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Background A number of studies have evaluated the association between cognitive function, pain, and physical activity. To our knowledge, however, no previous studies have evaluated these factors at the population level. Aims To evaluate the association between cognitive function in the elderly with pain, physical activity, and the interaction between these variables. Estimates are generated for the United States population. Methods We made use of the NHANES database (1999–2002), making adjustments so that our results represent the United States population. Cognitive function was evaluated through the Digit Symbol Substitution Test. Our main predictors were (1) pain, defined as soreness of either the shoulder, neck, lower back and joint, or a severe headache (2) physical activity, measured as the performance while performing tasks at home, physical activity intensity, walking, bicycle riding, and muscle strengthening. Results Most individual pain sites were not significantly associated with cognitive function, while all physical activity factors were associated with an increase in cognitive function. When evaluating the sample subset of those with cognitive scores lower than the median, a combination of more pain and less physical activity was consistently associated with lower cognitive scores when compared to those performing more physical activity with or without pain. When evaluating individuals with cognitive scores above the median, a similar association pattern was perceived. Conclusions Among the population of individuals above the age of 60, higher cognitive levels are associated with more physical activity and less with pain, although both factors might impact cognition. Public policy resources should be commensurate with these findings when targeting cognitive function among the aging population.

Background: The global incidence of impaired cognition increases with the overall aging of the population. Regarding prophylactic measures, it is unclear whether engaging in cognitively-stimulating activities can decrease the risk of cognitive impairment. Objective: To determine the association between Need for Cognition and cognitive ability within a representative mirroring sample of the elderly population in the United States. Methods: We evaluated the association between Need for Cognition (measured through cognitive effort and enjoyment scores) as a predictor and neurocognitive scores (number series, concept formation, calculations, word attack, picture vocabulary, auditory working memory and similarities) as outcomes using the CogUSA dataset. Results: A total of 1,174 participants of at least 64 years of age were part of this analysis. Participants attending college (49.4%) presented higher cognitive effort and enjoyment scores. The findings demonstrate a two-factor structure, the first related to neurocognitive tests and the second related to need for cognition, with good factor loadings. Conclusion: Need for Cognition and neurocognitive ability is strongly correlated and could perhaps be constructed as a single factor. Future research should focus on assessing the relationship between the Need for Cognition and cognitive function in the context of a multitude of other factors, thus determining the contribution of individual factors under different circumstances.

Nowadays, there is a renewed interest in bone changes in experimental and clinical nephrology. However, the need for understanding the peculiarity of bone can be traced back to the 5th century BC, when Empedocles of Acragas put forward a theory of a world made of air, water, fire, and earth governed by love and hate. By observing the various body tissues, he strove to demonstrate that they consisted of 4 elements assembled with different mathematical ratios (logos). Blood is considered the most perfect tissue, because the ratio between elements is one. Bone is a very unusual tissue because it is made of 2 parts of earth, 2 parts of water, and 4 parts of fire. This kind of reasoning could be considered the first cry in the birth of quantitative chemistry.

Objective: Although there has been contrasting evidence for a causative role of parathyroid hormone (PTH) in sleep disorders in patients on maintenance hemodialysis, a recent study disclosed the possibility that this role might exist at least in patients requiring parathyroidectomy because of failure of medical therapy. The present study was devised to assess a possible difference in sleep disorders of patients on hemodialysis needing parathyroidectomy and those in whom medical therapy controlled hyperparathyroidism. Design and Patients: To this end, a group of 22 patients requiring parathyroidectomy were studied by means of a sleep questionnaire, along with a group of 44 patients matched for age, gender, body weight, and duration of dialytic treatment. Results: Patients requiring parathyroidectomy slept fewer hours (P < .001), had a higher prevalence of sleep disorders (P < .001), and were more often insomniac (P < .001). Conclusions: This study indicates that patients on hemodialysis requiring parathyroidectomy for intractable hyperparathyroidism comprise a good model for investigating the causative role of PTH on disordered sleep, and that these patients have very poor sleep. These data support recent findings on the prevalence of sleep disorders in dialyzed patients with insuppressible hyperparathyroidism. © 2008 National Kidney Foundation, Inc.

Depression is the most frequent psychiatric problem in patients with chronic renal disease and may predict patient outcome and mortality. Depression is linked to stressful life characterized by many losses and by dependence, which even may lead to suicide. Despite the large number of patients with chronic kidney disease and the economic burden they represent, only a few of these patients receive adequate diagnosis and therapy. Diagnostic and Statistical Manual of Mental Disorders-IV criteria for major depression may help in differentiating symptoms of uremia and depression. Pharmacotherapy is available and antidepressants (tricyclic antidepressants and selective serotonin re-uptake inhibitors) have been used successfully in various studies. Finally, there is a need for further well-designed, longitudinal, survival studies to clarify the relationship better between depression and the different stages of renal dysfunction.

Epidemiological studies in CKD patients have disclosed high prevalence of sleep disorders (insomnia, restless leg syndrome, periodic limb movement disorder, central sleep apnea, obstructive sleep apnea, excessive daytime sleepiness, and a low quality sleep) which is inversely associated with eGFR. Diagnosis is made through either questionnaires, sleep logs, or polysomnography (the gold standard). Actigraphy is becoming popular because of its simplicity. Hypnotics are indicated for insomnia. Sleep apnea is best cured with nasal continuous positive airway pressure. Dopaminergic therapy has a role for restless leg syndrome (RLS) and periodic limb movements in sleep PLMS. Sleep disorders should be considered as a warning, and wake and sleep functions should be viewed as a vital sign. Any sleep complaint should be taken seriously and defined appropriately. Impaired quality of sleep is associated with impaired quality of life. Nephrologists and sleep specialists should work in close collaboration.

In 1992, the defmition of erectile dysfunction (ED) replaced the old term of impotence that had been used for many centuries, in order to avoid the general confusion existing until today in this field. In the past, the origin of impotence had been attributed to different causes such as psychological diseases, or witches and demons. In 1764, Fusanacci described impotence that can occur in the male as well as in the female, as a defect in reproduction. The main causes responsible for impotence were identified as inability to achieve erection, a very fluid seminal ejaculation, a defective organ, dryness of testicles, and lack of copulative power after many sexual intercourses with healthy women. Some decades later in 1847, Beatty affirmed that one of the most remarkable changes that can be observed in the passage from childhood to maturity is the development of the sexual organs, followed by the appearanee of new sensations. He dis1inguished impotenee that oeeurs only in men from sterility that for him affeets women, and divided the eauses of impotenee into 3 classes: organie, functional and moral (today defmed as psyehologieal). For Beatty, the . progress of knowledge had taken away magie and soreery from the human mind and now it was widespread only ," among the lowest and most ignorant classes of humble people. In this way, he shows the evolution ofmedieal scienee d~ in XIX eentury in aceepting only the rational explanation of the human diseases.

Objective Sleep disorders are very common in adult and children on maintenance hemodialysis and are not cured by renal transplantation. Setting/Design Studies in our laboratory of patients with a mean plasma creatinine concentration of 2 mg/dL, studied within 2 months of chronic kidney disease (CKD) diagnosis, have detected a high prevalence of sleep disorders that could not be explained by using the factors prevalent in hemodialysis patients. Main Outcome Measures To understand if the intrusiveness of the disease is a cause for the high prevalence of sleep disorders in early CKD, we have assessed, by means of a questionnaire, sleep disorders within 1 month from the diagnosis of renal dysfunction. Results A total of 100 CKD patients with a mean estimated creatinine clearance of 59.1 ± 26.7 mL/min were studied. The prevalence of sleep disorders was 89%. Conclusion We believe this high prevalence might represent the effects of disease's intrusiveness and difficulty in coping with the disease.

Survival is not enough is a yearly international event started in 2007 in Naples, Italy, in the week of the World Kidney Day to discuss the needs of renal patients and the quality of life of a category of patients living a machine-dependent life. Renal patients and their associations, philosophers, economists, nephrologists, and health care managers are enrolled to discuss about the possibility to grant the best cures and care without reducing the quality and the quantity of the services the patients need. Various quests have arisen for (1) a new cadre of managers capable of keeping health accounts in balance without cutting expenditure but by reducing waste of resources, (2) the promotion of prevention as the only measure capable of reducing costs in the long run, and (3) the promotion of clinical and translational research. The changes occurring in the health system should be viewed as a window of opportunity, including the advent of the medical-industrial complex firstly described in 1980, an event originating in the United States of America and now spreading worldwide. © 2012 National Kidney Foundation, Inc.

There are scanty data available on alexithymia in patients with end-stage renal disease, which point to an independent association with depression and social support. This study was devised to investigate the prevalence of alexithymia and sleep disorders in patients maintenance hemodialysis with insuppressible secondary hyperparathyroidism, who need parathyroidectomy (PTX), because previous data from our laboratories as well as those of others showed that this patient-group are the worst sleepers among hemodialysis patients with end-stage renal disease. A total of 40 patients needing PTX were enrolled and studied before the surgery. As for the control group, 80 patients on maintenance hemodialysis not needing PTX were enrolled. We measured alexithymia with the Toronto Alexithymia Score (TAS-20), sleep disorders with the Pittsburgh Sleep Quality Index (PSQI), and depression with Beck Depression Inventory (BDI), intact parathyroid hormone (iPTH), calcium, phosphate, use of antihypertensives, systolic and diastolic blood pressure, hemoglobin concentration, and albumin concentration. Patients needing PTX in comparison with those not needing PTX had significantly higher iPTH, calcium, and phosphate; they also had significantly higher systolic and diastolic blood pressure. They were more significantly alexithymic (P < .001), had more severe sleep disorders (P < .001), and were more depressed (P < .043). In multivariate analysis, BDI correlated significantly with iPTH concentration (r = 0.505, P < .001). A reduction of TAS-20 occurred after PTX which correlated with the number of patients on antihypertensive drugs, PSQI, BDI, hemoglobin concentration in the univariate and multivariate analysis. When TAS-20 and PSQI were adjusted for BDI (using analysis of variance) there was still a significant difference of TAS-20 and PSQI between patients needing PTX and not needing PTX (P < .001). This study confirms the high prevalence of sleep disorders in patients with unsuppressed secondary hyperparathyroidism and discloses a high prevalence of Alexithymia which is ameliorated by PTX. However, the correlation of Alexithymia with sleep disorders does not depend on depression.

Few studies have addressed the problem of sleep disturbances in patients with early-stage chronic kidney disease (CKD). A total of 220 patients newly diagnosed with CKD and 220 patients newly diagnosed with chronic hepatitis C were studied within 1 month from the diagnosis. They were evaluated by using the Charlson Comorbidity Index, the Pittsburgh Sleep Quality Index, and the Beck Depression Inventory. Patients with CKD were followed up for 4 years. Sleep disturbances affected 59.5% of patients with chronic hepatitis C and 84.6% of patients with CKD. Sleeping disorders that were severe and peculiar in early CKD improved significantly over time. Beck Depression Inventory disclosed significant depression, which was ameliorated over time. Charlson Comorbidity Index was constant over time. Logistic regression analysis failed to detect significant correlations for putative factors emerging from studies in hemodialyzed patients, with the exception of depression.

CKD is utilized as a paradigm, a chronic disease which allows decades of life conquered with great effort through a machine, a life with many losses and many dependencies. We must understand the patient's needs, which are not related to availability of drugs and machines and hospitals. We cannot provide good medical care with the limited amount of national product devoted to health care. Society is much older than ever before. We need a new cadre of economists working on health care with vision and ability, keeping in mind that there are no resources and there are no expenses which can be cut in medical care nowadays. We have to switch from curative medicine towards prevention, by implementing clinical research, bearing in mind that in the Western world, democracy was granted through the correct allocation of resources. The search for happiness and good quality of life are old concepts born in the Mediterranean area over the centuries, starting with Hesiod and Homer, and sleep and dreams were being investigated centuries before Freud was born.

About 85% of patients on maintenance hemodialysis have sleep disorders that depend on comorbidities, age, morning dialytic shift, and blood pressure. They are ameliorated by erythropoietin, by transplantation, and by daily and nocturnal dialysis. Some data exist on sleep disorders in CKD patients, and show that lack of a refreshing sleep is present even at early stages of the disease and may affect 82.2% of patients without any relationship to comorbidities.

Studies in patients on maintenance hemodialysis have disclosed a high prevalence of sleeping disorders, which have been linked to various factors including blood urea levels, creatinine levels, parathyroid hormone levels, anemia, systolic and diastolic blood pressure, quality of life, disease intrusiveness, and comorbidities. In contrast, few studies have been performed in patients with chronic kidney disease (CKD), who represent the target of the present study. A group of 52 CKD patients were enrolled after characterization of their renal function. Comorbidities were evaluated by means of the Charlson Comorbidity Index. Sleep disorders were evaluated by means of the Sleep Disorder Questionnaire (SDQ), a 26-item questionnaire providing a hierarchic classification for relevant insomnia, relevant hypersomnia, subclinical disorders, or absence of sleep complaints. Results indicate that, in the early stages of CKD, at a time the comorbidity index is low, sleep disorders are present in 80.7% of patients. This finding, which needs to be confirmed in a larger cohort of patients, indicates that sleep disorders affect the lives of CKD patients as soon a diagnosis of disease potentially progressing to end-stage renal disease was made.

Sleep disorders are among the factors that can reduce the quality of life in patients with chronic kidney disease. Chronic kidney disease patients could benefit from an accurate evaluation and treatment of insomnia because this sleep disorder is associated with a high persistence-relapse rate, poor physical health, and mental disease (anxiety, depression) both in terms of comorbidity and antecedent. A multilayer evaluation of insomnia is possible because of valid and reliable instruments (both objective and subjective). Furthermore, a rational etiologic model of insomnia allows better understanding and treatment as a result of effective cognitive-behavioral techniques.

Joseph Andreas Jacobus Plenck was born in 1735 in Vienna where he studied surgery with Johan Christian Retter. At age 35 he was appointed Professor of Surgery and Obstetrics by Maria Theresia. Subsequently he became professor and life long secretary of the Medical Military Academy know as the Josephinum where he worked up to 1807. He was one of the most brilliant scientific writers of his time. Here we analyze his medical treatise, Icones Plantarum Medicinalium secundum systema Lynnaei cum enumeratione virium et usus medici, chirurgici et diaetetici, published in folio in Latin and German. This is a therapy based on plants in which the author discusses the medical use of 758 plants. This article is centered on 111 plants with diuretic properties which still appear in many pharmacopoeias.

Gabriel Zerbi was born in Verona in 1445 and died in Dalmatia in 1505. He was professor of philosophy in Padua at the age of 22, and moved to Bologna where he became professor of medicine and philosophy. In Rome at the time of Sixtus V and Innocentius VIII, he was archiater and professor of medicine. He completed his academic career in Padua where he worked from 1494 to 1505 with a salary of 600 florins a month. A man of vast culture, a philosopher, physician and professor of medicine, he wrote many books: (1) Questiones Metaphysicae; (2) Gerentocomia; (3) De Cautelis Medicorum; (4) Liber anatomiae corporis humani et singulorum membrorum illius; (5) De anatomia infantiis et porci ex traditione Cophonis, and (6) Libellus de preservatione corporum a passione calculosa. His contribution to anatomy was superb. Through him the discipline became the basis of modern medicine. The core of this article deals with some passages of Zerbi’s chapters on the anatomy of the kidneys and bladder.

Cardiovascular disease is the leading cause of morbidity and mortality in end-stage renal disease. Causes include those usually found in the general population, those related to the uremic status, and those related to dialytic treatment. Hypertension, hypotension, anemia, hypoalbuminemia, malnutrition, dyslipidemia, reactive C protein, calcium-phosphate product, dialysis modalities, and hyperhomocysteinemia are discussed extensively. Special emphasis is put on hyperparathyroidism as a traditional toxin. The emergent role of sleep apnea has been confirmed in animal models as well as in humans studied using polysomnography. There are difficulties in diagnosing coronary disease, because angiography is not risk-free, is expensive, and should be reserved for patients having symptoms of heart failure and/or patients having diabetes mellitus, and/or patients entering a transplantation list. This allows patients with coronary disease to undergo coronary artery bypass (preferably) or percutaneous transluminal angioplasty. Patients for whom surgery is not appropriate should be treated using more traditional medical procedures. (C) 2001 by the National Kidney Foundation, Inc.

The two words that mean sexual dysfunction, impotence and erectile dysfunction (ED), express two different concepts. Impotence is a general male sexual dysfunction that includes libidinal, orgasmic, and ejaculatory dysfunction. ED is the inability to achieve or maintain an erection sufficient to allow satisfactory sexual intercourse and is part of the general male sexual dysfunction termed impotence that includes libidinal, orgasmic, and ejaculatory dysfunction. Uremic men of different ages report a variety of sexual problems, including sexual hormonal pattern alterations, reduction in or loss of libido, infertility, and impotence, conditioning their well-being status. In evaluating and treating sexual dysfunction, a nephrologist must consider factors involved in its pathogenesis, such as hypothalamic-pituitary-gonadal axis alterations, psychological problems related to chronic disease, secondary hyperparathyroidism, anemia, autonomic neuropathy, derangements in arterial supply or venous outflow, and the normal structure of cavernous body smooth muscle cells. The introduction of sildenafil to treat impotent patients has completely changed the approach to evaluating these subjects because this drug is considered an effective well-tolerated treatment for men with ED. In the past, we proposed an algorithm that gave the opportunity to explore the previously mentioned factors using such instrumental interventions as the nocturnal penile tumescence test, penile echo color Doppler, nervous conduction velocity, and cavernous body biopsy, addressed to prescribe needed surgical or medical interventions. The complexity of the proposed algorithm requires many diagnostic procedures and much time and economic resources to localize the pathological lesions responsible for ED. Because of the new oral drug sildenafil, we propose a new algorithm to test the possibility of obtaining an erection and classify patients as responders or nonresponders to the sildenafil test. © 2001 by the National Kidney Foundation, Inc.