Investigators have reported an increase, decrease, or no effect of age on interleukin-6 (IL-6) production. Differences in experimental conditions and the health status of subjects may explain these contradicting results. Because the subjects used in most of the previous studies were not carefully screened for health, we investigated the effect of age on IL-6 production in healthy young and elderly subjects. Twenty young (aged 20-30 years) and 26 elderly (>65 years) men completed the study. Each subject was screened for good health, undergoing physical examinations and laboratory tests. Circulating IL-6 levels were not significantly different between young and elderly subjects. A subgroup of subjects representing both young and elderly volunteers had high (>1000 pg/ml) circulating levels of IL-6. However, circulating IL-6 levels were low (<100 pg/ml) in the majority of subjects in both age groups. Peripheral blood mononuclear cells (PBMC) were cultured for IL-6 production in the presence or absence of phytohemagglutinin (PHA) or concanavalin (Con)A for 48 hours. Unstimulated secretion of IL-6 by PBMC cultured in autologous plasma (AP) or fetal bovine serum (FBS) was detectable in the majority of cultures. Age did not influence this spontaneous secretion of IL-6. PBMC stimulation with PHA or ConA significantly increased IL-6 production, but age did not affect the ability of PBMC to secrete IL-6 after stimulation when cultured in FBS. IL-6 production by PBMC cultured in AP and stimulated with PHA was not affected by age. However, when stimulated with ConA, PBMC from the elderly subjects produced less IL-6 than PBMC from the young subjects. Because IL-6 has been suggested to contribute to the age-related increase in prostaglandin (PG)E2 and nitric oxide (NO) production, we investigated the effect of age on the production of IL-6 by murine peritoneal macrophages (Mphi) as well as the effect of IL-6 on the production of other Mphi inflammatory products. Similar to the findings in humans, mouse age did not influence the level of IL-6 produced by Mphi. These data suggest that in healthy subjects, increased production of IL-6 is not a normal consequence of aging. Previously reported higher IL-6 levels in elderly subjects might reflect an underlying, undiagnosed disease state. PGE2 and NO production were not affected by the addition of IL-6 to Mphi from young mice or anti-IL-6 antibody to Mphi from old mice. Thus, IL-6 does not appear to influence the Mphi production of selected inflammatory molecules.

Objectives The Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) developed guidelines for the management of community-acquired pneumonia (CAP); however, there are sparse data on actual rates of antibiotic use in the emergency department (ED) setting. Methods Data were obtained from the National Hospital Ambulatory Medical Care Survey for ED visits during 1993 through 2008 for adults with a diagnosis of pneumonia. Results During the study period there were an estimated 23,252,000 pneumonia visits, representing 1.8% of all ED visits. The visit rate for pneumonia during this 15-year period may have increased (P trend = 0.055). Overall, 66% of adult patients with a primary diagnosis of pneumonia had documentation of an antibiotic administered while in the ED. There was an increase in antibiotic administration for adults with pneumonia from 1993 through 2008 (49% to 80%; P trend < 0.001). Specifically, there was an increase in use of macrolides from 1993 to 2006 (20% to 30%, P trend < 0.001) and a marked increase in use of quinolones from 0% to 39% from 1993 through 2008 (P trend < 0.001). Penicillin and cephalosporin use remained stable. Use of an antibiotic consistent with 2007 IDSA/ATS guidelines increased from 22% (95% CI = 16% to 27%) of cases in 1993–1994, to 68% (95% CI = 63% to 73%) of cases in 2007–2008 (P trend < 0.001). Conclusions ED visit rates for pneumonia increased slightly from 1993 through 2008. Although antibiotic administration in the ED has increased for adults with community-acquired pneumonia, guideline-concordant antibiotics may not be consistently administered.

I mprovements in melanoma mortality have not occurred across all ethnic groups. Minorities are diagnosed with melanoma at a more advanced stage and, as a result, face worse prognoses. 1 Total-body skin examination (TBSE) may help identify early skin cancers, an important predictor of survival. 2,3 Few studies have examined differences in TBSE rates among different populations, and changes in survey methodology have hindered prior efforts to analyze trends. 4 Herein, we analyze newly released nationally representative survey data to examine trends and predictors of TBSE. Methods. Data were drawn from the 2000 and 2010 National Health Interview Survey (NHIS), an annual survey of US adults. Data are publicly available; institutional review board approval was not required. The outcome variable considered was whether individuals reported receiving a TBSE within the past year. Rates and trends in TBSE were examined, and a multivariate logistic model examining predictors of TBSE was constructed. Demographic covariates included in the model were age, sex, ethnicity, marital status, region, and having an income below the poverty level. Factors potentially impacting health-seeking behavior included were a prior personal or family history of skin cancer, education level, employment status, health insurance status, and whether an individual reported delaying health care in the past year because of cost. The frequencies with which individuals reported wearing a hat and using sunscreen when in the sun for over an hour were included, as was the reported effect on one's skin after an hour of sun exposure. Self-reported health status, body mass index, physical activity, as well as smoking and alcohol use were also included. The NHIS uses a stratified multistage sample design. Estimates were weighted to construct nationally representative estimates, and multivariate logistic analysis of pooled data was conducted (Stata software, version 11.2; StataCorp LP).

The fast rate of increase in the number of older people in less-developed countries threatens to further strain the limited health resources of these countries. However, very little is known about their health status and the risk factors that contribute to it. In this article, we review the burden of infectious diseases in elderly people in less-developed countries, discuss the contribution of nutrition and immune response to morbidity and mortality, identify gaps in current knowledge, and suggest strategies to address this fast-growing public health problem.

The fast rate of increase in the number of older people in less-developed countries threatens to further strain the limited health resources of these countries. However, very little is known about their health status and the risk factors that contribute to it. In this article, we review the burden of infectious diseases in elderly people in less-developed countries, discuss the contribution of nutrition and immune response to morbidity and mortality, identify gaps in current knowledge, and suggest strategies to address this fast-growing public health problem.