The relationship between hiv duration, insulin resistance and diabetes risk

The risk of developing Type 2 Diabetes Mellitus in people living with HIV (PLWH) can be four times greater and can occur at an earlier age and even without the presence of obesity compared to those without HIV. Therefore, the purpose of this analytical cross-sectional study was to determine the relationship between HIV duration and glucose metabolism among PLWH. Eighty-two PLWH were categorized into shorter (≤15 years) or longer HIV duration (≥16 years) and then compared for differences in demographics, physical and clinical characteristics, biomarkers, and dietary intake. Compared to those with shorter HIV duration (n = 34), those with longer HIV duration (n = 48) were on average older (p = 0.02), reported lower consumption of alcohol (p = 0.05), had higher levels of homeostasis model assessment of insulin resistance (HOMA-IR, p = 0.02), were also more likely to be a woman (p = 0.06), and have higher levels of fasting insulin (p = 0.06). When adjusted for age and body weight, the levels of HOMA-IR and fasting insulin were higher (p = 0.02 and p = 0.04) with longer compared to shorter HIV duration, respectively. Longer exposure to HIV infection is associated with impaired insulin sensitivity. Continuing research aimed at the long-term effects of HIV infection and (antiretroviral therapy) is required

A cross-sectional assessment of metabolic syndrome in HIV-infected people of low socioeconomic status receiving antiretroviral therapy

BACKGROUND: Metabolic syndrome (MetS) is a constellation of symptoms used as a measure to identify patients at increased risk for cardiovascular disease, type 2 diabetes, and all-cause mortality. The results of prolonged life expectancy and cumulative toxic effects of antiretroviral therapy increase the chance that HIV can cause clinical abnormalities, including MetS. METHODS: We evaluated 89 people living with HIV (PLWH; mean age 48 ± 7 years; mean duration of HIV infection 17 ± 12 years; 47% men; 66% African-American, 22% Hispanic, and 10% non-Hispanic white; and 84% unemployed) enrolled in a community-based exercise training and nutrition education program targeting individuals of low socio-economic status (SES). The prevalence of MetS characteristics and the factors associated with the presence of MetS were analyzed. RESULTS: One in three (33%; 12 men and 17 women) PLWH met ATPIII criteria for MetS. In our cohort, MetS was driven by high waist circumference and elevated blood pressure. In addition, higher use of protease inhibitors, elevated hemoglobin A1c (HbA1c), greater self-reported daily caloric intake and consumption of carbohydrates, sugar, added sugar, and higher glycemic load were found among the individuals with MetS, compared to those without it. Elevated HbA1c and high total sugar consumption were the strongest predictors and accounted for 30% of the occurrence of MetS. CONCLUSIONS: The overall prevalence of MetS in our PLWH cohort receiving antiretroviral therapy is higher than previously reported in the general population and in other PLWH cohorts. Additional work is needed to determine whether MetS is a more disease dependent or lifestyle dependent condition in PLWH

A double-blind, randomized clinical trial of dietary supplementation on cognitive and immune functioning in healthy older adults

BACKGROUND: Declining cognitive function is relatively common and increasingly prevalent. Studies have shown that different nutrients (e.g., Ginkgo biloba and vitamin E) appear to be effective at improving memory and concentration, while less is known about their effect on immunity. METHODS: This study investigated the effect of Ginkgo Synergy® plus Choline (n = 33) and OPC Synergy® plus Catalyn® (n = 31) versus placebo (n = 33) in a 6-month, randomized, double-blind trial on cognitive and immune functioning among English-speaking, non-smoking, healthy older adults. The Stroop Color and Word Test, Trail Making Test A and B, Controlled Oral Word Association, Hopkins Verbal Learning, Mini-Mental State Exam, and Digit Symbol were administered at baseline and 3 and 6 months follow-up to assess cognitive functioning. Cytokines and growth factors were measured at baseline and 6 months to assess inflammation and immune functioning. Data were analyzed with linear mixed modeling. RESULTS: No serious adverse events were noted in this study. According to time on the Trail Making Test-B, the Ginkgo Synergy® plus Choline arm showed improvement from baseline to 3 months follow-up (mean difference = 24.2; SE = 6.4; 95% CI: 8.6, 39.7; p = 0.01). On the Controlled Oral Word Association Trial-S, the scores significantly increased for the Ginkgo Synergy® plus Choline arm from baseline to 6 months follow-up (mean difference = 2.1; SE = 0.8; 95% CI: 0.2, 3.9; p < 0.05) and for the OPC Synergy® plus Catalyn® arm from baseline to 3 months follow-up (mean difference = 2.1; SE = 0.8; 95% CI: 0.2, 4.0; p < 0.05). Epidermal growth factor significantly decreased from baseline to 6 months follow-up for the Ginkgo Synergy® plus Choline arm (mean difference = 120.7; SE = 28.4; 95% CI: 62.6, 178.8; p < 0.001). CONCLUSIONS: Our study showed isolated and modest effects of a Ginkgo biloba plus choline-based formula on cognitive and immune functioning among healthy older adults with no history of significant cognitive deficits. Our trial was registered with clinicaltrials.gov (ID: NCT01672359). This study was supported by a grant from Standard Process, Inc

The challenge of educating physicians about complementary and alternative medicine

The rapid growth of complementary/alternative medicine (CAM) predated both the 1992 establishment of the Office of Alternative Medicine at the National Institutes of Health and the release of Dr. David Eisenberg's 1993 groundbreaking article on the widespread use of CAM. Since these two watershed events, the use of nontraditional medical modalities has seen exponential expansion. Most physicians are not prepared to respond knowledgeably about CAM modalities, and, indeed, sorting out the viable CAM modalities can be a difficult task. Additional factors are poor and inadequate dialogue between physicians and CAM practitioners, doubts about CAM practitioners' competence, a lack of readily identifiable and recognizable qualifications of such practitioners, and the risk of offering unrealistic hope of a cure. All these factors place the patient in a sometimes perilously uncertain position. Incorporating systematic presentation of CAM information into the curricula of medical schools would provide future physicians the necessary tools and knowledge to enable their patients to use CAM modalities appropriately, with limited risks

A Case Study Analysis Of The Relationship Between A University Supervisor And Student Teachers

The purpose of this study was to identify the role of a University supervisor as it related to the needs and problems of a specific group of teachers. The university supervisor-student teacher relationship was examined by several methods: participant observation with the collection of nonobtrusive data, formal interviews, and content analysis of written assignments.A detailed coding system, the Feedback Analysis System, was developed to monitor the content of the written comments of the university supervisor on the student teachers\u27 weekly papers. An overall feedback pattern was determined, and differences among the students with respect to this pattern proved to be statistically significant. More than half the feedback was information-giving and more than half was supportive in nature. The changes in the way the student teachers wrote their last papers and the contents of those papers compared with their first papers indicated that the supervisor\u27s feedback may have had an influencing affect on the student teachers behavior, if only their writing behavior.A simplified coding system, the Content Analysis System for Self-Image, for the content of first and final weekly reaction papers was also developed. The assignment for the first and final paper was the same, Discuss your self-image as a classroom teacher including your strengths and areas in need of improvement. This simplified coding system for what the student teachers wrote showed the student teachers listing more strengths in the final set of papers than in the first set of papers. It also showed that the student teachers listed fewer human relation skills as needing improvement in the final set of papers than in the first set of papers. The supervisor\u27s feedback showed significant change from the first set of papers to the last. The supervisor gave fewer directives, asked fewer questions, made fewer uncertain statements, and was less supportive than expected in the last set of papers. The content analysis of the student teachers\u27 papers and the university supervisor\u27s written feedback demonstrated measurable changes over the course of the student teaching experience.The student teachers displayed anxious behavior in the beginning of their student teaching and recognized this behavior in their poststudent teaching interview. They described their relationship with the university supervisor as significant, supportive, comfortable, and one where constructive criticism was given. They felt they had increased in self-confidence and personal growth. They also said that the seminar was an important aspect of their academic and personal growth.This study demonstrated that the university supervisor-student teacher relationship was an important factor in the student teaching experience and that the amount and type of feedback given to the students by the supervisor was important. The reduced anxiety, personal growth and increased confidence felt by the students seemed to be directly related to their interaction with the supervisor

Social Anxiety and Training in Neurolinguistic Programming

The Liebowitz Social Phobia Scale measured the effect of training on social anxiety responses of 28 adults prior to and following a 21-day residential training, and at 6 mo. follow-up. Significant reductions posttraining and at follow-up were evident in the mean self-reported global scale scores on fear and avoidance behavior in social situations. The item scores, aggregated to reflect the situational domains of formal and informal speaking, being observed by others, and assertion, showed significant and continuing reduction from posttraining through follow-up. These findings are consistent with the hypothesis that this training may be associated with reduced responses to social anxiety, but as there was no formal control group, pretest scores from another study were used. Interpretation is limited

The Impact of the Addition of an Acupuncture Treatment Program to an Existing Metro-Dade County Outpatient Substance Abuse Treatment Facility

There are several varieties of treatment facilities and modalities for dealing with substance abuse. In this study, the addition of acupuncture treatments to the usual care program at an existing county-based substance abuse treatment clinic was tested. Men and women who voluntarily attended the clinic or who were remanded by the court to attend were randomized to receive usual care, usual care plus frequent urine testing, or usual care plus frequent urine testing and acupuncture treatments. Clients who received acupuncture treatments in addition to the usual care and frequent urine testing became clean (as measured by negative urine tests) in 57% of the time required for the frequent urine testing group. Difficulties experienced included low counselor compliance with the protocol and a high drop-out rate, indicating that further research is necessary; however, this study demonstrates that acupuncture can be a feasible and effective addition to existing drug treatment programs