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Background : In 2004 the New Zealand Ministry of Health announced additional funding, called Care Plus, for primary care to enhance provision of chronic illness care. There has, however, been no national evaluation of the impact of this additional funding. Objective : The main purpose of this study was to assess patient and primary health care provider (PHCPs) perceptions of chronic illness care in the Southern region of New Zealand. Design and Setting : Cross-sectional survey of patients with multiple chronic conditions in conjunction with a survey of all PHCPs in the Southern Region of New Zealand. Method : The Modified Patient Assessment of Chronic Illness Care (M-PACIC) survey was mailed to a random sample of 500 patients enrolled in Care Plus and all PHCPs in the region. M-PACIC assesses care across six domains: patient activation; delivery system; goal setting; problem solving; follow up and care coordination; and cultural sensitivity. Results : Thirty-one percent (n=198) of PHCPs responded compared to fifty-two percent (n= 259) of patients. At least one response was received from 77% of general practices in the region. The difference in perceptions of care between patients and PHCPs was statistically significant (p=

Objective: To determine the association of sarcopenic obesity with the onset of Instrumental Activities of Daily Living (IADL) disability in a cohort of 451 elderly men and women followed for up to 8 years. Research Methods and Procedures: Sarcopenic obesity was defined at study baseline as appendicular skeletal muscle mass divided by stature squared

Disruption of the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis has been reported and studied in menopause, hypothalamic amenorrhea, and anorexia nervosa, but not in weight-stable amenorrheic athletes. We investigated the effects of short-term transdermal estradiol on basal and exercise-stimulated serum GH, IGF-1, and associated binding proteins (IGFBP-1 and IGFBP-3) in seven weight-stable female amenorrheic athletes with percentage body fats greater that 12%. Each subject received a 72 h placebo patch followed by 144 h of transdermal estradiol. Serum samples for GH, IGF-1, IGFBP-1, and IGFBP-3 were obtained at baseline (t1), 72 hr (t2), 144 hr (t3), and during three 90-minute trials of aerobic exercise. Basal, and exercise GH, IGF-1, and IGFBP-1 were not different between trials. Baseline IGFBP-3 decreased from t1 to t2 (p = 0.04) and serum free fatty acids increased from t1 to t2, and t1 to t3 (p = 0.04, and 0.02 respectively). These findings differ from postmenopausal women, and women having weightloss-associated amenorrhea, suggesting that estrogen, exercise, and nutritional deficiencies may have independent effects on the GH/IGF-1 axis. Key words: transdermal estradiol, insulin-like growth factor binding protein-3, insulin-like growth factor binding protein-1, free fatty acids

Background: Elderly men and women lose muscle mass and strength with increasing age. Decreased physical activity, hormones, malnutrition and chronic disease have been identified as factors contributing to this loss. There are few data, however, for their multivariate associations with muscle mass and strength. This study analyzes these associations in a cross-sectional sample of elderly people from the New Mexico Aging Process Study. Methods: Data collected in 1994 for 121 male and 180 female volunteers aged 65–97 years of age enrolled in The New Mexico Aging Process Study were analyzed. Body composition was measured using dual energy X-ray absorptiometry; dietary intake from 3 day food records; usual physical activity by questionnaire; health status from annual physical examinations; and serum testosterone, estrone, sex-hormone binding globulin (SHBG), and insulin-like growth factor (IGF1) from radioimmunoassays of fasting blood samples. Statistical analyses included partial correlation and stepwise multiple regression. Results: The muscle mass and strength (adjusted for knee height) decreased with increasing age in both sexes. The muscle mass was significantly associated with serum free-testosterone, physical activity, cardiovascular disease, and IGF1 in the men. In the women, the muscle mass was significantly associated with total fat mass and physical activity. Age was not associated significantly with muscle mass after controlling for these variables. Grip strength was associated with age independent of muscle mass in both sexes. Estrogen (endogenous and exogenous) was not associated with muscle mass or strength in women. Conclusions: Age-related loss of muscle mass and strength occurs in relatively healthy, well-nourished elderly men and women and has a multifactorial basis. Sex hormone status is an important factor in men but not in women. Physical activity is an important predictor of muscle mass in both sexes.

Purpose Free cortisol is released into the serum compartment where it is in equilibrium with serum binding proteins, corticosteroid-binding globulin (CBG), and albumin. The distribution of serum cortisol among free, CBG-bound, and albumin-bound compartments is influenced by association and disassociation rate constants for CBG and albumin, the number of unoccupied protein binding sites, and concentrations of CBG and albumin. Free cortisol in serum or plasma is difficult to assay; thus, salivary cortisol has been proposed as an alternative measure of free cortisol. In this study, we sought to assess and compare numerical methods, using both quadratic (Coolens et al, 1987) and cubic (Keenan et al, 2004) equations to calculate serum free cortisol and compare these findings with salivary cortisol in healthy elderly subjects. Methods Serum and saliva samples were collected from 45 healthy, elderly subjects at 0700 h as part of the New Mexico Aging study (UNM HRRC 01-023). The salivary cortisol and total cortisol were measured using radioimmunoassay and ultrasensitive chemiluminescence, respectively. Serum CBG was measured by radioimmunoassay and serum albumin was measured using a bromcresol green method (UNM RAC 51). The cubic equation implied by Keenan et al and the quadratic equation described by Coolens et al were used to calculate free cortisol using our measured values for total cortisol, total CBG, and total albumin. Calculated free cortisol, total cortisol, and CBG concentration were then compared to salivary cortisol using Pearson9s and Spearman9s correlations. Results There was a significant linear correlation between salivary cortisol and free cortisol calculated using the cubic equation (r = .377, p = .033) and Coolen9s quadratic equation (r = .416, p = .018). In addition, we noted a linear correlation between CBG concentration and total cortisol (r = .441, p = .0049). Conclusion Our data indicate that the free cortisol calculated using either quadratic or cubic equations is correlated significantly with salivary cortisol but that other variables appear to influence measured salivary cortisol concentration. We did not observe the previously reported correlation between total and salivary cortisol, which suggests that aging may influence the relative distribution of cortisol in serum or salivary compartments.

View Large Image | Download PowerPoint SlideBasic Medical Endocrinology is intended to present information on normal endocrine physiology to prepare the student for studying endocrine diseases and also for understanding the molecular and cellular alterations that disrupt normal function. The previous edition was published nearly a decade ago, which is a long time given the vast strides that have been made in this field.The textbook is well reasoned and written, with some chapters in particular standing out. The section on the adrenal glands begins with an excellent overview of these complex organs. Goodson emphasizes and demonstrates how the adrenal glands are central to the maintenance of homeostasis, and the figures are particularly helpful. This section is filled with up-to-date information, including a discussion of the metabolites of arachidonic acid and their relationship to the new line of anti-inflammatory drugs as well as the relationship between glucocorticoids and cytokines. Although the text is not heavily focused on endocrine pathology, the negative feedback relationship between the adrenal glands and the pituitary is introduced with an emphasis on diagnostic and therapeutic applications.A salient and well written review of the glucose-fatty acid cycle starts off the section on regulation of fuel metabolism. The figure depicting the intra-organ flow of substrate and competitive regulatory effects helped to clarify this complex cycle. The section on long-term regulation of fuel storage, which includes recent advances in understanding the regulation of food intake and weight maintenance is important in light of the rapidly increasing problem of obesity in the USA and other countries. Leptin is introduced and covered in detail, but unfortunately other hormones, such as adiponectin, resistin and ghrelin, which are also known to be involved in the development and maintenance of obesity, are not discussed.In any textbook of this kind, the ongoing discovery of new hormones and actions makes the publication of completely up-to-date information throughout the book difficult. The list of suggested reading at the end of each chapter contained some current references up to 2002, but many were outdated and the relevance questionable.Overall the topics are well organized, except for the principles of hormonal integration, which followed chapters on the pituitary gland, thyroid gland, adrenal glands and the pancreatic islets. The terms describing hormonal integration were used in the preceding chapters, therefore the chapter on hormonal integration would be more useful following the introductory chapter in which information on hormonal regulation is more generally introduced. Although many of the figures in this text contained valuable information, the redundant use of the blue and gray color scheme and absence of photographs visually detracted from the textbook.Basic Medical Endocrinology should provide first year medical students with a basic knowledge of normal endocrine physiology at both cellular and molecular levels and prepare them for more advanced studies of endocrine pathology and therapies.

Objective : To increase lean body mass and improve health status in patients with wasting associated with the acquired immunodeficiency syndrome (AIDS) by treatment with recombinant human growth hormone (rhGH), recombinant human insulin-like growth factor 1 (rhIGF-1), or both. Design : Randomized, double-blind, placebo-controlled clinical trial. Setting : University of New Mexico Clinical Research Center and University of Texas Southwestern Medical Center. Patients : 60 patients with AIDS and wasting as defined by the Centers for Disease Control and Prevention. Patients were divided into four groups of 15 patients each. Intervention : Group 1 received 1.4 mg of rhGH once daily plus placebo twice daily ; group 2 received 5 mg of rhIGF-1 twice daily plus placebo once daily ; group 3 received 5 mg of rhIGF-1 twice daily plus 1.4 mg of rhGH once daily ; and group 4 received placebo three times daily. Measurements : Body weight, body composition, muscle strength, protein catabolism, quality of life, and immune status were assessed at baseline, and changes in these variables were measured at 6 and 12 weeks. Results : At 6 weeks, lean body mass had increased and total fat mass had decreased in the groups receiving rhGH, rhIGF-1, or both. Group 3 had the greatest changes in lean body mass (mean ± SE, 3.2 ± 0.59 kg ; P < 0.001) ; only in this group were changes in body mass maintained at 12 weeks. Only patients in group 1 had improvement in muscular strength of the knees and upper body (P = 0.04) and quality of life (P = 0.01). Immunologic function did not improve in any group. Conclusions : Growth factor therapy had significantly increased lean body mass and decreased fat mass by 6 weeks, but these improvements persisted for 12 weeks only in group 3. Growth factor therapy at the dosages used in this study is not recommended because the magnitude of weight gain was modest and improvements in quality-of-life measures varied.