Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults Childhood cumulative risk and later allostatic load: mediating role of substance use. Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study. Social relationships and their biological correlates: Coronary Artery Risk Development in Young Adults (CARDIA) study Contingency management reduces injection-related HIV risk behaviors in heroin and cocaine using outpatients. Application of the high-risk strategy to control dental caries. Allostatic load biomarkers and asthma in adolescents. Improving health behaviours of Latina mothers of youths and adults with intellectual and developmental disabilities. Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. Perceived discrimination among African American adolescents and allostatic load: a longitudinal analysis with buffering effects. Importance of functional measures in predicting mortality among older hospitalized patients. Effects of lifelong intervention with an oligofructose-enriched inulin in rats on general health and lifespan. The relationship between total anticholinergic burden (ACB) and early in-patient hospital mortality and length of stay in the oldest old aged 90 years and over admitted with an acute illness. The 32-year relationship between cholesterol and dementia from midlife to late life Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. Multisystemic therapy for poorly adherent youth with HIV: Results from a pilot randomized controlled trial Childhood psychosocial stressors and adult onset arthritis: Broad spectrum risk factors and allostatic load The case against calcium-based phosphate binders. Severe morbidity and mortality in untreated HIV-infected children in a paediatric care programme in Abidjan, Côte d'Ivoire, 2004-2009 An evaluation of Croí MyAction community lifestyle modification programme compared to standard care to reduce progression to diabetes/pre-diabetes in women with prior gestational diabetes mellitus (GDM): study protocol for a randomised controlled trial Cognitive behaviour therapy reduces dyspnoea ratings in patients with chronic obstructive pulmonary disease (COPD) Comparative Effectiveness on Cognitive Asthma Outcomes of the SHARP Academic Asthma Health Education and Counseling Program and a Non-Academic Program. Response to cholinesterase inhibitors affects lifespan in Alzheimer’s disease
Background Discrimination promotes multisystem physiological dysregulation termed allostatic load , which predicts morbidity and mortality . It remains unclear whether weight-related discrimination influences allostatic load . Purpose The aim of this study was to prospect ively examine 10-year associations between weight discrimination , allostatic load , and its components among adults 25–75 years in the Midlife Development in the US Biomarker Sub study . Methods Participants with information on weight discrimination were analyzed ( n=986 ) . At both timepoints , participants self-reported the frequency of perceived weight discrimination across nine scenarios as “ never/rarely ” ( scored as 0 ) , “ sometimes ” ( 1 ) , or “ often ” ( 2 ) . The two scores were averaged and then dichotomized as “ experienced ” versus “ not experienced ” discrimination . High allostatic load was defined as having ≥3 out of 7 dysregulated systems ( cardiovascular , sympathetic/parasympathetic nervous systems , hypothalamic pituitary axis , inflammatory , lipid/metabolic , and glucose metabolism ) , which collectively included 24 biomarkers . Relative risks ( RR ) were estimated from multivariate models adjusted for sociodemographic and health characteristics , other forms of discrimination , and BMI . Results Over 41 % of the sample had obesity , and 6 % reported weight discrimination at follow-up . In multivariable-adjusted analyses , individuals who experienced ( versus did not experience ) weight discrimination had twice the risk of high allostatic load ( RR , 2.07 ; 95 % CI , 1.21 ; 3.55 for baseline discrimination ; 2.16 , 95 % CI , 1.39 ; 3.36 for long-term discrimination ) . Weight discrimination was associated with lipid/metabolic dysregulation ( 1.56 ; 95 % CI 1.02 , 2.40 ) , glucose metabolism ( 1.99 ; 95 % CI 1.34 , 2.95 ) , and inflammation ( 1.76 ; 95 % CI 1.22 , 2.54 ) , but no other systems . Conclusions Perceived weight discrimination doubles the 10-year risk of high allostatic load . Eliminating weight stigma may reduce physiological dysregulation , improving obesity-related morbidity and mortality OBJECTIVE The present study investigated the long-term impact of exposure to  poverty-related stressors during childhood on allostatic load , an index of physiological dysregulation , and the potential mediating role of substance use . METHOD Participants ( n = 162 ) were rural children from New York State , followed for 8 years ( between the ages 9 and 17 ) .  Poverty- related stress was computed using the cumulative risk approach , assessing stressors across 9 domains , including environmental , psychosocial , and demographic factors . Allostatic load captured a range of physiological responses , including cardiovascular , hypothalamic pituitary adrenal axis , sympathetic adrenal medullary system , and metabolic activity . Smoking and alcohol/drug use were tested as mediators of the hypothesized childhood risk-adolescent allostatic load relationship . RESULTS Cumulative risk exposure at age 9 predicted increases in allostatic load 8 years later . Smoking , but not alcohol and drug use , was a significant mediator of the prospect i ve , longitudinal relationship between childhood cumulative risk and adolescent allostatic load . CONCLUSIONS The present paper contributes to the underst and ing of the role of early life stress in health across the life span and of the mechanisms by which adverse childhood environments impact health as children emerge into early adulthood . This knowledge will have implication s for early intervention efforts Puerto Ricans living in the United States mainl and present multiple disparities in prevalence of chronic diseases , relative to other racial and ethnic groups . Allostatic load ( AL ) , or the cumulative wear and tear of physiological responses to stressors such as major life events , social and environmental burden , has been proposed as a possible mechanism for the inequalities observed in minority groups , but has not been studied in Puerto Ricans . The aim of this study was to determine the association of AL to six chronic diseases ( abdominal obesity , hypertension , diabetes , and self-reported cardiovascular disease ( CVD ) , arthritis and cancer ) in Puerto Ricans , and to contrast AL to metabolic syndrome ( MetS ) . Participants of the Boston Puerto Rican Health Study ( n=1116 , ages 45 - 75 years ) underwent a  home-based interview  , where question naires were completed and biological sample s collected . A summary definition of AL was constructed using clinical ly-defined cutoffs and medication use for 10 physiological parameters in different body systems . Logistic regression models were run to determine associations between AL score and disease status , controlling for age , sex , smoking , alcohol use , physical activity , total fat intake and energy intake . Parallel models were also run with MetS score replacing AL . We found that increasing categories of AL score were significantly associated with abdominal obesity , hypertension , diabetes and self-reported cardiovascular disease ( CVD ) and arthritis , but not with self-reported cancer . The strength of associations of AL with all conditions , except diabetes and cancer , was similar to or larger than those of MetS score . In conclusion , Puerto Rican older adults experienced physiological dysregulation that was associated with increased odds of chronic conditions . AL was more strongly associated with most conditions , compared to MetS , suggesting that this cumulative measure may be a better predictor of disease . These results have prospect i ve research implication s for Puerto Ricans and other ethnic groups OBJECTIVE Analyses test the hypothesis that aspects of social relationships ( quantity of ties , social support and social strain ) are associated with differences in levels of biological risk across multiple major physiological regulatory systems and consequently overall multi-systems risk ( i.e. , allostatic load [ AL ] ) . METHODS Data are from the Coronary Artery Risk Development in Young Adults ( CARDIA ) study --a bi-ethnic , prospect i ve , multi-center epidemiological study , initiated in 1985 - 1986 to track the development of cardiovascular risk in young adulthood ( N=5115 ) . At the year 15 follow-up when participants were between 32 and 45 years of age , additional social and biological data were collected ; biological data used to assess AL were collected at the Oakl and , CA and Chicago , IL sites ( N=844 ) . RESULTS Social strains were most strongly and positively related to overall AL ( Cohen 's d=.79 for highest vs. lowest quartile ) , and to each of its component biological subsystems , independent of social ties and support as well as sociodemographics and health behaviors . Social ties and emotional support were also negatively related to AL ( Cohen 's d=.33 and d=.44 for lowest vs. highest quartiles of ties and support , respectively ) though controls for social strains reduced these associations to non- significance . Social support and social strain were more strongly related to overall AL than to any of its component subscales while social ties were less strongly related to AL and to its component subscales . There was no evidence that effects differed by sex , age or ethnicity . CONCLUSIONS Findings focus attention on the particularly strong relationship between social strains and profiles of biological risk and support the cumulative impact of social factors on biological risks , showing larger effects for cumulative AL than for any of the individual biological systems Intravenous drug use is a major vector of HIV transmission . We assessed whether contingency management ( CM ) , in which participants earn reinforcers for drug abstinence , reduces HIV risk behaviors in methadone-maintained opiate- and cocaine-using out patients . Participants ( n=116 ) were r and omly assigned to  prize-based CM or to receipt of prize draws noncontingently on a schedule yoked to the CM group . Both groups received methadone and individual counseling throughout treatment . The HIV-Risk Taking Behaviour Scale was administered in written question naire form at 2-week intervals ( HRBS ; [ Darke , S. , Hall , W. , Heather , N. , Ward , J. , & Wodak , A. ( 1991 ) . The reliability and validity of a scale to measure HIV risk-taking behaviour among intravenous drug users . AIDS , 5 , 181 - 185 ] ) . A mediation analysis was conducted to determine whether abstinence from opiates and cocaine mediated the effect of CM on HRBS scores . Changes in HRBS scores over time differed significantly by treatment ( F(9,334)=2.4 , p<0.05 ) , with HRBS scores decreasing over time in the CM group to a greater extent than in the noncontingent control group . Participants in the CM group had significantly lower rates of simultaneous cocaine/opiate-positive urine specimens than those in the noncontingent control group during CM treatment ( F(1,111)=6.8 , p=0.01 ) . The relationship between treatment condition and HRBS scores was mediated by abstinence . CM targeted toward cocaine and heroin use produces significant reductions in injection-related drug-taking behaviors associated with heightened risk for getting or transmitting HIV OBJECTIVE The aim of this prospect i ve study was to determine whether a child population with low overall caries frequency benefits when prevention is targeted to high-risk individuals . METHODS Data from clinical examinations and salivary tests were used to assess caries risk in 12-year-olds ( n=1465 ) . Children who were regarded as being at high risk of developing caries were r and omized into two groups . Half ( HRI group ) were offered intensive prevention ( counseling , F-varnish applications , F-lozenges , sealants , chlorhexidine ) , and the other half ( HRB group ) were provided the same basic prevention given to low-risk children ( counseling , one F-varnish application/year ) . A r and om sample of the low-risk children ( LRB ) was followed up for the same 3-year period as the high-risk children . The number of children completing the study was 216 in the LRB group , 199 in the HRI group and 174 in the HRB group . RESULTS The mean ( SD ) 3-year DMFS increment was 2.0 ( 2.4 ) , 4.4 ( 4.7 ) and 5.1 ( 5.0 ) in the LRB , HRI and HRB groups , respectively . Comparison between the LRB and HRB groups revealed that risk assessment was fairly successful in terms of mean DMFS increment . However , 63 % of the children in the LRB group developed at least one new lesion ( max . 12 ) . CONCLUSIONS The negligible difference between the HRI and HRB groups implies that intensifying prevention produced practically no additional benefit . By offering all children only basic prevention , virtually the same preventive effect could have been obtained with substantially less effort and lower costs RATIONALE Allostatic load ( AL ) , a novel measure of the physiologically dysregulated response of the body to stress , represents a biomarker of chronic stress exposure . OBJECTIVES To determine whether preadolescent children with high AL are more susceptible to asthma as adolescents . METHODS This was a prospect i ve evaluation of children recruited at 7 to 10 years of age in the nested case-control arm of the Study of Asthma , Genes and Environment and followed until 11 to 14 years of age .  AL was measured using eight biomarkers : fasting glucose , total cholesterol , high-density lipoprotein cholesterol , dehydroepi and rosterone sulfate , cortisol , systolic and diastolic blood pressure , and waist-to-hip ratio . AL , created from the sum of biomarkers in a high-risk quartile , was related to prevalence and incidence of asthma using logistic regression . MEASUREMENTS AND MAIN RESULTS Among 352 participants followed until 11 to 14 years of age , prevalent asthma was four times more likely in boys with high ( > 3 ) versus low ( ≤2 ) AL after adjusting for current asthma/atopy , age , ethnicity , parental history of asthma , and overweight status . Similar results were observed in the analysis of new-onset asthma in boys ( adjusted odds ratio , 4.35 ; 95 % confidence interval , 1.19 - 15.9 ) . In girls , there were no associations between AL and asthma . In the analysis of a subset of biomarkers , combinations of total cholesterol , glucose , and cortisol were associated with similar or greater risk of asthma prevalence or onset in boys . CONCLUSIONS AL and its biomarkers are associated with an increased likelihood of asthma in adolescent boys . The observed association between AL and asthma may be attributable to a combined subset of AL biomarkers BACKGROUND Latina mothers who care for children with intellectual and developmental disabilities ( IDD ) over the lifespan struggle to take care of their own health needs in the context of their caregiving experience . Services are typically aim ed at the persons with IDD and not their family caregivers . Yet , attending to family caregiver needs may contribute to better long-term care of persons with IDD who remain at home . To address this unmet need , we developed a culturally sensitive health education intervention for Latina mothers who care for youth and adults with IDD . The aim of the intervention is to improve maternal health-related self-efficacy and health behaviours , and to reduce stress . METHOD A r and omised control design was employed to determine preliminary efficacy of the intervention . Paired sample t-tests were conducted to examine within-group changes from baseline to 3-month post-test . Repeated- measures analysis of covariance was used to examine the group-by-time interaction effects . RESULTS Intervention participants showed greater increases between pre- and post-test in health-related self-efficacy ; self-care , nutrition and overall health behaviours . Both groups reported decreases in depressive symptoms and caregiver burden . CONCLUSIONS While additional research is needed to determine long-term effects and to replicate findings , our results suggest that this culturally sensitive health intervention is a promising way to increase health behaviours which may lead to overall good health for Latina mothers who care for children with IDD across the lifespan AIM Contingency management ( CM ) is efficacious in reducing drug use . This study examined whether CM also reduces human immunodeficiency virus ( HIV ) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment . DESIGN Data were analyzed from a subset of participants in a combined data set of three published r and omized controlled trials of CM treatments . SETTING A community-based methadone maintenance clinic . PARTICIPANTS One-hundred and sixty-five cocaine-abusing methadone maintenance patients . INTERVENTION Participants received either st and ard methadone treatment or st and ard methadone treatment with CM for 3 months . MEASUREMENTS The HIV Risk Behavior Scale ( HRBS ) was administered prior to r and omization to a study condition and 3 months after the study treatments ended . The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment . FINDINGS Relative to those assigned to st and ard care , participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors .  CM participants also achieved longer duration s of consecutive cocaine and opioid abstinence during treatment . Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores . CONCLUSIONS These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients This study was design ed to examine the prospect i ve relations of perceived racial discrimination with allostatic load ( AL ) , along with a possible buffer of the association . A sample of 331 African Americans in the rural South provided assessment s of perceived discrimination from ages 16 to 18 years . When youth were 18 years ,  caregivers reported parental emotional support and youth assessed peer emotional support . AL and potential confounder variables were assessed when youth were 20 . Latent growth mixture modeling identified two perceived discrimination classes : high and stable , and low and increasing . Adolescents in the high and stable class evinced heightened AL even with confounder variables controlled . The racial discrimination to AL link was not significant for young adults who received high emotional support CONTEXT Measures of physical and cognitive function are strong prognostic predictors of hospital outcomes for older persons , but current risk adjustment and burden of illness assessment indices do not include these measures . OBJECTIVE To evaluate and vali date the contribution of functional measures to the ability of 5 st and ard burden of illness indices ( Charlson , Acute Physiology and Chronic Health Evaluation [ APACHE ] II , Disease Staging , All Patient Refined Diagnosis Related Groups , and a clinician 's subjective rating ) in predicting 90-day and 2-year mortality among older hospitalized patients . DESIGN Two prospect i ve cohort studies . SETTING General medicine service , university teaching hospital . PATIENTS For the development cohort , 207 consecutive patients aged 70 years or older , and for the validation cohort , 318 comparable patients . MAIN OUTCOME MEASURE Death within 90 days and 2 years from the index admission . RESULTS In the development cohort , 29 patients ( 14 % ) and 81 patients ( 39 % ) died within 90 days and 2 years , respectively . A functional axis was developed using 3 independent risk factors : impairment in instrumental activities of daily living , Mini-Mental State Examination score of less than 20 , and shortened Geriatric Depression Scale score of 7 or higher , creating low- , intermediate- , and high-risk groups with associated mortality rates of 20 % , 32 % , and 60 % , respectively ( P<.001 ) ; the C statistic for the final model was 0.69 . The corresponding mortality rates in the validation cohort , in which 59 ( 19 % ) and 138 ( 43 % ) died within 90 days and 2 years , respectively , were 24 % , 45 % , and 60 % ( P<.001 ) ; the C statistic for the final model was 0.66 . For each burden of illness index , the functional axis contributed significantly to the predictive ability of the model for both 90 days and 2 years . When the functional axis and each burden of illness measure were analyzed in cross-stratified format , mortality rates increased progressively from low-risk to high-risk functional groups within strata of burden of illness indices ( double-gradient phenomenon ) . The contributions of functional and burden of illness measures were substantive and interrelated . CONCLUSIONS Functional measures are strong predictors of 90-day and 2-year mortality after hospitalization . Furthermore , these measures contribute substantially to the prognostic ability of 5 burden of illness indices . Optimal risk adjustment for older hospitalized patients should incorporate functional status variables Ageing is associated with changes in physiology and morphology ; nutritional strategies to decrease morbidity and to prolong life are of high interest . The aim of the study was to investigate the effects of lifelong supplementation with an oligofructose-enriched inulin on morphological and biological markers and lifespan in male and female rats . Male and female rats , age 3 months , were r and omised into two groups to receive either a diet with 10 % of an oligofructose-enriched inulin ( Synergy 1 ) or a st and ard diet ( control ) for 27 months . The rats were weighed every 2 weeks and their food intake was evaluated on four successive days every 4 - 6 weeks . Sample s were taken at 12 , 18 and 24 months of age . During the whole intervention period , male rats receiving Synergy 1 ( SYN1-M ) displayed lower body weight , cholesterol and plasma triacylglycerolaemia compared with the controls ( Cont-M ) . The survival rate at 24 months of age of SYN1-M rats was 35.3 % greater than that of Cont-M rats . In female rats , the Synergy 1 supplementation ( SYN1-F ) group also reduced body weight , cholesterol and triacylglycerolaemia levels , but results were less consistent over the experiment . The survival rate at 24 months of age in SYN1-F rats was 33.3 % greater compared with that of the control ( Cont-F ) group . To conclude , lifelong intervention with Synergy 1 improved biological markers during ageing and survival rate ( lifespan ) of rats The use of prescription drugs in older people is high and many commonly prescribed drugs have anticholinergic effects . We examined the relationship between ACB on mortality and in-patient length of stay in the oldest old hospitalised population . This was a retrospective analysis of prospect i ve audit using hospital audit data from acute medical admissions in three hospitals in Engl and and Scotl and . Baseline use of possible or definite anticholinergics was determined according to the Anticholinergic Cognitive Burden Scale . The main outcome measures were decline in-hospital mortality , early in-hospital mortality at 3- and 7-days and in-patient length of stay .  A total of 419 patients ( including 65 patients with known dementia ) were included [ median age=92.9 , inter-quartile range ( IQR ) 91.4 - 95.1 years ] . 256 ( 61.1 % ) were taking anticholinergic medications .  Younger age , greater number of pre-morbid conditions , ischemic heart disease , number of medications , higher urea and creatinine levels were significantly associated with higher total ACB burden on univariate regression analysis . There were no significant differences observed in terms of in-patient mortality , in-patient hospital mortality within 3- and 7-days and likelihood of prolonged length of hospital stay between ACB categories . Compared to those without cardiovascular disease , patients with cardiovascular disease showed similar outcome regardless of ACB load ( either = 0 or > 0 ACB ) . We found no association between ACB and early ( within 3- and 7-days ) and in-patient mortality and hospital length of stay outcomes in this cohort of oldest old in the acute medical admission setting Background : Cellular and animal studies suggest that hypercholesterolemia contributes to Alzheimer disease ( AD ) . However , the relationship between cholesterol and dementia at the population level is less clear and may vary over the lifespan . Methods : The Prospect i ve Population Study of Women , consisting of 1,462 women without dementia aged 38–60 years , was initiated in 1968–1969 in Gothenburg , Sweden . Follow-ups were conducted in 1974–1975 , 1980–1981 , 1992–1993 , and 2000–2001 . All-cause dementia was diagnosed according to DSM-III-R criteria and AD according to National Institute of Neurological and Communicative Disorders and Stroke – Alzheimer 's Disease and Related Disorders Association criteria . Cox proportional hazards regression examined baseline , time-dependent , and change in cholesterol levels in relation to incident dementia and AD among all participants . Analyses were repeated among participants who survived to the age of 70 years or older and participated in the 2000–2001 examination . Results : Higher cholesterol level in 1968 was not associated with an increased risk of AD ( highest vs lowest quartile : hazard ratio [ HR ] 2.82 , 95 % confidence interval [ CI ] 0.94–8.43 ) among those who survived to and participated in the 2000–2001 examination . While there was no association between cholesterol level and dementia when considering all participants over 32 years , a time-dependent decrease in cholesterol over the follow-up was associated with an increased risk of dementia ( HR 2.35 , 95 % CI 1.22–4.58 ) . Conclusion : These data suggest that midlife cholesterol level is not associated with an increased risk of AD . However , there may be a slight risk among those surviving to an age at risk for dementia . Declining cholesterol levels from midlife to late life may better predict AD risk than levels obtained at one timepoint prior to dementia onset . Analytic strategies examining this and other risk factors across the lifespan may affect interpretation of results CONTEXT There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity . Research ers have also suggested that the combination of loss , prolonged distress , the physical dem and s of caregiving , and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems , leading to increased mortality . OBJECTIVE To examine the relationship between caregiving dem and s among older spousal caregivers and 4-year all-cause mortality , controlling for sociodemographic factors , prevalent clinical disease , and sub clinical disease at baseline . DESIGN Prospect i ve population -based cohort study , from 1993 through 1998 with an average of 4.5 years of follow-up . SETTING Four US communities . PARTICIPANTS A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses . MAIN OUTCOME MEASURE Four-year mortality , based on level of caregiving : ( 1 ) spouse not disabled ; ( 2 ) spouse disabled and not helping ; ( 3 ) spouse disabled and helping with no strain reported ; or(4 ) spouse disabled and helping with mental or emotional strain  reported . RESULTS After 4 years of follow-up , 103 participants ( 12.6 % ) died . After adjusting for sociodemographic factors , prevalent disease , and sub clinical cardiovascular disease , participants who were providing care and experiencing caregiver strain had mortality risks that were 63 % higher than noncaregiving controls ( relative risk [ RR ] , 1.63 ; 95 % confidence interval [ CI ] , 1.00 - 2.65 ) . Participants who were providing care but not experiencing strain ( RR , 1.08 ; 95 % CI , 0.61 - 1.90 ) and those with a disabled spouse who were not providing care ( RR , 1.37 ; 95 % CI , 0.73 - 2.58 ) did not have elevated adjusted mortality rates relative to the noncaregiving controls . CONCLUSIONS Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality  among elderly spousal caregivers . Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls Abstract Adherence to antiretroviral medication for the treatment of HIV is a significant predictor of virologic suppression and is associated with dramatic reductions in mortality and morbidity and other improved clinical outcomes for pediatric patient population s. Effective strategies for addressing adherence problems in youth infected with HIV are needed and require significant attention to the complex interplay of multiple , interacting causal risk factors that lead to poor self-care . Within the context of a pilot r and omized trial , we evaluated the feasibility and initial efficacy of a multisystemic therapy ( MST ) intervention adapted to address HIV medication adherence problems against a usual care condition that was bolstered with a single session of motivational interviewing ( MI ) . For 34 participating youth , health outcomes ( viral load [ VL ] and CD4 count ) were obtained from approximately 10 months pre-baseline through approximately 6 months post-baseline and self-reported medication adherence outcomes were obtained quarterly from baseline through 9 months post-baseline . Using mixed-effects regression models we examined within- and between-groups differences in the slopes of these outcomes . Feasibility was supported , with a 77 % recruitment rate and near-maximal treatment and research retention and completion rates . Initial efficacy also was supported , with the MST condition but not the MI condition demonstrating statistically and clinical ly significant VL reductions following the start of treatment . There was also some support for improved CD4 count and self-reported medication adherence for the MST but not the MI condition . MST was successfully adapted to improve the health outcomes of youth poorly adherent to antiretroviral medications . Replication trials and studies design ed to identify the mechanisms of action are important next steps ABSTRACT Neural , endocrine , and immune stress mediators are hypothesized to increase risks of diverse chronic diseases , including arthritis . Retrospective data from the World Mental Health Surveys ( N = 18,309 ) were employed to assess whether adult onset of arthritis was associated with childhood adversities and early onset psychological disorder . Cox proportional hazard models assessed the association of number of childhood adversities and the presence of early onset psychological disorder with arthritis age of onset . Controlling for age , sex , and early onset mental disorder , relative to persons with no childhood adversities , persons with two adversities had an increased risk of adult onset arthritis ( hazard ratio = 1.27 , 95 % CI = 1.08 , 1.50 ) , while persons with three or more adversities had a higher risk ( HR = 1.44 , CI = 1.24 , 1.67 ) . Early onset depressive and /or anxiety disorder was associated with an increased risk of adult onset arthritis after controlling for childhood adversities ( HR = 1.43 , CI = 1.28 , 1.61 ) . Since psychosocial stressors may be broad spectrum risk factors that increase risks of diverse chronic conditions in later life ( e.g. arthritis , heart disease , diabetes , asthma , and chronic pain ) , prospect i ve studies of childhood psychosocial stressors may be most productive if multiple disease outcomes are assessed in the same study . Results from this study provide method ological guidance for future prospect i ve studies of the relationship between childhood psychosocial stressors and subsequent risk of adult onset arthritis Disturbances of mineral metabolism are associated with significant morbidity and mortality in patients with chronic kidney disease . Unfortunately , some of the treatments for these disturbances also have been found to be associated with morbidity . More recently , there is increasing evidence in the form of prospect i ve , r and omized trials that the use of calcium-based phosphate binders contributes to progressive coronary artery and aorta calcification compared with the non-calcium-containing binder sevelamer . Moreover , there is compelling biologic plausibility that hyperphosphatemia and excess exogenous calcium administration can accelerate vascular calcification . Unfortunately , there is no bedside test that can determine whether there is a dose of calcium salts ( either as maintenance or as cumulative dose ) that can be administered safely , and , unfortunately , the serum calcium concentration does not reflect calcium balance . Therefore , calcium-based phosphate binders should be avoided in many , if not most , patients who are undergoing dialysis Background Clinical evolution of HIV-infected children who have not yet initiated antiretroviral treatment ( ART ) is poorly understood in Africa . We describe severe morbidity and mortality of untreated HIV-infected children . Methods All HIV-infected children enrolled from 2004 - 2009 in a prospect i ve HIV programme in two health facilities in Abidjan , Côte d'Ivoire , were eligible from their time of inclusion . Risks of severe morbidity ( the first clinical event leading to death or hospitalisation ) and mortality were documented retrospectively and estimated using cumulative incidence functions . Associations with baseline characteristics were assessed by competing risk regression models between outcomes and antiretroviral initiation . Results 405 children were included at a median age of 4.5 years ; at baseline , 66.9 % were receiving cotrimoxazole prophylaxis , and 27.7 % met the 2006 WHO criteria for immunodeficiency by age . The risk of developing a severe morbid event was 14 % ( 95%CI : 10.7 - 17.8 ) at 18 months ; this risk was lower in children previously exposed to any prevention of mother-to-child-transmission ( PMTCT ) intervention ( adjusted subdistribution hazard ratio [ sHR ] : 0.16 , 95 % CI : 0.04 - 0.71 ) versus those without known exposure . Cumulative mortality reached 5.5 % ( 95%CI : 3.5 - 8.1 ) at 18 months . Mortality was associated with immunodeficiency ( sHR : 6.02 , 95 % CI : 1.28 - 28.42 ) . Conclusions Having benefited from early access to care minimizes the severe morbidity risk for children who acquire HIV . Despite the receipt of cotrimoxazole prophylaxis , the risk of severe morbidity and mortality remains high in untreated HIV-infected children . Such evidence adds arguments to promote earlier access to ART in HIV-infected children in Africa and improve care interventions in a context where treatment is still not available to all Background Universal screening using the International Association of Diabetes and Pregnancy Study Groups ( IADPSG ) criteria has identified a prevalence of gestational diabetes mellitus ( GDM ) of 12.4 % in women living in Irel and . Women with prior GDM are at increased risk of developing type 2 diabetes later in life . A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes , and medical management . No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM . Through a two-group , parallel r and omised controlled trial ( RCT ) , this study aims to assess the clinical impact , cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM . Methods / Design A total of 54 women with a history of GDM and persistent post-partum glucose dysfunction ( impaired glucose tolerance ( IGT ) or impaired fasting glucose ( IFG ) ) , are r and omly assigned to a  control arm ( n = 27 ) or to the Croí MyAction intervention group ( n = 27 ) . The control arm receives usual health care advice - written information on diet and lifestyle changes for reducing diabetes risks and visits with general practitioners as required . The intervention group receives usual health care as per the control group in addition to attending a 12-week intensive lifestyle modification programme known as Croí MyAction . Croí MyAction involves 2.5 hour sessions once per week ( for 12 weeks ) comprising a group exercise programme , group health promotion or education seminars , and one-to-one meetings with a multidisciplinary health care team to personalise risk factor reductions . R and omisation and allocation to the intervention arms is carried out by an independent research er , ensuring that the allocation sequence is concealed from study research ers until the interventions are assigned . The primary analysis is based on glucose dysfunction , comparing a mean reduction in fasting plasma glucose ( FPG ) levels on a 75 gram oral glucose tolerance test ( OGTT ) in the two groups at a one-year , post-intervention follow-up . The trial is funded by the Irish Health Research Board ( HRB ) . Ethics approval was obtained on 27 March 2012 from the Clinical Research Ethics Committee , Galway University Hospitals , Health Service Executive of Irel and ( Ref : C.A.691).Trial registration Current Controlled Trials IS RCT N41202110 There is evidence that psychological factors contribute to the perception of increased difficulty of breathing in patients with chronic obstructive pulmonary disease ( COPD ) , and increase morbidity . We tested the hypothesis that cognitive behaviour therapy ( CBT ) decreases ratings of perceived dyspnoea in response to resistive loading in patients with COPD . From 31 patients with COPD , 18 were r and omised to four sessions of specifically targeted CBT and 13 to routine care . Prior to r and omisation , participants were tested with an inspiratory external resistive load protocol ( loads between 5 and 45cmH2O/L/s ) . Six months later , we re-measured perceived dyspnoea in response to the same inspiratory resistive loads and compared results to measurements prior to r and omisation . There was a significant 17 % reduction in dyspnoea ratings across the loads for the CBT group , and no reduction for the routine care group . The decrease in ratings of dyspnoea suggests that CBT to alleviate breathing discomfort may have a role in the routine treatment of people with COPD Asthma morbidity and mortality is higher among older school-age children and early adolescents than other age groups across the lifespan . NIH recommended exp and ing asthma education to schools and community setting s to meet cognitive outcomes that have an impact on morbidity and mortality . Guided by the acceptance of asthma model , an evidence -guided , comprehensive school-based academic health education and counseling program , Staying Healthy-Asthma Responsible & Prepared ™ ( SHARP ) , was developed . The program complements existing school curricula by integrating biology , psychology , and sociology content with related spelling , math , and reading and writing assignments . Feasibility , benefits , and efficacy have been established . We compared the effectiveness of SHARP to a non-academic program , Open Airways for Schools , in improving asthma knowledge and reasoning about symptom management . A two-group , cluster-r and omized , single-blinded design was used with a sample of 205 students in grade s 4 - 5 with asthma and their caregivers . Schools were matched prior to r and omization . The unit of analysis was the student . Certified elementary school teachers delivered the programs during instructional time . Data were collected from student/caregiver dyads at baseline and at 1 , 12 , and 24 months after the intervention . In multilevel modeling , students enrolled in the academic SHARP program demonstrated significant ( p < .001 ) improvement in asthma knowledge and reasoning over students enrolled in the non-academic program . Knowledge advantages were retained at 24 months . Findings support delivery in schools of the SHARP academic health education program for students with asthma Background A varying response to cholinesterase inhibitor ( ChEI ) treatment has been reported among patients with Alzheimer 's disease ( AD ) . Whether the individual-specific response , specific ChEI agent or dose affects mortality is unclear . We aim ed to examine the relationship between the 6-month response to ChEI and lifespan . Methods Six hundred and eighty-one deceased patients with a clinical AD diagnosis and a Mini-Mental State Examination ( MMSE ) score of 10 - 26 at the start of ChEI therapy ( baseline ) were included in a prospect i ve , observational , multicentre study in clinical practice . At baseline and after 6 months of treatment , the participants were assessed using the  MMSE , the Alzheimer 's Disease Assessment Scale-cognitive subscale ( ADAS-cog ) , the Clinician 's Interview-Based Impression of Change ( CIBIC ) , the Instrumental Activities of Daily Living ( IADL ) scale , and the Physical Self-Maintenance Scale ( PSMS ) . The individuals ' socio-demographic characteristics , ChEI dose , and date of death were recorded . Responses to ChEI and the association of possible risk factors with survival were analysed using general linear models . Results A longer lifespan ( mean of 0.5 years ) was observed among the improved/unchanged patients , as measured by MMSE or CIBIC score , but not by ADAS-cog score , after 6 months of ChEI therapy . In the multivariate models , increased survival time was independently related to a better 6-month response in MMSE , CIBIC , IADL , and PSMS scores , female sex , no antihypertensive/cardiac or antidiabetic therapy , younger age , lower education , milder disease stage at baseline , and higher ChEI dose . Apolipoprotein E genotype did not affect mortality significantly . The patients who received a higher ChEI dose during the first 6 months had a mean lifespan after baseline that was 15 months longer than that of those who received a lower dose . Conclusions A better short-term response to ChEI might prolong survival in naturalistic AD patients . In individuals who received and tolerated higher ChEI doses , a longer lifespan can be expected
Lifestyle coping behaviours therefore have a significant contribution to AL .
This study is among the first to explore multiple domains of HRB in relation to AL .
Health risk behaviours ( HRB ) across the lifespan have been associated with higher cumulative physiological burden as measured by allostatic load ( AL ) .
This study examines the contribution of HRB and their effects on multisystem biological risk associated with morbidity and early mortality .