Expression of neurturin, glial cell line-derived neurotrophic factor, and their receptor components in light-induced retinal degeneration

PURPOSE: Dysregulation of neurturin (NTN) expression has been linked to photoreceptor apoptosis in a mouse model of inherited retinal degeneration. To investigate the extent to which any such dysregulation depends on the nature of the apoptotic trigger, the expression of NTN, glial cell line-derived neurotrophic factor (GDNF), and their corresponding receptor components were compared in a rat model of light-induced retinal degeneration. METHODS: Retinal expression of NTN, GDNF, their corresponding receptors GFRalpha-2 and -1, the transmembrane receptor tyrosine kinase (Ret), and cSrc-p60, a member of the cytoplasmic protein-tyrosine kinases family, were analyzed by Western blot analysis and immunocytochemistry in cyclic light- and dark-reared rats in the presence and absence of intense light exposure. RESULTS: All components for NTN-mediated signaling activation are present in rat photoreceptors and retinal pigment epithelium, the cells primarily affected by light-induced damage. The expression levels of GDNF, its receptor components, and NTN, were not affected by light-induced stress. However, GFRalpha-2 expression strikingly increased with the extent of retinal damage, especially at the photoreceptors, in contrast to decreased levels that were observed previously in an inherited degeneration model. CONCLUSIONS: The present study indicates that the expression of receptors of the GDNF family is independently regulated in normal and light-damaged rat retina, and in conjunction with previous work, suggests that the pattern of modulation of these genes during photoreceptor degeneration is determined by the nature of the apoptotic trigger. Such differential responses to different modes of retinal degeneration may reflect influences of the neurotrophic system on photoreceptor survival or in the regulation of neuronal plasticity.     

Vasculitis of the lacrimal sac wall in Wegener granulomatosis

A 35-year-old woman with a 4-year history of generalized Wegener granulomatosis (WG) had clinically controlled disease. She was evaluated for a 6-month history of right lacrimal sac mass. On examination, a right chronic dacryocystitis and mucocele were observed. A right external dacryocystorhinostomy was performed. The surgical biopsy specimen from the lacrimal sac showed leukocytoclastic vasculitis with more aggressive damage to the small vessels in the deeper mucosa and focal microhemorrhages. The patient was free of symptoms 1 year after surgery. We believe this is the first report of generalized WG presenting features of an active vasculitis of the lacrimal sac wall on surgical biopsy specimen. We conclude that the lacrimal drainage system can be affected directly by focal WG vasculitis, suggesting that nasolacrimal duct obstruction is not always due to contiguous paranasal disease.     

Providing health care to low-income women: a matter of trust

BACKGROUND: Trust is an important indicator of quality in patient-provider relationships and predicts adherence to certain protective health behaviours. It has been relatively unexplored among low-income or minority women. OBJECTIVES: We explored health care experiences that influence patient trust among low-income women in the USA with respect to professionals and lay health workers (LHWs). METHODS: Focus groups were conducted with 33 prenatal and postpartum women, aged 18-45 years, recruited from community-based public prenatal care programmes. Focus groups were audio-recorded, transcribed, and independently coded by readers. A model of factors associated with trust was developed based on the major thematic categories. RESULTS: Most women were Black (67%) and had completed high school (85%). Factors related to greater trust specific to patient-provider relationships were: continuity of the patient-provider relationship, effective communication, demonstration of caring and perceived competence. Women with less trust in their physicians reported an unwillingness to follow his/her advice. Most women reported having more trusting relationships with LHWs and nurses than with physicians, probably due to greater contact with these staff. Several women with a low level of trust reported experiences of discrimination due to lack of insurance. CONCLUSIONS: Prenatal care presents a unique opportunity for providers to contribute to the elimination of health disparities among low-income women. Improving continuity with public health prenatal care providers and building strong relationships with LHWs may enhance quality of care and contribute to achieving this goal. Better patient-provider communication is also a practical area of focus towards improving patient trust.     

Public health interactions with the public: can quality be assured? "This call may be monitored for quality assurance purposes"

I describe what happened when a citizen called her state health department "after-hours" to report possible contamination of food at a commercial establishment. The call, inadequately handled by the health department, illustrates the need to assure quality of the public health responses to calls on a 24 hour, 7-day week basis. I examine possible reasons for the poor response. Health departments should consider training for those assigned to handle phone calls from the public, such as that provided to poison control center personnel. In addition, a quality assurance program should routinely assess the adequacy of public health responses. As medical care is available on an emergency basis, 24 hours a day, 7 days a week, emergency services for prevention of illness in the population should be available to the public at all times with the response provided by appropriately trained individuals.     

Changes in weight and body image over time in women with eating disorders

BACKGROUND: This study examined the changes in body image and weight in young women with an adolescent eating disorder, relative to women without an eating disorder (noED). METHOD: Three diagnostic groups, anorexia nervosa (AN; n = 10), bulimia nervosa (BN; n = 27), and binge eating disorder (BED; n = 42) and three comparison groups (noED; n = 659 each) were compared on body mass index (BMI) and self-reported current body size, ideal body size, and weight dissatisfaction. Dependent variables were examined 2 and 1 year before the onset, the onset year, and 1 and 2 years after the onset of the eating disorder in a model that was adjusted for ethnicity and BMI. RESULTS: BMI was lower in the AN group at all time points except 2 years before onset. AN girls evidenced a significantly stronger relation between BMI and current self-ratings and weight dissatisfaction than noED girls. BMI did not differ between the BN group and the noED group. Girls with BN reported larger current body sizes and greater weight dissatisfaction across all time points. The BED group had higher BMI than the noED group across time. BED girls reported greater current body size ratings and weight dissatisfaction than the noED girls. Girls with AN, BN, or BED did not differ from the noED girls on body ideal ratings. DISCUSSION: Body weight seems to influence perception of body size more so for girls with AN than for noED girls. No support was found for an accelerated weight gain over time for BN. Weight may increase over time for the BED group relative to the noED group, but larger studies are needed. Across all three groups, ideal body size appears to be unrelated to diagnostic status. Rather, the risk for developing an eating disorder appears to arise from size overestimation and related weight dissatisfaction.     

Measuring eating concerns in Black and White adolescent girls

OBJECTIVE: Few instruments exist to measure eating concerns in adolescent girls from diverse ethnic backgrounds. METHODS: A Children's version of the Eating Disorder Inventory (EDI-C) has been under development for several years and was designed to be more appropriate for younger children with lower reading levels. However, little is known about the validity of this instrument. The current study reports on the factor structure of an early version of the EDI-C using nonclinical samples of 1,073 White and 1,155 Black girls (ages 11-12). RESULTS: Factor analysis resulted in an eight-factor solution for each group that included a weight concerns factor and an emotional distress factor. For Black girls only, the positively worded items from the Body Dissatisfaction subscale loaded on a separate factor. Four of five factors were similar to the original EDI subscales (Bulimia, Interpersonal Distrust, Maturity Fears, and Perfectionism), although the latter was unique to White girls. DISCUSSION: The factor structure was generally similar for Black and White girls, although the separate body satisfaction factor and lack of shared variance for the perfectionism factor for Black girls suggest that EDI data obtained from ethnic minority samples may need to be interpreted cautiously.     

Report of the National Institutes of Health workshop on overcoming barriers to treatment research in anorexia nervosa

OBJECTIVE: Anorexia nervosa (AN) is associated with serious medical morbidity and has the highest mortality rate of all psychiatric disorders. The National Institutes of Health (NIH) Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa convened on September 26-27, 2002 to address the dearth of treatment research in this area. The goals of this workshop were to discuss the stages of illness and illness severity, pharmacologic interventions, psychological interventions, and methodologic considerations. METHOD: The program consisted of a series of brief presentations by moderators, each followed by a discussion of the topic by workshop participants, facilitated by the session chair. RESULTS: This report summarizes the major discussions of these sessions and concludes with a set of recommendations related to the development of treatment research in AN based on these findings. DISCUSSION: It is crucial that treatment research in this area be prioritized.     

Gender differences in factors affecting use of health services: an analysis of a community study of middle-aged and older Australians

Research on patterns of self-rated health and health service use suggests that women report having poorer health than men, and that, after controlling for health measures, women are more likely to obtain formal health care. Proposed reasons for these differences have included that women's self-rated health is more strongly influenced by psychosocial factors or negative affect and that women are likely to obtain services when at better levels of self-rated health, compared with men. Our study explored gender differences in the effects of non-health attributes on decisions to obtain primary medical services for an Australian community-based sample of 4140 adults from two age groups: 40-44 years and 60-64 years. Participants provided information on measures of physical and mental health, and on predisposing and enabling factors that could affect their levels of health service use. Information on visits made to general practitioners (GPs) in a 6-month period was obtained from the national insurer. We found that men and women who obtained no GP services reported comparable levels of physical and mental health and that, for both men and women, measures of health needs were most strongly associated with their obtaining care. After controlling for measures of mental and physical health and enabling factors, we found that non-health factors that could predispose an individual to obtain care had greater impact on men's but not women's decisions to obtain any GP services. Our findings do not support the hypothesis that in choosing to obtain medical care, women are more strongly influenced by non-health factors compared with men.