Shifting dementia discourses from deficit to active citizenship

Within western cultures, portrayals of dementia as ‘a living death’ are being challenged by people living with the diagnosis. Yet dementia remains one of the most feared conditions. The sociological lens of citizenship provides a conceptual framework for reviewing the role of society and culture in repositioning dementia away from deficit to a discourse of agency and interdependence. Awareness of cognitive change, and engaging with the diagnostic process, moves people into a transitional, or ‘liminal’ state of uncertainty. They are no longer able to return to their previous status, but may resist the unwanted status of ‘person with dementia’. Drawing on qualitative studies on social participation by people with dementia, we suggest that whether people are able to move beyond the liminal phase depends on acceptance of the diagnosis, social capital, personal and cultural beliefs, the responses of others and comorbidities. Some people publicly embrace a new identity whereas others withdraw, or are withdrawn, from society to live in the shadow of the fourth age. We suggest narratives of deficit fail to reflect the agency people with dementia can enact to shape their social worlds in ways which enable them to establish post‐liminal citizen roles. (A Virtual Abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA )     

Corticosterone supplementation reduced selective protein kinase C isoform expression in the epidermis of adrenalectomized mice.

Previous research in this laboratory demonstrated elevated plasma corticosterone and reduced protein kinase C (PKC) activity and selective isoform expression in the epidermis of dietary energy-restricted mice. Because PKC is implicated in skin carcinogenesis and because both energy restriction and glucocorticoid hormone inhibit skin carcinogenesis, the purpose of the present research was to determine whether the elevated glucocorticoid hormone in the energy-restricted mouse contributed to the changes in PKC protein expression. Two strategies were used to control corticosterone in adrenalectomized mice: (a) corticosterone-containing pellets were implanted in mice, and a dose response increase in corticosterone was observed with 5-, 10-, and 35-mg corticosterone implants with average peak values of 68 +/- 22 ng/ml (P < 0.01); and (b) corticosterone was administered in the drinking water, and plasma corticosterone was elevated in a dose-dependent manner in mice killed at 6:00-6:30 p.m. (P < 0.01; peak values of 300-400 ng/ml). The expression of PKCalpha, PKCdelta, and PKCepsilon protein were not consistently altered by corticosterone with the two strategies. PKCeta protein expression was elevated in the adrenalectomized mice administered 3 or 60 microg of corticosterone/ml in drinking water (P < 0.01). PKCzeta protein expression was reduced by all doses of corticosterone in the implant or drinking water (P < 0.05), and a reduction of 41% was achieved with the mice administered 60 microg of corticosterone/ml in drinking water. In mice fed control or energy-restricted diet, with or without adrenalectomy, PKCzeta protein was reduced in sham-operated, energy-restricted mice in comparison with control diet, sham-operated mice (P < 0.02), whereas PKCzeta protein was not significantly different between adrenalectomized control and adrenalectomized, energy-restricted mice. These data indicate that administration of corticosterone in drinking water most closely mimicked the circulating corticosterone and epidermal PKC changes observed in dietary energy restriction. Elevated plasma glucocorticoid levels in the dietary energy-restricted mouse may contribute to the alteration of PKC protein levels in the epidermis.     

Beitrag zur GefÄ\transplantation

Ohne Zusammenfassung     

Comparative studies on the effects of semipurified and commercial diet on longevity and spontaneous and induced lesions in the Syrian golden hamster

Syrian golden hamsters were fed a semipurified or commercial diet from weaning throughout life. Bis(2‐oxopropyl)nitrosamine (BOP) was administered at 8 weeks of age (10 mg/kg body wt, sc). Longevity was improved by 26% and 36% increases in the mean life‐spans of male and female hamsters, respectively, fed the semipurified diets. Carcinogen treatment did not alter survival. The age‐adjusted occurrence rates of pancreatic ductular proliferation, carcinomas, adenomas, and common duct polyps were higher in hamsters fed commercial diet; this indicates an earlier onset of these BOP‐induced lesions in hamsters fed this diet. However, their overall incidences were generally similar when the two diet groups were compared. Acinar cell nodules were observed only in hamsters fed semipurified diets and were elevated in BOP‐treated females. The onset of pancreatic ductular proliferation and adenomas, bile duct proliferation, parathyroid hyperplasia, and common duct papillary hyperplasia was earlier in females than in male hamsters, especially in groups fed commercial ration. Generalized vascular calcification was observed at an elevated rate and reached a higher overall incidence in hamsters fed commercial ration. The age‐adjusted rate of amyloidosis was high in female hamsters and elevated in groups that consumed the commercial ration. In addition, colitis and islet cell hyperplasia occurred more often and earlier in hamsters fed commercial ration, but gallbladder stones occurred most in animals fed semipurified diet. This paper discusses the possible association between these and other observed lesions and survival.     

Nurse Practitioner-Based Diabetes Care Management

Background

Limited evidence exists on the impact of nurse practitioner-managed diabetes mellitus care coordination programs in the primary care setting and specifically on the use of telehealth to manage veterans with diabetes in the home.

Objective

To compare the impact of nurse practitioner-based diabetes mellitus care management programs using either a telehealth or a telephone intervention. Specific aims were to (i) compare the efficacy of telehealth and telephone interventions in a diabetes care management program, with regards to glycemic control; (ii) examine the impact of program exposure on the control of diabetes following patient disenrollment from the program; and (iii) identify the average duration of use of a telehealth or telephone intervention required to reach individualized glycemic goals.

Design, setting, and patient population

A retrospective pre-post cohort study of a nurse practitioner-managed diabetes care coordination program was performed in primary care clinics in a Midwest Veterans Administration Medical Center in the US. The cohort included in this study consisted of 259 patients who were enrolled in the program between August 2003 and October 2005 and who disenrolled from the program before January 2006.

Results

The mean reductions in glycosylated hemoglobin (HbA_1c) associated with the program were 2.4% for the telehealth intervention (baseline 9.86%; end of program 7.46%) and 2.39% for telephone intervention (baseline 9.75%; end of program 7.36%). No significant difference in the reduction in HbA_1c was noted between telehealth and telephone interventions (p = 0.96) after adjusting for baseline HbA_1c and age.The number of days of participation in the program was greater for the telehealth group than the group receiving the telephonic intervention (192.2 vs 161.9) but this difference was not statistically significant (p = 0.13). Approximately 75% of the patients (n = 192) worked with nurse practitioners and had reached individualized glycemic goals at disenrollment. Among these patients, those receiving the telehealth intervention had a 3.1% (SD = 1.9, p < 0.001) reduction in HbA_1c and those receiving the telephone intervention had a 2.7% (SD = 1.9, p < 0.001) reduction in HbA_1c, over a mean period of 204 days.Both interventions lost some of their effect following program disenrollment. The mean rise in HbA_1c in the post-program period was 0.69% for the telehealth intervention and 0.63% for the telephone intervention (the average number of post-program days was 434 days for the telehealth intervention and 323 days for the telephone intervention). After adjusting for HbA_1c at disenrollment and the number of days between disenrollment and the latest HbA_1c measurement, no significant difference in the rise in HbA_1c was seen between the two interventions (p = 0.80).

Conclusion

When employed for a comparable number of days, telehealth and telephone communication technologies used by nurse practitioners to provide individualized diabetes care management have similar effects on glycemic control. After disenrollment, HbA_1c increased slightly, suggesting that veterans need continuous individualized care, in addition to routine follow-up, to manage their diabetes.

     

Tolerance of diets deficient or excessive in selenium by Syrian hamsters

Syrian hamsters were fed torula yeast (TY) diets with 8 selenium (Se) supplement levels (0.0-10.0 ppm Se as sodium selenite) or casein (C) diets with 5 supplement levels (0.0-5.0 ppm Se as sodium selenite) for 25 weeks. Whole blood Se, plasma glutathione peroxidase (GSH-Px) activity and erythrocyte GSH-Px activity were measured after 5, 10, 15 and 25 weeks. At 25 weeks hematology was examined and tissue samples analyzed for Se and evaluated for histopathological lesions. While survival was not influenced by dietary Se, food consumption and body weight gain were altered in animals given TY, as those fed 0.0, 0.05 or 10.0 ppm Se consumed less diet. Weight gains at 25 weeks were highest in animals at the 0.1 ppm Se level and reduced in those given unsupplemented TY or 10.0 ppm Se supplements. Hemoglobin, hematocrit and red blood cell counts were reduced in females fed the lowest and highest Se supplements with TY diets. With both C and TY, whole blood Se rose with increasing dietary Se and in the case of TY, Se was elevated with each feeding increment, except between the 0.05 and 0.1 ppm or the 0.25 and 0.5 ppm levels. Plasma GSH-Px increased with rising Se up to 10 ppm, and erythrocyte GSH-Px activity increased up to 5 ppm Se. Erythrocyte GSH-Px values were higher in animals fed C diets. Histopathological observations were normal at all Se levels. Syrian hamsters tolerated dietary Se from 0.05 to 5.0 ppm Se for 25 weeks of observation without detrimental effects.     

The influence of dietary fat and protein on the aging hamster: Hemoglobin,glucose, triglycerides,and serum proteins

Hamsters were fed one of three levels of casein (9, 18, and 36 g/385 Kcal) combined with one of three levels of corn oil (4.5, 9.0, and 18.0 g/385 Kcal) from 8 weeks of age. Blood samples were collected 2, 5, 11, and 17 months after animals began to receive the various diets. Whole blood hemoglobin was highest in animals fed the high-protein diets at the 5-and 11-month measurements, but also high in animals fed the medium-protein diet at the 17-month measurement. The medium-and high-fat diets resulted in the highest hemoglobin values. Serum triglycerides and plasma glucose were elevated in hamsters fed high-fat or high-protein diets at nearly every collection period. Each serum protein fraction was influenced differently by the diets. Increasing dietary fat and/or protein increased serum albumin. Serum alpha one globulin was elevated in hamsters of both sexes fed high-fat diets. In contrast, low-protein diets reduced the concentration of this fraction in males only. Beta globulins were influenced by dietary fat. At 5 and 17 months, high-fat diets elevated this fraction, but at 11 months depressed it. Gamma globulins were elevated by feeding high-fat diets to female hamsters. The age and sex of hamsters are influential in determining their responses to different diets.     

Efficacy of apraclonidine 1% versus pilocarpine 4% for prophylaxis of intraocular pressure spike after argon laser trabeculoplasty.

OBJECTIVE: The authors compared the efficacy of apraclonidine 1% versus pilocarpine 4% prophylaxis of post-argon laser trabeculoplasty (ALT) intraocular pressure (IOP) spike. DESIGN: Prospective randomized clinical trial. PARTICIPANTS: Two hundred twenty-eight eyes of 228 patients with primary open-angle glaucoma undergoing ALT were studied. INTERVENTION: Patients were given 1 drop of either apraclonidine 1% (n = 114) or pilocarpine 4% (n = 114) 15 minutes before ALT. MAIN OUTCOME MEASURES: Peri-ALT IOPs and incidences of post-ALT IOP spikes at 5 minutes, 1 hour, and 24 hours were compared between the two groups. RESULTS: The two groups were similar in age, race, and medical dependency. Post-ALT mean IOPs at 5 minutes, 1 hour, and 24 hours were significantly lower than pre-ALT mean IOPs in both apraclonidine (P < 0.001) and pilocarpine (P < 0.001) groups. Incidences of IOP spikes greater than 1, 3, and 5 mmHg at 1 hour post-ALT were 21.1%, 14.9%, and 8.8% for the apraclonidine group and 12.3%, 5.3%, and 4.4% for the pilocarpine group (P = 0.076, 0.015, and 0.18 chi-square test). In the apraclonidine prophylaxis group, patients on long-term apraclonidine showed significantly higher incidence of post-ALT IOP spike than the patients without such long-term apraclonidine use (35.7%, 15 of 42 eyes, vs. 12.5%, 9 of 72 eyes; P = 0.003). In addition, peri-ALT pilocarpine prophylaxis tended to be less effective in patients undergoing long-term pilocarpine therapy but without statistical significance (17.4%, 8 of 46 eyes, vs. 9.4%, 6 of 64 eyes; P = 0.17). CONCLUSION: Peri-ALT pilocarpine 4% was at least as effective as, if not more effective than, apraclonidine 1% in post-ALT IOP spike prophylaxis. Peri-ALT apraclonidine prophylaxis was not effective in patients on long-term apraclonidine, and peri-ALT pilocarpine prophylaxis tended to be less effective in patients undergoing long-term pilocarpine therapy. Pilocarpine 4% can be considered as a first-choice drug for post-ALT IOP spike prophylaxis, especially in patients under treatment with apraclonidine.