Sleep Disturbances and Glucose Metabolism in Older Adults: The Cardiovascular Health Study.

ObjectiveWe examined the associations of symptoms of sleep-disordered breathing (SDB), which was defined as loud snoring, stopping breathing for a while during sleep, and daytime sleepiness, and insomnia with glucose metabolism and incident type 2 diabetes in older adults.Research design and methodsBetween 1989 and 1993, the Cardiovascular Health Study recruited 5,888 participants ≥65 years of age from four U.S. communities. Participants reported SDB and insomnia symptoms yearly through 1989-1994. In 1989-1990, participants underwent an oral glucose tolerance test, from which insulin secretion and insulin sensitivity were estimated. Fasting glucose levels were measured in 1989-1990 and again in 1992-1993, 1994-1995, 1996-1997, and 1998-1999, and medication use was ascertained yearly. We determined the cross-sectional associations of sleep symptoms with fasting glucose levels, 2-h glucose levels, insulin sensitivity, and insulin secretion using generalized estimated equations and linear regression models. We determined the associations of updated and averaged sleep symptoms with incident diabetes in Cox proportional hazards models. We adjusted for sociodemographics, lifestyle factors, and medical history.ResultsObserved apnea, snoring, and daytime sleepiness were associated with higher fasting glucose levels, higher 2-h glucose levels, lower insulin sensitivity, and higher insulin secretion. The risk of the development of type 2 diabetes was positively associated with observed apnea (hazard ratio [HR] 1.84 [95% CI 1.19-2.86]), snoring (HR 1.27 [95% CI 0.95-1.71]), and daytime sleepiness (HR 1.54 [95% CI 1.13-2.12]). In contrast, we did not find consistent associations between insomnia symptoms and glucose metabolism or incident type 2 diabetes.ConclusionsEasily collected symptoms of SDB are strongly associated with insulin resistance and the incidence of type 2 diabetes in older adults. Monitoring glucose metabolism in such patients may prove useful in identifying candidates for lifestyle or pharmacological therapy. Further studies are needed to determine whether insomnia symptoms affect the risk of diabetes in younger adults

Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries

PMCID: PMC3570554This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Basic Body Awareness Therapy versus standard care in hip osteoarthritis. A randomized controlled trial

Background Compensational movement patterns in hip osteoarthritis (HOA) are associated with hip dysfunction. Basic Body Awareness Therapy (BBAT) promotes functional movement quality and might, accordingly, be beneficial in HOA. Objective To examine the outcomes of BBAT compared to standard care in people with HOA after first receiving patient education (PE). Study Design A prospective, assessor-blinded, and block-randomized controlled trial. Methods Community-living adults with HOA participating in PE were randomly allocated to an intervention group receiving BBAT in groups (12 sessions offered once a week), or a comparison group. Data at baseline (pretest) and at 6 months (posttest) were analyzed. Primary outcomes were pain during walking assessed by the Numeric Rating Scale (NRS) and function by the Hip Osteoarthritis Outcome Score, subscale ADL (HOOS A). Secondary outcomes addressed physical capacity, movement quality, and self-reported aspects of function and health. Results At pretest, there were no significant differences in demographic and test data between the intervention (n = 51) and the comparison (n = 50) group. Forty-one intervention and 45 comparison participants completed the posttest. At posttest, no significant differences in change between groups were found on NRS (p = 0.694, effect size (ES) = 0.02) or HOOS A (p = 0.783, ES = 0.07). Among secondary outcomes, movement quality improved significantly more (p < 0.001, ES = 0.84) in the intervention group. Compliance with BBAT varied substantially. Per-protocol analysis showed changes in favor of the intervention group for self-efficacy (p = 0.049, ES = 0.36), health (p = 0.037, ES = 0.44), and function (p = 0.029, ES = 0.53) when only intervention participants who completed at least 10 sessions of BBAT were included. Conclusions BBAT was not found to be a more effective treatment modality than self-initiated standard care to reduce pain during walking and improve daily functioning in people with HOA. Movement quality was significantly more improved in participants receiving BBAT, and improvement in other health aspects was associated with sufficient therapy compliance.publishedVersio

Annotated bibliography on the role of foliage-feeding insects in the forest ecosystem

This bibliography, an apparently haphazard sampling of literature from many sources, grew out of a general project that was intended to elucidate the role of consumers in the forest system. The 124 articles briefly abstracted here are ones that give some insight into the role of foliage-feeding insects. The process of consumption and its effect on the forest were explored most thoroughly. This is by no means a complete listing; however, some review articles are cited that will provide an in-depth look into a few specialized subjects. I had three objectives in this search of the literature: (1) to locate materials relevant to the impact or role of foliage-feeding insects in the forest system, (2) to aid in forming concepts of possible control functions exerted by these insects, and (3) to find information necessary for building energy-flow models. Literature strictly related to the stated objectives was scarce. Closely allied fields also were explored and articles containing data, models, and background information on insects in other systems are included in the bibliography. Population models are not included, because some good bibliographies already list them. Originally, the direct impact of insects on forest trees was the subject for the literature search, but the subject was expanded as more facets of the role of foliage-feeding insects became apparent. The topic was expanded to include (1) the gross observed impact of defoliation and (2) aspects of tree physiology that could be affected by insects, but where insects are not directly considered. Because the process of consumption was an important focal point, literature on factors that affect consumption rates--such as feeding stimulation, assimilation efficiency, ability to locate food, nutritional requirements, and food quality--also were explored. Insect energetics and environmental effects on physiological processes were included in the literature search to aid in the formulation of energy-flow models. I hope this bibliography will serve, not just as a listing, but as a stimulant to a greater expansion of the topics explored. Each article included here has been abstracted briefly and given a set of key words. Some articles were of interest mainly because they contained relevant data. How these data were related is included in the abstract. A sampling of the table headings gives the gist of the contents. Articles with background material for concepts may have only topics of discussion listed. Key ideas were given when these could be expressed briefly. Many articles contain much more information than is indicated by the abstract or key word set. Inclusion of articles and of specific information within their abstracts was at the discretion of the reviewer with, presumably, the rational objectives in mind

The Huntington's disease mutation impairs Huntingtin's role in the transport of NF-κB from the synapse to the nucleus

Expansion of a polyglutamine (polyQ) tract in the Huntingtin (Htt) protein causes Huntington's disease (HD), a fatal inherited neurodegenerative disorder. Loss of the normal function of Htt is thought to be an important pathogenetic component of HD. However, the function of wild-type Htt is not well defined. Htt is thought to be a multifunctional protein that plays distinct roles in several biological processes, including synaptic transmission, intracellular transport and neuronal transcription. Here, we show with biochemical and live cell imaging studies that wild-type Htt stimulates the transport of nuclear factor κ light-chain-enhancer of activated B cells (NF-κB) out of dendritic spines (where NF-κB is activated by excitatory synaptic input) and supports a high level of active NF-κB in neuronal nuclei (where NF-κB stimulates the transcription of target genes). We show that this novel function of Htt is impaired by the polyQ expansion and thus may contribute to the etiology of HD

Consumer modeling status report : round 1

"During the four meetings of the consumer modeling committee, discussion centered on the formation of systems models and the problems they will pose for researchers concerned with consumer populations. Two coarse models were developed from these discussions, a compartment model (Figure 1) and a process model (Figure 2). The compartments are defined along functional trophic lines with materials or energy, or both, flowing between them. The process model is used to define the processes that govern the rate of flow between compartments."--P. 1