was determined by the MNA and functional status by two questionnaires (Instrumental and Basic Activities of Daily Living; IADL, ADL) and three performance tests (handgrip strength, HGS; Short Physical Performance Battery, SPPB; Timed 'Up and Go' Test, TUG). A categorical and a covariance analytical approach were used to test for differences in functional status between MNA groups (well nourished, risk of malnutrition, malnourished). In addition, functional parameters were correlated with total MNA, a modified MNA version (modMNA), where functional items were excluded, and MNA subscales ('functionality', 'general assessment', 'anthropometry', 'dietary assessment', and 'subjective assessment'). RESULTS: 57% of the participants were at risk of malnutrition and 12% malnourished. 35% reported severe limitations in IADL, 18% in ADL. 40%, 39% and 35% had severe limitations in HGS, SPPB and TUG; 9%, 28% and 34% were not able to perform the tests. Functional status deteriorated significantly from the well nourished to the malnourished group in all functional measures. The modMNA was weak but still significantly related to all functional parameters except TUG. The subscale 'functionality' revealed strongest correlations with functional measures. All other MNA subscales showed only weak or no associations. CONCLUSION: More than one half of the seniors receiving home care were at nutritional risk and poor functional level, respectively. Malnutrition according to MNA was significantly associated to both questionnaire- and performance-based functional measures even after exclusion of functional MNA items.

Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: resident interviews versus assessment by nursing staff.

BACKGROUND: When the Mini Nutritional Assessment (MNA) was developed, the authors did not specifically focus on the nursing home setting. Due to a number of particularities of nursing home residents, such as cognitive and linguistic disabilities, a number of uncertainties with regard to its application await clarification. AIMS AND OBJECTIVES: The aim of this study was to compare the results of two different modes of MNA application in nursing homes: resident interviews versus assessment by nursing staff. METHOD: The MNA was applied to 200 residents of two municipal nursing homes in Nuremberg, Germany. First one-on-one interviews of the residents were conducted by two researchers from our group. Next, the MNA was applied by the attending nursing staff who was blinded to the results of the first MNA. To evaluate the prognostic properties of the two different approaches, data on mortality of the screened residents were collected during a six-month follow-up period. RESULTS: Among 200 residents (f 147 m 53, f 86.5 +/- 7.4 y. m 83.0 +/- 8.5 y.), the MNA could be applied to 138 residents (69.0%) by one-on-one interviews and to 188 residents (94.0%) by the nursing staff. 15.2% of the residents were categorised as malnourished by the interviews and 8.7% by the nursing staff's assessment. The agreement of the two forms was low for the MNA short form (weighted kappa = 0.31; 95% CI: 0.14 - 0.47) as well as for the full MNA (weighted kappa = 0.35; 95% CI: 0.27 - 0.44). After exclusion of residents with cognitive impairment (n=89), agreement for the full version increased (weighted kappa = 0.47, 95% CI 0.25 - 0.68). 25 (12.5%) study participants deceased during the follow-up period. Mortality was significantly associated with the mortality for both approaches, while the MNA application by the nursing staff proved to be superior (nursing staff p < 0.001, residents p < 0.05). CONCLUSIONS: The results of the MNA in nursing home residents may differ substantially when resident interviews are compared to assessment by nursing staff. The authors recommend that the MNA should be routinely applied by the nursing staff. The application rate is higher and interference with cognitive as well as linguistic deficits is lower. In future studies, the mode of MNA application in nursing home residents should be clearly stated to facilitate comparability of results.

The prevalence of Helicobacter pylori: are emergency medicine residents at risk?.

Helicobacter pylori is strongly associated with peptic ulcer disease and gastric cancer. It is a cause of chronic active gastritis. Our hypothesis was that Emergency Physicians might be at increased risk for infection due to their exposure to gastric contents from procedures performed in the Emergency Department. Our goal was to test a group of Emergency Physicians for H. pylori infection. In this cross sectional study, we tested a group of volunteers from an Emergency Medicine residency program for H. pylori infection by serum analysis for IgG. A matched control group was also tested. Forty-five subjects were enrolled; one subject's sample was lost. Three of 44 subjects (6.8%) were positive for H. pylori antibodies. Seven of 44 controls (15.9%) tested positive. Thus, Emergency Physicians do not have increased H. pylori infection rates and may be at less risk than the general population. Routine testing is not recommended.

Activation of signal transducer and activator of transcription-3 during proliferative phases of 3T3-L1 adipogenesis.

Signal transducer and activator of transcription-3 (STAT3) is abundantly expressed in preadipocytes and adipocytes, but little is known about its activation status or functional role during adipogenesis. In this report we investigate STAT3 activation in 3T3-L1 preadipocytes before and after differentiation into adipocytes. STAT3 was highly tyrosine phosphorylated and bound to DNA in proliferating preadipocytes, but not in growth-arrested preadipocytes or adipocytes. In growth-arrested confluent preadipocytes, induction of differentiation with methylisobutylxanthine, dexamethasone, and high dose insulin led to a delayed, but prolonged (3-day), increase in STAT3 tyrosine phosphorylation. This increase in STAT3 phosphorylation coincided temporally with postconfluent preadipocyte mitotic clonal expansion. Insulin and methylisobutylxanthine alone, but not dexamethasone, induced STAT3 tyrosine phosphorylation in postconfluent cells. Diminution of endogenous STAT3 expression by antisense morpholino oligonucleotides significantly decreased preconfluent preadipocyte proliferation. Collectively, these findings suggest a regulatory role for STAT3 during the proliferative phases of adipogenesis.

Interleukin-4 mediates STAT6 activation in 3T3-L1 preadipocytes but not adipocytes.

STAT6 is abundantly expressed in 3T3-L1 preadipocytes and adipocytes but activating ligands are not well defined. In this report, we provide evidence that interleukin 4 (IL-4) induced JAK2-mediated STAT6 tyrosine phosphorylation and DNA binding in 3T3-L1 preadipocytes but not in 3T3-L1 adipocytes. Loss of IL-4-mediated STAT6 tyrosine phosphorylation occurred 2 days after preadipocytes were induced to differentiate into adipocytes but when cells remained phenotypically preadipocytes. 3T3-L1 adipocytes were still responsive to IL-4 through tyrosine phosphorylation of other cellular proteins. We conclude that IL-4 signals through STAT6 in 3T3-L1 preadipocytes but not in 3T3-L1 adipocytes. This differentiation-dependent loss of STAT6 activation may be critical for distinct biological effects of IL-4 in 3T3-L1 preadipocytes and adipocytes.

Induction of electrical excitability by NGF requires autocrine action of a CNTF-like factor.

The overlapping expression of neurotrophin and neural cytokine receptors indicates that most neuronal populations are responsive to both classes of factors, yet relatively little is known about how these two trophic signaling systems interact to regulate neuronal phenotype. We report here that one hallmark of NGF's effects on target cells, the induction of membrane electrical excitability, requires the intermediary action of a CNTF-like factor. We found that NGF's regulation of voltage-gated potassium channels, unlike its regulation of voltage-gated sodium and calcium channels, involves a CNTF-like autocrine/paracrine loop. We showed that NGF induces secretion of a soluble factor that mimics the action of exogenous CNTF in regulating voltage-gated potassium channels and that NGF's ability to regulate this potassium channel is blocked by three independent reagents that inhibit the signaling of CNTF and/or related factors. The identity of this autocrine factor does not appear to be CNTF itself. Thus, a CNTF-like autocrine/paracrine factor is both necessary and sufficient for the regulation of potassium channels by NGF and is a key determinant of the type of electrical excitability that NGF induces in target cells.

Hazards associated with metalworking by artists.

Metalworking is the constructive sculptural application of various technologic processes for producing art from ferrous and nonferrous metals. Self-employed artists and their workplaces are not protected by governmental agencies. We describe the techniques involved in metalworking processes and discuss the physical trauma and medical syndromes associated with each process, as well as safety, prevention, and treatment aspects of the basic syndromes.

Acute idiopathic thrombocytopaenic purpura in childhood: report of a case presenting in general dental practice.

Acute idiopathic thrombocytopaenic purpura is the most common of the thrombocytopaenias of childhood. Clinically it is associated with petechiae, mucocutaneous bleeding and occasionally haemorrhage into tissues. The oral mucosa is frequently involved. This paper describes a case presenting in general dental practice.

Neurotrophin regulation of ionic currents and cell size depends on cell context.

Trk receptor activation by neurotrophins is often considered to have a defined set of actions on target neurons, including supporting neuronal survival, inducing morphological differentiation, and regulating a host of target genes that specify neuronal phenotype. It is not known if all such regulatory effects are obligatory, or if some may vary depending on the cell context in which the receptors are expressed. We have examined this issue by comparing neurotrophin effects on the regulation of electrical excitability and morphological differentiation in two strains of PC12 cells. We found that while neurotrophins induced neurite extension and increased calcium currents in both PC12 cell types, sodium current levels were regulated in only one of these strains. Moreover, we found little correlation between calcium current levels and the extent of morphological differentiation when compared in individual cells of a single strain. Thus, the regulatory effects of neurotrophins on cell phenotype are not fully determined by the Trk receptors that they activate; rather, they can vary with differences in cell context that arise not only between different cell lineages, but also between individual cells of clonal relation.

Neurotrophins differentially regulate voltage-gated ion channels.

Neurotrophic factors profoundly affect neuronal differentiation, but whether they influence neuronal phenotype in instructive ways remains unclear: do different neurotrophic factors always trigger identical programs of differentiation or can each impose distinct functional properties even when acting upon the same population of target neurons? We addressed this issue by examining the regulatory effects of the four neurotrophins on the molecular components of electrical excitability, voltage-gated ion channels, within a single cellular context. Using patch clamp methods, we studied neurotrophin regulation of voltage-gated sodium, calcium, and potassium currents in SK-N-SH neuroblastoma cells. We found that each neurotrophin induced a unique pattern of expression of ionic currents despite similar activation of initial signal transduction events. Thus, each neurotrophin imposed a different excitable phenotype even when acting upon the same target cells.

Art hazards.

The diseases associated with art forms range from trauma (vibration syndrome, flying objects, etc) and heat exposure, to heavy metal and solvent exposure. Specific substances such as ozone, cadmium, and molybdenum have unique diseases associated with them. Sadly, artists may not have the medical knowledge to know how to deal with or avoid hazards. They and their immediate families often may be at risk. Many artists are not educated in what protective gear to use and do not have the money to purchase the specialized equipment for their particular work, or they refuse to wear protective gear because they are uncomfortable in the conditions encountered in the workplace. Education is often required for the use of the protective gear (respiratory, eyewear, contact protection). To make matters worse, artists are poorly protected from toxins. Government regulations are not adequate to protect self-employed artists. Laws regulating children's exposure do not address long-term toxicity. Most artists with acute problems present to the ED first. An awareness of the occupational hazards to which self-employed artists are exposed will prevent the treating physician from overlooking important clues. When an artist presents with unusual symptoms, the physician must get a complete occupational history and must have the patient bring a list or samples of any substances to which he or she has been exposed. In essence, artists are a group of enthusiastic, hardworking people that can be protected by a keen awareness of these basic principles by the treating physician.

Regulation of voltage-gated ion channels by NGF and ciliary neurotrophic factor in SK-N-SH neuroblastoma cells.

Neurotrophic factors have powerful effects on neuronal differentiation and the maintenance of neuronal phenotype, but understanding of their regulation of one important aspect of neuronal function, excitability, remains limited. We have examined the regulation of voltage-gated ion channels by two unrelated neurotrophic factors, NGF and ciliary neurotrophic factor (CNTF), in the SK-N-SH neuroblastoma cell line that is responsive to both factors. NGF and CNTF have strikingly different neuronal specificities and distributions in the nervous system, and might be expected to have significantly different effects on neuronal function. Using whole-cell, perforated-patch, and single-channel recording, we found that treatment with NGF increased levels of voltage-gated sodium, calcium, and potassium currents. In contrast, CNTF treatment increased levels of potassium currents only. NGF and CNTF appeared to regulate the same delayed-rectifier potassium current; in addition, NGF treatment resulted in increased levels of a second potassium current component. Such differential effects of neurotrophic factors on the expression of voltage-gated ion channels would have profound effects on the excitability of target neurons in vivo.

CSF monoamine levels in normal-weight bulimia: evidence for abnormal noradrenergic activity.

Normal-weight bulimic patients have disturbed appetite, mood, and neuroendocrine function and often respond to antidepressants. Since these findings suggest abnormalities in brain monoaminergic pathways, the authors measured CSF monoamine concentrations in 27 normal-weight bulimic patients and 14 volunteers. Bulimic patients had a significantly lower mean CSF norepinephrine concentration. Levels of CSF 5-HIAA, the major serotonin metabolite, and CSF HVA, the major dopamine metabolite, were normal, although more frequent binge-eating in bulimic subjects was associated with a significantly lower CSF HVA level. Whether trait- or state-related, monoaminergic disturbances are part of this disorder's neurobiological syndrome. The lower CSF norepinephrine concentration suggests bulimia is not simply a variant of affective disorders.