Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA–viral peptide interaction as the major factor modulating durable control of HIV infection.

Feeling lonely is associated with systemic inflammation in middle-aged community-dwelling US adults.

Background The ubiquity of the Internet is changing the way people obtain their health information. While there is an abundance of heart failure information online, the quality and health literacy demand of these information are still unknown. Objective The purpose of this study was to evaluate the quality and health literacy demand (readability, understandability, and actionability) of the heart failure information found online. Methods Google, Yahoo, Bing, Ask.com, and DuckDuckGo were searched for relevant heart failure websites. Two independent raters then assessed the quality and health literacy demand of the included websites. The quality of the heart failure information was assessed using the DISCERN instrument. Readability was assessed using seven established readability tests. Finally, understandability and actionability were assessed using the Patient Education Materials Assessment Tool for Print Materials (PEMAT-P). Results A total of 46 websites were included in this analysis. The overall mean quality rating was 46.0 ± 8.9 and the mean readability score was 12.6 grade reading level. The overall mean understandability score was 56.3% ± 16.2. Finally, the overall mean actionability score was 34.7% ± 28.7. Conclusions The heart failure information found online was of fair quality but required a relatively high health literacy level. Web content authors need to consider not just the quality, but also the health literacy demand of the information found in their websites. This is especially important considering that low health literacy is likely prevalent among the usual audience.

Background/Objectives Current measures of cytokines involve urine, blood or saliva which have drawbacks including circadian rhythm variations and complicated collection methods. Sweat has been used to measure cytokines in young and middle-aged adults, but not older adults. We sought to determine the feasibility of using sweat to measure cytokines in older adults compared to younger adults. Design Two visit cross-sectional pilot study stratified by age group. Setting Independent living facility and Johns Hopkins University both in Maryland. Participants 23 community-dwelling adults aged 65 and older and 26 adults aged 18–40 were included. Those with active cancer treatment or with a known terminal illness diagnosis were excluded. Measurements Sweat interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α) were collected using a non-invasive sweat patch worn for 72 hours by each participant. Samples were measured with a single molecule array (SIMOA) technology for ultrasensitive, multiplexed detection of proteins. Results 23 older adults and 26 younger adults with mean ages of 77±8.0 years and 28±5.5 years, respectively, completed the study. Both groups had high rates of compliance with patch wearing and removal. Higher concentrations of TNF-α, IL-6 and IL-10 were observed in older adults compared to younger adults, which remained significant after controlling for race, sex, body mass index, and chronic disease count (0.110±0.030 vs. 0.054±0.020pg/mL, 0.089±0.012 vs. 0.048±0.018pg/mL, and 0.124±0.029 vs. 0.067±0.025pg/mL, respectively). Conclusion These results suggest that sweat patches are a feasible method to collect cytokine data from older adults. Preliminary group differences in cytokine measurement between older and younger groups correspond with current literature that cytokines increase with age, suggesting that sweat measurement using the sweat patch provides a new method of exploring the impact of inflammation on aging. Further research using sweat and the sweat patch is recommended.

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Background: With rapidly growing numbers of homebound older adults, the need for effective home-based health interventions is increasingly recognized. Advanced practice registered nurses (NPs) are one of the most common providers of home-based primary care. Limited information is available to address the scope and nature of NP-led home-based primary care and associated outcomes.Objective: To synthesize research evidence of NP visits in home-based primary care.Data Sources: Six electronic databases-PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Web of Science, and Scopus-were searched to identify peer-reviewed research articles addressing homebased primary care interventions led by NPs. Independent screening resulted in 17 relevant articles from 14 unique studies to include in the review.Conclusions: Nurse practitioners provided health assessments, education, care planning and coordination primarily by face-to-face home visits. Despite a variability in terms of study design, setting, and sample, NP-led home-based primary care was in general associated with less hospitalization and fewer emergency department visits. Evidence was mixed in relation to patient-reported outcomes such as subjective health, functional status, and symptoms. Costs and patient or caregiver satisfaction were additional outcomes addressed, but the findings were inconsistent.Implications for Practice: Recent policy changes to authorize NPs to independently assess, diagnose, and order home care services directly affect how NPs approach home-based primary care programs. Our findings support NP-led home-based primary care to decrease consequential health utilization and suggest the need for further evaluating the care models in diverse populations with more patient-reported and caregiver outcomes.

The USA was built on legalized racism that started with enslavement and continues in the form of structural racial discrimination. This discrimination is difficult to measure because its many manifestations are hard to observe and dynamic. A useful tool would measure across settings, institutions, time periods in a person’s life and the country’s history. The purpose of this study was to design a measure of structural racial discrimination that meets those criteria and can be used in large national datasets. To do this, we started with an exploratory mixed-methods instrument design, including qualitative interviews with 15 older Black adults and focus groups with 38 discrimination researchers and other key stakeholders. We then identified 27 indicators of structural racial discrimination across nine theorized discrimination contexts. We matched these with historical administrative data sets to develop an instrument that could quantify older Black Americans’ exposure to structural racial discrimination across contexts, the life course, and geographies. These can be mapped to the life course of structural discrimination based on the home addresses of those surveyed. Linking these to available indicators is a promising approach. It is a low burden for participants and enables increasingly multifaceted and focused measurement as more national datasets become available. A flexible, feasible comprehensive measure of structural discrimination could allow not only more thorough documentation of inequities but also allow informed decision making about policies and programs intended to promote racial equity. Significance Statement To our knowledge, this is the first study that presents a framework for assessing structural racial discrimination across contexts, life course, and geography that is grounded in theory and in the lived experience of intended participants. Leading researchers and policy makers have called for improved measures of structural racism and discrimination and specifically for a lifecourse approach to measurement. This study is a step in that direction. Classification Social Sciences

BackgroundFalls reflect sentinel events in older adults, with significant negative consequences. Although fall risk factors have been identified as intrinsic (e.g., muscle weakness, balance problems) and extrinsic (e.g., home hazards), most prevention programs target only intrinsic factors. We present the rationale and design of a home-based multicomponent fall prevention program—the LIVE LiFE program—for community-living older adults. The program adapts and expands the successful Lifestyle Intervention Functional Exercise (LiFE) program by adding home safety, vision contrast screening, and medication review. The specific aims of the study are to (1) adapt the LiFE program to a US context and expand it into a multicomponent program (LIVE LiFE) addressing intrinsic and extrinsic fall risks, (2) examine feasibility and acceptability, and (3) estimate program impact on multiple outcome measures to prepare for an efficacy trial.MethodsThe study involves two phases: an open-label pilot, followed by a two-group, single-blinded randomized pilot trial. Eligible participants are community-living adults 70+ years reporting at least one injurious fall or two non-injurious falls in the previous year. Participants are randomized in a 2:1 ratio to the program group (LIVE LiFE, n = 25) or the control group (written fall risk assessment, n = 12). The open-label pilot participants (n = 3) receive the program without randomization and are assessed based on their experience, resulting in a stronger emphasis on the participant’s personal goals being integrated into LIVE LiFE. Fall risk and balance outcomes are assessed by the Timed Up and Go and the 4-Stage Balance Test at 16 weeks. Additional outcomes are incidence of falls and near falls, falls efficacy, fear of falling, number of home hazards, and medications assessed at 16 weeks. Incidence of falls and near falls, program adherence, and satisfaction are assessed again at 32 weeks.DiscussionBy expanding and adapting the evidence-based LiFE program, our study will help us understand the feasibility of conducting a multicomponent program and estimate its impact on multiple outcome measures. This will support moving forward with an efficacy trial of the LIVE LiFE program for older adults who are at risk of falling.Trial registrationClinicalTrials.gov, NCT03351413. Registered on 22 November 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-3114-5) contains supplementary material, which is available to authorized users.