Dexamethasone promotes tolerance in vivo by enriching CD11clo CD40lo tolerogenic macrophages.

We previously showed that antigen immunization in the presence of the immunosuppressant dexamethasone (a strategy we termed "suppressed immunization") could tolerize established recall responses of T cells. However, the mechanism by which dexamethasone acts as a tolerogenic adjuvant has remained unclear. In the present study, we show that dexamethasone enriches CD11c(lo) CD40(lo) macrophages in a dose-dependent manner in the spleen and peripheral lymph nodes of mice by depleting all other CD11c(+) CD40(+) cells including dendritic cells. The enriched macrophages display a distinct MHC class II (MHC II)(lo) CD86(hi) phenotype. Upon activation by antigen in vivo, CD11c(lo) CD40(lo) macrophages upregulate IL-10, a classic marker for tolerogenic antigen-presenting cells, and elicit a serum IL-10 response. When presenting antigen in vivo, these cells do not elicit recall responses from memory T cells, but rather stimulate the expansion of antigen-specific regulatory T cells. Moreover, the depletion of CD11c(lo) CD40(lo) macrophages during suppressed immunization diminishes the tolerogenic efficacy of the treatment. These results indicate that dexamethasone acts as a tolerogenic adjuvant partly by enriching the CD11c(lo) CD40(lo) tolerogenic macrophages.

Disparities in knowledge of heart attack and stroke symptoms among adult men: an analysis of behavioral risk factor surveillance survey data.

CONTEXT: The staggering burden of myocardial infarction and stroke in men and for men of African-American descent in particular provided the impetus for this study. Morbidity and mortality from these vascular disorders can be reduced by early treatment, which requires correct prehospital identification of symptoms. OBJECTIVE: The purpose of this study was to assess current knowledge of myocardial infarction and stroke symptoms and to examine if there were disparities in knowledge of these among U.S. males. DESIGN: This is a cross-sectional study analyzing public use 2003-2005 Behavioral Risk Factor Surveillance Survey data. Univariate, bivariate and multivariate techniques were used. SETTING: Random-digit-dial telephone survey focused on health risk factors and behaviors. Data collection was done under the direction of the Centers for Disease Control and Prevention. PATIENTS OR OTHER PARTICIPANTS: Data collections targeted noninstitutionalized U.S. adults 18-90 years of age. This study focused on the adult male population. MAIN OUTCOME MEASURES: From the 13 heart attack and stroke symptom knowledge questions asked on the survey, a heart attack and stroke knowledge score was computed for each respondent. RESULTS: Multivariate analysis revealed that both Caucasian and African-American men earning low scores on the knowledge questions were more likely to: have less than a high-school education, have deferred medical care in the past 12 months because of cost and not have health insurance in the past 12 months. African-American men were also more likely to live in households with annual incomes < $35,000 and were more likely to not have a primary care provider; this was not true for Caucasian men. CONCLUSIONS: There is a disparity in myocardial infarction and stroke symptom knowledge along racial and socioeconomic lines. African-American males, poorer individuals and those with lower levels of education had significantly lower scores. Since these subgroups are also among those at higher risk for stroke and myocardial infarction, targeting measures to enhance knowledge in these groups might yield more benefit than programs aimed at the general male populace.

Adolescent daily cigarette smoking: is rural residency a risk factor?

INTRODUCTION: Daily cigarette smoking among US adolescents remains a significant public health problem. Understanding risk is important in order to develop strategies to reduce this type of tobacco use. PURPOSE: The primary objective of this research was to examine whether rural residency is an independent risk factor for being a daily smoker among adolescents ages 12 to 18 years. METHODS: This is a cross-sectional study where univariate, bivariate, and multivariate analyses were performed on a merged 1997-2003 Youth Risk Behavior Surveillance System dataset to determine whether rural residence was a significant risk factor for daily cigarette smoking, after adjusting for demographic factors. RESULTS: Using daily smoking as the dependent variable, initial multivariate analyses revealed that adolescents who lived either in suburban (OR=.34, CI=.32, .36) or urban (OR=.33, CI=.31, .35) locales were less likely to become daily smokers than adolescents living in rural locales. Subsequent logistic regression analysis yielded that rural youths who became daily smokers were more likely to: have used smokeless tobacco products in the past 12 months (OR=1.25, CI=1.04,1.51); be female (OR=1.42, CI=1.23, 1.64); be Caucasian (OR=1.53, CI=1.28, 1.84); have first smoked a whole cigarette when they were 12 years of age or younger (OR=2.08, CI=1.82, 2.38); and have smoked at school in the past 30 days (OR=14.52, CI=11.97, 17.60). CONCLUSIONS: The results indicate that rural residency is a risk factor for tobacco use among US youth.

Results of chart reviews conducted to evaluate primary care patients seen by second and third year family medicine residents for potential adverse polypharmacy.

OBJECTIVE: To determine the prescribing patterns of family medicine residents for patients aged more than 60 years with 2 or more chronic diseases and seen at least twice in a 12 month timeframe. METHODS: This is a descriptive analysis which was based on chart reviews. The setting was the University of Illinois-Rockford Family Practice Residency. Patients aged 60 years with 2 or more chronic diseases who were seen at least twice by second and third year residents. RESULTS: FINDINGS FROM THIS CHART REVIEW INCLUDE: 28.8% of the prescribed medications were not effective for the documented condition, 26.3% of the prescribed doses were incorrect, and 44.5% of the drugs prescribed were not the least expensive alternative. DISCUSSION: This preliminary study suggests a need for a focused intervention with family medicine residents regarding inappropriate polypharmacy issues with older patients.