The influence of dietary cholesterol on cardiac and hepatic Beta-adrenergic receptors in egyptian sand rats

We examined the effects of dietary cholesterol on cardiac and hepatic beta-adrenergic receptor functioning. Age-matched adult desert rodents (Psammomys obesus) were randomized to either a 5% cholesterol diet (CD, n = 20), or normal rabbit chow (RC, n = 18). After a 2-month exposure to the diets, animals were sacrificed and tissue from both heart and liver were retained for radioligand bindings studies. In heart tissue, cholesterol fed animals, relative to controls, showed an increased production of adenosine 3,5>-cyclic monophosphate (cAMP) in response to isoproterenol. Cholesterol supplementation was not associated with an increase in heart beta-adrenergic receptor number. Animals fed the 5% cholesterol diet showed significant increases in the number of beta-adrenergic receptor sites in hepatic tissue (M = 13.2 vs. 10.4 pmol/mg protein, CD and RC, respectively). The increased number of receptor sites in the liver was accompanied by a significant increase in isoproterenol-stimulated cAMP production. Results are supportive of the hypothesis that dietary cholesterol contributes to an upregulation of beta-adrenergic receptor function in cardiac, as well as hepatic tissue. These findings may be relevant to the observations of excessive stress-induced cardiovascular reactivity in persons with high cholesterol levels.

Depression and long-term mortality risk in patients with coronary artery disease

Previous research has established that patients with coronary artery disease (CAD) have an increased risk of death if they are depressed at the time of hospitalization. Follow-up periods have been short in these studies; therefore, the present investigation examined this phenomenon over an extended period of time. Patients with established CAD (n = 1,250) were assessed for depression with the Zung Self-Rating Depression Scale (SDS) and followed for subsequent mortality. Follow-up ranged up to 19.4 years. SDS scores were associated with increased risk of subsequent cardiac death (p = 0.002) and total mortality (p < 0.001) after controlling for initial disease severity and treatment. Patients with moderate to severe depression had a 69% greater odds of cardiac death and a 78% greater odds of mortality from all causes than nondepressed patients. Increased risk was not confined to the initial months after hospitalization. Patients with high SDS scores at baseline still had a higher risk of cardiac death > 5 years later (p < 0.005). Compared with the nondepressed, patients with moderate to severe depression had an 84% greater risk 5 to 10 years later and a 72% greater risk after > 10 years. Patients with mild depression had intermediate levels of risk in all models. The heightened long-term risk of depressed patients suggests that depression may be persistent or frequently recurrent in CAD patients and is associated with CAD progression, triggering of acute events, or both.

Interpersonal Hostility Assessment Technique: description and validation against the criterion of coronary artery disease

High levels of hostility are associated with adverse health outcomes. The Interpersonal Hostility Assessment Technique (IHAT; Barefoot, 1992) measures hostility from verbal behavior during a standardized interview. Four types of behaviors are scored as hostility: evading the question, irritation, and indirect and direct challenges to the interviewer. The sum of the frequencies of these acts is a Hostile Behavior Index (HBI), which is divided into two components: verbal, scored with speech content in mind, and paraverbal, based on vocal stylistics. This study examined characteristics of IHAT assessments in 129 male coronary patients. Satisfactory interrater reliabilities were obtained. The HBI correlated highly (.58) with coronary artery disease severity after controlling for traditional risk factors. This relation was not affected by question topic or by differential weighting of the four hostile behaviors. Both HBI components were significantly correlated with disease. Results are discussed in terms of their implications for hostility assessment.

Psychosocial factors: role in cardiac risk and treatment strategies

Recent epidemiologic research has identified several psychosocial factors that impact unfavorably on prognosis among patients with established coronary heart disease (CHD). Several biologic and behavioral characteristics have been identified in patients with these psychosocial risk factors that are biologically plausible mediators of their adverse impact on prognosis. Several small-scale clinical trials offer encouraging evidence that both behavioral and pharmacologic interventions have the potential to ameliorate the health-damaging effects of psychosocial risk factors in patients with CHD. In this article we review the evidence on these points and offer recommendations as to how incorporation of this new knowledge into clinical care of the patient with CHD can lead to reduced mortality and morbidity rates in this population.

Correlates of perceived social support and equality of interpersonal relationships at mid-life

An investigation into the correlates of perceived social support and the equality of interpersonal relationships at mid-life was conducted using a sample of 3954 adults from the University of North Carolina Alumni Heart Study (UNCAHS). Participants ranged in age from forty to fifty years. Results suggested that while the number of family roles and social activities are the same for men and women, women perceive a greater availability of social support and report they give more than they take in relationships with family. There was no association found between the perceived availability of social support and global indices of equality of interpersonal relationships; suggesting an independence between these two psychological aspects of social support. Further, multiple regression correlational analyses indicated gender, level of social activity, and self-esteem as significant predictors of perceived social support; with self-esteem being the best single predictor. Relatedly, gender and number of children were found to be significant predictors of the perceived equality of relationships with family. These findings suggest differences in mid-life men and women's psychological perception of the availability of social support, and the give and take of relationships with family.

The ratio of the water and food consumption of chickens and its significance in the chemotherapy of coccidiosis

An investigation was made of the relationship between the water and food consumption of healthy and sick chickens Using coccidiosis as a disease model, and uninfected chickens as healthy controls, male birds of an egg-production breed and males and females of a meat-production breed were found to have simultaneously reduced water and food intakes 4 days after infection with Eimeria acervulina or E. maxima, and from 4 to 6 days after infection with E. tenella. This phenomenon was associated with reduction of weight gains and poor food conversion ratios. Whether birds were healthy or sick, and regardless of the degree reduction of dietary intake, there was a more or less constant relationship between their food and water consumption. The ratio of the weights of water and food consumed had a value of about 1.9, with a range of 1.1-2.4. It is concluded that neither water nor food has an advantage over the other as a vehicle for chemotherapy. However, other factors, such as case and speed of administration, and avoidance of adsorption onto food particles, favour the drinking-water route.

Epidemiological studies of coccidiosis in the domesticated fowl (Gallus gallus):III. The influence of the fowl's defaecation pattern on the excretion patterns of Eimeria tenella and E acervulina oocysts

Fifteen 61-day-old chickens (3 lots of 5) caged singly were inoculated five times during 3 days with Eimeria tenella or E. acervulina to simulate field infections, or kept as uninfected controls. During a 32 h experimental period of constant illumination, beginning on the tenth day after the first inoculation, every dropping produced by the birds as recorded, collected separately and examines for oocysts. All the chickens exhibited a bimodal pattern of colonic defaecation between 07.30 and 15.30 GMT the next day, with peaks at 17.00 on the first day and 11.00 on the second. Caecal defaecation practically ceased between 17.30 and 02.30 the next morning. Overall, colonic and caecal droppings were passed in the ratio 11.1:1. The patterns of oocyst excretion of both Eimeria species during the same 32-hour period exhibited peaks at 15.30 on the first day. Oocysts of either species were found both in caecal and colonic droppings. The chickens' defaecation pattern was superimposed upon the parasites' oocyst excretion patterns, the influence being more marked when lower numbers of oocysts were being excreted.

Epidemiological studies of coccidiosis in the domesticated fowl (Gallus gallus): IV. reciprocity between the immune status of floor-reared chickens and their excretion of oocysts

Chickens reared in floorpens for 20 weeks and naturally infected with Eimeria acervulina, E. tenella, E brunetti and E. maxima suffered outbreaks of coccidiosis, subsequently developing immunity to disease caused by each species. Thereafter, fluctuations in immunity occurred, assessed by oocyst production following challenge, which did not produce clinical signs. These fluctuations where characterized by reciprocity between immunity to each species and the excretion of oocysts of the respective species. Hence, as birds approached the solidly immune state, oocyst excretion was almost completely inhibited. Immunity then began to wane, and oocyst excretion increased once more, stimulating immunity to reach such a level that oocyst excretion was again reduced, and so on. Immunity to each species developed independently in the same birds, and protection against disease was maintained for 20 weeks. Oocysts of E.acervulina, E.tenella, E.brunetti and E.maxima were first detected in the faeces of chickens after 2, 3, 4 and 9 weeks respectively. Respective peak counts occurred at 4, 4, 12 and 9 weeks.

Residents' breast examination performance. How often? How well?

The American Cancer Society recommends annual clinical breast examination (CBE) for women with average risk of breast cancer beginning at age 40. The purpose of the current chart review study was to determine the adequacy of CBE performed by house officers in a community teaching hospital. A chart audit of 92 women aged 50 or older who were consecutively admitted to the medical service was used as a baseline measure of CBE documentation. Two subsequent series of 100 women each were evaluated. The first series, which also involved women admitted to the medical service, followed increased emphasis on the importance of CBE during twice daily conferences with supervisor staff. The second series involved women admitted to the obstetrics/gynecology service. In that series, house staff used two history/physical examination forms: one with a slot dedicated to CBE and one without a dedicated slot. Results indicate that supervisors' stressing the importance of CBE resulted in only slight improvement in house officers' performance, even in the presence of risk factors for breast cancer. In the third chart audit, CBE was documented by 88% of house staff who used a form with a dedicated slot for CBE; there were no CBE documentations among staff who used a form without a dedicated slot. The dedicated form was more successful in increasing CBE performance and documentation than verbal emphasis about the importance of breast cancer screening.

Job strain and the prevalence and outcome of coronary artery disease

BACKGROUND

It has been hypothesized that jobs that have both high psychological demands and low decision latitude ("job strain") can lead to coronary disease. The objective of this study was to test whether job strain was correlated with the presence of coronary disease at angiography or with long-term outcome in patients with angiographic coronary disease.

METHODS AND RESULTS

Employed patients under the age of 65 years undergoing diagnostic coronary angiography completed a self-administered questionnaire about their job duties and work environment. Job strain was measured by the method of Karasek. Patients were separated into three groups, based on extent of coronary disease: significant disease (> or = 75% stenosis), insignificant disease (> 0% but < 75% stenosis), and normal coronary arteries. Statistical analyses were performed using logistic regression and the Cox proportional hazards model. The 1489 patients enrolled had a median age of 52 years; 76% were male and 88% were white. By design, all patients were employed, 60% in white-collar jobs and only 16% in jobs requiring heavy labor. Traditional cardiac risk factors were most prevalent in the 922 patients with significant coronary artery disease, at intermediate levels in the 204 patients with insignificant disease, and least prevalent in the 363 patients with normal coronary arteries (all P < .01). Job strain was actually more common in patients with normal coronary arteries (35%) than in patients with insignificant (26%) or significant disease (25%, P < .002). In a multivariate analysis, job strain was not significantly correlated with the presence of coronary disease. Job strain was not correlated with angina frequency at the time of angiography. Job strain was not a predictor of cardiac events (cardiac death or nonfatal myocardial infarction) during follow-up.

CONCLUSIONS

Job strain was not correlated with the prevalence or severity of coronary artery disease in a cohort of patients undergoing coronary angiography. The outcome of patients with angiographically defined coronary disease was not affected by the level of job strain as measured by the method of Karasek.

Intra-articular pressure changes in rheumatoid and normal peripheral joints

OBJECTIVE

To investigate the intraarticular pressure (IAP) dynamics of a spectrum of joints in rheumatoid and normal subjects in order to determine whether a reperfusion event is likely to occur at these sites.

METHODS

IAP was measured in the metacarpophalangeal (MCP) (n = 8), wrist (n = 8), ankle (n = 4), and elbow joints (n = 4) of rheumatoid subjects, in addition to the MCP (n = 8), wrist (n = 6), and ankle joints (n = 1) of normal healthy controls, using the hand held portable 295-1 Intra-Compartmental Pressure Monitor System (Stryker, UK).

RESULTS

Resting IAP was positive in all rheumatoid joints, and subatmospheric or weakly atmospheric in normal subjects (p < 0.01). Exercise produced an increase in IAP in rheumatoid subjects only (p < 0.01). The addition of saline to normal joints mimicked the IAP changes seen in the rheumatoid group.

CONCLUSION

These observations suggest that increased resting IAP is a marker for chronic joint inflammation. The IAP increase seen in the rheumatoid group during exercise supports the concept of hypoxic reperfusion mediated joint injury.

Patient use of a computer for prevention in primary care practice

A computerized health information system for prevention can provide an efficient way to enhance the doctor-patient interaction and provide patient-specific education materials. A computer system called HealthTouch was developed by family physicians and placed in 29 randomly selected primary care practices in Virginia for 1 year. Data were collected from three sources: randomly selected patients' charts, the HealthTouch data base, and patient telephone interviews. Data from these sources were combined, and frequency distributions and comparisons of responses by demographic attributes were analyzed using the chi-square statistic. During the study year, 9799 adult patients used the HealthTouch system. HealthTouch users were younger, on average, than the overall patient population, and the majority (89%) were either very satisfied or satisfied with the system. Computers are effective tools to collect, organize, and store patient information about prevention.

Coccidiosis: a radiological study of sulphaquinoxaline distribution in infected and uninfected chickens

Using scintillation counting and autoradiographical techniques, the whole-body distribution in week-old uninfected chickens of the anticoccidial agent sulphaquinoxaline (SQ) labelled with 35S was established at various time intervals after a single oral dose either alone or following continuous in-feed medication with unlabelled SQ, and after a single intravenous dose. The distribution was also established in chickens infected with the coccidia Eimeria acervulina or E. tenella, after a single oral dose of radiolabelled SQ administered either alone or following continuous in-feed medication with unlabelled SQ, as for uninfected chicks. In all uninfected chicks, SQ was rapidly absorbed from the gut and was distributed to all tissues. It appeared at high concentrations in the bile and kidneys 0.5 h after dosing. In chickens that had previously received unlabelled SQ in the diet, a radiolabelled dose maintained steadier tissue concentrations than the sharp rise and fall detected after a single oral dose. Intravenous dosing of uninfected chicks showed that SQ was secreted by the crop, gizzard and caecal epithelia into their lumina. Infection with E. acervulina or E. tenella coincided with an overall 3.5-fold sustained increase of SQ concentration in chick tissues. An updated hypothesis including these new observations for the anticoccidial mode of action of SQ in chickens is expounded.

Age differences in reported recollective experience are due to encoding effects, not response bias

Three experiments examined whether reduced recollective experience reported in old age is due to a criterion shift towards more cautious responses by older subjects. In Experiment 1 Young and Old subjects took a recognition test without specific instructions on how they should encode the presented words. For recognised items subjects indicated whether they recollected the item's previous occurrence or whether they just knew it had been on the list. They then rated their confidence that the word came from the study list. Although overall recognition levels were equivalent, older adults recollected less and reported more know responses than the younger subjects. However, there was no overall difference in confidence, contrary to a criterion shift explanation. In Experiment 2A specific encoding instructions removed the age-related change in recollective experience entirely. Experiment 2B reproduced the test conditions of Experiment 2A, but without specific encoding instructions, and replicated the pattern of know responding found in Experiment 1. Thus the three experiments together suggest that the amount of recollection experienced by the elderly is not explicable in terms of cautiousness, but is driven by the encoding carried out by the elderly at presentation.

Epidemiological studies of coccidiosis in the domesticated fowl (Gallus gallus): II. Physical condition and survival of Eimeria acervulina oocysts in poultry-house litter

The survival of coccidial oocysts in poultry-house litter has been examined. The experimental design ensured that viable oocysts were not continuously replenished by multiplication in chicks. Hence, reliable oocyst survival data were obtained, which is not possible in a commercial house where there is a continuously changing population of coccidia. Litter was seeded directly from infected chicks with unsporulated oocysts of Eimeria acervulina. Whilst sporulation proceeded rapidly, oocysts simultaneously began to deteriorate after only 24 h. After five days, most oocysts were disintegrating. Viable oocysts were, however, detected (using sentinel birds) up to day 23, although subsequently the viability of the oocyst population began to wane. Few viable oocysts were detectable after 38 days, despite some intact sporulated oocysts being evident up to 54 days. The physical condition of oocysts is therefore not a reliable indication of their viability. The surface temperature of the litter was 25-28 degrees C throughout and the moisture content varied from 31.0 to 62.1%; these conditions were not limiting factors for oocyst sporulation.

Epidemiological studies of coccidiosis in the domesticated fowl (Gallus gallus): I. The fate of ingested oocysts of Eimeria tenella during the prepatent period in susceptible chicks

A small proportion of sporulated and unsporulated coccidial oocysts (Eimeria tenella) inoculated per os into domesticated fowl were recovered intact within about one day, well within the usual 5-day ¿prepatent period.¿ Recovery rates of sporulated oocysts were ca. 2-9% from chicks inoculated at all ages tested from 2 to 28 days. From chicks within the same age range, the recovery rates for unsporulated oocysts were ca. 15-21%. The higher recovery rates of unsporulated oocysts indicated that they were more resistant to disruption in the gizzard than sporulated oocysts. Up to 83% of unsporulated oocysts that survived passage through the host's gut were able subsequently to sporulate. The first oocysts recovered, either sporulated or unsporulated, appeared at virtually the same time in all the chicks tested, despite the oldest birds having guts twice as long as the youngest. Moreover, the lengths of oocyst recovery periods in the oldest birds were 10-25% of those in the youngest.

Use of prostate-specific antigen for prostate cancer screening in primary care practice

OBJECTIVE

To examine prostate-specific antigen (PSA) as a screening test in randomly selected primary care practices.

DESIGN

Chart abstractions of a random selection of 552 men (age, > or = 50 years) and physician and practice-level surveys.

SETTING

Fifty-eight randomly selected, nonteaching, non-governmental, primary care practices in a 43-county area in Virginia.

MAIN OUTCOME MEASURES

Documented evidence of PSA screening for asymptomatic male patients and physician self-report on regular (annual or biannual) use of PSA screening.

RESULTS

Of 496 asymptomatic men, 123 (25%) seen in a 1-year period had documentation of PSA screening. Sixty (50%) of 120 asymptomatic men with documentation of a health maintenance examination had a PSA screening, whereas only 63 (17%) of 376 men without health maintenance examination had a PSA screening (chi 2, P < .001), after adjusting for race, insurance status, and age. Comparison of PSA screening use before and after the November 1992 publication of the American Cancer Society guidelines on PSA screening revealed that PSA screening after the publication date was 26%, compared with 19% before the data (P = .045), adjusting for health maintenance examination and the length of time for which the patient was eligible for screening. Logistic regression on physician self-report of regular vs not regular PSA use found an odds ratio of 6.12 (95% confidence interval, 1.28 to 29.30) for influence of the guidelines and 0.96 (95% confidence interval, 0.93 to 0.99) for the proportion receiving Medicaid or uninsured in the practice.

CONCLUSIONS

Despite controversy over PSA as a screening test, PSA screening has now spread substantially in primary care practice.

Effects of oxidized LDL on mononuclear phagocytes: inhibition of induction of four inflammatory cytokine gene RNAs, release of NO, and cytolysis of tumor cells

A critical step in development of atherosclerosis is the interaction of oxidized low-density lipoprotein (LDL) with mononuclear phagocytes. Oxidized LDL, as well as acetyl-LDL, is rapidly taken up into macrophages via a family of scavenger receptors. We report that macrophages treated with oxidized LDL have markedly lower levels of mRNA specific for the genes MCP-1, TNF-alpha, IL-1 alpha, and KC as measured by Northern blot analyses of lipopolysaccharide (LPS)-stimulated macrophages. By contrast, acetyl-LDL does not inhibit these genes at the doses at which oxidized-LDL is effective. Similar effects are observed whether the LDL is oxidized in the presence of Cu2+ or of Fe2+. Such inhibition also occurs when maleylated bovine serum albumin (BSA), which also clears by one or more scavenger receptors on macrophages, is used as the stimulant. Fe2+ or Cu2+ oxidized LDL inhibits release of nitric oxide when triggered by LPS and direct cytolysis of tumor cells when triggered by maleylated BSA or LPS. Taken together, the data presented indicate that oxidized LDL inhibits induction of several important gene RNAs as well as functional markers that characterize the development of inflammatory and fully activated macrophages.

Comments on a process for identifying stages of dementia in residents of nursing facilities

This paper gives a description of how items of the Global Deterioration Scale's Brief Cognitive Rating Scale and Functional Assessment Staging can be verified by reviewing specific sections and items of the Minimum Data Set for Nursing Facility Resident Assessment and Care Screening which is completed annually and updated every three months or when significant changes in health occur. A likely outcome of such comparison is improved understanding of the cognitive and functional status of residents with dementia and other medical conditions.

Velocimetry of gas flows using degenerate four-wave mixing

A method of velocimetry of gaseous flows based on resonant degenerate four-wave mixing (DFWM) is described. Spatially resolved velocity measurements are derived from Doppler shifts of DFWM signals generated in NOseeded into flows of air or N(2). Velocities in the range of 60 to 200 ms(-1) have been measured with an uncertainty of +/-30 ms(-1).

Hostility in asymptomatic men with angiographically confirmed coronary artery disease

The association of hostility and coronary artery disease was evaluated in a case-control study of aircrew members who had been referred for coronary angiography on the basis of noninvasive tests or risk factor status. The asymptomatic status of the sample and the structured nature of the referral process minimize the methodologic problems normally associated with studies of patients undergoing angiography. Cases (n = 24) had some angiographic evidence of coronary artery disease, whereas controls (n = 25) were found to have no evidence of occlusion. An interaction was observed between smoking history and a measurement of hostility based on observations of the respondent's behavior during a standard interview. Among nonsmokers, cases had higher hostility scores than did controls (p = 0.004). This association was not present among smokers. Self-reported hostility did not discriminate cases from controls. These findings support the notion that hostility plays a role in the pathogenesis of coronary atherosclerosis and point to the potential importance of interactions between hostility and other risk factors.

Personality measures as predictors of smoking initiation and cessation in the UNC Alumni Heart Study

MMPI data collected from a sample of college men and women during 1964-1967 were used to predict smoking initiation and cessation over a 20-year follow-up period. People who subsequently began smoking were more rebellious, impulsive, sensation seeking, and hostile; were less likely to present a positive self-image; and were socially extraverted while in college. People who continued to smoke 20 years later were more hostile and sensation seeking. The personality variables that predicted smoking initiation and cessation were the same for men and women. Discussion centers on the potential role of hostility as a predictor of smoking cessation.

Caffeine and cholesterol: interactions with hostility

The consumption of caffeinated beverages has been linked to elevated serum cholesterol and an increased risk of coronary disease, although the relationships are inconsistent across studies and remain controversial. The effect of caffeine on cholesterol and coronary disease risk may be modulated by other factors. Using cohort data from a subsample of the University of North Carolina Alumni Heart Study, we investigated whether the relationships between caffeinated beverage consumption and serum lipid and lipoprotein levels in middle-aged men and women were modulated by levels of trait hostility. After adjustment for other risk factors, higher caffeinated beverage intake was associated with higher low-density lipoprotein cholesterol levels and a higher ratio of total to high-density lipoprotein cholesterol, both indicative of greater coronary disease risk. The interactive effects of hostility and caffeine intake were ambiguous, although there were trends for caffeine intake to have stronger effects on low-density lipoprotein and on total cholesterol in people with less hostility. Additional studies of personality characteristics and other factors that can modulate the cholesterol-raising effects of coffee drinking may be warranted because they might clarify the health consequences associated with coffee drinking and lead to the identification of individuals who would benefit most from changes in their coffee drinking.