Changes in activities of wives caring for their husbands following stroke.

PURPOSE: The purpose of this study was to explore the perspectives of caregivers of persons with stroke with respect to their own physical activity. METHODS: A qualitative, descriptive approach was used to study 10 caregivers of persons with stroke, recruited from a stroke exercise class in a large urban rehabilitation facility. Caregivers participated in individual, semi-structured interviews that were audiotaped, transcribed verbatim, and analysed using a constant comparative method. An inductive, iterative approach was applied to determine the codes and themes. RESULTS: Four main themes were identified: change in role, change in activity, barriers to activity and health, and change in meaning of activity. Barriers to activity included guilt, time, and energy. Participants revealed that activity became more therapeutic after stroke and that participants preferred purposeful, functional, and partnered activities. CONCLUSIONS: These findings emphasize the importance of the husband-wife dyad and of movement toward a family-centred care approach. Education should be provided to caregivers regarding their role, barriers, and health-promoting activities. Future research should focus on determining appropriate physical-activity programmes for caregivers as well as on evaluating implementation of partnered exercise programmes for caregivers and persons with stroke.

Detection of familial defective apoB (FDB) mutations in hypercholesterolemic children and adolescents by denaturing high performance liquid chromatography (DHPLC).

OBJECTIVE: To seek apolipoprotein B (apoB) gene mutations in children and adolescents presenting to a lipid clinic with hypercholesterolemia and suspected of familial defective apoB (FDB), employing a new automated denaturing high performance liquid chromatography (DHPLC) method. DESIGN AND METHODS: 131 patients between the ages of 3 and 18 years were screened for the presence of FDB mutations using DHPLC. Patients who exhibited aberrant DHPLC chromatograms were sequenced. RESULTS: Three patients were found to be positive for the R3500Q mutation in which a single nucleotide G-->A transition resulted in arginine to glutamine substitution at codon 3500 in exon 26 of the apoB-100 gene. All three subjects had elevated total cholesterol and LDL cholesterol levels, and high or borderline high plasma apoB levels. No R3500W or R3531C apoB mutations were found. CONCLUSIONS: Automated DHPLC can be readily applied in rapid screening of hypercholesterolemic children presenting to a lipid clinic. Using DHPLC, this study revealed that the FDB mutation (R3500Q) is an important contributing factor to hypercholesterolemia observed in a pediatric lipid clinic population.

Effect of rosuvastatin on insulin sensitivity in an animal model of insulin resistance: evidence for statin-induced hepatic insulin sensitization.

Statin-treatment of fructose-fed/insulin resistant hamsters was recently shown to ameliorate metabolic dyslipidemia and hepatic VLDL overproduction. Here, we provide evidence that rosuvastatin treatment of insulin resistant hamsters can induce improvements in hepatic and whole body insulin sensitivity. Treatment with 10 mg/kg/day rosuvastatin for 10 days significantly reduced fasting insulin (-59%) and triglyceride (-50%) levels in fructose-fed hamsters (p<0.05). Following an intraperitoneal (IP) glucose challenge, rosuvastatin-treated hamsters exhibited enhanced glucose clearance compared to untreated hamsters maintained on the high-fructose diet (area under curve (AUC)=1772+/-223 mM min vs. 2413+/-253 mM min, respectively; p<0.002) with a significant reduction in 2h post-challenge glucose (n=5, p<0.02). Rosuvastatin-treatment also significantly improved sensitivity to an IP insulin challenge (AUC=314+/-39 mM min vs. 195+/-22 mM min for rosuvastatin-treated and fructose-fed hamsters, respectively; p<0.04, n=3). At the molecular level, significant increases in tyrosine-phosphorylation of the hepatic insulin receptor and IRS-1 were observed for rosuvastatin-treated hamsters (+37% and +58%, respectively) compared to fructose-fed controls following an intravenous (IV) bolus of insulin (p<0.05). Increases in insulin receptor and IRS-1 phosphorylation were also observed in muscle and adipose tissue. Analysis of hepatic Akt phosphorylation and mass revealed a small (25%) increase in serine phosphorylation of Akt with no significant change in Akt mass, although serine-phosphorylation and mass of Akt2 were significantly increased (+32%, p=0.03, and +42%, p=0.01, respectively). Interestingly, expression of PTP-1B, a key negative regulator of insulin signaling, showed a non-significant trend toward reduction in liver and was significantly reduced in adipose tissue (-20% and -37%, respectively). Taken together, these data suggest that statin-treatment increases whole body and peripheral tissue insulin sensitivity via improved cellular insulin signal transduction.

Pediatric reference intervals for lipids and apolipoproteins on the VITROS 5,1 FS Chemistry System.

OBJECTIVES: Lipid biomarkers are integral in the assessment of dyslipidemia and cardiovascular risk, conditions that have become increasingly prevalent in pediatric populations. A comprehensive set of pediatric reference intervals for traditional or recently established lipid analytes is not currently available. DESIGN AND METHODS: 525 outpatient samples from a pediatric population were categorized into five age groups ranging from 0 to 20 years of age. Groups were further partitioned by gender. Serum or plasma samples were analyzed on the VITROS 5,1 FS Chemistry System for cholesterol and triglycerides by dry-film methods, direct HDL-C and LDL-C by selective detergent elimination, and apolipoproteins AI and B by immunoturbidimetry. Reference intervals were established by non-parametric methods at the 2.5th and 97.5th percentiles. RESULTS: Lipid levels show age- and gender-related differences, particularly during the first year of life and in young adults following puberty. Concentrations of total cholesterol, LDL-C, and apo B were lowest in the 12 months after birth and remained relatively constant throughout childhood, but decreased for males in early adulthood. Triglyceride levels increased gradually throughout childhood and adolescence, and along with cholesterol, the upper limits of these intervals exceeded the recommended concentrations of lipid levels in children. For HDL-C and apo AI, no age- or sex-related differences were found until after puberty when values for males decreased slightly. CONCLUSIONS: Our current reference intervals in children and adolescents provide an important update for lipid markers and suggest earlier incidence of hypercholesterolemia when compared to previous ranges. Increased profiling of lipids is anticipated, and these will aid in the early assessment of cardiovascular risk in pediatric populations.