The RETHINK Study: Could pain catastrophising explain why some women are more likely to attend hospital during the latent phase of labour

OBJECTIVE

To examine the prevalence of pain catastrophising and identify whether it impacts on the timing of hospital admission when in labour.

METHODS

A longitudinal cohort study. Nulliparous women, experiencing an uncomplicated pregnancy in England, were recruited between 25 and 33 weeks gestation. Participants completed two online questionnaires, (1) on recruitment, including the Pain Catastrophizing Scale (PCS) and the Wijma Delivery Expectancy Questionnaire (WDEQ-A) (2) at three weeks postnatal.

RESULTS

A total of 389 eligible participants entered the study. The percentage of women who were pain catastrophisers (PCS ≥ 20) was 28.1 %, while 7.6 % had a high pain catastrophising score (PCS ≥ 30). There was no association between pain catastrophising and the timing of hospital admission. The percentage of women reporting fear of childbirth (WDEQ-A score of ≥ 85) was 10.6 %. Fear of childbirth was highly associated with PCS scores (p <.001) at both the lower (≥20) and higher (≥30) thresholds.

CONCLUSION

Although not statistically significant, there was a tendency for women who pain catastrophise to present to hospital in the latent phase. The highly significant association between PCS and WDEQ-A scores has implications for the identification of these women and suggests that the PCS can be used as a screening tool to identify those women who have heightened fear around pain and who may also go on to develop clinically relevant fear of childbirth. Further studies are needed to confirm the acceptability of the PCS as a screening tool with women.

Measurement invariance of the Center for Epidemiologic Studies Scale-Depression within and across six diverse intervention trials

Depression, a major contributor to the global burden of disease, is an outcome of interest in clinical trials. Researchers and clinicians note that depression often presents differently across cultures, posing challenges in the accurate measurement of depressive symptoms across populations. A commonly used self-administered screening tool to measure depressive symptoms, the Center for Epidemiologic Studies Scale-Depression (CES-D), has been translated into dozens of languages and used in thousands of studies, yet gaps remain in our understanding of its factor structure and invariance across studies and over time in the context of interventions. In this secondary analysis, we sampled six recent trials from lower- and middle-income countries to (a) establish the factor structure of the CES-D, (b) assess measurement invariance of the CES-D across treatment versus control arms and over time, (c) examine cross-study invariance, and (d) identify items that may be driving potential noninvariance. We performed exploratory/confirmatory factor analysis to establish the factor structure of the CES-D within each trial and used multiple group confirmatory analysis to assess within-study cross-arm/cross-time and cross-study invariance. After removal of positive affect items, a unidimensional model performed equivalently over time and across arms within trials, but exhibited noninvariance across trials, supporting prior literature describing differences in factor structure of the scale across populations. While our findings suggest that the CES-D without positive affect items is a valid measure of depressive symptoms within trials in our sample, caution is warranted in interpreting the findings of meta-analyses and multisite/multicountry studies using the CES-D as an outcome measure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Qualitative Exploration of Women's Lives and Resilience in Substance Use Disorder Recovery

OBJECTIVE

This study sought to explore constructs of the Whole Health resilience model to identify potential intervention and local research opportunities as a precursor to intervention development, as well as to describe women's resilience in Substance Use Disorder (SUD) recovery including current strengths, coping, self-care, needs and priorities in the context of their everyday lives.

METHODS

Qualitative data were collected from December 2018 to January 2020 in the Mid-South United States. In-depth interviews of 17 women age 25 to 65 years in SUD recovery for 2 weeks or longer were conducted in 9 different settings including a Medication Assisted Treatment (MAT) hospital setting, a MAT pilot program in a community corrections setting, an incarceration re-entry residential program, community-based peer support organizations (eg, Narcotics Anonymous, Alcoholics Anonymous), a residential SUD treatment facility and a yoga teachers' online group. These data were analyzed with a hybrid approach (inductive and deductive coding).

RESULTS

The major themes that emerged from the analysis included social support, individual-level cognitive and spiritual strategies; self-care; stressors, priorities, needs, and self-care barriers and trauma. In this context, women needed a wide range of support including treatment of severe physical injuries, professional psychological support, help with restoring relationships, SUD treatment and recovery services, job training and coaching, health insurance advice, transportation, intimate partner violence (IPV) counseling and housing. Peer-support groups and faith communities were instrumental in many (but not all) of these women's lives in recovery-a gap was identified for women who did not have social support from these groups.

CONCLUSION

These data highlight the need for developing interventions for women in SUD recovery that take a holistic view of resilience life areas, as well as integrate professional services, family support, community support and approach care as wrap-around support that includes integration of social services to meet women's basic needs.

An Exploratory Study of the Acceptability and Feasibility of Yoga Among Women in Substance Use Disorder Recovery

Objectives: This qualitative study explored the acceptability and feasibility of yoga among women in substance use disorder (SUD) recovery. Design: Seventeen women in SUD recovery for 2 weeks or longer were recruited from nine sites in the mid-South, including a Medication-Assisted Treatment clinic in a hospital setting, prison re-entry housing, community-based peer support organizations (e.g., Alcoholics Anonymous [AA], Narcotics Anonymous [NA]), a residential SUD treatment facility, a yoga teachers' online group, and through referrals. The median age of participants was 41.5, with ages ranging from 25 to 65. We used an interpretive description approach to explore both the perceptions of women without yoga experience and the experiences of women with yoga experience to collect formative data for intervention development and implementation. The interviews were recorded and transcribed verbatim. A hybrid analysis (i.e., inductive and deductive coding) was applied to the data. Results: Women's narratives included a high prevalence of trauma exposure. Overall, women in this sample were interested in either beginning or continuing yoga. Barriers to participation included perceived lack of self-efficacy of yoga, weight, and physical injuries. Additional environmental barriers included balancing care of self with caring for others, including partners, children, and NA/AA sponsees; as well as prioritizing finances, housing, employment, and transportation. Conclusion: High prevalence of trauma exposure among women in SUD recovery necessitates careful consideration of co-occurring psychiatric disorders such as post-traumatic stress disorder, anxiety and depression and the necessary professional psychological support, as well as serious physical injuries that require modification in yoga āsana classes. As transportation and balancing care needs were salient in these data, rural SUD populations could be served with telehealth interventions that provide SUD recovery support with integrative health practices such as adjunctive yoga interventions.

Depressive symptoms and adipokines in women: Study of women's health across the nation

Small clinical studies suggest depression is associated with alterations in adiponectin and leptin, adipocyte-derived secretory proteins involved in metabolic regulation; however, longitudinal data on these association are lacking. This study examined cross-sectional and longitudinal associations of depressive symptoms and major depressive disorder (MDD) with adiponectin and leptin in healthy middle-aged women (mean (SD) age, 45.6 (2.5) years). Cross-sectional analyses included 575 women with baseline adipokine data; longitudinal analyses included 262 women with 2-4 adipokine measurements over 5 years. The 20-item Center for Epidemiologic Studies Depression scale (CES-D) was used to assess depressive symptoms; history of MDD was determined by the Structured Clinical Interview for DSM-IV. Adipokines were assayed from stored serum specimens; values were log-transformed for analyses. Linear and repeated measure random effects regression models evaluated associations of baseline CES-D scores with baseline adipokine concentrations and changes over time, respectively. Secondary analyses evaluated the relation of MDD history with adipokine concentrations. Mean (SD) baseline concentrations of adiponectin and leptin were 9.90 (4.92) μg/mL and 27.02 (20.06) ng/mL; both increased over time (p < .0001). CES-D scores were associated with lower adiponectin at baseline (per 1-SD: estimate=-0.04, SE=.02, p=.03) and over time (per 1-SD: estimate=-0.055, SE = .024, p=.02). Associations were unchanged in risk factor-adjusted models. Women with elevated CES-D scores (≥16) had 6.9% (95% CI: -1.1%, 14.3%; p = .089) lower median adiponectin at baseline and 11.5% (95% CI: 1.5%, 20.4%, p = .025) lower median adiponectin over time in adjusted models, compared to women with CES-D<16. Rate of change in adipokines did not vary by baseline depressive symptoms or MDD history. Depressive symptoms and MDD history were unrelated to leptin. In women at midlife, depressive symptoms are associated with lower adiponectin, a critical anti-inflammatory biomarker involved in metabolic and cardiovascular conditions.

Yoga as an intervention for psychological symptoms following trauma: A systematic review and quantitative synthesis

Despite evidence of the physiologic impact of trauma, treatments are only beginning to focus on the impact of trauma on the body. Yoga may be a promising treatment for trauma sequelae, given research that supports yoga for general distress. The present study aims to systematically assess and quantitatively synthesize the effectiveness of yoga interventions for psychological symptoms (posttraumatic stress disorder [PTSD], depression, anxiety symptoms) following potentially traumatic life events. The following electronic databases were systematically searched: PsycINFO, Ovid Medline/PubMed, Cumulative Index to Nursing and Allied Health Literature, and Embase/Embase Classic. Google Scholar, Mendeley, Open Research and Contributor Identification, and Fig Share were hand searched post hoc. The review focused on studies with a comparison group that measured psychological symptoms before and after intervention. After screening and reviewing, 12 articles (N = 791) were included, with interventions ranging from 2 days to 16 weeks. If a study contained multiple conditions, between-groups differences were only examined between the yoga and inactive control group. Though overall between-groups (yoga vs. comparison) effect sizes ranged from ds = 0.40-1.06, the systematic review and quantitative synthesis did not find strong evidence for the effectiveness of yoga as an intervention for PTSD, depression, and anxiety symptoms following traumatic life experiences due to low quality and high risk of bias of studies. As yoga has promise for managing psychological symptoms among trauma survivors, this review calls for more rigorous design of future studies to allow definitive conclusions regarding the use of yoga in mental health treatment of trauma survivors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

Adverse experiences in childhood and adolescence, defined as subjectively perceived threats to the safety or security of the child's bodily integrity, family, or social structures, are known to be associated with cardiometabolic outcomes over the life course into adulthood. This American Heart Association scientific statement reviews the scientific literature on the influence of childhood adversity on cardiometabolic outcomes that constitute the greatest public health burden in the United States, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. This statement also conceptually outlines pathways linking adversity to cardiometabolic health, identifies evidence gaps, and provides suggestions for future research to inform practice and policy. We note that, despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course. Future studies that focus on mechanisms, resiliency, and vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions. Given that childhood adversities affect cardiometabolic health and multiple health domains across the life course, interventions that ameliorate these initial upstream exposures may be more appropriate than interventions remediating downstream cardiovascular disease risk factor effects later in life.

Correlation of the functional difficulties questionnaire (FDQ-9) with dynamic balance using the SMART instrumented wobbleboard

OBJECTIVES

To investigate concurrent validity of the Functional Difficulties Questionnaire (FDQ-9) using balance tasks on the SMARTwobbleboard. Poor balance is associated with reduced physical activity which may impact on quality of life. There is a requirement to use simple tests to assess balance so that suitable interventions can be employed to ameliorate poor balance and enhance uptake of physical activity.

DESIGN

Observational study employing 30 healthy volunteers who completed the FDQ-9 and undertook three balance tasks on the SMARTwobbleboard: double leg stance eyes open (DLSEO); double leg stance eyes closed (DLSEC) and single leg stance eyes open (SLSEO).

RESULTS

There were moderate significant correlations between the FDQ-9 and DLSEO and SLSEO. There were significant between group differences in dynamic balance for participants with FDQ-9 ≤ 18 (indicative of no functional difficulties) and FDQ-9 ≥ 19 (indicative of one or more functional difficulties) for DLSEO and SLSEO.

CONCLUSIONS

Significant moderate correlations were recorded between the FDQ-9 and the SMARTwobbleboard in healthy adults indicating a relationship between dynamic balance and questionnaire scores (DLSEO and SLSEO). Initial findings contribute to the concurrent validity of the FDQ-9 which could also be used as a simple tool for assessing balance.

Abuse in Childhood or Adolescence and Gestational Diabetes: A Retrospective Cohort Study

INTRODUCTION

Early life abuse has been linked to later Type 2 diabetes, but its association with gestational diabetes has not been examined. The aim of this study was to examine the association between childhood and adolescent abuse victimization and risk of gestational diabetes in the Nurses' Health Study II.

METHODS

Participants were asked about experiences of physical and sexual abuse in childhood or adolescence in 2001 and about history of pregnancy complications in 2009. Mothers of singleton live births who provided information on their abuse history comprised the study sample. Modified Poisson regression was used to estimate risk ratios and 95% CIs for gestational diabetes as a function of physical and sexual abuse victimization. Analyses were conducted in 2014-2015.

RESULTS

Of 45,550 women in the analysis, 8% reported severe physical abuse and 11% reported forced sexual activity in childhood or adolescence. Approximately 3% (n=3,181) of pregnancies were complicated by gestational diabetes. In adjusted models, severe physical abuse was associated with a 42% greater gestational diabetes risk (risk ratio=1.42, 95% CI=1.21, 1.66) relative to no physical abuse. Forced sexual activity was associated with a 30% greater risk (95% CI=1.14, 1.49). Women with histories of both physical and sexual abuse were at higher risk than women exposed to a single type of abuse. These associations were not explained by overweight status in early adulthood or prior to pregnancy.

CONCLUSIONS

Childhood and adolescent victimization is associated with increased risk of gestational diabetes in adult women.

Child maltreatment and hypertension in young adulthood

BACKGROUND

Maltreatment during childhood and adolescence has been associated with chronic conditions in adulthood including cardiovascular disease. However, less is known about the effects of childhood maltreatment on cardiovascular risk factors prior to development of cardiovascular disease, or whether these effects are evident in young adulthood. Furthermore, few studies have examined sex differences and most studies have relied on self-reported outcome measures that are subject to misclassification.

METHODS

We examined the relationship between child maltreatment and hypertension in young adulthood in the National Longitudinal Study of Adolescent Health, a nationally representative school-based sample of US adolescents. Participants retrospectively (mean age 29.9, n = 11384) reported on their experiences of child maltreatment prior to the 6th grade (prior to age 11) during follow-up. Child neglect, physical and sexual violence as well as a measure of social services visits to the home were examined. Blood pressure was measured during an in-home visit. Hypertension was defined as measured SBP of at least 140 mmHg or DBP of at least 90 mmHG measured in adulthood, or self-reported use of antihypertensive medications.

RESULTS

In adjusted models, women who experienced sexual abuse in early childhood had a higher prevalence of hypertension (Prevalence Ratio (PR) 1.43 95% CI 1.00, 2.05) compared to women who did not experience sexual abuse. Among men, experiencing sexual abuse was not statistically significantly associated with hypertension. Experiencing neglect, physical abuse or having visitations by social services at home during childhood was not associated with hypertension among either women or men.

CONCLUSION

Sexual abuse in early childhood is associated with hypertension in young women.

Socioeconomic status and the incidence of atrial fibrillation in whites and blacks: the Atherosclerosis Risk in Communities (ARIC) study

BACKGROUND

No previous studies have examined the interplay among socioeconomic status, sex, and race with the risk of atrial fibrillation (AF).

METHODS AND RESULTS

We prospectively followed 14 352 persons (25% black, 75% white, 55% women, mean age 54 years) who were free of AF and participating in the Atherosclerosis Risk in Communities (ARIC) study. Socioeconomic status was assessed at baseline (1987-1989) through educational level and total family income. Incident AF through 2009 was ascertained from electrocardiograms, hospitalizations, and death certificates. Cox regression was used to estimate hazard ratios and 95% CIs of AF for education and family income. Interactions were tested between socioeconomic status and age, race, or sex. Over a median follow-up of 20.6 years, 1794 AF cases occurred. Lower family income was associated with higher AF risk (hazard ratio 1.45, 95% CI 1.27 to 1.67 in those with income less than $25 000 per year compared with those with $50 000 or more per year). The association between education and AF risk varied by sex (P=0.01), with the lowest education group associated with higher AF risk in women (hazard ratio 1.88, 95% CI 1.55 to 2.28) but not in men (hazard ratio 1.15, 95% CI 0.97 to 1.36) compared with the highest education group. Adjustment for cardiovascular risk factors attenuated the associations. There were no interactions with race or age. Blacks had lower AF risk than whites in all income and education groups.

CONCLUSIONS

Lower family income was associated with a higher AF risk overall, whereas the impact of education on AF risk was present only in women. Differences in socioeconomic status do not explain the lower risk of AF in blacks compared with whites.

Perceived stress is associated with subclinical cerebrovascular disease in older adults

OBJECTIVE

To examine the association of perceived stress with magnetic resonance imaging (MRI) markers of subclinical cerebrovascular disease in an elderly cohort.

METHODS

Using a cross-sectional study of a community-based cohort in Chicago, 571 adults (57% women; 58.1% African American; 41.9% non-Hispanic white; mean [SD] age: 79.8 [5.9] years) from the Chicago Health and Aging Project, an epidemiologic study of aging, completed questionnaires on perceived stress, medical history, and demographics as part of an in-home assessment and 5 years later underwent a clinical neurologic examination and MRI of the brain. Outcome measures were volumetric MRI assessments of white matter hyperintensity volume (WMHV), total brain volume (TBV), and cerebral infarction.

RESULTS

Stress was measured with six items from the Perceived Stress Scale (PSS); item responses, ranging from never (0) to often (3), were summed to create an overall stress score (mean [SD]: 4.9 [3.3]; range: 0-18). Most participants had some evidence of vascular disease on MRI, with 153 participants (26.8%) having infarctions. In separate linear and logistic regression models adjusted for age, sex, education, race, and time between stress assessment and MRI, each one-point increase in PSS score was associated with significantly lower TBV (coefficient = -0.111, SE = 0.049, t[563] = -2.28, p = 0.023) and 7% greater odds of infarction (odds ratio: 1.07; 95% confidence interval: 1.01, 1.13; Wald χ(2)[1] = 4.90; p = 0.027). PSS scores were unrelated to WMHV. Results were unchanged with further adjustment for smoking, body mass index, physical activity, history of heart disease, stroke, diabetes, hypertension, depressive symptoms, and dementia.

CONCLUSIONS

Greater perceived stress was significantly and independently associated with cerebral infarction and lower brain volume assessed 5 years later in this elderly cohort.

Psychosocial distress and stroke risk in older adults

BACKGROUND AND PURPOSE

To investigate the association of psychosocial distress with risk of stroke mortality and incident stroke in older adults.

METHODS

Data were from the Chicago Health and Aging Project, a longitudinal population-based study conducted in 3 contiguous neighborhoods on the south side of Chicago, IL. Participants were community-dwelling black and non-Hispanic white adults, aged 65 years and older (n=4120 for stroke mortality; n=2649 for incident stroke). Psychosocial distress was an analytically derived composite measure of depressive symptoms, perceived stress, neuroticism, and life dissatisfaction. Cox proportional hazards models examined the association of distress with stroke mortality and incident stroke over 6 years of follow-up.

RESULTS

Stroke deaths (151) and 452 incident strokes were identified. Adjusting for age, race, and sex, the hazard ratio (HR) for each 1-SD increase in distress was 1.47 (95% confidence interval [CI]=1.28-1.70) for stroke mortality and 1.18 (95% CI=1.07-1.30) for incident stroke. Associations were reduced after adjustment for stroke risk factors and remained significant for stroke mortality (HR=1.29; 95% CI=1.10-1.52) but not for incident stroke (HR=1.09; 95% CI=0.98-1.21). Secondary analyses of stroke subtypes showed that distress was strongly related to incident hemorrhagic strokes (HR=1.70; 95% CI=1.28-2.25) but not ischemic strokes (HR=1.02; 95% CI=0.91-1.15) in fully adjusted models.

CONCLUSIONS

Increasing levels of psychosocial distress are related to excess risk of both fatal and nonfatal stroke in older black and white adults. Additional research is needed to examine pathways linking psychosocial distress to cerebrovascular disease risk.

Adolescent obesity, change in weight status, and hypertension: racial/ethnic variations

We sought to determine whether change in weight status between adolescence and young adulthood was associated with the risk of developing hypertension among adolescents and whether sex and racial/ethnic group differences existed in the National Longitudinal Study of Adolescent Health. The sample was restricted to participants who self-identified as black, Hispanic, or white non-Hispanic (n=8543). Height and weight were measured in adolescence (mean 16 years) and again in adulthood (mean 29 years). We categorized the weight of participants into 4 groups: stayed normal weight; gained weight (normal weight in adolescence and obese in adulthood); lost weight (overweight/obese in adolescence nonobese in adulthood); and chronically overweight/obese. Hypertension was defined as measured systolic blood pressure of at least 140 mm Hg or diastolic blood pressure of at least 90 mm Hg measured in adulthood or use of antihypertensive medications. A higher risk of hypertension was noted for all sex and racial/ethnic groups who became obese in adulthood. Furthermore, those who were chronically overweight/obese were at higher risk of hypertension for all groups, with odds ratios ranging from 2.7 in Hispanic men to 6.5 in Hispanic women. Except for black men, those who lost weight during follow-up had no significant increased risk compared with those who maintained normal weight. Overall, there was an increased risk of hypertension for those who gained weight in adulthood and among those who remained obese from adolescence to young adulthood. These data give further evidence for prevention strategies that begin earlier in life to reduce or delay the onset of chronic disease in young adults.

Vertebrate herbivory impacts seedling recruitment more than niche partitioning or density-dependent mortality

In tropical forests, resource-based niches and density-dependent mortality are mutually compatible mechanisms that can act simultaneously to limit seedling populations. Differences in the strengths of these mechanisms will determine their roles in maintaining species coexistence. In the first assessment of these mechanisms in a Congo Basin forest, we quantified their relative strengths and tested the extent to which density-dependent mortality is driven by the distance-dependent behavior of seed and seedling predators predicted by the Janzen-Connell hypothesis. We conducted a large-scale seed addition experiment for five randomly selected tropical tree species, caging a subset of seed addition quadrats against vertebrate predators. We then developed models to assess the mechanisms that determine seedling emergence (three months after seed addition) and survival (two years after seed addition). As predicted, both niche differentiation and density-dependent mortality limited seedling recruitment, but predation had the strongest effects on seedling emergence and survival. Seedling species responded differently to naturally occurring environmental variation among sites, including variation in light levels and soil characteristics, supporting predictions of niche-based theories of tropical tree species coexistence. The addition of higher densities of seeds into quadrats initially led to greater seedling emergence, but survival to two years decreased with seed density. Seed and seedling predation reduced recruitment below levels maintained by density-dependent mortality, an indication that predators largely determine the population size of tree seedlings. Seedling recruitment was unrelated to the distance to or density of conspecific adult trees, suggesting that recruitment patterns are generated by generalist vertebrate herbivores rather than the specialized predators predicted by the Janzen-Connell hypothesis. If the role of seed and seedling predation in limiting seedling recruitment is a general phenomenon, then the relative abundances of tree species might largely depend on species-specific adaptations to avoid, survive, and recover from damage induced by vertebrate herbivores. Likewise, population declines of herbivorous vertebrate species (many of which are large and hunted) may trigger shifts in species composition of tropical forests.

Cerebral malaria protection in mice by species-specific Plasmodium coinfection is associated with reduced CC chemokine levels in the brain

Cerebral malaria is a major pathological complication of Plasmodium falciparum infection in humans. Epidemiological observations have suggested that the clinical evolution of P. falciparum infections may be influenced by the concurrent presence of another Plasmodium species. Infection of susceptible mouse strains with P. berghei ANKA (PbA) provides an experimental model of cerebral malaria which has been extensively used to identify different components of the immune system involved in cerebral malaria. This model has also been employed to investigate the influence of experimental mixed-Plasmodium-species infections on the expression of cerebral malaria; PbA-induced cerebral malaria is completely inhibited by the simultaneous presence of P. yoelii yoelii 17 X clone 1.1 parasites, and accumulation of CD8(+) T cells in the brain vasculature is abolished. We investigated whether brain levels of CD8(+) -T-cell-chemoattractant chemokines CCL3, CCL4 and CCL5 are reduced in these protected coinfected mice compared with PbA-infected mice. Coinfected mice were found to exhibit significantly reduced levels of all three chemokines on day 6 post-infection. This finding may contribute to the abolition of the accumulation of CD8(+) T cells in the brain vasculature and the prevention of the development of cerebral malaria in coinfected mice.

Decoupling the effects of logging and hunting on an afrotropical animal community

In tropical forests, hunting nearly always accompanies logging. The entangled nature of these disturbances complicates our ability to resolve applied questions, such as whether secondary and degraded forest can sustain populations of tropical animals. With the expansion of logging in central Africa, conservation depends on knowledge of the individual and combined impacts of logging and hunting on animal populations. Our goals were (1) to decouple the effects of selective logging and hunting on densities of animal guilds, including apes, duikers, monkeys, elephant, pigs, squirrels, and large frugivorous and insectivorous birds and (2) to compare the relative importance of these disturbances to the effects of local-scale variation in forest structure and fruit abundance. In northern Republic of Congo, we surveyed animals along 30 transects positioned in forest disturbed by logging and hunting, logging alone, and neither logging nor hunting. While sampling transects twice per month for two years, we observed 47 179 animals of 19 species and eight guilds in 1154 passages (2861 km). Species densities varied by as much as 480% among forest areas perturbed by logging and/or hunting, demonstrating the strong effects of these disturbances on populations of some species. Densities of animal guilds varied more strongly with disturbance type than with variation in forest structure, canopy cover, and fruit abundance. Independently, logging and hunting decreased density of some guilds and increased density of others: densities varied from 44% lower (pigs) to 90% higher (insectivorous birds) between logged and unlogged forest and from 61% lower (apes) to 77% higher (frugivorous birds) between hunted and unhunted forest. Their combined impacts exacerbated decreases in populations of some guilds (ape, duiker, monkey, and pig), but counteracted one another for others (squirrels, insectivorous and frugivorous birds). Together, logging and hunting shifted the relative abundance of the animal community away from large mammals toward squirrels and birds. Logged forest, even in the absence of hunting, does not maintain similar densities as unlogged forest for most animal guilds. To balance conservation with the need for economic development and wild meat in tropical countries, landscapes should be spatially managed to include protected areas, community hunting zones, and production forest.

War-related stressors are associated with asthma risk among older Kuwaitis following the 1990 Iraqi invasion and occupation

BACKGROUND

Contemporary warfare involving civilian populations is a growing public health concern. In addition to the psychological impact, war-related trauma may result in physiological alterations and even broader health effects. Associations were examined between war-related stressors and incident asthma in elderly Kuwaiti civilians following the Iraqi invasion.

METHODS

A random sample of all Kuwaiti nationals aged 50-69 years on the day prior to the invasion were identified. Among the 7873 meeting eligibility criteria, 5567 (71%) agreed to participate and 5028 completed the questionnaire (91% of those eligible). Of these, 3759 were in Kuwait during the invasion, of whom 2294 were alive at follow-up. After exclusions for prevalent asthma or missingness on covariates, 2066 were available for analysis. War-related experiences were summarised into a continuous score using Rasch modelling. Relative Cox proportional hazard rates (HR) were calculated for asthma adjusting for covariates.

RESULTS

Over 13 years of follow-up, physician-diagnosed asthma was reported by 66/996 (6.6%) men and 104/1070 (9.7%) women. In models adjusted for gender, socioeconomic status, smoking, BMI, and air pollution related to burning oil fires, those reporting highest stress exposure were more than twice as likely to report asthma (HR 2.3, 95% CI 1.3, 3.9) compared to civilians reporting no stressors. Experiences were more salient when anchored to fear for loss of life.

CONCLUSIONS

War-related trauma is associated with increased asthma risk in these elderly civilians. Although prior research has documented the significant and persistent psychological toll of war, these findings implicate even broader health effects.

Bushmeat supply and consumption in a tropical logging concession in northern Congo

Unsustainable hunting of wildlife for food empties tropical forests of many species critical to forest maintenance and livelihoods of forest people. Extractive industries, including logging, can accelerate exploitation of wildlife by opening forests to hunters and creating markets for bushmeat. We monitored human demographics, bushmeat supply in markets, and household bushmeat consumption in five logging towns in the northern Republic of Congo. Over 6 years we recorded 29,570 animals in town markets and collected 48,920 household meal records. Development of industrial logging operations led to a 69% increase in the population of logging towns and a 64% increase in bushmeat supply. The immigration of workers, jobseekers, and their families altered hunting patterns and was associated with increased use of wire snares and increased diversity in the species hunted and consumed. Immigrants hunted 72% of all bushmeat, which suggests the short-term benefits of hunting accrue disproportionately to "outsiders" to the detriment of indigenous peoples who have prior, legitimate claims to wildlife resources. Our results suggest that the greatest threat of logging to biodiversity may be the permanent urbanization of frontier forests. Although enforcement of hunting laws and promotion of alternative sources of protein may help curb the pressure on wildlife, the best strategy for biodiversity conservation may be to keep saw mills and the towns that develop around them out of forests.

Logging concessions can extend the conservation estate for Central African tropical forests

The management of tropical forest in timber concessions has been proposed as a solution to prevent further biodiversity loss. The effectiveness of this strategy will likely depend on species-specific, population-level responses to logging. We conducted a survey (749 line transects over 3450 km) in logging concessions (1.2 million ha) in the northern Republic of Congo to examine the impact of logging on large mammal populations, including endangered species such as the elephant (Loxodonta africana), gorilla (Gorilla gorilla), chimpanzee (Pan troglodytes), and bongo (Tragelaphus eurycerus). When we estimated species abundance without consideration of transect characteristics, species abundances in logged and unlogged forests were not different for most species. When we modeled the data with a hurdle model approach, however, analyzing species presence and conditional abundance separately with generalized additive models and then combining them to calculate the mean species abundance, species abundance varied strongly depending on transect characteristics. The mean species abundance was often related to the distance to unlogged forest, which suggests that intact forest serves as source habitat for several species. The mean species abundance responded nonlinearly to logging history, changing over 30 years as the forest recovered from logging. Finally the distance away from roads, natural forest clearings, and villages also determined the abundance of mammals. Our results suggest that logged forest can extend the conservation estate for many of Central Africa's most threatened species if managed appropriately. In addition to limiting hunting, logging concessions must be large, contain patches of unlogged forest, and include forest with different logging histories.

Prevalence estimate of intimate partner violence in Jordan

This study examined the prevalence of intimate partner violence in Jordan among a sample of 517 reproductive health clinic attendees. Intimate partner violence was measured using the World Health Organization's domestic violence questionnaire which was modified by the results of focus group discussions conducted in Amman. The percentages of women experiencing at least 1 form of control or violence since marriage were: control, 97.2%; psychological violence, 73.4%; physical violence, 31.2%; and sexual violence, 18.8%. Modifications of the WHO questionnaire were needed to measure control and psychological violence in Jordan. Similar modifications might be required when conducting research in the Region.

Contrasting roles of neuronal Msk1 and Rsk2 in Bad phosphorylation and feedback regulation of Erk signalling

Activated extracellular-signal-regulated kinase (Erk) phosphorylates and activates downstream kinases including ribosomal S6 kinase 2 (Rsk2/RPS6KA3) and mitogen- and stress-activated kinase 1 (Msk1, RPS6KA5). Rsk2 plays an important role in neuronal plasticity, as patients with Coffin-Lowry syndrome, where Rsk2 is dysfunctional, have impaired cognitive function. However, the relative role of neuronal Rsk2 and Msk1 in activating proteins downstream of Erk is unclear. In PC12 cells and in cortical neurones, the calcium ionophore A23187-induced phosphorylation of Erk, Msk1, Rsk2 and also the Bcl-2-associated death protein (Bad), which protects against neurotoxicity. Specific knockdown of Msk1 with small interfering RNA reduced the ability of A23187 to induce Bad phosphorylation in both PC12 cells and cortical neurones. Conversely, specific knockdown of Rsk2 potentiated Bad phosphorylation following A23187 treatment, and also elevated Erk phosphorylation in both cell types. This indicates that Msk1 rather than Rsk2 mediates neuronal Bad phosphorylation following Ca(2+) influx and implicates Rsk2 in a negative-feedback regulation of Erk activity.

Are Plant Populations Seed Limited? A Critique and Meta‐Analysis of Seed Addition Experiments

We examine the relative importance of processes that underlie plant population abundance and distribution. Two opposing views dominate the field. One posits that the ability to establish at a site is determined by the availability of suitable microsites (establishment limitation), while the second asserts that recruitment is limited by the availability of seeds (seed limitation). An underlying problem is that establishment and seed limitation are typically viewed as mutually exclusive. We conducted a meta-analysis of seed addition experiments to assess the relative strength of establishment and seed limitation to seedling recruitment. We asked (1) To what degree are populations seed and establishment limited? (2) Under what conditions (e.g., habitats and life-history traits) are species more or less limited by each? (3) How can seed addition studies be better designed to enhance our understanding of plant recruitment? We found that, in keeping with previous studies, most species are seed limited. However, the effects of seed addition are typically small, and most added seeds fail to recruit to the seedling stage. As a result, establishment limitation is stronger than seed limitation. Seed limitation was greater for large-seeded species, species in disturbed microsites, and species with relatively short-lived seed banks. Most seed addition experiments cannot assess the relationship between number of seeds added and number of subsequent recruits. This shortcoming can be overcome by increasing the number and range of seed addition treatments.

Plants as reef fish: fitting the functional form of seedling recruitment

The life histories of many species depend first on dispersal to local sites and then on establishment. After dispersal, density-independent and density-dependent mortalities modify propagule supply, determining the number of individuals that establish. Because multiple factors influence recruitment, the dichotomy of propagule versus establishment limitation is best viewed as a continuum along which the strength of propagule or establishment limitation changes with propagule input. To evaluate the relative importance of seed and establishment limitation for plants, we (1) describe the shape of the recruitment function and (2) use limitation and elasticity analyses to quantify the sensitivity of recruitment to perturbations in seed limitation and density-independent and density-dependent mortality. Using 36 seed augmentation studies for 18 species, we tested four recruitment functions against one another. Although the linear model (accounting for seed limitation and density-independent mortality) fitted the largest number of studies, the nonlinear Beverton-Holt model (accounting for density-dependent mortality) performed better at high densities of seed augmentation. For the 18 species, seed limitation constrained population size more than other sources of limitation at ambient conditions. Seedling density reached saturation with increasing seed density in many studies, but at such high densities that seedling density was primarily limited by seed availability rather than microsite availability or density dependence.

N-Methyl-D-aspartate and Brain-Derived Neurotrophic Factor Induce Distinct Profiles of Extracellular Signal-Regulated Kinase, Mitogen- and Stress-Activated Kinase, and Ribosomal S6 Kinase Phosphorylation in Cortical Neurons

Stimulation of N-methyl-D-aspartate (NMDA) receptors is believed to underlie long-term memory formation, and excessive NMDA receptor activation has been linked to several neuropathological conditions. Phosphorylation and activation of p42/44 mitogen-activated protein kinase (ERK) is believed to mediate many of these effects, but the downstream targets of ERK in response to NMDA activation have not been determined. In primary cultures of rat cortical neurons, we found that NMDA was able to elevate phosphorylation of mitogen- and stress-activated kinase 1 (MSK1) as well as ERK. Likewise, brain-derived neurotrophic factor (BDNF) treatment increased phosphorylation of MSK1 and ERKs. The NMDA-induced MSK1 phosphorylation was sensitive to the MEK inhibitor 2'-amino-3'-methoxyflavone (PD98059) and the p38 inhibitor 4-(4-fluorophenyl)-2-(4-methylsulfinylphenyl)-5-(4-pyridyl)1H-imidazole (SB203580). MSK1 activation by NMDA was transient, although ERK remained phosphorylated within the neuronal cytoplasm for several hours. Although BDNF increased ribosomal S6 kinase (RSK) phosphorylation, NMDA had no discernable effect on the phosphorylation of RSKs. Thus, phosphorylation and activation of MSK1 but not RSK could be an important step in the pathway linking NMDA-induced ERK phosphorylation to the activation of transcription factors required for the formation of long-term memory.

Differences in the neurochemical characteristics of the cortex and striatum of mice with cerebral malaria

Fatal murine cerebral malaria is an encephalitis and not simply a local manifestation in the brain of a systemic process. Histopathologically, murine cerebral malaria has been characterized by monocyte adherence to the endothelium of the microvasculature, activation of microglial cells, swelling of endothelial cell nuclei, microvasculature damage, and breakdown of the blood-brain barrier with cerebral oedema. Brain parenchymal cells have been proposed to be actively involved in the pathogenesis of murine cerebral malaria. We, therefore, compared the neurochemical characteristics ofPlasmodium bergheiANKA-infected mice with controls to determine whether cerebral malarial infection significantly impairs specific neuronal populations. Between 6 and 7 days after infection, we found a significant loss of neurones containing substance P, with preservation of cells containing somatostatin, neuropeptide Y and calbindin in the striatum of infected mice compared with controls. In the cortex of infected mice, we found a significant reduction in the number of cells containing substance P, somatostatin and neuropeptide Y. The number of calbindin-containing neurones was unchanged. This study found significant changes in the neurochemical characteristics of the cortex and striatum of mice infected withP. bergheiANKA, which may contribute to their cerebral symptoms.

Fruiting trees as dispersal foci in a semi-deciduous tropical forest

Quantification of seed rain patterns is an initial step toward explaining variation in plant recruitment, and consequently, organization of forest communities. Spatially contagious patterns of seed deposition, where seeds are patchily dispersed with some sites receiving relatively high densities and others receiving low densities of seeds, may be a common phenomenon for which we have very little knowledge. For example, prior feeding events by frugivores (monkeys and birds) combined with transport and dispersal of seeds to other fruiting trees may result in the contagious deposition of non-conspecific seeds below them. Here, we examined whether fruiting trees act as dispersal foci in the semi-deciduous tropical rainforest of the Dja Reserve, Cameroon. Seed rain was sampled below the canopies of nine tree species: three typically dispersed by large, frugivorous birds, three dispersed by monkeys, and three dispersed by wind. We found no evidence that monkeys generate spatially contagious patterns of seed rain under fruiting trees at which they feed. However, we found that rates of deposition of non-conspecific seeds and species richness of seeds delivered by birds (hornbills and turacos) were significantly greater during fruiting than non-fruiting periods, and significantly greater under fruiting individuals of bird-dispersed tree species than under fruiting individuals of monkey- or wind-dispersed tree species. Additionally, during fruiting periods, the composition of non-conspecific seed rain under bird-dispersed tree species was more similar to other bird-dispersed trees than to monkey- or wind-dispersed tree species. The contagious dispersal of non-conspecific seeds to fruiting, bird-dispersed trees leads to higher seed densities under fruiting trees than those caused by local seed production. Non-conspecific seeds deposited in high densities may experience increased seed mortality even far from parent trees if predators are generalists. Alternatively, in the absence of complete density-dependent mortality, contagious seed dispersal could result in associations among species dispersed by the same dispersal agent.

Analysis of the 5' flanking region of the interleukin 10 gene in patients with systemic sclerosis

OBJECTIVES

Fibrosis, a feature of systemic sclerosis (SSc), is more severe in the diffuse compared with the limited disease variant. Interleukin 10 (IL-10) is an anti-inflammatory cytokine which reduces type 1 collagen mRNA levels in human fibroblasts. The 5' flanking region of the IL-10 gene is highly polymorphic, with three single base pair substitutions at position -1082(G/A), -819(C/T) and -592(C/A), which results in differential IL-10 production. The GCC/GCC genotype is associated with high IL-10 production while the ATA/ATA genotype with low production. We postulated that there would be a difference in IL-10 polymorphisms in patients with limited (lSSc) and diffuse (dSSc) disease.

METHODS

Patients with limited (lSSc, n = 89) or diffuse (dSSc, n = 51) disease plus controls (n = 94) were recruited. DNA was isolated from peripheral blood and polymorphisms analysed using amplification refractory mutation system (ARMS) polymerase chain reaction (PCR).

RESULTS

dSSc patients were less likely to carry the genotype indicative of high IL-10 production when compared with controls (controls vs dSSc; 29 vs 4%, chi2 = 15.7, 5 df, P = 0.005) and lSSc patients (lSSc vs dSSc; 21 vs 4%, chi2 = 17.5, 5 df, P = 0.002). There was no difference between control and lSSc patients. While there was no difference between controls and lSSc haplotypes, the GCC haplotype distribution did differ significantly between controls and dSSc patients (controls vs dSSc; 54 vs 36%, chi2 = 11.2, 2 df, P = 0.001). A significant difference was also observed between lSSc and dSSc haplotype distribution (lSSc vs dSSc; 48 vs 36%, chi2 = 13.5, 2 df, P < 0.001).

CONCLUSION

We demonstrate that IL-10 genotypes associated with high IL-10 production are under-represented in dSSc. This may have implications in the disease pathology.

11beta-hydroxylase and aldosterone synthase expression in fetal rat hippocampal neurons

The central nervous system produces many of the enzymes responsible for corticosteroid synthesis. A model system to study the regulation of this local system would be valuable. Previously, we have shown that primary cultures of hippocampal neurons isolated from the fetal rat can perform the biochemical reactions associated with the enzymes 11beta-hydroxylase and aldosterone synthase. Here, we demonstrate directly that these enzymes are present within primary cultures of fetal rat hippocampal neurons.

Analysis of transforming growth factor beta1 gene polymorphisms in patients with systemic sclerosis

OBJECTIVES

To determine the distribution of transforming growth factor beta1 (TGFbeta1) genotypes at codon 10 (+869 polymorphism) and codon 25 (+915 polymorphism) in patients with scleroderma (SSc). Differences between diffuse and limited SSc (dSSc and lSSc) were also investigated.

METHODS

Patients with lSSc (n=89) and dSSc (n=63) were compared with 147 controls. DNA was isolated from peripheral blood and polymorphisms at codons 10 (C/T) and 25 (G/C) of the TGFbeta1 gene analysed by polymerase chain reaction and sequence specific oligonucleotide probing.

RESULTS

Significantly more patients with SSc than controls carried allele C at codon 10 (controls v SSc, 38% v 48%, chi(2)=8.2, 1df, p=0.004), OR=1.95 (95% CI 1.16 to 3.27). The difference remained when patients with SSc were split into those with limited or diffuse disease, (controls v dSSc, chi(2)=5, 1df, p=0.02 and controls v lSSc, chi(2)=6, 1df, p=0.013). The patients with SSc had significantly more subjects heterozygous at codon 10 (controls v SSc, chi(2)=45, 1df, p<0.0001). Possession of allele C at codon 10 gave an OR=4.8 (95% CI 2.8 to 8.4). No difference in allele frequency was seen between patients with SSc and controls at codon 25. More patients with SSc than controls carried the GG genotype (controls v SSc, 80% v 88%, chi(2)=7, 2df, p=0.027). Possession of allele G gave an OR=1.7 (95% CI 0.5 to 5.9). There was no difference between diffuse and limited disease at either codon.

CONCLUSIONS

These results suggest that patients with SSc are genetically predisposed to high TGFbeta1 production. These polymorphisms do not, however, explain the difference in the clinical phenotypes of limited and diffuse SSc.

Home based neuromuscular electrical stimulation as a new rehabilitative strategy for severely disabled patients with chronic obstructive pulmonary disease (COPD)

BACKGROUND

Passive training of specific locomotor muscle groups by means of neuromuscular electrical stimulation (NMES) might be better tolerated than whole body exercise in patients with severe chronic obstructive pulmonary disease (COPD). It was hypothesised that this novel strategy would be particularly effective in improving functional impairment and the consequent disability which characterises patients with end stage COPD.

METHODS

Fifteen patients with advanced COPD (nine men) were randomly assigned to either a home based 6 week quadriceps femoris NMES training programme (group 1, n=9, FEV(1)=38.0 (9.6)% of predicted) or a 6 week control period before receiving NMES (group 2, n=6, FEV(1)=39.5 (13.3)% of predicted). Knee extensor strength and endurance, whole body exercise capacity, and health related quality of life (Chronic Respiratory Disease Questionnaire, CRDQ) were assessed.

RESULTS

All patients were able to complete the NMES training programme successfully, even in the presence of exacerbations (n=4). Training was associated with significant improvements in muscle function, maximal and endurance exercise tolerance, and the dyspnoea domain of the CRDQ (p<0.05). Improvements in muscle performance and exercise capacity after NMES correlated well with a reduction in perception of leg effort corrected for exercise intensity (p<0.01).

CONCLUSIONS

For severely disabled COPD patients with incapacitating dyspnoea, short term electrical stimulation of selected lower limb muscles involved in ambulation can improve muscle strength and endurance, whole body exercise tolerance, and breathlessness during activities of daily living.

Management of lymphoma patients in a cancer unit: an audit of 15 years' experience in a district general hospital

The objectives were to analyse data obtained in a district general hospital medical oncology unit over a 15-year period, and to provide a comparator for standards of care for lymphoma patients in new cancer units. Prospectively collected data were analysed on 208 consecutive patients presenting with lymphoma, on an 'all-comers' basis, between 1981 and 1996. Treatment was with radiotherapy and/or chemotherapy, according to local protocols. The outcome measure was survival from the date of diagnosis. The 5-year actuarial survival was 72.7% for Hodgkin's disease and 55.7% for non-Hodgkin's lymphoma. Age and stage of disease were the only predictors of survival in a multivariate analysis. Histological classification was not a useful predictor of survival in this analysis. Survival figures comparable with those obtained nationally and across Europe are attainable in a cancer unit. Multiple pathways of referral of lymphoma patients operate in our region.

Seasonal variation in the feeding ecology of the grey-cheeked mangabey (Lophocebus albigena) in Cameroon

Seasonal fluctuations in resource abundance often cause primates to change their feeding behavior and ecology. The objective of this study was to examine the response of a largely frugivorous monkey, the grey-cheeked mangabey (Lophocebus albigena), to seasonal variations in fruit abundance. We used 15-min scan sampling to quantify feeding, activity, and habitat use by monkeys between February and December 1998 in the Dja Reserve, Cameroon. L. albigena were found to have omnivorous feeding habits, consuming the fruits, seeds, leaves, and flowers of 132 plant species. Although monkeys fed from many plant species, only five plant species accounted for 45% of all feeding records. The number of feeding observations on a plant species was significantly correlated with its fruit production. L. albigena responded to fruit-lean periods by shifting from a diet dominated by fruit to one dominated by seeds, flowers, and young leaves. This diet shift coincided with greater use of swamp habitat and higher dietary diversity. L. albigena spent the greatest percentage of scan samples feeding and traveling, but activities varied significantly over the day. Individuals spent a significantly higher percentage of scan samples feeding during the fruit-rich season than in the fruit-lean season. Comparing our results to those of studies in Gabon and Uganda, we found that L. albigena differ across regions in the number of plant species they consume and time spent feeding. These differences may be a result of variations in tree diversity or the strength of seasonal fluctuations in resource abundance among sites.

alpha-adducin and angiotensin I-converting enzyme polymorphisms in essential hypertension

This study focused on two genes that have previously been implicated in hypertension and may influence renal sodium handling, adducin, and angiotensin I-converting enzyme (ACE). We compared their polymorphic frequencies and interaction in patients with essential hypertension (n=128) and individually age- and gender-matched normotensive control subjects. The alpha-adducin G460W polymorphism was genotyped by DNA amplification and restriction digestion. The ACE I/D polymorphism was assayed by a triple-primer method, with a "nested" polymerase chain reaction primer situated completely within the insertion sequence of the I: allele. The distributions of genotypes and alleles for the two polymorphisms were not significantly different between the case and control populations, and the cross-classification of cases by alpha-adducin and ACE genotype gave a distribution similar to that of control subjects. We have previously reported that the distributions of genotypes for two linked polymorphisms in the aldosterone synthase gene (one in the steroidogenic factor-1 [SF-1] binding site and the other an intronic conversion [IC]) were significantly different between this cohort of essential hypertensives and matched control subjects. The cross-classification of cases by alpha-adducin and SF-1, alpha-adducin and IC, ACE and SF-1, and ACE and IC genotype gave a distribution similar to that of control subjects. Hence, no evidence was found to suggest an association between either the alpha-adducin G460W or the ACE I/D polymorphism and hypertension in a careful case-control study. Furthermore, the alpha-adducin G460W, ACE I/D, and aldosterone synthase SF-1 and IC polymorphisms do not appear to interact in our hypertensive population.

Using (1)H magnetic resonance imaging and complementary analytical techniques to characterize developmental changes in the Zantedeschia Spreng. tuber

Nuclear magnetic resonance imaging (MRI) and complementary analytical techniques were used to examine tissue structure and developmental changes occurring during active growth in the root tuber of ZANTEDESCHIA: Spreng. cv. Chianti, a commercially significant cut flower. Plants were observed during the period of leaf senescence and tuberization at the end of the first growth cycle of micropropagated plantlets and, following cool storage to break endodormancy, during development occurring after the replanting of ecodormant tubers. MRI distinguished two distinct regions within the tuber, and the differences in the binding state of water in the two regions were reflected in differences in tissue morphology and function. An abundance of free water was observed in tissue comprised of large parenchyma cells, at the base of the tuber. This tissue appeared to be involved in maintaining the viability of the plant during the period of dormancy, a function indicated primarily by increased metabolic activity in this tissue during dormancy, and reduced metabolic activity during periods of active growth. In contrast, water was more tightly bound in tissue comprised of small parenchyma cells. This tissue appeared to operate as a region for dynamic carbohydrate storage. The initial increase in the free water content of this tissue during the growth phase was linked to the mobilization of starch during canopy development. The subsequent decrease in free water in the remainder of the growth period was linked to the reaccumulation of starch while the tuber functioned as a sink for photosynthate prior to canopy senescence.

Corticosteroid production by fetal rat hippocampal neurons

11beta-hydroxylase and aldosterone synthase catalyse the final stages of corticosterone and aldosterone synthesis respectively. Previously, we established that they are expressed in the rat brain, particularly the cerebellum and the hippocampus. Primary cultures of fetal rat neurons were studied. RT-PCR and immunohistochemistry established that neurons express 11beta-hydroxylase and aldosterone synthase mRNAs and protein. After incubating the cells with 10microM DOC for 24 hours, medium was analysed for aldosterone and corticosterone. Median % conversion of DOC to corticosterone was 7.6% compared to 0.4% in controls. Median % conversion of DOC to aldosterone was 6.2% compared to 0.06% in controls. Corticosteroids mediate a number of functions of mammalian brain, including blood pressure homeostasis, salt appetite and neuronal excitability. Local production of these steroids could have significant effects on these processes.

Expression of 11beta-hydroxylase and aldosterone synthase genes in the rat brain

The terminal stages of cortisol and aldosterone production in the human adrenal gland are catalysed by the enzymes 11beta-hydroxylase and aldosterone synthase, which are encoded by the CYP11B1 and CYP11B2 genes respectively. Recent studies have suggested that aldosterone and cortisol are also made in other tissues such as the brain, heart and vascular system and may play a role in cardiovascular homeostasis. The aim of this study was to confirm the presence of these enzymes and localise them precisely in the rat brain. Reverse transcription-polymerase chain reaction (RT-PCR)/Southern blotting confirmed transcription of CYP11B1 and CYP11B2 in whole brain and hypothalamus minces from Wistar-Kyoto rats. 11beta-Hydroxylase and aldosterone synthase were immunolocalised in paraffin-embedded rat adrenal and brain sections using mouse monoclonal antibodies. Negative controls utilised a mouse monoclonal antibody raised against a non-mammalian epitope. In the brain, 11beta-hydroxylase and aldosterone synthase were detected in the cerebellum, especially the Purkinje cells, as well as the hippocampus. The specificities of the 11beta-hydroxylase and aldosterone synthase antibodies were confirmed by positive immunostaining of the relevant regions of the adrenal cortex. This is the first direct evidence that steroid hydroxylases involved in the final stages of corticosteroid biosynthesis are present in specific regions of the central nervous system.

Skeletal muscle strength and endurance in patients with mild COPD and the effects of weight training

This study poses two questions: 1) is there an abnormality in isokinetic skeletal muscle strength and endurance in mild chronic obstructive pulmonary disease (COPD)? and 2) what is the effect of a randomized, controlled, 12 week hospital outpatient weight training programme in terms of skeletal muscle function and exercise tolerance? Upper and lower limb isokinetic maximum and sustained muscle function were compared in 43 COPD patients (age 49+/-11 yrs), mean forced expiratory volume in one second (FEV1) 77+/-23% pred and 52 healthy, sedentary subjects (age 51 (10) yrs), mean FEV1 109+/-16% pred. The 43 COPD patients were randomly allocated into training (n=26) and control (n=17) groups. Isokinetic and isotonic muscle function, whole body endurance, maximal exercise capacity and lung function were measured. The COPD patients had reduced isokinetic muscle function (with the exception of sustained upper limb strength) as compared with healthy sedentary subjects. Muscle function improved after weight training in the COPD patients. Whole body endurance during treadmill walking also improved with no change in maximal oxygen consumption. A deficit in skeletal muscle function can be identified in patients with mild chronic obstructive pulmonary disease which cannot be explained by factors such as hypoxaemia and malnutrition. Intervention with weight training is effective in countering this deficit which the authors conclude is probably due to muscle deconditioning.

Article I: Prevention and education regarding rabies in human beings. National Working Group on Rabies Prevention and Control

Substantial changes in the epizootic characteristics of rabies have transpired in the United States during the past 50 years. Traditional veterinary practices and public health recommendations have effectively controlled rabies in dogs and prevented associated human fatalities; however, they have been unable to adequately address the problem of rabies in wildlife. Attributable in part to a renewed focus on emerging infectious diseases, a conference was held at the Centers for Disease Control and Prevention in 1993 to begin discussion focused on the reemergence of rabies and to formulate new suggestions for prevention and control of rabies in the United States. Three major working groups were formed from a national committee of professionals representing a broad array of biomedical disciplines. These groups concentrated on prevention of rabies in human beings, education, laboratory diagnosis of rabies, and rabies control in animals. The groups described the perceived minimum requirements to promote prevention and control of rabies in the United States into the next century. The following article describes the needs and recommendations identified by the prevention and education working group. Two other articles, scheduled for the Nov 15 and Dec 1, 1999 issues of JAVMA, will relay the needs and recommendations of the working groups on laboratory diagnosis of rabies and rabies in wildlife.

Physical activity and asthma

The relationship between asthma and exercise and the resultant disability (ie, the impact on activities of daily living, including physical activity) shows wide interpatient and intrapatient variability, being influenced not only by the disease but additional psychosocial variables. There are a variety of helpful pharmacologic and nonpharmacologic measures in dealing with simple exercise-induced asthma, and new therapeutic options are being developed. The cardiorespiratory performance characteristics of asthmatic patients are very frequently suboptimal, either because of symptom-limited exercise tolerance or secondary deconditioning consequent upon inactivity. Medically supervised physical training can produce significant beneficial change. Recommendations for rehabilitation of asthmatic patients would include individualized exercise prescription and advice based on objective criteria of exercise capability, with flexibility in the programs offered, in order to cater to the broadest spectrum of patient disability.

Treatment of endothelial cells with serum from women with preeclampsia: effect on neutrophil adhesion

OBJECTIVE

The purpose of our study was to determine whether the previously reported neutrophil activation that occurs in the maternal circulation of women with preeclampsia is due to a factor (or factors) in serum that increases neutrophil adhesion to endothelial cells.

METHODS

The extent of neutrophil adhesion to endothelial cells incubated with serum from women with preeclampsia (n = 12) was compared with serum from normal, pregnant women matched for maternal age and gestational age at blood sampling (n = 12). Preeclampsia was defined as persistent diastolic blood pressure above 90 mmHg, with proteinuria greater than 0.3 g per 24 hours, in patients who were normotensive before 20 weeks' gestation. The ability of serum (with and without heat inactivation of the complement system) from both groups of patients to stimulate neutrophil adhesion to endothelial monolayers was tested in a 15-minute quantitative assay using fluorescence-labeled neutrophils. The extent of neutrophil adhesion was quantified indirectly from fluorescence counts.

RESULTS

No significant differences were found regarding neutrophil-endothelial cell adhesion in response to media alone, serum from women with preeclampsia, and serum from normal, pregnant women. This was also the case when the serum was heat inactivated to destroy the complement system. However, heat inactivated serum produced a significantly greater extent of adhesion compared with serum containing an intact complement system, regardless of whether the patient had preeclampsia.

CONCLUSION

This study found no evidence of a factor in serum from women with preeclampsia that could alter neutrophil-endothelial cell adhesion via a direct effect on the endothelium. However, our data suggest that adhesion may be regulated in an inhibitory manner by the complement system.

Low intensity peripheral muscle conditioning improves exercise tolerance and breathlessness in COPD

This randomized, controlled study investigated the physiological effects of a specially designed 12 week programme of isolated conditioning of peripheral skeletal muscle groups. The programme required minimal infrastructure in order to allow continued rehabilitation at home after familiarization within hospital. Forty eight patients, aged 40-72 yrs with chronic obstructive pulmonary disease (COPD) (mean (SD) forced expiratory volume in one second (FEV1) 61 (27)% of predicted normal) were randomly allocated into training (n = 32) and control (n = 16) groups. Physiological assessments were performed before and after the 12 week study period, and included peripheral muscle endurance and strength, whole body endurance, maximal exercise capacity (maximum oxygen consumption (V'O2,max)) and lung function. The training group showed significant improvement in a variety of measures of upper and lower peripheral muscle performance, with no additional breathlessness. Whole body endurance measured by free arm treadmill walking increased by 6,372 (3,932-8,812) 3 (p < 0.001). Symptom-limited maximal V'O2 was unchanged. However, the training group showed a reduction in ventilatory equivalents for oxygen and carbon dioxide, both at peak exercise and at equivalent work rate (Wmax). In summary, low intensity isolated peripheral muscle conditioning is well-tolerated, simple and easy to perform at home. The various physiological benefits should enable patients across the range of severity of chronic obstructive pulmonary disease to improve daily functioning.

Sump bay fever: inhalational fever associated with a biologically contaminated water aerosol

OBJECTIVE

To investigate the clinical, serological, and environmental features of a work related inhalational fever associated with exposure to an aerosol generated from a biologically contaminated 130,000 gallon water pool in a building used for testing scientific equipment.

METHOD

Cross sectional survey of all exposed subjects (n = 83) by symptom questionnaire, clinical examination, spirometry, and serology for antibody to Pseudomonads, pool water extract, and endotoxin. In symptomatic patients diffusion capacity was measured, and chest radiology was performed if this was abnormal. Serial peak flow was recorded in those subjects with wheeze. Bacterial and fungal air sampling was performed before and during operation of the water pool pump mechanism. Endotoxin was measured in the trapped waters and in the pumps. Serum cotinine was measured as an objective indicator of smoking.

RESULTS

Of the 20 symptomatic subjects, fever was most common in those with the highest exposure (chi 2 42.7, P < 0.001) in the sump bay when the water was (torrentially) recirculated by the water pumps. Symptoms occurred late in the working day only on days when the water pumps were used, and were independent of the serum cotinine. Pulmonary function was normal in most subjects (spirometry was normal in 79/83, diffusion capacity was low in five subjects, chest radiology was normal). Peak flow recording did not suggest a work relation. The bacterial content of the aerosol rose from 6 to > 10,000 colony forming units per cubic metre (cfu/m3) (predominantly environmental Pseudomonads) when the pumps were operating. High endotoxin concentrations were measured in the waters and oil sumps in the pumps. Low concentrations of antibody to the organisms isolated were detected (apart from two subjects with high antibody) but there was no relation to exposure or the presence of symptoms and similar antibody was found in the serum samples from a non-exposed population. The fever symptoms settled completely with the simple expedient of changing the water and cleaning the pumps.

CONCLUSION

Given the results of our study, the development of inhalational fever in this unique environment and clearly restricted cohort was closely related to the degree of exposure to contaminated aerosol and mainly occurred in the absence of distinct serological abnormality and independent of cigarette smoking.

Efficiency of sampling: birthweight and gestational age distributions in two cohorts, < 31 weeks and 500-1499 grams

We studied the efficiency of two common sampling strategies used to assemble cohorts to study the long-term problems of preterm infants: infants with birthweights of 500-1499 g, and infants with gestational ages (GA) of < 31 weeks. Birthweight, GA and 2-year outcome data from a population based study of infants < 2001 g, the Central New Jersey Brain Hemorrhage Study (NBH), were used to define the birthweight and GA distributions, at enrollment and at the age of 2 years, of overlapping subsets: infants 500-1499 g (n = 599) and infants < 31 weeks of age (n = 522). Using frequencies from the NBH study, we estimated that 1000 infants of 500-1499 g enrolled at birth would produce 712 infants at the age of 2 years, 498 below 31 weeks and 214 above. Enrolling 1000 infants < 31 weeks would produce a cohort of 697 infants at the age of 2, all of whom were < 31 weeks. Neither sampling strategy maximised the statistical power to investigate the pathophysiological determinants of long-term outcomes associated with short GA. Both methods oversampled older GAs. A stratified sampling technique based on GA, designed to produce equal numbers of subjects at each week of GA, would improve statistical power to study long-term outcomes. As we move from descriptive to analytical studies of preterm infants, we need to devise efficient, GA-based, sampling strategies that maximise statistical power to test pathophysiological hypotheses.

Use of static and dynamic NMR microscopy to investigate the origins of contrast in images of biological tissues

NMR imaging experiments have been carried out on a fruit (Actinidia deliciosa) and plant stem (Stachys sylvatica) using a wide range of image contrasts. These included T1, T2, T2*, diffusion, flow and chemical shift selection. In the case of fruit imaging we calculated relaxation time and diffusion maps and established that the imaged parameters varied significantly with fruit ripening. These changes we attribute to changes in water dynamics resulting from elevated sugar concentrations. For the plant stem, water flow has been observed in the xylem vessels with a maximum velocity of 70 microns s-1. The role of image artifacts is considered and, in the case of transverse relaxation, we have demonstrated that it is necessary to use a precursor Carr-Purcell-Meiboom-Gill pulse train if additional diffusive attenuation is to be avoided.

The influence of education on morbidity and mortality in asthma (including the use of open access hospital admission for severe attacks)

Despite the availability of effective drugs, asthma morbidity and mortality are increasing. Undertreatment is a significant contributory factor providing the rationale for improved concentration on education of asthmatics. A review of asthma education programmes reveals improvements in a variety of outcome measures. However, the types of patients studied in these programmes are very variable and it remains an unproven assumption that previously non-compliant and undertreated patients are amenable to improving asthma through education. The problems of compliance are common both in childhood and adult asthma. Further concentration on strategies to improve the management of this particular sub-group require development. In general, education programmes appear more effective when they consist of specific self-management instructions rather than general education regarding the disease process.