Single-Arm Resistance Training Study to Determine the Relationship between Training Outcomes and Muscle Growth Factor mRNAs in Older Adults Consuming Numerous Medications and Supplements.

OBJECTIVES: Determine if the muscle mRNA levels of three growth factors (insulin-like growth factor-1 [IGF1], ciliary neurotropic factor [CNTF], and vascular endothelial growth factor-D [VEGFD]) are correlated with muscle size and strength gains from resistance exercise while piloting a training program in older adults taking medications and supplements for age-associated problems. DESIGN: Single-arm prospective study. SETTING: US Veterans Affairs hospital. PARTICIPANTS: Older (70±6 yrs) male Veterans (N=14) of US military service. INTERVENTION: Thirty-five sessions of high-intensity (80% one-rep max) resistance training including leg press, knee curl, and knee extension to target the thigh muscles. MEASUREMENTS: Vastus lateralis biopsies were collected and body composition (DEXA) was determined pre- and post-training. Simple Pearson correlations were used to compare training outcomes to growth factor mRNA levels and other independent variables such as medication and supplement use. RESULTS: Average strength increase for the group was ≥ 25% for each exercise. Subjects averaged taking numerous medications (N=5±3) and supplements (N=2±2). Of the growth factors, a significant correlation (R>0.7, P≤0.003) was only found between pre-training VEGFD and gains in lean thigh mass and extension strength. Mass and strength gains were also correlated with use of α-1 antagonists (R=0.55, P=0.04) and pre-training lean mass (R=0.56, P=0.04), respectively. CONCLUSIONS: Muscle VEGFD, muscle mass, and use of α-1 antagonists may be predisposing factors that influence the response to training in this population of older adults but additional investigation is required to determine if these relationships are due to muscle angiogenesis and blood supply.

Psychiatric problems following bereavement by murder or manslaughter.

Bereavement by murder or manslaughter is often associated with a high incidence of factors which increase the risk of lasting psychological problems after bereavement. In this study it appears that self-perpetuating vicious circles often accounted for the persistence of symptoms, which fitted the diagnostic categories of post-traumatic stress disorders, anxiety states, panic syndromes, obsessive revenge-seeking, and depression. Therapeutic approaches should be aimed at interrupting these vicious circles and fostering the work of grieving.

Care of the dying. The role of the psychiatrist.

This paper examines the negative assumptions held by many of the staff of terminal care units and argues the case for involving psychiatrists and members of allied professions in a variety of roles which are of great importance to the future of terminal care.

Terminal care: home, hospital, or hospice?

KIE: Recent research is reviewed to determine which components of hospice care for the terminally ill can be transferred to general medical wards and to compare care in the home with that in the hospital or hospice. Studies of the terminal care of cancer patients in London in 1967-1969 and 1977-1979 indicated that, by the latter date, there was no significant difference in pain control between St. Christopher's Hospice and surrounding hospitals, but that the quality of life of home care patients remained poor. Psychosocial care of patient and family was superior in the hospice. Accordingly, the author opposes economically-motivated proposals to give priority to development of home care services and stresses the need for good care in all settings.^ieng

'Hospice' versus 'hospital' care--re-evaluation after 10 years as seen by surviving spouses.

This study compares terminal cancer care in 1967-69 with care in 1977-79 as evaluated by surviving spouses of patients who died in St Christopher's Hospice and other local hospitals. Patients and their surviving spouses reported less personal distress in both settings in 1977-79 than in 1967-69 and the patients were also thought to have suffered less pain. These differences were found before, during and, in surviving spouses, after the period of terminal care. They were confirmed in subsamples of 30-34 patients matched for age, sex, socio-economic status and duration of terminal period. Improvements may be attributable to the training in terminal care provided by staff of the Hospice since 1967 and augmented in its Study Centre which was opened in 1973. Although pain and distress in the patient is no longer a major problem in either setting, spouses in 1977-79 remain less anxious at St Christopher's Hospice than at other hospitals; they play a larger part in the care of the patient and are in closer contact with staff before and after bereavement.

Terminal care: evaluation of effects on surviving family of care before and after bereavement.

To evaluate the effects on the family of a comprehensive programme of terminal cancer care, 20 close relatives of patients who had died in a Palliative Care Unit (PCU) were compared with a matched group of 20 relatives of patients who had died of cancer in other wards of the same teaching hospital. Interviewed by telephone 1 year and 2 weeks after bereavement, relatives of PCU patients report significantly fewer psychological symptoms and less lasting grief and anger than relatives of patients who had died elsewhere. Factors thought to have contributed to good outcomes were successful relief of pain, awareness by relatives of the coming death of the patient and support given to relatives after bereavement. Two case examples illustrate these findings.

Terminal care: evaluation of an advisory domiciliary service at St Christopher's Hospice.

In a matched, comparative study the provision of an advisory service to families who were nursing a patient with incurable cancer at home enabled the patient to stay at home longer than he otherwise would and helped the family and primary care team to cope with the added burden which resulted. Families seem to have been well satisfied with the help which was given and there were considerable savings in cost to the health service.