Healthcare affordability is a worry for many Americans. We examine whether the relationship between having problems paying medical bills and mental health problems changed as the Affordable Care Act ...(ACA) was implemented, which increased health insurance coverage. Data from the 2013-2016 Health Reform Monitoring Survey, a survey of Americans aged 18-64, were used. Using zero-inflated negative binomial regression, adjusted for predisposing, enabling, and need factors, we examined differences in days of mental health symptoms by problems paying medical bills (n = 85,430). From 2013 to 2016, the rates of uninsured and problems paying medical bills decreased from 15.1% to 9.0% and 22.0% to 18.6%, respectively. Having one or more days of mental health symptoms increased from 39.3% to 42.9%. Individuals who reported problems paying medical bills had more days of mental health symptoms (Beta = 0.133, p < 0.001) than those who did not have this problem. Insurance was not significantly associated with days of mental health symptoms. Over the 4-year period, there were not significant differences in days of mental health symptoms by problems paying medical bills or insurance status. Despite improvements in coverage, the relationship between problems paying medical bills and mental health symptoms was not modified.
Oxidative stress with higher levels of leptin and inflammatory response are key processes related to pathogenesis of both T. cruzi infection and aging. Nuclear factor erythroid 2-related factor 2 ...(Nrf2) controls the expression of several genes implicated in the oxidative stress response in many pathological conditions. Melatonin is a pleiotropic hormone with, antioxidant, anti-inflammatory and anti-aging actions. Then, we hypothesized that Nrf2 response is impaired during the acute T. cruzi (9 days) infection and that melatonin rescues Nrf2 responses. Young (5 weeks-old) and middle-aged (18 months-old) male Wistar rats were infected with T. cruzi. Nrf2 translocation and markers of inflammation and oxidative stress were analyzed in blood and spleen. Increased apoptosis levels and oxidative stress indicators were observed in the rat spleen during T. cruzi infection. These responses were accompanied by decreased Nrf2 expression and increased expression of nuclear factor kappa B (NFκB). Melatonin (5 mg/kg/day; p.o. gavage) attenuated the superoxide anion (O2−) and hydrogen peroxide (H2O2) production induced by T. cruzi infection. Increased expressions of catalase and superoxide dismutase (SOD) were detected in the spleen of melatonin-treated rats infected with T. cruzi. Melatonin treatment inhibited the spleen NF-κB activation and downregulates the levels of circulating interleukin (IL)-4, IL-10 and tumor necrosis factor (TNF)-α in T. cruzi middle-aged infected rats. Increased levels of the chemokine CXCL1 in middle-aged control rats was observed, confirming that aging alters the production of this chemokine. In T. cruzi infected young animals, CXCL1 was up-regulated when compared to non-infected young ones. For young or middle-aged animals, melatonin treatment had no significant effect on CXCL1 levels. Our findings demonstrate an important role for Nrf2/NF-kB regulation as a possible mechanism by which melatonin attenuates oxidative stress, and provide new insights for further studies of this indoleamine as a therapeutic co-adjuvant agent against T. cruzi infection.
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•Melatonin regulates Nrf2/NF-kB response during acute T. cruzi infection;•The induction of Nrf2 regulation by melatonin was linked to improved Nrf2 nuclear translocation;•Treatment with melatonin reduced NF-κB expression in middle-aged treated animals, infected or not;•Melatonin regulates CD4+T and CD8+ T lymphocytes and splenocyte apoptosis.
Whole lung lavage (WLL) is still the gold-standard therapy for pulmonary alveolar proteinosis (PAP). The few studies on the duration of the effect of WLL, belonging to a rather remote period, show ...significant but transient benefits. In 21 patients with idiopathic PAP, the duration of any benefit and, in 16 of them, the time course of lung function improvement (at baseline, 1 week, 6 months, 1 yr and then every 2 yrs after WLL) were evaluated. The present WLL technique takes longer, is invasively monitored and partially modified with respect to past techniques. More than 70% of patients remained free from recurrent PAP at 7 yrs. The bulk of the improvement in spirometric results was almost completely gained in the immediate post-WLL period due to the efficient clearance of the alveoli. At a median of 5 yrs, recovery of diffusing capacity of the lung for carbon monoxide was incomplete (75 +/- 19% of the predicted value) and there were residual gas exchange abnormalities (alveolar to arterial oxygen tension difference 3.6 +/- 1.5 kPa (27 +/- 11 mmHg)) and exercise limitation, probably explained by engorgement of lymphatic vessels. In conclusion, whole lung lavage for idiopathic pulmonary alveolar proteinosis is currently a safe procedure in an experienced setting, and provides long-lasting benefits in the majority of patients.
Background: Several studies have provided evidence of a strong association between asthma and allergic or nonallergic rhinitis, leading to the hypothesis that allergic rhinitis (AR) and asthma ...represent a continuum of the same disease.
Aim: The aims of our study were: (i) to measure the comorbidity of AR and asthma and asthma‐like symptoms and (ii) to assess whether asthma, AR, and their coexistence share a common pattern of individual risk factors.
Methods: The subjects are participants from the Italian multicentre, cross‐sectional survey on respiratory symptoms in the young adult general population (Italian Study of Asthma in Young Adults, ISAYA). The relationship between individual risk factors and asthma, AR and their coexistence, was studied by means of a multinomial logistic regression.
Results: About 60% of asthmatics reported AR. On the other hand, subjects with AR presented an eightfold risk of having asthma compared to subjects without AR. Age was negatively associated with asthma OR = 0.89, 95% confidence interval (CI): 0.82–0.96, AR (OR = 0.92, 95% CI: 0.86–0.98), and asthma associated with AR (OR = 0.83, 95% CI: 0.79–0.88). The risk of AR without asthma was significantly higher in the upper social classes (OR = 1.23, 95% CI: 1.08–1.39). Active current smoking exposure was positively associated with asthma alone (OR = 1.24, 95% CI: 1.09–1.41) and negatively associated with AR with (OR = 0.69, 95% CI: 0.54–0.88) or without (OR = 0.76, 95% CI: 0.69–0.84) asthma.
Conclusions: Asthma and AR coexist in a substantial percentage of patients; bronchial asthma and AR, when associated, seem to share the same risk factors as AR alone while asthma without AR seems to be a different condition, at least with respect to some relevant risk factors.
Thermal conductivity, thermal diffusivity, density and viscosity of cashew juice were measured at 30 °C for soluble solids content ranging from 5.5 to 25 °Brix. Thermal conductivity and diffusivity ...were determined using a linear heat source probe. Both properties were found to decrease with the increase of soluble solids content, while density and viscosity increased. Empirical models were fitted to the experimental data for each property and the accuracy of those models was checked.
Background: The knowledge of the natural history of asthma from birth to adulthood could provide important clues for its cause and for the understanding of epidemiologic findings.
Objective: This ...study is aimed at assessing the incidence and remission of asthma from birth to the age of 44 years by using data from 18,873 subjects involved in a large, nationally representative, cross-sectional study carried out in Italy from 1998 through 2000.
Methods: The onset of asthma was defined as the age at the first attack, and remission was considered present when a subject was neither under treatment nor had experienced an asthma attack in the last 24 months. Person-years and survival techniques were used for the analysis.
Results: The average annual incidence rate for the 1953 to 2000 period was 2.56/1000 persons per year. Incidence peaked in boys less than 10 years of age (4.38/1000 persons per year) and in women 30 years of age or older (3.1/1000 persons per year) and showed a generational increase (incident rate ratio = 2.63 and 95% CI = 2.20-3.12 for 1974-1979 vs 1953-1958 birth cohort). The overall remission rate was 45.8% (41.6% in women and 49.5% in men,
P < .001). Asthmatic patients in remission had an earlier age at onset (7.8 vs 15.9 years,
P < .001) and a shorter duration of the disease (5.6 vs 16.1 years,
P < .001) than patients with current asthma. The probability of remission was strongly (
P < .001) and inversely related to the age at onset (62.8% and 15.0% in the <10- and ≥20-years age-at-onset groups, respectively).
Conclusion: With respect to its natural history, asthma presents 2 different forms: early-onset asthma, which occurs early in childhood, affects mainly boys, and has a good prognosis, and late-onset asthma, which generally occurs during or after puberty, mainly affects women, and has a poor prognosis. The minority of patients with early-onset asthma who do not remit represents more than 35% of patients with current asthma in the general young adult population. (J Allergy Clin Immunol 2002;110:228-35.)
Osmotic dehydration process was investigated in this study. This process was carried out in an incubator at temperatures of 25 and 60 °C and constant agitation. Frozen mature acerolas were blanched ...in water (80 °C for 3 min) and dehydrated using binary (water
+
sucrose) and ternary (water
+
sucrose
+
salt) solutions. The concentration of sucrose ranged from 30% to 60% (w/w) for binary solution and from 20% to 50% (w/w) for ternary solution with 10% (w/w) of salt. Responses of water loss (WL), solid gain (SG), solid gain/water loss ratios (SG/WL) and water reduction (WR) were evaluated. The best conditions were determinated by using SG/WL as a process parameter. The chosen conditions were: a binary solution with 60% (w/w) of sucrose and a ternary solution of 50% (w/w) of sucrose plus 10% (w/w) of salt, both at a temperature of 60 °C.
Summary Rationale and objectives Response to mailed epidemiological surveys has decreased in recent decades. Since subjects with respiratory symptoms are usually early responders to surveys performed ...in Southern Europe, this trend could bias prevalence estimates. The present study aimed at evaluating the impact of non-response bias on prevalence estimates of respiratory symptoms and smoking habits. Methods In 9 centres, participating in the Italian Study on Asthma in Young Adults (ISAYA), random samples of people aged 20–45 years were administered a mailed questionnaire between 1998 and 2000. Non-responders were contacted again first by mail and then by phone. Cumulative response percentage was 30.5%, 52.4% and 72.7% (18,873/25,969), respectively, after the 1st, 2nd and 3rd contact. Results The prevalence of self-reported current asthma, asthma-like symptoms, and chronic cough/phlegm was more than halved from the first contact (5.6%, 17.8%, 14.6% respectively) to the third contact (2.7%, 6.4%, 6.9%). This pattern was less pronounced when considering allergic rhinitis and past asthma, whose prevalence decreased, respectively, from 21.5% to 15.6% and from 3.5% to 2.6%. At the same time the proportion of current smokers increased from 29.2% to 38%, while the proportion of ex-smokers decreased from 16.5% to 10.1%. In a multinomial logistic model current asthma, asthma-like symptoms, chronic cough/phlegm and smoking habits, and to a lower extent past asthma and allergic rhinitis, were significant predictors of late response. Conclusions In Italy when response percentage is low, the prevalence of current asthma, chronic cough/phlegm and ex-smokers is overestimated, while the proportion of current smokers is underestimated.
Background: Variations in the prevalence of respiratory symptoms according to geo‐climatic factors could provide important clues to the knowledge of the aetiology of asthma.
Methods: Geo‐climatic ...variations in the prevalence of current asthma, allergic rhinitis and chronic cough, and phlegm were assessed on a random sample of 18 873 subjects (response rate = 72.7%) from different climatic regions of Italy. An ecological analysis, supported by robust statistical methods, was employed to investigate potential trends.
Results: The prevalence of all symptoms was significantly heterogeneous throughout the peninsula. Only asthma‐like symptoms showed a north–south trend: the prevalence increased at a decreasing latitude odds ratio (OR) varies from 0.92 to 0.96, P < 0.05, at a decreasing distance from the sea (OR: 0.90–0.93 for 30 km distance, P < 0.05), at higher annual mean temperatures (OR: 1.11–1.14, P < 0.05) and at smaller annual temperature ranges (OR: 0.94–0.95, P < 0.05). Of the geo‐climatic variables considered, temperature range had the greatest influence on most asthma‐like symptoms. No association was found between geo‐climatic variables and allergic rhinitis or chronic cough and phlegm.
Conclusions: Asthma prevalence seems to be significantly affected by climate as asthma‐like symptoms were more common in central‐southern Italy, with a Mediterranean climate, than in areas with a continental climate (northern Italy).
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