Association between levels of pentraxin 3 and incidence of chronic kidney disease in the elderly

OBJECTIVE: Higher levels of the novel inflammatory marker pentraxin 3 (PTX3) predict cardiovascular mortality in patients with chronic kidney disease (CKD). Yet, whether PTX3 predicts worsening of kidney function has been less well studied. We therefore investigated the associations between PTX3 levels, kidney disease measures and CKD incidence. METHODS: Cross-sectional associations between serum PTX3 levels, urinary albumin/creatinine ratio (ACR) and cystatin C-estimated glomerular filtration rate (GFR) were assessed in two independent community-based cohorts of elderly subjects: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS, n = 768, 51% women, mean age 75 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 651, mean age 77 years). The longitudinal association between PTX3 level at baseline and incident CKD (GFR <60 mL( ) min(-1)  1.73 m(-) ²) was also analysed (number of events/number at risk: PIVUS 229/746, ULSAM 206/315). RESULTS: PTX3 levels were inversely associated with GFR [PIVUS: B-coefficient per 1 SD increase -0.16, 95% confidence interval (CI) -0.23 to -0.10, P < 0.001; ULSAM: B-coefficient per 1 SD increase -0.09, 95% CI -0.16 to -0.01, P < 0.05], but not ACR, after adjusting for age, gender, C-reactive protein and prevalent cardiovascular disease in cross-sectional analyses. In longitudinal analyses, PTX3 levels predicted incident CKD after 5 years in both cohorts [PIVUS: multivariable odds ratio (OR) 1.21, 95% CI 1.01-1.45, P < 0.05; ULSAM: multivariable OR 1.37, 95% CI 1.07-1.77, P < 0.05]. CONCLUSIONS: Higher PTX3 levels are associated with lower GFR and independently predict incident CKD in elderly men and women. Our data confirm and extend previous evidence suggesting that inflammatory processes are activated in the early stages of CKD and drive impairment of kidney function. Circulating PTX3 appears to be a promising biomarker of kidney disease.

Inflammation, oxidative stress, glomerular filtration rate, and albuminuria in elderly men : a cross-sectional study

BACKGROUND: The role of inflammation and oxidative stress in mild renal impairment in the elderly is not well studied. Accordingly, we aimed at investigating the associations between estimated glomerular filtration rate (eGFR), albumin/creatinine ratio (ACR), and markers of different inflammatory pathways and oxidative stress in a community based cohort of elderly men. FINDINGS: Cystatin C-based GFR, ACR, and biomarkers of cytokine-mediated inflammation (interleukin-6, high-sensitivity C-reactive protein[CRP], serum amyloid A[SAA]), cyclooxygenase-mediated inflammation (urinary prostaglandin F2alpha [PGF2alpha]), and oxidative stress (urinary F2 isoprostanes) were assessed in the Uppsala Longitudinal Study of Adult Men(n = 647, mean age 77 years). RESULTS: In linear regression models adjusting for age, BMI, smoking, blood pressure, LDL-cholesterol, HDL-cholesterol, triglycerides, and treatment with statins, ACE-inhibitors, ASA, and anti-inflammatory agents, eGFR was inversely associated with CRP, interleukin-6, and SAA (beta-coefficient -0.13 to -0.19, p < 0.001 for all), and positively associated with urinary F2-isoprostanes (beta-coefficient 0.09, p = 0.02). In line with this, ACR was positively associated with CRP, interleukin-6, and SAA (beta- coefficient 0.09-0.12, p < 0.02 for all), and negatively associated with urinary F2-isoprostanes (beta-coefficient -0.12, p = 0.002). The associations were similar but with lower regression coefficients in a sub-sample with normal eGFR (>60 ml/min/1.73 m2, n = 514), with the exception that F2-isoprostane and SAA were no longer associated with eGFR. CONCLUSION: Our data indicate that cytokine-mediated inflammation is involved in the early stages of impaired kidney function in the elderly, but that cyclooxygenase-mediated inflammation does not play a role at this stage. The unexpected association between higher eGFR/lower albuminuria and increased F2-isoprostanes in urine merits further studies.

The oral language skills of young offenders: a pilot invesitgation

Although there is a large body of evidence attesting to the poor social skills of juvenile offenders, few workers have examined the underlying language skills of this population. This pilot study investigated the language skills of a group of young offenders in comparison to non-offending school students. Data were gathered from 15 community-based young offender males, aged between 13 and 21 years (M = 16.5 years, SD = 2.1) from the Victorian southern region Juvenile Justice Units. The comparison group comprised 15 male students, aged between 15 and 17 years (M = I 6.4 years; SD = 0.5 I) from government high schools in south-eastern metropolitan Melbourne. Each participant completed a narrative discourse task and measures of speed of processing, and abstract language. It was hypothesised that the young offender group would perform more poorly on each of the language tasks than the comparison group. Independent t tests (with a modified alpha level to control for family-wise error rates) showed that there were significant differences in the expected direction, on all language measures. Notwithstanding the pilot nature of the investigation, implications of these findings for both further research and intervention/early intervention are described.

Conservation and development interventions as networks: The case of the India ecodevelopment project, Karnataka

Experience with community-based biodiversity conservation programs in the 1980s and 1990s contributed to the conviction among donor agencies and researchers that such programs must be based on the active support of local resource users, appropriate incentives, and institutional support. Yet the continuing struggles of practitioners to implement conservation interventions that are socially and ecologically sustainable point to difficulty in realizing these principles on the ground. Actor-oriented research in rural development and actor network theory emphasize that the capacity of facilitators to engage effectively in negotiation processes and establish strong networks with key actors is critical in mediating intervention outcomes. Drawing on the case of the India Ecodevelopment Project at Rajiv Gandhi (Nagarahole) National Park in Karnataka, India, this paper explores the role of relationships and networks between actors in a conservation and development intervention, finding that practitioners need to focus on negotiation and network building as a central rather than subsidiary part of the intervention process. Associated with this is the need for change in the way donor and implementing agencies conduct themselves, to promote communication and greater flexibility in intervention processes.

Overcoming the stigma of chronic illness: strategies for normalisation of a 'spoiled identity'

This paper addresses the concept of chronic illness as a socially constructed experience of stigma. The stigma of having a chronic illness affects the person's self-concept, capacity to adapt to the illness and the quality of his/her social networks. Social stigma is a delegitimising social process derived from both popular and medical views of chronic illness. Based on research into the coping strategies of a range of people with long-term, serious chronic illnesses, the paper argues that government health policies and services in Australia can best help people with chronic illness by supporting their self-help groups and community-based activities.

Communautés, enjeaux environmenentaux et recherche en éducation relative à; l'environment

This article will draw upon two recent international community-based environmental projects to explore issues concerning the nature, status and role of research in environmental education. A number of features of community-based environment development projects in two different cultures will be described, illustrating the complexity and contextuality of the processes by which environmental issues are resolved. The implications for research that seeks to acknowledge and respect relationships within community contexts will also be considered.

Equal to life: empowerment through drama and research in a drama group for people with disabilities

This article draws from findings of qualitative research of a community- based drama and theatre group for adults with intellectual disabilities. The article considers constraints experienced by people with disabilities and explores the ways that experiences in drama and theatre can be particularly empowering for them. The article also reveals the ways that participants can increasingly become collaborators in the research and are empowered through the research process and through the opportunity to have their voices heard.

How feasible are healthy eating and physical activity for young women?

Objective: This study investigated young women’s perceptions of the feasibility of physical activity and healthy eating behaviours, and how these vary by socioeconomic status, domestic characteristics and weight status. Design: This population-based study used a mailed questionnaire to investigate perceptions of the feasibility of commonly recommended healthy eating and physical activity behaviours among a sample of young women. The feasibility of 29 physical activity behaviours (e.g. relating to frequency, intensity, duration, domain/setting) and 15 healthy eating behaviours (e.g. relating to location/setting, fruit and vegetable intake, fat/sugar intake) was assessed. Height, weight and sociodemographic details were also obtained. Setting: Nation-wide community-based survey. Subjects: A total of 445 women aged 18–32 years selected randomly from the Australian electoral roll. Results: Most women reported that they either were already engaged in many of the healthy eating behaviours or saw these as highly feasible. Many physical activity behaviours, on the other hand, were perceived as less feasible, particularly among women with children and women who were overweight. Conclusions: Health promotion messages and strategies aimed at increasing physical activity and healthy eating are unlikely to succeed unless they take into account perceptions that these behaviours are not feasible. For young women, this may involve promoting more time-effective, flexible ways of achieving recommended physical activity. Messages specifically targeted to women with children, and women who are overweight, are required.

How well do Australian women comply with dietary guidelines?

Objective: To investigate the proportion of middle-aged Australian women meeting national dietary recommendations and its variation according to selected sociodemographic and behavioural characteristics.

Design: This cross-sectional population-based study used a food-frequency questionnaire to investigate dietary patterns and compliance with 13 commonly promoted dietary guidelines among a cohort of middle-aged women participating in the Australian Longitudinal Study on Women's Health.

Setting: Nation-wide community-based survey.

Subjects: A total of 10 561 women aged 50–55 years at the time of the survey in 2001.

Results: Only about one-third of women complied with more than half of the guidelines, and only two women in the entire sample met all 13 guidelines examined. While guidelines for meat/fish/poultry/eggs/nuts/legumes and ‘extra’ foods (e.g. ice cream, chocolate, cakes, potatoes, pizza, hamburgers and wine) were met well, large percentages of women (68–88%) did not meet guidelines relating to the consumption of breads, cereal-based foods and dairy products, and intakes of total and saturated fat and iron. Women working in lower socio-economic status occupations, and women living alone or with people other than a partner and/or children, were at significantly increased risk of not meeting guidelines.

Conclusions: The present results indicate that a large proportion of middle-aged Australian women are not meeting dietary guidelines. Without substantial changes in their diets, and help in making these changes, current national guidelines appear unachievable for many women.

The early detection of postpartum depression: midwives and nurses trial a checklist

Objective: To evaluate the use of a standard pen-and-paper test versus the use of a checklist for the early identification of women at risk of postpartum depression and to investigate the experiences of nurses in using the checklist.

Design: A prospective cohort design using repeated measures.

Setting: The booking-in prenatal clinic at a regional hospital in Victoria, Australia, and the community-based postpartum maternal and child health service.

Participants: 107 pregnant women over 20 years of age.

Main Measures: Postpartum Depression Prediction Inventory (PDPI), Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS), demographic questionnaire, and data on the outcome from the midwives and nurses.

Results: The PDPI identified 45% of the women at risk of depression during pregnancy and 30% postpartum. The PDSS and EPDS both identified the same 8 women (10%), who scored highly for depression at the 8-week postpartum health visit. Nurses provided 80% of the women with anticipatory guidance on postpartum depression in the prenatal period and 46% of women at the 8-week postpartum health visit. Nurse counseling or anticipatory guidance was provided for 60% of the women in the prenatal period.

Conclusion: The PDPI was found to be a valuable checklist by many nurses involved in this research, particularly as a way of initiating open discussion with women about postpartum depression. It correlated strongly with both the PDSS and the EPDS, suggesting that it is useful as an inventory to identify women at risk of postpartum depression.

The relationship between residence and the pharmacological management of challenging behavior in individuals with intellectual disability

Many individuals with intellectual disability are administered psychotropic drugs to manage their challenging behavior. The increased relocation of individuals from institutions into community-based accommodation during the past decade provides an opportunity to examine the relationship between setting and drug administration. This study provides acomparison of drug use according to the type of residential facility of 873 individuals reported to have been administered drugs for behavioral restraint in March 2000, with 762 individuals reported in March 1993. In 2000, individuals in institutions were reported toreceive a moderately greater number of drugs concurrently than those in the community. However, there were no differences in the proportion of individuals prescribed drugs relative to the total population living in the respective settings. This is in contrast to the findings from 1993, where drug use was greater in individuals who were living in institutions. It was also more common for individuals who continued to be medicated across time to have previously lived in an institution. Although relocation into the community may be associated with improved living conditions, it is important to recognize that this change in living conditions is not necessarily associated with less use of drugs to manage behavior.

Participatory research in EE: some issues of epistemology and methodology

The conference theme of epistemology and methodology suggests an interest in epistemological issues in environmental education research. I have argued previously that for too long there seemed to be a blindness in environmental education research: that there was an unwarranted assumption that all research in environmental education was and should be conducted within an applied science conceptual framework that did not recognise nor problematise the epistemological assumptions of research. In this paper I intend to address the issue of epistemological coherence between the substantive subject matters of environmental education on the one hand and research, methodology on the other. The paper will draw upon two recent international environmental education projects to explore issues concerning the nature, status and role of research in environmental education. A number of features of community-based environment development projects in two different settings will be described, illustrating the complexity and contextuality of environmental issues as subject matters for environmental education. The implications for research that seeks to acknowledge and respect relationships within community contexts will be considered in relation to the following questions: Whose research agenda? The importance of project partnerships Participants' preconceptions about the nature of research. What is 'rigor' in participatory research in environmental education'?

Development and application of model of resource utilization, costs, and outcomes for stroke (MORUCOS): an Australian economic model for stroke.

Objectives: To outline the development, structure, data assumptions, and application of an Australian economic model for stroke (Model of Resource Utilization, Costs, and Outcomes for Stroke [MORUCOS]). Methods: The model has a linked spreadsheet format with four modules to describe the disease burden and treatment pathways, estimate prevalence-based and incidence-based costs, and derive life expectancy and quality of life consequences. The model uses patient-level, community-based, stroke cohort data and macro-level simulations. An interventions module allows options for change to be consistently evaluated by modifying aspects of the other modules. To date, model validation has included sensitivity testing, face validity, and peer review. Further validation of technical and predictive accuracy is needed. The generic pathway model was assessed by comparison with a stroke subtypes (ischemic, hemorrhagic, or undetermined) approach and used to determine the relative cost-effectiveness of four interventions. Results: The generic pathway model produced lower costs compared with a subtypes version (total average first-year costs/case AUD$15,117 versus AUD$17,786, respectively). Optimal evidence-based uptake of anticoagulation therapy for primary and secondary stroke prevention and intravenous thrombolytic therapy within 3 hours of stroke were more cost-effective than current practice (base year, 1997). Conclusions: MORUCOS is transparent and flexible in describing Australian stroke care and can effectively be used to systematically evaluate a range of different interventions. Adjusting results to account for stroke subtypes, as they influence cost estimates, could enhance the generic model.

Antioxidants and basal cell carcinoma of the skin : a nested case-control study

Objective To investigate the relationship between basal cell carcinoma (BCC) and antioxidant nutrients, specifically carotenoids, vitamin E and selenium.

Methods The Nambour Skin Cancer Study is an ongoing, community-based study of randomly selected adult residents of a township in sub-tropical Queensland, Australia. Using a nested case–control design, incident cases of BCC (n=90) were compared with age and sex matched controls (n=90). Dietary exposure was measured using food frequency questionnaire estimates of intake as well as serum biomarkers. Other determinants of skin cancer including sun exposure were also considered. Dietary intakes were adjusted for energy intake, and serum carotenoids and vitamin E were adjusted for serum cholesterol. Odds ratios were calculated across quartiles of dietary intake and serum biomarkers and linear trends were assessed using logistic regression, adjusting for age, sex and supplement use.

Results and conclusions In this prospective study no significant associations were found between BCC and carotenoids, vitamin E or selenium, as measured by serum biomarkers or dietary intake, although there was a suggestion of a positive association with lutein intake.

Not the same : a comparison of female and male clients seeking treatment from problem gambling counselling services

Previous studies of problem gamblers portray this group as being almost exclusively male. However, this study demonstrates that females comprised 46% of the population (n = 1,520) of persons who sought assistance due to concerns about their gambling from the publicly-funded BreakEven counselling services in the state of Victoria, Australia, in one 12-month period. This suggests that the model of service delivery which is community based counselling on a non-residential basis may be better able to attract female clients than treatment centres where males predominate such as veterans centres. A comparative analysis of the social and demographic characteristics of female and male gamblers within the study population was undertaken. As with previous studies, we have found significant differences between males and females who have sought help for problems associated with their gambling. Gender differences revealed in this study include females being far more likely to use electronic gaming machines (91.1% vs. 61.4%), older (39.6 years vs. 36.1 years), more likely to be born in Australia (79.4% vs. 74.7%), to be married (42.8% vs. 30.2%), living with family (78.9% vs. 61.5%) and to have dependent children (48.4% vs. 35.7%), than males who present at these services. Female gamblers (A$7,342) reported average gambling debts of less than half of that owed by males (A$19,091). These gender differences have implications for the development and conduct of problem gambling counselling services as it cannot be assumed that models of service which have demonstrated effectiveness with males will be similarly effective with females.