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.

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.

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.