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Langa K.M.,University of Michigan | Langa K.M.,usa practice management
Alzheimer's Research and Therapy | Year: 2015

Background: The number of older adults with dementia will increase around the world in the decades ahead as populations age. Current estimates suggest that about 4.2 million adults in the US have dementia and that the attributable economic cost of their care is about 200 billion per year. The worldwide dementia prevalence is estimated at 44.3 million people and the total cost at 604 billion per year. It is expected that the worldwide prevalence will triple to 135.5 million by 2050. However, a number of recent population-based studies from countries around the world suggest that the age-specific risk of dementia may be declining, which could help moderate the expected increase in dementia cases that will accompany the growing number of older adults. Discussion: At least nine recent population-based studies of dementia incidence or prevalence have shown a declining age-specific risk in the US, England, The Netherlands, Sweden, and Denmark. A number of factors, especially rising levels of education and more aggressive treatment of key cardiovascular risk factors such as hypertension and hypercholesterolemia, may be leading to improving 'brain health' and declining age-specific risk of Alzheimer's disease and dementia in countries around the world. Summary: Multiple epidemiological studies from around the world suggest an optimistic trend of declining population dementia risk in high-income countries over the past 25 years. Rising levels of education and more widespread and successful treatment of key cardiovascular risk factors may be the driving factors accounting for this decline in dementia risk. Whether this optimistic trend will continue in the face of rising worldwide levels of obesity and diabetes and whether this trend is also occurring in low-and middle-income countries are key unanswered questions which will have enormous implications for the extent of the future worldwide impact of Alzheimer's disease and dementia on patients, families, and societies in the decades ahead. © 2015 Langa; licensee BioMed Central.

Much of diabetes care needs to be carried out by patients between office visits with their health care providers. Yet, many patients face difficulties carrying out these tasks. In addition, many adults with diabetes cannot count on effective support from their families and friends to help them with their self-management. Peer support programmes are a promising approach to enhance social and emotional support, assist patients in daily management and living with diabetes and promote linkages to clinical care. This background paper provides a brief overview of different approaches to mobilize peer support for diabetes self-management support, discusses evidence to date on the effectiveness of each of these models, highlights logistical and evaluation issues for each model and concludes with a discussion of directions for future research in this area.

Iwata Y.,Duke University | Matsushita T.,Duke University | Horikawa M.,Duke University | DiLillo D.J.,Duke University | And 9 more authors.
Blood | Year: 2011

Regulatory B cells control inflammation and autoimmunity in mice, including the recently identified IL-10-competent B10 cell subset that represents 1% to 3% of spleen B cells. In this study, a comparable IL-10-competent B10 cell subset was characterized in human blood. B10 cells were functionally identified by their ability to express cytoplasmic IL-10 after 5 hours of ex vivo stimulation, whereas progenitor B10 (B10pro) cells required 48 hours of in vitro stimulation before they acquired the ability to express IL-10. B10 and B10pro cells represented 0.6% and approximately 5% of blood B cells, respectively. Ex vivo B10 and B10pro cells were predominantly found within the CD24 hiCD27+ B-cell subpopulation that was able to negatively regulate monocyte cytokine production through IL-10-dependent pathways during in vitro functional assays. Blood B10 cells were present in 91 patients with rheumatoid arthritis, systemic lupus erythematosus, primary Sjögren syndrome, autoimmune vesiculobullous skin disease, or multiple sclerosis, and were expanded in some cases as occurs in mice with autoimmune disease. Mean B10 + B10pro-cell frequencies were also significantly higher in patients with autoimmune disease compared with healthy controls. The characterization of human B10 cells will facilitate their identification and the study of their regulatory activities during human disease. © 2011 by The American Society of Hematology.

Llewellyn D.J.,University of Exeter | Lang I.A.,University of Exeter | Langa K.M.,University of Michigan | Langa K.M.,usa practice management | Melzer D.,University of Exeter
Journals of Gerontology - Series A Biological Sciences and Medical Sciences | Year: 2011

Background: Recent European studies suggest that vitamin D deficiency may be associated with increased odds of cognitive impairment in older persons, although findings from the United States are equivocal. Our objective was to investigate the association between vitamin D deficiency and cognitive impairment in the elderly U.S. population. Methods: Three thousand and three hundred twenty-five adults aged 65 years or more completed cognitive assessments, medical examinations, and physical performance measures and provided blood samples in the Third National Health and Nutrition Examination Survey, a nationally representative cross-sectional study of the U.S. noninstitutionalized population. We determined whether low levels of serum 25-hydroxyvitamin D (25(OH)D) were associated with increased odds of cognitive impairment using logistic regression models. Cognitive impairment was assessed using measures of immediate and delayed verbal memory, orientation, and attention (impairment was defined as the worst 10% of the distribution of combined scores). Results: The multivariate adjusted odds ratios (95% confidence interval) of cognitive impairment in participants who were 25(OH)D insufficient (≥50 < 75 nmol/L), deficient (≥25 < 50 nmol/L), and severely deficient (<25 nmol/L) in comparison with those sufficient (≥75 nmol/L) were 0.9 (0.6-1.3), 1.4 (1.0-2.1), and 3.9 (1.5-10.4), respectively (p for linear trend =.02). Log-transformed levels of 25(OH)D were also significantly associated with the odds of cognitive impairment (p =.02). Conclusions: These findings suggest that vitamin D deficiency is associated with increased odds of cognitive impairment in the elderly U.S. population. Further exploration of a possible causal relationship between vitamin D deficiency and cognitive impairment is warranted. © The Author 2010.

Pines J.M.,Office for Clinical Practice Innovation | Pines J.M.,George Washington University | Newman D.,Mount Sinai School of Medicine | Pilgrim R.,usa practice management | Schuur J.D.,Brigham and Womens Hospital
Health Affairs | Year: 2013

The acute care system reflects the best and worst in American medicine. The system, which includes urgent care and retail clinics, emergency departments, hospitals, and doctors' offices, delivers 24/7 care for life-threatening conditions and is a key part of the safety net for the under-and uninsured. At the same time, it is fragmented, disconnected, and costly. We describe strategies to contain acute care costs. Reducing demands for acute care may be achieved through public health measures and educational initiatives; in contrast, delivery system reform has shown mixed results. Changing providers' behavior will require the development of care pathways, assessments of goals of care, and practice feedback. Creating alternatives to hospitalization and enhancing the interoperability of electronic health records will be key levers in cost containment. Finally, we contend that fee-for-service with modified payments based on quality and resource measures is the only feasible acute care payment model; others might be so disruptive that they could threaten the system's effectiveness and the safety net. © 2013 Project HOPE-The People-to-People Health Foundation, Inc.

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