Integrating HIV and substance misuse services: a person-centred approach grounded in human rights

Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.

Child Involvement in Choosing a Recipe, Purchasing Ingredients, and Cooking at School Increases Willingness to Try New Foods and Reduces Food Neophobia

OBJECTIVE

To investigate the effect of involving children in their feeding process (choosing a recipe, purchasing the ingredients, and cooking) on their lunch food choice in a school environment.

DESIGN

Quasi-experimental.

SETTING

Two schools in Bilbao, Spain.

PARTICIPANTS

A total of 202 children (aged 8-9 years) participated in the study (43% girls), with 99 in the nutrition education (NE) group and 103 in the hands-on (HO) group.

INTERVENTION

Three 1-hour workshops (1 workshop/wk), different for each group: HO, cooking-related activities, and NE, healthy habits promotion through nutrition education activities.

MAIN OUTCOME MEASURES

Food neophobia, diet quality, cooking self-efficacy and attitudes toward cooking, and food intake and selection of the experimental lunches.

ANALYSIS

Chi-square test of independence, ANCOVA, and t tests were performed.

RESULTS

Students from the HO group selected and ate more spinach/broccoli (P < 0.001 and P = 0.02, respectively) for the first lunch; and selected more spinach/broccoli (P = 0.04) for the second lunch. After the intervention, improvements were observed for spinach liking and neophobia for the HO group and cooking self-efficacy and KidMed score for both groups.

CONCLUSIONS AND IMPLICATIONS

Both interventions succeeded in improving children's diet quality, but only the HO group reduced food neophobia levels. Therefore, involving children in choosing a recipe, purchasing ingredients, and cooking may promote changing eating behaviors toward healthy habits such as increasing vegetable consumption.

Factors associated with health-related quality of life (HRQoL): differential patterns depending on age

PURPOSE

The aims of this study were: (1) to analyze age differences in health-related quality of life (HRQoL) between the young old (aged 65-84) and the oldest old (aged 85 and over), and (2) to investigate three types of predictors: (a) physical health [Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living, comorbidity, use of medication], (b) global cognitive ability and (c) psychosocial factors, specifically personality traits, social support and emotional functioning (positive and negative affect and life satisfaction), which may influence the HRQoL of both the young old and the oldest old.

METHOD

A cross-sectional study was conducted with 257 healthy community-dwelling elderly people. HRQoL was assessed using the SF-36 Health Survey. Functional and health status, global cognitive ability and psychosocial variables were also assessed.

RESULTS

Age differences were found in HRQoL, with the oldest old scoring lower for this variable. Multiple stepwise hierarchical linear regression analyses revealed that, in relation to the physical health component, use of medication, BADL and positive affect had the greatest influence among the young old (65-84), whereas among the oldest old, neuroticism and the BADL were the most influential factors. As regards the mental health component, neuroticism, use of medication and positive affect were the main predictor variables among the young old, while neuroticism and negative affect had the greatest influence among the oldest old group.

CONCLUSION

The oldest old had a poorer HRQoL in both dimensions measured (physical and mental). There appear to be differences between the determinants of HRQoL for young old and oldest old adults, suggesting that these associations change with age.

Profiles in emotional aging: does age matter?

OBJECTIVES

The aim of this research project was to define emotional profiles in elderly people and to analyze the presence of each one in different age groups (from 65 to 74, 75 to 84, 85 to 94 and 95 to 104).

METHOD

The sample group comprised 257 elderly people not suffering from cognitive impairment who were independent in the Basic and Instrumental Activities of Daily Living. The following emotional variables were analyzed: positive and negative affect, life satisfaction, loneliness, and regulation strategies.

RESULTS

Cluster analyses revealed three emotional profiles: 'dissatisfied' (elderly people with high levels of negative affect and loneliness who are unhappy with their lives and use problem solving to regulate their emotions), 'happy' (those with good levels of positive affect and life satisfaction, low levels of loneliness and negative affect and little use of passive strategies), and 'resilient' (those with low levels of positive and negative affect and medium levels of loneliness who are more or less satisfied with their lives and who use passive strategies to regulate their emotions). A relationship was observed between age and profile. Among the under 85s, the most common profile was 'happy', while among the over 85s, the most common profile was 'resilient.' The 'happy' profile was also observed in participants over the age of 85, although to a lesser extent. The prevalence of the 'dissatisfied' profile decreased with age.

CONCLUSION

These results highlight the fact that although age seems to be a key factor in determining profile, individual differences should not be overlooked, even among the oldest old.

Age differences among older adults in the use of emotion regulation strategies. What happens among over 85s and centenarians?

OBJECTIVE

Past research on emotion regulation strategies has concluded that older adults use more passive strategies than young adults. However, we found scarce research in this field focusing on the oldest old (i.e. those aged 85 and over). The aim of this study was to analyze whether or not differences exist in the way older adults aged 85 and over (centenarians included) use emotion regulation strategies, in comparison with younger age groups (65-74 and 75-84 years old).

METHOD

Participants were 257 older adults from Spain, all aged between 65 and 104. The sample was divided into four age groups: 65-74; 75-84; 85-94; and 95-104 years old. Participants completed the Strategy Questionnaire after reading each of the vignettes designed to elicit feelings of either sadness or anger. The questionnaire measures four types of regulation strategies: Passive, Express, Solve and Seek.

RESULTS

The 85-94 age group and centenarians were found to use proactive (Express, Seek) and Solve strategies less in comparison with younger age groups when regulating sadness and anger. In contrast, an increased use of Passive strategies was observed in the regulation of both emotions in the 85-94 age group. Significant differences were also found between centenarians and younger age groups in the use of Passive strategies for sadness, although not for anger.

CONCLUSION

Age differences were observed in the use of emotion regulation strategies, with older age groups using proactive strategies less and passive strategies more.

Serving the underserved: an HIV testing program for populations reluctant to attend conventional settings

OBJECTIVES

We assess the contribution of a rapid-HIV testing program run by Médicos del Mundo and oriented to vulnerable populations reluctant to attend conventional settings.

METHODS

We compare the program outcomes with a network of 20 HIV/STI clinics (EPIVIH) and the Spanish National Surveillance System (SNHSS).

RESULTS

33.3% of the new diagnoses were women (8.6% EPIVIH and 17.7% SNHSS). Transsexuals were 6.9% (1.9% EPIVIH), female sex workers 23.6% (2.0% EPIVIH) and 19.4% Sub-Saharan Africans (3.8% EPIVIH and 7.8% SNHSS). HIV prevalence in men was slightly higher than in the EPIVIH and almost twice among women.

CONCLUSIONS

This program is contributing substantially to the promotion of HIV diagnosis in female sex workers, sub-Saharan Africans and transsexuals, which are less present at clinical settings.

Diet, cognition, and Alzheimer's disease: food for thought

INTRODUCTION

The prevention of Alzheimer's disease (AD) has become a real challenge due to its rising prevalence and the lack of an effective cure. Diet and nutrients have gained significant interest as potentially modifiable protective factors.

PURPOSE

The aim of this review is to provide an updated summary of evidence related to the effect of diet and nutritional factors on the risk of AD and cognitive aging, and discuss the potential mechanisms and confounding factors involved.

METHODS

A search was conducted in Medline and Web of Knowledge for epidemiological and clinical studies in the international literature from January 2000 to February 2013 using combinations of the following keywords: "Alzheimer's disease", "mild cognitive impairment", "cognitive function", "dietary factors", "omega-3", "antioxidants", "B vitamins", "dietary patterns", and "Mediterranean diet".

RESULTS AND CONCLUSION

Data from observational studies point to a protective role for certain nutrients, such as omega-3 fatty acids, antioxidants or B vitamins, and dietary patterns (Mediterranean diet). However, data from randomized controlled trials do not show a consistent effect. Whether confounding factors such as age, disease stage, other dietary components, cooking processes, and other methodological issues explain the divergent results remains to be established. Moreover, if certain nutrients protect against dementia, it is as yet unknown whether they may have a general effect on brain vascular health or directly interfere with the etiopathogenesis of AD.

The impact of adherence and disease control on resource use and charges in patients with mild asthma managed on inhaled corticosteroid agents

OBJECTIVE

Inadequate asthma control may affect asthma resource use and treatment charges, consequently contributing to the growing economic burden of asthma. The study objective was to determine the impact of medication adherence and asthma control on resource use and charges in mild asthmatic patients treated with inhaled corticosteroids (ICSs).

RESEARCH DESIGN AND METHODS

A claims database was analyzed retrospectively from October 2001-December 2007 to identify mild asthmatic patients aged 12-65 years who began ICS treatment. Demographics, drug utilization, and resource use for each patient were identified for the 365-day period before and after the index date (pre-index and post-index periods, respectively). Patients were designated as having high control high adherence (HCHA) or low control low adherence (LCLA) based on post-index exacerbations and the percentage of days covered; not all patients who qualified for study inclusion met adherence designation requirements. Differences between the HCHA and LCLA cohorts in resource use (eg, asthma treatment days) and asthma-related treatment charges were assessed.

RESULTS

Compared with the HCHA cohort (n = 483), the LCLA cohort (n = 258) had more asthma treatment days (2.9 vs 3.9, respectively; P < 0.0001) and higher overall asthma treatment charges ($2655 vs $3345, respectively; P < 0.0001) in the post-index period. An adjusted odds ratio suggested that patients receiving mometasone furoate (MF) were approximately 5 times more likely to belong to the HCHA cohort than patients receiving any other ICS (P < 0.0001).

CONCLUSIONS

Better asthma control and adherence to prescribed ICSs are associated with lower asthma-related resource use and charges. Mild asthmatic patients receiving MF were more likely to be in the HCHA cohort than patients receiving other ICSs, perhaps due to the once-daily dosing of MF. Current NAEPP guidelines recommend low-dose ICS monotherapy for mild persistent asthma; thus, it is critical to optimize mild persistent asthma control and limit unnecessary resource use and charges.

A randomized, two-year study of the efficacy of cognitive intervention on elderly people: the Donostia Longitudinal Study

BACKGROUND

Research on non-pharmacological therapies (cognitive rehabilitation) in old age has been very limited, and most has not considered the effect of interventions of this type over extended periods of time.

OBJECTIVE

To investigate a new cognitive therapy in a randomized study with elderly people who did not suffer cognitive impairment.

METHODS

The efficacy of this therapy was evaluated by means of post-hoc analysis of 238 people using biomedical, cognitive, behavioural, quality of life (QoL), subjective memory, and affective assessments.

RESULTS

Scores for learning potential and different types of memory (working memory, immediate memory, logic memory) for the treatment group improved significantly relative to the untreated controls.

CONCLUSIONS

The most significant finding in this study was that learning potential continued at enhanced levels in trained subjects over an intervention period lasting two years, thereby increasing rehabilitation potential and contributing to successful ageing.

Effect of dietary quercetin and sphingomyelin on intestinal nutrient absorption and animal growth

Research on cancer and other conditions has shown flavonoids and sphingolipids to be food components capable of exerting chemoprotective action. Nevertheless, little is known about their effects on healthy individuals and their potential usefulness as therapeutic agents. The present study examined the possible action of a dietary flavonoid, quercetin, and a sphingolipid, sphingomyelin, as functional foods in healthy animals. In particular, the effect on animal growth of supplementing a conventional diet with one or other of these substances (0·5% quercetin and 0·05% sphingomyelin) was considered. Possible action affecting intestinal physiology was also analysed by measuring the uptake of sugar and dipeptide, mediated by the Na+-dependent sugar transporter SGLT1 and the dipeptide Na+/H+ exchanger PEPT1 respectively, and the activity of related intestinal enzymes such as sucrase, maltase and aminopeptidase N. Both substances seemed to modify small intestinal activity in healthy mice, altering intestinal enzymatic activity and nutrient uptake. These effects observed in the small intestine did not impair normal development of the animals, as no differences in serum biochemical parameters or in organ and body weights were found. The findings should help in elucidating the mechanisms of action of these food components with a view to their possible use in the prevention of certain pathological conditions.

Modulación de la fisiología gastrointestinal mediante cepas probióticas de Lactobacillus casei y Bifidobacterium bifidum

The products called functional foods, which besides being merely nutritional have different beneficial effects on the organism, are situated in the context of diet and health promotion. Amongst these functional foods we can distinguish, amongst others, between probiotic and prebiotic compounds. The micro-organisms most widely used in probiotic foods belong to the Lactobacillus and Bifidobacterium types. In this article we have studied the effect of diets supplemented with Lactobacillus casei or Bifidobacterium bifidum on animal development and especially on the intestinal function, centred on their immune, digestive and absorptive activity in growing animals. The bacteria strains used modify the activity of the small intestine of healthy mice, significantly affecting their enzymatic activity (sucrase, maltase and aminopeptidase) and the collection of nutrients (galactose and glycilsarcosine), as well as the intestinal immune activity (higher number of Peyer's patches). However, these effects do not appear to disturb the development of the growing animals since no significant differences are appreciated in their body weight or in their blood parameters. These results make clear the possible beneficial effects on intestinal physiology and contribute to the understanding of the possible mechanisms of action of the probiotics, which could be employed in the preventive treatment of different pathologies related to the digestive apparatus.

Genes related to iron metabolism and susceptibility to Alzheimer's disease in Basque population

Alzheimer's disease (AD) is the most common dementing disorder and presents with a progressive and irreversible cognitive decline of gradual onset. To date, several reports have involved iron in AD physiopathology. In this study, we have analysed TFC2 variant and HFE mutations (H63D and C282Y) in 211 AD patients and 167 controls recruited from an area of the Basque Country. Furthermore, we have studied APOE genotype as it is a well-known risk factor for AD. APOE epsilon 4 allele was associated with an increased risk of AD and an earlier age at onset, whereas no association was found between TFC2 or HFE C282Y mutation and disease susceptibility. The frequency of H63D mutation was higher in control population (29.9%) than in AD patients (18%), suggesting a protective role of this allele on AD either due to the presence of the mutation itself or through the effect of other related genes in the ancestral haplotype in which it is included.

Jejunal microvilli atrophy and reduced nutrient transport in rats with advanced liver cirrhosis: improvement by Insulin-like Growth Factor I

Background

Previous results have shown that in rats with non-ascitic cirrhosis there is an altered transport of sugars and amino acids associated with elongated microvilli. These alterations returned to normal with the administration of Insulin-Like Growth Factor-I (IGF-I). The aims of this study were to explore the evolution of these alterations and analyse the effect of IGF-I in rats with advanced cirrhosis and ascites. Thus, jejunal structure and nutrient transport (D-galactose, L-leucine, L-proline, L-glutamic acid and L-cystine) were studied in rats with ascitic cirrhosis.

Methods

Advanced cirrhosis was induced by CCl₄ inhalation and Phenobarbital administration for 30 weeks. Cirrhotic animals were divided into two groups which received IGF-I or saline during two weeks. Control group was studied in parallel. Jejunal microvilli were studied by electron microscopy. Nutrient transport was assessed in brush border membrane vesicles using ¹⁴C or ³⁵S-labelled subtracts in the three experimental groups.

Results

Intestinal active Na⁺-dependent transport was significantly reduced in untreated cirrhotic rats. Kinetic studies showed a decreased V_max and a reduced affinity for sugar and four amino acids transporters (expressed as an increased K_t) in the brush border membrane vesicles from untreated cirrhotic rats as compared with controls. Both parameters were normalised in the IGF-I-treated cirrhotic group. Electron microscopy showed elongation and fusion of microvilli with degenerative membrane lesions and/or notable atrophy.

Conclusions

The initial microvilli elongation reported in non ascitic cirrhosis develops into atrophy in rats with advanced cirrhosis and nutrient transports (monosaccharides and amino acids) are progressively reduced. Both morphological and functional alterations improved significantly with low doses of IGF-I.

Effect of insulin-like growth factor-I on nitrogen balance and intestinal galactose transport in rats with moderate liver cirrhosis

The malnutrition caused by liver cirrhosis (LC) often worsens the course of the disease. Patients affected by LC often have a low bioavailability of the anabolic liver peptide insulin-like growth factor (IGF)-I. The present study was undertaken to investigate the effect of low doses of IGF-I on the nutritional status and in vivo jejunal transport of D-galactose in anatomically, pathologically and biochemically confirmed moderate, non-ascitic, cirrhotic rats. LC was experimentally induced in growing rats by inhalation of CCl4 and addition of phenobarbital to drinking water. Both the nutritional status, as evaluated by N balance, and in vivo intestinal transport of D-galactose, were significantly impaired in cirrhotic rats. As compared with healthy rats, administration of 20 microg human recombinant IGF-I/kg body weight for 14 d to cirrhotic rats significantly improved N balance variables and restored in vivo intestinal transport of the sugar. However, IGF-I had no effect on the steatorrhoea associated with LC. These results suggest that low doses of IGF-I may have beneficial effects on the malnutrition associated with moderate LC.

Local (gut) and systemic metabolism of rats is altered by consumption of raw bean (Phaseolus vulgaris L var athropurpurea)

The composition of the raw legume Phaseolus vulgaris L. var. athropurpurea (PhVa) and its effects on the metabolism of young growing rats have been evaluated. The levels of protein, unsaturated fatty acids, carbohydrate, fibre and bioactive factors present in PhVa were comparable with those in other Phaseolus vulgaris varieties. However, the lectins of PhVa were predominantly of the leucoagglutinating type, and concentrated in the albumin protein fraction. Rats fed a diet (110 g total protein, 16.0 MJ/kg) in which PhVa meal provided about half of the protein excreted high levels of N in faeces and urine, and grew more slowly, than rats fed a high-quality control diet (ad libitum or pair-fed). Small intestine, large intestine and pancreas weights were increased (by almost 100 %, P<0.05), whilst skeletal muscle, thymus and spleen weights were reduced. Blood insulin (16.20 v. 0.50 mU/l, P<0.05, thyroxine, glucose, protein (60.5 v. 48.3 g/l, P<0.05) and LDL-cholesterol were lowered, whilst glucagon (155.3 v. 185.4 ng/l, P<0.05), triiodothyronine and urea were elevated, as were urinary urea, creatinine and glucose. These changes in the local (gut) and systemic metabolism of rats were probably mediated primarily by lectins in PhVa, which were concentrated in the albumin protein fraction, whereas in many other Phaseolus vulgaris lines they are distributed across the globulin and albumin fractions.

Nutritional quality of extruded kidney bean (Phaseolus vulgaris L. var. Pinto) and its effects on growth and skeletal muscle nitrogen fractions in rats

The influence of extrusion cooking on the protein content, amino acid profile, and concentration of antinutritive compounds (phytic acid, condensed tannins, polyphenols, trypsin, chymotrypsin, alpha-amylase inhibitors, and hemagglutinating activity) in kidney bean seeds (Phaseolus vulgaris L. var. Pinto) was investigated. Growing male rats were fed diets based on casein containing raw or extruded kidney beans with or without methionine supplementation for 8 or 15 d. Rates of growth, food intake, and protein efficiency ratio were measured and the weight of the gastrocnemius muscle and the composition of its nitrogenous fraction was determined. Extrusion cooking reduced (P < 0.01) phytic acid, condensed tannins, and trypsin, chymotrypsin, and (alpha-amylase inhibitory activities. Furthermore, hemagglutinating activity was abolished by extrusion treatment. Protein content was not affected by this thermal treatment. Rats fed raw kidney bean lost BW rapidly and the majority died by 9 d. Pretreatment of the beans by extrusion cooking improved food intake and utilization by the rats and they gained BW. Supplementation of extruded kidney bean with methionine further enhanced (P < 0.01) food conversion efficiency and growth. However, BW gains and muscle composition still differed (P < 0.01) from those of rats fed a high-quality protein.

Liver proteolytic activity in tannic acid-fed birds

The influence of tannic acid in the rate of growth (BWG), feed intake, protein efficiency ratio, and liver proteolytic activities (cathepsin A and D) were measured in growing male chickens. These birds were fed ad libitum over a 15-d experiment on 20% protein standard diets containing heated soybean (control, C) as the main source of protein. Tannic acid (TA; 25 g/kg diet) was added to all diets, except the control. It has been found that in comparison to control-fed birds, TA-fed birds showed a significant reduction (P < 0.01) in BWG, protein efficiency ratio, and relative weight of liver, together with a significant increase (P < 0.01) in the activities of cathepsin A and D in liver. Addition of TA to the control diet had no significant effect on feed intake. The possible nature of these results is discussed.

Virulent strains of Salmonella enteritidis disrupt the epithelial barrier of Caco-2 and HEp-2 cells

To confirm the existence in nature of Salmonella enteritidis strains of different degrees of virulence and to elucidate the mechanisms underlying the effects of such strains on the epithelial barrier function, the consequences of infection of Caco-2 cells and HEp-2 cells with 15 S. enteritidis strains in a chicken infection model were examined. The more virulent strains of S. enteritidis, which are biofilm producers in adherence test medium, were able to disrupt HEp-2 and Caco-2 monolayers, as shown by transmonolayer electrical resistance and lactate dehydrogenase activity. In contrast, the low-virulence strains of S. enteritidis, which do not produce biofilms in adherence test medium, had no effect on the same cells. An avirulent rough mutant of Salmonella minnesota exhibited a pattern of behaviour similar to that of the low virulence strains of S. enteritidis, whilst a clinical Salmonella typhi strain caused rapid injury to the monolayers. The effect of supernatants of Salmonella cultures in adherence test medium on the integrity of Caco-2 cell monolayers indicated that the high-virulence S. enteritidis strains, but not the low-virulence strains, release a soluble factor when incubated under optimum biofilm-forming conditions, which enables the disruption of the integrity of Caco-2 monolayers.

Altered intestinal transport of amino acids in cirrhotic rats: the effect of insulin-like growth factor-I

The intestine is an important target organ for insulin-like growth factor-I (IGF-I), an anabolic hormone synthesized in the liver upon growth hormone (GH) stimulation. Levels of IGF-I are reduced in cirrhosis, and altered GH/IGF-I axis may contribute to malnutrition in cirrhotic patients. Our aim was to study Na(+)-dependent jejunal transport of amino acids (L-leucine, L-proline, L-glutamic acid, and L-cysteine) in cirrhotic rats and to analyze the effect of IGF-I on this function. IGF-I or saline was administered for 2 wk to rats with CCl(4)-induced cirrhosis and saline was administered to healthy control rats. Transport of amino acids was assessed in brush-border membrane vesicles (BBMV) using (14)C- or (35)S-labeled amino acids, and the kinetic constants V(max) and K(t) were determined. Na(+)-independent uptake of L-leucine, L-proline, L-glutamic acid, and L-cysteine by BBMV was similar in all groups. Na(+)-dependent uptake of all four amino acids was significantly diminished in cirrhotic rats compared with both controls and IGF-I-treated cirrhotic rats. The latter two groups exhibited similar V(max) and K(t), whereas untreated cirrhotic rats had reduced V(max) and increased K(t) compared with normal controls and IGF-I-treated cirrhotic animals. In conclusion, the transport of all four tested amino acids by BBMV is impaired in cirrhotic rats, and low doses of IGF-I can correct this defect.