Defining the role of corticotropin releasing factor binding protein in alcohol consumption.

The corticotropin releasing factor (CRF) exerts its effects by acting on its receptors and on the binding protein (CRFBP), and has been implicated in alcohol use disorder (AUD). Therefore, identification of the exact contribution of each protein that mediates CRF effects is necessary to design effective therapeutic strategies for AUD. A series of in vitro/in vivo experiments across different species were performed to define the biological discrete role of CRFBP in AUD. First, to establish the CRFBP role in receptor signaling, we developed a novel chimeric cell-based assay and showed that CFRBP full length can stably be expressed on the plasma membrane. We discovered that only CRFBP(10 kD) fragment is able to potentiate CRF-intracellular Ca2+ release. We provide evidence that CRHBP gene loss increased ethanol consumption in mice. Then, we demonstrate that selective reduction of CRHBP expression in the center nucleus of the amygdala (CeA) decreases ethanol consumption in ethanol-dependent rats. CRFBP amygdalar downregulation, however, does not attenuate yohimbine-induced ethanol self-administration. This effect was associated with decreased hemodynamic brain activity in the CRFBP-downregulated CeA and increased hemodynamic activity in the caudate putamen during yohimbine administration. Finally, in alcohol-dependent patients, genetic variants related to the CRFBP(10 kD) fragment were associated with greater risk for alcoholism and anxiety, while other genetic variants were associated with reduced risk for anxiety. Taken together, our data provide evidence that CRFBP may possess both inhibitory and excitatory roles and may represent a novel pharmacological target for the treatment of AUD.

Is the contralateral hip at risk in patients with unilateral symptomatic cam femoroacetabular impingement? A quantitative T1ρ MRI study.

OBJECTIVES: To assess the profile of weight-bearing cartilage of hips with a cam deformity using T1ρ magnetic resonance imaging (MRI) and evaluate for a side-to-side difference in the T1ρ profile of patients with bilateral cam morphology but only unilateral hip pain. METHODS: 19 patients with bilateral cam morphology undergoing osteochondroplasty for unilateral hip pain were prospectively recruited. Anterior and anterosuperior alpha angles were measured using computer tomography. All patients underwent bilateral 1.5T T1ρ MRI. The cartilage bilayer of the hip joint was evaluated and the mean T1ρ relaxation time calculated for each quadrant of the weight-bearing surface. RESULTS: Mean T1ρ relaxation times were not significantly different when each quadrant was compared to the rest of the weight-bearing surface of the symptomatic (P = 0.068) and asymptomatic hips (P = 0.102). There was also no significant side-to-side difference between the same quadrants of symptomatic and asymptomatic hips. No correlation was detected between alpha angle and the mean T1ρ relaxation time in each quadrant. There was no significant difference in mean alpha angles between the symptomatic and asymptomatic sides at the anterior (54.2 vs 56.0°; P = 0.382) and anterosuperior positions (65.1 vs 65.2°; P = 0.971). CONCLUSION: We conclude that previously observed regional variation in T1ρ values of normal hips is altered in hips with cam morphology. No difference in T1ρ values between symptomatic and asymptomatic cam hips was demonstrated. Therefore, regardless of the presence of hip pain, a cam deformity may predispose to hip joint cartilage degradation and increase the risk of hip osteoarthritis.

The family partners for health study: a cluster randomized controlled trial for child and parent weight management.

OBJECTIVE: The purpose of this study was to test a two-phased nutrition and exercise education, coping skills training, and exercise intervention program for overweight or obese low-income ethnic minority 2nd to 4th grade children and their parents in rural North Carolina, USA. METHODS: A cluster randomized controlled trial was carried out with 358 children (7-10 years) and a parent for each child (n=358). General linear mixed models were used to determine the effects of the intervention on weight, adiposity, health behaviors, and eating and exercise self-efficacy by examining changes in children and parents from baseline to completion of the study (18 months). RESULTS: At 18 months, children in the experimental group did not have a significantly decreased body mass index (BMI) percentile (P=0.470); however, they showed a reduction in the growth rate of their triceps (P=0.001) and subscapular skinfolds (P<0.001) and an improvement in dietary knowledge (P=0.018) and drank less than one glass of soda per day (P=0.052) compared with the control group. Parents in the experimental group had decreased BMI (P=0.001), triceps (P<0.001) and subscapular skinfolds (P<0.001) and increased nutrition (P=0.003) and exercise (P<0.001) knowledge and more often drank water or unsweetened drinks (P=0.029). At 18 months, children in the experimental group did not show significant improvement in eating (P=0.956) or exercise self-efficacy (P=0.976). Experimental parents demonstrated improved socially acceptable eating self-efficacy (P=0.013); however, they did not show significant improvement in self-efficacy pertaining to emotional eating (P=0.155) and exercise (P=0.680). CONCLUSION: The results suggest that inclusion of children and parents in the same intervention program is an effective way to decrease adiposity and improve nutrition behaviors in both children and parents and improve weight and eating self-efficacy in parents.

Local frequency density of states around field inhomogeneities in magnetic resonance imaging: effects of diffusion.

A method describing NMR-signal formation in inhomogeneous tissue is presented which covers all diffusion regimes. For this purpose, the frequency distribution inside the voxel is described. Generalizing the results of the well-known static dephasing regime, we derive a formalism to describe the frequency distribution that is valid over the whole dynamic range. The expressions obtained are in agreement with the results obtained from Kubos line-shape theory. To examine the diffusion effects, we utilize a strong collision approximation, which replaces the original diffusion process by a simpler stochastic dynamics. We provide a generally valid relation between the frequency distribution and the local Larmor frequency inside the voxel. To demonstrate the formalism we give analytical expressions for the frequency distribution and the free induction decay in the case of cylindrical and spherical magnetic inhomogeneities. For experimental verification, we performed measurements using a single-voxel spectroscopy method. The data obtained for the frequency distribution, as well as the magnetization decay, are in good agreement with the analytic results, although experiments were limited by magnetic field gradients caused by an imperfect shim and low signal-to-noise ratio.

Scaling laws for transverse relaxation times.

Simple scaling laws are useful tools in understanding the effect of changing parameters in MRI experiments. In this paper the general scaling behavior of the transverse relaxation times is discussed. We consider the dephasing of spins diffusing around a field inhomogeneity inside a voxel. The strong collision approximation is used to describe the diffusion process. The obtained scaling laws are valid over the whole dynamic range from motional narrowing to static dephasing. The dependence of the relaxation times on the external magnetic field, diffusion coefficients of the surrounding medium, and the characteristic scale of the field inhomogeneity is analyzed. For illustration the generally valid scaling laws are applied to the special case of a capillary, usually used as a model of the myocardial BOLD effect.

Health-promotion practices of young black women at risk for diabetes.

PURPOSE: The purpose of this study was to assess the health-promoting practices of young black women at risk for type 2 diabetes. METHODS: The sample consisted of 30 black women from an urban area who had a history of gestational diabetes and/or a first-degree relative with diabetes. Participants completed the Health-Promoting Lifestyle Profile II Survey and an interview. Both were used to categorize health-promoting practices, exercise, diet, knowledge of diabetes prevention, and general health. RESULTS: Demographic information and interview revealed a propensity towards obesity, despite education and income levels. The results for the Lifestyle II Survey showed a higher average total score for healthy nutrition than physical activity, which were inconsistent with the qualitative data obtained by interview. Fifty percent stated that they exercised as a general health-promoting behavior. Self-reported daily caloric, fiber, and fat intake was high to moderate; 60% reported initiating diet modifications secondary to a desire to lose weight or for medical problems; and 26% reported receiving information on diabetes prevention from a healthcare provider. CONCLUSIONS: A systematic approach of planning and actively incorporating health-promoting activities into one's lifestyle as a young adult may protect or delay the onset of diabetes and prevent complications.

Using focus groups to characterize the health beliefs and practices of black women with non-insulin-dependent diabetes.

The purpose of this focus group intervention was to characterize the health beliefs, self-care practices, diabetes education needs, weight-loss issues, and facilitators and barriers to diabetes health care in black women with non-insulin-dependent diabetes. Major themes that emerged from the focus group were motivation to prevent complications, unrealistic weight goals set by providers, multiple barriers to diet and exercise, and a dual role of family as supporter and deterrent to diabetes management, especially related to diet. These findings suggest that culturally sensitive and appropriate patient educational programs must be provided for minority groups such as black women who have higher rates of diabetes-related complications.

Diabetes care concentration: a program of study for advanced practice nurses.

THE DIABETES RESEARCH and Training Center at the Albert Einstein College of Medicine, in collaboration with Yale University School of Nursing, initiated a project to develop and implement a concentration of study at the Master's level within the field of diabetes. The concentration has resulted in involvement of advanced practice nurses in management and care of individuals with diabetes. In the article, an epidemiological perspective in diabetes care is given, along with information on how the program developed and evolved over the past 5 years. Program graduates have become certified diabetes educators and completed a Master's thesis in the area of diabetes care, resulting in practice-oriented publications.

Nurse practitioner practice patterns based on standards of medical care for patients with diabetes.

OBJECTIVE: To determine to what extent nurse practitioner (NP) practice patterns of diabetes care are consistent with standards of care suggested by the American Diabetes Association (ADA). RESEARCH DESIGN AND METHODS: A descriptive study was conducted to examine practice patterns. A convenience sample of 78 charts was audited, representing a proportionate number of charts for each of the six masters-prepared, certified NPs employed in an ambulatory primary-care center. RESULTS: Practice patterns related to diabetes care revealed a discrepancy between established standards of care and the degree to which care was documented. All six NPs acknowledged that they became clinically competent to care for patients with diabetes on the job. CONCLUSIONS: Results of this small study suggest that NPs are not consistently following standards of care suggested by the ADA.

Obesity: assessment and intervention for primary care practice.

The 1976-1980 National Health and Nutrition Examination Survey revealed that an estimated 34 million adults (26%) between the ages of 20 and 75 are obese. The health implications of obesity are well known and contribute to the increased morbidity and early mortality in those who are affected. As a result, obesity has become a public health concern that has been targeted as a national health objective in Healthy People 2000. The overall health objective, related to the problem of overweight in adults, is to reduce the prevalence from 26% to < 20%.

Non-insulin-dependent diabetes and obesity in the black and Hispanic population: culturally sensitive management.

The prevalence of diabetes is considerably higher among ethnic minorities, particularly black and Hispanic Americans, than in the nonminority white population. Obesity, a significant risk factor for non-insulin-dependent diabetes mellitus (NIDDM), also is more common in these ethnic groups. Because the combined effects of obesity and NIDDM can lead to potentially serious complications, overweight patients with NIDDM must be treated aggressively. However, effective treatment of these ethnic groups requires a sensitivity to and recognition of their unique cultural values. Diabetes educators and health care providers need to take into account specific ethnic beliefs, customs, food patterns, and health care practices, with the goal of incorporating these cultural factors into a practical and beneficial treatment regimen.

Type II non-insulin-dependent diabetes mellitus.

Type II non-insulin-dependent diabetes mellitus (NIDDM) occurs predominantly in adults, especially in those individuals over age 30. This disease was formerly called maturity-onset or adult-onset diabetes. A subclass of NIDDM was devised, however, for those families in which children, adolescents, or young adults develop what is referred to as maturity-onset diabetes of the young. This article reviews issues related to treatment modalities for those with type II NIDDM, including dietary management, physical activity, and pharmacologic therapy.

Metabolic impact of education in NIDDM.

OBJECTIVE: To evaluate the impact of a model program of diabetes education and weight reduction on diabetes control and weight loss in obese individuals with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: Eighty-two obese diabetic subjects were randomized to three levels of educational intensity: 1) a single individual session, 2) a 12-wk behavior-oriented diabetes education and weight control group intervention, or 3) group intervention plus six individual follow-up sessions. Repeated measures of weight, fasting blood glucose, and HbA1c were collected. Measures of diabetes knowledge, skills, and attitudes were also obtained. RESULTS: By 6 mo, all three intervention groups had a significant weight loss (P less than 0.01). The mean weight loss of approximately 10 lb was independent of treatment group and was maintained over the duration of the study. However, significant improvement in metabolic control was associated with participation in the diabetes education-weight reduction intervention. CONCLUSIONS: The findings of this study indicate that a cognitive behavioral group intervention of diabetes knowledge and weight reduction training can produce weight loss and improvements in diabetes control. The addition of individual counseling as a follow-up maintenance strategy does not appear to have any advantage.

Weight reduction interventions for persons with a chronic illness: findings and factors for consideration.

Obesity in persons with a concomitant chronic illness poses complex issues relating to the choice of appropriate interventions. More recent emphasis on modification of risk factors has resulted in the need to prescribe complex therapeutic regimens with multiple treatment goals. The traditional approach to weight reduction in such persons has been nutrition education. Studies have shown, however, that knowledge alone does not translate into self-care behaviors that in turn result in weight loss and weight maintenance. Although the latter outcomes continue to be primary goals of therapy in obese individuals with a chronic illness, improvement in the physiologic parameters associated with the illness is also a desired outcome. Behavior therapy and group support appear to be enabling factors that go beyond knowledge to facilitate behavior change and subsequent changes in health-related indexes. This article describes various approaches to the problem of combined interventions for patients education and weight reduction. Findings and factors are discussed about whether the primary goal of weight reduction interventions for persons with a chronic illness should focus on pounds lost or improvement in metabolic or physiologic status.

Patient perceptions of diabetes treatment goals.

The current treatment of type II noninsulin dependent diabetes mellitus (NIDDM) and obesity involves complex regimens for weight reduction and improvement in metabolic control that necessitate active participation by the patient in establishing treatment goals and strategies. However, well-documented rates of nonadherence suggest that weaknesses may exist in patient-provider communications that preclude such patient participation. This study examines patient perceptions of diabetes treatment goals as established with their health care providers. Fifty-four individuals with type II NIDDM and obesity were surveyed. To determine the degree of congruence between patient and health care provider, the physicians of study participants were also surveyed. A 53% discrepancy rate was found to exist in the area of overall treatment goals. In addition, a 57% and 43% rate of discrepancy was found for the specific goals of weight loss and blood glucose levels, respectively. Further findings and the implications for practice are discussed in this paper.