Effect of acute and chronic autophagy deficiency on skeletal muscle apoptotic signaling, morphology, and function.

Autophagy is a catabolic process that targets and degrades cytoplasmic materials. In skeletal muscle, autophagy is required for the control of mass under catabolic conditions, but is also basally active in the maintenance of myofiber homeostasis. In this study, we found that some specific autophagic markers (LC3-I, LC3-II, SQSTM1) were basally lower in glycolytic muscle compared to oxidative muscle of autophagy competent mice. In contrast, basal autophagic flux was higher in glycolytic muscle. In addition, we used several skeletal muscle-specific Atg7 transgenic mouse models to investigate the effect of acute (iAtg7-/-) and chronic (cAtg7-/-) autophagy deficiency on skeletal muscle morphology, contractility, and apoptotic signaling. While acute autophagy ablation (iAtg7-/-) resulted in increased centralized nuclei in glycolytic muscle, it did not alter contractile properties or measures of apoptosis and proteolysis. In contrast, with chronic autophagy deficiency (cAtg7-/-) there was an increased proportion of centralized nuclei, as well as reduced force and altered twitch kinetics in glycolytic muscle. Glycolytic muscle of cAtg7-/- mice also displayed an increased level of the pro-apoptotic protein BAX, as well as calpain and proteasomal enzymatic activity. Collectively, our data demonstrate cumulative damage from chronic skeletal muscle-specific autophagy deficiency with associated apoptotic and proteasomal upregulation. These findings point towards the importance of investigating different muscle/fiber types when studying skeletal muscle autophagy, and the critical role of autophagy in the maintenance of myofiber function, integrity, and cellular health.

Social anxiety in a multiple sclerosis clinic population.

BACKGROUND: Little is known about social anxiety in MS. OBJECTIVE: We estimated the prevalence of social anxiety symptoms and their association with demographic and clinical features in a clinic-attending sample of patients with MS. METHODS: Patients attending the Dalhousie MS Research Unit for regularly scheduled visits completed the Social Phobia Inventory (SPIN), the Hospital Anxiety and Depression Scale (HADS), and the Health Utilities Index (HUI). Neurological disability was determined by ratings on the Expanded Disability Status Scale (EDSS). RESULTS: A total of 251 patients completed self-report scales of anxiety and depression symptoms. In all, 245 (98%) provided sufficient data for analysis. In all, 30.6% (n=75) had clinically significant social anxiety symptoms as defined by a SPIN threshold score of 19. Half of those with social anxiety had general anxiety (HADSA>or=11) and a quarter had depression (HADSD>or=11). Severity of social anxiety symptoms was associated with reduced health-related quality of life and not related to neurological disability. CONCLUSIONS: Social anxiety symptoms are common in persons with MS, contribute to overall morbidity, but are unrelated to the overall severity of neurologic disability. Greater awareness and routine systematic inquiry of social anxiety symptoms is an important component of comprehensive care for persons with MS.

Comparison of conventional and accelerated hepatitis B immunisation schedules for homeless drug users.

This historical control study examines the uptake of two hepatitis B immunisation schedules at an inner city primary care centre for homeless people in Northern England. Originally homeless patients disclosing current or past illicit drug use were offered hepatitis B immunisation. In 1999 a conventional hepatitis B vaccine schedule was offered (immunisations at 0, 1, and 6 months) whereas in 2000 an accelerated schedule was introduced (immunisations at 0, 7 and 21 days). There was an increase in the uptake of hepatitis B vaccination by homeless drug users once the accelerated schedule was introduced. Furthermore, the completion rates for the accelerated vaccination regimen were almost seven times higher than for the conventional one. This indicates that the accelerated hepatitis B schedule should be the regime of choice for patients with a current or past history of drug use.

Do physicians who diagnose more mental health disorders generate lower health care costs?

BACKGROUND: Underrecognition and undertreatment of mental health disorders in primary care have been associated with poor health outcomes and increased health care costs, but little is known about the impact of the diagnoses of mental health disorders on health care expenditures or outcomes. Our goal was to examine the relationships between the proportion of mental health diagnoses by primary care physicians and both health care expenditures and the risk of avoidable hospitalizations. METHODS: We used cross-sectional analyses of claims data from an independent practice association-style (IPA) managed care organization in Rochester, New York, in 1995. The sample was made up of the 457 primary care physicians in the IPA and the 243,000 adult patients assigned to their panels. We looked at total expenditures per panel member per year generated by each primary care physician and avoidable hospitalizations among their patients. RESULTS: After adjustment for case mix, physicians who recorded a greater proportion of mental health diagnoses generated significantly lower per panel member expenditures. For physicians in the highest quartile of recording mental health diagnoses, expenditures were 9% lower than those of physicians in the lowest quartile (95% confidence interval, 5% - 13%). There was a trend (P = .051) for patients of physicians in the highest quartile of recording mental health diagnoses to be at lower risk for an avoidable hospitalization than those of physicians in the lowest quartile. CONCLUSIONS: Primary care physicians with higher proportions of recorded mental health diagnoses generate significantly lower panel member costs, and their patients may be less likely to be admitted for avoidable hospitalization conditions.

Association of perceived family criticism with health behaviors.

BACKGROUND: Criticism from family members has been implicated in psychiatric illnesses such as schizophrenia, depression, and eating disorders. Perceived family criticism has also been linked to primary health care use. In our study, we examined the association between perceived family criticism and health behaviors, as well as the potential mediating role of negative affect. METHODS: A questionnaire was mailed to patients receiving care at a family medicine center. Perceived family criticism was measured using the Family Emotional Involvement and Perceived Criticism Scale. Diet, regular exercise, smoking status, and levels of depression, hostility, and physical health were also assessed through self report. RESULTS: Nine hundred twenty-two (62%) active family medicine patients responded to our questionnaire. Complete data were available for 875 patients. In univariate analysis, a high level of perceived family criticism was associated with various demographic characteristics, poorer physical health, negative affect, higher fat intake, lack of exercise, and smoking. In multivariate analysis, the association between a high level of perceived criticism and health behavior was independent of demographic characteristics and physical health, for example, high-fat diet (odds ratio [OR] = 1.47; 95% confidence interval [CI], 1.11 - 1.95), no regular exercise (OR = 1.37; 95% CI, 1.02 - 1.84) and current smoking (OR = 1.38; 95% CI, 1.00 - 1.90). None of these associations was statistically significant after controlling for depression and hostility. CONCLUSIONS: A high level of perceived family criticism is associated with adverse health behaviors. This association appears to be explained by resultant depression and hostility.

A prospective study of hope, optimism, and health.

The present investigation sought to distinguish hope from optimism in the context of a 10-wk. prospective study involving reports of health outcomes. Gottschalk's (1985) Hope Scale and Scheier and Carver's (1987) Life Orientation Test which assesses optimism were given to subjects, along with a health questionnaire. Ten weeks later subjects were given a second health questionnaire. To rule out potential confounds we included measures of neuroticism, depression, extroversion, and social desirability. After controlling for the effects of correlated confounds, we found that lower hope scores (but not optimism) were correlated with several dimensions of reported health, including frequency and severity of illness.

Backflow in low-volume suction lines: the impact of pressure changes.

A previous study indicated that fluid can flow backward in low-volume suction lines when patients close their lips around the saliva ejector tip. The authors investigated this phenomenon further. They documented physical and mechanical parameters of saliva ejector backflow in low-volume suction lines and concluded that backflow is possible but can be avoided with simple precautions.

Perspectives on patient-doctor communication.

Until recently, the content, structure, and function of communication between doctors and patients has received little attention and has been excluded from the realm of scientific inquiry; as a result, most clinicians have had little formal training in communication skills. In this paper leaders in doctor-patient communication present four approaches that are currently used as the basis for clinical training and research, summarize the progress made in forming a consensus, and outline the implications of these perceptions for practicing physicians.

Gender differences in the expression of depressive symptoms in middle adolescents: an extension of earlier findings.

Subjects in the present study were 153 French Canadian high school students (98 females, 55 males) participating in the second phase of a larger longitudinal study (Baron & Groulx, 1990; Baron, Régimbald, & Groulx, 1991). The purpose of this study was to investigate whether, consistent with the findings obtained at the first phase of the study, females maintain higher mean scores than do males on all items discriminating between groups on the basis of gender. Separate discriminant function analyses of both the Reynolds Adolescent Depression Scale (RADS) and the Beck Depression Inventory (BDI); items were consistent, with lower mean scores for males on all interpretable items. Results are discussed with respect to variability in the instruments, and in view of previous research aimed at examining the expression of depressive symptoms in this and other adolescent samples.

Social relationships and health: the relative roles of family functioning and social support.

The associations between social relationships and health have been examined using two major research traditions. Using a social epidemiological approach, much research has shown the beneficial effect of social supports on health and health behaviors. Family interaction research, which has grown out of a more clinical tradition, has shown the complex effects of family functioning on health, particularly mental health. No studies have examined the relative power of these two approaches in explicating the connections between social relationships and health. We hypothesized that social relationships (social support and family functioning) would exert direct and indirect (through depressive symptoms) effects on health behaviors. We also hypothesized that the effects of social relationships on health would be more powerfully explicated by family functioning than by social support. We mailed a pilot survey to a random sample of patients attending a family practice center, including questions on depressive symptoms, cardiovascular health behaviors, demographics, social support using the ISEL scale, and family functioning using the FEICS scale. FEICS is a self-report questionnaire designed to assess family emotional involvement and criticism, the media elements of family expressed emotion. Eighty-three useable responses were obtained. Regression analyses and structural modelling showed both direct and indirect statistically significant paths from social relationships to health behaviors. Family criticism was directly associated (standardized coefficient = 0.29) with depressive symptoms, and family emotional involvement was directly associated with both depressive symptoms (coefficient = 0.35) and healthy cardiovascular behaviors (coefficient = 0.32). The results support the primacy of family functioning factors in understanding the associations among social relationships, mental health, and health behaviors. The contrasting relationships between emotional involvement and depressive symptoms on the one hand and emotional involvement and health behaviors on the other suggest the need for a more complex model to understand the connections between social relationships and health.

Family Interventions in Physical Health: How family interaction affects health.

As we begin to understand the relationships between family interaction and physical health, we can develop interventions that focus on education, support, and problem solving. The author reviews existing research on family interventions in physical health and proposes guidelines for developing, implementing, and studying family interventions.

Maternal serum alpha-fetoprotein screening: benefits, risks, and costs.

Based upon previously published reports, the benefits and risks of screening a hypothetical population of 10,000 women are analyzed, and the cost benefit of maternal serum alpha-fetoprotein screening is reviewed. Five hundred women would have an initially elevated serum alpha-fetoprotein and experience moderately severe anxiety until further tests are completed. One hundred fifty pregnancies would undergo amniocentesis with approximately one spontaneous abortion resulting from the procedure. Fifty sets of twins, 86 pregnancies with underestimated gestational age, and 50 pregnancies at risk for low birthweight or fetal death would be identified. All four anencephalics and three of four fetuses with spina bifida would be detected. The benefits to pregnant women of prenatal screening for neural tube defects exceed the risks. At the present incidence of neural tube defects, the cost of prenatal screening to society approximately equals the economic savings. If the incidence of neural tube defects continues to fall, the benefits, risks, and costs will have to be reevaluated. There are insufficient data to determine adequately the benefits, risks, and costs of the screening for Down's syndrome with maternal serum alpha-fetoprotein, and such screening should be discouraged.