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1.
Risk Manag Healthc Policy ; 14: 4073-4081, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34616194

RESUMO

Background: Despite a flood of research on job satisfaction, few studies have examined how and why social support influences job satisfaction. This study aimed to explore how social support has an indirect effect on job satisfaction by examining its impact on emotional exhaustion and anxiety symptoms among residents of the physicians standardized residency training program in China. Methods: This cross-sectional study adopted questionnaires to collect data from residents in the standardized residency training program in China. The PROCESS macro for SPSS based on ordinary least-squares regression and the bootstrap method was used. The indirect effect of social support was examined using bootstrapping procedures. A serial multiple mediation model was examined in which social support was associated with job satisfaction via emotional exhaustion and anxiety symptoms. Results: There were 269 residents who provided usable data for the analysis. The mean age of residents was 25.98 years old. Close to half (52%) of the participants were female. The total indirect effect of social support on job satisfaction was significant (ab=0.21, SE=0.05, CI=0.12 to 0.32). The specific indirect effect 1 (social support→emotional exhaustion→job satisfaction) was significant (a1b1=0.12, SE=0.04, CI=0.05 to 0.19). The specific indirect effect 2 (social support→anxiety symptoms→job satisfaction) was significant (a2b2=0.07, SE=0.03, CI=0.02 to 0.13).The specific indirect effect 3 (social support→emotional exhaustion→anxiety symptoms→job satisfaction) was also found to be significant through both optimism and work engagement (a1a3b2=0.03, SE=0.01, CI=0.01 to 0.05). Conclusion: It seems critical for hospital management to develop a supportive work environment to improve the effects of emotional exhaustion and anxiety symptoms and to provide sufficient support to improve job satisfaction among residents in standardized residency training programs.

2.
BMC Psychiatry ; 21(1): 460, 2021 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-34548045

RESUMO

BACKGROUND: Although studies indicate that social support is related to emotional exhaustion, depression symptoms, and anxiety symptoms, the underlying mechanism between those variables remains unknown. METHODS: Based on a sample of 254 residents in standardized residency training programs, two mediation models were tested in which emotional exhaustion served as a mediator in the relationship between social support and anxiety symptoms/depression symptoms. We used the following self-reported questionnaires as instruments to collect data: zung self-rating depression scale, zung self-rating anxiety scale, social support rating scale, and emotional exhaustion scale. RESULTS: In the final study sample, the mean age of the residents was 25.92 years old (SD =1.88), and a total of 41.3% were male, and 58.7% were female. This current study suggested that social support was proven to be a relevant factor affecting anxiety symptoms and depression symptoms. Particularly, the results also indicated that emotional exhaustion partially mediated the impact of social support on anxiety symptoms and depression symptoms among Chinese residents in the standardized residency training program. CONCLUSIONS: Our study signifies that enhancements in social support and reduction of emotional exhaustion can directly or indirectly affect anxiety symptoms and depression symptoms among Chinese residents in the standardized residency training program. These findings will offer insight for health-sector managers to develop programs aimed at social support and adopt individual-level interventions and organization-level interventions to reduce emotional exhaustion.


Assuntos
Depressão , Internato e Residência , Adulto , Ansiedade/diagnóstico , Depressão/diagnóstico , Emoções , Feminino , Humanos , Masculino , Apoio Social , Inquéritos e Questionários
3.
J Sci Food Agric ; 96(11): 3937-43, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27166835

RESUMO

BACKGROUND: Chalkiness has a deleterious influence on rice appearance and milling quality. We identified a notched-belly mutant with a high percentage of white-belly, and thereby developed a novel comparison system that can minimize the influence of genetic background and growing conditions. Using this mutant, we examined the differences in chemical composition between chalky and translucent endosperm, with the aim of exploring relations between occurrence of chalkiness and accumulation of starch, protein and minerals. RESULTS: Comparisons showed a significant effect of chalkiness on chemical components in the endosperm. In general, occurrence of chalkiness resulted in higher total starch concentration and lower concentrations of the majority of the amino acids measured. Chalkiness also had a positive effect on the concentrations of As, Ba, Cd, Cr, Mn, Na, Sr and V, but was negatively correlated with those of B, Ca, Cu, Fe and Ni. By contrast, no significant chalkiness effect on P, phytic acid-P, K, Mg or Zn was observed. In addition, substantial influence of the embryo on endosperm composition was detected, with the embryo showing a negative effect on total protein, amino acids such as Arg, His, Leu, Lys, Phe and Tyr, and all the 17 minerals measured, excluding Ca, Cu, P and Sr. CONCLUSION: An inverse relation between starch and protein as well as amino acids was found with respect to chalkiness occurrence. Phytic acid and its colocalized elements K and Mg were not affected by chalkiness. The embryo exerted a marked influence on chemical components of the endosperm, in particular minerals, suggesting the necessity of examining the role of the embryo in chalkiness formation. © 2016 The Authors. Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.


Assuntos
Aminoácidos/análise , Carboidratos da Dieta/análise , Mutação , Oryza/química , Proteínas de Vegetais Comestíveis/análise , Sementes/química , Oligoelementos/análise , Aminoácidos/metabolismo , China , Carboidratos da Dieta/metabolismo , Endosperma/química , Endosperma/genética , Endosperma/crescimento & desenvolvimento , Endosperma/metabolismo , Humanos , Magnésio/análise , Magnésio/metabolismo , Microscopia Eletrônica de Varredura , Valor Nutritivo , Oryza/genética , Oryza/crescimento & desenvolvimento , Oryza/metabolismo , Ácido Fítico/análise , Ácido Fítico/biossíntese , Proteínas de Vegetais Comestíveis/biossíntese , Potássio/análise , Potássio/metabolismo , Sementes/genética , Sementes/crescimento & desenvolvimento , Sementes/metabolismo , Amido/análise , Amido/biossíntese , Oligoelementos/metabolismo
4.
Mediators Inflamm ; 2016: 9348037, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26980948

RESUMO

Acute lung injury (ALI) induced by intestinal ischemia/reperfusion (II/R) has high incidence and mortality, in which IL-1ß was essential for the full development of ALI. However, the detailed regulating mechanism for this phenomenon remains to be unclear. The purpose of this study was to investigate whether inhibition of P38 MAPK could downregulate the expression of IL-1ß to protect lung from acute injury in II/R rats. Here, we found that the level of pulmonary edema at 16 hours after operation (hpo) was obviously enhanced compared to that in 8hpo and sham groups. Immunofluorescent staining demonstrated that IL-1ß and P38 MAPK were detected in lung tissues. And rats with II/R have the highest translation level for IL-1ß and phosphorylation of P38 MAPK in lung tissues at 16hpo compared with 8hpo and sham groups. Moreover, administration of SB239063, an inhibitor of P38 α and ß, could effectively downregulate the expressions of IL-1ß and protects lung tissues from injury in II/R rats. Our findings indicate that the inhibition of P38 α and ß may downregulate the expression of IL-1ß to protect lung from acute injury in II/R, which could be used as a potential target for reducing ALI induced by II/R in the future clinical trial.


Assuntos
Lesão Pulmonar Aguda/metabolismo , Interleucina-1beta/metabolismo , Pulmão/metabolismo , Traumatismo por Reperfusão/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo , Lesão Pulmonar Aguda/patologia , Lesão Pulmonar Aguda/prevenção & controle , Animais , Inibidores Enzimáticos/uso terapêutico , Pulmão/patologia , Masculino , Fosforilação , Edema Pulmonar/metabolismo , Edema Pulmonar/patologia , Edema Pulmonar/prevenção & controle , Ratos , Ratos Sprague-Dawley , Proteínas Quinases p38 Ativadas por Mitógeno/antagonistas & inibidores
5.
Disabil Rehabil Assist Technol ; 8(3): 181-9, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-22794937

RESUMO

PURPOSE: This article provides rehabilitation professionals and engineers with a theoretical and pragmatic rationale for the inclusion of haptic feedback in the rehabilitation of central nervous system disorders affecting the hand. METHOD: A narrative review of haptic devices used in sensorimotor hand rehabilitation was undertaken. Presented papers were selected to outline and clarify the underlying somatosensory mechanisms underpinning these technologies and provide exemplars of the evidence to date. RESULTS: Haptic devices provide kinaesthetic and/or tactile stimulation. Kinaesthetic haptics are beginning to be incorporated in central nervous system rehabilitation; however, there has been limited development of tactile haptics. Clinical research in haptic rehabilitation of the hand is embryonic but initial findings indicate potential clinical benefit. CONCLUSIONS: Haptic rehabilitation offers the potential to advance sensorimotor hand rehabilitation but both scientific and pragmatic developments are needed to ensure that its potential is realized.


Assuntos
Biorretroalimentação Psicológica/instrumentação , Biorretroalimentação Psicológica/fisiologia , Doenças do Sistema Nervoso Central/reabilitação , Distúrbios Somatossensoriais/reabilitação , Tato/fisiologia , Interface Usuário-Computador , Doenças do Sistema Nervoso Central/complicações , Doenças do Sistema Nervoso Central/fisiopatologia , Simulação por Computador , Humanos , Atividade Motora/fisiologia , Propriocepção/fisiologia , Distúrbios Somatossensoriais/etiologia , Distúrbios Somatossensoriais/fisiopatologia
6.
J Surg Res ; 174(2): 326-33, 2012 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-21392794

RESUMO

BACKGROUND: Splanchnic ischemia is common in critically ill patients, and it can result in injury not only of the intestine but also in distant organs, particularly in the lung. Local inflammatory changes play a pivotal role in the development of acute lung injury after intestinal ischemia, but the underlying molecular mechanisms are not fully understood. We sought to examine the role of Toll-like receptor 4 (TLR4) in the mouse model of intestinal ischemia-reperfusion (I/R)-induced lung injury and inflammation. MATERIALS AND METHODS: Adult male TLR4 mutant (C3H/HeJ) mice and TLR4 wild-type (WT) (C3H/HeOuJ) mice were subjected to 40 min of intestinal ischemia by clamping the superior mesenteric artery followed by 6 h of reperfusion. Lung histology was assessed and parameters of pulmonary microvascular permeability, inflammatory cytokine expression, and neutrophil infiltration were measured. Activation of mitogen-activated protein kinases (MAPKs) and the transcription factors nuclear factor κB (NF-κB) and activator protein-1 (AP-1) in the lungs were also detected. RESULTS: After intestinal I/R, lungs from TLR4 mutant mice demonstrated a significantly lower histological injury, a marked reduction of epithelial apoptosis associated with the decreased level of cleaved caspase-3 and the increased ratio of Bcl-xL to Bax proteins, and a large reduction in pulmonary vascular permeability and myeloperoxidase (MPO) activity in comparison with WT mice. TLR4 mutant mice also displayed marked decreases in tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and macrophage inflammatory protein-2 (MIP-2) expression. Following intestinal I/R, phosporylation of p38 MAPK and activation of NF-κB and AP-1 were significantly inhibited in lung tissue from TLR4 mutant mice compared with WT controls. CONCLUSIONS: These data suggest that TLR4 plays an important role in the pathogenesis of intestinal I/R-induced acute lung injury and inflammation and that p38 kinase and NF-κB may be involved in TLR4 signaling-mediated lung inflammatory processes during intestinal I/R.


Assuntos
Lesão Pulmonar Aguda/metabolismo , Intestinos/irrigação sanguínea , Traumatismo por Reperfusão/complicações , Receptor 4 Toll-Like/metabolismo , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/patologia , Animais , Apoptose , Permeabilidade Capilar , Citocinas/metabolismo , Ativação Enzimática , Células Epiteliais/patologia , Pulmão/metabolismo , Pulmão/patologia , Masculino , Camundongos , Camundongos Endogâmicos C3H , Subunidade p50 de NF-kappa B/metabolismo , Infiltração de Neutrófilos , Traumatismo por Reperfusão/patologia , Fator de Transcrição AP-1/metabolismo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
7.
Burns ; 36(7): 992-8, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20537801

RESUMO

INTRODUCTION: Early diagnosis and treatment for thermal injury with septic complications continue to be a serious clinical problem. In this study, plasma biomarkers of rats in the burn and/or septic models were investigated with a metabolomic method. METHODS: Rat plasma samples were analyzed by ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS). Multivariate analysis, the principal components analysis (PCA), was used to validate metabolic changes. In addition, another multivariate method, the orthogonal partial least-squares analysis (OPLS), was used to profile potential biomarkers in models. RESULTS: Nine characteristic metabolites, including hypoxanthine, indoxyl sufate, glucuronic acid, gluconic acid, proline, uracil, nitrotyrosine, uric acid, and trihydroxy cholanoic acid were identified in models of thermal injury and/or sepsis. CONCLUSION: These biomarkers were mainly involved in oxidative stress and tissue damage, and might supply evidence for distinguishing burned septic patients from non-septic ones.


Assuntos
Queimaduras/sangue , Sepse/sangue , Aminoácidos/sangue , Animais , Biomarcadores/sangue , Ácidos Carboxílicos/sangue , Cromatografia Líquida de Alta Pressão/métodos , Modelos Animais de Doenças , Compostos Heterocíclicos/sangue , Masculino , Espectrometria de Massas , Metabolômica/métodos , Ratos , Ratos Sprague-Dawley , Sepse/diagnóstico
8.
J Diabetes Complications ; 22(3): 153-63, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18413218

RESUMO

OBJECTIVE: To determine the relationships between C-reactive protein (CRP) levels and features of Type 1 diabetes. RESEARCH DESIGN AND METHODS: Serum CRP was measured by nephelometry in a cross-sectional study of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort (n=983) and nondiabetic subjects (n=71). RESULTS: CRP levels [geometric mean (95% CI)] were higher in diabetic than in control subjects, 1.6 (1.5-1.7) vs. 1.2 (1.1-1.5) mg/l, P=.019. CRP was higher in diabetic women (n=438) than in men (n=545) [2.0 (1.8-2.3) vs. 1.3 (1.2-1.5), P<.001]. Diabetic subjects formerly in the DCCT intensive treatment group had higher CRP levels than those who were randomized to the conventional treatment group [1.8 (1.6-1.9), n=479 vs. 1.5 (1.3-1.6), n=456, P=.010], attributable to greater BMI in the prior intensive group. In diabetes, CRP correlated with HbA(1c) (r=0.13, P<.0001) and with insulin resistance traits: BMI (r=0.34, P<.0001), waist-to-hip ratio (WHR; males: r=0.35, P<.0001; females: r=0.22, P<.0001), diastolic blood pressure (r=0.07, P=.025), triglycerides (r=0.19, P<.0001), apoB (r=0.22, P<.0001), LDL particle concentration (r=0.26, P<.0001), and LDL particle size (r=-0.22, P<.0001). CRP was not associated with complications. Significant independent predictors of CRP in diabetes were gender, BMI, WHR, concurrent HbA(1c), and oral contraceptive pill use. CONCLUSIONS: CRP was elevated relative to nondiabetic subjects, and in diabetes was higher in females. Elevated CRP in Type 1 diabetes was associated with poor glycemic control, larger body habitus, and other factors that comprise the insulin resistance syndrome. Nevertheless, CRP levels were not associated with complications. Longitudinal studies are warranted.


Assuntos
Proteína C-Reativa/metabolismo , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/metabolismo , Angiopatias Diabéticas/epidemiologia , Adulto , Estudos de Coortes , Diabetes Mellitus Tipo 1/sangue , Angiopatias Diabéticas/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipertensão/sangue , Lipídeos/sangue , Masculino , Fatores de Risco , Caracteres Sexuais
9.
J Pediatr Hematol Oncol ; 28(3): 147-53, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16679937

RESUMO

OBJECTIVE: Although improvements in the management of sickle cell disease (SCD) have increased patient survival into adulthood, morbidity and mortality from end-organ damage remain major concerns. One of the most serious complications of SCD is renal failure, affecting about 20% of patients. The clinical manifestations of sickle cell nephropathy (SCN) involve changes in glomerular ultrastructure, albuminuria, and a progressive decline in glomerular hemodynamics. The mechanisms or factors that promote SCN are not fully elucidated. In the present study, the role of renal kallikrein as a risk marker for promoting SCN was explored in a cross-sectional study. METHODS AND RESULTS: We measured the urinary excretion rate of active kallikrein in 73 children with sickle cell anemia (hemoglobin SS, SC, or S thalassemia) and in 30 control healthy African American children. The findings demonstrated that a significant difference in the excretion rate of log kallikrein in male versus female patients with SCD, P<0.0078 was observed. In children with SCD, cross-sectional analysis revealed a positive and significant correlation between the excretion rate of active kallikrein and log albumin excretion rate (AER), P<0.0088. Regression analysis also determined that the excretion rate of active kallikrein negatively correlates with hemoglobin in children with SCD, P<0.0096. In addition, an inverse relationship between log AER and hemoglobin was observed in male patients with SCD, P<0.0143. In children with SCD, cross-sectional analysis revealed a positive and significant correlation between log AER and age, suggesting age as a risk marker for AER in SCD. In multivariate regression analysis, our findings demonstrate a strong association between log AER and age and log kallikrein in children with SCD. About 20% of the variability in log AER in SCD patients is influenced by age and 6% is influenced by log kallikrein, P<0.0001 and P<0.02, respectively. CONCLUSIONS: These findings provide the first evidence that the excretion rate of active kallikrein is positively and independently correlated with log AER in children with SCD, and suggest that kallikrein could be a marker for progressive nephropathy. Longitudinal studies are essential to address this issue.


Assuntos
Anemia Falciforme/complicações , Calicreínas/urina , Nefropatias/etiologia , Nefropatias/fisiopatologia , Adolescente , Albuminas/análise , Biomarcadores/análise , Criança , Estudos Transversais , Feminino , Hemoglobinas/análise , Humanos , Masculino , Fatores de Risco , Fatores Sexuais
10.
Diabetes Care ; 28(6): 1339-45, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15920049

RESUMO

OBJECTIVE: The aim of this study was to evaluate the effect of depression on all-cause and coronary heart disease (CHD) mortality among adults with and without diabetes. RESEARCH DESIGN AND METHODS: We studied 10,025 participants in the population-based National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale. Four groups were created based on diabetes and depression status in 1982: 1) no diabetes, no depression (reference group); 2) no diabetes, depression present; 3) diabetes present, no depression; and i4) diabetes present, depression present. Cox proportional hazards regression models were used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group compared with the reference group. RESULTS: Over 8 years (83,624 person-years of follow-up), 1,925 deaths were documented, including 522 deaths from CHD. Mortality rate per 1,000 person-years of follow-up was highest in the group with both diabetes and depression. Compared with the reference group, HRs for all-cause mortality were no diabetes, depression present, 1.20 (95% CI 1.03-1.40); diabetes present, no depression 1.88 (1.55-2.27); and diabetes present, depression present, 2.50 (2.04-3.08). HRs for CHD mortality were no diabetes, depression present, 1.29 (0.96-1.74); diabetes present, no depression 2.26 (1.60-3.21); and diabetes present, depression present, 2.43 (1.66-3.56). CONCLUSIONS: The coexistence of diabetes and depression is associated with a significantly increased risk of death from all causes, beyond that due to having either diabetes or depression alone.


Assuntos
Doença das Coronárias/epidemiologia , Depressão/epidemiologia , Angiopatias Diabéticas/epidemiologia , Adulto , Estudos de Coortes , Doença das Coronárias/mortalidade , Demografia , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Probabilidade , Modelos de Riscos Proporcionais , Inquéritos e Questionários , Análise de Sobrevida , Fatores de Tempo
11.
J Diabetes Complications ; 19(1): 18-25, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15642486

RESUMO

AIM: We investigated the associations of apolipoprotein C-III (apoCIII) protein and apoCIII gene variation with microvascular disease complications in Type 1 diabetes. METHODS: The serum apoCIII concentration, and both a T(-455)-->C and a SacI gene polymorphisms were determined in 409 patients in the DCCT/EDIC cohort of patients with Type 1 diabetes. Correlations with albumin excretion rate (AER) and the severity of retinopathy were investigated. RESULTS: Higher apoCIII concentrations were associated (P<.0001) with increased triglycerides (r=.78), total (r=.61) and LDL (r=.40) cholesterol, apoAI (r=.26), and apoB (r=.50), AER (r=.08), and the severity of retinopathy (ETDRS score, r=.11), and these relationships persisted after controlling for age, gender, body mass index (BMI), and HbA1c level. The apoCIII concentration was significantly higher in the group of patients with macroalbuminuria (AERs 300 mg/24 h) compared to the groups with microalbuminuria (AER 40-299 mg/24 h; P<.0001) or normoalbuminuria (AER <40 mg/24 h) (P<.0001). The apoCIII concentration also was significantly higher in the group of patients with severe retinopathy (ETDRS 10-23) compared to those with moderate (ETDRS 4-9; P<.02) or mild retinopathy (ETDRS 1-3; P<.0001). Neither the T(-455)-->C polymorphism nor a SacI polymorphism in the 3' UTR were associated with circulating apoCIII concentrations, nor the severity of nephropathy or retinopathy. CONCLUSIONS: Elevated apoCIII levels have been associated with increased macrovascular disease risk. In the DCCT/EDIC cohort of patients, there was an independent positive association of apoCIII level with microvascular complications of Type 1 diabetes.


Assuntos
Apolipoproteínas C/sangue , Apolipoproteínas C/genética , Diabetes Mellitus Tipo 1/genética , Angiopatias Diabéticas/genética , Polimorfismo Genético , Adulto , Apolipoproteína C-III , Estudos de Coortes , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/epidemiologia , Retinopatia Diabética/sangue , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/genética , Feminino , Predisposição Genética para Doença/epidemiologia , Genótipo , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Fatores de Risco , Albumina Sérica/metabolismo , Índice de Gravidade de Doença
12.
Metabolism ; 53(10): 1296-304, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15375785

RESUMO

Serum apolipoprotein C-III (apoCIII) concentration and apoCIII gene polymorphisms have been shown to be a risk factor for cardiovascular disease; however, the underlying mechanisms remain unclear. In addition, no studies have been performed that address these issues in type 1 diabetes. The current study investigated apoCIII protein and apoCIII gene variation in a normotriglyceridemic (82 +/- 57 mg/dL) population of patients with type 1 diabetes, the Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications (DCCT/EDIC) cohort. Blood samples were obtained in 409 patients after an overnight fast. Serum apoCIII concentration was highly correlated with multiple changes in lipids and lipoproteins that resulted in an adverse cardiovascular disease risk profile. Higher apoCIII concentrations were associated (P < .0001) with increased triglycerides (r = 0.78), total (r = 0.61) and low-density lipoprotein (LDL) (r = 0.40) cholesterol, apoA-I (r = 0.26), and apoB (r = 0.50), and these relationships persisted after controlling for age, gender, body mass index (BMI), and hemoglobin A1c (HbA1c). Nuclear magnetic resonance (NMR) lipoprotein subclass analyses demonstrated that apoCIII was correlated with an increase in very-low-density lipoprotein (VLDL) subclasses (P = .0001). There also was a highly significant positive relationship between serum apoCIII concentration and the LDL particle concentration in both men (r = 0.49, P = .001) and women (r = 0.40, P = .001), and a highly significant negative relationship between serum apoCIII levels and average LDL particle size in both men (r = -0.37, P = .001) and women (r = -0.22, P = .001) due primarily to an augmentation in the small L1 subclass (r = 0.42, P = .0001). Neither the T(-455) --> C polymorphism affecting an insulin response element in the apoCIII gene promoter nor a SacI polymorphism in the 3'UTR were associated with any alterations in circulating apoCIII concentrations, serum lipids, apolipoprotein concentrations, lipoprotein composition, or parameters measured by NMR lipoprotein subclass analyses. In summary, elevated apoCIII concentration was associated with risk factors for cardiovascular disease in normolipidemic type 1 diabetic patients through associated changes in lipoprotein subfraction distributions, which were independent of apoCIII genotype.


Assuntos
Apolipoproteínas C/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/genética , Lipoproteínas/sangue , Lipoproteínas/genética , Polimorfismo Genético/fisiologia , Regiões 3' não Traduzidas/genética , Adulto , Apolipoproteína C-III , Primers do DNA , Feminino , Genótipo , Humanos , Lipoproteínas LDL/sangue , Espectroscopia de Ressonância Magnética , Masculino , Tamanho da Partícula , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Triglicerídeos/sangue
13.
Public Health Rep ; 119(3): 322-30, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15158111

RESUMO

Racial and Ethnic Approaches to Community Health (REACH 2010) is a U.S. Centers for Disease Control and Prevention demonstration program that responds to the U.S. Department of Health and Human Services' goal to eliminate racial and ethnic disparities in health status by the year 2010. As part of REACH 2010, community projects were funded to develop, implement, and evaluate community action plans to improve health care and outcomes for racial and ethnic populations. This article describes the program and details the progress of the REACH 2010: Charleston and Georgetown Diabetes Coalition in reducing disparities in care. Approaches employed by the Coalition included community development, empowerment, and education related to diabetes; health systems change associated with access, care, and education; and coalition advocacy. Racial disparities were identified for 12,000 African Americans with diabetes in this urban/rural South Carolina community. After 24 months, significant differences that initially ranged from 11% to 28% in African Americans (when compared with whites/others) were not observed on 270 chart audits for A1C, lipid and kidney testing, eye examinations, and blood pressure control. Future efforts will focus on maintaining progress, eliminating other disparities, and identifying the contributions of each intervention in eliminating racial disparities.


Assuntos
Afro-Americanos/estatística & dados numéricos , Serviços de Saúde Comunitária/organização & administração , Diabetes Mellitus/terapia , Justiça Social , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etnologia , Coalizão em Cuidados de Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , South Carolina/epidemiologia
14.
Invest Ophthalmol Vis Sci ; 45(3): 910-8, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-14985310

RESUMO

PURPOSE: To determine associations between retinopathy status and detailed serum lipoprotein subclass profiles in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) cohort. METHODS: Persons with type 1 diabetes (440 women, 548 men) from the DCCT/EDIC cohort were studied. Retinopathy was characterized by Early Treatment Diabetic Retinopathy Study (ETDRS) scores, hard exudate scores, and ETDRS scores minus the hard exudate component. Lipoproteins were characterized by conventional lipid profile, nuclear magnetic resonance lipoprotein subclass profile (NMR-LSP), apoA1, apoB, lipoprotein(a), and susceptibility of LDL to oxidation. Data were analyzed with and without the following covariates: age, gender, duration of diabetes, HbA(1c), albumin excretion rate (AER), creatinine clearance, hypertension, body mass index, waist-hip ratio, DCCT treatment group, smoking status. RESULTS: The severity of retinopathy was positively associated with triglycerides (combined cohort) and negatively associated with HDL cholesterol (men, combined cohort). NMR-LSP identified retinopathy as being positively associated with small and medium VLDL and negatively with VLDL size. In men only, retinopathy was positively associated with small LDL, LDL particle concentration, apoB concentration, and small HDL and was negatively associated with large LDL, LDL size, large HDL, and HDL size. No associations were found with apoA1, Lp(a), or susceptibility of LDL to oxidation. All three measures of retinopathy revealed the same associations. CONCLUSIONS: NMR-LSP reveals new associations between serum lipoproteins and severity of retinopathy in type 1 diabetes. The data are consistent with a role for dyslipoproteinemia involving lipoprotein subclasses in the pathogenesis of diabetic retinopathy.


Assuntos
Retinopatia Diabética/sangue , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Lipoproteínas VLDL/sangue , Adolescente , Adulto , Estudos de Coortes , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Lipoproteínas HDL/classificação , Lipoproteínas LDL/classificação , Lipoproteínas VLDL/classificação , Espectroscopia de Ressonância Magnética , Masculino
15.
Am J Public Health ; 93(12): 2074-8, 2003 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-14652337

RESUMO

OBJECTIVES: This study identified racial/ethnic disparities in influenza vaccination in high-risk adults. METHODS: We analyzed data on influenza vaccination in 7655 adults with high-risk conditions, using data from the 1999 National Health Interview Survey (NHIS). We stratified data by age and used multiple logistic regression to adjust for gender, education, income, employment, and health care access. RESULTS: After control for covariates, White patients with diabetes, chronic heart conditions, and cancer had a higher prevalence of influenza vaccination than did Black patients with the same conditions. Similarly, White patients with 2 or more high-risk conditions were more likely to receive the influenza vaccine than Black patients with the same conditions. CONCLUSIONS: Significant racial/ethnic differences exist in influenza vaccination of high-risk individuals, and missed vaccination opportunities seem to contribute to the less-than-optimal influenza vaccination coverage in the United States.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Adulto , Idoso , Asma/etnologia , Estudos Transversais , Diabetes Mellitus/etnologia , Características da Família , Feminino , Pesquisas sobre Serviços de Saúde , Cardiopatias/etnologia , Humanos , Programas de Imunização/provisão & distribuição , Vacinas contra Influenza/provisão & distribuição , Influenza Humana/etnologia , Masculino , Pessoa de Meia-Idade , Neoplasias/etnologia , Doença Pulmonar Obstrutiva Crônica/etnologia , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos
16.
Kidney Int ; 64(3): 817-28, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12911531

RESUMO

BACKGROUND: Lipoproteins may contribute to diabetic nephropathy. Nuclear magnetic resonance (NMR) can quantify subclasses and mean particle size of very low density lipoprotein (VLDL), low density lipoprotein (LDL), and high density lipoprotein (HDL), and LDL particle concentration. The relationship between detailed lipoprotein analyses and diabetic nephropathy is of interest. METHODS: In a cross-sectional study, lipoproteins from 428 women and 540 men from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort were characterized by conventional lipid enzymology, NMR, apolipoprotein levels, and LDL oxidizibility. Linear regression was performed for each lipoprotein parameter versus log albumin excretion rate (AER), with and without covariates for age, diabetes duration, HbA1c, hypertension, body mass index, waist-hip ratio, and DCCT treatment group. Significance was taken at P < 0.05. RESULTS: By multivariate analysis, conventional profile, total triglycerides, total- and LDL cholesterol, but not HDL cholesterol, were associated with AER. NMR-determined large, medium, and small VLDL were associated with AER in both genders (except large VLDL in women), and intermediate density lipoprotein (IDL) was associated with AER (men only). LDL particle concentration and ApoB were positively associated with AER (in men and in the total cohort), and there was a borderline inverse association between LDL diameter and AER in men. Small HDL was positively associated with AER and a borderline negative association was found for large HDL. No associations were found with ApoA1, Lp(a), or LDL oxidizibility. CONCLUSION: Potentially atherogenic lipoprotein profiles are associated with renal dysfunction in type 1 diabetes and further details are gained from NMR analysis. Longitudinal studies are needed to determine if dyslipoproteinemia can predict patients at risk of nephropathy, or if lipoprotein-related interventions retard nephropathy.


Assuntos
Nefropatias Diabéticas/sangue , Lipoproteínas/sangue , Adolescente , Adulto , Albuminúria , Criança , LDL-Colesterol/sangue , Estudos de Coortes , Creatinina/sangue , Estudos Transversais , Nefropatias Diabéticas/urina , Feminino , Humanos , Lipoproteínas IDL , Lipoproteínas LDL/sangue , Lipoproteínas VLDL/sangue , Espectroscopia de Ressonância Magnética , Masculino , Análise Multivariada , Caracteres Sexuais , Triglicerídeos/sangue
17.
Diabetes ; 52(5): 1215-21, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12716755

RESUMO

The relevance and significance of the plasma kallikrein/kinin system as a risk factor for the development of vascular complications in diabetic patients was explored in a cross-sectional study. We measured the circulating levels of plasma prekallikrein (PK) activity, factor XII, and high-molecular weight kininogen in the plasma of 636 type 1 diabetic patients from the Diabetes Control and Complications Trial/Epidemiology and Diabetes Intervention and Complications Study cohort. The findings demonstrated that type 1 diabetic patients with blood pressure > or =140/90 mmHg have increased PK levels compared with type 1 diabetic patients with blood pressure <140/90 (1.53 +/- 0.07 vs. 1.27 +/- 0.02 units/ml; P < 0.0001). Regression analysis also determined that plasma PK levels positively and significantly correlated with diastolic (DBP) and systolic blood pressures (SBP) as continuous variables (r = 0.17 and 0.18, respectively; P < 0.0001). In multivariate regression analysis, the semipartial r(2) value for PK was 2.93% for SBP and 2.92% for DBP (P < 0.0001). A positive correlation between plasma PK levels and the urinary albumin excretion rate (AER) was also observed (r = 0.16, P < 0.0001). In categorical analysis, patients with macroalbuminuria had a significantly higher level of plasma PK than normoalbuminuric patients (1.45 +/- 0.08 vs. 1.27 +/- 0.02 units/ml; P < 0.01), whereas microalbuminuric patients had an intermediate PK value (1.38 +/- 0.05 units/ml; P = NS). Among patients in the microalbuminuric subgroup, we observed a positive and independent correlation between PK and AER in univariate and multivariate regression analysis (r = 0.27, P < 0.03; n = 63). We concluded that in type 1 diabetes, 1) PK levels are elevated in association with increased blood pressure; 2) PK levels are independently correlated with AER and are categorically elevated in patients with macroalbuminuria; and 3) although the positive correlation between PK and AER within the subgroups of patients with microalbuminuria suggest that PK could be a marker for progressive nephropathy, longitudinal studies will be necessary to address this issue.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 1/sangue , Nefropatias Diabéticas/sangue , Hipertensão/sangue , Pré-Calicreína/análise , Albuminúria , Pressão Sanguínea , Índice de Massa Corporal , Peso Corporal , Estudos de Coortes , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 1/urina , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/fisiopatologia , Fator XII/análise , Feminino , Humanos , Calicreínas/análise , Cininogênio de Alto Peso Molecular/análise , Cininas/análise , Masculino , Fatores de Risco
18.
Diabetes Care ; 26(5): 1439-48, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12716802

RESUMO

We examined whether plasma fibrinogen levels and the beta-fibrinogen gene G(-455)-->A polymorphism were related to microvascular or macrovascular disease in patients (n = 909) with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/ EDIC). Univariate regression showed that fibrinogen levels were correlated with BMI (r = 0.15; P < 0.0001), HbA(1c) (r = 0.11; P = 0.0014), total cholesterol (r = 0.17; P < 0.0001), and LDL cholesterol (r = 0.16; P < 0.0001) in all patients. In men, but not women, waist-to-hip ratio (r = 0.20; P < 0.0001) and triglycerides (r = 0.13; P = 0.0047) also became powerful predictors of fibrinogen level; in women, but not men, fibrinogen was correlated with both diastolic (r = 0.16; P = 0.0011) and systolic (r = 0.11; P = 0.0241) blood pressure. Fibrinogen was correlated with urinary albumin excretion rates in men (r = 0.13; P = 0.0033), but not in women. In both sexes, however, the development of proteinuria (albumin excretion >300 mg/24 h) was accompanied by 1.5-fold increment in plasma fibrinogen compared with patients with normal excretion or microalbuminuria. In addition, high fibrinogen levels were associated with a lower average ankle-brachial index in women (r = -0.13; P = 0.0075), but not men. Multiple regression analyses demonstrated that plasma fibrinogen was independently correlated with high albumin excretion rate in men, and with low average ankle-brachial index in women. Fibrinogen was not correlated with the severity of retinopathy. Carotid artery intima-medial thickness was not correlated with fibrinogen, and the G(-455)-->A polymorphism in the 5' promoter region of the beta-fibrinogen gene did not influence circulating fibrinogen levels. However, the presence of the more common G(-455) allele was associated with greater intima-medial thickness in the internal carotid artery (ANCOVA P = 0.045). Last, hyperfibrinogenemia in type 1 diabetes is associated with components of the insulin resistance syndrome trait cluster, and the association is influenced by sex.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 1/genética , Angiopatias Diabéticas/genética , Nefropatias Diabéticas/genética , Fibrinogênio/genética , Doenças Vasculares Periféricas/genética , Adenina , Adulto , Albuminúria/sangue , Albuminúria/genética , Sequência de Bases , Estudos de Coortes , Primers do DNA , Diabetes Mellitus Tipo 1/sangue , Angiopatias Diabéticas/sangue , Nefropatias Diabéticas/sangue , Retinopatia Diabética/sangue , Feminino , Fibrinogênio/análise , Guanina , Humanos , Masculino , Doenças Vasculares Periféricas/sangue , Polimorfismo de Nucleotídeo Único/genética , Análise de Regressão
19.
Diabetes Care ; 26(3): 810-8, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12610042

RESUMO

OBJECTIVE: To relate the nuclear magnetic resonance (NMR)-determined lipoprotein profile, conventional lipid and apolipoprotein measures, and in vitro oxidizibility of LDL with gender and glycemia in type 1 diabetes. RESEARCH DESIGN AND METHODS: In the 1997-1999 Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications (DCCT/EDIC) cohort, serum from 428 women and 540 men were characterized by conventional lipids, NMR, apolipoprotein levels, and LDL susceptibility to in vitro oxidation. Simple and partial correlation coefficients were calculated for each lipoprotein-related parameter versus gender, with and without covariates (age, diabetes duration, concurrent HbA(1c), DCCT randomization, hypertension, BMI, waist-to-hip ratio, and albuminuria). For concurrent HbA(1c), data were analyzed as above, exchanging gender for HbA(1c). Associations were significant if P < 0.05. RESULTS: Although men and women had similar total and LDL cholesterol and triglycerides, men exhibited the following significant percent differences in NMR profiles versus women: small VLDL 41; IDL -30; medium LDL 39; small LDL 21; large HDL -32; small HDL 35; LDL particle concentration 4; VLDL and HDL diameters -8 and -4, respectively. Small VLDL, small HDL, medium LDL (women only), small LDL (men only), and LDL particle concentration were positively correlated, and HDL size was inversely correlated, with concurrent HbA(1c). NMR profile was unrelated to prior DCCT randomization. Susceptibility of LDL to oxidation was unrelated to gender and glycemia. CONCLUSIONS: Male gender and poor glycemia are associated with a potentially more atherogenic NMR lipoprotein profile. Neither gender nor glycemia influence LDL oxidation in vitro.


Assuntos
Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Lipoproteínas/sangue , Adulto , Glicemia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , VLDL-Colesterol/sangue , Estudos de Coortes , Diabetes Mellitus Tipo 1/complicações , Feminino , Hemoglobina A Glicada/análise , Humanos , Hiperglicemia/sangue , Hiperglicemia/complicações , Hiperglicemia/epidemiologia , Lipoproteínas LDL/metabolismo , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Triglicerídeos/sangue
20.
Am J Public Health ; 93(2): 324-9, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12554594

RESUMO

OBJECTIVES: This study examined whether differences in access to health care, health coverage, and socioeconomic status (SES) explained racial differences in influenza and pneumococcal vaccination rates in individuals with diabetes. METHODS: We analyzed data on 1906 individuals from the 1998 National Health Interview Survey. We used multiple logistic regression to adjust for race/ethnicity, age, access to care, health insurance, and SES, and used SUDAAN for statistical analyses to yield national estimates. RESULTS: Whites had higher vaccination rates than did African Americans or Hispanics. After adjustment for covariates, race/ethnicity predicted receipt of both vaccines independent of age, access to care, health care coverage, and SES. CONCLUSIONS: Racial disparity in vaccination rates for adults with diabetes is independent of access to care, health care coverage, and SES.


Assuntos
Diabetes Mellitus/etnologia , Grupos Étnicos/psicologia , Acesso aos Serviços de Saúde , Vacinas contra Influenza/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Vacinas Pneumocócicas/administração & dosagem , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos
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