In vivo immunoreactive adrenocorticotropin (ACTH) production by human mononuclear leukocytes from normal and ACTH-deficient individuals.

Mononuclear leukocytes from 25 children (16 with normal pituitary ACTH production and 9 with ACTH deficiency) were examined for in vivo ACTH production by immunofluorescence with antiserum to ACTH-(1-13) amide. The protocol included 3 study periods: control, after administration of insulin, and after administration of typhoid vaccine (an interferon-alpha inducer). Plasma cortisol and mononuclear leukocyte ACTH immunofluorescence were measured before (0900 h) and 1, 2, 4, 6, 8, and 10 h after treatment on each of the 3 study days. In vitro studies with human leukocytes from normal subjects incubated with ACTH, insulin, or typhoid vaccine were also performed. Patients with normal pituitary ACTH production had an increase in the number of ACTH immunofluorescence-positive cells 1 h after insulin administration [25 +/- 5% (+/- SEM) to 44 +/- 6% P less than 0.05], and no change after typhoid administration. ACTH-deficient patients had no change after insulin administration and a significant rise 6 h after typhoid vaccine treatment (24 +/- 12% to 50 +/- 6%; P less than 0.05). The number of ACTH immunofluorescence-positive cells did not increase when mononuclear leukocytes were incubated in vitro with ACTH or insulin (with or without glucose deprivation). However, typhoid antigen enhanced this response from 8% to 55%. These data suggest that the number of human mononuclear leukocytes containing immunoreactive ACTH is increased by at least 2 stimuli: 1) a central factor(s), such as CRH, accounting for the in vivo rise 1 h after insulin administration in patients with an intact hypothalamic-pituitary axis, and 2) an interferon inducer (e.g. typhoid antigen), accounting for the typhoid antigen-induced rise in the number of ACTH-positive cells in vivo in ACTH-deficient patients and in vitro.

Long-term effects of HIV counseling and testing for women: behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n = 106) and a comparison group of never-tested women (n = 54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority.

"A grief observed": the experience of HIV-related illness and death among women in a clinic-based sample in New Haven, Connecticut.

This study examined how women in a clinic-based sample in New Haven, Connecticut, (N = 168), have been affected by the AIDS epidemic. The aims of this study were to (a) document the proportion of women who knew individuals who were HIV positive, who were symptomatic with AIDS, or who had died from AIDS; (b) compare the demographics of women who knew someone infected with HIV with those of women who did not know anyone infected with HIV; and (c) examine prospectively the effects of the number of AIDS-related losses on women's mental health. Many women have been deeply affected by the AIDS epidemic: Nearly 3/4 of the women in this study knew at least 1 person who had died of AIDS. Women who experienced multiple AIDS-related losses over the course of the study were significantly more anxious than those who experienced no loss or 1 loss. Implications for clinical interventions are discussed.

Safer sex: social and psychological predictors of behavioral maintenance and change among heterosexual women.

Women of diverse backgrounds from 4 community health clinics in southern Connecticut were involved in a longitudinal, prospective study (n = 189). Data from interviews 3 months apart were used for the current analyses. The purpose of this study was to develop predictive models of safer sexual behavior among heterosexual women. Specifically, there was an interest in identifying factors to predict the maintenance or initiation of safer behavior over time. Relationship involvement and attitudes toward condoms were important in both models. Beyond this, differences in explanatory models emerged, reflecting the importance of examining behavior maintenance and change independently. Depression, health locus of control, and outcome efficacy belief made significant contributions to understanding the maintenance of safer sexual behavior. HIV counseling and testing, partner risk, and optimism helped to explain the initiation of safer sexual behavior. Implications for future interventions are discussed.

Stress alters adenylyl cyclase activity in the pituitary and frontal cortex of the rat.

We hypothesized that sustained biosynthesis of proopiomelanocortropin (POMC) from the anterior pituitary during chronic stress might result in enhanced membrane adenylyl cyclase (AC) activity, facilitating amplification of the CRH signal despite falling numbers of CRH receptors. Therefore, we investigated the effects of stress on AC activity in anterior pituitaries from Sprague-Dawley rats exposed to stress. Following 12 h of intermittent, cold, swim stress, stressed rats had plasma corticosterone levels that were 10 fold higher than in nonstressed animals and showed a 40% reduction in the specific binding of 125I-CRH to anterior pituitary membranes. Moreover, stressed rats showed a 3 fold increase in anterior pituitary POMC mRNA levels. To test the hypothesis that factors released during stress enhanced the AC signal transduction system, thereby leading to increased POMC gene expression, we measured anterior pituitary cAMP and assayed AC activity from membranes prepared from anterior pituitary of control and stressed rats. Levels of cAMP were 2 fold higher in pituitaries from stressed rats compared to controls. The significant increase in cAMP was accompanied by a significant increase of AC activity. To test what component(s) of the AC complex are altered by stress, type I and II AC mRNA as well as Gs alpha, Gi(1-3) alpha and G beta protein levels were determined. Type II AC mRNA was significantly increased 1.7 fold in stressed rats compared with controls, whereas no consistent alteration in G-protein levels were detected. Enhanced AC activity following cold swim stress was not limited to the pituitary, to one line of rat, nor one type of stress. In Fisher rats, both cold swim and restraint stress enhanced AC activity in the pituitary and in the frontal cortex. In summary, stress enhances AC activity in the anterior pituitary. The increase in AC activity is associated with increased steady state levels of type II AC mRNA. Factor(s) released during stress may enhance AC signal transduction and allow for persistent elevation in POMC gene expression despite the inhibitory influences of glucocorticoids.

Limited effects of HIV counseling and testing for women. A prospective study of behavioral and psychological consequences.

OBJECTIVES: To assess the consequences of human immunodeficiency virus (HIV) counseling and testing for seronegative women in terms of sexual behavior and psychological outcomes. DESIGN: The design is prospective and longitudinal, using repeated measures. Participants were interviewed at recruitment, 2 weeks later (when tested women received results), and 3 months later. SETTING: Four community health clinics in southern Connecticut; all provide HIV counseling and testing and other specialized and primary health care services. STUDY PARTICIPANTS: A sequential sample of women were recruited for two study groups: those seeking HIV counseling and testing (n = 152), and a comparison group never tested for HIV (n = 78), matched by clinic, race, and age. MAIN OUTCOME MEASURES: A composite measure of sexual risk was developed, based on sexual activity, condom use, and partner risk factors. Psychometrically valid and reliable measures of general psychological functioning and acquired immunodeficiency syndrome (AIDS)--specific psychological indicators were also used. RESULTS: Average level of sexual risk was lower for tested than nontested women at all three interviews. For both groups, there was no significant change in sexual risk from baseline to 3-month follow-up. At the individual level, there was no difference in the number of women who decreased or increased sexual risk. For tested women, intrusive thoughts about AIDS and estimated chance of getting AIDS decreased after counseling and testing. CONCLUSIONS: Behavioral and psychological consequences of HIV counseling and testing for women at risk for HIV were limited. These results have implications for further prevention interventions.

Corticotropin releasing factor induction of leukocyte-derived immunoreactive ACTH and endorphins.

Human peripheral leukocytes infected by virus or treated with endotoxin will, like unstimulated mouse spleen macrophages, synthesize immunoreactive corticotrophin (ir-ACTH) and endorphins. The ir-ACTH produced appears to be identical with authentic ACTH, while enough of the material has been produced in hypophysectomized mice infected with virus to demonstrate a steroidogenic response. Because the production of ACTH by in vivo pituitary cells and by leukocytes is suppressed by dexamethasone both in vitro and in vitro, suggesting that the production of ACTH and endorphins by leukocytes is indeed controlled, we have investigated the effects of corticotropin releasing-factor (CRF), which is known to regulate the pituitary production of both ACTH and beta-endorphin. We now report that the production of ACTH and endorphins by leukocytes is indeed induced by synthetic CRF and, in turn, suppressed by dexamethasone, suggesting that, as in pituitary cells, the proopiomelanocortin (POMC) gene may be expressed and similarly controlled in leukocytes.

Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse.

PURPOSE: In this paper, we develop and test a model for predicting sexual risk for HIV and other STDs. METHODS: Researchers interviewed 528 women and men with a history of substance abuse about their past experiences of physical and sexual abuse, symptoms, and sexual risk behavior (number of partners, trading sex for drugs or money, unprotected intercourse, and sexual orientation). The model explores direct and indirect associations of physical abuse and sexual abuse with sexual risk. RESULTS: Depression and severity of problems with drugs and alcohol were expected to mediate associations between abuse and sexual risk. However, analyses did not substantiate any indirect effects. Being female, more severe drug problems and, among men, past sexual abuse were significant predictors of sexual risk. CONCLUSION: Prevention interventions would do well to address not only drug addiction, but also past sexual abuse in men and depression in women.

Employment and coronary risk in women at midlife: a longitudinal analysis.

This study investigated the relation between employment and cholesterol in 541 women aged 42-50 years who resided in Allegheny County, Pennsylvania, in 1985-1988. Employment, health-related variables, and cholesterol were assessed at baseline and 3 years later. At baseline, employed and nonemployed women did not differ in cholesterol or health behaviors. However, women employed at baseline had a significant decrease in total high density lipoprotein cholesterol (1.9 mg/dl) and high density lipoprotein2 cholesterol subfraction (3.2 mg/dl) at follow-up. Those who were employed at both assessments had the lowest high density lipoprotein cholesterol at follow-up. These effects could not be accounted for by sociodemographics or employment quality variables. Post hoc analyses were conducted to examine health behaviors as a potential mechanism to account for the association between employment status and cholesterol. Over the study period, those who were employed at baseline were less likely to increase exercise and more likely to gain weight than those who were not employed at baseline. With menopause-related changes in metabolism, this can result in detrimental effects for cholesterol levels and coronary health. The results highlight the importance of longitudinal assessment in the study of employment and health.