Program logic of a mental health outreach service for socially anxious youth.

Youth mental health is a major concern both in Australia and internationally. Identifying at-risk young people is a core service priority. This report describes a "Youth Social Inclusion Program" developed in Australia to assist young people identified as having social difficulties that prevent them linking into formal mental health services. This report describes the Australian service context and uses the "program explication" methodology to document: the program activities, therapeutic processes, and underpinning evidence for the benefits of this service. Program explication is a consulting method designed to assist services to identify and review implicit program logic assumptions against evaluation literature. We demonstrate the application of this method in exploring the assumptions and evidence for the Youth Social Inclusion Program, targeting outreach to socially anxious young people in Australia. The Youth Social Inclusion Program involved seven logically consistent activities. Our literature search revealed moderate evidence for the expected benefits of the activities. This practice-based design drew on several theoretical perspectives. Given that the program logic has been established, we outline a proposal for further evaluation.

Regulation of Na+,K+-ATPase alpha-subunit expression by mechanical strain in aortic smooth muscle cells.

We have previously demonstrated that vascular sodium pump activity is stimulated in several rat models of hypertension. In addition, others have reported an upregulation of mRNA for the Na+,K+-ATPase alpha1-subunit in hypertension. To test the effect of sustained, cyclic, stretch-relaxation stimuli on the expression of alpha1- and alpha2-subunits of Na+,K+-ATPase in vascular smooth muscle cells, we used the Flexercell strain unit to stretch rat aortic smooth muscle cells for several days on a collagen-coated silicone elastomer substratum. Six-second cycles of stretch-relaxation were applied to obtain 10% average surface elongation (22% maximum) for 4 days. Control cells were not stretched but were grown on a similar surface. The effect of Gd3+, a blocker of stretch-activated channels, was also investigated. At the end of 4 days, protein expression of alpha1- and alpha2-subunits was determined by Western blot analysis. Intensity of the bands for alpha1- and alpha2-subunits was quantified with the use of a computerized image analyzer. In the stretched cells, both the alpha1- and the alpha2-subunit protein-band intensities were significantly increased compared with those of the non-stretched cells. Treatment with 50 micromol/L Gd3+ during the application of stretch prevented the upregulation of alpha2-expression but not that of alpha1-expression. Sodium pump activity, the functional counterpart of Na+,K+-ATPase, was inhibited as a result of stretch; Gd3+ had no effect on this variable. Our results suggest that in vascular smooth muscle, stretch may be a signal for the upregulation of both the alpha1- and alpha2-isoforms. However, a differential response of the two isoforms to the blocker of stretch-activated channels implies involvement of different mechanisms. This alteration in protein expression is not reflected in the function of the enzyme.