The Developmental Unfolding of Sibling Influences on Alcohol Use over Time.

Research has long demonstrated that siblings are similar in their alcohol use, however much of this work relies on cross-sectional samples or samples of adolescents alone and/or exclusive focus on older siblings' impact on younger siblings. Using a three time-point design from early adolescence to early adulthood (M ages = 14.9, 18.3, and 22.4 years, respectively; 55% female; 54% European ancestry, 38% Asian ancestry), we evaluated the prospective older and younger sibling influences on alcohol use across time (N = 613 sibling pairs; 35% sisters, 26% brothers, 39% mixed-gender; average age difference = 2.34 years; 34% full-biological siblings, 46% genetically-unrelated adopted siblings, 20% pairs where one child was the biological offspring of parents and the other was adopted). The results from both the traditional and random-intercept cross-lagged panel analyses showed that older siblings' alcohol use predicted younger siblings' alcohol use across each developmental transition and across a variety of sibling contexts (e.g., gender composition, age difference, genetic relatedness). On the other hand, younger siblings' alcohol use only predicted older siblings' alcohol use when siblings were close in age (1.5 years or less) and under conditions of high sibling companionship. These results add to a body of literature illustrating how both older and younger siblings are important socializing agents of adolescent and early adult alcohol use. Assessing or co-treating siblings for alcohol problems may be an important add-on to existing adolescent and early adult alcohol prevention and intervention programs.

Working with primary care clinicians and patients to introduce strategies for increasing referrals for pulmonary rehabilitation.

BACKGROUND: Pulmonary rehabilitation (PR), a programme of exercise, education and psycho-social support, is recommended for patients with chronic obstructive pulmonary disease but referral rates are relatively low compared with need. AIM: Working with primary care clinicians (GPs and practice nurses) from eight practices, this project developed strategies for influencing clinician and patient behaviours as a means of increasing referral rates for PR. METHODS: A participatory action research design was employed. Semi-structured questionnaires captured clinicians' baseline knowledge of PR and their ideas for increasing referrals. Actionable changes were then recommended. Audits (at baseline, mid-point and end of project) were used to assess and initiate improvements in the quality of practice data about PR referrals. The impacts of these changes were explored via further clinician surveys (free text questionnaire). Semi-structured questionnaires, posted to patients eligible for PR, assessed their characteristics, and, where applicable, their views on PR referral processes and reasons for not wanting PR. FINDINGS: The baseline survey of clinicians (n=22) revealed inadequate knowledge about PR, particularly among GPs. Actionable changes recommended included in-house education sessions, changes to practice protocols, and 'pop-ups' and memory aids (mugs and coasters) to prompt clinician/patient discussions about PR. Audit findings resulted in changes to improve the quality and availability of coded information about patients eligible for PR. These changes, supported by clinicians (n=9) in the follow-up survey, aimed to facilitate and increase the quality of patient/clinician discussions about PR. Findings from the patient survey (n=126, response rate 25.7%) indicate that such changes will increase the uptake of PR as patients who accepted a referral for PR provided more positive feedback about their discussions with clinicians. CONCLUSIONS: The strategies introduced were relatively easy to implement and the anticipated advantage is more patients accessing the health and quality of life benefits that PR offers.

Does lycopene offer human LDL any protection against myeloperoxidase activity?

Lycopene is a lipophilic antioxidant that is largely transported in human blood by Low Density Lipoproteins (LDL). One of the early events in the aetiology of atherosclerosis is thought to be the oxidation of LDL. Myeloperoxidase an enzyme secreted by neutrophils and macrophages is thought to oxidise human LDL particles. In this study, isolated human LDL was challenged with myeloperoxidase or copper, and the LDL was screened for lipoperoxidation and oxidation of apolipoprotein B100, depletion of lycopene and oxidation of cholesterol. Myeloperoxidase induced oxidation of LDL through direct interaction with apolipoprotein B100. No lipoperoxidation was observed following myeloperoxidase treatment; however, 7-ketocholesterol was detected indicating the products of myeloperoxidase interact with the surface of the LDL particles. Lycopene does react with the products of myeloperoxidase in solvent, but played no role in protecting against enzyme derived oxidation of human LDL.