Variability in sleep disturbance, physical activity and quality of life by level of depressive symptoms in women with Type 2 diabetes.

AIMS: To examine (1) the prevalence of depressive symptoms in women with Type 2 diabetes, (2) the associations between depressive symptoms and the following dependent variables: sleep disturbance; physical activity; physical health-related; and global quality of life, and (3) the potential moderating effects of antidepressants and optimism on the relationship between depressive symptoms and dependent variables. METHODS: Participants in the Women's Health Initiative who had Type 2 diabetes and data on depressive symptoms (N=8895) were included in the analyses. In multivariable linear regression models controlling for sociodemographic, medical and psychosocial covariates, we examined the main effect of depressive symptoms, as well as the interactions between depressive symptoms and antidepressant use, and between depressive symptoms and optimism, on sleep disturbance, physical activity, physical health-related quality of life; and global quality of life. RESULTS: In all, 16% of women with Type 2 diabetes reported elevated depressive symptoms. In multivariable analyses, women with depressive symptoms had greater sleep disturbance (P<0.0001) and lower global quality of life (P<.0001). We found evidence of significant statistical interaction in the models for quality-of-life outcomes: the increased risk of poor physical health-related quality of life associated with antidepressant use was stronger in women without vs with depressive symptoms, and the association between greater optimism and higher global quality of life was stronger in women with vs without depressive symptoms. CONCLUSIONS: To improve health behaviours and quality of life in women with Type 2 diabetes, sociodemographic and medical characteristics may identify at-risk populations, while psychosocial factors including depression and optimism may be important targets for non-pharmacological intervention.

Comparison of skin perfusion response with alternating and constant pressures in people with spinal cord injury.

STUDY DESIGN: Two-way factorial mixed design, the between-subjects factor as the spinal cord injury (SCI) status (SCI and non-SCI) and the within-subjects factor as the pressure pattern (alternating and constant pressures). OBJECTIVES: To compare the effects of alternating and constant pressures on weight-bearing tissue perfusion in people with SCI, with application for improving alternating pressure support surface usage. SETTING: University research laboratory. SUBJECTS: A total of 28 participants were studied, 7 participants with cervical injury, 7 participants with injury below T6 and 14 healthy controls. METHODS: Sacral skin perfusion was continuously measured using laser Doppler flowmetry under 10 min preloading, 20 min loading (alternating or constant pressures) and 10 min postloading. Alternating pressure was applied with low-interface pressure at 0 mm Hg and high-interface pressure at 60 mm Hg with a cycle time of 5 min; constant pressure was applied with interface pressure at 30 mm Hg. RESULTS: The results showed that pressure pattern affects skin perfusion responses in weight-bearing tissues (P < 0.01). Alternating pressure stimulates an increase in skin perfusion (1.21 ± 0.08 au) as compared with constant pressure (0.74 ± 0.07 au) in people with SCI (P < 0.01). There was no overall difference in the skin perfusion responses of patients with SCI as compared with non-SCI patients (P > 0.05). CONCLUSION: This study has shown that alternating pressure enhances the skin perfusion of weight-bearing tissues as compared with constant pressure in people with SCI. The protocol tested in this study may be used to guide the selection of parameters of commercial alternating pressure support surfaces for preventing pressure ulcers in people with SCI.

Echocardiographic left ventricular mass and physical activity: quantification of the relation in spinal cord injured and apparently healthy active men.

To assess the relation of echocardiographic left ventricular (LV) mass to reported physical activity, 2 groups of subjects with widely different physical activity levels were evaluated: 50 men with spinal cord injuries and 166 apparently healthy, active men. Multivariate analysis revealed that reported physical activity was a significant independent predictor of LV mass index (LV mass/body surface area) in both injured patients and healthy, active subjects after controlling for age and blood pressure. The relation between LV mass index and physical activity (linear regression) was similar for both groups; LV mass index = 0.00321 (physical activity) + 82.8 and LV mass index = 0.00335 (physical activity) +88.4 for patients and healthy active subjects, respectively. These results suggest that physical activity as assessed by self-report is associated with echocardiographically detectable differences in LV mass in groups with widely divergent physical activity levels. In addition, for each of these groups 1,000 kcal/week of physical activity apparently results in a change of approximately 3 g/m2 in LV mass index. This information may have practical use for correction of LV mass for the effects of physical activity.

Factors related to sleep disturbance in older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis.

OBJECTIVES: To describe the types and frequencies of sleep complaints and the biopsychosocial factors associated with sleep disturbance in a large community sample of older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis (OA). DESIGN: Baseline analyses of an observational prospective study. SETTING AND PARTICIPANTS: Participants were 429 men and women aged 65 years and older experiencing knee pain or knee pain with radiographic evidence of OA enrolled in the Observational Arthritis Study in Seniors (OASIS). MEASUREMENTS: Demographic variables (age, gender, ethnicity, education), health (X-rays of knee rated for OA severity, medical conditions, medication use, smoking status, body mass index, self-rated health), physical functioning (self-rated physical functioning, physical performance), knee pain, and psychosocial functioning (social support, depression) were measured. RESULTS: Problems with sleep onset, sleep maintenance, and early morning awakenings occurred at least weekly among 31%, 81%, and 51% of participants, respectively. Bivariate correlates of greater sleep disturbance in those with OA were less education, cardiovascular disease, more arthritic joints, poorer self-rated health, poorer physical functioning, poorer physical performance, knee pain, depression, and less social support. In regression analyses, each set of variables representing the domains of health, physical functioning, pain, and psychosocial functioning contributed to the prediction of sleep disturbance beyond the demographic set. Finally, in a simultaneous model, white race (trend, P = .06), poorer self-rated health, poorer physical functioning, and depressive symptoms were predictive of sleep disturbance. CONCLUSIONS: Sleep disturbance is common in older adults experiencing knee pain or knee pain with radiographic evidence of OA and is best understood through the consideration of demographic, physical health, physical functioning, pain, and psychosocial variables. Interventions that take into account the multidetermined nature of sleep disturbance in knee pain or knee OA are most likely to be successful.

Evaluation of the effect of spinal cord injury on serum PSA levels.

OBJECTIVES: Prostatic structure and secretory activity are thought to be influenced by autonomic innervation of the prostate. Prostatic denervation is especially likely in patients with spinal cord injury (SCI) at the level of the cauda equina or the conus medullaris, where the peripheral nerve supply to the prostate may be specifically damaged. This may result in changes in serum prostate-specific antigen (PSA) levels, either directly or indirectly. Therefore, we measured serum PSA levels and also studied the influence of factors such as age, catheterization, duration of SCI, urinary tract infection, and history of cystitis on serum PSA values in men with SCI. METHODS: Serum PSA levels were determined in 79 men with SCI (age older than 40 years) using banked sera by the Abbott MEIA PSA assay. Variables such as age, catheterization, duration of SCI, urine culture results, and history of cystitis were obtained from a review of patient records. Comparisons were made with a randomly selected, non-SCI control population of 501 men, 40 to 89 years old, who underwent serum PSA determination at our institution. Statistical comparisons were performed using the Mann-Whitney U test (nonparametric), since the populations were not normally distributed. Multivariate logistic regression analysis was used to assess the correlation between the various factors and the serum PSA levels in men with SCI. RESULTS: No statistically significant differences were found in the median serum PSA values between the SCI group and the non-SCI control population. The age-specific PSA values obtained in the SCI group were also comparable to those reported for the general population at large. Age (P <0.03) and the presence of a catheter (P <0.0002) were the only two factors that were correlated with higher serum PSA values in the SCI group by regression analysis. CONCLUSIONS: Men with SCI tended to have serum PSA value distributions that were similar to those of the general population. However, those in the SCI group who had indwelling catheters were more likely to have higher PSA values at baseline, as were older men with SCI.

Assessment of physical activity in inactive populations.

The ability to index activity objectively in disabled or impaired activity populations is critical for our understanding of the long-term health consequences of reduced activity. The current research employed the large-scale integrated activity monitor as an objective measure of free living daily activity in 28 subjects with traumatic spinal cord injury. All the spinal cord-injured subjects wore the monitors for 2 d while in-patients at a rehabilitation center. The results indicated that the instruments can accurately index individual physical activity levels in this population, which has drastically reduced activity. Furthermore, group differences in activity were discriminated where paraplegic activity (mean, 32.0 counts X h-1) was significantly greater than quadriplegic activity (mean, 15.1 counts X h-1) (P less than 0.01) despite the markedly low activity levels. The results thus indicate that activity sensors can index individual activity levels at the very low end of the activity spectrum.

Activity in the spinal cord-injured patient: an epidemiologic analysis of metabolic parameters.

Individuals with traumatic spinal cord injury (SCI) represent a population with extreme inactivity. The purpose of the current research was to investigate the metabolic differences between extremely inactive disabled individuals (SCI sedentary group), active disabled individuals (SCI athletes), and able-bodied individuals. Fasting morning blood samples were obtained for the determination of high density lipoprotein cholesterol (HDLc) subfractions, glucose, and insulin. The sedentary SCI group was comprised of 77 consecutive male admissions to a rehabilitation center. The 17 SCI athletes were recruited prior to competition at the annual National Wheelchair Games. Total HDLc and both its subfractions were significantly lower (P less than 0.01) in the male SCI sedentary population than in the SCI athletes or able-bodied controls. HDL2 was significantly elevated (P less than 0.01) in the SCI athlete compared to the SCI sedentary group (42.7 vs 34.1 mg X dl-1) and was similar to the control population (46.1 mg X dl-1). Glucose levels were similar in the two SCI groups but were both significantly lower (P less than 0.05) than in the able-bodied controls. These data suggest that the extreme inactivity observed in disabled populations is associated with lower HDLc concentrations and presumably an increase in coronary heart disease risk if these values were to persist over time. Additionally, it appears that physical activity is associated with increases in total HDLc, primarily through the HDL2 subfraction. Glucose and insulin were similar for both SCI groups despite the marked difference in activity levels, suggesting that these parameters may not be associated with activity.

Anxiety, depression and disability across the lifespan.

The authors examined the relationship between anxiety, depression and physical disability, after controlling for demographic and health variables, in a sample of 374 adults aged 18-94. Results indicate that anxiety, depression and comorbid anxiety and depression are associated with higher levels of disability, after controlling for factors such as age, gender, income, self-rated health, number of medical conditions and number of physician visits in the past year. Furthermore, anxiety, depression and comorbid anxiety and depression have a differential effect on disability according to age, with older adults with any of these symptoms reporting higher levels of disability than younger adults. These findings suggest that physicians working with older adults should assess for and treat anxiety as well as depressive symptoms.

Treatment of minor depression in older adults: a pilot study comparing sertraline and exercise.

The purpose of this study was to conduct a pilot clinical trial to test the feasibility and efficacy of an exercise program and anti-depressant treatment compared with usual care in improving the emotional and physical functioning of older adults with minor depression. Participants were 37 older adults with minor depression who were randomized to exercise, sertraline, or usual care; 32 participants completed the 16-week study. Outcomes included measures of both emotional (clinician and self-report) and physical (observed and self-report) functioning. There were trends for the superiority of the exercise and sertraline conditions over usual care in improving SF-36 mental health scores and clinician-rated depression scores. Individuals in the exercise condition showed greater improvements in physical functioning than individuals in the usual care condition. Both sertraline and exercise show promise as treatments for late-life minor depression. However, exercise has the added benefit of improving physical functioning as well.

Age differences in the presentation of anxiety.

The research on anxiety and age has produced inconsistent findings. One reason for this may be that the manifestation of anxiety symptoms is age-related. The purpose of this study was to determine if there are age-related differences in the presentation of affective, cognitive, and somatic symptoms of anxiety. Primary care patients ranging in age from 19-87 years completed three self-report measures of anxiety. Results indicate that older adults report less worry than younger adults. There were no age differences in the report of somatic and affective symptoms. Thus, worry appears to play a less prominent role in the presentation of anxiety in older adults. These findings suggest that older adults do experience anxiety differently than younger adults.

Predictors of stage of adoption for colorectal cancer screening.

BACKGROUND: Although colorectal cancer is the third most common cancer in women, little is known about predictors of adherence to screening. METHODS: A randomly selected sample of 202 predominantly low-income and African-American women were interviewed. Knowledge of, attitudes and beliefs about, and practices related to flexible sigmoidoscopy (FS) screening were assessed. RESULTS: The majority of participants were in the precontemplation stage of adoption (56%). There were significant differences by stage of adoption for FS beliefs, FS barriers, risk of developing colorectal cancer, worry about getting colorectal cancer, and physician recommendation to get a FS. Predictors of adherence to FS guidelines were perceiving fewer barriers to getting a FS and having a physician recommend a FS. CONCLUSION: Seventy-two percent of the women in this study were nonadherent to FS screening guidelines. Psychosocial factors play an important role in screening for colorectal cancer. Ways of reducing barriers and increasing physician recommendations should be explored.

Psychological factors related to stage of mammography adoption.

This study examined the differences among women at different stages of mammography adoption on Health Belief Model variables, response efficacy, knowledge, and avoidance. A random sample of 361 women aged > or =40 years were grouped into six stages of mammography adoption (precontemplation, contemplation, action, maintenance, relapse precontemplation, relapse contemplation). A multivariate analysis of variance (ANOVA) revealed significant differences among women on all components of the Health Belief Model except perceived seriousness, as well as differences on response efficacy, knowledge, and avoidance. Results indicate that there are significant differences between women who have never had a mammogram (precontemplation and contemplation stages) and women who have had a mammogram in the past but are currently noncompliant (relapse stages). Further, significant differences were found between compliant women who have had one mammogram (action) and compliant women who have had multiple mammograms (maintenance) on barriers, motivation, confidence, and avoidance.

Memory enhancement training for older adults with mild cognitive impairment: a preliminary study.

'Mild cognitive impairment' (MCI) in older adults refers to a significant decline in memory function but not other cognitive functions. Pharmacological and non-pharmacological treatments for MCI are needed. The present randomized clinical trial tests the efficacy of a cognitive and behavioral treatment to improve memory performance and participants' attitudes about their memory. A multi-faceted intervention that included education about memory loss, relaxation training, memory skills training, and cognitive restructuring for memory-related beliefs was compared to a no-treatment control condition. Outcomes included memory performance and appraisals of memory function and control. Results indicate that the treated group had significantly better memory appraisals than controls at the end of treatment and at a six-month follow-up. There were no differences between groups on memory performance at post-test but at follow-up the trained individuals showed a trend toward better word list recall than controls. Findings suggest that individuals with MCI can benefit from multi-component memory enhancement training. Further development of such training programs and tests of their efficacy alone and in combination with medications are needed.

High density lipoprotein cholesterol concentrations in physically active and sedentary spinal cord injured patients.

Individuals with traumatic spinal cord injury (SCI) are extremely inactive yet little is known about the long-term consequences of chronic inactivity. Current research investigated the concentrations of high density lipoprotein cholesterol (HDLc) and its subfractions HDL2 and HDL3 in 66 extremely sedentary SCI admissions to a rehabilitation center. High density lipoprotein cholesterol is a primary risk factor for cardiovascular disease with decreased levels associated with increased cardiovascular risk. The concentrations of HDLc observed in the SCI sedentary population were compared with 22 olympic caliber wheelchair athletes (SCI athletes) and 126 able-bodied controls. Total HDLc, HDL2, and HDL3 was significantly lower in the male SCI sedentary population (34.2 mg/dl, 8.9 mg/dl, 25.3 mg/dl) than the male SCI athletes (42.7 mg/dl, 13.9 mg/dl, 28.8 mg/dl) or male able-bodied control populations (47.1mg/dl, 11.3mg/dl, 35.8 mg/dl). A similar pattern emerged for the female subjects. The reduction in HDLc seen in the SCI sedentary would predict over a 60% increased risk of heart attack compared to nondisabled controls. The primary difference between the two SCI groups was the level of physical activity, suggesting that this may be an important parameter for elevating total HDLc and HDL2, and presumably decreasing the risk for coronary heart disease. Therefore, physical activity positively affects total HDL and the supposedly antiatherogenic subfraction HDL2 in the SCI patient.

Clinical usefulness of the novel marker BLCA-4 for the detection of bladder cancer.

PURPOSE: Previous studies at our laboratory identified 6 bladder cancer specific nuclear matrix proteins termed BLCA-1 to 6. We recently developed an immunoassay that detects the bladder cancer specific nuclear matrix protein BLCA-4. We analyzed urine samples from patients with bladder cancer, those with spinal cord injury and normal volunteers to determine the BLCA-4 level in these 3 groups. MATERIALS AND METHODS: Urine samples obtained from 51 normal controls, and 54 patients with bladder cancer and 202 with spinal cord injury were tested for BLCA-4. We evaluated the association of BLCA-4 level with tumor grade and stage, urine cytology and bladder cancer history in the nonspinal cord injured population. Similarly we compared parameters associated with BLCA-4, such as spinal cord injury duration, catheterization, history of urinary tract infection, smoking and urine culture, in spinal cord injured patients. RESULTS: We established a normal cutoff point of 13 optical density units per microg. protein for the BLCA-4 assay. The BLCA-4 level was less than the cutoff in all 51 normal controls, while in 53 of the 55 urine samples (96.4%) of patients with bladder cancer and 38 of the 202 (19%) of spinal cord injured patients urinary BLCA-4 was greater than the cutoff. There was no correlation of any individual factors studied in these cases, including urinary tract infection and urinary BLCA-4. CONCLUSIONS: Elevated urinary BLCA-4 levels may accurately identify bladder cancer and distinguish these patients from normal individuals. There is no correlation of urinary BLCA-4 with a history of urinary tract infection, smoking, catheterization or cystitis considered independently. Urinary BLCA-4 determination appears to have high potential as a test for screening and monitoring bladder cancer in the general population and in groups at high risk for the disease, such as those with spinal cord injury.

Anger and acne: implications for quality of life, patient satisfaction and clinical care.

BACKGROUND: Acne is a common skin disorder with a significant psychological and social impact for some people. Little is known about how personality and emotional traits affect acne and its impact on quality of life and treatment. Trait anger (TA), which is related to heart disease and other morbidities, may also affect acne and patients' adjustment to it. OBJECTIVES: To evaluate the relationship between TA and acne severity, skin-related quality of life, satisfaction with treatment, and adherence to treatment. PARTICIPANTS AND METHODS: A sample of 479 individuals with acne completed a survey instrument to assess acne severity, skin care practices, skin-related quality of life, satisfaction with treatment, adherence, TA and demographic variables. Respondents who reported high TA were compared with individuals with low TA on outcome variables. Regression analyses adjusted for covariates and identified the significant predictors of quality of life, satisfaction and adherence. RESULTS: High TA was unrelated to acne severity (P = 0.2) or frequency of face washing (P = 0.9). Anger was significantly related to both global quality of life (P < 0.001) and skin-related quality of life (P = 0.002) as well as to satisfaction with treatment (P = 0.001) and adherence to treatment advice (P = 0.05) in bivariate analyses. Regression analyses revealed that high TA remained a significant predictor of global (P < 0.001) and skin-related quality of life (P = 0.003) and satisfaction with treatment (P = 0.04), but not adherence to treatment advice (P = 0.8) after controlling for covariates. CONCLUSIONS: Anger is associated with the quality of patients' lives and with their satisfaction with treatment. Care of acne patients should include attention to anger and other chronic emotional states, quality of life, as well as to clinical severity. Simple guidelines are suggested for how clinicians might approach this important aspect of care.

La apoptosis y su relación con diversos nutrientes / Apoptosis and its relationship with diverse nutrients

La homeostasis en los organismos se logra gracias a un balance entre la división y la muerte celular. La apoptosis es uno de los principales mecanismos que regulan la muerte celular. Este proceso constituye un control de calidad y un mecanismo de reparación, por esto, una larga lista de enfermedades se han asociado a alteraciones de ella, desde enfermedades degenerativas como el Alzheimer, hasta proliferativas como los cánceres, pasando por desordenes autoinmunes y otras. Se ha demostrado que compuestos y nutrientes en la dieta, o derivados de esta, están estrechamente relacionados a los mecanismos apoptóticos, provocándolos o inhibiéndolos, afectando positiva o negativamente la salud y asociándose a varias enfermedades. Entre los más estudiados están ciertos aminoácidos y antioxidantes como el zinc y las vitaminas A y E, principalmente anti-apoptóticos; por otra parte están las isoflavonas, los ácidos grasos omega 3, el colesterol y los ácidos butírico, araquidónico y linoleico, principalmente pro-apoptóticos y otros como los terpenoides con propiedades tanto pro- como anti-apoptóticas. Estos nutrientes actúan a distintos niveles de las vías apoptóticas por lo que conocer sus propiedades nos permitirá desarrollar terapias complejas para prevenir, tratar o actuar como coadjuvantes en los diferentes padecimientos.

The homeostasis of the organism is maintained by a balance between cell division and death, apoptosis being one of the main mechanisms that regulate cell death. This process involves a quality control and a reparation pathway. A long list of diseases has been associated to a malfunctioning of this process, going from degenerative diseases such as Alzheimer´s, to proliferative ones, like cancer, including also autoimmune disorders, and others. It has been shown that different compounds, and nutrients from the diet, or derived from it, are closely related to apoptotic mechanisms, promoting, or inhibiting this type of cell death, affecting human health positively or negatively. These compounds have been associated to certain diseases. Among the most characterized of these nutrients are some amino acids and molecules with anti-oxidant activity such as zinc and the vitamins A and E, which are mainly antiapoptotic. On the other hand, isoflavones, omega 3 fatty acids, cholesterol, as well as butyric, arachidonic, and linoleic acids, are mainly proapoptotic. Some compounds like terpenoids have been associated with either anti or proapoptotic properties. All of these nutrients act at different levels of the apoptotic pathways, so the elucidation of their properties will help to develop complex therapies to prevent, treat or function as coadjuvants in the treatment of different diseases.