Proenkephalin gene expression in the brainstem regulates post-exercise hypotension.

The opioid receptor antagonist naloxone reverses the reduction in blood pressure following exercise. We have previously demonstrated that compared to genetically matched controls, spontaneously hypertensive rats (SHR) have decreased proenkephalin mRNA levels in the nucleus tractus solitarius (NTS), the caudal (CVLM) and rostral ventrolateral medulla (RVLM) of the brainstem. We hypothesized that in SHR an acute bout of exercise would increase proenkephalin mRNA in the NTS and RVLM. Female 12-week-old SHR (n = 4/group) were randomly assigned to exercise and control groups. Mean arterial pressure (MAP) and heart rate were recorded at rest and every 5 min for 30 min following: (1) 40 min of treadmill running at 30 m/min, 10% grade; or (2) 40 min of rest on the treadmill. Rats were sacrificed 30 min post-exercise or post-rest. Exercise induced increases in MAP and heart rate, approximately 18 mmHg and approximately 140 beats/min, respectively, P < 0.001. There were no differences in pre-exercise/rest MAP between groups, or in control rats following rest on the treadmill, 162.5 +/- 3 vs. 163.1 +/- 4 mmHg, control and control after treadmill rest, respectively; NS P > 0.05. The pre- to post-exercise reduction in MAP after 40 min of treadmill running was from 164 +/- 5.1 to 146 +/- 2.0 mmHg (P < 0.001) as recorded 30 min post-exercise. At 30 min post-exercise proenkephalin mRNA levels in the NTS, CVLM and RVLM were increased: 97, 198 and 227%, respectively, P < 0.01. These data reconfirm the existence of post-exercise hypotension in SHR and suggest that increases in enkephalin synthesis and release in the NTS, CVLM, and RVLM may be involved in regulating post-exercise hypotension.

Use of survey data in a corporatewide health promotion program: The MetLife experience.

MetLife developed a corporate-wide health promotion program based on a survey of its employees, its local management, and its medical personnel. The survey's goals were to determine the wellness topics of greatest interest to employees, as well as topics believed by local management and medical personnel to be of greatest need. There was surprising unanimity concerning what employees said they wanted and what managers and medical personnel believed were needed. Stress management--including relaxation techniques and time management skills--was high on all three surveys, as were the basic of nutrition, exercise, healthy aging, cancer, and men's and women's health issues.

MetLife's experience with fitness and wellness programming.

MetLife converted a recreational gymnasium into a fitness and wellness facility designed to reduce the risk of cardiovascular disease in employees. Fitness assessments, customized workouts, and specialized classes were offered. One hundred and fifty-two employees who exercise regularly had initial and six-month fitness tests. This group's evaluation data showed favorable cardiovascular trends with decreases of 3.6 percent in resting heart rate, 6.4 percent in total cholesterol, 3.5 percent in systolic blood pressure, 2.8 percent in diastolic blood pressure and an increase of 2.7 percent in HDL cholesterol. Continuing analysis of the program will establish the efficacy of MetLife's Wellness and Fitness Program.

An organizational model of community health agencies for health education internships.

An essential element in the preparation of aspiring health care professionals is the internship experience. It is usually identified, by student and professionals alike, as the single most important aspect of training. The selection of any agency which provides such a vital function, however, can be confusing. There are thousands of different community health agencies which are specifically concerned with a particular aspect of human health for some designated subset of the general population. These agencies range from the well known giants like the World Health Organization, the American Cancer Society, and the National Institutes of Health, to the less well know but equally important agencies like Compassionate Friends and the National Atoxia Foundation. The purpose of this article is to identify a classification system that will organize the seemingly disparate health care industry. It is hoped that this system will enable users, such as aspiring young professionals seeking field placement or employment, or local consumers seeking assistance for a health problem, to distinguish among the plethora of agencies, institutions, and organizations concerned with health/medical care and make intelligent choices concerning their selection and utilization.

Spectrum of IgG2 subclass deficiency in children with recurrent infections: prospective study.

Serum immunoglobulins and IgG subclasses were measured in 30 children with recurrent infections. Seven patients had low IgG2 concentrations (less than 3SD below the geometric mean for age). Four of these seven patients had normal concentrations of IgG, IgA and IgM, and thus would have been considered immunologically normal by routine criteria. The seven children with IgG2 deficiency had more severe infections than the 23 children with normal IgG2. Five children had recurrent pneumonia or sinusitis, one had recurrent invasive Haemophilus influenzae type b infections, and one had severe pneumococcal meningitis. Their immunologic abnormalities were heterogeneous. Two children had isolated IgG2 deficiency, two had IgG2-IgG4 deficiency, one had IgG2-IgG4-IgA deficiency, one had IgG2-IgA deficiency, and one had severe IgG1-IgG2 deficiency with abnormal T cell function and thrombocytopenia. Thus IgG2 deficiency occurs frequently among children with recurrent infections, and is associated with a variety of clinical and immunologic abnormalities.

The role of the school in consumer health education.

Ethical consumer health education is education that is noncoercive and facilitates an individual's voluntary adoption of health improving behaviors. Patients and consumers attempting to utilize the medical marketplace for cure or prevention may be ill-prepared to do so because of the complexity of the marketplace, the strong marketing influences of the marketplace, and their own lack of fundamental preparation in the rudiments of decision-making, valuing, assertiveness, data collection, and other skills necessary to be a good consumer. For this reason, school-based consumer health education is necessary to prepare current and future consumers to safely and efficiently use the medical marketplace.

Effect of mitogen concentration on glucocorticoid suppression of normal and cystic fibrosis lymphocyte activation.

It has previously been demonstrated that glucocorticoid suppression of mitogen-induced lymphocyte activation is a function of mitogen dose. Glucocorticoids suppress lymphocyte activation more at low doses, which induce suboptimal lymphocyte activation, than at higher doses which are optimal for lymphocyte activation. This observation suggests that glucocorticoid suppression of lymphocyte activation might be greater than normal in disease states which are associated with depressed mitogen-induced lymphocyte activation. To test this hypothesis, lymphocytes from normal individuals and patients with cystic fibrosis were activated by a full range of concentrations of concanavalin A (Con A) in the presence or absence of dexamethasone. Con A activation of cystic fibrosis lymphocytes was markedly depressed compared to the activation of normal lymphocytes at all doses of Con A, but the suppressive effect of dexamethasone on the activation of normal and cystic fibrosis lymphocytes was the same. We conclude that glucocorticoid suppression of lymphocyte activation is more a function of mitogen dose than of the level of lymphocyte activation and is not necessarily greater than normal in disease states which are associated with depressed mitogen-induced lymphocyte activation.

Deficient activity of the alternative pathway of complement in beta thalassemia major.

Patients with thalassemia major suffer frequent and serious infections, especially after splenectomy. To explore the basis for this susceptibility, we examined activity of the complement system in sera from 24 patients. All sera had normal or increased activity of the classic complement pathway. However, six of the 24 (three with and three without splenectomy) had abnormal alternative pathway function, and mean alternative pathway activity was significantly decreased in both splenectomized and nonsplenectomized patients. Mean concentrations of C3, factor B, properdin, and immunoglobulins were normal. Defective alternative pathway function, especially in conjunction with asplenia, could contribute to the propensity to infection that exists in thalassemia.

Activity of the alternative complement pathway after splenectomy: comparison to activity in sickle cell disease and hypogammaglobulinemia.

Patients with sickle cell disease and individuals who have undergone splenectomy share defects of certain host defense mechanisms and a predisposition to severe pyogenic bacterial infections. Since patients with sickle cell disease can have deficient activity of the alternative complement pathway, we have tested such activity in sera from splenectomized children and adults. A new kinetic hemolytic assay has been used, and we have compared results to those obtained with sera from patients with sickle cell disease or hypogammaglobulinemia. Sera from six of 58 splenectomized individuals (10%) had defective function of the alternative pathway, compared to 10 of 62 sera from patients with sickle cell disease (16%) and 10 of 18 sera from hypogammaglobulinemic patients (56%). Deficiency of antibody, a rate-influencing component of alternative pathway activity in this system, appears responsible for deficient activity in the hypogammaglobulinemic sera. The molecular basis for the deficiency found in sickle cell disease or after splenectomy is not clear. Defective function of the alternative complement pathway could contribute to the increased predisposition to bacterial infection that exists in these three patient groups.