Barriers and facilitators of obesity management in families of youth with emotional and behavioral disorders

While youth with emotional and behavioral disorders experience increased rates of obesity, few obesity interventions exist that are tailored to their needs. Qualitative methods were employed to elucidate obesity management practices in this population. In all, 56 participants (i.e. 21 youths with emotional and behavioral disorders, 20 caregivers of youth with emotional and behavioral disorders, and 15 mental health providers) were recruited from community mental health centers. Participants completed a demographic form and semi-structured interview regarding obesity-related behaviors. Barriers (e.g. psychiatric symptoms) and facilitators (e.g. social support) to obesity management were identified. These results highlight preferred intervention components for this unique population.

Barriers and facilitators of a healthy lifestyle among persons with serious and persistent mental illness: perspectives of community mental health providers

The investigators used qualitative methods to examine perspectives of community mental health professionals on obesity management in adults with serious mental illness (SMI). Data from 5 focus groups were subjected to constant comparison analysis and grounded theory. Results showed that influences at individual, social, community, and societal levels impact development and maintenance of obesity. Mental health providers desired a collaborative relationship with health promotion program staff. They also believed that frequent, group-based health promotion should include participation incentives for adults with SMI and should occur over durations of at least 6-months to achieve improved health outcomes for this population.

Depression, diabetic complications and disability among persons with comorbid schizophrenia and type 2 diabetes

BACKGROUND

People with schizophrenia are at increased risk for type 2 diabetes, its complications, depression, and disability. However, little is known about the interrelationships of these 3 factors in adults with schizophrenia and type 2 diabetes.

OBJECTIVE

We sought to assess the number of diabetic complications and depressive symptom severity as predictors of disability and evaluate depressive symptom severity as a mediator of the relationship between diabetic complications and disability in a sample of 62 adults with schizophrenia and type 2 diabetes.

METHODS

Two- and 3-step sequential regression models were used to evaluate the relationship of depression and number of diabetic complications with disability. Path analysis with bootstrapping was used to evaluate depressive symptom severity as a mediator of the relationship between complications and disability.

RESULTS

Diabetic complications significantly predicted disability scores when controlling for age, gender, socioeconomic status, hemoglobin A1C, positive symptom severity, and negative symptom severity. The addition of depression severity scores resulted in a significant increase in explained variance in disability scores. In the final model, only depression severity scores were significantly associated with disability scores. The full model accounted for 56.2% of the variance in disability scores. Path analysis revealed a significant indirect association of diabetic complications to disability through depression severity scores while controlling for all covariates. The association between complications and disability was nonsignificant when depressive symptom severity was included in the model.

CONCLUSIONS

Depressive symptoms may present an important and tractable target for interventions aimed at reducing disability in people with schizophrenia and type 2 diabetes.

Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use

The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician.

The effect of brimonidine tartrate on retinal blood flow in patients with ocular hypertension

PURPOSE

To study the effects of topical brimonidine tartrate 0.2%, an alpha(2)-agonist ocular hypotensive drug, on retinal capillary blood flow in patients with ocular hypertension.

METHODS

The study was a double-masked, randomized, placebo-controlled trial set in a tertiary eye center. Ocular hypertensive patients with repeatable intraocular pressures greater than 21 mm Hg and normal visual fields and optic disks were consecutively recruited. After an eye examination, baseline retinal blood flow measurements were made with confocal scanning laser Doppler flowmetry in one study eye. Patients were then randomly assigned to receive either brimonidine or placebo (saline) twice daily for 8 weeks. Blood flow and intraocular pressure measurements were then repeated after 4 and 8 weeks.

RESULTS

Seventeen patients were randomly assigned to receive brimonidine, and 14 received placebo. One patient in each group failed to complete the study. The mean group differences in baseline age and intraocular pressure were not statistically significant (59. 23 [+/-10.24] and 52.23 [+/-16.46] years, respectively, and 24.84 [+/-2.08] and 24.56 [+/-2.85] mm Hg, respectively). Brimonidine reduced intraocular pressure by 17.90% and 16.17% at 4 and 8 weeks, respectively, with a significant difference in treatment effect compared with the placebo group (P <.007). The group difference in treatment effect in any of the three hemodynamic parameters velocity, volume, and flow was within 8% and not significantly different at 4 or 8 weeks (P.360). Based on a type I error of 0.05, our study had a power greater than or equal to 75% to detect group differences in treatment effect of greater than or equal to 15% to 20%.

CONCLUSIONS

Brimonidine reduces intraocular pressure without altering retinal capillary blood flow in patients with ocular hypertension.

The effect of brimonidine tartrate on retinal blood flow in patients with ocular hypertension [corrected]

PURPOSE

To study the effects of topical brimonidine tartrate 0.2%, an alpha2-agonist ocular hypotensive drug, on retinal capillary blood flow in patients with ocular hypertension.

METHODS

The study was a double-masked, randomized, placebo-controlled trial set in a tertiary eye center. Ocular hypertensive patients with repeatable intraocular pressures greater than 21 mm Hg and normal visual fields and optic disks were consecutively recruited. After an eye examination, baseline retinal blood flow measurements were made with confocal scanning laser Doppler flowmetry in one study eye. Patients were then randomly assigned to receive either brimonidine or placebo (saline) twice daily for 8 weeks. Blood flow and intraocular pressure measurements were then repeated after 4 and 8 weeks.

RESULTS

Seventeen patients were randomly assigned to receive brimonidine, and 14 received placebo. One patient in each group failed to complete the study. The mean group differences in baseline age and intraocular pressure were not statistically significant (59.23 [+/-10.24] and 52.23 [+/-16.46] years, respectively, and 24.84 [+/-2.08] and 24.56 [+/-2.85] mm Hg, respectively). Brimonidine reduced intraocular pressure by 17.90% and 16.17% at 4 and 8 weeks, respectively, with a significant difference in treatment effect compared with the placebo group (P < .007). The group difference in treatment effect in any of the three hemodynamic parameters velocity, volume, and flow was within 8% and not significantly different at 4 or 8 weeks (P > .360). Based on a type I error of 0.05, our study had a power greater than or equal to 75% to detect group differences in treatment effect of greater than or equal to 15% to 20%.

CONCLUSIONS

Brimonidine reduces intraocular pressure without altering retinal capillary blood flow in patients with ocular hypertension.

Differential responses of adult cardiac fibroblasts to in vitro biaxial strain patterns

Different patterns of extracellular matrix (ECM) remodeling in the heart are thought to be dependent on altered mechanical and chemical conditions and can contribute to cardiac dysfunction. Cardiac fibroblasts are the primary regulators of the ECM and may respond to mechanical factors in vitro. We hypothesized that different types of in vitro strains, e.g. tensile or compressive, can stimulate different functional responses in cultured adult rat cardiac fibroblasts. In this study, we first showed that a single step in strain applied by a uniaxial stretch system stimulated collagen III and fibronectin mRNA levels and transforming growth factor-beta(1) (TGF-beta(1)) activity in the adult phenotype of rat cardiac fibroblasts. Two-dimensional deformations were measured by tracking fluorescent microspheres attached to the substrate and cultured cells. For 10% uniaxial strain, mean principal strains were 0. 104 +/- 0.018 in the direction of stretch and -0.042 +/- 0.013 in the perpendicular direction, verifying that the fibroblasts were simultaneously subjected to tensile (positive) and compressive (negative) strains. Furthermore, these cells were also subjected to area change and to shear. In order to examine the distinct effects of different types of deformation on cardiac fibroblasts, an equibiaxial stretch system was used to apply either pure tensile or compressive area strains, in the absence of shear. Magnitudes of equibiaxial strain were selected to apply local cell area changes identical to those applied in the uniaxial system. Results showed that pure tensile and compressive area strains induced divergent responses in ECM mRNA levels. TGF-beta(1) activity was dependent on the magnitude of applied area strain regardless of the mode of deformation. These findings demonstrate that adult cardiac fibroblasts may respond differently to varied types of mechanical loading, suggesting that ECM remodeling may be locally regulated by specific mechanical stimuli in the heart.

Equibiaxial strain and strain rate stimulate early activation of G proteins in cardiac fibroblasts

Cardiac fibroblasts are responsible for the production of the extracellular matrix of the heart, with alterations of fibroblast function implicated in myocardial infarction and cardiac hypertrophy. Here the role of heterotrimeric GTP-binding proteins (G proteins) in the mechanotransduction of strain in rat cardiac fibroblasts was investigated. Cells in an equibiaxial stretch device were incubated with the photoreactive GTP analog azidoanalido [alpha-32P]GTP (AAGTP) and were subjected to various regimens of strain. Autoradiographic analysis showed a 42-kDa protein labeled for cells exposed to 12 cycles of 3% strain or 6 cycles of 6% strain over 60 s (strain rate of 1.2%/s), whereas 6 cycles of 3% strain (0.6%/s) elicited no measurable response. To further investigate the role of strain rate, a single 6% cycle over 10 or 60 s (1.2% and 0.2%/s, respectively) was applied, with the more rapid cycle stimulating AAGTP binding, whereas the lower strain rate showed no response. In cells subjected to a single 6% cycle/10 s, immunoprecipitation identified the AAGTP-labeled 42-kDa band as the G protein subunits G alpha q and G alpha i1. These results demonstrate that G protein activation represents one of the early mechanotransduction events in cardiac fibroblasts subjected to mechanical strain, with the rate at which the strain is applied modulating this response.

The perceived life stressors among elderly Chinese immigrants: are they different from those of other elderly Americans?

This is a descriptive study examining the perceived life stressors among elderly Chinese immigrants and comparing their stressors to those experienced by other elderly Americans. Lazarus and Folkman's stress theory and Roy's adaptation model were used as the theoretical basis for this study. Based on this framework, it was predicted that elderly Chinese immigrants would report more life stressors than elderly Americans, because they experience a changing cultural environment along with the aging process. The sample was a convenience sample of 30 elderly people from two Chinese churches in one northeastern metropolitan city. Participants were asked to describe a stressful event that they had experienced within the past month. Data were collected by a bilingual (Chinese and English) interviewer using open-ended questions. The research design was based on Manfredi and Pickett's (1987) research exploring the stressors among elderly Americans, and those research results provide the comparison data for this study. The findings suggest that the amount and sources of stress reported by elderly Chinese immigrants are different from those reported by other elderly Americans. Additional studies are needed to identify the coping strategies used by elderly Chinese immigrants. These findings have implications for gerontologists, policy makers, community healthcare providers, and the Chinese immigrant population.

Multiaxial myocardial mechanics and extracellular matrix remodeling: mechanochemical regulation of cardiac fibroblast function

Substantial evidence suggests that not only does the structure of the cardiac extracellular matrix affect the mechanical properties of myocardium, but that mechanical loading affects the synthesis of the extracellular matrix. However, loading conditions in vivo are nonhomogeneous and multiaxial. An experimental approach that combines mechanics and cell biology is used to examine the mechanisms of extracellular matrix remodeling in the heart. The results indicate that differential biological responses in adult cardiac fibroblasts can be correlated with specific physical signals, such as the magnitude and two dimensional (2D) pattern of strain. Some effects of flow-function relations are discussed.

Regulation of the Salmonella typhimurium pepT gene by cyclic AMP receptor protein (CRP) and FNR acting at a hybrid CRP-FNR site

The Salmonella typhimurium pepT gene is induced nearly 30-fold in response to anaerobiosis. Anaerobic expression is dependent on the transcriptional regulator encoded by fnr (previously oxrA). Primer extension analysis and site-directed mutagenesis experiments show that pepT is transcribed from two sigma 70 promoters. One promoter (P1) is FNR dependent and anaerobically induced, while the other (P2) appears to be constitutive. The potABCD operon is divergently transcribed from a promoter near pepT P2. Sequence analysis of pepT promoter mutations which either elevate anaerobic expression or confer constitutive expression revealed that these mutations affect the -10 region of the P1 or P2 promoter, respectively. The pepT200 mutation, which changes the -10 region of the FNR-dependent P1 promoter to the consensus, has the surprising effect of allowing five- to sevenfold anaerobic induction in the absence of FNR. We have shown that the anaerobic induction of pepT-lacZ in a pepT200 fnr strain is dependent on wild-type alleles of both crp and cya. In a pepT200 pepT-lacZ strain, beta-galactosidase activity was elevated aerobically in the presence of exogenous cyclic AMP (cAMP) and was elevated also in succinate minimal medium relative to its level in glucose minimal medium. Primer extension analysis confirmed that P1 is the cAMP receptor protein (CRP)-dependent promoter. Site-directed mutagenesis experiments indicated that a hybrid CRP-FNR binding site positioned at -41 of the P1 promoter is utilized by both FNR and CRP. CRP-cAMP also appeared to repress FNR-dependent transcription of pepT under anaerobic conditions in both the pepT+ and pepT200 backgrounds. Although both CRP and FNR are capable of binding the hybrid site and activating transcription of pepT, CRP requires the consensus -10 sequence for efficient activation.

Molecular characterization of the oafA locus responsible for acetylation of Salmonella typhimurium O-antigen: oafA is a member of a family of integral membrane trans-acylases

Lipopolysaccharide (LPS) coats the surface of gram-negative bacteria and serves to protect the cell from its environment. The O-antigen is the outermost part of LPS and is highly variable among gram-negative bacteria. Strains of Salmonella are partly distinguished by serotypic differences in their O-antigen. In Salmonella typhimurium, the O-antigen is acetylated, conferring the 05 serotype. We have previously provided evidence that this modification significantly alters the structure of the O-antigen and creates or destroys a series of conformational epitopes. Here we report the detailed mapping, cloning, and DNA sequence of the oafA gene. The locus contains one open reading frame that is predicted to encode an inner membrane protein, consistent with its role in modification of the O-antigen subunit. The OafA protein shows homology to proteins in a number of prokaryotic and one eukaryotic species, and this defines a family of membrane proteins involved in the acylation of exported carbohydrate moieties. In many of these instances, acylation defines serotype or host range and thus has a profound effect on microbe-host interaction.

An equibiaxial strain system for cultured cells

We developed a device that applies homogeneous equibiaxial strains of 0-10% to a cell culture substrate and quantitatively verified transmission of substrate deformation to cultured cardiac cells. Clamped elastic membranes in both single-well and multiwell versions of the device are uniformly stretched by indentation with a plastic ring, resulting in strain that is directly proportional to the pitch-to-radius ratio. Two-dimensional deformations were measured by tracking fluorescent microspheres attached to the substrate and to cultured adult rat cardiac fibroblasts. For nominal stretches up to 18%, strains along circumferential and radial axes were equal in magnitude and homogeneously distributed with negligible shear. For 5% stretch, circumferential and radial strains in the substrate were 0.046 +/- 0.005 and 0.048 +/- 0.004 [not significant (NS)], respectively, and shear strain was 0.001 +/- 0.003 (NS). Calibration of both single-well and multiwell versions permits strain selection by device rotation. The reproducible application and quantification of homogeneous equibiaxial strain in cultured cells provides a quantitative approach for correlating mechanical stimuli to cellular transduction mechanisms.

Adenovirus-mediated overexpression of human transforming growth factor-beta 1 in rat cardiac fibroblasts, myocytes and smooth muscle cells

Transforming growth factor-beta 1 (TGF-beta 1) is known to regulate cardiac cell function and its overexpression in the heart is thought to contribute to the development of cardiac hypertrophy and fibrosis. We wished to develop a high efficiency gene transfer method that could be used both in vitro and in vivo and result in the overexpression of TGF-beta 1. For this purpose, we constructed a replication-deficient human adenovirus 5 vector encoding for human TGF-beta 1 and used for control purposes an adenovirus lacZ vector. The adenovirus 5 construct was capable of infecting neonatal rat cardiac myocytes, fibroblasts and VSMCs. Of the three cell types, cardiac myocytes appear more susceptible to infection by the adenovirus 5 construct as assessed through beta-galactosidase staining. Infection of cardiac fibroblasts, myocytes and VSMCs with the hTGF-beta 1 adenovirus leads to the expression of hTGF-beta 1 mRNA and enhanced levels of bioactive and total TGF-beta 1 protein. Infection with hTGF-beta 1 adenovirus also results in enhanced levels of collagen type III gene expression in VSMCs and fibroblasts whereas in cardiac myocytes it leads to increased levels for sarcomeric and beta-actin. Thus, this adenoviral vector might be used for the exploration of in vivo effects of altered levels of cardiac TGF-beta 1.

Angiotensin II stimulates the autocrine production of transforming growth factor-beta 1 in adult rat cardiac fibroblasts

Angiotensin II (Ang II) has been implicated in the development of cardiac hypertrophy and myocardial fibrosis. While recent in vivo and in vitro studies performed in cultured cardiac myocytes and fibroblasts support this role for Ang II, the mechanisms of Ang II action at the cellular level remain unclear. In the present study, we postulated that Ang II action in adult cardiac fibroblasts may stimulate the autocrine production and release of transforming growth factor-beta 1 (TGF-beta 1), a known regulator of cardiac fibroblast and myocyte function. We examined the ability of Ang II to regulate the gene expression, biological activity, and protein production of TGF-beta 1 in cultured adult rat cardiac fibroblasts. Treatment of fibroblast cultures with Ang II (10(-9) M) induced a two-fold increase in TGF-beta 1 mRNA levels within 4 h that was sustained through 24 h (P < 0.01). TGF-beta 1-like activity in Ang II-treated cultures was significantly increased compared with control as measured by bioassay (P < 0.001). Specificity for TGF-beta 1-like activity was confirmed through its neutralization with a TGF-beta 1 specific antibody (100 micrograms/ml). Total concentration of TGF-beta 1 (latent plus active forms) in conditioned media from Ang II-treated cardiac fibroblasts was also found to be greater than control (P < 0.01). These findings suggest that the effects of Ang II in the adult myocardium may be mediated in part by autocrine/paracrine mechanisms, including the production and release of TGF-beta 1 by cardiac fibroblasts.

Trophic effects of angiotensin II on neonatal rat cardiac myocytes are mediated by cardiac fibroblasts

Cultured neonatal rat cardiac fibroblasts (NF) and myocytes (NM) were used to examine the distribution of angiotensin II (ANG II) receptors and the potential role of NF in mediating the trophic response to ANG II in the heart. In NM preparations cultured for 2-5 days, specific binding to 125I-ANG II was < 10% of the specific binding in cultured NF. Binding assays, immunocytochemistry, and autoradiography in NM cultured for > 5 days identified two populations of cells, one with fibroblast-like morphology and high density of ANG II receptors and another with low binding, comparable to NM cultures at day 5 or earlier. Conditioned medium (CM) from untreated NF increased cell surface area and net [3H]leucine (Leu) incorporation 1.4-fold in NM. CM from ANG II-treated NF enhanced [3H]Leu incorporation 2.2-fold in NM. This potentiating effect of ANG II was inhibited by losartan and was absent when ANG II was added directly to NM. In addition, studies using antibodies and bioassay for transforming growth factor-beta 1 (TGF-beta 1) suggested that TGF-beta 1 does not mediate the trophic effects of ANG II on NM. We conclude that ANG II receptors are localized predominantly on NF and that ANG II can indirectly stimulate hypertrophy of NM by stimulating NF to produce a transferrable factor(s). These data suggest that cardiac fibroblasts may play a critical role in mediating the hypertrophic response to ANG II in the rat heart.

Animated visualization of a high resolution color three dimensional digital computer model of the whole human head

The interactive visualization of animated images through a computerized three dimensional (3D) full color model of an unstained cadaveric human head is presented. Serial full color images were taken of the blockface of a cryomicrotomed frozen human head every 200 microns. From this series of images a three dimensional digital model with a resultant pixel resolution of 200 microns3 was created on a UNIX workstation. Using this database, resampled images were computed along orthogonal axes and written sequentially to a write-once-read-many times (WORM) videodisc unit. Playback of this customized videodisc dataset provides animations of the digitally reconstructed slices and 3D reconstructed surface models. An interactive interface to the animated sequences is provided through a PC based tutorial package. This tutorial program is able to access videodisc frames to display animations and labeled still images in a software window to illustrate various neuroanatomic topics. The technique of animation as applied to this high resolution 3D model provides insight into complex spatial relationships and has great potential in research and as a teaching tool in the neurosciences.

Parents' accuracy in estimating child weight status

Mothers of 107 preschool children estimated their child's weight status, and the accuracy of these estimates was examined. The majority of mothers (72%) were accurate. Of those who were inaccurate, 83% had underestimated the child's weight status, whereas only 17% had overestimated. Mothers of heavier children were more likely to underestimate their child's weight status.

Percutaneous gastrostomy and gastroenterostomy: 2. Clinical experience

This report describes the authors' initial experience with percutaneous gastrostomy (PG) and gastroenterostomy (PGE) in 40 patients. Indications for PG and PGE included alimentation (35 patients) and small bowel decompression (five). Seldinger technique with air distension of the stomach via a nasogastric tube (20 patients) is a simple method to insert small (7-9 French) and firm catheters; tube exchanges for larger and softer catheters often are necessary by this method (23 procedures in 17 patients). Coaxial trocar technique (19 patients) permits initial insertion of softer and often larger catheters (9-14 French feeding tubes), which are less likely to clog or require exchange; the intragastric balloon support method facilitates trocar insertion. Now preferred is a system that uses 18-gauge needle puncture and allows coaxial insertion of a final soft feeding tube at the initial procedure. Small bowel catheter positioning (PGE) (31 patients) was more common than gastrostomy alone (8 patients); "downhill puncture" toward the gastric antrum assists direct guide-wire cannulation of the duodenum via the gastric puncture (12 patients). Five complications occurred; two were major and included catheter dislodgement in one patient. Another patient, who had a pharyngeal tumor, suffered profound respiratory difficulty from premedication and nasogastric tube malposition; patients with head and neck tumors present particular problems with nasogastric tube passage and airway monitoring. Inability to pass a nasogastric tube does not preclude PG and PGE, as direct puncture of the stomach is feasible.

Supratentorial ependymomas. Neuroimaging and clinicopathological correlation

In 10 patients with supratentorial ependymomas, the tumors exhibited hyperdensity on computerized tomography (CT) scanning prior to contrast infusion and, with one exception, all tumors were mixed lesions with the low densities suggesting cystic or necrotic portions. Eighty percent of the tumors contained small calcifications. Characteristically, the tumors were well demarcated and demonstrated moderate to marked enhancement after the intravenous administration of contrast material. Angiograms obtained in some patients showed mild hypervascular tumor staining and absence of large feeding arteries. The degree of contrast enhancement, angiographic vascularity, and tumor stain was compared to the pathological anaplasia of the tumors. No correlation was observed. Of four patients who were still alive during a follow-up period of 4 years or longer, three had recurrences with inoperable tumors; the remaining patient is without recurrence after craniospinal radiation. This same patient belonged to a group of five patients with a diagnosis of high-grade ependymoma, four of whom had recurrence. Follow-up CT accurately recorded the clinical course of each patient. Annual routine follow-up examinations are proposed for patients with low-grade ependymomas, and for those with high-grade ependymomas follow-up CT should be performed every 6 months. The characteristic appearance and behavior of these tumors include several distinctive features on angiographic and CT images.