Resistance exercise and insulin regulate AS160 and interaction with 14-3-3 in human skeletal muscle

A single bout of aerobic exercise can enhance insulin action, but whether a similar effect occurs after resistance exercise is unknown. Hyperinsulinemic-euglycemic clamps were performed on eight male subjects at rest and after a single bout and three repeated bouts of resistance exercise over 7 days. Skeletal muscle biopsies were taken before and after the clamp and immediately after a single exercise bout. Whole-body insulin action measured by glucose infusion rate decreased (P < 0.05) after a single exercise bout, whereas in response to repeated bouts of resistance exercise, the glucose infusion rate was similar to the rest trial. In skeletal muscle, Akt substrate of 160 kDa (AS160) phosphorylation, an Akt substrate implicated in the regulation of GLUT4 translocation, and its interaction with 14-3-3 was decreased (P < 0.05) only after a single exercise bout. Insulin increased (P < 0.05) phosphorylation of AS160 and its interaction with 14-3-3, but the insulin response was not influenced by resistance exercise. Phosphorylation of insulin receptor substrate-1 and Akt were similar to changes in AS160 phosphorylation after exercise and/or insulin. In conclusion, a single bout of resistance exercise impairs whole-body insulin action. Regulation of AS160 and interaction with 14-3-3 in skeletal muscle are influenced by resistance exercise and insulin but do not fully explain the effect of resistance exercise on whole-body insulin action.

Do as I say, not as I do: Ralph Greenson, Anna Freud, and superrich patients

Ralph Greenson's The Technique and Practice of Psychoanalysis acted as a bible for generations of analysts on what to do and what not to do in psychoanalysis. Yet Greenson ignored the strictures of his own textbook, The Technique and Practice of Psychoanalysis, in his treatment of a number of superrich patients and celebrities, such as Marilyn Monroe and Lita Annenberg Hazen. This article presents new evidence from the examination of the papers of Ralph Greenson and Anna Freud at UCLA and the Library of Congress. Although it is well known that Greenson stretched boundaries with Monroe, his practice of blurring boundaries with other patients, and helping to funnel their money to Anna Freud's Hampstead Center, is not known. Hazen was not only President of Greenson's Foundation for Research in Psychoanalysis but was also, through Greenson's encouragement, a major contributor to Anna Freud's Hampstead Center. Greenson even went so far as to answer a personal advertisement on her behalf and fly to New York for a weekend to interview the suitor. These activities took place with Anna Freud's knowledge, approval, and collusion. Other cases are also discussed. If only he had taken his own advice.

Fresh Freud: no longer lost in translation

The new translations of Freud into English highlight the question as to the nature of Freud's quest and achievement. They show a livelier Freud than the Strachey translations (Freud, 1953-1974), who used everyday language in his work instead of trying to establish a new technical vocabulary for an esoteric new discipline. However, with the new Penguin editions thus far, fresh Freud is no longer lost in translation. The Standard Edition was created importantly to create an authoritative international trademark and was made more natural "scientific" in appearance. The fresh translations show a Freud in tune with Karl Popper's (1976) approach in his later work that viewed science as essentially problem solving. The example of "Mourning and Melancholia" (Freud, 1917/ 1964, 1917/1981, 1917/2005) is discussed as an exercise in exploration, conjectures, criticism, construct formation, and problem solving. Translation issues are discussed. Instead of being a particular trade mark, the very fact of there being new and different translations opens Freud's works to further questioning about their meanings and intents in the marketplace of ideas and practices

The impact of shift-work and organizational climate on health outcomes in nurses

Shift workers have a higher rate of negative health outcomes than day shift workers. Few studies however, have examined the role of difference in workplace environment between shifts itself on such health measures. This study investigated variation in organizational climate across different types of shift work and health outcomes in nurses. Participants (n = 142) were nursing staff from a metropolitan Melbourne hospital. Demographic items elicited the type of shift worked, while the Work Environment Scale and the General Health Questionnaire measured organizational climate and health respectively. Analysis supported the hypotheses that different organizational climates occurred across different shifts, and that different organizational climate factors predicted poor health outcomes. Shift work alone was not found to predict health outcomes. Specifically, permanent night shift workers had significantly lower coworker cohesion scores compared with rotating day and evening shift workers and significantly higher managerial control scores compared with day shift workers. Further, coworker cohesion and involvement were found to be significant predictors of somatic problems. These findings suggest that differences in organizational climate between shifts accounts for the variation in health outcomes associated with shift work. Therefore, increased workplace cohesion and involvement, and decreased work pressure, may mitigate the negative health outcomes of shift workers.

Introduction to diabetes

This chapter contains sections titled:

* Incidence and prevalence of diabetes
* Overview of diabetes
* Management strategies
* Management targets and regimens
* Short-term complications
* Long-term complications
* Psychological aspects
* Diabetes management requires integrated approaches
* People with diabetes' needs, capacities and resources
* Health professionals' needs
* Integration - is it possible?
* Complementary therapies
* Summary
* References

Behavior and beliefs related to dietary fat are influenced by weight-control status

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The rising prevalence of diabetes and impaired glucose tolerance : the Australian diabetes, obesity and lifestyle study

OBJECTIVE—To determine the population-based prevalence of diabetes and other categories of glucose intolerance (impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]) in Australia and to compare the prevalence with previous Australian data.

RESEARCH DESIGN AND METHODS—A national sample involving 11,247 participants aged >=25 years living in 42 randomly selected areas from the six states and the Northern Territory were examined in a cross-sectional survey using the 75-g oral glucose tolerance test to assess fasting and 2-h plasma glucose concentrations. The World Health Organization diagnostic criteria were used to determine the prevalence of abnormal glucose tolerance.

RESULTS—The prevalence of diabetes in Australia was 8.0% in men and 6.8% in women, and an additional 17.4% of men and 15.4% of women had IGT or IFG. Even in the youngest age group (25–34 years), 5.7% of subjects had abnormal glucose tolerance. The overall diabetes prevalence in Australia was 7.4%, and an additional 16.4% had IGT or IFG. Diabetes prevalence has more than doubled since 1981, and this is only partially explained by changes in age profile and obesity.

CONCLUSIONS—Australia has a rapidly rising prevalence of diabetes and other categories of abnormal glucose tolerance. The prevalence of abnormal glucose tolerance in Australia is one of the highest yet reported from a developed nation with a predominantly Europid background.

Abbreviations: 2hPG, 2-h plasma glucose • AusDiab, Australian Diabetes, Obesity and Lifestyle Study • CD, Census Collector District • FPG, fasting plasma glucose • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • KDM, known diabetes mellitus • NDM, newly diagnosed diabetes mellitus • OGTT, oral glucose tolerance test • WHO, World Health Organization

Effect of exercise intensity on skeletal muscle AMPK signaling in humans

The effect of exercise intensity on skeletal muscle AMP-activated protein kinase (AMPK) signaling and substrate metabolism was examined in eight men cycling for 20 min at each of three sequential intensities: low (40 ± 2% Vo₂ peak), medium (59 ± 1% Vo₂ peak), and high (79 ± 1% Vo₂ peak). Muscle free AMP/ATP ratio only increased at the two higher exercise intensities (P < 0.05). AMPK a1 (1.5-fold) and AMPK a2 (5-fold) activities increased from low to medium intensity, with AMPK a2 activity increasing further from medium to high intensity. The upstream AMPK kinase activity was substantial at rest and only increased 50% with exercise, indicating that, initially, signaling through AMPK did not require AMPK kinase posttranslational modification. Acetyl-CoA carboxylase (ACC)-ßphosphorylation was sensitive to exercise, increasing threefold from rest to low intensity, whereas neuronal NO synthase (nNOS)µphosphorylation was only observed at the higher exercise intensities. Glucose disappearance (tracer) did not increase from rest to low intensity, but increased sequentially from low to medium to high intensity. Calculated fat oxidation increased from rest to low intensity in parallel with ACCß phosphorylation, then declined during high intensity. These results indicate that ACCß phosphorylation is especially sensitive to exercise and tightly coupled to AMPK signaling and that AMPK activation does not depend on AMPK kinase activation during exercise.

Genetic variation in BEACON influences quantitative variation in metabolic syndrome-related phenotypes

The BEACON gene (also known as UBL5) was identified as differentially expressed between lean and obese Psammomys obesus, a polygenic animal model of obesity, type 2 diabetes, and dyslipidemia. The human homologue of BEACON is located on chromosome 19p, a region likely to contain genes affecting metabolic syndrome–related quantitative traits as established by linkage studies. To assess whether the human BEACON gene may be involved in influencing these traits, we exhaustively analyzed the complete gene for genetic variation in 40 unrelated individuals and identified four variants (three novel). The two more common variants were tested for association with a number of quantitative metabolic syndrome–related traits in two large cohorts of unrelated individuals. Significant associations were found between these variants and fat mass (P = 0.026), percentage of fat (P = 0.001), and waist-to-hip ratio (P = 0.031). The same variants were also associated with total cholesterol (P = 0.024), LDL cholesterol (P = 0.019), triglycerides (P = 0.006), and postglucose load insulin levels (P = 0.018). Multivariate analysis of these correlated phenotypes also yielded a highly significant association (P = 0.0004), suggesting that BEACON may influence phenotypic variation in metabolic syndrome–related traits.

Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the third national health and nutrition examination survey

OBJECTIVE— To determine the association between serum 25-hydroxyvitamin D (25OHD) and diabetes risk and whether it varies by ethnicity.
RESEARCH DESIGN AND METHODS— We performed an analysis of data from participants who attended the morning examination of the Third National Health and Nutrition Examination Survey (1988–1994), a cross-sectional survey of a nationally representative sample of the U.S. population. Serum levels of 25OHD, which reflect vitamin D status, were available from 6,228 people (2,766 non-Hispanic whites, 1,736 non-Hispanic blacks, and 1,726 Mexican Americans) aged ≥20 years with fasting and/or 2-h plasma glucose and serum insulin measurements.
RESULTS— Adjusting for sex, age, BMI, leisure activity, and quarter of year, ethnicityspecific odds ratios (ORs) for diabetes (fasting glucose ≥7.0 mmol/l) varied inversely across quartiles of 25OHD in a dose-dependent pattern (OR 0.25 [95% CI 0.11– 0.60] for non-Hispanic whites and 0.17 [0.08–0.37] for Mexican Americans) in the highest vitamin D quartile (25OHD ≥81.0 nmol/l) compared with the lowest 25OHD (≥43.9 nmol/l). This inverse association<br />was not observed in non-Hispanic blacks. Homeostasis model assessment of insulin resistance (loge) was inversely associated with serum 25OHD in Mexican Americans (P ≥ 0.0024) and non-Hispanic whites (P≥0.058) but not non-Hispanic blacks (P≥0.93), adjusting for confounders.
CONCLUSIONS— These results show an inverse association between vitamin D status and diabetes, possibly involving insulin resistance, in non-Hispanic whites and Mexican Americans. The lack of an inverse association in non-Hispanic blacks may reflect decreased sensitivity to vitamin D and/or related hormones such as the parathyroid hormone.

Home-based resistance training is not sufficient to maintain improved glycemic control following supervised training in older individuals with type 2 diabetes

OBJECTIVE—To examine whether improvements in glycemic control and body composition resulting from 6 months of supervised high-intensity progressive resistance training could be maintained after an additional 6 months of home-based resistance training.

RESEARCH DESIGN AND METHODS—We performed a 12-month randomized controlled trial in 36 sedentary, overweight men and women with type 2 diabetes (aged 60–80 years) who were randomly assigned to moderate weight loss plus high-intensity progressive resistance training (RT&WL group) or moderate weight loss plus a control program (WL group). Supervised gymnasium-based training for 6 months was followed by an additional 6 months of home-based training. Glycemic control (HbA_1c), body composition, muscle strength, and metabolic syndrome abnormalities were assessed at 0, 3, 6, 9, and 12 months.

RESULTS—Compared with the WL group, HbA_1c decreased significantly more in the RT&WL group (–0.8%) during 6 months of supervised gymnasium-based training; however, this effect was not maintained after an additional 6 months of home-based training. In contrast, the greater increase in lean body mass (LBM) observed in the RT&WL group compared with the WL group (0.9 kg, P < 0.05) after the gymnasium-based training tended to be maintained after the home-based training (0.8 kg, P = 0.08). Similarly, the gymnasium-based increases in upper body and lower body muscle strength in the RT&WL group were maintained over the 12 months (P < 0.001). There were no between-group differences for changes in body weight, fat mass, fasting glucose, or insulin at 6 or 12 months.

CONCLUSIONS—In older adults with type 2 diabetes, home-based progressive resistance training was effective for maintaining the gymnasium-based improvements in muscle strength and LBM but not glycemic control. Reductions in adherence and exercise training volume and intensity seem to impede the effectiveness of home-based training for maintaining improved glycemic control.

Women exposed to intimate partner violence : expectations and experiences when they encounter health care professionals : a meta-analysis of qualitative studies

Background The appropriate response of health care professionals to intimate partner violence is still a matter of debate. This article reports a meta-analysis of qualitative studies that answers 2 questions: (1) How do women with histories of intimate partner violence perceive the responses of health care professionals? and (2) How do women with histories of intimate partner violence want their health care providers to respond to disclosures of abuse?

Methods Multiple databases were searched from their start to July 1, 2004. Searches were complemented with citation tracking and contact with researchers. Inclusion criteria included a qualitative design, women 15 years or older with experience of intimate partner violence, and English language. Two reviewers independently applied criteria and extracted data. Findings from the primary studies were combined using a qualitative meta-analysis.

Results Twenty-nine articles reporting 25 studies (847 participants) were included. The emerging constructs were largely consistent across studies and did not vary by study quality. We ordered constructs by the temporal structure of consultations with health care professionals: before the abuse is discussed, at disclosure, and the immediate and further responses of the health care professional. Key constructs included a wish from women for responses from health care professionals that were nonjudgmental, nondirective, and individually tailored, with an appreciation of the complexity of partner violence. Repeated inquiry about partner violence was seen as appropriate by women who were at later stages of an abusive relationship.

Conclusion Women’s perceptions of appropriate and inappropriate responses partly depended on the context of the consultation, their own readiness to address the issue, and the nature of the relationship between the woman and the health care professional.

Effect of AICAR treatment on gycogen metabolism in skeletal muscle

AMP-activated protein kinase (AMPK) is proposed to stimulate fat and carbohydrate catabolism to maintain cellular energy status. Recent studies demonstrate that pharmacologic activation of AMPK and mutations in the enzyme are associated with elevated muscle glycogen content in vivo. Our purpose was to determine the mechanism for increased muscle glycogen associated with AMPK activity in vivo. AMPK activity and glycogen metabolism were studied in red and white gastrocnemius muscles from rats treated with 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR) in vivo, and also in muscles incubated with AICAR in vitro. In vivo AICAR treatment reduced blood glucose and increased blood lactate compared with basal values. AICAR increased muscle α2 AMPK activity, glycogen, and glucose-6-phosphate concentrations. Glycogen synthase activity was increased in the red gastrocnemius but was decreased in the white gastrocnemius. Glycogen phosphorylase activity increased in both muscles, with an inhibition initially observed in the red gastrocnemius. In vitro incubation with AICAR activated α2 AMPK but had no effect on either glycogen synthase or glycogen phosphorylase. These results suggest that AICAR treatment does not promote glycogen accumulation in skeletal muscle in vivo by altering glycogen synthase and glycogen phosphorylase. Rather, the increased glycogen is due to the well-known effects of AICAR to increase glucose uptake.

Redistribution of glucose from skeletal muscle to adipose tissue during catch-up fat. A link between catch-up growth and later metabolic syndrome.

Catch-up growth, a risk factor for later obesity, type 2 diabetes, and cardiovascular diseases, is characterized by hyperinsulinemia and an accelerated rate for recovering fat mass, i.e., catch-up fat. To identify potential mechanisms in the link between hyperinsulinemia and catch-up fat during catch-up growth, we studied the in vivo action of insulin on glucose utilization in skeletal muscle and adipose tissue in a previously described rat model of weight recovery exhibiting catch-up fat caused by suppressed thermogenesis per se. To do this, we used euglycemic-hyperinsulinemic clamps associated with the labeled 2-deoxy-glucose technique. After 1 week of isocaloric refeeding, when body fat, circulating free fatty acids, or intramyocellular lipids in refed animals had not yet exceeded those of controls, insulin-stimulated glucose utilization in refed animals was lower in skeletal muscles (by 20–43%) but higher in white adipose tissues (by two- to threefold). Furthermore, fatty acid synthase activity was higher in adipose tissues from refed animals than from fed controls. These results suggest that suppressed thermogenesis for the purpose of sparing glucose for catch-up fat, via the coordinated induction of skeletal muscle insulin resistance and adipose tissue insulin hyperresponsiveness, might be a central event in the link between catch-up growth, hyperinsulinemia and risks for later metabolic syndrome.

Distributions of caregiving tasks among family members: the place of gender and availability.

To extend family-oriented approaches to caregiving, participants in 2 studies were asked to distribute tasks among a set of adult children, first with information only about gender and then with systematically varied information about commitments to paid work, marriage, and/or parenting. Making the distributions, using a computer-based program, were 2 groups of older adults (ages 60 to 90 years). In Study 1, gender composition was kept constant (2 sons and 2 daughters). In Study 2, it was varied. The results showed several ways in which people combine attention to gender and to availability. The results also pointed to the need to consider both the number and type of tasks allocated. The results are discussed in terms of implications for the way caregiving is regarded, the development of multiple-factor models for variations among family members, and the possible replications and extensions to other circumstances and populations.