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1.
Artigo em Inglês | MEDLINE | ID: mdl-34364999

RESUMO

BACKGROUND & AIMS: Dietary modification is common in patients with digestive diseases to improve symptoms; however, food avoidance can become problematic. Avoidant Restrictive Food Intake Disorder (ARFID) is characterized as failure to meet one's nutritional needs owing to sensory hypersensitivity, lack of interest in eating, or fear of aversive consequences from eating, and is associated with negative medical and psychosocial outcomes. This study characterizes ARFID behaviors in adults with achalasia, celiac sprue, eosinophilic esophagitis, and inflammatory bowel disease. METHODS: In this cross-sectional study, 289 adults aged 18 and older completed self-report measures evaluating use of dietary treatment, ARFID symptoms, and psychosocial outcomes. Primary analyses investigated the occurrence of ARFID in patients with achalasia, celiac, eosinophilic esophagitis, and inflammatory bowel disease. Secondary analyses explored the associations between ARFID symptoms and clinical and psychosocial outcomes. RESULTS: More than half (53.7%) of the total sample met the diagnostic criteria for ARFID based on the Nine-Item ARFID Screen (NIAS), with 78.4% of patients with achalasia meeting criteria. Patients on a physician-directed diet showed greater fear of gastrointestinal symptoms (P = .025), less interest in food (P = .046), and a higher total NIAS score (P = .045). For patients using dietary therapy, those who had met with a dietitian reported higher NIAS scores (P = .039). Food avoidance/restriction was associated with increased anxiety and depression, and diminished health-related quality of life. CONCLUSIONS: It is likely that ARFID rates, as measured by the NIAS, are inflated in these 4 patient groups. These findings highlight the need for updated assessments of ARFID in patients with complex digestive diseases.

2.
Nat Commun ; 12(1): 2291, 2021 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863895

RESUMO

Plants need to protect themselves from excess light, which causes photo-oxidative damage and lowers the efficiency of photosynthesis. Photosystem II subunit S (PsbS) is a pH sensor protein that plays a crucial role in plant photoprotection by detecting thylakoid lumen acidification in excess light conditions via two lumen-faced glutamates. However, how PsbS is activated under low-pH conditions is unknown. To reveal the molecular response of PsbS to low pH, here we perform an NMR, FTIR and 2DIR spectroscopic analysis of Physcomitrella patens PsbS and of the E176Q mutant in which an active glutamate has been replaced. The PsbS response mechanism at low pH involves the concerted action of repositioning of a short amphipathic helix containing E176 facing the lumen and folding of the luminal loop fragment adjacent to E71 to a 310-helix, providing clear evidence of a conformational pH switch. We propose that this concerted mechanism is a shared motif of proteins of the light-harvesting family that may control thylakoid inter-protein interactions driving photoregulatory responses.


Assuntos
Adaptação Fisiológica , Bryopsida/fisiologia , Luz/efeitos adversos , Complexo de Proteína do Fotossistema II/metabolismo , Estresse Fisiológico , Bryopsida/efeitos da radiação , Ácido Glutâmico/genética , Concentração de Íons de Hidrogênio/efeitos da radiação , Mutagênese Sítio-Dirigida , Ressonância Magnética Nuclear Biomolecular , Fotossíntese/fisiologia , Complexo de Proteína do Fotossistema II/genética , Complexo de Proteína do Fotossistema II/isolamento & purificação , Complexo de Proteína do Fotossistema II/ultraestrutura , Conformação Proteica em alfa-Hélice , Proteínas Recombinantes/genética , Proteínas Recombinantes/isolamento & purificação , Proteínas Recombinantes/metabolismo , Proteínas Recombinantes/ultraestrutura , Tilacoides/efeitos da radiação
3.
Biophys J ; 120(2): 270-283, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33285116

RESUMO

Photosynthetic light-harvesting complexes (LHCs) of higher plants, moss, and green algae can undergo dynamic conformational transitions, which have been correlated to their ability to adapt to fluctuations in the light environment. Herein, we demonstrate the application of solid-state NMR spectroscopy on native, heterogeneous thylakoid membranes of Chlamydomonas reinhardtii (Cr) and on Cr light-harvesting complex II (LHCII) in thylakoid lipid bilayers to detect LHCII conformational dynamics in its native membrane environment. We show that membrane-reconstituted LHCII contains selective sites that undergo fast, large-amplitude motions, including the phytol tails of two chlorophylls. Protein plasticity is also observed in the N-terminal stromal loop and in protein fragments facing the lumen, involving sites that stabilize the xanthophyll-cycle carotenoid violaxanthin and the two luteins. The results report on the intrinsic flexibility of LHCII pigment-protein complexes in a membrane environment, revealing putative sites for conformational switching. In thylakoid membranes, fast dynamics of protein and pigment sites is significantly reduced, which suggests that in their native organelle membranes, LHCII complexes are locked in specific conformational states.


Assuntos
Chlamydomonas reinhardtii , Tilacoides , Chlamydomonas reinhardtii/metabolismo , Clorofila , Complexos de Proteínas Captadores de Luz/metabolismo , Fotossíntese , Complexo de Proteína do Fotossistema II/metabolismo , Tilacoides/metabolismo
4.
J Health Commun ; 23(12): 1064-1071, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30526400

RESUMO

Health systems and insurers alike are increasingly interested in leveraging mHealth (mobile health) tools to support patient health-related behaviors including medication adherence. However, these tools are not widely used by older patients. This study explores patient preferences for functionality in a smartphone application (app) that supports medication self-management among older adults with multiple chronic conditions. We conducted six discussion groups in Chicago, Miami, and Denver (N = 46). English-speaking older adults (55 and older) who owned smartphones and took five or more prescription medicines were invited to participate. Discussions covered familiarity with and use of current apps and challenges with taking multidrug regimens. Participants reviewed a range of possible mobile app functions and were asked to give feedback regarding the acceptability and desirability of each to support medication management. Very few participants (n = 3) reported current use of a mobile app for medication support, although all were receptive. Challenges to medication use were forgetfulness, fear of adverse events, and managing medication information from multiple sources. Desired features included (1) a list and consolidated schedule of medications, (2) identification and warning of unsafe medication interactions, (3) reminder alerts to take medicine, and (4) the ability record when medications were taken. Features relating to refill ordering, pharmacy information, and comparing costs for medication were not considered to be as important for an app.


Assuntos
Adesão à Medicação , Aplicativos Móveis , Preferência do Paciente , Autogestão/métodos , Idoso , Feminino , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Smartphone
5.
Med Decis Making ; 38(3): 334-343, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29436308

RESUMO

BACKGROUND: Although there has been increasing interest in patient engagement, few measures are publicly available and suitable for patients with limited health literacy. OBJECTIVE: We sought to develop a Consumer Health Activation Index (CHAI) for use among diverse patients. METHODS: Expert opinion, a systematic literature review, focus groups, and cognitive interviews with patients were used to create and revise a potential set of items. Psychometric testing guided by item response theory was then conducted among 301 English-speaking, community-dwelling adults. This included differential item functioning analyses to evaluate item performance across participant health literacy levels. To determine construct validity, CHAI scores were compared to scales measuring similar personality constructs. Associations between the CHAI and physical and mental health established predictive validity. A second study among 9,478 adults was used to confirm CHAI associations with health outcomes. RESULTS: Exploratory factor analyses revealed a single-factor solution with a 10-item scale. The CHAI showed good internal consistency (alpha = 0.81) and moderate test-retest reliability (ICC = 0.53). Reading grade level was found to be at the 6th grade. Moderate to strong correlations were found with similar constructs (Multidimensional Health Locus of Control, r = 0.38, P < 0.001; Conscientiousness, r = 0.41, P < 0.001). Predictive validity was demonstrated through associations with functional health status measures (depression, r = -0.28, P < 0.001; anxiety, r = -0.22, P < 0.001; and physical functioning, r = 0.22, P < 0.001). In the validation sample, the CHAI was significantly associated with self-reported physical and mental health ( r = 0.31 and 0.32 respectively; both P < 0.001). CONCLUSIONS: The CHAI appears to be a valid, reliable, and easily administered tool that can be used to assess health activation among adults, including those with limited health literacy. Future studies should test the tool in actual use and explore further applications.


Assuntos
Indicadores Básicos de Saúde , Autocuidado/instrumentação , Inquéritos e Questionários/normas , Adulto , Idoso , Análise Fatorial , Feminino , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Participação do Paciente , Psicometria , Reprodutibilidade dos Testes
6.
Photosynth Res ; 135(1-3): 227-237, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28646418

RESUMO

We report the application of NMR dynamic spectral editing for probing the structure and dynamics of molecular constituents in fresh, intact cells and in freshly prepared thylakoid membranes of Chlamydomonas reinhardtii (Cr.) green algae. For isotope labeling, wild-type Cr. cells were grown on 13C acetate-enriched minimal medium. 1D 13C J-coupling based and dipolar-based MAS NMR spectra were applied to distinguish 13C resonances of different molecular components. 1D spectra were recorded over a physiological temperature range, and whole-cell spectra were compared to those taken from thylakoid membranes, evaluating their composition and dynamics. A theoretical model for NMR polarization transfer was used to simulate the relative intensities of direct, J-coupling, and dipolar-based polarization from which the degree of lipid segmental order and rotational dynamics of the lipid acyl chains were estimated. We observe that thylakoid lipid signals dominate the lipid spectral profile of whole algae cells, demonstrating that with our novel method, thylakoid membrane characteristics can be detected with atomistic precision inside intact photosynthetic cells. The experimental procedure is rapid and applicable to fresh cell cultures, and could be used as an original approach for detecting chemical profiles, and molecular structure and dynamics of photosynthetic membranes in vivo in functional states.


Assuntos
Chlamydomonas reinhardtii/citologia , Chlamydomonas reinhardtii/metabolismo , Espectroscopia de Ressonância Magnética , Simulação de Dinâmica Molecular , Temperatura , Tilacoides/metabolismo
8.
Sci Rep ; 7(1): 15200, 2017 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-29123155

RESUMO

Plants adapt to fluctuating light conditions by a process called non-photochemical quenching (NPQ), where membrane protein PsbS plays a crucial role and transforms a change in the pH-gradient across the thylakoid membrane under excess light conditions into a photoprotective state, leading to de-excitation of antenna chlorophylls. The PsbS activation mechanism is elusive and has been proposed to involve a monomerization step and protonation of specific residues. To elucidate its function, it is essential to produce PsbS in large quantities, stabilize PsbS in a membrane-mimicking environment and analyze its pH-dependent conformational structure. We present an approach for large-scale in-vitro production and spectroscopic characterization of PsbS under controlled, non-crystalline conditions. We produced PsbS of the moss Physcomitrella patens in milligram quantities in E. coli, refolded PsbS in several detergent types and analyzed its conformation at neutral and low pH by Dynamic Light Scattering and NMR spectroscopy. Our results reveal that at both pH conditions, PsbS exist as dimers or in apparent monomer-dimer equilibria. Lowering of the pH induces conformational changes, destabilizes the dimer state and shifts the equilibria towards the monomeric form. In vivo, a similar response upon thylakoid lumen acidification may tune PsbS activity in a gradual manner.


Assuntos
Bryopsida , Proteínas de Plantas/química , Proteínas de Plantas/metabolismo , Dobramento de Proteína , Multimerização Proteica , Difusão Dinâmica da Luz , Escherichia coli/genética , Escherichia coli/metabolismo , Concentração de Íons de Hidrogênio , Espectroscopia de Ressonância Magnética , Proteínas de Plantas/genética , Conformação Proteica , Proteínas Recombinantes/química , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo
9.
Biochim Biophys Acta Biomembr ; 1859(1): 40-47, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27793630

RESUMO

In the photosynthetic apparatus of plants and algae, the major Light-Harvesting Complexes (LHCII) collect excitations and funnel these to the photosynthetic reaction center where charge separation takes place. In excess light conditions, remodeling of the photosynthetic membrane and protein conformational changes produces a photoprotective state in which excitations are rapidly quenched to avoid photodamage. The quenched states are associated with protein aggregation, however the LHCII complexes are also proposed to have an intrinsic capacity to shift between light harvesting and fluorescence-quenched conformational states. To disentangle the effects of protein-protein and protein-lipid interactions on the LHCII photoprotective switch, we compared the structural and fluorescent properties of LHCII lipid nanodiscs and proteoliposomes with very low protein-to-lipid ratios. We demonstrate that LHCII proteins adapta fully fluorescent state in nanodiscs and in proteoliposomes with highly diluted protein densities. Increasing the protein density induces a transition into a mildly-quenched state that reaches a plateau at a molar protein-to-lipid ratio of 0.001 and has a fluorescence yield reminiscent of the light-harvesting state in vivo. The low onset for quenching strongly suggests that LHCII-LHCII attractive interactions occur inside membranes. The transition at low protein densities does not involve strong changes in the excitonic circular-dichroism spectrum and is distinct from a transition occurring at very high protein densities that comprises strong fluorescence quenching and circular-dichroism spectral changes involving chlorophyll 611 and 612, correlating with proposed quencher sites of the photoprotective mechanisms.


Assuntos
Complexos de Proteínas Captadores de Luz/química , Fosfatidilcolinas/química , Folhas de Planta/química , Proteolipídeos/química , Galactolipídeos/química , Galactolipídeos/metabolismo , Glicolipídeos/química , Glicolipídeos/metabolismo , Cinética , Luz , Complexos de Proteínas Captadores de Luz/isolamento & purificação , Complexos de Proteínas Captadores de Luz/metabolismo , Nanoestruturas/química , Fosfatidilcolinas/metabolismo , Fosfatidilgliceróis/química , Fosfatidilgliceróis/metabolismo , Folhas de Planta/fisiologia , Proteolipídeos/metabolismo , Espectrometria de Fluorescência , Spinacia oleracea/química , Spinacia oleracea/fisiologia
10.
Biochim Biophys Acta ; 1857(12): 1849-1859, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27626974

RESUMO

Photosynthetic thylakoid membranes contain the protein machinery to convert sunlight in chemical energy and regulate this process in changing environmental conditions via interplay between lipid, protein and xanthophyll molecular constituents. This work addresses the molecular effects of zeaxanthin accumulation in thylakoids, which occurs in native systems under high light conditions through the conversion of the xanthophyll violaxanthin into zeaxanthin via the so called xanthophyll cycle. We applied biosynthetic isotope labeling and 13C solid-state NMR spectroscopy to simultaneously probe the conformational dynamics of protein, lipid and xanthophyll constituents of thylakoids isolated from wild type (cw15) and npq2 mutant of the green alga Chlamydomonas reinhardtii, that accumulates zeaxanthin constitutively. Results show differential dynamics of wild type and npq2 thylakoids. Ordered-phase lipids have reduced mobility and mobile-phase lipids have enlarged dynamics in npq2 membranes, together spanning a broader dynamical range. The fraction of ordered lipids is much larger than the fraction of mobile lipids, which explains why zeaxanthin appears to cause overall reduction of thylakoid membrane fluidity. In addition to the ordered lipids, also the xanthophylls and a subset of protein sites in npq2 thylakoids have reduced conformational dynamics. Our work demonstrates the applicability of solid-state NMR spectroscopy for obtaining a microscopic picture of different membrane constituents simultaneously, inside native, heterogeneous membranes.


Assuntos
Espectroscopia de Ressonância Magnética Nuclear de Carbono-13 , Chlamydomonas reinhardtii/metabolismo , Fluidez de Membrana , Lipídeos de Membrana/metabolismo , Proteínas de Membrana/metabolismo , Ressonância Magnética Nuclear Biomolecular , Fotossíntese , Proteínas de Plantas/metabolismo , Tilacoides/metabolismo , Zeaxantinas/metabolismo , Chlamydomonas reinhardtii/genética , Eletroforese em Gel de Poliacrilamida , Transferência de Energia , Cinética , Complexos de Proteínas Captadores de Luz/metabolismo , Proteínas de Membrana/química , Proteínas de Membrana/genética , Mutagênese Sítio-Dirigida , Mutação , Proteínas de Plantas/química , Proteínas de Plantas/genética , Conformação Proteica , Proteínas Quinases/metabolismo , Prótons , Relação Estrutura-Atividade , Temperatura
11.
J Health Commun ; 21(1): 67-75, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26313690

RESUMO

Studies investigating preferences for shared decision making (SDM) have focused on associations with sociodemographic variables, with few investigations exploring patient factors. We aimed to investigate the relationship between patient activation and preferences for SDM in 6 common medical decisions among a nationally representative cross-sectional survey of American adults. Adults older than 18 were recruited online (n = 2,700) and by telephone (n = 700). Respondents completed sociodemographic assessments and the Patient Activation Measure. They were also asked whether they perceived benefit (yes/no) in SDM in 6 common medical decisions. Nearly half of the sample (45.9%) reached the highest level of activation (Level 4). Activation was associated with age (p < .001), higher income (p = .001), higher education (p = .010), better self-rated health (p < .001), and fewer chronic conditions (p = .050). The proportion of people who agreed that SDM was beneficial varied from 53.1% (deciding the necessity of a diagnostic test) to 71.8% (decisions associated with making lifestyle changes). After we controlled for participant characteristics, higher activation was associated with greater perceived benefit in SDM across 4 of the 6 decisions. Preferences for SDM varied among 6 common medical scenarios. Low patient activation is an important barrier to SDM that could be ameliorated through the development of behavioral interventions.


Assuntos
Tomada de Decisões , Participação do Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
12.
J Am Chem Soc ; 137(25): 8113-20, 2015 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-25955727

RESUMO

UVR8 is a novel UV-B photoreceptor that regulates a range of plant responses and is already used as a versatile optogenetic tool. Instead of an exogenous chromophore, UVR8 uniquely employs tryptophan side chains to accomplish UV-B photoreception. UV-B absorption by homodimeric UVR8 induces monomerization and hence signaling, but the underlying photodynamic mechanisms are not known. Here, by using a combination of time-resolved fluorescence and absorption spectroscopy from femto- to microseconds, we provide the first experimental evidence for the UVR8 molecular signaling mechanism. The results indicate that tryptophan residues at the dimer interface engage in photoinduced proton coupled electron transfer reactions that induce monomerization.


Assuntos
Proteínas de Arabidopsis/química , Arabidopsis/química , Proteínas Cromossômicas não Histona/química , Transporte de Elétrons , Elétrons , Luz , Modelos Moleculares , Processos Fotoquímicos , Multimerização Proteica , Prótons , Espectrometria de Fluorescência
13.
Health Expect ; 18(6): 3262-73, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25475371

RESUMO

BACKGROUND: There are increasing opportunities for the public to access online health information, but attitudinal barriers to use are less well-known. Patient activation is associated with key health outcomes, but its relationship with using online health information is not known. OBJECTIVE: We examined the relationship between patient activation and the likelihood of accessing a range of different types of online health information in a nationally representative US sample. DESIGN: Cross-sectional nationally representative survey. SETTING AND PARTICIPANTS: Data were from an online (n = 2700) and random digit dial telephone survey (n = 700) of US adults (total n = 3400). MAIN VARIABLES STUDIED: Respondent characteristics and the Patient Activation Measure. MAIN OUTCOME MEASURES: Self-reported access of five types of online health information in the past 12 months (online medical records, cost estimation tools, quality comparison tools, health information about a specific condition, preventive health information). RESULTS: Approximately, one-fifth of the sample had accessed their medical record (21.6%), treatment cost estimation tools (17.3%) and hospital and physician quality comparison tools (21.8%). Nearly half of the sample had accessed information about medical conditions or treatments (48.3%) or preventive health and well-being (45.9%). In multivariable analyses adjusted for participant characteristics, respondents with greater patient activation were more likely to have accessed all types of health information other than cost estimation tools. DISCUSSION AND CONCLUSIONS: Activated people are more likely to make use of online heath information. Increasing patient activation could improve the public's ability to participate in health care and personal health self-management by encouraging health information seeking.


Assuntos
Informação de Saúde ao Consumidor/estatística & dados numéricos , Registros de Saúde Pessoal/psicologia , Comportamento de Busca de Informação , Participação do Paciente/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Custos de Cuidados de Saúde , Humanos , Internet/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Estados Unidos
14.
Phys Chem Chem Phys ; 16(12): 5571-80, 2014 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-24513782

RESUMO

The major photosystem II antenna complex, LHCII, possesses an intrinsic conformational switch linked to the formation of a photoprotective, excitation-quenching state. Recent solid state NMR experiments revealed that aggregation-induced quenching in (13)C-enriched LHCII from C. reinhardtii is associated with changes to the chemical shifts of three specific (13)C atoms in the Chla conjugated macrocycle. We performed DFT-based NMR calculations on the strongly-quenched crystal structure of LHCII (taken from spinach). We demonstrate that specific Chla-xanthophyll interactions in the quenched structure lead to changes in the Chla(13)C chemical shifts that are qualitatively similar to those observed by solid state NMR. We propose that these NMR changes are due to modulations in Chla-xanthophyll associations that occur due to a quenching-associated functional conformation change in the lutein and neoxanthin domains of LHCII. The combination of solid-state NMR and theoretical modeling is therefore a powerful tool for assessing functional conformational switching in the photosystem II antenna.


Assuntos
Chlamydomonas reinhardtii/química , Complexos de Proteínas Captadores de Luz/química , Ressonância Magnética Nuclear Biomolecular , Complexo de Proteína do Fotossistema II/química , Chlamydomonas reinhardtii/metabolismo , Complexos de Proteínas Captadores de Luz/metabolismo , Modelos Moleculares , Complexo de Proteína do Fotossistema II/metabolismo , Conformação Proteica , Teoria Quântica
15.
J Epidemiol Community Health ; 68(6): 557-64, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24489044

RESUMO

BACKGROUND: The purpose of this study is to determine the prevalence of diabetes distress and its relationship with health behaviours and clinical outcomes in low-income patients. METHODS: Secondary analyses were conducted using baseline data from a clinical trial evaluating a diabetes self-management intervention. Interviews were conducted with 666 participants receiving care at nine safety net clinics in Missouri. Distress was measured using the Diabetes Distress Scale, and outcomes included medication adherence, physical activity, nutrition and clinical biomarkers (haemoglobin A1C (HbA1C), blood pressure, low-density lipoprotein (LDL) cholesterol). RESULTS: In a sample of 666 participants, 14.1% and 27.3% of patients were identified as highly and moderately distressed, respectively, with higher rates among younger, female and lower income patients. When compared with moderately and no distress groups, highly distressed patients were less adherent to medications (20.7% vs 29.9% vs 39.4%, p<0.001) and had higher HbA1C values (9.3% (SD=2.0) vs 8.2% (SD=1.8) vs 7.8% (SD=1.7), p<0.001), diastolic blood pressure (81.8 (SD=9.4) vs 80.2 (9.7) vs 78.9 (SD=8.8), p=0.02) and LDL cholesterol (104.6 (SD=42.4) vs 97.2 (34.3) vs 95.5 (37.9)) In multivariable analyses, high and moderate distress were associated with lower medication adherence (OR=0.44; 0.27 to 0.23, p=0.001) and (OR=0.58; 0.42 to 0.79; p=0.001), respectively, and higher HbA1C in only the highly distressed group (B=1.3; 0.81 to 1.85; p<0.001) compared with the no distress group. CONCLUSIONS: Diabetes distress is prevalent and linked to poorer adherence to health behaviours and glycemic control in a sample of patients receiving care from low-income clinics.


Assuntos
Diabetes Mellitus/psicologia , Cooperação do Paciente/psicologia , Autocuidado/psicologia , Estresse Psicológico/etiologia , Glicemia/análise , Pressão Sanguínea/fisiologia , Comorbidade , Estudos Controlados Antes e Depois , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Feminino , Hemoglobina A Glicada/análise , Letramento em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Análise Multivariada , Cooperação do Paciente/estatística & dados numéricos , Pobreza , Provedores de Redes de Segurança , Estresse Psicológico/epidemiologia , Estresse Psicológico/fisiopatologia
16.
Phys Chem Chem Phys ; 16(21): 9930-9, 2014 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-24430275

RESUMO

Light-harvesting in photosynthesis is determined by the excitonic interactions in disordered antennae and the coupling of collective electronic excitations to fast nuclear motions, producing efficient energy transfer with a complicated interplay between exciton and vibrational coherences. Two-dimensional electronic spectroscopy (2DES) is a powerful tool to study the presence of these coherences in photosynthetic complexes. However, the unambiguous assignment of the nature of the observed coherences is still under debate. In this paper we apply 2DES to an excitonically coupled bacteriochlorophyll dimer, the B820 subunit of the light harvesting complex 1 (LH1-RC) of R. rubrum G9. Fourier analysis of the measured kinetics and modeling of the spectral responses in a complete basis of electronic and vibrational states allow us to distinguish between pure vibrational, mixed exciton-vibrational (vibronic), and predominantly exciton coherences. The mixed coherences have been found in a wide range of oscillation frequencies, whereas exciton coherences give the biggest contributions for the frequencies in the 400-550 cm(-1) range, corresponding to the exciton splitting energy of the B820 dimer. Significant exciton coherences are also present at higher frequencies, i.e., up to 800 cm(-1), which are determined by realizations of the disorder with a large energy gap between the two pigments (which increases the apparent value of the exciton splitting). Although the B820 dimer is a model system, the approach presented here represents a basis for further analyses of more complicated systems, providing a tool for studying the interplay between electronic and vibrational coherences in disordered photosynthetic antennae and reaction centres.


Assuntos
Bacterioclorofilas/química , Análise Espectral/métodos , Dimerização , Modelos Químicos , Teoria Quântica , Vibração
17.
J Am Med Inform Assoc ; 21(3): 542-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24163156

RESUMO

OBJECTIVE: To systematically review mobile applications currently available to patients to support outpatient medication self-management. METHODS: Three online stores were searched in March 2013 using nine distinct search terms. Applications were selected if they supported general outpatient medication self-management for adults; they were excluded if they focused on only one medication or condition, provided only a medication list or reference, only ordered refills, were written in a non-English language, or were for local pharmacy/hospital patients only. A multi-step review process was utilized by two independent reviewers to identify eligible applications. A standardized form was used to abstract data. User reviews were compiled from a subsample of applications and qualitatively coded to identify common criticisms. RESULTS: 14,893 applications were initially identified. After the multi-step review process, 424 applications were deemed eligible for inclusion by reviewers (κ=0.85). On average, applications were rated 2.8 stars (out of 5) from 107 reviews. Almost all provided medication reminders (91.0%), half enabled patients to create a medication history or log (51.5%), and 22% could email the log to a third party. Few helped patients organize their regimen (6.2%), check for drug interactions (2.8%), or identify pills (4.0%). User reviews (N=1091) from the subsample of 26 applications revealed common criticisms, including technical malfunctions, poor compatibility with certain medications, and absence of desired features. CONCLUSIONS: Hundreds of applications exist in the marketplace to support medication self-management. However, their quality, content, and functionality are highly variable. Research is needed to determine optimal capabilities, evaluate utility, and determine clinical benefit.


Assuntos
Aplicativos Móveis , Autoadministração , Adulto , Humanos , Aplicativos Móveis/normas , Aplicativos Móveis/estatística & dados numéricos
18.
Clin Gastroenterol Hepatol ; 12(3): 451-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23954647

RESUMO

BACKGROUND & AIMS: Optimal colonoscopy preparation requires patients to adhere to written instructions and be activated to complete the task. Among patients with chronic disease, health literacy and patient activation have been associated with outcome, but these factors have not been studied for colonoscopy. We examined the association between health literacy, patient activation, and quality of bowel preparation. METHODS: We analyzed outpatient colonoscopy results from 462 adults, 55-74 years old (mean, 62 ± 6 years), who previously completed extensive neurocognitive assessments as part of a prospective study (Health Literacy and Cognitive Function in Older Adults). We collected information on cecal intubation, polyp detection, bowel preparation quality, and histopathology. RESULTS: One-third of the patients (n = 134) had suboptimal quality of bowel preparation; 15% (n = 62) had fair quality, and 17% (n = 72) had poor quality. Limited health literacy was associated with a lower level of education (P < .001), diabetes (P < .001), and a higher number of chronic conditions (P < .001), but not quality of colonoscopy preparation. No baseline characteristics were associated with patient activation. In multivariable analysis, after adjusting for demographics and clinical characteristics, diabetes (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.14-5.25) and patient activation (OR, 2.12; 95% CI, 1.30-3.45) were independent predictors of suboptimal bowel preparation quality, but limited health literacy was not (OR, 0.76; 95% CI, 0.38-1.52). CONCLUSIONS: We investigated the relationship between health literacy, patient activation, and colonoscopy preparation quality. Lower patient activation was an independent predictor of suboptimal bowel preparation quality. Interventions to improve colonoscopy preparation quality should consider the importance of patient activation within their design.


Assuntos
Colonoscopia/métodos , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação/estatística & dados numéricos , Cuidados Pré-Operatórios/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
J Gen Intern Med ; 29(1): 59-67, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24002623

RESUMO

BACKGROUND: We compared two implementation approaches for a health literacy diabetes intervention designed for community health centers. METHODS: A quasi-experimental, clinic-randomized evaluation was conducted at six community health centers from rural, suburban, and urban locations in Missouri between August 2008 and January 2010. In all, 486 adult patients with type 2 diabetes mellitus participated. Clinics were set up to implement either: 1) a clinic-based approach that involved practice re-design to routinely provide brief diabetes education and counseling services, set action-plans, and perform follow-up without additional financial resources [CARVE-IN]; or 2) an outsourced approach where clinics referred patients to a telephone-based diabetes educator for the same services [CARVE-OUT]. The fidelity of each intervention was determined by the number of contacts with patients, self-report of services received, and patient satisfaction. Intervention effectiveness was investigated by assessing patient knowledge, self-efficacy, health behaviors, and clinical outcomes. RESULTS: Carve-out patients received on average 4.3 contacts (SD = 2.2) from the telephone-based diabetes educator versus 1.7 contacts (SD = 2.0) from the clinic nurse in the carve-in arm (p < 0.001). They were also more likely to recall setting action plans and rated the process more positively than carve-in patients (p < 0.001). Few differences in diabetes knowledge, self-efficacy, or health behaviors were found between the two approaches. However, clinical outcomes did vary in multivariable analyses; carve-out patients had a lower HbA1c (ß = -0.31, 95 % CI -0.56 to -0.06, p = 0.02), systolic blood pressure (ß = -3.65, 95 % CI -6.39 to -0.90, p = 0.01), and low-density lipoprotein (LDL) cholesterol (ß = -7.96, 95 % CI -10.08 to -5.83, p < 0.001) at 6 months. CONCLUSION: An outsourced diabetes education and counseling approach for community health centers appears more feasible than clinic-based models. Patients receiving the carve-out strategy also demonstrated better clinical outcomes compared to those receiving the carve-in approach. Study limitations and unclear causal mechanisms explaining change in patient behavior suggest that further research is needed.


Assuntos
Centros Comunitários de Saúde/organização & administração , Atenção à Saúde/organização & administração , Diabetes Mellitus Tipo 2/terapia , Letramento em Saúde , Adulto , Idoso , Instituições de Assistência Ambulatorial/organização & administração , Aconselhamento , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/psicologia , Estudos de Viabilidade , Feminino , Hemoglobina A Glicada/metabolismo , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Missouri , Satisfação do Paciente , Autocuidado , Autoeficácia , Fatores Socioeconômicos , Telefone
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