Obesity blunts insulin-mediated microvascular recruitment in human forearm muscle

We have previously shown that skeletal muscle capillaries are rapidly recruited by physiological doses of insulin in both humans and animals. This facilitates glucose and insulin delivery to muscle, thus augmenting glucose uptake. In obese rats, both insulin-mediated microvascular recruitment and glucose uptake are diminished; however, this action of insulin has not been studied in obese humans. Here we used contrast ultrasound to measure microvascular blood volume (MBV) (an index of microvascular recruitment) in the forearm flexor muscles of lean and obese adults before and after a 120-min euglycemic-hyperinsulinemic (1 mU . min(-1) . kg(-1)) clamp. We also measured brachial artery flow, fasting lipid profile, and anthropomorphic variables. Fasting plasma glucose (5.4 +/- 0.1 vs. 5.1 +/- 0.1 mmol/l, P = 0.05), insulin (79 +/- 11 vs. 38 +/- 6 pmol/l, P = 0.003), and percent body fat (44 +/- 2 vs. 25 +/- 2%, P = 0.001) were higher in the obese than the lean adults. After 2 h of insulin infusion, whole-body glucose infusion rate was significantly lower in the obese versus lean group (19.3 +/- 3.2 and 37.4 +/- 2.6 mumol . min(-1) . kg(-1) respectively, P < 0.001). Compared with baseline, insulin increased MBV in the lean (18.7 +/- 3.3 to 25.0 +/- 4.1, P = 0.019) but not in the obese group (20.4 +/- 3.6 to 18.8 +/- 3.8, NS). Insulin increased brachial artery diameter and flow in the lean but not in the obese group. We observed a significant, negative correlation between DeltaMBV and BMI (R = -0.482, P = 0.027) in response to insulin. In conclusion, obesity eliminated the insulin-stimulated muscle microvascular recruitment and increased brachial artery blood flow seen in lean individuals.     

Helping the helpers: an international training program for professionals providing social services for hiv‐positive children and their families in Southern Kazakhstan

Over one hundred children and some of their parents were infected with HIV in state hospitals in the Chimkent region in Southern Kazakhstan. After this tragedy, the Regional Department of Public Health organized social services for these families and asked the American Jewish Joint Distribution Committee (JDC) to provide them with training and supervision. Twelve seminars were conducted for the social workers in Chimkent over an 18‐month period. The JDC team also met with the local medical staff as well as with governmental and nongovernmental organizations to assess their needs and provide organizational support for the social services. This article presents an analysis of the psychosocial challenges associated with the mass HIV infection episode in Kazakhstan. The analysis is based on Hofstede's ( 2001 ) theory of cultural values, theories on cross‐cultural interaction (Cushner & Brislin, 1995 ), and principles of multicultural social work (Potocky‐Tripodi, 2002 ). The training program is described, and its results are discussed. General principles and practical recommendations for planning and implementing cross‐cultural international humanitarian programs in the field of HIV are suggested. © 2011 Wiley Periodicals, Inc.     

Assessing Homework Problems in Children with ADHD: Validation of a Parent-Report Measure and Evaluation of Homework Performance Patterns

The factor structure of a parent-report measure of child homework problems, the Homework Problems Checklist (HPC), was examined in a geographically and ethnically diverse sample of children with attention-deficit/hyperactivity disorder (ADHD). This measure was completed by the parents of 579 children ages 7.0–9.9 diagnosed with ADHD Combined Type as part of the multimodal treatment study of children with ADHD (MTA). Results replicated previous work showing two salient factors that measure homework completion behaviors (Factor I) and homework management behaviors (Factor II). This two-factor solution remained consistent when examined across child sex and ethnicity subgroups. Analysis of patterns revealed that homework problems are greater for children in higher grades and that children with ADHD and comorbid learning disabilities experience significantly more homework problems than children with ADHD alone. This study also replicated previous work showing that homework problems and ADHD inattentive symptoms are highly correlated whereas correlations between homework problems and hyperactivity and impulsivity are low to moderate. Implications of the findings for the assessment of homework problems in children with ADHD and for intervention are discussed.