OBJECTIVE -Although glycemic levels are known to rise with normal aging, the nondiabetic A1C range is not age specific. We examined whether A1C was associated with age in nondiabetic subjects and in subjects with normal glucose tolerance (NGT) in two populationbased cohorts.RESEARCH DESIGN AND METHODS -We performed cross-sectional analyses of A1C across age categories in 2,473 nondiabetic participants of the Framingham Offspring Study (FOS) and in 3,270 nondiabetic participants from the National Health and Nutrition Examination Survey (NHANES) [2001][2002][2003][2004]. In FOS, we examined A1C by age in a subset with NGT, i.e., after excluding those with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Multivariate analyses were performed, adjusting for sex, BMI, fasting glucose, and 2-h postload glucose values.RESULTS -In the FOS and NHANES cohorts, A1C levels were positively associated with age in nondiabetic subjects. Linear regression revealed 0.014-and 0.010-unit increases in A1C per year in the nondiabetic FOS and NHANES populations, respectively. The 97.5th percentiles for A1C were 6.0% and 5.6% for nondiabetic individuals aged Ͻ40 years in FOS and NHANES, respectively, compared with 6.6% and 6.2% for individuals aged Ն70 years (P trend Ͻ 0.001). The association of A1C with age was similar when restricted to the subset of FOS subjects with NGT and after adjustments for sex, BMI, fasting glucose, and 2-h postload glucose values.CONCLUSIONS -A1C levels are positively associated with age in nondiabetic populations even after exclusion of subjects with IFG and/or IGT. Further studies are needed to determine whether age-specific diagnostic and treatment criteria would be appropriate. Diabetes Care 31:1991-1996, 2008G lycemia is recognized to change with age. The prevalence of diabetes and impaired glucose homeostasis (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT]) is increased among older individuals (1). Given the large size of the elderly type 2 diabetic population (approximately 15.3% diagnosed and 6.9% undiagnosed) (2), it is important to consider the effects of aging on glycemic measures, particularly as targets are set for diabetes management.A1C levels are used globally as an index of average glycemia over the preceding 8 -12 weeks (3), as a marker for risk of development of diabetes complications, and to guide therapy (4). Some reports have demonstrated an association of A1C with age (5-13), whereas others have not (14 -17). Higher A1C levels with advanced age may be a function of a higher prevalence of undiagnosed diabetes in older individuals. The nondiabetic range for A1C, used worldwide and for all agegroups, was established by the Diabetes Control and Complications Trial (DCCT) Ͼ20 years ago (18). A group of 124 nondiabetic healthy volunteers aged 13-39 years was drawn from local DCCT clinics to generate the A1C distribution. The volunteers did not have an oral glucose tolerance test (OGTT) to exclude undiagnosed diabetes and were not representative of ...

These findings from northern Manhattan suggest that among foreign-born persons, tuberculosis is largely caused by reactivation of latent infection, whereas among U.S.-born persons, many cases result from recent transmission. Strategies for the control and elimination of tuberculosis among foreign-born persons at high risk should be directed toward the treatment of latent tuberculosis infection.

The risk for ARR among HIV-infected persons with TB did not depend on the rifamycin used but, rather, on the rifampin dosing schedule in the intensive phase of treatment.

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Notwithstanding the reported awareness and use of psychological interventions in physiotherapy practice, barriers to implementation exist indicating that further research is necessary to address how to effectively equip physiotherapists, to employ such techniques within their scope of practice. Implications for rehabilitation Physiotherapists use and have positive attitudes and beliefs towards a variety of psychological interventions including goal setting, positive, and motivational talk, cognitive behavioral therapy strategies and offering social support. Barriers preventing the incorporation of psychological interventions in practice include, lack of knowledge, time constraints, and role clarity. Despite the use of such interventions, physiotherapists identify the need for further training, to be better equipped to confidently utilize these in practice. These results justify the incorporation of training in psychological interventions in physiotherapist qualifying studies, but also as continued professional development opportunities for physiotherapists currently working in the field.

Context:In December 2005, in characterizing diabetes as an epidemic, the New York City Board of Health mandated the laboratory reporting of hemoglobin A1C laboratory test results. This mandate established the United States' first population-based registry to track the level of blood sugar control in people with diabetes. But mandatory A1C reporting has provoked debate regarding the role of public health agencies in the control of noncommunicable diseases and, more specifically, both privacy and the doctor-patient relationship.Methods: This article reviews the rationale for adopting the rule requiring the reporting of A1C test results, experience with its implementation, and criticisms raised in the context of the history of public health practice.Findings: For many decades, public health agencies have used identifiable information collected through mandatory laboratory reporting to monitor the population's health and develop programs for the control of communicable and noncommunicable diseases. The registry program sends quarterly patient rosters stratified by A1C level to more than one thousand medical providers, and it also sends letters, on the provider's letterhead whenever possible, to patients at risk of diabetes complications (A1C level >9 percent), advising medical follow-up. The activities of the registry program are similar to those of programs for other reportable conditions and constitute a joint effort between a governmental public health agency and medical providers to improve patients' health outcomes.

The optimal duration of tuberculosis treatment for persons infected with human immunodeficiency virus (HIV) has been debated. A cohort of 4571 culture-positive drug-susceptible patients who received > or =24 weeks of standard 4-drug tuberculosis treatment were assessed to determine the incidence of tuberculosis relapse. Tuberculosis "recurrence" was defined as having a positive culture < 30 days after the last treatment date and "relapse" as having a positive culture > or =30 days after the last treatment. Patients infected with HIV were more likely than those who were uninfected to have recurrence or relapse (2.0 vs. 0.4 per 100 person-years, P< .001). Patients infected with HIV who received < or =36 weeks of treatment were more likely than those who received > 36 weeks to have a recurrence (7.9% vs. 1.4%, P< .001). Clinicians should be aware of the possibility of recurrence of tuberculosis 6-9 months after the start of treatment. Sputum evaluation to ensure cure or assessment 3 months after completion of treatment should be performed among persons infected with HIV who receive the shorter regimen.

Real-time universal genotyping decreased unnecessary treatment.