Plasma Citrate and Succinate Are Associated With Neurocognitive Impairment in Older People With HIV

Abstract Background Neurocognitive impairment (NCI) is associated with monocyte activation in people with HIV (PWH). Activated monocytes increase glycolysis, reduce oxidative phosphorylation, and accumulate citrate and succinate, tricarboxylic acid (TCA) cycle metabolites that promote inflammation—this metabolic shift may contribute to NCI and slowed gait speed in PWH. Methods Plasma citrate and succinate were assayed by liquid chromatography–mass spectrometry from 957 participants upon entry to a multicenter, prospective cohort of older PWH. Logistic, linear, and mixed-effects linear regression models were used to examine associations between entry/baseline TCA cycle metabolites and cross-sectional and longitudinal NCI, neuropsychological test scores (NPZ-4), and gait speed. Results Median age was 51 (range 40–78) years. Each 1 standard deviation (SD) citrate increment was associated with 1.18 higher odds of prevalent NCI at baseline (P = .03), 0.07 SD lower time-updated NPZ-4 score (P = .01), and 0.02 m/s slower time-updated gait speed (P < .0001). Age accentuated these effects. In the oldest age-quartile, higher citrate was associated with 1.64 higher odds of prevalent NCI, 0.17 SD lower NPZ-4, and 0.04 m/s slower gait speed (P ≤ .01 for each). Similar associations were apparent with succinate in the oldest age-quintile, but not with gait speed. In participants without NCI at entry, higher citrate predicted a faster rate of neurocognitive decline. Conclusions Higher plasma citrate and succinate are associated with worse cross-sectional and longitudinal measures of neurocognitive function and gait speed that are age-dependent, supporting the importance of altered bioenergetic metabolism in the pathogenesis of NCI in older PWH.

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Regional Microstructural Integrity in Relation to Gait Speed: The Atherosclerosis Risk in Communities Study

Innovation in Aging ◽

10.1093/geroni/igab046.275 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 72-72

Author(s):

Kevin Sullivan ◽

Chad Blackshear ◽

Timothy Hughes ◽

Rebecca Gottesman ◽

Prashanthi Vemuri ◽

...

Keyword(s):

Corpus Callosum ◽

Gait Speed ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Linear Regression Models ◽

Total Brain Volume ◽

Cross Sectional ◽

Atherosclerosis Risk In Communities ◽

Total Brain ◽

Microstructural Integrity

Abstract Brain imaging-based biomarkers of neuropathology are associated with mobility in older adults, but the relation of regional microstructural integrity to gait speed in the context of a broader neuropathological profile is less understood. We examined cross-sectional associations of microstructural integrity with 4-meter usual-pace gait speed (cm/s) in a subsample of ARIC study participants who completed 3T MRI brain scans with diffusion tensor imaging(2011-13; n=1785; mean age=76.2±5.3, 60% Female, 28% Black). We considered total brain and six regional averages of fractional anisotropy (FA; lower=worse microstructural integrity) and mean diffusivity (MD; higher=worse microstructural integrity): frontal, temporal, parietal, occipital, anterior and posterior corpus callosum. Associations were tested in multivariable linear regression models adjusted for demographics, cardiovascular risk factors, and with and without additional neuropathological indices: total brain volume, white matter hyperintensities, infarcts, and microhemorrhages. When modeled separately, all neuropathology indices were associated with slower gait speed. Every standard deviation(SD) higher total brain FA was associated with +2.56 cm/s gait speed (95%CI: 1.64,3.48) and every SD higher MD was associated with -4.27 cm/s gait speed (-5.34,-3.20). All regional estimates were comparable. When adjusted for all other neuropathology indices, only posterior corpus callosum FA (β=1.72; 0.67,2.77), total MD (β=-1.63; -3.02,-0.25), frontal lobe MD (β=-1.76; -3.03,-0.48), and temporal lobe MD (β=-1.40; -2.78,-0.02) remained significantly associated with gait speed. Microstructural integrity is an informative measure of brain pathology in relation to mobility, with regional measures tied to executive, memory, and somatosensory function being more informative when a broader neuropathological profile is considered.

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SITTING PATTERNS, PHYSICAL ACTIVITY, AND PHYSICAL FUNCTIONING IN OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.072 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S20-S20

Author(s):

Dori E Rosenberg ◽

Mikael Anne Greenwood-Hickman ◽

Rod walker ◽

KatieRose Richmire ◽

Paul Crane ◽

...

Keyword(s):

Physical Activity ◽

Physical Function ◽

Gait Speed ◽

Regression Models ◽

Sitting Time ◽

Linear Regression Models ◽

Cross Sectional ◽

Prolonged Sitting ◽

Change In Mean ◽

Lower Physical Activity

Abstract We examined cross-sectional associations between physical function and device-based (activPAL) sedentary patterns and physical activity. Physical function tasks included time to complete 5 chair stands and walk a 10-foot gait speed course. We estimated associations using linear regression models adjusting for age and sex; coefficients represent estimated change in mean activPAL measures associated with each second increase in gait/chair stands time. Longer gait speed times were associated with more total sitting time (b=0.19, p < 0.01), fewer steps (b=-788.0, p<0.001), fewer sitting breaks (b=-1.7, p<0.01), and more prolonged sitting bouts (b=0.19, p<0.01). Longer chair stand times were associated with more total sitting time (b=0.06, p<0.001), less standing time (b=-0.04, p<0.01), fewer steps (b=-176.8, p<0.001), fewer sitting breaks (b=-0.45, p<0.01), and more prolonged sitting bouts (b=0.07, p<0.001). Prolonged patterns of sitting time and higher total sitting time, in addition to lower physical activity, were consistently associated with worse physical function.

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Classifying Disfluencies in Preschool- and School-Age Spanish–English Bilinguals Who Do Not Stutter: An Exploratory Study

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_persp-19-00164 ◽

2020 ◽

Vol 5 (1) ◽

pp. 119-130

Author(s):

Raúl Rojas ◽

Farzan Irani

Keyword(s):

Exploratory Study ◽

Evidence Base ◽

Medium Effect ◽

Bilingual Children ◽

Linear Regression Models ◽

Cross Sectional ◽

Total Percentage ◽

Narrative Production ◽

Language Measures ◽

Mean Length Of Utterance

Purpose This exploratory study examined the language skills and the type and frequency of disfluencies in the spoken narrative production of Spanish–English bilingual children who do not stutter. Method A cross-sectional sample of 29 bilingual students (16 boys and 13 girls) enrolled in grades prekindergarten through Grade 4 produced a total of 58 narrative retell language samples in English and Spanish. Key outcome measures in each language included the percentage of normal (%ND) and stuttering-like (%SLD) disfluencies, percentage of words in mazes (%MzWds), number of total words, number of different words, and mean length of utterance in words. Results Cross-linguistic, pairwise comparisons revealed significant differences with medium effect sizes for %ND and %MzWds (both lower for English) as well as for number of different words (lower for Spanish). On average, the total percentage of mazed words was higher than 10% in both languages, a pattern driven primarily by %ND; %SLDs were below 1% in both languages. Multiple linear regression models for %ND and %SLD in each language indicated that %MzWds was the primary predictor across languages beyond other language measures and demographic variables. Conclusions The findings extend the evidence base with regard to the frequency and type of disfluencies that can be expected in bilingual children who do not stutter in grades prekindergarten to Grade 4. The data indicate that %MzWds and %ND can similarly index the normal disfluencies of bilingual children during narrative production. The potential clinical implications of the findings from this study are discussed.

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Folate Nutritional Status among Psoriasis Patients not Exposed to Antifolate Drug

Current Nutrition & Food Science ◽

10.2174/1573401314666180702100301 ◽

2020 ◽

Vol 16 (4) ◽

pp. 543-553

Author(s):

Luciana Y. Tomita ◽

Andréia C. da Costa ◽

Solange Andreoni ◽

Luiza K.M. Oyafuso ◽

Vânia D’Almeida ◽

...

Keyword(s):

Folic Acid ◽

Linear Regression ◽

Multiple Linear Regression Model ◽

Folate Intake ◽

Serum Folate ◽

Linear Regression Models ◽

Cross Sectional ◽

Folic Acid Fortification ◽

Plasma Folate ◽

Psoriasis Severity

Background: Folic acid fortification program has been established to prevent tube defects. However, concern has been raised among patients using anti-folate drug, i.e. psoriatic patients, a common, chronic, autoimmune inflammatory skin disease associated with obesity and smoking. Objective: To investigate dietary and circulating folate, vitamin B12 (B12) and homocysteine (hcy) in psoriatic subjects exposed to the national mandatory folic acid fortification program. Methods: Cross-sectional study using the Food Frequency Questionnaire, plasma folate, B12, hcy and psoriasis severity using the Psoriasis Area and Severity Index score. Median, interquartile ranges (IQRs) and linear regression models were conducted to investigate factors associated with plasma folate, B12 and hcy. Results: 82 (73%) mild psoriasis, 18 (16%) moderate and 12 (11%) severe psoriasis. 58% female, 61% non-white, 31% former smokers, and 20% current smokers. Median (IQRs) were 51 (40, 60) years. Only 32% reached the Estimated Average Requirement of folate intake. Folate and B12 deficiencies were observed in 9% and 6% of the blood sample respectively, but hyperhomocysteinaemia in 21%. Severity of psoriasis was negatively correlated with folate and B12 concentrations. In a multiple linear regression model, folate intake contributed positively to 14% of serum folate, and negative predictors were psoriasis severity, smoking habits and saturated fatty acid explaining 29% of circulating folate. Conclusion: Only one third reached dietary intake of folate, but deficiencies of folate and B12 were low. Psoriasis severity was negatively correlated with circulating folate and B12. Stopping smoking and a folate rich diet may be important targets for managing psoriasis.

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Social Engagement and Episodic Memory in Non-Hispanic Black and White Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1101 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 343-343

Author(s):

Abbey Hamlin ◽

A Zarina Kraal ◽

Laura Zahodne

Keyword(s):

Social Support ◽

Older Adults ◽

Episodic Memory ◽

Cognitive Aging ◽

Social Engagement ◽

Future Research ◽

Social Activities ◽

Linear Regression Models ◽

Significant Positive Association ◽

Cross Sectional

Abstract Social engagement may confer cognitive benefits in older adulthood, but studies have typically been restricted to largely non-Hispanic White (NHW) samples. Levels of social engagement vary across race such that NHW report larger social networks, more frequent participation in social activities, and greater social support than non-Hispanic Blacks (NHB). Associations between social engagement and cognition may also vary by race, but research is sparse. The current cross-sectional study examined associations between different aspects of social engagement and episodic memory performance, as well as interactions between social engagement and race among NHB and NHW participants in the Michigan Cognitive Aging Project (N = 247; 48.4% NHB; age = 64.19 ± 2.92). Social engagement (network size, activities, support) was self-reported. Episodic memory was a z-score composite of immediate, delayed, and recognition trials of a list-learning task. Separate hierarchical linear regression models quantified interactions between race and each of the three social engagement variables on episodic memory, controlling for sociodemographics, depressive symptoms, and health conditions. Results showed a main effect of more frequent social activity on better episodic memory, as well as an interaction between race and social support indicating a significant positive association in NHB but not NHW. These preliminary findings suggest that participating in social activities may be equally beneficial for episodic memory across NHB and NHW older adults and that social support may be particularly beneficial for NHB. Future research is needed to determine the potential applications of these results in reducing cognitive inequalities through the development of culturally-relevant interventions.

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Burnout Determinants among Nurses Working in Palliative Care during the Coronavirus Disease 2019 Pandemic

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073358 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3358

Author(s):

José Vítor Gonçalves ◽

Luísa Castro ◽

Guilhermina Rêgo ◽

Rui Nunes

Keyword(s):

Palliative Care ◽

Health Care Professionals ◽

Online Survey ◽

Three Dimensions ◽

Linear Regression Models ◽

Perceived Health Status ◽

Cross Sectional ◽

National Network ◽

Work Related ◽

High Level

Nurses working in palliative care are at risk of burnout. The Copenhagen Burnout Inventory was used to determine burnout levels of nurses working in the Portuguese national network of palliative care. We evaluated the contribution of personal, work, and COVID-19 variables in three burnout subclasses: personal, work, and patient-related. A cross-sectional, exploratory, and quantitative design was employed and participants were sampled using convenience and snowball technique. An online survey was conducted and 153 nurses participated in our study. Socio-demographic characterization was conducted, levels of burnout and determinants were explored through multiple linear regression models for its three dimensions. High levels of personal, working, and patient burnout were present in 71 (46%), 68 (44%), and 33 nurses (22%), respectively. Most of them agreed that COVID-19 had an impact on their activities. Significant personal and work related burnout factors found were specialization in palliative care, self-perceived health status, unit type, weekly hours of work, and allocation to COVID-19 units. Gender was found to be a significant factor in patient-related burnout. There is a high level of burnout among nurses working in the Portuguese national network of palliative care. Measures for identification and mitigation of burnout are necessary to protect health care professionals.

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Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

BMC Psychiatry ◽

10.1186/s12888-021-03180-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhong Li ◽

Sayward E. Harrison ◽

Xiaoming Li ◽

Peiyin Hung

Keyword(s):

Continuity Of Care ◽

Psychiatric Care ◽

The United States ◽

Psychiatric Services ◽

Linear Regression Models ◽

Cross Sectional ◽

Promising Alternative ◽

American Hospital ◽

American Hospital Association ◽

Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

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Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice

BMJ Open ◽

10.1136/bmjopen-2020-039625 ◽

2020 ◽

Vol 10 (11) ◽

pp. e039625

Author(s):

Jason I Chiang ◽

John Furler ◽

Frances Mair ◽

Bhautesh D Jani ◽

Barbara I Nicholl ◽

...

Keyword(s):

Type 2 Diabetes ◽

General Practice ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Linear Regression Models ◽

Sectional Study ◽

Cross Sectional ◽

Long Term Conditions ◽

Australian General Practice

ObjectivesTo explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).DesignCross-sectional study.SettingAustralian general practice.Participants69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.ConclusionsMultimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.

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Starchy Vegetables and Metabolic Syndrome in Costa Rica

Nutrients ◽

10.3390/nu13051639 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1639

Author(s):

Zhongyao Li ◽

Dongqing Wang ◽

Edward A. Ruiz-Narváez ◽

Karen E. Peterson ◽

Hannia Campos ◽

...

Keyword(s):

Metabolic Syndrome ◽

Regression Models ◽

Fasting Blood Glucose ◽

Population Based ◽

Cross Sectional Study ◽

Costa Rican ◽

Least Square ◽

Inverse Association ◽

Linear Regression Models ◽

Cross Sectional

Only a few studies primarily examined the associations between starchy vegetables (other than potatoes) and metabolic syndrome (MetS). We aimed to evaluate the association between starchy vegetables consumption and MetS in a population-based sample of Costa Rican adults. We hypothesized that a higher overall intake of starchy vegetables would not be associated with higher MetS prevalence. In this cross-sectional study, log-binomial regression models were used to estimate prevalence ratios (PRs) of MetS across quintiles of total, unhealthy, healthy starchy vegetables, and individual starchy vegetables (potatoes, purple sweet potatoes, etc.), among 1881 Costa Rican adults. Least square means and 95% confidence intervals (CIs) from linear regression models were estimated for each MetS component by categories of starchy vegetable variables. Higher intakes of starchy vegetables were associated with a higher prevalence of MetS in crude models, but no significant trends were observed after adjusting for confounders. A significant inverse association was observed between total starchy and healthy starchy vegetables consumption and fasting blood glucose. In this population, starchy vegetables might be part of a healthy dietary pattern.

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Associations of cells from both innate and adaptive immunity with lower nerve conduction velocity: the Maastricht Study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001698 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001698

Author(s):

Haifa Maalmi ◽

Kristiaan Wouters ◽

Hans H C M Savelberg ◽

Jeroen H P M van der Velde ◽

Jos P H Reulen ◽

...

Keyword(s):

T Cells ◽

Adaptive Immunity ◽

Conduction Velocity ◽

Nerve Conduction ◽

Nerve Conduction Velocity ◽

Essential Feature ◽

Sensory Nerve ◽

Linear Regression Models ◽

Cross Sectional ◽

Innate And Adaptive Immunity

IntroductionDistal sensorimotor polyneuropathy (DSPN) is common in people with diabetes but is also found in pre-diabetes. Peripheral nerve myelin damage, which can be assessed by reduced nerve conduction velocity (NCV), is an essential feature of DSPN. Emerging evidence indicates that the development of DSPN may involve the activation of the immune system. However, available studies have mainly investigated circulating immune mediators, whereas the role of immune cells remains unclear. Therefore, we aimed to test whether leukocyte subsets are associated with NCV.Research design and methodsThis cross-sectional study analyzed data from 850 individuals (of whom 252 and 118 had type 2 diabetes and pre-diabetes, respectively) of the Maastricht Study. NCV was measured in the peroneal and tibial motor nerves and the sural sensory nerve and summed to calculate a standardized NCV sum score. Associations between percentages of leukocyte subsets and NCV sum scores were estimated using linear regression models adjusted for demographic, lifestyle, metabolic and clinical covariates.ResultsAfter adjustment for covariates, higher percentages of basophils and CD4+ T cells were associated with lower NCV (p=0.014 and p=0.005, respectively). The percentage of CD8+ T cells was positively associated with NCV (p=0.022). These associations were not modified by glucose metabolism status (all pinteraction >0.05). No associations were found for monocytes, eosinophils, neutrophils, lymphocytes, total T cells, Treg cells and B cells.ConclusionsThe associations of basophils, CD4+ and CD8+ T cells with NCV suggest that cell types from both innate and adaptive immunity may be implicated in the development of DSPN.

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