A systematic review of preclinical studies exploring the role of insulin signalling in executive function and memory.

Beside its involvement in somatic dysfunctions, altered insulin signalling constitutes a risk factor for the development of mental disorders like Alzheimer's disease and obsessive-compulsive disorder. While insulin-related somatic and mental disorders are often comorbid, the fundamental mechanisms underlying this association are still elusive. Studies conducted in rodent models appear well suited to help decipher these mechanisms. Specifically, these models are apt to prospective studies in which causative mechanisms can be manipulated via multiple tools (e.g., genetically engineered models and environmental interventions), and experimentally dissociated to control for potential confounding factors. Here, we provide a narrative synthesis of preclinical studies investigating the association between hyperglycaemia - as a proxy of insulin-related metabolic dysfunctions - and impairments in working and spatial memory, and attention. Ultimately, this review will advance our knowledge on the role of glucose metabolism in the comorbidity between somatic and mental illnesses.

An Electrophysiological and Proteomic Analysis of the Effects of the Superoxide Dismutase Mimetic, MnTMPyP, on Synaptic Signalling Post-Ischemia in Isolated Rat Hippocampal Slices.

Metabolic stress and the increased production of reactive oxygen species (ROS) are two main contributors to neuronal damage and synaptic plasticity in acute ischemic stroke. The superoxide scavenger MnTMPyP has been previously reported to have a neuroprotective effect in organotypic hippocampal slices and to modulate synaptic transmission after in vitro hypoxia and oxygen-glucose deprivation (OGD). However, the mechanisms involved in the effect of this scavenger remain elusive. In this study, two concentrations of MnTMPyP were evaluated on synaptic transmission during ischemia and post-ischemic synaptic potentiation. The complex molecular changes supporting cellular adaptation to metabolic stress, and how these are modulated by MnTMPyP, were also investigated. Electrophysiological data showed that MnTMPyP causes a decrease in baseline synaptic transmission and impairment of synaptic potentiation. Proteomic analysis performed on MnTMPyP and hypoxia-treated tissue indicated an impairment in vesicular trafficking mechanisms, including reduced expression of Hsp90 and actin signalling. Alterations of vesicular trafficking may lead to reduced probability of neurotransmitter release and AMPA receptor activity, resulting in the observed modulatory effect of MnTMPyP. In OGD, protein enrichment analysis highlighted impairments in cell proliferation and differentiation, such as TGFß1 and CDKN1B signalling, in addition to downregulation of mitochondrial dysfunction and an increased expression of CAMKII. Taken together, our results may indicate modulation of neuronal sensitivity to the ischemic insult, and a complex role for MnTMPyP in synaptic transmission and plasticity, potentially providing molecular insights into the mechanisms mediating the effects of MnTMPyP during ischemia.

Insulin and disorders of behavioural flexibility.

Behavioural inflexibility is a symptom of neuropsychiatric and neurodegenerative disorders such as Obsessive-Compulsive Disorder, Autism Spectrum Disorder and Alzheimer's Disease, encompassing the maintenance of a behaviour even when no longer appropriate. Recent evidence suggests that insulin signalling has roles apart from its regulation of peripheral metabolism and mediates behaviourally-relevant central nervous system (CNS) functions including behavioural flexibility. Indeed, insulin resistance is reported to generate anxious, perseverative phenotypes in animal models, with the Type 2 diabetes medication metformin proving to be beneficial for disorders including Alzheimer's Disease. Structural and functional neuroimaging studies of Type 2 diabetes patients have highlighted aberrant connectivity in regions governing salience detection, attention, inhibition and memory. As currently available therapeutic strategies feature high rates of resistance, there is an urgent need to better understand the complex aetiology of behaviour and develop improved therapeutics. In this review, we explore the circuitry underlying behavioural flexibility, changes in Type 2 diabetes, the role of insulin in CNS outcomes and mechanisms of insulin involvement across disorders of behavioural inflexibility.

Removal of sugar sweetened beverages from sale in a hospital setting-Consumer opinion and influence on purchasing behavior.

ISSUE ADDRESSED: This study investigated the impact of removing sugar sweetened beverages (SSBs) from sale in a regional health service. Drink purchasing patterns were measured by product ordering data. Consumer opinion regarding the intervention, self-reported packaged drink purchase and consumption were also explored. METHODS: Packaged drinks were classified into two categories, SSB or non-SSB and drink types. Drink sales were determined by the collection of product ordering data for all packaged drink types sold, six months prior to and twelve months after the removal of SSBs. A consumer survey was undertaken six months after SSB removal to assess consumer opinion regarding SSB removal, self-reported SSB consumption and purchase. Descriptive and Wilcoxon rank-sum tests analyses assessed differences in packaged drinks purchase, self-reported SSB consumption and purchase. Open-ended survey responses were thematically analysed. RESULTS: The median monthly number of juices, and diet drinks ordered increased significantly (P = .05). 59% of the survey respondents regularly consumed SSBs and 58% agreed or strongly agreed with removing SSBs from sale. However, some consumers felt it was a removal of their freedom of choice. CONCLUSIONS: Removing SSBs from sale can result in consumers making healthier purchases. There was support for the initiative as it is seen as the responsibility of the health service to role model healthy eating behaviours. SO WHAT?: This study indicates removal of SSBs from sale is a promising health promotion intervention that can contribute to positive behaviour change, and potentially influence longer-term health and wellbeing.

A crisis emerges: Lesbian health between breast cancer and HIV/AIDS.

In this essay, I argue that lesbians have come to be a population of concern for state-based health organizations as a result of lesbian health activism that drew connections between breast cancer and HIV/AIDS. In order to develop this analysis, I tell the story of the rise of lesbian breast cancer activism in concert with HIV/AIDS in San Francisco in the early 1990s. The state recognition of lesbian health needs, and with it the solidification of lesbian as a biopolitical category, was catalyzed by associations with the AIDS crisis and HIV activism, but also required an articulated difference, or lesbian specificity, which breast cancer provided. And yet, documenting the multiple, and potentially contradictory, ways that these associations were made resists understanding "lesbian" as a static category.

Parents' supportive reactions to sexual orientation disclosure associated with better health: results from a population-based survey of LGB adults in Massachusetts.

This study investigated associations between coming out to parents, experiences of parental support, and self-reported health behaviors and conditions among a population-based sample of LGB individuals using data collected via the 2002 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS; N = 177). We explored the following two hypotheses: 1) Lesbian, gay, and bisexual (LGB) individuals who had never disclosed their sexual orientation to a parent would report higher levels of risk behaviors and poorer health conditions than those who had come out; and 2) among LGB respondents who had come out to their parents, the individuals whose parents had reacted unsupportively would report higher levels of risk behaviors and poorer health conditions than those who had come out to parents who were supportive. Approximately two thirds of gay and bisexual (GB) males and lesbian and bisexual (LB) females reported receiving adequate social and emotional support from the parent to whom they first disclosed their sexual orientation. Among LB females, no disclosure of sexual orientation to a parent was associated with significantly elevated levels of past-month illicit drug use (AOR 12.16, 95% CI 2.87-51.54), fair or poor self-reported health status (AOR 5.71, 95% CI 1.45-22.51), and >15 days of depression in the past month (AOR 5.95, 95% CI 1.78-19.90), controlling for potential confounders. However, nondisclosure to a parent by GB males was not associated with greater odds of any of the health indicators assessed. Among GB males, those with unsupportive parents were significantly more likely to report current binge drinking (AOR 6.94, 95% CI 1.70-28.35) and >15 days depression in the past month (AOR 6.08, 95% CI 1.15-32.15), and among LB females, those with unsupportive parents were significantly more likely to report lifetime illicit drug use (AOR 11.43, 95% CI 2.50-52.30), and >15 days depression in the past month (AOR 5.51, 95% CI 1.36-22.36). We conclude that coming out may be associated with better health for LB women, and that parents who react nonsupportively when their children disclose LGB sexual orientation may contribute to children's increased odds of depression and hazardous substance use.

Comparing sexual minority cancer survivors recruited through a cancer registry to convenience methods of recruitment.

PURPOSE: Sexual minority women, defined as having a lesbian or bisexual identity or reporting a preference for a female partner, are not considered by cancer surveillance. This study assesses the representativeness of sexual minority breast cancer survivors, defined as having a lesbian or bisexual identity or reporting a preference for a female partner, who were recruited into a convenience sample compared with a population-based registry sample of sexual minority breast cancer survivors. METHODS: Long-term survivors of non-metastatic breast cancer who self-reported as sexual minority were recruited from a cancer registry and subsequently from the community using convenience recruitment methods. Sexual minority breast cancer survivors who screened eligible participated in a telephone survey about their quality of life and factors associated therewith. RESULTS: Participants in the convenience sample were similar to the registry-based sample with respect to adjustment to cancer, physical health, trust in physician, coping, social support, and sexual minority experiences. Compared with the convenience sample, breast cancer survivors in the registry sample were more likely married, more educated, diagnosed more recently, at an earlier stage of cancer, and more likely treated with breast-conserving surgery; they differed on adjuvant therapies. DISCUSSION: Because sexual minority breast cancer survivors who volunteered for the community-based sample shared most characteristics of the sample recruited from the cancer registry, we concluded that the community sample had comparable representational quality. In the absence of cancer surveillance of sexual minorities, thoughtful convenience recruitment methods provide good representational quality convenience samples.

Overweight and obesity in long-term breast cancer survivors: how does sexual orientation impact BMI?

In noncancer populations lesbians have greater odds of obesity compared with heterosexual women, suggesting a similar pattern among cancer survivors. Weight of cancer survivors is an important area of study because obesity is associated with an increased risk of recurrence and shorter survival. Sixty-nine lesbian and bisexual and 257 heterosexual survivors of breast cancer were recruited to participate in a one-time telephone survey. Multinomial logit models do not support disparities in obesity due to sexual orientation. Our findings in breast cancer survivors suggest that lesbians are more likely to improve their weight-related behaviors after cancer than heterosexual women.

Planning for future care needs: experiences of unmarried heterosexual and sexual minority women.

This study examined the experiences of legally unmarried, middle-aged and older sexual minority (e.g., lesbian, bisexual) and heterosexual women in planning for future care needs and long-term assistance. A total of 215 women (90 sexual minority women and 125 heterosexual women) 41-78 years of age completed a survey about long-term care planning strategies, including: (1) executing a will; (2) naming a health care proxy; (3) purchasing long-term care insurance; and (4) discussing potential living arrangements with at least one family member. Overall, 18.5% of women reported completing zero of the strategies, and 3.4% reported completing all four. Over half (59%) had completed at least two strategies. Women were most likely to have executed a will (68%) and named a health care proxy (61%). Both sexual minority women and heterosexual women were most likely to have talked to a family member of choice, rather than a biological family member about living with them if they were unable to care for themselves. Currently, serving as a health care proxy was an important correlate for having made long-term care plans and was particularly important for sexual minority women. Women who are not in traditional marriage relationships tend to adopt long-term care planning strategies that legally clarify and establish the nature of their important relationships.

Advance care planning by unmarried women of different sexual orientations: the importance of social support.

We examined social support as a facilitator of advance care planning in unmarried women of different sexual orientations. Survey participants consisted of 215 women, 90 who reported a preference for partnering with women (WPW) and 125 for partnering with men (WPM). Our findings indicate that the association between social support and advance care planning was mixed. Specifically, social support had no significant impact on executing a will for either WPW or WPM. Among WPW, naming a health-care proxy was associated with reporting a partner who provided social support. For WPM, having a partner for social support was not associated with naming a health-care proxy. These insights help in the understanding of women's advance care planning.

Using cancer registry data for recruitment of sexual minority women: successes and limitations.

OBJECTIVE: To identify and recruit an unknown and presumably small subgroup of survivors, that is, lesbian or bisexual women with breast cancer. METHODS: This report describes our multistep approach to recruit a representative sample of heterosexual and sexual minority breast cancer survivors. We used census data to identify geographic areas with a greater prevalence of sexual minority women (SMW), that is, lesbian and bisexual women. We then obtained the breast cancer cases from a cancer registry for these geographic areas. In the absence of sexual orientation data in cancer registries, all potentially eligible women with breast cancer needed to be contacted by telephone to determine their sexual orientation. RESULTS: Among the 1341 women screened who answered the question about sexual orientation, 6.3% were SMW. Overall, we processed 4143 cases to obtain completed data on 69 SMW and 257 heterosexual women with breast cancer. CONCLUSIONS: Our findings suggest that it is resource intensive but feasible to recruit a representative sample of breast cancer survivors of different sexual orientations. Our findings can inform future studies that seek to recruit sexual minority populations from cancer registries about some of the limitations to this approach.