Domiciliary care for the elderly sick--economy or neglect?

This paper reports an investigation of the costs of domiciliary care for 139 elderly sick patients under the care of the home nursing service. The data suggest that there may be little economic advantage in home care for seriously disabled elderly people. The revenue cost of domiciliary care was equal to or greater than the average associated with residential or hospital custodial care in such patients. Even so, the cost of services received at home did not disclose the real need for domiciliary care, since at present this is obscured by compulsory rationing and the separation of responsibility between health and social services. It is suggested that the supposed economic advantage of domiciliary care will depend increasingly on restricting such services, thus increasing the degree of neglect to some patients.     

Molecular systems biology at the crossroads: to know less about more,or to know more about less?

Systems biology is a rapidly evolving discipline that endeavours to understand the detailed coordinated workings of entire organisms, with the ultimate goal to detect differences between health and disease, or to understand how cells or entire organisms react to the environment. The editorial provides a critical evaluation of what molecular systems analysis can and cannot accomplish with existing methodologies, and how systems biology needs to merge with reductionism to yield a more comprehensive and mechanistically insightful model of a cell or organism.     

Carbohydrates: is the advice to eat less justified for diabetes and cardiovascular health?

PURPOSE OF REVIEW: Recent randomized controlled trials examining diets of varying carbohydrate composition recommended for people with diabetes and cardiovascular disease and those at risk are summarized. RECENT FINDINGS: Severe carbohydrate restriction results in appreciable initial weight loss and improvement in risk factors. After a year, however, the beneficial effects are equal to or less than those achieved on conventional alternatives. Some people develop elevations of LDL cholesterol. Modest carbohydrate restriction with relatively high intakes of cis-unsaturated fatty acids and protein is acceptable to many people and is more likely to produce sustained benefit in terms of weight loss and cardiovascular risk indicators. SUMMARY: Diets involving moderate carbohydrate restriction are suitable alternatives to high-carbohydrate, high-fibre diets for weight loss and reduction of cardiovascular disease and diabetes risk, as well as to treat individuals with the conditions. As such diets are generally high in protein and unsaturated fatty acids, they are not recommended for those with established or incipient nephropathy. High-carbohydrate, high-fibre diets remain appropriate for use in all those situations, provided carbohydrate is derived principally from minimally processed wholegrain breads and cereals and intact vegetables and fruit. Lower carbohydrate options may be preferable for markedly insulin-resistant individuals.     

EKC and the income elasticity hypothesis Land for housing or land for future?

This paper investigates the relationships between land consumption and per capita gross domestic product (GDP) for a panel of 20 Italian regions over the period 1980–2010. As proxy of land consumption, it uses the supply of new housing, being residential construction the main cause of soil sealing. To test this hypothesis it runs a panel data regression model. In the considered period, results show the existence of an inverted EKC whereas, on a longer period, a N-shaped curve may be inferred. Contrary to the EKC hypothesis, both fixed effect and random effect model estimates show that higher income does not induce greater environmental awareness or, in different words, that the income elasticity hypothesis holds for housing demand rather (or more) than for environment. According to these results, considering the specificity of the resource under consideration, the paper claims for a shift from market to public policy. A tighter urban planning and a higher “environmental” property taxation could be efficient strategies to combat land consumption.     

Misfolding of membrane proteins in health and disease: the lady or the tiger?

Protein misfolding is increasingly recognized as a factor in many diseases, including cystic fibrosis, Parkinson's, Alzheimer's and atherosclerosis. Many proteins involved in misfolding-based pathologies are membrane-associated, such that the bilayer may play roles in normal and aberrant folding. It can be argued that the in vivo partitioning of eukaryotic membrane proteins between folding and misfolding pathways is under kinetic control. Moreover, the balance between these pathways can be surprisingly delicate.     

Explore less to control more: why and when should plants limit the horizontal exploration of soil by their roots?

In ecosystems limited by soil nutrients, some plants show a restricted horizontal distribution of their roots. We explored the hypothesis that this particular pattern is a foraging strategy emerging from tradeoffs between soil exploration (that increases the pool of nutrients available for plants) and the local control of nutrient cycling within the soil that we call soil occupation. We developed two general analytical models of the cycling of a limiting nutrient in a plant population that is not limited by water. They allowed to explore how plant productivity is affected when roots do not exploit the whole soil available and to determine the conditions for which plant nutrient stock is maximized when plants limit their exploration of soil. We predict that a restricted exploration strategy can be beneficial when 1) there is at least one tradeoff between a nutrient cycling parameter and soil exploration, 2) nutrient availability in the unexplored soil is poor and 3) the area of soil explored by plants is stable over time. The exploration limitation strategy results in spatially heterogeneous and nutrient‐conservative ecosystems. Our results should apply well to perennial tussock grasses within tropical nutrient‐limited ecosystems and raises interesting cues for the construction of more sustainable agro‐ecosystems. Overall, our study underlines the importance of considering the multiplicity of root–soil interactions and of their scales when considering root foraging strategies.     

A retrospective analysis of health care utilization for patients with mitochondrial disease in the United States: 2008–2015

Background

Oral cholic acid (CA) replacement has been shown to be an effective therapy in children with primary bile acid synthesis defects, which are rare and severe genetic liver diseases. To date there has been no report of the effects of this therapy in children reaching adulthood. The aim of the study was to evaluate the long-term effectiveness and safety of CA therapy.

Methods

Fifteen patients with either 3β-hydroxy-Δ⁵-C₂₇-steroid oxidoreductase (3β-HSD) (n = 13) or Δ⁴–3-oxosteroid 5β-reductase (Δ⁴–3-oxo-R) (n = 2) deficiency confirmed by mass spectrometry and gene sequencing received oral CA and were followed prospectively.

Results

The median age at last follow-up and the median time of follow-up with treatment were 24.3 years (range: 15.3–37.2) and 21.4 years (range: 14.6–24.1), respectively. At last evaluation, physical examination findings and blood laboratory test results were normal in all patients. Liver sonograms were normal in most patients. Mean daily CA dose was 6.9 mg/kg of body weight. Mass spectrometry analysis of urine showed that excretion of the atypical metabolites remained low or traces in amount with CA therapy. Liver fibrosis scored in liver biopsies or assessed by elastography in 14 patients, after 10 to 24 years with CA therapy, showed a marked improvement with disappearance of cirrhosis (median score < F1; range: F0-F2). CA was well tolerated in all patients, including five women having 10 uneventful pregnancies during treatment.

Conclusions

Oral CA therapy is a safe and effective long-term treatment of 3β-HSD and Δ⁴–3-oxo-R deficiencies and allows affected children to reach adulthood in good health condition without the need for a liver transplantation.

     

The economy of inflammation: when is less more?

In ecology, tolerance of parasites refers to host mitigation of the fitness costs of an infection. This concept of parasite tolerance contrasts with resistance, whereby hosts reduce the intensity of an infection. Anti-inflammatory cells and molecules have been implicated as mechanisms of parasite tolerance, suggesting that a major role of tolerance is in minimizing collateral damage associated with inflammation. A framework is proposed here in which the cost-benefit outcome of an inflammatory host-response is hypothesized to be dependent on host life-history, parasite virulence, and the efficacy of a current inflammatory or anti-inflammatory response. Testable predictions, both within and among host species, are presented for this hypothesis.     

Consequences of the interaction between nutrients and plant secondary metabolites on herbivore selectivity: benefits or detriments for plants?

Concentrations of nutrients and plant secondary metabolites (PSM) vary temporally and spatially, creating a multidimensional feeding environment. Interactions between nutrients and PSM are poorly understood because research has relied largely on studying the isolated effects of nutrients or PSM on foraging behavior. Nevertheless, their interactions can influence food selection and the dynamics of plant communities. Our objective was to explore how interactions between nutrients and PSM influence food selection. For 7 d, three groups of lambs received intraruminal infusions of three different doses of a PSM (0=Control; low and high) and 2 h later they were offered two foods that contained either low (high in energy) or high (high in protein) protein/energy ratios. The foods were offered 7 d before (baseline) and 7 d after PSM infusions. We conducted five trials each with a different PSM- terpenoids, cyanogenic glycosides, sodium nitrate, quebracho tannin, and lithium chloride. Lambs consistently preferred the food high in energy to the food high in protein, but toxins modified the degree to which this preference was manifest. Terpenoids, nitrate, and lithium chloride depressed intake of the food high in energy. Cyanogenic glycosides had the opposite effect, and at higher doses they depressed intake of the food high in protein. Tannins enhanced intake of the food high in energy at lower doses and they depressed its ingestion at higher doses. Thus, PSM selectively depressed or enhanced intake depending on the macronutrient composition of the foods. These results imply that the probability of a plant being eaten will depend not only on its chemical defenses but also on the quantity and quality of nutrients in the plant and its neighbors, and that the ability of herbivores to learn associations between nutrients and PSM may have a substantial impact on the way herbivores regulate ecosystem processes.     

Conflicts of interest in health care: who guards the guardians?

Conflicts of interest are rife in all areas of human endeavor, including medicine. Dealing with them is often difficult, because various disclosure remedies are sometimes too weak, while explicit prohibitions against participation in certain forms of research could block the needed synergies between scientists who work in universities, government, and industry. The situation is made still more difficult, because any effort to control one set of conflicts will necessarily generate another in its stead, as is well captured in Juvenal's famous question, "Who will guard the guardians?" That problem is more acute today, because many of our social watchdogs are in fact complex organizations that are rife with their own internal conflicts of interest. The problem is acute for the FDA, for example, which so fears the release of harmful drugs that it often keeps beneficial ones off the market. The problem can also arise in connection with the review of medical research by major journals, which is well illustrated by the recent effort of the New England Journal of Medicine to attack a Vioxx study it published in order to protect its own reputation.     

Atypical presentation of depression in the elderly: fact or fiction?

Depression in the elderly is often thought to have a different clinical presentation in many patients. This so-called atypical depression is characterised by less sadness and feelings of guilt and more somatic symptoms, impaired cognition and behavioural symptoms. Studies that compare depressive signs and symptoms in elderly and younger patients are reviewed. Published studies do not support the suggestion that major depression in the elderly often have a different clinical presentation. Vascular depression and depression in patients with severe dementia may be exceptions. Conceptual and methodological issues that play an important role are discussed.