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Working With LGBT Baby Boomers and Older Adults: Factors That Signal a Welcoming Service Environment. - Journal of gerontological social work
Many providers recognize the importance of creating culturally competent services for lesbian, gay, bisexual, and transgender (LGBT) older adults. Although multiple resources list steps to make professional practices more LGBT-welcoming, these resources provide no empirical data to support their recommendations. LGBT older adults (NÂ =Â 327) were asked to describe what signals that a provider is LGBT-welcoming. Six of the top 10 signals related to provider behavior and suggest the importance of staff training; the balance included display of signage and rainbow flags, use of inclusive language on forms and the presence of LGBT-identified staff. Results provide evidence-based recommendations for working with LGBT older adults.
Documented lifestyle education among young adults with incident hypertension. - Journal of general internal medicine
Only 38% of young adults with hypertension have controlled blood pressure. Lifestyle education is a critical initial step for hypertension control. Previous studies have not assessed the type and frequency of lifestyle education in young adults with incident hypertension.The purpose of this study was to determine patient, provider, and visit predictors of documented lifestyle education among young adults with incident hypertension.We conducted a retrospective analysis of manually abstracted electronic health record data.A random selection of adults 18-39 years old (n = 500), managed by a large academic practice from 2008 to 2011 and who met JNC 7 clinical criteria for incident hypertension, participated in the study.The primary outcome was the presence of any documented lifestyle education during one year after meeting criteria for incident hypertension. Abstracted topics included documented patient education for exercise, tobacco cessation, alcohol use, stress management/stress reduction, Dietary Approaches to Stop Hypertension (DASH) diet, and weight loss. Clinic visits were categorized based upon a modified established taxonomy to characterize patients' patterns of outpatient service. We excluded patients with previous hypertension diagnoses, previous antihypertensive medications, or pregnancy. Logistic regression was used to identify predictors of documented education.Overall, 55% (n = 275) of patients had documented lifestyle education within one year of incident hypertension. Exercise was the most frequent topic (64%). Young adult males had significantly decreased odds of receiving documented education. Patients with a previous diagnosis of hyperlipidemia or a family history of hypertension or coronary artery disease had increased odds of documented education. Among visit types, chronic disease visits predicted documented lifestyle education, but not acute or other/preventive visits.Among young adults with incident hypertension, only 55% had documented lifestyle education within one year. Knowledge of patient, provider, and visit predictors of education can help better target the development of interventions to improve young adult health education and hypertension control.
Friends, family, and caregiving among midlife and older lesbian, gay, bisexual, and transgender adults. - Journal of homosexuality
The study examines the frequency and nature of the informal caregiving experience for midlife and older lesbian, gay, bisexual, or transgender (LGBT) adults. Responses from a Twin Cities Metropolitan Area LGBT aging needs assessment survey were analyzed for social supports, current caregiving activity and availability of a caregiver. The majority of respondents identified a primary caregiver who was not a legal relation; and compared to the general population were (a) less likely to have traditional sources of caregiver support and (b) more likely to be serving as a caregiver and caring for someone to whom they were not legally related. Implications of the findings for enhancing resources to more fully support the 10% of caregivers that are caring for non-kin are discussed.
Superoxide mediates acute renal vasoconstriction produced by angiotensin II and catecholamines by a mechanism independent of nitric oxide. - American journal of physiology. Heart and circulatory physiology
NAD(P)H oxidases (NOX) and reactive oxygen species (ROS) are involved in vasoconstriction and vascular remodeling during hypertension produced by chronic angiotensin II (ANG II) infusion. These effects are thought to be mediated largely through superoxide anion (O(2)(-)) scavenging of nitric oxide (NO). Little is known about the role of ROS in acute vasoconstrictor responses to agonists. We investigated renal blood flow (RBF) reactivity to ANG II (4 ng), norepinephrine (NE, 20 ng), and alpha(1)-adrenergic agonist phenylephrine (PE, 200 ng) injected into the renal artery (ira) of anesthetized Sprague-Dawley rats. The NOX inhibitor apocynin (1-4 mg.kg(-1).min(-1) ira, 2 min) or the superoxide dismutase mimetic Tempol (1.5-5 mg.kg(-1).min(-1) ira, 2 min) rapidly increased resting RBF by 8 +/- 1% (P < 0.001) or 3 +/- 1% (P < 0.05), respectively. During NO synthase (NOS) inhibition (N(omega)-nitro-l-arginine methyl ester, 25 mg/kg iv), the vasodilation tended to increase (apocynin 13 +/- 4%, Tempol 10 +/- 1%). During control conditions, both ANG II and NE reduced RBF by 24 +/- 4%. Apocynin dose dependently reduced the constriction by up to 44% (P < 0.05). Similarly, Tempol blocked the acute actions of ANG II and NE by up to 48-49% (P < 0.05). In other animals, apocynin (4 mg.kg(-1).min(-1) ira) attenuated vasoconstriction to ANG II, NE, and PE by 46-62% (P < 0.01). During NOS inhibition, apocynin reduced the reactivity to ANG II and NE by 60-72% (P < 0.01), and Tempol reduced it by 58-66% (P < 0.001). We conclude that NOX-derived ROS substantially contribute to basal RBF as well as to signaling of acute renal vasoconstrictor responses to ANG II, NE, and PE in normal rats. These effects are due to O(2)(-) rather than H(2)O(2), occur rapidly, and are independent of scavenging of NO.
Antidepressant effects of exercise: evidence for an adult-neurogenesis hypothesis? - Journal of psychiatry & neuroscience : JPN
It has been hypothesized that a decrease in the synthesis of new neurons in the adult hippocampus might be linked to major depressive disorder (MDD). This hypothesis arose after it was discovered that antidepressant medications increased the synthesis of new neurons in the brain, and it was noted that the therapeutic effects of antidepressants occurred over a time span that approximates the time taken for the new neurons to become functional. Like antidepressants, exercise also increases the synthesis of new neurons in the adult brain: a 2-3-fold increase in hippocampal neurogenesis has been observed in rats with regular access to a running wheel when they are compared with control animals. We hypothesized, based on the adult-neurogenesis hypothesis of MDD, that exercise should alleviate the symptoms of MDD and that potential mechanisms should exist to explain this therapeutic effect. Accordingly, we evaluated studies that suggest that exercise is an effective treatment for MDD, and we explored potential mechanisms that could link adult neurogenesis, exercise and MDD. We conclude that there is evidence to support the hypothesis that exercise alleviates MDD and that several mechanisms exist that could mediate this effect through adult neurogenesis.
Hippocampal cell proliferation is reduced following prenatal ethanol exposure but can be rescued with voluntary exercise. - Hippocampus
The ingestion of ethanol during pregnancy has a number of deleterious consequences for the unborn offspring, producing structural and functional deficits that affect the brain and many other organs into adulthood. The hippocampus is a brain area that is particularly sensitive to ethanol's adverse effects. In a previous study we showed that voluntary exercise can ameliorate deficits in long-term potentiation and behavior that occur following prenatal ethanol exposure (Eur J Neurosci, 2005, 21, 1719-1726). In the present study, we investigated the effects of prenatal ethanol exposure on neurogenesis in adulthood, and tested the hypothesis that voluntary exercise would ameliorate any deficits observed. Sprague-Dawley females were administered one of three diets throughout gestation: (i) ethanol (E), a liquid diet containing 36.5% ethanol-derived calories; (ii) pair-fed (PF), a liquid control diet, with maltose-dextrin isocalorically substituted for ethanol, in the amount consumed by an E partner (g/kg body wt/day of gestation); and (iii) ad-libitum-fed control (C), normal laboratory chow and water, ad libitum. The offspring were housed individually at postnatal day (PND) 35, and at PND 50 were randomly assigned to cages either with or without an exercise wheel. BrdU (200 mg/kg, I.P.) was injected on PND 57, and animals terminated either 24 h (proliferation) or 4 weeks (neurogenesis) later. Our results demonstrate that prenatal ethanol exposure significantly decreases both cell proliferation and neurogenesis in the adult dentate gyrus. Animals in the PF condition also showed reduced neurogenesis. In contrast, all animals that engaged in voluntary exercise showed a significant increase in cell proliferation and neurogenesis. These results indicate that prenatal ethanol exposure can suppress both cell proliferation and neurogenesis, and that these effects may be, at least in part, nutritionally mediated. Importantly, voluntary exercise appears to have beneficial effects for these long-lasting deficits in hippocampal volume and cell number that have been observed in animals exposed to ethanol in utero.(c) 2006 Wiley-Liss, Inc.
Environmental enrichment and voluntary exercise massively increase neurogenesis in the adult hippocampus via dissociable pathways. - Hippocampus
Environmental enrichment (EE) and voluntary exercise (VEx) have consistently been shown to increase adult hippocampal neurogenesis and improve spatial learning ability. Although it appears that these two manipulations are equivalent in this regard, evidence exists that EE and VEx affect different phases of the neurogenic process in distinct ways. We review the data suggesting that EE increases the likelihood of survival of new cells, whereas VEx increases the level of proliferation of progenitor cells. We then outline the factors that may mediate these relationships. Finally, we provide a model showing that VEx leads to the convergence of key somatic and cerebral factors in the dentate gyrus (DG) to induce cell proliferation. Although insufficient evidence exists to provide a similar model for EE, we suggest that EE-induced cell survival in the DG involves cortical restructuring as a means of promoting survival. We conclude that EE and VEx lead to an increase in overall hippocampal neurogenesis via dissociable pathways, and should therefore, be considered distinct interventions with regard to hippocampal plasticity and associated behaviors.(c) 2006 Wiley-Liss, Inc.
NO and NO-independent mechanisms mediate ETB receptor buffering of ET-1-induced renal vasoconstriction in the rat. - American journal of physiology. Regulatory, integrative and comparative physiology
Vascular endothelin (ET) type B (ET(B)) receptors exert dilator and constrictor actions in a complex interaction with ET(A) receptors. We aimed to clarify the presence and relative importance of nitric oxide (NO) and other mechanisms underlying the dilator effects of ET(B) receptors in rat kidneys. Complete inhibition of NO production with Nomega-nitro-L-arginine methyl ester (L-NAME, 25 mg/kg iv) enhanced the renal vasoconstriction elicited by ET-1 injected into the renal artery from -15 to -30%. Additional infusion of the NO donor nitroprusside (NP) into the renal artery did not reverse this effect (-29%) but effectively buffered ANG II-mediated vasoconstriction. Similarly, ET-1 responses were enhanced after a smaller intrarenal dose of L-NAME (-22 vs. -15%) and were unaffected by subsequent NP infusion (-21%). These results indicate that the responsiveness to ET-1 is buffered by ET(B) receptor-stimulated phasic release of NO, rather than its static mean level. Infusion of the ET(B) receptor antagonist BQ-788 into the renal artery further enhanced the ET-1 constrictor response to NP+L-NAME (-92 vs. -49%), revealing an NO-independent dilator component. In controls, vasoconstriction to ET-1 was unaffected by vehicle (-27 vs. -20%) and markedly enhanced by BQ-788 (-70%). The same pattern was observed when indomethacin (Indo) was used to inhibit cyclooxygenase (-20% for control, -22% with Indo, and -56% with ET(B) antagonist) or methylsulfonyl-6-(2-propargyloxyphenyl)-hexanamide (MS-PPOH) or miconazole+Indo was used to inhibit epoxygenase alone (-10% for control, -11% with MS-PPOH, and -35% with ET(B) antagonist) or in combination (-14% for control, -20% with Indo + miconazole, and -43% with ET(B) antagonist). We conclude that phasic release of NO, but not its static level, mediates part of the dilator effect of ET(B) receptors and that an NO-independent mechanism, distinct from prostanoids and epoxyeicosatetraenoic acids, perhaps ET(B) receptor clearance of ET-1, plays a major buffering role.
Dual constrictor and dilator actions of ET(B) receptors in the rat renal microcirculation: interactions with ET(A) receptors. - American journal of physiology. Renal physiology
The vascular actions of endothelin-1 (ET-1) reflect the combination of vasoconstrictor ET(A) and ET(B) receptors on smooth muscle cells and vasodilator ET(B) receptors on endothelial cells. The present study investigated the contribution of ET receptor subtypes using a comprehensive battery of agonists and antagonists infused directly into the renal artery of anesthetized rats to evaluate the actions of each receptor class alone and their interactions. ET-1 (5 pmol) reduced renal blood flow (RBF) 25+/-1%. ET(A) antagonist BQ-123 attenuated this response to a 15+/-1% decrease in RBF (P < 0.01), indicating net constriction by ET(B) receptors. Combined receptor blockade (BQ-123+BQ-788) resulted in a renal vasoconstriction of 7+/-1% (P = 0.001 vs. BQ-123), supporting a constrictor action of ET(B) receptors. In marked contrast, the ET(B) antagonist BQ-788 enhanced the ET-1 RBF response to 60+/-5% (P < 0.001), suggesting ET(B)-mediated net dilation. Consistent with ET(A) blockade, the ET(B) agonist sarafotoxin 6C (S6C) produced vasoconstriction, reducing RBF by 23+/-5%. Dose-response curves for ET-1 and S6C showed similar degrees of constriction between 0.2 and 100 pmol. Both antagonists (BQ-123, BQ-788) were equally effective at threefold lower than the standard doses, suggesting complete inhibition. We conclude that ET(B) receptors alone exert a net constrictor effect but cause a net dilator influence when costimulated with ET(A) receptors. Such opposing actions indicate more complex than additive interaction between receptor subtypes. Model analysis suggests ET(A)-mediated constriction is appreciably greater without than with costimulation of ET(B) receptors. Possible explanations include ET-1 clearance by ET(B) receptors and/or a dilator ET(B) receptor function that counteracts constriction.
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