Development Of Chronic Conditions Research Articles

Racial inequalities in the development of multimorbidity of chronic conditions: results from a Brazilian prospective cohort

BackgroundThe occurrence of multimorbidity and its impacts have differentially affected population subgroups. Evidence on its incidence has mainly come from high-income regions, with limited exploration of racial disparities. This study investigated the association between racial groups and the development of multimorbidity and chronic conditions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).MethodsData from self-reported white, brown (pardos or mixed-race), and black participants at baseline of ELSA-Brasil (2008–2010) who were at risk for multimorbidity were analysed. The development of chronic conditions was assessed through in-person visits and self-reported diagnosis via telephone until the third follow-up visit (2017–2019). Multimorbidity was defined when, at the follow-up visit, the participant had two or more morbidities. Cumulative incidences, incidence rates, and adjusted incidence rate ratios (IRRs) were estimated using Poisson models.ResultsOver an 8.3-year follow-up, compared to white participants: browns had a 27% greater incidence of hypertension and obesity; and blacks had a 62% and 45% greater incidence, respectively. Blacks also had 58% more diabetes. The cancer incidence was greater among whites. Multimorbidity affected 41% of the participants, with a crude incidence rate of 57.5 cases per 1000 person-years (ranging from 56.3 for whites to 63.9 for blacks). Adjusted estimates showed a 20% higher incidence of multimorbidity in black participants compared to white participants (IRR: 1.20; 95% CI: 1.05–1.38).ConclusionsSignificant racial disparities in the risk of chronic conditions and multimorbidity were observed. Many associations revealed a gradient increase in illness risk according to darker skin tones. Addressing fundamental causes such as racism and racial discrimination, alongside considering social determinants of health, is vital for comprehensive multimorbidity care. Intersectoral, equitable policies are essential for ensuring health rights for historically marginalized groups.

Prenatal progesterone treatment modulates fetal brain transcriptome and impacts adult offspring behavior in mice

Maternal exposure to elevated levels of steroid hormones during pregnancy is associated with the development of chronic conditions in offspring that manifest in adulthood. However, the effects of progesterone (P4) administration during early pregnancy on fetal development and subsequent offspring behavior remain poorly understood. In this study, we aimed to investigate the effects of P4 treatment during early pregnancy on the transcript abundance in the fetal brain and assess the behavioral consequences in the offspring during adolescence and adulthood. Using RNA-seq analysis, we examined the impact of P4 treatment on the fetal brain transcriptome in a dosage-dependent manner. Our results revealed differential regulation of genes involved in neurotransmitter transport, synaptic transmission, and transcriptional regulation. Specifically, we observed bidirectional regulation of transcription factors (TFs) by P4 at different doses, highlighting the critical role of these TFs in neurodevelopment. To assess behavioral outcomes, we conducted open field and elevated plus maze tests. Offspring treated with low-dose P4 (LP4) displayed increased exploratory behavior during both adolescence and adulthood. In contrast, the high-dose P4 (HP4) group exhibited impaired exploration and heightened anxiety-like behaviors compared to the control mice. Moreover, in a novel object recognition test, HP4-treated offspring demonstrated impaired object recognition memory during both developmental stages. Additionally, both LP4 and HP4 groups showed reduced social interaction in the three-chamber test. These results suggest that prenatal exposure to P4 exerts a notable influence on the expression of genes associated with neurodevelopment and may induce alterations in behavioral characteristics in progeny, highlighting the need to monitor progesterone levels during pregnancy for long-term impacts on fetal brain development and behavior.

Immunomodulation of wound healing leading to efferocytosis.

Effectively eliminating apoptotic cells is precisely controlled by a variety of signaling molecules and a phagocytic effect known as efferocytosis. Abnormalities in efferocytosis may bring about the development of chronic conditions, including angiocardiopathy, chronic inflammatory diseases and autoimmune diseases. During wound healing, failure of efferocytosis leads to the collection of apoptosis, the release of necrotic material and chronic wounds that are difficult to heal. In addition to the traditional phagocytes-macrophages, other important cell species including dendritic cells, neutrophils, vascular endothelial cells, fibroblasts and keratinocytes contribute to wounding healing. This review summarizes how efferocytosis-mediated immunomodulation plays a repair-promoting role in wound healing, providing new insights for patients suffering from various cutaneous wounds.

Overweight and Obesity Among In-School Children and Adolescents (5-19 Years) in Ghana: A Scoping Review of Prevalence and Risk Factors.

Overweight and obesity are linked to the severity of infections and the development of chronic conditions among children and adolescents in Ghana. Hence, estimating the current prevalence and its determinants is imperative to guide public health interventions. This review mapped evidence on the prevalence and determinants of overweight and obesity among in-school children and adolescents (aged 5-19 years) in Ghana. Three main databases (PubMed, Central, and JSTOR) were searched for studies conducted in Ghana. Also, the study included only studies published online between 2010 and 2022. The search produced 1214 records, with an additional 23 identified through a search conducted in Google, Google Scholar, the WHO library, HINARI, and institutional repositories. After a thorough screening, 24 records were synthesized. The prevalence of overweight/obesity among the 23,663 in-school children and adolescents in Ghana was 0.5%-47.06%. Females have higher odds of being overweight than males. In addition, lack of nutrition and physical activity (PA) knowledge and low participation in school sports and physical activities exposed in-school children and adolescents in Ghana to overweight and obesity. Consumption of unhealthy foods, late bed, smoking, loneliness, watching television, and playing computer games exposed schoolchildren and adolescents in Ghana to overweight and obesity. There are relatively high levels of overweight and obesity among school-going children and adolescents in Ghana. Addressing sex gaps in PA, ensuring healthy eating, and limiting sedentary lifestyles is the surest way to promote healthy weight among in-school children and adolescents in Ghana.

MECHANISMS UNDERLYING SLEEP AND DEVELOPMENT OF CHRONIC CONDITIONS IN OLDER ADULTS

Abstract Mounting evidence suggests poor sleep is associated with the development of chronic conditions. Numerous mechanisms for these links have been proposed, including inflammation, metabolic function, and brain structure. In this symposium, we will present five studies focused on links between poor sleep and subsequent development of chronic disease across adulthood. Specifically, we will examine this relationship at multiple levels from the cellular to the clinical level with the ultimate goal of identifying potential mechanisms and consequences of links between poor sleep and chronic conditions. Paper 1 will identify within-person patterns of various sleep experiences and link them to incident chronic conditions over a 10-year period. Paper 2 will examine associations between sleep parameters, measured via wrist actigraphy, and levels of adipokines, which are adipose-derived cytokines associated with development of metabolic disease. In Paper 3, we will shift our focus to examine the association between poor sleep and inflammatory biomarkers, specifically C-reactive protein, circulating and lipopolysaccharide-stimulated cytokines. Paper 4 will assess the impact of poor sleep health on fear of falling and actual falls. Paper 5 will focus on the effects of poor sleep and arousal with cognition and brain structure, specifically within a population of patients with chronic pain. As Discussant, Dr. Christina McCrae will integrate these findings and suggest directions for future research. In summary, our symposium will elucidate biological and psychological mechanisms linking poor sleep to manifestation of chronic disease. Better understanding of these mechanisms will inform the development of interventions to promote successful aging.

The PSY-SIM Model: Using Real-World Data to Inform Health Care Policy for Individuals With Chronic Psychotic Disorders.

Few microsimulation models have been developed for chronic psychotic disorders, severe and disabling mental disorders associated with poor medical and psychiatric outcomes, and high costs of care. The objective of this work was to develop a microsimulation model for individuals with chronic psychotic disorders and to use the model to examine the impact of a smoking cessation initiative on patient outcomes. Using health records and survey data from Ontario, Canada, the PSY-SIM model was developed to simulate health and cost outcomes of individuals with chronic psychotic disorders. The model was then used to examine the impact of the Smoking Treatment for Ontario Patients (STOP) program from Ontario on the development of chronic conditions, life expectancy, quality of life, and lifetime health care costs. Individuals with chronic psychotic disorders had a lifetime risk of 63% for congestive heart failure and roughly 50% for respiratory disease, cancer and diabetes, and a life expectancy of 76 years. The model suggests the STOP program can reduce morbidity and lead to survival and quality of life gains with modest increases in health care costs. At a long-term quit rate of 4.4%, the incremental cost-effectiveness ratio of the STOP program was $41,936/QALY compared with status quo. Smoking cessation initiatives among individuals with chronic psychotic disorders can be cost-effective. These findings will be relevant for decision-makers and clinicians looking to improving health outcomes among this patient population.

Anthropometric measures, predicted visceral adipose tissue and biomarkers of chronic inflammation.

Evidence has linked low-grade systemic inflammation and visceral adipose tissue (VAT) with development of chronic conditions. Cytokines and select proteins released by VAT may promote a low-grade inflammatory response. A number of equations have been developed to estimate VAT levels. In this study, we compared predicted VAT equation relationships with biomarkers of inflammation. This was a cross-sectional study of 2038 men and women aged 46-73 years. Correlation and linear regression analyses were performed to examine inflammatory biomarker relationships with four commonly assessed anthropometric measures and 10 predicted VAT equations. Compared with anthropometric measures, predicted VAT equations were found to explain a greater proportion of variance in CRP (R2 = .075, p = .001), IL-6 (R2 = .060, p = .001), TNF-α (R2 = .017, p = .005), resistin (R2 = .011, p = .012), monocyte (R2 = .027, p = .001), eosinophil (R2 = .012, p = .01) and basophil (R2 = .015, p = .002) levels in males, and a greater variance in concentrations of C3 (R2 = .175, p = .001), IL-6 (R2 = .090, p = .001), TNF-α (R2 = .036, p = .001), adiponectin (R2 = .121, p = .001), the adiponectin-to-leptin ratio (R2 = .444, p = .001), resistin (R2 = .025, p = .001), white blood cell count (R2 = .057, p = .001), neutrophils (R2 = .061, p = .001) and lymphocytes (R2 = .020, p = .001) in females. Equations for assessing VAT levels might be useful to characterise metabolic health. Further studies that examine predicted VAT relationships with disease and mortality outcomes are warranted.

ВЛИЯНИЕ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ НА РАЗВИТИЕ ХРОНИЧЕСКОЙ НЕИНФЕКЦИОННОЙ ПАТОЛОГИИ СИСТЕМАТИЧЕСКИЙ ОБЗОР

Significance. COVID-19, a severe acute respiratory syndrome–associated coronavirus disease, has quickly spread around the world, affecting millions of people in different countries. This infection has affected various organs and systems and increased the risk of complications of chronic non-communicable diseases, but also contributed to the emergence of new cases. The scale and consequences of COVID-19 necessitate medical professionals and health systems better understand COVID19 possible outcomes for the patient, including the development of chronic non-communicable diseases (NCD) that the virus can cause. However, not all of them are known to medical professionals; adequate response measures are unknown either. The purpose of the study was to analyze effects of COVID-19 on the NCD development and aggravation. Material and methods. The systematic review is based on 64 publications on the effect of COVID-19 on various organs and systems and aggravated NCD that were published from 01.04.2020 to 31.01.2023. The publications were searched in PubMed, Google Scholar и eLibrary. Results. Patients with concomitant diseases are at higher risks for severe COVID-19 with adverse outcomes. COVID-19 can cause NCD in healthy people and facilitate the development of comorbidities in patients under medical follow-up for another condition. Conclusion. Proceeding from the study results, it is important both to understand the degree of the COVID-19 impact on the development of chronic conditions in patients, and keep in mind the ever-increasing volume of medical care for such patients. Scope of application. The study results can be used to efficiently plan volumes of medical care within the framework of the program of state guarantees of free medical care.

Implications of Plant Foods in Weight Management: Focus on Metabolic Health

Plant foods are important component of human diet and they are excellent source health-promoting compounds, such as amino acids, dietary fibers, complex carbohydrates, unsaturated fatty acids, as well as minerals and vitamins which have been shown to increase vitality and subsequently reduce risk of chronic disease. Importantly, eatable plants despite relatively low caloric value are nutrient-dense foods, which are rich in various phytochemicals, such as polyphenols, that have been found to be beneficial for improving metabolic health, in particular lowering systemic inflammation, increasing antioxidant capability and promoting weight loss. To date, epidemiological evidence consistently demonstrated a beneficial impact of adopting plant-based dietary lifestyle characterized by increased intake of whole unprocessed foods, including fresh vegetables and fruits, whole grains, pulses and legumes as well as nuts and seeds, in expense of processed meats, refined carbohydrates and added sugar foods, have potential to reduce risk of high burden diseases, such type 2 diabetes, obesity or cardiovascular disease. Consequently, to assess the most applicable composition of plant-based diets for achieving metabolic improvements, nutritional value of consumed plants should be evaluated. Therefore, accounting for differences in phytochemical content of various fruits, vegetables, grains, pulses, nuts and seeds the main aim of this literature review is to assess the recent clinical evidence of their contribution to weight management, and reduction of risk factors implicated in development of chronic conditions, such as cardiovascular diseases, diabetes or obesity.

Affect Reactivity to Daily Stressors Mediates the Relationship Between Personality Traits and Physical Health

Researchers hypothesize that how people react to daily stressful events partly explains the personality-health relationship, yet no study has examined longitudinal associations between these factors. The current study examined the role of negative affect reactivity to daily stressors as a mediating pathway between personality and physical health outcomes using three waves of data spanning 20-years from a nationwide probability sample of 1,176 adults. Results indicate that Wave 1 neuroticism was associated with greater negative affect reactivity at Wave 2, which then predicted the development of chronic conditions and functional limitations at Wave 3. Higher conscientiousness was associated with less negative affect reactivity, which in turn predicted better physical health at Wave 3. Negative affect reactivity partially mediated both personality traits and physical. These findings highlight the usefulness of using a daily stress framework for understanding how personality impacts health over time, which has important implications for disease prevention.

Health assessment in patients with autosomal recessive osteopetrosis before and after allogeneic hematopoietic stem cell transplantation

Here we report the results of long-term monitoring of children with malignant infantile osteopetrosis (MIOP) before and after a successful hematopoietic stem cell transplantation (HSCT). We present patient health data collected 3-6 years after the completion of treatment, including information on the children's physical and mental health and social adaptation. The study was approved by the Independent Ethics Committee and the Scientifi Council of the N.I. Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation. HSCT is the only currently available radical treatment for MIOP. At the time of the treatment, all the patients exhibited severe visual impairment (descending optic atrophy), transfusiondependent bone marrow dysfunction, hepatosplenomegaly, signifiant skeletal abnormalities and growth retardation. In this study, we included 5 MIOP patients with successful transplantation who had been treated from 2014 to 2018. Four patients underwent HSCT from unrelated 10/10 HLA-identical donors and 1 patient received HSCT from a related 10/10 HLA-identical donor. The ratio of boys to girls was 2:3, the median age at the time of the transplantation was 7 (2–11) years. All the patients demonstrated full donor chimerism after HSCT. Hematopoietic recovery was achieved within the fist 150 days after HSCT. Radiological investigations showed gradual partial reduction of skeletal changes typical of MIOP. All the subjects demonstrated growth of the axial skeleton, facial bone remodeling and abatement of phenotypic features of the disease. The patients' vision remained the same as before HSCT. All the patients reported that their health and quality of life had improved after HSCT. The degree of visual impairment had a substantial impact on the quality of life and social rehabilitation of the patients. The second major factor affcting the quality of life was the development of chronic conditions after HSCT, namely, epilepsy and chronic “graft-versus-host” disease of the lung that require constant medical monitoring and limit rehabilitation potential. The patients' parents gave their consent to the use of their children's data, including photographs, for research purposes and in publications.

Interpregnancy Care: An Opportunity to Improve Women's Health and Reduce the Risk of Maternal Morbidity and Mortality.

Interpregnancy care is the health care provided to a woman during the postpartum and preconception periods between pregnancies. Half of maternal deaths occur postpartum and cardiometabolic complications of pregnancy increase the risk for maternal morbidity and mortality and development of chronic conditions. By improving women's health between and beyond pregnancies, interpregnancy care has the potential to improve pregnancy outcomes and women's long-term health. This practice brief report summarizes evidence regarding the impact of interpregnancy care on pregnancy and long-term health outcomes for women with hypertension, diabetes, substance use, and mental health disorders. Existing evidence is limited but demonstrates that the utilization of interventions during this period may result in improved health outcomes. Additional research efforts are needed to better understand the impact of interpregnancy care on women's health throughout the life course.

Formal social participation protects physical health through enhanced mental health: A longitudinal mediation analysis using three consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE).

Previous studies have shown that formal social participation may reduce the risk of developing chronic conditions. Yet, the underlying mechanisms are largely unknown. In this study, we assessed the potential mediating roles of quality of life and depressive symptoms using longitudinal data. We analyzed nationally representative data from three consecutive waves (2011, 2013, 2015) of the SHARE survey, including 28,982 adults from 12 European countries aged 50 years and above at baseline. Measures were self-reported and included formal social participation (i.e. active participation within volunteer organizations, educational institutions, clubs, religious organizations, or political/civic groups), quality of life (CASP-12), depressive symptoms (EURO-D), and chronic conditions. Structural equation modeling was used to construct a focused longitudinal path model. Formal social participation at baseline was inversely associated with the number of chronic conditions at 4-year follow-up. We identified two significant longitudinal mediation patterns: 1) formal social participation predicted higher levels of quality of life, which in turn, predicted lower levels of chronic conditions; and 2) formal social participation predicted lower levels of depressive symptoms, which, in turn, also predicted lower levels of chronic conditions. Formal social participation functions as a protective factor against the onset or development of chronic conditions. This association is partially explained by enhanced quality of life and diminished depressive symptoms.

Age at natural menopause and development of chronic conditions and multimorbidity: results from an Australian prospective cohort.

Is age at natural menopause (ANM) associated with the development of multiple chronic conditions (multimorbidity) in postmenopausal life? Women with premature menopause experience increased odds of developing individual chronic conditions and multimorbidity. ANM is considered as a marker of age-related morbidity and mortality in postmenopausal life. Multimorbidity affects more than 60% of older women and has been recognized as the most common 'chronic condition'. Few studies have examined the association between ANM and the development of multimorbidity. A prospective national cohort study of 11 258 Australian women, aged 45-50years in 1996. Women were followed from 1996 to 2016. Information about ANM and 11 chronic conditions (diabetes, hypertension, heart disease, stroke, arthritis, osteoporosis, asthma, chronic obstructive pulmonary disease, depression, anxiety and breast cancer) were estimated approximately every 3years. Multimorbidity is defined as 2 or more of these 11 conditions. Generalized estimating equations were used to link the categorical ANM with individual chronic conditions and multimorbidity. Among 5107 women reporting ANM, 2.3% experienced premature menopause (≤40years) and 55.1% developed multimorbidity. Compared with women who experienced menopause at age 50-51years, women with premature menopause had twice the odds of experiencing multimorbidity by age 60 (OR = 1.98, 95% CI 1.31 to 2.98) and three times the odds of developing multimorbidity in their 60s (OR = 3.03, 95% CI 1.62 to 5.64). Women with premature menopause also experienced higher incidence of most individual chronic conditions. The main limitation of this study was the use of self-reported data, but with repeated assessments from prospective study design and the validity of most of the chronic conditions from hospital data, the potential for non-differential misclassification is minimized. To our knowledge, this is the first study to assess the association of premature menopause and development of multimorbidity in a larger national cohort of mid-aged women. Health professionals should consider comprehensive screening and assessment of risk factors for multimorbidity when treating women who experienced premature menopause. The Australian Longitudinal Study on Women's Health was supported by the Australian Government Department of Health. X.X. is funded by an International Postgraduate Research Scholarship from the Australian government and a UQ Centennial Scholarship from The University of Queensland. G.D.M. is supported by the National Health and Medical Research Council Principal Research Fellowship (APP1121844). None of the authors has any conflicts of interest to declare.

The influence of clinical variables on the risk of developing chronic conditions in ICU survivors

PurposeTo assess the association of clinical variables and the development of specified chronic conditions in ICU survivors. Materials and methodsA retrospective cohort study, combining a national health insurance claims database and a national quality registry for ICUs. Claims data from 2012 to 2014 were combined with clinical data of patients admitted to an ICU during 2013. To assess the association of clinical variables (ICU length of stay, mechanical ventilation, acute physiology score, reason for ICU admission, mean arterial pressure score and glucose score) and the development of chronic conditions (i.e. heart diseases, COPD or asthma, Diabetes mellitus type II, depression and kidney diseases), logistic regression was used. Results49,004 ICU patients were included. ICU length of stay was associated with the development of heart diseases, asthma or COPD and depression. The reason for ICU admission was an important risk factor for the development of all chronic conditions with adjusted ORs ranging from 2.05 (CI 1.56; 2.69) for kidney diseases to 5.14 (CI 3.99; 6.62) for depression. ConclusionsClinical variables, especially the reason for ICU admission, are associated with the development of chronic conditions after ICU discharge. Therefore, these clinical variables should be considered when organizing follow-up care for ICU survivors.

P85 Preliminary Evaluation of the 2018 Fruit and Vegetable Prescription Program

Objective To determine the impact of the Fruit and Vegetable Prescription (FVRx) program supplemented with education related to nutrition, cooking skills, and food resource management on nutrition behaviors and related clinical outcomes. Use of Theory or Research Prior research shows that food insecurity is associated with the development of chronic conditions. In addition to providing access to healthy foods, this program was designed to improve cooking skills and food resource management skills based on Social Cognitive Theory. Target Audience This intervention targeted low-income, food insecure adults receiving primary care from one of four urban clinics in the Southeast (n = 113). Program Description Participants received FVRx equal to $1/day for each participant and household member. Monthly clinic visits included nutrition education and individualized goal setting. Participants were offered six weekly Cooking Matters courses. Evaluation Methods Participants completed surveys at baseline and at the end of the Cooking Matters classes. Clinical outcomes were collected at monthly clinic visits. Analyses were conducted for participants with data at both time points using either Wilcoxon signed rank test for ordinal count data, paired t-test for continuous data, or longitudinal adjusted statistical modeling for clinical outcomes. Results Food insecurity scores declined by -0.24 (95% confidence interval -0.45, -0.03). The frequency in which participants reported being confident in basic cooking skills increased by 13.0% (95% confidence interval 5.3%, 20.7%) and being confident in purchasing healthy foods for their families on a budget increased by 15.6% (95% confidence interval 4.5%, 26.7%). The scores for frequency of consumption increased by 0.3 for non-starchy vegetables (95% confidence interval 0.1, 0.6). BMI decreased by -0.07 (95% confidence interval -0.14, -0.10), diastolic blood pressure (mmHg) decreased by -1.85 (95% confidence interval -3.00, -0.71), and hemoglobin A1C decreased by -0.15 (95% confidence interval -0.30, 0.00). Conclusions This study demonstrated that a FVRx program supplemented with nutrition education improved nutrition behaviors and clinical outcomes. Funding SNAP-Ed, Open Hand Atlanta, Wholesome Wave Georgia, The Common Market, Grady Health System.

Sparganin A alleviates blood stasis syndrome and its key targets by molecular docking.

Blood stasis syndrome is implicated in the development of chronic conditions, including cardio- and cerebrovascular diseases. Cyclo-(Tyr-Leu), named Sparganin A (SA), is a compound isolated from the ethanol extract of Rhizoma Sparganii. Here, the successful extraction of SA from Rhizoma Sparganii was verified by extensive spectral analysis using 1H NMR and 13C NMR. To determine the biological effects of SA, a mouse model of acute blood stasis was established by subcutaneous injection of adrenaline hydrochloride and placing the animals in an ice water bath. In this model, the concentration of TXB2, PAI-1, FIB, ET-1 was measured by ELISA, and thymus index (TI), hepatic index (HI), and spleen index (SI) were calculated. Molecular docking by SYBYL and functional analysis of the putative targets by STRING and Cytoscape were employed to identify the key targets of SA. The accumulated results documented that SA exhibits anticoagulative activity, and its key targets are VEGFA and SERPINE1. SA may be involved in the pathological process of complement and coagulation cascades. This study demonstrates that SA may be a promising drug to control coagulation in blood stasis syndrome.

Esquizofrenia y su asociación con enfermedades médicas crónicas

The life expectancy of patients with schizophrenia (SCH) is 11 to 20 years less than the general population. There is an association between SCH and various diseases and chronic conditions, highlighting the cardio-metabolic diseases. This association has been attributed to the use of antipsychotics, however, evidence has also shown intrinsic susceptibility of schizophrenic patients the development of chronic conditions. This review aims to update knowledge about chronic conditions such as cardiometabolic risk and sleep, bone and kidney disorders related to SCH. These patients have a high prevalence of risk behaviors, including smoking and poor diet. They have a worse metabolic profile than the general population and a greater likelihood of developing metabolic syndrome, diabetes and cardiovascular disease. SCH has also been associated with other chronic diseases such as osteoporosis and chronic kidney disease. The high prevalence of these comorbidities in schizophrenic population is not explained solely by the antipsychotic treatment, therefore intrinsic mechanisms associated to SCH are postulated to be associated with these conditions. This new information requires a change in the multidisciplinary medical approach for the study and management of schizophrenic patients.

Expression and regulation of chemokine receptor CXCR3 (CD183) on human gastrointestinal stem cells (hGISC) derived primary epithelial cells

Abstract Expression of Chemokine receptor CXCR3 (CD183) by cells in inflamed tissues play essential role in the development of chronic conditions by attracting leucocytes to the inflammatory sites. CXCR3 expression in intestinal epithelium has also been implicated in celiac disease by means of its potential role in peptide (gliadin) uptake and triggering of immune responses in the small intestine. Therefore, having an CXCR3 expressing intestinal epithelial cell system in long-term culture would be a valuable tool for discovery and development of new treatments for celiac and/or other gastrointestinal inflammatory diseases. Earlier, we have developed a method for growing human intestinal primary epithelial cells (HIPEC) from isolated human gastrointestinal stem cells (hGICSs) in long-term culture. Now we examined two small intestinal HIPEC lines for CXCR3 expression by immunocytochemical staining and subsequent fluorescence microscopic analysis. Our results showed that CXCR3 was either undetectable or weakly expressed in normal jejunal HIPECs that had columnar characteristics whereas CXCR3 was detected on HIPECs with enriched MUC2 positive goblet epithelial cells. CXCR3 was also detectable in HIPECs derived from an actively inflamed tissue from a patient with ulcerative colitis (UC). Stimulation of normal HIPECs with proinflammatory signaling agents LPS, TNFα or IFNγ showed a minimum effect on the level of CXCR3 expression when added individually. However combinations of LPS with either TNFa or IFNg or both increased the CXCR3 expression on HIPECs. These findings may help better understand of the disease mechanisms and development of new treatment for inflammatory conditions such as celiac disease and/or ulcerative colitis.

Disability among Persons Aging with HIV/AIDS.

Persons surviving to older ages with HIV/AIDS often face an accelerated aging accompanied by increased comorbidity and decline in health and function. In this chapter, we review the process of disablement among persons aging with HIV/AIDS, from chronic conditions to impairments and functional limitations, leading to disability. Chronic immune activation related to chronic HIV infection may contribute to early development of chronic conditions that are common in older adults resulting in premature disablement. Anatomical and physiological changes related to the aging process make people vulnerable to physical and cognitive impairments. In old age, quality of life depends mainly on avoidance and management of age-associated diseases rather than chronological parameters. Interventions to manage chronic conditions associated with aging may have a significant impact on quality of life in older persons with HIV infection. Because of the complexity of physical and cognitive impairments among persons aging with HIV infection, a range of supports and interventions will be needed to effectively address the problem of disablement in this population.