Reflections of Medical Students on Visiting Chronically Ill Older Patients in the Home

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66114/1/j.1532-5415.2006.00918.x.pd

A Genome-Wide Association Study of Diabetic Kidney Disease in Subjects With Type 2 Diabetes

dentification of sequence variants robustly associated with predisposition to diabetic kidney disease (DKD) has the potential to provide insights into the pathophysiological mechanisms responsible. We conducted a genome-wide association study (GWAS) of DKD in type 2 diabetes (T2D) using eight complementary dichotomous and quantitative DKD phenotypes: the principal dichotomous analysis involved 5,717 T2D subjects, 3,345 with DKD. Promising association signals were evaluated in up to 26,827 subjects with T2D (12,710 with DKD). A combined T1D+T2D GWAS was performed using complementary data available for subjects with T1D, which, with replication samples, involved up to 40,340 subjects with diabetes (18,582 with DKD). Analysis of specific DKD phenotypes identified a novel signal near GABRR1 (rs9942471, P = 4.5 x 10(-8)) associated with microalbuminuria in European T2D case subjects. However, no replication of this signal was observed in Asian subjects with T2D or in the equivalent T1D analysis. There was only limited support, in this substantially enlarged analysis, for association at previously reported DKD signals, except for those at UMOD and PRKAG2, both associated with estimated glomerular filtration rate. We conclude that, despite challenges in addressing phenotypic heterogeneity, access to increased sample sizes will continue to provide more robust inference regarding risk variant discovery for DKD.Peer reviewe

Overview of Nitrate in Nebraska\u27s Ground Water

The primary concern over nitrate in ground water is the occurrence of a disease called methemoglobinemia in human infants who drink water containing the nitrate ion. Nitrate contaminated water leads to lack of oxygen in the blood, causing oxygen starvation of the brain and, in some severe cases, death. Infant farm animals, particularly piglets, are similarly affected by nitrate. Two areas exist in Nebraska where nitrate contamination of ground water is becoming a serious problem. These problem areas are in Holt County and the Central Platte region. Most nitrate contamination is related to excessive application of commercial fertilizer on irrigated cropland with sandy topsoil and a shallow ground water table. Excess irrigation water dissolves the highly soluble nitrate ion, which results from the fertilizer, and the solution moves down to the ground water table. Although several treatment processes to remove nitrate, including reverse osmosis, electrodialysis, and ion exchange, have been studied, none has proven economically feasible to use on a large scale. Instead, some communities with nitrate contaminated wells are replacing contaminated wells with new wells pumping non-contaminated water. On a smaller scale, some rural people with contaminated wells are using small home distillation units to provide nitrate-free water

Mild cognitive dysfunction of caregivers and its association with care recipients' end-of-life plans and preferences.

Little is known about the association between cognitive dysfunction among informal caregivers and patients' plans and preferences for patients' end of life care. We report on the frequency of cognitive dysfunction among both patients and caregivers and examine associations between caregivers' cognitive screening scores and end of life plans and preferences of patients with advanced cancer. The current sample was derived from a National Cancer Institute- and National Institute of Mental Health-funded study of patients with distant metastasis who had disease progression on at least first-line chemotherapy, and their informal caregivers (n = 550 pairs). The Pfeiffer Short Portable Mental Status, a validated cognitive screen, was administered to patients and caregivers. Patients were interviewed about their end of life plans and preferences. Logistic regression models regressed patients' advance care planning and treatment preferences on caregivers' cognitive screen scores. Patients' cognitive screen scores were included as covariates. Most caregivers (55%) were spouses. Almost 30% of patients scored worse on the cognitive screen than their caregivers and 12% of caregivers scored worse than the patients. For each additional error that caregivers made on the cognitive screen, patients were more likely (AOR = 1.59, p = 0.002) to report that they preferred that everything possible be done to keep them alive and were less likely (AOR = 0.75, p = 0.04) to have a living will or a health care proxy/durable power of attorney. Worse caregiver cognitive screening scores were associated with higher likelihood of patients' reporting that they wanted everything done to save their lives and a lower likelihood of having a living will or other type of advanced care plan. Future studies should confirm these findings in other populations and determine the mechanisms that may underlie the identified relationships