Biochemical,psychometric, and neuropsychological studies in heterozygotes for various lipidoses

Summary A sample of 38 clinically unaffected carriers for various lipidoses and their noncarrier relatives was studied with biochemical, psychological, and neuropsychological tests under blind conditions. The largest group of carriers was that for metachromatic leucodystrophy (MLD). The mean activity of arylsulphatase A or cerebroside sulphatase in the obligate carriers was 25%–30% of the control values, some heterozygotes showing little more activity than MLD patients. It was found that compared with the controls all heterozygotes (both obligate and facultative) differ unfavourably in some personality traits and in WISA subtests, including capacity for spatial cognition. These differences are especially obvious in a group of seven MLD carriers from the same family.With respect to reaction times, performance was significantly slower in MLD carriers, and particularly in those with enzyme activity lower than 30% of the control values.     

Prenatal diagnosis of X-linked choroideremia with mental retardation,associated with a cytologically detectable X-chromosome deletion

Summary We describe a family in which an X-chromosome deletion is segregating with choroideremia, an X-linked recessive condition. The DNA sequences DXYS1 and DXS3, defined by the probes pDP34 and 19.2 respectively, are absent in the affected male (who is also mentally retarded), and hemizygous in his mother and in his carrier sister, who presented early in pregnancy. Analysis of chorionic villus DNA formed the basis of prenatal exclusion of choroideremia in her male fetus. In three female relatives, studied with late-labelling techniques, the deleted X was preferentially inactivated in 86–100% of cells studied. This family confirms the localisation of the choroideremia locus to within Xq1321, and places the loci for anhidrotic ectodermal dysplasia and the X-linked immunodeficiencies outside this region.     

Kinship Influences Cannibalism in the Wolf Spider, Pardosa milvina

Recent studies have called into question the role of Wright's coefficient of relatedness (r) in the interactions among relatives. Kin selection theory predicts a positive relationship between relatedness and frequency of altruistic acts, but a number of researchers have reported the opposite relationship. I used a lycosid spider (Pardosa milvina) to test the hypothesis that genetic relatedness would affect the propensity of a cannibalistic species to prey on genetic relatives. I considered lack of predation to be a form of altruism where the predator incurs a cost (loss of a meal) that benefits potential prey. Specifically, I questioned whether direct genetic offspring would be avoided as prey items and whether the sex or reproductive condition of a cannibalistic predator would affect the likelihood of predation on conspecific juveniles. As predicted by kin selection theory, spiderling mothers ate significantly fewer of their own offspring than they did of nonkin spiderlings of the same age. Adult virgin female and adult male spiders ate significantly more spiders than females that had recently carried spiderlings. Females with egg sacs consumed significantly fewer spiderlings than did virgin female spiders. These findings support Hamilton's rule and suggest that, in some systems, genetic relatedness plays a strong role in governing altruistic behavior toward relatives.     

Familial Correlations of Onset Age of Hepatocellular Carcinoma: A Population-Based Case-Control Family Study

Background

There was lack of evidence for familial aggregation in onset age of hepatocellular carcinoma (HCC) in Chinese population. We conducted a population-based case-control family study to examine familial correlation of age of HCC onset in Taixing, China.

Methods

A total of 202 cases and 202 matched controls as well as their relatives were included in the study. Lifetime cumulative risks of HCC were estimated using the Kaplan-Meier approach. Cross ratios (CRs) were obtained from stratified Cox proportional hazard models, to assess the familial correlation of onset age.

Results

The mean age of HCC onset was decreased as increasing number of HCC cases in a family. The onset age was the earliest for first-degree relatives, intermediate for second-degree relatives, and latest for non-blood relatives (spouse) (log-rank test, P<0.01). The onset age was significantly correlated between probands and their relatives. In stratified Cox proportional hazard models, the CRs for the probands versus their fathers, mothers, siblings and uncles/aunts were 6.25 (95% confidence interval (CI): 1.84–21.25), 9.81 (95% CI: 1.24–77.56), 6.22 (95% CI: 1.37–28.36) and 3.24 (95% CI: 1.26–8.33), respectively. After adjustment for hepatitis B virus infection, the CRs remained significant.

Conclusion

This current study suggested a significant correlation of onset age for HCC among blood relatives. Familial HCC cases yielded earlier age of onset and their relatives have higher HCC risk in early age, highlighting intensive surveillance should be start at an earlier age for individuals with family history of HCC.     

Variable expression of cerebral cavernous malformations in carriers of a premature termination codon in exon 17 of the Krit1 gene

Background

Cerebral cavernous malformations (CCM) present as either sporadic or autosomal dominant conditions with incomplete penetrance of symptoms. Differences in genetic and environmental factors might be minimized among first-degree relatives. We therefore studied clinical expression in a family with several affected members.

Methods

We studied a three-generation family with the onset of CCM as a cerebral haemorrhage in the younger (four-year-old) sibling. Identification and enumeration of CCMs were performed in T2-weighted or gradient-echo MRIs of the whole brains. Genetic analysis comprised SCCP, sequencing and restriction polymorphism of the Krit1 gene in the proband and at risk relatives.

Results

The phenotypes of cerebral cavernous malformations (CCMs) in carriers of Krit1 mutations were very variable. We identified a novel frameshift mutation caused by a 1902A insertion in exon 17 of the Krit1 gene, which leads to a premature TAA triplet and predicts the truncating phenotype Y634X. A very striking finding was the absence of both clinical symptoms and CCMs in the eldest sibling harbouring the 1902insA.

Conclusions

Patients in this family, harbouring the same mutation, illustrate the very variable clinical and radiological expression of a Krit1 mutation. The early and critical onset in the proband contrasts with minor clinical findings in affected relatives. This consideration is important in genetic counselling.

     

X-chromosome methylation in manifesting and healthy carriers of dystrophinopathies: concordance of activation ratios among first degree female relatives and skewed inactivation as cause of the affected phenotypes

The X-chromosome activity states of 11 manifesting carriers of dystrophinopathies, all with normal karyotypes, were estimated by restriction fragment length polymorphism (RFLP)-methylation analysis with the probes M27 (DXS255), p2-19(DXS605) and pSPT/PGK (PGK1) to test the role of skewed X-inactivation ratios as the cause of their affected phenotypes. In eight cases preferential inactivation of the putative X chromosome carrying the normal dystrophin allele in 90% of their peripheral lymphocytes was observed, two cases showed non-appparent deviant ratios (6040 and 7030) from the theoretically expected values around the mean of 50% and in one case the three markers employed yielded no information. The analysis of the X-inactivation ratio in six mother-daughter pairs, all non-manifesting Duchenne muscular dystrophy (DMD) carriers, and in the close female relatives of the patients showed: (a) neither of the two X chromosomes was preferentially inactivated with respect to their parental origin; (b) a high concordance among the activation ratios of mothers and daughters, a result difficult to explain just in terms of random X-chromosome inactivation.     

A 13-15/21 Translocation Chromosome in Carrier Father and Mongol Son

Cytogenetic and dermatoglyphic features were studied in a family in which the mongoloid propositus inherited a 13-15/21 translocation chromosome from his father. Seven other healthy male carriers scattered throughout the pedigree produced nine chromosomally normal children and five carrier children in addition to the mongoloid propositus. These results show that carrier males do not necessarily produce an unusually large proportion of carrier children as previous reports would indicate. Dermatoglyphic studies showed that translocation carriers in this family have neither significantly more centralized nor less centralized palmar axial triradii than non-carrier relatives. No direct evidence was therefore found for the hypothesis that an allele is present on chromosome 21 which influences the height of the triradius.     

c-Ha-ras-1 alleles in bladder cancer,Wilms' tumour and malignant melanoma

Summary Polymorphism of the human c-Ha-ras-1 gene has been analysed in DNA from 168 individuals using the enzymes MspI and HpaII. In all, 35 bladder cancer patients, 28 melanoma patients, 22 Wilms' tumour patients, 24 first-degree relatives of Wilms' tumour or melanoma patients and 59 unaffected controls were studied. A total of 13 different fragment sizes was detected, 4 common and 9 unusual. Of the latter, 4 were observed only in cancer patients or their first-degree relatives. The frequency of unusual alleles was significantly greater in bladder cancer patients and in the combined tumour group than in controls, thus providing support for the association of unique Ha-ras alleles and cancer. Some unaffected relatives of patients carried unusual alleles, and thus there is no absolute relationship between Ha-ras genotype and disease.     

Decreased fertility in related females heterozygous for the 1/29 chromosome translocation

Eighteen heifers and 120 cows which were descendants of a presumed 1/29 carrier Simmental bull were karotyped. Nine heifers (50%) and 48 cows (40%) were found to be heterozygous for the 1/29 translocation (59, XX, t(1q;29q)). The other animals were chromosomally normal (i.e., 60, XX) or not karotyped. The 48 1/29 cows were compared with 72 chromosomally normal cows with regards to days to first conception, calving interval, percentage of calves conceived, percentage of calves weaned and production efficiency (% calved conceived × % calved weaned). Nine carrier heifers were compared to the nine noncarrier heifers as to pregnancy status. Carrier, noncarrier and nonkarotyped relatives were compared to each other and to contemporary females with regard to pregnancy status at their initial exposure to males. The percentage of calves conceived (calving efficiency) in the 72 noncarrier and the 48 females heterozygous for the 1/29 translocation were 81.5 and 74.8%, respectively (P<0.07). Although days to first conception was longer and percentage of calves weaned and production efficiency were lower in the female heterozygous for the 1/29 translocation, the differences were not statistically different (P>0.10) from the noncarriers. Pregnancy rate was 44.4 and 66.7% (P>0.10) for nine carrier and nine noncarrier heifers, respectively. The pregnancy rate of carrier (65.4%), noncarrier (73.2%) and nonkarotyped (77.8%) relatives of this sire at their mating as yearlings, did not differ (P>0.10). The pregnancy rate as yearlings of carrier females (65.4%) and contemporary heifers (79.8%) did differ (P<0.05). Comparing the pregnancy rate as yearlings of all descendants (72.0%) of the Simmental sire to contemporary heifers (79.8%), a significant decrease (P<0.05) was found indicating that fertility of this sire may have been lower than other sires or that other factors beside the translocation affected fertility.     

Amyloid Beta Peptide 1-40 and the Function of Rat Hippocampal Hemicholinium-3 Sensitive Choline Carriers: Effects of a Proteolytic Degradation In Vitro

Effects of amyloid beta peptide 1-40 (Abeta) and of plant cysteine proteases bromelain and papain on the high-affinity uptake of choline (HACU) and the specific binding of [³H]hemicholinium-3 ([³H]HC-3) have been investigated on hippocampal synaptosomes from young adult male Wistar rats under basal and stimulated conditions (55 mM KCl). Depolarization increased significantly the HACU levels (the changes were predominantly in Vmax) and mildly the [³H]HC-3 binding (the changes especially in K_D). Nonaggregated Abeta at low nM concentrations suppressed the depolarization effects but was ineffective under basal conditions during a short-term incubation. Higher M concentrations decreased the HACU and binding under basal conditions in a time-dependent manner. The binding changes were firstly associated with alterations in K_D and secondarily were accompanied also by a drop in Bmax. The results suggest that Abeta directly influences high-affinity carriers, inhibits their transport activity and enhances their sensitivity to proteolytic cleavage. Stimulation increases the sensitivity of carriers to the interaction with Abeta.     

Guiding intensive care physicians’ communication and behavior towards bereaved relatives: study protocol for a cluster randomized controlled trial (COSMIC-EOL)

Background

Providing appropriate support and care for end-of-life patients and their relatives is a major concern and a daily responsibility for intensivists. Bereaved relatives of non-surviving patients in intensive care units (ICUs) often suffer from prolonged grief, posttraumatic stress disorder, anxiety, and depression. A physician-driven intervention, consisting of three meetings with the family, might reduce the post-ICU burden of bereaved family members 6?month after death. The patient’s nurse is actively involved at each step. We hypothesize that this strategy will improve communication in the end-of-life setting and thus, should reduce the post-ICU burden for family members, specifically the development of prolonged grief 6?months after the death.

Methods/design

The COSMIC-EOL trial is a prospective, multicenter, cluster randomized controlled trial in which centers are allocated to two parallel arms: (1) intervention centers where relatives benefit from three-step physician-driven support during the dying and death process and (2) control centers where, during the dying and death process, relatives receive the standard of care practice. Each of the 36 participating centers will include 25 relatives of patients with a length of stay ≥2?days. Participating relatives will be followed up by phone at 1, 3, and 6?months after the patient’s death to complete questionnaires permitting evaluation of their post-ICU burden. The main outcome is prolonged grief measured 6?months after the death using the PG-13. Other outcomes include evaluation of quality of dying, quality of communication, anxiety, depression, and post-traumatic stress. The estimated duration of the study is 36?months.

Discussion

The results of the trial will provide information about the effectiveness of physician-driven support for relatives of patients dying in an ICU. The study is expected to demonstrate a decrease in the ICU burden for bereaved relatives who benefitted from this intervention.

Trial Registration

ClinicalTrials.gov, NCT02955992. Registered on November 3rd 2016.

     

Bipolar manic-depressive psychoses: Results of a genetic investigation

Summary Ninety-five patients with bipolar manicdepressive disorders were followed from 1959 to 1975, and their first-degree relatives (N=617) were studied. In the search for heterogeneity of bipolar illness the patients were subclassified according to various criteria: sex, age at onset, number of episodes, and longitudinal syndrome subtypes (Dm, MD, Md), and the genetic findings were used as an external criterion.The first-degree relatives of female probands showed a higher morbidity risk for psychiatric disorders than the relatives of male probands, and the highest morbidity risk was found in the female relatives of female probands. Early onset and late-onset patients did not differ from a genetic point of view. Patients with ten episodes or more showed slightly higher family morbidity than those with less than ten episodes.The three subtypes of bipolar disorders preponderantly depressed (Dm), nuclear type (MD), and preponderantly manic (Md), showed significant genetic differences. The families of type Dm had the highest morbidity, and families of type Md, the lowest! The type MD took an intermediate position. The results are surprising and not compatible with current hypotheses of multifactorial heredity assuming a continuum from depression to mania with distinct thresholds for the manifestation of unipolar depression, bipolar psychosis, and pure mania. The findings also do not suggest the existence of a drug-induced hypomania.Father-son transmission was frequent, and this fact excludes a substantial amount of X-chromosomal inheritance.Parents, siblings, and children exhibited roughly the same morbidity risk. If a proband had an affected parent, the morbidity risk for his siblings and children was nearly twice as high as without such a parent (38% vs 21%). The analysis of the intrafamilial distribution of diagnoses supported the assumption that neurotic depression belongs to the true spectrum of affective psychoses.     

Familial pericentric and paracentric inversions of chromosome 1

Summary We investigated 33 individuals (21 carriers) from one family with a pericentric inversion involving a large part of chromosome 1 (1p36.11q32). In addition, we investigated 15 individuals (10 carriers) from another family with a paracentric inversion of a small part of chromosome 1(1p321p36.1). In each family, the index patient was ascertained because three miscarriages had occurred. Each carrier of these inversions was phenotypically normal. If the miscarriages of the index patients are excluded, the frequency of recognized miscarriages among the carriers of childbearing age was 9% (4 of 46) for the family with pericentric inversion and 17% (4 of 23) for the family with paracentric inversion. One of the pericentric inv(1) carriers had had a stillborn daughter. The carriers of the pericentric inversion who were of childbearing age had 41 children; carriers of the paracentric inversion who were of childbearing age had 19 children. No live-born children with birth defects were observed in either family. This evidence, together with the low frequency of miscarriages, suggests that crossover within the inversion loop occurs much less frequently than might be expected from the large size of this inversion. Our investigation suggests that the risk of recognized miscarriages, stillbirths, and live-born children with recombinant chromosomes who have birth defects may be much lower for inv(1) carriers than previously reported. The risk of having a malformed child because of a recombinant chromosome is probably less than 3% for carriers of the pericentric inversion and less than 6% for the carriers of the paracentric inversion.     

The Association between Intelligence Scores and Family History of Psychiatric Disorder in Schizophrenia Patients,Their Siblings and Healthy Controls

Background

The degree of intellectual impairment in schizophrenia patients and their relatives has been suggested to be associated with the degree of familial loading for schizophrenia. Since other psychiatric disorders are also more present in relatives of schizophrenia patients, the definition of family history should be broadened. The association between family history for psychiatric disorder and intelligence scores was investigated in patients with non-affective psychosis, their unaffected siblings and controls.

Methods

A sample of 712 schizophrenia proband families (696 patients and 766 siblings) and 427 healthy control families (517 subjects) participated in this study. Family history of psychiatric disorder was determined while excluding the data of the participating schizophrenia patient. A dichotomous division was made between families with no first- or second degree relative with psychiatric disorder and families with one or more affected relatives. Total intelligence scores were estimated by admission of the short form of the Wechsler Adult Intelligence Scale III.

Results

A significant interaction was found between family history of psychiatric disorder and clinical status (F(2,1086.87)= 4.17; p=.016). Patients with a positive family history of psychiatric disorder obtained higher intelligence scores compared to patients with no family history (mean IQ scores are 95.52 and 92.72) with an opposite effect in controls (mean IQ scores are 108.71 and 111.19). No significant difference was found between siblings of schizophrenia patients with or without a positive family history (mean IQ scores are 102.98 and 103.24).

Conclusion

In patients with schizophrenia, a negative family history of psychiatric disorder was associated with relatively low IQ suggesting that the etiology in these patients may involve environmental or genetic factors which are unique to the patient and are not observed in other relatives. Possible factors include severe environmental stressors containing premature birth or brain injury and genetic factors (e.g de novo Copy Number Variants).     

A Qualitative Study to Appraise Patients and Family Members Perceptions,Knowledge, and Attitudes towards Venous Thromboembolism Risk

Objective

This study aimed to examine perception, knowledge and concerns developed by patients and their family as regards venous thromboembolism (VTE) risk.

Methods

We conducted a qualitative study. Participants were: (1) patients with unprovoked VTE with either factor V Leiden mutation or G20210A prothrombin gene mutation or not; and (2) their first-degree relatives. Interviews took place mostly at Brest University Hospital. Participants produced narratives of the patient’s illness, stressing their perception of the disorder, its mechanisms, etiology, circumstances and risk factors. Interviews were audiotaped and transcribed verbatim. On an ongoing basis, central themes were identified and data from narratives were categorized by these themes.

Results

A total of ten patients and 25 first-degree relatives were interviewed. Analyses of patient’s narratives suggested 4 main themes: (1) concerns about initial symptoms and suspicion of VTE. The longer the duration of the initial phase, the more likely anxiety took place and persisted after diagnosis; (2) underestimation of potential life-threatening episode once being managed in emergency; (3) possible biographical disruption with inability to cope with the event; and (4) secondary prevention attitudes motivated by remains of the episode and favoring general prevention attitudes. Analyses of the first-degree relatives narratives suggested 3 main themes: (1) common interpretation of the VTE episode shared within the family; (2) diverse and sometimes confusing interpretation of the genetic status; and, (3) interpretation of clinical signs linked to VTE transmission within the family.

Conclusions

Construction of the risk of VTE is based on patient’s initial experience and shared within the family. Collection of narratives illustrates the gap between these perceptions and current medical knowledge. These results support the need to collect the perceptions of the VTE episode and its consequences, as a prerequisite to any health education process.     

Distinguishing between carrier and noncarrier embryos with the use of long-read sequencing in preimplantation genetic testing for reciprocal translocations

Balanced reciprocal translocation carriers are usually phenotypically normal but are at an increased risk of infertility, recurrent miscarriage or having affected children. Preimplantation genetic testing on chromosomal structural rearrangement (PGT-SR) offers a way to screen against unbalanced embryos. Here, we demonstrated a new method to distinguish carrier from noncarrier embryos. Translocation breakpoints were first delineated by nanopore sequencing followed by polymerase chain reaction (PCR) across breakpoints. High-resolution breakpoint mapping was successful in all (9/9) balanced reciprocal translocation carriers. Retrospective analysis of their embryo biopsies with breakpoint PCR showed 100% concordant results with PGT-SR on trophectoderm biopsies (40/40) and 53% concordance on blastomere biopsies (8/15). The low concordant rate in blastomeres was due to failure in the amplification of derivative chromosomes involving large deletions. Breakpoint PCR also showed 100% concordant results with prenatal/postnatal outcomes on 5 pregnancies, indicating that our new method can accurately distinguish carrier from noncarrier embryos.     

Bacterial Diversity in a Marine Methanol-Fed Denitrification Reactor at the Montreal Biodome,Canada

The bacterial biota of a methanol-fed denitrification reactor used to treat seawater at the Montreal Biodome were investigated using culture-dependent and molecular biology methods. The microbiota extracted from the reactor carriers were cultivated on three media. Three isolate types were recovered and their 16S ribosomal DNA (rDNA) genes were determined. The analysis showed that the isolate types were related to -Proteobacteria. They are members of the Hyphomicrobium and Paracoccus genera and the Phyllobacteriaceae family. Uncultured bacteria were identified through a 16S rDNA library generated from total DNA extracted from the microbiota. Clones were screened for different restriction profiles and for different DGGE (denaturing gradient gel electrophoresis) migration profiles. More than 70% of clones have the same restriction profile, and the sequence of representative clones showed a relation with the Methylophaga members of the Piscirickettsia family (-Proteobacteria). Sequences from other profiles were related to bacterial species involved in denitrification. The number of species in the denitrification reactor was estimated at 15. Bacterial colonization on newly added carriers in the denitrification reactor was monitored by PCR-DGGE. The DGGE migration profiles evolved during the first 5 weeks and then remained essentially unchanged. PCR-DGGE was also used to monitor the microbial profiles in various aquarium locations. As expected, bacterial populations differed from one location to another, except for the sand and trickling filters which presented similar DGGE migration profiles.     

Response to DNA-damaging agents in cultured cells from patients with X-linked duchenne muscular dystrophy phenotype: male DMD,female DMD,possible carriers

Using blood cultures the response to gamma () radiation was examined in a male DMD and his mother, in a female DMD and her mother and in a normal control. In a series of experiments chromosome aberrations were determined after 3 separate -irradiation dose levels: 0, 150, 300 rads. The DMD patients showed a response to ionising radiations different from control, in fact the percentage of aberrations was lower than the control. In this preliminary study a slight difference between normal and possible carriers was also found.     

Matrilineal Cohesion and Social Networks in Macaca fuscata

In a provisioned troop of Japanese macaques (Macaca fuscata) in Arashiyama, Japan, greater adherence to Kawamura's rules of matrilineal rank inheritance and youngest ascendancy occurred among high-ranking females versus low-ranking females. Accordingly, high-ranking females formed more clustered hierarchies and low-ranking females had more dispersed hierarchies. A proximate explanation for this finding may be related to differences in how females maintain their social networks. To determine whether the clustering in the hierarchy was reflected in patterns of social cohesiveness, I compared network sizes of coalition and grooming partners for females in each third of the hierarchy. I calculated the proportion of available partners that were coalition and grooming partners within each category of relatedness (0.5 r 0.004 and r = 0). High-ranking females formed coalitions with a large proportion of their close relatives and a small proportion of their distant relatives; middle-ranking females supported an intermediate proportion of their close relatives and a small proportion of their distant relatives; and, low-ranking females formed coalitions with very few available close and distant relatives. High-ranking females groomed nearly all available close relatives and an intermediate proportion of distant relatives, whilst middle- and low-ranking females groomed a large proportion of available close relatives and a very small proportion of distant relatives. Thus, levels of clustering within the hierarchy appeared to reflect levels of social cohesion, in terms of grooming and coalition formation.     

Chronic Diseases Knowledge and Related Factors among the Elderly in Jinan,China

Background

It has been reported that the prevalence of chronic diseases is high among old people and they have poor chronic diseases knowledge. This study was therefore designed to evaluate the awareness rate of chronic diseases knowledge among people aged over 60 years, to explore its related factors and to provide evidence for future health education.

Methods

A cross-sectional study was conducted from April to August in 2011. People aged 60 years and above from 3 communities in Jinan were selected by cluster sampling. Nine hundred and twenty five participants were interviewed face-to-face using a structured questionnaire.

Results

The awareness rates of chronic diseases knowledge varied from 29.5% to 90.2%. Four healthy lifestyles including quitting smoking and less drinking, keeping broad-minded, maintaining balanced diet and moderate physical activity were best known (from 86.3% to 90.2%). The least known knowledge were 2 complications of hypertension: nephropathy (29.5%) and retinopathy (37.2%). Participants with the following characteristics or behaviors were more likely to have higher chronic diseases knowledge: younger age, female, Han Chinese, higher level of education, having health insurance, participating in societies, having family history of chronic diseases, frequently gathering with friends/relatives, usually going to provincial hospitals/hospitals affiliated with medical universities, usually going to municipal hospitals and usually going to community health center/station.

Conclusions

Old people in Jinan had incomplete chronic diseases knowledge and the overall awareness rate was not high. The older people’s chronic diseases knowledge should be improved and health education programs should target males, older people with lower educational level, having no health insurance, having no family history of chronic diseases, participating in no societies, and less frequently gathering with friends/relatives. Also, lower level medical facilities should improve their skills of health education.