Disruption of IL-17-mediated immunosurveillance in the respiratory mucosa results in invasive Streptococcus pyogenes infection.

Introduction: Streptococcus pyogenes is a Gram-positive pathogen that causes a significant global burden of skin pyoderma and pharyngitis. In some cases, infection can lead to severe invasive streptococcal diseases. Previous studies have shown that IL-17 deficiency in mice (IL-17-/-) can reduce S. pyogenes clearance from the mucosal surfaces. However, the effect of IL-17 on the development of severe invasive streptococcal disease has not yet been assessed. Methods: Here, we modeled single or repeated non-lethal intranasal (IN) S. pyogenes M1 strain infections in immunocompetent and IL-17-/- mice to assess bacterial colonization following a final IN or skin challenge. Results: Immunocompetent mice that received a single S. pyogenes infection showed long-lasting immunity to subsequent IN infection, and no bacteria were detected in the lymph nodes or spleens. However, in the absence of IL-17, a single IN infection resulted in dissemination of S. pyogenes to the lymphoid organs, which was accentuated by repeated IN infections. In contrast to what was observed in the respiratory mucosa, skin immunity did not correlate with the systemic levels of IL-17. Instead, it was found to be associated with the activation of germinal center responses and accumulation of neutrophils in the spleen. Discussion: Our results demonstrated that IL-17 plays a critical role in preventing invasive disease following S. pyogenes infection of the respiratory tract.

Using clinical guidelines to assess the potential value of laboratory medicine in clinical decision-making.

INTRODUCTION: It is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking. Since clinical guidelines aim to document best-practice decision making for specific disease conditions, inclusion of any laboratory test means that the best available evidence is recommending clinicians use it. Cardiovascular disease (CVD) is the world's most common cause of mortality, so this study reviewed all CVD guidelines published by five national/international authorities to determine what proportion of them recommended laboratory testing. MATERIALS AND METHODS: Five leading CVD guidelines were examined, namely the European Society of Cardiology (ESC), the UK National Institute for Health and Clinical Excellence (NICE), the American College of Cardiology (ACC), the Australian Heart Foundation (AHF) and the Cardiac Society of Australia and New Zealand (CSANZ). RESULTS: A total of 101 guidelines were reviewed. Of the 33 individual ESC guidelines relating to CVD, 24/33 made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment. The same applied to 15/20 of NICE guidelines, 24/32 from the ACC and 15/16 from the AHF/CSANZ. Renal function and blood count testing were the most recommended (39 and 26 times), with lipid, troponin and natriuretic peptide measurement advocated 25, 19 and 19 times respectively. CONCLUSIONS: This study has shown that laboratory testing is advocated by between 73% and 94% of individual CVD guideline recommendations from five national/international authorities. This provides an index to assess the potential value of laboratory medicine to healthcare.

Supportive care for older people with frailty in hospital: An integrative review.

BACKGROUND: Growing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care. AIM: To identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation. DESIGN: An integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term 'supportive care'. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken. DATA SOURCES: Literature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n=52) were integrated using synthesis of themes. RESULTS: Relevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings. CONCLUSION: The findings and model developed here will inform future interventions and can help staff and hospital managers to develop appropriate strategies, staff training and resource allocation models to improve the quality of health care for older people.

Self-rated health and associated factors among older people living alone in Shanghai.

AIM: Self-rated health is a reliable and important health measure related to older people's mortality and quality of life. Few studies regarding the self-rated health of older people living alone have been carried out in Mainland China. The present study aimed to investigate the self-rated health of older people living alone in Shanghai and its associated factors. METHODS: A stratified random cluster sample of 521 community-dwelling older people living alone in Shanghai completed structured questionnaires through face-to-face interviews. The data collected included self-rated health, physical health, depression, functional ability, physical activity, health services satisfaction, loneliness, social support and sociodemographic variables. RESULTS: More than two-fifths of the participants (43.2%) reported good self-rated health. Multinomial logistic regression analyses found that chronic disease, acute disease, functional ability, satisfaction with health services, depression and age were predictors of self-rated health. CONCLUSIONS: Identifying factors associated with the self-rated health of older people living alone could inform the delivery of appropriate health and social care interventions to promote older people's health.

Loneliness and social support of older people living alone in a county of Shanghai, China.

China has an ageing population with the number of older people living alone increasing. Living alone may increase the risk of loneliness of older people, especially for those in China where collectivism and filial piety are emphasised. Social support may fill the need for social contacts, thereby alleviating loneliness. However, little is known about loneliness and social support of older people living alone in China. This study investigated loneliness and social support of older people living alone, by conducting a cross-sectional questionnaire survey with a stratified random cluster sample of 521 community-dwelling older people living alone in a county of Shanghai. Data were collected from November 2011 to March 2012. The instruments used included the UCLA Loneliness Scale version 3 and the Social Support Rate Scale. The participants reported a moderate level of loneliness. Their overall social support level was low compared with the Chinese norm. Children were the major source of objective and subjective support. Of the participants, 53.9% (n = 281) and 47.6% (n = 248) asked for help and confided when they were in trouble, but 84.1% (n = 438) never or rarely attended social activities. The level of loneliness and social support differed among the participants with different sociodemographic characteristics. There were negative correlations between loneliness and overall social support and its three dimensions. The findings suggest that there is a need to provide more social support to older people living alone to decrease their feelings of loneliness. Potential interventions include encouraging more frequent contacts from children, the development of one-to-one 'befriending' and group activity programmes together with identification of vulnerable subgroups.

Loneliness and social support of older people in China: a systematic literature review.

Loneliness is a serious problem for older people, which can be alleviated by social support. The dramatic population ageing together with social and economic change in China increases the likelihood of loneliness and the availability of different sources of social support of older people. The aim of this review was to identify the prevalence of loneliness and its related factors and sources of social support of older people in China. Electronic literature searches were conducted in September 2011 using Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Twenty-six papers were identified and reviewed. The prevalence of loneliness varied across the studies, reflecting the different measurements and samples. Marital status, gender, age, educational level, economic level, living arrangements, health status and social support were significant factors related to loneliness. The family was the most important source of social support followed by friends. The receipt of family support improved subjective well-being and mental health, but the effects of support from friends were inconsistent. Chinese older people received relatively little support from neighbours, governmental or other social organisations. Further well-designed studies are needed to identify additional factors related to loneliness and to understand the support from friends, neighbours, formal organisations and other sources.

Validity and reliability of the modified Chinese version of the Older People's Quality of Life Questionnaire (OPQOL) in older people living alone in China.

AIMS AND OBJECTIVES: This study aimed to test the validity and reliability of a modified Chinese version of the OPQOL among older people living alone in China. BACKGROUND: China has an ageing population with an increasing number of older people living alone who may have a poorer quality of life (QoL) in the light of the traditional culture of collectivism and filial piety. An appropriate instrument is important to assess their QoL. The Older People's Quality of Life Questionnaire (OPQOL) was developed directly from the views of older people and has been validated in England. There has been no psychometric evaluation of the scale in China. METHODS: The OPQOL was translated and modified prior to being administered to a stratified random cluster sample of 521 older people living alone. Validity was assessed through convergent validity, discriminant validity and construct validity. Reliability was assessed through internal consistency and test-retest reliability. RESULTS: Exploratory factor analysis indicated eight factors accounting for 63.77% of the variance. The convergent validity was supported by moderate correlations with functional ability, social support and loneliness with Spearman's rho of -0.50, 0.49 and -0.53, respectively. The discriminant validity was confirmed by differentiating QoL scores between the depressed and non-depressed groups. The Cronbach's α coefficient was 0.90 for the total scale and over 0.70 for most of its dimensions. The 2-week test-retest reliability ranged from 0.53 to 0.87. CONCLUSIONS: The modified Chinese version of the Older People's Quality of Life has acceptable validity and reliability as a useful instrument to measure the QoL of older people living alone in China.

Quality of life and related factors: a questionnaire survey of older people living alone in Mainland China.

PURPOSE: There is a growing population of older people living alone within the context of dramatic population ageing and changing living arrangements. However, little is known about the quality of life (QoL) of older people living alone in Mainland China. This study aimed to investigate QoL and its related factors among Chinese older people who live alone. METHODS: A stratified random cluster sample of 521 community-dwelling older people living alone in Shanghai completed a structured questionnaire through face-to-face interviews. QoL was measured using the Older People's Quality of Life Questionnaire. Other data collected included self-rated health, physical health, cognitive function, depression, functional ability, loneliness, social support, physical activity, health services satisfaction, satisfaction with overall dwelling conditions and socio-demographic variables. RESULTS: Older people living alone in Mainland China rated social relationships and financial circumstances as sources of low satisfaction within their QoL. Multiway analysis of variance showed that satisfaction with overall dwelling conditions, self-rated health, functional ability, depression, economic level, social support, loneliness, previous occupation and health services satisfaction were independently related to QoL, accounting for 68.8% of the variance. Depression and previous occupation had an interaction effect upon QoL. CONCLUSIONS: This study identified nine factors influencing the QoL of older people living alone in Mainland China. Interventions to increase satisfaction with dwelling conditions, improve economic level, social support and functional ability, decrease loneliness and depression and improve health services satisfaction appear to be important for enhancing their QoL.

The nurse's role in closing the diagnostic gap for people with dementia.

Inequalities in health-care access exist for people with dementia (PWD), as reflected in regional, national and international variations in diagnostic rates. This article considers three overlapping themes that emerged from a literature search on the subject: GP competencies, confidence and belief systems; lack of awareness of dementia and different belief systems among carers; and the context of primary health care. These three themes support policy drivers on perceived barriers to achieving a diagnosis of dementia. The context of primary health care, with GPs often regarded as the first point of contact for PWD and their carers, further inhibits inclusive and equitable access to health care for all. Nurses work at the interface between the community and PWD, and are well placed to identify subtle changes during the early stage of dementia. Due to a rising ageing population, the context of primary care needs to change, utilising nurses' roles within public health and secondary prevention.