Influence of graphic format on comprehension of risk information among American Indians.

BACKGROUND: Presentation of risk information influences patients' ability to interpret health care options. Little is known about this relationship between risk presentation and interpretation among American Indians. METHODS: Three hundred American Indian employees on a western American Indian reservation were invited to complete an anonymous written survey. All surveys included a vignette presenting baseline risk information about a hypothetical cancer and possible benefits of 2 prevention plans. Risk interpretation was assessed by correct answers to 3 questions evaluating the risk reduction associated with the plans. Numeric information was the same in all surveys, but framing varied; half expressed prevention benefits in terms of relative risk reduction and half in terms of absolute risk reduction. All surveys used text to describe the benefits of the 2 plans, but half included a graphic image. Surveys were distributed randomly. Responses were analyzed using binary logistic regression with the robust variance estimator to account for clustering of outcomes within participant. RESULTS: Use of a graphic image was associated with higher odds of correctly answering 3 risk interpretation questions (odds ratio = 2.5, 95% confidence interval = 1.5-4.0, P < 0.001) compared to the text-only format. These findings were similar to those of previous studies carried out in the general population. Neither framing information as relative compared to absolute risk nor the interaction between graphic image and relative risk presentation was associated with risk interpretation. CONCLUSION: One type of graphic image was associated with increased understanding of risk in a small sample of American Indian adults. The authors recommend further investigation of the effectiveness of other types of graphic displays for conveying health risk information to this population.

Fas and Fas-associated death domain protein regulate monocyte chemoattractant protein-1 expression by human smooth muscle cells through caspase- and calpain-dependent release of interleukin-1alpha.

We previously reported that treatment of human vascular smooth muscle cells (SMCs) with proapoptotic stimuli, including Fas ligand plus cycloheximide (FasL/Chx), or overexpression of Fas-associated death domain protein (FADD) result in increased expression of monocyte chemoattractant protein-1 (MCP-1) and other proinflammatory genes. In this study, we demonstrate that Fas/FADD-induced MCP-1 upregulation is driven by an autocrine/paracrine signaling loop in which interleukin (IL)-1alpha synthesis and release are activated through caspase- and calpain-dependent processes. Untreated SMCs contain very little IL-1alpha protein or transcript. Both were increased greatly in response to Fas/FADD activation, primarily through an autocrine/paracrine pathway in which secreted IL-1alpha stimulated additional IL-1alpha synthesis and release. Caspase 8 (Csp8) activity increased in response to FasL/Chx treatment, and Csp8 inhibitors markedly reduced IL-1alpha release and MCP-1 upregulation. In contrast, Csp8 activity was not significantly increased in response to FADD overexpression and caspase inhibitors did not effect FADD-induced MCP-1 upregulation. Both FasL/Chx treatment and FADD overexpression increased the activity of calpains. Calpain inhibitors reduced IL-1alpha release and MCP-1 upregulation in both FADD-overexpressing SMCs and FasL/Chx-treated SMCs without blocking Csp8 activity. This indicates that calpains are not required for activation of caspases and that caspase activation is not sufficient for IL-1alpha release and MCP-1 upregulation. These data suggest that calpains play a dominant role in Fas/FADD-induced IL-1alpha release and MCP-1 upregulation and that caspase activation may function to amplify the effects of calpain activation.