Recruitment of rural community-dwelling older adults: barriers, challenges, and strategies.

The significant increase in the number of older adults in the USA, particularly in rural areas, has signaled the need for more research to address the health care needs of this complex, heterogeneous, and vulnerable population. However, accessing older adults in rural areas presents an especially difficult challenge for gerontological researchers. Barriers can include the normal physiological changes that accompany aging, prevalence of chronic illness and medication use, lower literacy rates, transportation issues, and a distrust of 'outsiders' and research in general. Specific strategies that may facilitate participation include the use of gatekeepers to gain entry, increased personal contact by researchers sensitive to the unique needs of older adults, and other media approaches tailored to the rural community. Understanding the characteristics of rural older adults, along with careful planning of recruitment strategies, is crucial to obtaining adequate participation and the acceptance of future research efforts.

Weight gain and adipose tissue metabolism after smoking cessation in women.

BACKGROUND: Cigarette smoking increases the risk of cardiovascular disease, and is an important preventable cause of death and illness. One major deterrent to smoking cessation is a gain in body weight. Understanding the mechanisms that contribute to this weight gain may maximize the success of long-term smoking cessation. We hypothesized that smoking cessation is associated with an increase in adipose tissue lipoprotein lipase (AT-LPL) activity and/or a decrease in lipolysis, two metabolic factors that determine the balance between fat storage and fat utilization, and thus affect the propensity for weight gain. MATERIALS AND METHODS: Ten premenopausal women (37.1+/-6.2 y, 31.7+/-6.4 kg/m(2) body mass index (BMI), mean+/-s.d.) participated in a 4 week smoking cessation program. Measurements of body weight, waist and hip circumferences, adipose cell metabolism and resting metabolic rate were obtained at baseline and after 4 weeks of smoking cessation. RESULTS: Of the 10 women who began the intervention, five successfully completed the smoking cessation intervention. After 4 weeks of smoking cessation, there were significant increases in body weight (95.1+/-13.9-97.7+/-14.4 kg, P<0.05), with no change in waist and hip circumferences or resting energy expenditure. Gluteal AT-LPL activity significantly increased in all women by 2.8-fold (1.65+/-1.30-4.72+/-3.34 nmol/g/min, P<0.05). Abdominal AT-LPL activity increased in four out of the five women, but did not reach statistical significance (1.14+/-0.88-3.50+/-3.76 nmol/g/min, P=0.14). The increase in body weight correlated with the increase in gluteal AT-LPL activity (r=0.89, P<0.05), as well as the baseline activity of gluteal AT-LPL (r=0.86, P=0.06). There were no changes in basal or stimulated lipolysis in the gluteal or abdominal fat depots. CONCLUSIONS: These results suggest that smoking cessation is associated with significant increases in body weight, as well as changes in adipose cell metabolism, in particular increases in AT-LPL activity. This increase in LPL activity may contribute to the increase in body weight associated with smoking cessation.

Anxiety and depression: incidence and patterns in patients after coronary artery bypass graft surgery.

The purpose of this longitudinal study was to describe the incidence and patterns of anxiety and depression in older patients who undergo coronary bypass graft surgery and to determine the influence of gender and age on psychological recovery. A sample of 31 patients was assessed pre- and postoperatively at 2 to 3 days and at 2, 4, 8, and 12 weeks. Younger subjects experienced higher anxiety, reaching statistical significance at 2 and 4 weeks. Women had significantly higher trait and state anxiety and a higher, nonsignificant incidence of depression at all times. Younger subjects were more depressed at 2 to 3 days and at weeks 2 and 4. Because women and younger patients are at higher risk for psychological distress, they should be targeted for interventions.

A multibehavioral intervention to decrease cardiovascular disease risk factors in older men.

The purpose of this study was to compare the effectiveness of two mutibehavioral interventions: stress management (SM) (nutrition, exercise, and stress management) and education (ED) (nutrition, exercise, and education) on reduction of cardiovascular disease (CVD) risk factors in older men. A convenience sample (n = 33) of older men (66 +/- 5 years) with at least one CVD risk factor participated in this 6-month intervention. Mean receiving the SM intervention (n = 25) exercised at the facility twice weekly (at > or = 70% maximum heart rate for 40 minutes) and received 12 hours each of nutrition and stress management class instruction. Men receiving the ED intervention (n = 8) received the same exercise and nutrition protocols but received 12 hours of education without stress management. There were no significant differences in body habitus, metabolic response, exercise endurance, blood pressure, or heart rate between groups at baseline. The SM group had significant pre-post differences in weight, body mass index, intraabdominal fat, subcutaneous fat, total cholesterol, low-density lipoprotein, triglycerides, VO2, supine systolic and diastolic blood pressures. The ED group demonstrated significant pre-post differences only in supine diastolic blood pressure. There were significant change score differences between the groups in triglycerides, subcutaneous fat, VO2, and body mass index. Results suggest that a 6-month multibehavioral intervention with stress management is effective in decreasing CVD risk factors in older men.

Predictors of coping efficacy, negative moods and post-traumatic stress syndrome following major trauma.

The purpose of the study was to test relationships among injury appraisals, coping, social support and outcomes of coping efficacy, mood states and post-traumatic stress syndrome. A purposive sample of 152 hospitalized patients a week following major trauma was recruited from two trauma centres. The measures included the modified Ways of Coping Scale; the brief Social Support Questionnaire; the brief Profile of Mood State; the Impact of Event Scale; and selected demographic and injury related variables. Data were analyzed by multivariate statistics. The results indicated that perceived controllability, satisfaction with social support, wishful-thinking coping and problem-focused coping were the significant predictors for coping efficacy; perceived stressfulness, problem-focused coping and wishful thinking explained a significant amount of variance in mood states; avoidance coping and wishful-thinking coping were predictors for post-traumatic stress syndrome. The moderating effects of emotion-focused coping at high and medium levels were identified.

An overview of forensic psychiatric care of the adolescent.

The field of forensic psychiatric nursing is a relatively recent addition to the specialty of psychiatric nursing. This paper provides an overview of forensic psychiatric care of adolescent patients. It describes the juvenile justice system, identifies various theoretical models useful for understanding youthful offenders, and explores risk and protective factors. Psychiatric comorbidities and treatment considerations also are presented.

Self-efficacy targeted treatments for weight loss in postmenopausal women.

Matching behavioral treatment programs to different types of obese clients is a rarely studied strategy, thus guidelines for identifying who might benefit most from which program remain elusive. This study categorized the weight control self-efficacy beliefs of obese, postmenopausal women, and determined the effects of self-efficacy targeted versus non-targeted (control) treatment on weight loss outcomes (body habitus, physical conditioning, affect, and eating behaviors). Obese (BMI 33 +/- 5), postmenopausal (60 +/- 6 years old) women (n = 59) participated in a 6-month weight loss program. The 37 women categorized by Q methodology as Assured (self-confident, independent) were randomized to Assured (AT) or Non-Targeted (NT) treatment; the 22 Disbelievers (doubtful, wavering) were randomized to Disbeliever (DT) or NT treatment. At baseline, the Assureds had significantly smaller body girths and reported significantly greater self-esteem, fewer symptoms of binge eating, and less negative affect overeating than the Disbelievers. Improvement in these variables with weight loss erased significant differences between the groups and was a desired outcome. Treatment delivery type may have influenced attrition rate, since significantly more Assureds dropped from NT than AT and significantly more Disbelievers dropped from DT than NT. Thus, the self-efficacy type may serve as a means to identify different types of treatment needs (flexible vs. rigid) to sustain women's adherence and success in the program. The significant weight loss outcomes for women in all groups argues for the incorporation of strategies to enhance self-efficacy but not the need for specific treatments that directly target self-efficacy types.

A profile of early versus late onset of obesity in postmenopausal women.

Obesity is a serious health problem among women across the life span. Although people can become obese at any age, there is a large proportion of older women who have been obese since childhood. The purpose of this study was to determine whether postmenopausal women with an early versus late onset of obesity manifested differences in body habitus, eating behaviors, and mood. One hundred thirty-five postmenopausal women with obesity responded to self-report questionnaires on weight history, weight loss and maintenance expectancy, eating behaviors, and mood. Women with an early onset of obesity had a significantly higher body mass index (BMI), waist circumference, and highest attained adult body weight than women with a late onset of obesity. They had attempted a significantly larger number of diets and had lost more weight on any single diet. The groups also differed significantly on binge eating and overeating in response to negative affect. There was a tendency for women with an early onset to have more depressive and anxious symptoms. Postmenopausal women with an early onset of obesity differed physiologically and psychologically from those with a late onset. Tailoring dietary and behavioral interventions to profiles of postmenopausal women based on onset of obesity may improve the overall efficacy of weight loss programs.

Examination of steroid-induced changes in LHRH gene transcription using 33P-and 35S-labeled probes specific for intron 2.

We previously demonstrated that estrogen, but not progesterone, induces a increase in LHRH messenger RNA levels between 0800 and 1200 h in numerous of the rostral preoptic area/organum vasculosum of the lamina terminalis (rPOA/OVLT). To determine whether these changes are a result of increased transcription, we used in situ hybridization histochemistry to examine the temporal effects of estradiol (E2) and progesterone on cellular levels of intron-2-containing LHRH heteronuclear RNA transcripts. To make our method sufficiently sensitive to detect changes in these levels, we used 33P/35S probes to minimize both background and grain stacking over labeled cell nuclei. We found that levels of LHRH heteronuclear RNA rose between 0800 and 1000 in OVX, E2-treated rats, remained elevated at 1200 h, and declined by 1400 h. Progesterone did not affect these E2-induced changes. Our results suggest that an E2-dependent signal initiates LHRH gene transcription in neurons of the rPOA/OVLT hours before LHRH release begins and that progesterone does not affect this signal.

Effects of estrogen and progesterone on luteinizing hormone-releasing hormone messenger ribonucleic acid levels: consideration of temporal and neuroanatomical variables.

We examined temporal effects of estradiol (E2) and progesterone on cellular levels of LHRH messenger RNA (mRNA) in several brain regions. Female rats were ovariectomized and implanted with SILASTIC brand capsules of oil or E2 1 week later (day 0). Progesterone capsules were implanted on the morning of day 2. Using in situ hybridization histochemistry, we found that on day 2, E2 induced a complex temporal pattern of changes in LHRH mRNA levels. Levels in ovariectomized E2-treated animals were lower than control values in the morning, then increased before the LH surge and declined again as the surge waned. The magnitude of these changes was greatest in neurons of the rostral preoptic area/organum vasculosum of the lamina terminalis, but a similar pattern was detected in neurons of the medial preoptic area. No changes were seen in neurons of the diagonal band of Broca. Our finding that the effect of E2 on LHRH mRNA levels depends on the time of day and brain region examined largely reconciles discrepancies among previous studies. Progesterone triggered events that advanced the onset of and augmented the LH surge, but had no effect on LHRH mRNA levels. These findings support the hypothesis that the mechanism by which E2 induces region-specific changes in LHRH mRNA levels before the surge is separate from the progesterone-amplified mechanism that induces LHRH release.

Expression of messenger ribonucleic acid encoding tissue inhibitor of metalloproteinases-2 within ovine follicles and corpora lutea.

Metalloproteinase inhibitors, such as tissue inhibitors of metalloproteinases 1 and 2 (TIMP-1 and -2), play a key role in the regulation of metalloproteinases that modify extracellular matrix composition. Although expression of TIMP-1 within ovarian tissues has been well characterized, little information is available regarding expression of TIMP-2. The objective of the present studies was to characterize the ontogeny and localization of TIMP-2 messenger RNA (mRNA) within ovine preovulatory follicles and luteal tissue. Total cellular RNA was isolated from preovulatory follicles collected before (presurge; n = 3), or 12-14 h after (post surge; n = 4) an LHRH-induced gonadotropin surge, and from luteal tissue collected on days 3, 7, 10, 13, and 16 post estrus (n = 5, 5, 4, 5, and 5, respectively). TIMP-2 mRNA was expressed by both presurge and postsurge follicles, and expression did not increase after the gonadotropin surge (P = 0.44). In situ hybridization localized TIMP-2 mRNA primarily to the thecal layer of post-surge follicles (n = 3). TIMP-2 mRNA was also localized in a heterogeneous distribution within corpora lutea collected on days 3 and 10 post estrus (n = 3 each). Concentrations of TIMP-2 mRNA (picograms per microgram tissue DNA) were greater in corpora lutea collected during the early luteal phase (days 3 and 7) than the late luteal phase (day 16; P < 0.05). TIMP-2 mRNA was detected in purified populations of both small (n = 4) and large (n = 3) luteal cells, and mRNA concentrations (picograms per microgram DNA) were greater in the large luteal cells (P < or = 0.0002). In addition, immunoreactive TIMP-2 (approximately 21,000 M(r)) was detected by Western blot analysis of ovine luteal cell secreted proteins. We conclude that 1) TIMP-2 mRNA is expressed by the thecal layer of ovine preovulatory follicles and expression is not increased by the preovulatory gonadotropin surge; 2) expression of TIMP-2 mRNA is maximal during the early luteal phase; and 3) expression of TIMP-2 mRNA is greatest in large luteal cells.

Effects of acute ethanol administration and cold exposure on the hypothalamic-pituitary-thyroid axis.

A single dose of ethanol increases cellular levels of the mRNA encoding thyrotropin-releasing hormone (TRH) in neurons of the paraventricular nucleus (PVN), but blocks the cold-induced increase in the levels of this mRNA. Because the thyrotropic response to cold is dependent upon TRH secretion, we hypothesized that ethanol uncouples the stimulus-induced regulation of TRH secretion from the stimulus-induced regulation of TRH expression. We employed two complementary strategies to test this hypothesis. The first was to determine whether ethanol alters pituitary sensitivity to TRH. Animals given a single intraperitoneal injection of ethanol (3 g/kg) that produced a blood alcohol concentration of nearly 300 mg/100 mL exhibited the same increase in circulating levels of TSH following an intravenous infusion of TRH. Thus, ethanol does not appear to alter pituitary sensitivity to TRH. Second, we tested whether ethanol blocks the cold induction of c-fos expression in TRH neurons of the PVN. Both cold exposure and ethanol induced the expression of c-fos in the PVN and in TRH neurons; the effects of cold and ethanol on c-fos expression were additive. Thus, ethanol clearly does not block the cold activation of TRH neurons.

Differential effects of estrogen and progesterone on levels of POMC mRNA levels in the arcuate nucleus: relationship to the timing of LH surge release.

Beta-endorphin is thought to be an important inhibitor of LHRH neuronal activity and also to play a role in conveying information about changes in steroid levels to LHRH neurons. We have previously shown that the mRNA encoding the precursor of beta-endorphin, proopiomelanocortin (POMC), fluctuates during the estrous cycle with the most dramatic changes occurring on proestrus. POMC mRNA levels decline before the onset of LH surge release but then dramatically rise and remain elevated during the surge. In the present studies we tested the hypothesis that the decline in POMC mRNA levels immediately before the proestrus LH surge is mediated by estrogen and the rise during the surge by progesterone. To test this hypothesis, we compared changes in POMC mRNA levels between ovariectomized (OVX) and OVX estrogen (E2)-treated rats and between OVX E2-treated rats with and without progesterone. Animals were examined at hourly intervals after the administration of progesterone, then at every 4 h during the LH surge. Using in situ hybridization histochemistry, we found that E2 decreased POMC mRNA levels in OVX rats before the onset of the LH surge and further suppressed levels during the surge. Compared to animals treated with E2 alone, progesterone advanced the time at which both the LH surge began and the time at which POMC mRNA levels declined. After a transient decline, POMC mRNA levels rose in these progesterone-treated animals and remained elevated throughout the period of the LH surge. These results support the hypothesis that progesterone times the LH surge and limits its appearance to one day be exerting a biphasic effect on the activity of beta-endorphinergic neurons of the arcuate nucleus.

Influence of food restriction on neuropeptide-Y, proopiomelanocortin, and luteinizing hormone-releasing hormone gene expression in sheep hypothalami.

Chronic food restriction decreases secretion of LH as a result of inhibitory influences on secretion of LHRH. We have previously reported that neuropeptide-Y (NPY) may directly or indirectly mediate this inhibitory effect on LHRH secretion. In the study reported here, we tested the hypothesis that long-term food restriction suppresses tonic release of LH as a result of 1) an increase in biosynthetic activity of NPY neurons in the arcuate nucleus of the hypothalamus, 2) an increase in activity of neurons that secrete beta-endorphin, and 3) a decrease in biosynthesis of LHRH. To test predictions of the hypothesis, we compared levels of mRNA encoding NPY, proopiomelanocortin (POMC; the precursor peptide of beta-endorphin), and LHRH, as well as tonic secretion of LH in food-restricted and well-nourished ewe lambs. Ten ewe lambs were ovariectomized at 18 wk of age and randomly assigned to receive either 100% nutritional requirements (FED; n = 5), or 30% requirements (R; n = 5) between 18 and 25 wk of age. At 25 wk of age, blood samples were taken every 10 min for 6 h and assayed for LH. The tonic release of LH in R lambs was less than that of FED lambs. Hypothalami were collected 4 days after blood sampling and sectioned at 12 microns for use in in situ hybridization. Radiolabeled molecular probes specific for mRNAs encoding NPY, POMC, or LHRH were hybridized to hypothalamic tissue sections. Levels of NPY mRNA were 88% greater in R vs. FED lambs (p < 0.01), whereas levels of POMC mRNA were 52% lower in R vs. FED lambs (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Depression in patients with COPD.

Patients with chronic obstructive pulmonary disease (COPD) can have an accompanying depression that interferes with nursing management and reduces patients' quality of life. Nurses need to understand more about that depression, how depression can be manifested and measured in older adults, and how depression in those with COPD differs from that seen in other chronic diseases. Self-report questionnaires can be used to identify depression initially and determine the need for further assessment. The DSM III-R criteria is recommended for those who wish to use a clinical evaluation tool. Treatment for the depression seen in COPD can include pharmacologic therapy and life changes, as well as individual and family therapies.

Rapid increase in LHRH mRNA levels following NMDA.

To test the hypothesis that changes in LHRH mRNA levels are tightly linked to changes in LHRH secretion, intact male rats were infused with NMDA, a substance which increases LH release by a hypothalamic action. NMDA significantly elevated cellular levels of LHRH mRNA at 15 and 60 min. Similar changes in LH levels were induced by NMDA. These effects of NMDA on LHRH mRNA levels were not due to a generalized excitatory effect in the brain because levels of mRNAs encoding proopiomelanocortin (POMC) and tyrosine hydroxylase (TH) in the arcuate-periarcuate region were not altered by NMDA and levels of TH mRNA were decreased significantly at 15 and 60 min in neurons of the zona incerta. These data strongly support the hypothesis that changes in cellular levels of LHRH mRNA are tightly linked temporally to changes in LHRH secretion.

Mechanisms of multidrug resistance in HL60 cells: detection of resistance-associated proteins with antibodies against synthetic peptides that correspond to the deduced sequence of P-glycoprotein.

HL60 cells isolated for resistance to Adriamycin are multidrug resistant and defective in the cellular accumulation of drug. These cells do not however overexpress mdr1 and do not contain detectable levels of P-glycoprotein. In the present study we have prepared antisera against synthetic peptides that correspond to various sequence domains of P-glycoprotein and have examined by Western blot analysis the reactivity of these antisera with proteins contained in membranes of HL60/Adr cells. All antisera are highly reactive with a Mr 180,000 (p180) P-glycoprotein contained in membranes of HL60 cells isolated for resistance to vincristine (HL60/Vinc). In contrast, of 13 antisera tested 12 do not react with any resistance-associated protein in the HL60/Adr isolate. One antiserum (ASP14) is however highly reactive with a Mr 190,000 protein (p190) contained in HL60/Adr membranes. This protein is not detected in drug-sensitive cells. ASP14 also reacts with proteins p195 and p50 contained in a second independent HL60/Adr isolate. Analysis of membrane subfractions shows that p190 is located primarily in the endoplasmic reticulum with only low levels contained in plasma membranes. Additional studies demonstrate that endoplasmic reticulum of HL60/Adr cells contain a major Mr 190,000 protein that is capable of binding the photoaffinity agent 8-azido[alpha-32P]ATP. p195 contained in a second HL60/Adr isolate is also labeled with 8-azido[alpha-32P]ATP. These results thus demonstrate that antiserum against a specific P-glycoprotein sequence detects a p190 (p195) resistance-associated membrane protein in two independent HL60/Adr isolates. p190 (p195) and P-glycoprotein thus contain a minor sequence homology and based on the specificity of ASP14 this occurs in a region which may be involved in nucleotide binding. Possibly this sequence is common to and essential for the functionality of proteins which contribute to resistance by reducing cellular drug levels.