Increased rate of apoptosis in intimal arterial smooth muscle cells through endogenous activation of TNF receptors.

Intimal proliferation of smooth muscle cells (SMCs) is a key event in the vascular response to injury, including the early stages of atherosclerosis and restenosis after angioplasty. Tumor necrosis factor-alpha (TNF-alpha) has been reported to stimulate growth of cultured human SMCs, but activation of TNF receptors is also known to induce cell death by apoptosis. We report here that SMCs isolated from the neointima of injured rat aortas are characterized by increased expression of TNF-alpha in response to interleukin-1beta and gamma-interferon compared with medial SMCs. Basal and serum-stimulated DNA synthesis was higher in intimal than in medial SMCs. In contrast to previous findings on human SMCs, exposure to interleukin-1beta/gamma-interferon or TNF-alpha did not affect the growth of rat medial SMCs, inhibited DNA synthesis, and decreased cell numbers in cultures of intimal SMCs. Incubation of intimal SMCs with these cytokines also resulted in induction of terminal dUTP nick end-labeling positivity and caspase-3 expression, suggesting cell death by apoptosis, whereas medial cells were markedly less sensitive in this respect. Cytokine-induced apoptosis in intimal cells was effectively inhibited by treatment with antibodies against TNF receptors. These findings suggest that endogenous activation of TNF receptors may represent a way to limit accumulation of SMCs in injured arteries. This mechanism may also be important in SMC death in advanced atherosclerotic plaques.

A comparison of views of individuals with type 2 diabetes mellitus and diabetes educators about barriers to diet and exercise.

Diet and exercise are the cornerstones of treatment for persons with type 2 diabetes mellitus, yet patients find these areas of self-management to be the most difficult. Considerable research has indicated that barriers to diet and exercise are critical influences determining adherence to diet and exercise plans. Standards of practice require educators to assess patient barriers to self-management. However, little research has investigated whether patients and educators perceive these barriers similarly. This project's objectives were to compare and contrast patients' and educators' perspectives of patient barriers to following a meal or exercise plan, and to identify differences in patients' perceived barriers as related to patient characteristics. Patients with type 2 diabetes mellitus (n = 97) from three eastern Washington area hospitals and diabetes educators (n = 143) from the Washington Association of Diabetes Educators (WADE) were recruited for a mail survey. From the patient survey, the proportion of patients on meal plan (52%) or exercise plan (26%) was low. Certain barriers were prominent for both patients and educators relative to diet (difficulty maintaining a diet away from home, liking foods not in the meal plan) and exercise (not a high priority, weather). However, multivariate analyses indicated that patients and educators view barriers differently. Similarities and differences between educators and patients in response to barriers are discussed relative to enhancing diabetes counseling and education, and overall communication between educators and patients.

Diabetes educators' perspectives on barriers for patients and educators in diabetes education.

PURPOSE: This study assessed diabetes educators' perspectives on barriers that potentially affect patient access to and utilization of diabetes education. METHODS: A 40-item questionnaire was developed to collect needs assessment data on diabetes education programs. The questionnaire was mailed to a Washington State professional practice group in diabetes education (N = 143). RESULTS: Most respondents were registered nurses (61%) or registered dietitians (27%); 74% were certified diabetes educators. The educators' perceptions of the difficulty that type 1 versus type 2 patients experience in different areas of self-management after diabetes education underscored the importance of learning effective long-term skills for self-care. Some of the reasons given for type 2 patients dropping out of diabetes education programs were also cited as barriers to conducting follow-up, such as education being a low priority for the patient and the patient not being able to afford diabetes care services. CONCLUSIONS: Educators appeared to relate many patient barriers to a lack of patient understanding of the evolving nature of diabetes and the subsequent need for educational support. The role of continuing education for all patients needs to be emphasized to the patient during the initial education, as well as to the healthcare community and the patient's support network.

Late adolescents' perceptions of their caregiver's feeding styles and practices and those they will use with their own children.

The purpose of this study was to examine the perceptions of late adolescents regarding their caregivers' feeding styles and practices and their perceptions of those they plan to use with their children. The 546 subjects were from a randomly selected sample of 1,000, nonparenting, 18 to 23-year old college students who responded to a questionnaire. Two distinct feeding styles emerged: adult-controlled and cooperative. The adult-controlled style reflects a perception of control which the adult decides what and how much a child will eat. The cooperative style reflects shared control where the adult decides what food will be presented and the child decides how much and whether to eat. Chi-square analysis of the relationship between subjects' perceptions of their caregivers' feeding styles and their perceptions of the styles they believe they will use with their children, resulted in a positive association. To examine perceived past and future feeding practices, a Pearson's r was computed on subscales from a factor analysis. Results indicated positive correlations between subjects' perceived past and future feeding practices. These results suggest generational transmission of feeding styles and practices. A recommendation is made for parent and nutrition educators to focus on both parenting styles and feeding practices.