Exploring the Motivational Drivers of Young Adults with Diabetes for Participation in Kidney Research.

Understanding motivational drivers and barriers to patient participation in diabetes research are important to ensure research is relevant and valuable. Young adults with type 1 diabetes (T1D) completed a 31-question qualitative survey evaluating participant experience, understanding, and motivators and barriers to research involvement. A total of 35 participants, 19-28 years of age, 60% female, completed the survey. Motivating factors included personal benefit, relationship with the study team, curiosity, financial compensation, altruism, and nostalgia. Older participants (>22 years) reported higher levels of trust in the study team (p = 0.02) and their relationship with the study team positively influenced their decision to participate (p = 0.03). Financial compensation was a strong motivator for participants with higher education (p = 0.02). Age, sex, education level, and trust in the study team influenced participants' understanding. Barriers included logistics and lack of familial support. Important motivational drivers and barriers to participation in research by young adults with T1D must be considered to increase research engagement and facilitate the discovery of new knowledge.

A population-based, cross-sectional study of the prevalence and correlates of sedentary behaviour of adults with intellectual disabilities.

BACKGROUND: High levels of sedentary behaviour have a negative impact on health and well-being. There is limited evidence on the prevalence and correlates of sedentary behaviour of adults with intellectual disabilities (ID). METHODS: A population-based sample of adults with ID were invited to take part in a comprehensive health check programme. Demographic and health data were collected during a structured interview and physical examination. Screen time was used as a proxy measure of sedentary behaviour. Bivariate and multivariate statistical modelling examined correlates of screen time. RESULTS: Fifty per cent of the 725 participants reported four or more hours of screen time per day. Male gender, higher levels of intellectual ability, mobility problems, obesity, not having hearing impairment and not having epilepsy were all significantly associated with higher screen time in the final multivariate model (R2  = 0.16; Hosmer-Lemeshow goodness of fit statistic P = 0.36). CONCLUSIONS: This is the first study to publish population-based data on the prevalence and correlates of sedentary behaviour in adults with ID. Compared with adults who do not have ID, adults with ID have higher levels, and different correlates, of sedentary behaviour. A better understanding of the social context of sedentary behaviour will inform the design of effective behaviour change programmes for adults with ID.

Anticholinergic medicines in an older primary care population: a cross-sectional analysis of medicines' levels of anticholinergic activity and clinical indications.

WHAT IS KNOWN AND OBJECTIVES: Adverse clinical outcomes have been associated with cumulative anticholinergic burden (to which low-potency as well as high-potency anticholinergic medicines contribute). The clinical indications for which anticholinergic medicines are prescribed (and thus the 'phenotype' of patients with anticholinergic burden) have not been established. We sought to establish the overall prevalence of prescribing of anticholinergic medicines, the prevalence of prescribing of low-, medium- and high-potency anticholinergic medicines, and the clinical indications for which the medicines were prescribed in an older primary care population. METHODS: This was a cross-sectional analysis of a cohort study of Australian early-career general practitioners' (GPs') clinical consultations - the Registrar Clinical Encounters in Training (ReCEnT) study. In ReCEnT, GPs collect detailed data (including medicines prescribed and their clinical indication) for 60 consecutive patients, on up to three occasions 6 months apart. Anticholinergic medicines were categorized as levels 1 (low-potency) to 3 (high-potency) using the Anticholinergic Drug Scale (ADS). RESULTS: During 2010-2014, 879 early-career GPs (across five of Australia's six states) conducted 20 555 consultations with patients aged 65 years or older, representing 35 506 problems/diagnoses. Anticholinergic medicines were prescribed in 10·4% [95% CIs 9·5-10·5] of consultations. Of the total anticholinergic load of prescribed medicines ('community anticholinergic load') 72·7% [95% CIs 71·0-74·3] was contributed by Level 1 medicines, 0·8% [95% CIs 0·5-1·3] by Level 2 medicines and 26·5% [95% CIs 24·8-28·1] by Level 3 medicines. Cardiac (40·0%), Musculoskeletal (16·9%) and Respiratory (10·6%) were the most common indications associated with Level 1 anticholinergic prescription. For Level 2 and 3 medicines (combined data), Psychological (16·1%), Neurological (16·1%), Musculoskeletal (15·7%) and Urological (11·1%) indications were most common. WHAT IS NEW AND CONCLUSION: Anticholinergic medicines are frequently prescribed in Australian general practice, and the majority of the 'community' anticholinergic burden is contributed by 'low'-anticholinergic potency medicines whose anticholinergic effects may be largely 'invisible' to prescribing GPs. Furthermore, the clinical 'phenotype' of the patient with high anticholinergic burden may be very different to common stereotypes (patients with urological, psychological or neurological problems), potentially making recognition of risk of anticholinergic adverse effects additionally problematic for GPs.

Relative recovery of haematopoietic stem cell products after cryogenic storage of up to 19 years.

There is an increasing trend towards long-term frozen storage of haematopoietic stem cells. For such stem cells, harvested from peripheral blood (PB) or BM, it is not known if stem cell viability decreases with time. In this study, 31 separate bags of stem cell product (SCP) stored for 11-19 years (median 15 years) were assessed for total nucleated cell (TNC) count, colony forming unit-granulocyte/macrophage (CFU-GM), CD34⁺ cell count and cell viability. The results were compared with the initial results obtained for the products at the time of stem cell harvest, and the percentage recovery of each parameter was plotted against time. Recovery of TNC, CD34⁺ cell count and cell viability decreased with time (P=<0.01) but CFU-GM did not. This study shows that SCPs harvested from PB and BM do deteriorate with long-term storage. This could have an impact on rates of engraftment.

Estimated ultraviolet exposure levels for a sufficient vitamin D status in North America.

Solar UV radiation is a major provider of vitamin D for humans. This study examines the distribution of solar UV radiation weighted according to the vitamin D action spectrum over the USA and Canada. Hourly and daily doses of spectrally integrated UV irradiance using the vitamin D action spectrum were estimated using a statistical relationship between UV irradiance and global solar irradiance, total ozone, and dew point temperature for 45 sites in Canada and 52 in the USA. Brewer spectrophotometer measurements at 12 sites in Canada and 21 sites in the USA were used to validate the obtained results. Different characteristics of the vitamin D action spectrum-weighted UV irradiance distribution over North America are presented in the form of monthly maps and as a data file. The time required to obtain standard vitamin D dose is also calculated for six types of skin.

CD38 as a prognostic marker in chronic lymphocytic leukaemia at a single New Zealand centre: patient survival in comparison to age- and sex-matched population data.

AIM: The aim of this study is to determine whether the analysis of CD38 expression by chronic lymphocytic leukaemia (CLL) cells provides useful additional prognostic information. METHODS: Clinical, laboratory, overall survival (OS) and treatment-free survival (TFS) data were collected on 130 CLL patients who had CD38 expression analysed at Canterbury Health Laboratories, New Zealand (NZ) during 1998-2008. RESULTS: The detection of any level of CD38 expression by CLL cells was associated with a significantly shorter OS and TFS. When analysis was restricted to Binet stage A patients, CD38 expression identified a subset of patients (21%) who, in common with Binet stage B/C patients, had a significantly shorter OS and TFS (P<0.0015), and a TFS at 4 years of <10%. In contrast, CD38-negative Binet stage A patients had an OS that was not significantly different from that of an age/sex-matched NZ population and a 5-year TFS of 77%. CONCLUSION: This study indicates that, when combined with clinical staging, the presence of any detectable CD38 expression can be used to further improve the identification of CLL patients with more aggressive disease (i.e. Binet stage B/C or Binet stage A and CD38 positive). This will allow better identification of those patients requiring more intensive monitoring and also allow improved patient counselling regarding prognosis.

On the relationship between erythemal and vitamin D action spectrum weighted ultraviolet radiation.

Erythemally weighted solar ultraviolet (UV) radiation is often used to characterize the production of vitamin D in a human body. However, the vitamin D production action spectrum is different than that for erythemal UV. The vitamin D action spectrum weighted UV is more sensitive to UV-B, while the erythemal UV action spectrum has higher weighting coefficients than the vitamin D action spectrum in the UV-A part of the spectrum. Therefore, by using the erythemal UV as an estimate for the vitamin D action spectrum weighted UV can give results that differ by up to a factor of 5. This study examines the relationship between erythemal and vitamin D action spectrum weighted UV radiation using measurements of spectral UV at the surface by Brewer spectrophotometers that are part of the US and Canadian observational networks. It is shown that the ratio of vitamin D action spectrum weighted UV to erythemal UV is nearly constant for high levels of UV (UV Index greater than 5.5) and therefore vitamin D action spectrum weighted UV can be described in terms of erythemal UV. For lower levels of UV though this relationship should not be used. A simple formula that calculates vitamin D action spectrum weighted UV from UV Index is developed. An empirical formula that expresses the ratio of vitamin D action spectrum weighted UV to erythemal UV as a function of the solar zenith angle and column ozone is also suggested. The geographical distributions of vitamin D action spectrum weighted UV in the US and Canada are discussed.

Identification of a circulating soluble form of CD80: levels in patients with hematological malignancies.

The release of soluble forms of CD80 provides a potentially powerful mechanism for the modulation of anti-tumor responses. In this report we investigated whether a soluble form of CD80 (sCD80) circulates in vivo and whether levels are altered in patients with hematological malignancies. Circulating sCD80 was detected by ELISA in all normal donor (0.024-0.318 ng/ml) and patient (0.02-3.75 ng/ml) blood analyzed. The majority of acute myeloid leukemia (13/17) and multiple myeloma (11/12) patients had normal sCD80 levels. Significantly elevated levels were detected in chronic lymphocytic leukemia (CLL, P = 0.0001) and mantle cell lymphoma (MCL, P = 0.0002) patients. MCL patients had the highest levels with 8/9 having levels > 0.318 ng/ml. Increased sCD80 levels in CLL were significantly associated with poor prognosis markers such as low platelet (P = 0.01) and hemoglobin (P = 0.002) levels, elevated WBC counts (P = 0.03) and expression of CD38 (P = 0.048). The immunoreactivity of the sCD80 in both normal and patient plasma was inhibited by the presence of CTLA-4-Ig, suggesting sCD80 is functional. Comparison of sCD80 and soluble CD86 levels demonstrated that these molecules were independently elevated in 39% of patients. The finding that a proportion of CLL and the majority of MCL patients contain elevated levels of sCD80 and the demonstration that sCD80 can interact with CTLA-4-Ig suggests a potential role for sCD80 in modulating anti-tumor responses during the malignant process.

Managing sedation withdrawal in children who undergo prolonged PICU admission after discharge to the ward.

Children who undergo a prolonged stay within the intensive care unit require adequate sedation and analgesia. During the recovery phase there will need to be a period of sedation withdrawal to prevent occurrence of an abstinence syndrome. We present a strategy developed within our hospital for managing this process which uses the resource of the Pain Service, along with guidelines to help prevent the development of withdrawal, and a plan for managing any signs of abstinence which occur.

Behaviors, attitudes, and knowledge of low-income consumers regarding nutrition labels.

This exploratory study interviewed 130 participants in federal food assistance programs and 51 low-income nonparticipants to assess their behaviors and attitudes toward and awareness of the nutrition label. Regarding label use, 35.4 percent of participants and 45.1 percent of nonparticipants seldom/never read labels while grocery shopping, 31.5 percent of participants and 19.6 percent of nonparticipants sometimes read them, and 33.1 percent of participants and 35.3 percent of nonparticipants always/frequently read labels in the grocery store. In addition, 38.5 percent of participants and 41.2 percent of nonparticipants seldom/never read labels at home, 33.1 percent of participants and 27.5 percent of nonparticipants sometimes read them, and 28.5 percent of participants and 31.4 percent of nonparticipants always/frequently read labels at home. There were no significant differences between mean scores of participants and nonparticipants on how to use the nutrition label. Findings challenge nutritionists working with low-income individuals to develop more learning opportunities that teach how to use nutrition labels.

Effects of socioeconomic status on the obesity knowledge of adolescents from six Latin American cities.

OBJECTIVE: To examine the effects of socioeconomic status (SES) on the obesity knowledge of adolescents in six Latin American cities. DESIGN: Data were collected using an anonymous, self-administered questionnaire consisting of demographic questions and a 25-item multiple-choice obesity knowledge test. Test items were clustered under five topics: the fat and calorie content of foods and beverages; weight loss methods; energy expenditure; food preparation methods; and the relationship between obesity and health. SUBJECTS: A total of 1272 ninth grade students from higher and lower SES families were recruited at schools in Buenos Aires, Argentina (n=195); Guatemala City, Guatemala (n=212); Havana, Cuba (n=213); Lima, Peru (n=218); Panama City, Panama (n=195); and Santiago, Chile (n=239). RESULTS: Mean test scores reflected a low level of obesity knowledge among adolescents from higher and lower SES groups in all six cities. Nevertheless, a trend for higher scores emerged in favor of adolescents from wealthier families. This income effect persisted after controlling for gender and weight status. The weakest knowledge areas among youth from the higher SES groups were food preparation methods and the relationship between obesity and health while those for adolescents from the lower SES groups were the fat and calorie content of foods and beverages and the relationship between obesity and health. Classroom instruction about obesity was generally more available to students from the higher SES groups. The majority of adolescents from both SES groups were interested in learning more about weight loss methods, energy expenditure, and the fat and calorie content of foods and beverages. The topic of least interest was the relationship between obesity and health. CONCLUSION: These preliminary findings suggest a need for more obesity education programs for adolescents, especially for those living in poverty.

Dietetics majors' weight-reduction beliefs, behaviors, and information sources.

One hundred twenty-eight female dietetics majors aspiring to be registered dietitians were surveyed to identify and assess their reasons for wanting to lose weight and the weight-loss techniques and information sources they used and would recommend to clients. Fisher's exact tests were used to analyze behavioral data, and binomial tests to determine whether proportions of students achieving their desired weight-loss outcomes were significantly greater than 50%. Most dieters wanted to lose weight to improve their appearance and increase their self-esteem. Sound weight-loss techniques that were used and recommended include increased exercise, low-fat foods and snacks, and portion control. Accurate information sources used and recommended included food labels and college nutrition courses. Unsound weight-loss techniques and potentially inaccurate information sources were also used and would be recommended by a few students. Findings suggest a need for more learning opportunities focusing on enhancement of self-esteem and weight management.

Literacy of women attending family planning clinics in Virginia and reading levels of brochures on HIV prevention.

A study estimating the extent to which the reading level of HIV educational brochures matches the reading ability (measured by educational attainment) of women attending public family planning clinics in Virginia shows that the mean reading level of the brochures sampled is grade 9.9. The educational attainment of 18% of Virginia family planning clients falls below this level. The mean reading level of brochures targeted to adolescents (grade 8.3) and the mean reading level of those targeted to minority women (grade 9.1) are significantly lower than the mean for all sampled brochures. Use of the targeted brochures would improve access to information on HIV prevention for 16% of adolescents and 6% of minority women who attend family planning clinics in Virginia.

PIP: A review of human immunodeficiency virus (HIV) prevention educational materials distributed at Title X-funded family planning clinics in Virginia revealed a poor fit between the reading level of the materials and the literacy level of the intended audiences. The mean reading level of the 112 brochures on HIV analyzed was grade 9.9. The 29 brochures aimed at minority women had a mean reading level of grade 9.1, while the 12 intended for adolescents had a mean level of grade 8.3. The educational level of family planning clients as a group and specific target populations were calculated from data collected on 566 clients at 23 Virginia clinics. This analysis indicated that the educational attainment of 18% of Virginia family planning clients is below that required to read the HIV materials; this equates to a total of 14,500 women. If it is assumed that actual reading level is two grades lower than completed years of schooling, this figure escalates to 39%, or 32,221 women. The proportion of women whose educational attainment equaled or exceeded the reading level of the specially targeted brochures was 6% among minority women and 16% for adolescents. Greater attention to the readability of HIV educational materials is urged.

The role of palatability in the food intake response of rats fed high-protein diets.

Male albino rats, trained to eat over a 3-h period, reduced their food intake from 0.38 +/- 0.04 g of a low-protein diet to 0.14 +/- 0.03 g of a high-protein diet, within 1 min following diet presentation. Since this occurred before the metabolic effects of a high-protein diet should be seen, we suggest that, although neophobia could play a role, poor initial palatability may be a significant factor in this early depression in food intake. To differentiate initial palatability from responses to metabolic feedback, we designed a feeding paradigm using positive or negative taste cues and a 6-h feeding period. Pre-treatment with a 6% casein diet containing 0.15% quinine HCl resulted in near equal consumption of a 75% casein and a 6% casein unadulterated diet during the first 30 min after introduction of the diets. Later, the rate of consumption of the high-protein diet was lower than of the lower-protein diet, likely the result of post-absorptive factors. We suggest that prevention of the early reduction in food intake due to initial palatability may facilitate study of post-absorptive response(s) to high-protein diets.

Learned preference and aversion for complete and isoleucine-devoid diets in rats.

Choice tests using flavored solutions were conducted to demonstrate a learned preference or aversion in rats fed replete (complete) or isoleucine (ILE)-devoid diets. In the first learning trial, rats demonstrated a preference for the flavored solutions paired with the replete diet at 6 and 24 h (p < 0.001), and an aversion for the solutions paired with the ILE-devoid diet at 6 h (p < 0.05). In the second trial, using a different concentration of tastant, rats ingested significantly more of the flavored solution paired with the replete diet at 24 h (11.4 +/- 3.0 g vs. 5.4 +/- 1.0 g, respectively; p < 0.05), and significantly more of a novel flavored solution than of the solution paired with the ILE-devoid diet at 24 h (12.4 +/- 2.4 g vs. 1.7 +/- 0.6 g, respectively; p < 0.001). These results suggest that learning contributes to the rat's ability to self-select diets that promote growth, and that a learning paradigm pairing flavored solutions with complete and indispensible amino acid-devoid diets may be used to demonstrate learned preferences and aversions for such diets in rats.

Effectiveness of a college course focused on evaluation of health claims.

This study measured the effectiveness of a college course designed to instruct students to make critical evaluations of therapeutic claims for foods, nutrient supplements, weight-reduction products and diets, and alternative healthcare systems. Experimental and comparison groups were pretested and posttested to determine changes in source reliance and cognitive learning. The experimental group received instruction in five cognitive areas: (1) health and nutrition quackery, (2) consumer protection, (3) basic concepts in health and nutrition, (4) nutritional supplements and health foods, and (5) conventional and unconventional treatment of chronic diseases. The experimental group scored significantly higher in all five conceptual areas on the posttest, and in each case scored significantly higher than the comparison group did. Both groups rated medical/scientific sources of health and nutrition information as highly accurate during the two survey periods. The experimental group showed a change in source reliance, moving from dependence on the popular print media and individuals without formal education in a health field to medical/scientific sources, whereas the comparison group continued to use the popular press and electronic media. Findings suggest that a source targeted to the needs and interests of a specific group can bring about significant increases in knowledge gain and desirable changes in source reliance.

Learned preference for the limiting amino acid in rats fed a threonine-deficient diet.

Preference for an odor associated with protein is only seen in protein-deprived rats. We hypothesized that rats depleted of the amino acid threonine (THR) would prefer a flavored solution paired with a THR replete diet. Rats were given a flavored drink paired with THR-deficient (DEV) diet followed by a second flavor paired with a corrected (COR) diet. In choice testing, the animals clearly selected the COR-paired flavor, while control rats preferred the other flavor. This did not, however, differentiate between aversion to the DEV-paired flavor and learned preference for the COR-paired flavor. In subsequent tests, an unpaired flavor was given rather than the DEV-paired flavor. The COR-paired flavor was included in the test as before. In the second and third trials, using either DEV or a less profoundly deficient diet, animals depleted of THR selected the COR-paired flavor to a greater extent than control rats. We conclude that animals deficient in the essential amino acid, THR, show a learned preference for the flavor paired with repletion.