bluuebunny/crossref_metadata_2025 huggingface dataset:
STRENGTHENING PRIMARY HEALTH CARE: BUILDING THE CAPACITY OF RURAL COMMUNITIES TO ACCESS HEALTH FUNDING
Authors: McDonald John , Brown Leann , Murphy Angela
Published: August 2010

ABSTRACT: Present health funding models can place onerous pressures on rural health services. Staff may lack the time, resources, access to data, and the expertise needed to complete complex and lengthy funding submissions. This present study describes an innovative capacity‐building approach to working with Victorian rural communities seeking to access health care funding through the Regional Health Services Program. This approach used several strategies: engaging stakeholders in targeted rural communities, developing an information kit and running a workshop on preparing submissions to the Regional Health Services Program, facilitating community consultations, and providing ongoing support with submissions. Six rural communities were supported in this way. Four have been funded to date, with a combined annual recurrent budget for new primary health care services of over $2.5 million. Each community has developed a service delivery model that meets the particular needs of their local area. This capacity‐building approach is both effective and replicable to other health funding opportunities.
WHY NURSES ARE ATTRACTED TO RURAL AND REMOTE PRACTICE
Authors: Hegney Desley , McCarthy Alexandra , Rogers‐Clark Cath , Gorman Don
Published: August 2010

ABSTRACT: This is the second paper of a larger study that examined the factors influencing the decisions of rural and remote area nurses, formerly employed by Queensland Health, to leave or to remain in this area of nursing. The study was a cross‐sectional survey that gathered data from nurses who had resigned from permanent positions in Queensland Health during the period February 1999 to May 2000. This paper reports only those factors that influenced their decision to remain in rural and remote area practice, which can be categorised into personal, professional and rural influences. The results of this study are congruent with previous national and international research findings into these issues for nurses in rural and remote areas. The paper makes recommendations to attract nurses to the rural and remote work force.
THE NEEDS OF CANCER PATIENTS AND THEIR FAMILIES FROM RURAL AND REMOTE AREAS OF QUEENSLAND
Authors: Clavarino Alexandra M. , Lowe John B. , Carmont Sue‐Ann , Balanda Kevin
Published: August 2010

ABSTRACT: This study examines the impact of travelling for treatment on cancer patients and their families. Twenty‐eight consecutive cancer patients, who were receiving radiation therapy treatment and 19 family carers, completed a structured needs assessment questionnaire and an in‐depth interview.

Both patients and carers reported moderate to high levels of unmet psychological need. Carers were found to have higher levels of anxiety than patients, although both groups had higher anxiety levels than the general population. Taking more responsibility for household tasks and organising new living arrangements for the family were the most frequently identified demands of a dual burden of caring. Nearly 40% of carers reported some disruption to their schedule and half reported experiencing financial difficulties. The qualitative interviews highlight the disruption that parents and children experience under the present system, particularly in relation to the demands of family life and the need to maintain some level of continuity and security for children.
INCREASING RURAL ACTIVITY AND CURRICULUM CONTENT IN THE ADELAIDE UNIVERSITY MEDICAL SCHOOL
Authors: Laurence Caroline , Newbury Jonathan , Wilkinson David
Published: August 2010

ABSTRACT: This study aimed to document the level of rural activity and curriculum content in the Adelaide University Medical School. A questionnaire was distributed to all heads of departments within the Medical School and additional information was obtained from reports and discussions with key personnel. There has been an increase in the proportion of students with a rural background enrolled from 9% in 1994 to 22% in 2000. There has also been an increase in the number of weeks available for rural placements from 12 (mostly optional) to 29 weeks (some mandatory), and an increase in the number of departments offering rural placements. There has also been improved academic support to rural practitioners and many departments directly provide services in rural communities. A new combined University Department of Rural Health (UDRH)/Rural Clinical School associated with the Adelaide University Medical School aims to provide at least half of all clinical training to 25% of all medical students of Australian origin.
LONG‐TERM EMPLOYMENT OUTCOMES IN A RURAL AREA FOLLOWING TRAUMATIC BRAIN INJURY
Authors: Coetzer B. R. , Hayes N. M. , Toit P. L. Du
Published: August 2010

ABSTRACT: One of the major sequelae following traumatic brain injury is a change in employment status. This poses significant challenges for rehabilitation services. Several studies have investigated the longer‐term outcome after traumatic brain injury. Longer‐term outcome in an economically disadvantaged rural environment with limited rehabilitation services has not been studied extensively. A group of individuals (n =65) who sustained a traumatic brain injury were compared regarding pre‐ and post‐employment status. The moderate and severely injured sub‐groups showed a significant change in employment status. Ideally rehabilitation programs should target re‐employment as an outcome. Limited employment opportunities in rural areas may make this more difficult to achieve.
STAFF PERCEPTIONS OF CARE FOR DELIBERATE SELF‐HARM PATIENTS IN RURAL WESTERN AUSTRALIA: A QUALITATIVE STUDY
Authors: Slaven Janine , Kisely Stephen
Published: August 2010

ABSTRACT: Suicide has been a major community concern in Esperance, a geographically isolated port on the south coast of Western Australia. This study to explores the views of regional health staff on barriers to the effective management of deliberate self‐harm (DSH) and ways in which those barriers could be addressed. Semi‐structured interviews were tape‐recorded, transcribed and subjected to qualitative content analysis. Interviewees included 77% of general practitioners (n = 7), 18% of nurses (n = 13) and 55% of mental health professionals (n = 5). The most important barrier was a lack of structure to treating DSH, resulting in deficiencies and inconsistencies in its management. Suggestions to improve the management of DSH included better communication between services, support for nurses in raising the issue of suicide, use of a simple risk assessment tool, the development of a nurse liaison position, and a multidisciplinary planning group.

The higher rates of DSH and completed suicide in rural and remote regions compared with metropolitan areas make secondary prevention particularly important.
INDIGENOUS MEN TAKING THEIR RIGHTFUL PLACE IN SOCIETY? A PRELIMINARY ANALYSIS OF A PARTICIPATORY ACTION RESEARCH PROCESS WITH YARRABAH MEN'S HEALTH GROUP
Authors: Tsey Komla , Patterson David , Whiteside Mary , Baird Leslie , Baird Bradley
Published: August 2010

ABSTRACT: Men's groups are increasingly being accepted as an important strategy in improving health and well‐being, especially in Indigenous communities. However, it is hard to find systematic documentation and evaluation of such initiatives in the literature. This paper analyses the formative stages of a participatory action research (PAR) process which aims to engage and support the members of the Yarrabah Men's Health Group plan, implement and evaluate their activities. Data for the paper are based on a combination of a review of relevant literature, analysis of project documentation, participant observation and discussion and reflection with the participants of the men's group. The paper highlights the importance of (a) using a reflective approach, such as PAR, to engage men's support groups to clearly define the principles and values which both define them and to which they aspire and (b) personal development, education and employment, as a prerequisite for Indigenous men taking greater control and responsibility for their lives. These types of micro‐level studies have important implications for the way community development is perceived and approached in Indigenous settings. There are also implications for the roles that academic researchers can play in supporting and adding value to community‐driven initiatives to the mutual benefit of both parties.
BALANCING HOSPITAL AND COMMUNITY TREATMENT: EFFECTIVENESS OF AN EXTENDED‐HOURS COMMUNITY MENTAL HEALTH TEAM IN A SEMI‐RURAL REGION OF AUSTRALIA
Authors: Habibis Daphne , Hazelton Mike , Schneider Rosemary , Davidson John , Bowling Alison
Published: August 2010

Objective: To examine the effectiveness of the introduction of a community mental health team on consumer psychosocial outcomes.

Design: Longitudinal panel design.

Setting: District general hospital in a semi‐rural region of Australia.

Numbers: Two matched groups (n = 37 in each group)

Main outcome measure: These included: Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Rosenberg Self‐Esteem, Life Skills Profile as well as self‐report.

Results: The study found that the introduction of the new service resulted in few significant differences in consumer outcomes.

Conclusions: The paper argues that because the state was the only specialist mental health service provider and it was unable to offer assertive community treatment, hospital care remained central. Evidence that a substantial proportion of consumers and carers preferred hospital to community care is placed against this background. The paper argues that in regions like these, where community‐based services are likely to remain underdeveloped, it may be best to maintain quality hospital services and to target community services more precisely on what is achievable rather than developing community services at the expense of hospital care.
IDENTIFYING MUSCULOSKELETAL CONDITIONS AMONG RURAL INDIGENOUS PEOPLES
Authors: Vindigni Dein , Perkins Janice
Published: August 2010

Objective: To critically review the methodological properties of previous musculoskeletal studies among Indigenous populations. In particular, non‐rheumatic, musculoskeletal conditions of mechanical origin are examined as these appear to be commonly related to syndromes of pain and disability.

Design: Systematic review.

Setting: Rural, Indigenous communities throughout the world.

Subjects: Indigenous peoples aged 16 and over living in rural communities.

Main outcome measure: Minimum requirements for methodologically sound musculoskeletal health research according to previously published criteria.

Results: Due to methodological limitations in the 14 studies reviewed, only five methodologically acceptable studies were found.

Conclusion: Given the paucity of methodologically sound musculoskeletal studies among Indigenous populations, the true prevalence of musculoskeletal conditions in these communities remains largely unknown.
GETTING THE BALANCE RIGHT? GPS WHO CHOSE TO STAY IN RURAL PRACTICE
Authors: Hays Richard , Wynd Shona , Veitch Craig , Crossland Lisa
Published: August 2010

Background: Despite major challenges to the retention of rural GPs in Australia, little is known about why some rural GPs stay long‐term within their communities.

Method: A group of rural GPs interviewed as part of another study about 10 years ago were re‐interviewed to explore their attitudes to their reasons for staying.

Results: Eighteen of the original group of 23 could be contacted and 13 were interviewed. Factors that appeared to promote staying in rural practice were: strong attachment to the community; and practice arrangements that allow for adequate time off‐call and for holidays. However, several GPs were stressed and some had considered leaving. The stressors were similar to those identified in earlier research, including overwork and having to send children to boarding school.

Conclusion: Personal and professional support arrangements within the community appear to be associated with decisions by rural GPs to remain in practice for substantial periods of time. Retention strategies should focus on facilitation of local integration.
WORK OF FEMALE RURAL DOCTORS
Authors: Wainer Jo
Published: August 2010

Objectives: To identify the impact of family life on the ways women practice rural medicine and the changes needed to attract women to rural practice.

Design: Census of women rural doctors in Victoria in 2000, using a self‐completed postal survey.

Setting: General and specialist practice.

Subjects: Two hundred and seventy‐one female general practitioners and 31 female specialists practising in Rural, Remote and Metropolitan Area Classifications 3–7. General practitioners are those doctors with a primary medical degree and without additional specialist qualifications. Main outcome measure: Interaction of hours and type of work with family responsibilities.

Results: Generalist and specialist women rural doctors carry the main responsibility for family care. This is reflected in the number of hours they work in clinical and non‐clinical professional practice, availability for oncall and hospital work, and preference for the responsibilities of practice partnership or the flexibility of salaried positions. Most of the doctors had established a satisfactory balance between work and family responsibilities, although a substantial number were overworked in order to provide an income for their families or meet the needs of their communities. Thirty‐six percent of female rural general practitioners and 56% of female rural specialists preferred to work fewer hours. Female general practitioners with responsibility for children were more than twice as likely as female general practitioners without children to be in a salaried position and less likely to be a practice partner. The changes needed to attract and retain women in rural practice include a place for everyone in the doctor's family, flexible practice structures, mentoring by women doctors and financial and personal recognition.
EDUCATIONAL NEEDS OF RURAL AND REMOTE AUSTRALIAN NON‐SPECIALIST MEDICAL PRACTITIONERS FOR OBSTETRIC ULTRASOUND
Authors: Glazebrook Roz , Manahan Dan , Chater Bruce , Barker Peter , Row David , Steele Brendan , Morris Graham , Cornelius Sally , McLellan Tony
Published: August 2010

Objective: To determine the educational needs of rural and remote non‐specialist Australian doctors for obstetric ultrasound.

Design: Survey design.

Setting: The study surveyed rural and remote doctors practising in a variety of settings including general practice, rural hospitals, Aboriginal communities and flying doctor organisations throughout Australia.

Subjects: Subjects included 314 solo and group practice rural general practitioners, rural hospital medical superintendents, senior medical officers, Aboriginal community controlled health service doctors, flying doctors, rural locums, registrars and two rural obstetricians. A total of 55% of the subjects were general practitioners in group practice. Respondents included 68 (22%) women and 246 (78%) men.

Results: The response rate was 32%. The highest priority areas of need for education included detecting foetal abnormalities and anomalies (19.1%), basic routine ultrasonography (17.17%), placental position (17.17%), dating (17.17%), foetal viability (12.88%) and morphology scan (12.26%). The main areas where doctors stated they lacked confidence included detecting foetal abnormalities (29.09%), basic routine ultrasonography (including machine use), such as, carrying out and interpreting obstetric ultrasound scans (27.27%), morphology scans (16.36%) and placental position (14.54%).

Conclusion: The study showed there was a large unmet need for education in obstetric ultrasound among rural and remote non‐specialist doctors. Information from the needs assessment was used to develop the Australian College of Rural and Remote Medicine national obstetric ultrasound professional development program.
ARE RURAL PEOPLE GETTING HEARTSMART?
Authors: Aoun Samar , Rosenberg Michael
Published: August 2010

Objective: This study evaluates the impact of a cardiac rehabilitation program (HeartSmart) in a rural area on the quality of life, dietary behaviour, weight loss and physical activity participation of patients with cardiovascular disease (CVD) or at high risk of CVD.

Design: The evaluation of the program consisted of a single group pre and post‐test design with follow‐up at 3, 6 and 12 months after program completion, complemented with a cross‐sectional survey of non‐participants as a pseudo comparison group.

Setting: The HeartSmart program is a hospital‐based cardiac rehabilitation program in Bunbury, a regional centre of Western Australia.

Subjects: A total of 203 participants and 159 non‐participants.

Interventions: The program consisted of 7 weeks of education and exercise sessions.

Results: The program had a high rate of completion (92%). Evaluation results suggested that HeartSmart participants demonstrated significant improvements in quality of life, compliance with medication, dietary behaviour, weight loss and physical activity participation. The largest changes were mostly observed between pre and post‐program stages, with sustained behaviour change at 6 months after the completion of the program. Further evidence of the HeartSmart benefits was provided through significantly better health‐related behaviour, confidence to diet and exercise, dietary fat intake, cardiac knowledge and quality of life scores among HeartSmart participants compared with non‐participants.

Conclusions: While this program has achieved its objectives, there are a few issues that need to be considered by similar programs: the post‐program stage of patient follow‐up by general practitioners; the geographical disadvantage of those living outside regional centres to access the service; enhancing the primary prevention aspect of the program; adapting the program to the needs of Aboriginal clients; facilitating evaluations by resourcing and training program staff in computer skills.
Trichomonas vaginalis in Vanuatu
Authors: Fotinatos Nina , Warmington Adrian , Walker Todd , Pilbeam Mark
Published: August 2010

Objective:  To assess the prevalence of Trichomonas vaginalis in two island populations of Vanuatu using the Pap smear as the screening technique.

Study design:  Women were randomly selected from specific sites on the islands of Efate (urban setting) and Ambae (rural setting). Pap smears were collected, screened and reported.

Setting:  The first collection site was the Women's Health/Antenatal Care Clinic at Vila Central Hospital in Port Vila, the capital city located on the island of Efate, and the second collection site was a rural village on a sparsely populated inhabited northern island, Ambae.

Participants:  A total of 905 Ni‐Vanuatu women participants: Efate (n = 562) 62%, and Ambae (n = 343) 38%. The mean age was 35.8 years: Efate 32.6 years, and Ambae 40.8 years.

Main outcome measure:  The presence or absence of T. vaginalis in these Pap smears was documented during the study's cervical screening process.

Results:  The overall prevalence of T. vaginalis within the study participants was 25.3%. Almost half of the infected sample group were in the age group of 30–39 years (43.8%). The prevalence of T. vaginalis in Efate was 14.7%, compared with 43.4% in Ambae.

Conclusion:  The prevalence of T. vaginalis in Vanuatu women is significantly higher compared with developed countries. Women in rural settings are less likely to have access to sexually transmitted disease prevention and treatment programs, thus contributing to high infection rates compared with women in urban settings. Cultural and educational differences in the rural setting might also contribute to higher sexually transmitted disease rates among these women.
How do registered nurses define rurality?
Authors: Kulig Judith C. , Andrews Mary Ellen , Stewart Norma L. , Pitblado Roger , MacLeod Martha L. P. , Bentham Donna , D'Arcy Carl , Morgan Debra , Forbes Dorothy , Remus Gail , Smith Barbara
Published: August 2010

Objective:  The objective of this analysis was to identify the meaning of rurality for registered nurses (RNs) practising in rural and remote Canada.

Setting and design:  An existing Statistics Canada definition was used to stratify Canada's 10 provinces into urban and rural areas. As part of a national multi‐method study, a random sample of RNs in these rural strata, plus all RNs working in outpost settings and northern territories, were surveyed concerning the nature of nursing practice. Content analysis was used to identify themes from an open‐ended question: ‘How do you define rural/remote?’ Refinement of the themes was conducted by the survey team and credibility was supported through investigator triangulation.

Participants:  Of the 3933 RNs who responded to the survey (68% response rate), 3412 provided a definition of rural/remote. A subsample of 1285 RNs was used for detailed thematic analysis because these respondents provided definitions with a clear referent to rural and/or to remote; the remaining sample was used for verification of themes.

Results:  Four defining themes were identified by RNs for both rural and remote: community characteristics, geographical location, health human and technical resources, and nursing practice characteristics.

Conclusions:  The themes can be used as content domains or dimensions of rurality to improve our understanding of how to describe rural communities, including geographical location and nursing practice, from the perspective of RNs.
Prevalence and predictors of depressive symptoms among rural older Australians and Americans
Authors: Buys Laurie , Roberto Karen A. , Miller Evonne , Blieszner Rosemary
Published: August 2010

Objective:  To examine the predictors of depressive symptoms among older married rural Australian and American men and women, using comparable measures from two separate studies.

Design:  Postal survey for Australians; telephone interviews for Americans.

Setting:  Rural Australia (six states and two territories) and America (Virginia).

Participants:  Older married rural men and women, aged 65 years and over, in Australia (n = 216) and America (n = 156).

Main outcome measures:  Whether predictors of depressive symptoms, specifically demographic factors, health, pain, functional limitations and social networks, differed according to nationality or sex.

Results:  Approximately one‐third of older rural Australian (37%) and Americans (28%) reported recently experiencing depressive symptoms. For Australian men and women, pain was the strongest predictor of depressive symptoms. For American women, dissatisfaction with social support predicted depressive symptoms, whereas no variable predicted depressive symptoms in American men.

Conclusions:  In the context of a globally ageing population, the fact that nearly one in three older rural people on two continents described themselves as recently feeling depressed is a troubling finding of considerable importance to both practitioners and policy‐makers. The findings raise questions about the cultural acceptance, definition and manifestations of symptoms of depression in rural communities, as well as the role of different public health and support systems in the two countries.
Multidetector spiral CT venography in the diagnosis of upper extremity deep venous thrombosis
Authors: Sabharwal R , Boshell D , Vladica P
Published: August 2010

Upper extremity deep vein thrombosis is a rare thrombotic disorder (1–4% of all DVT) which has the potential for considerable morbidity. We present a case which demonstrates the limitations in diagnostic accuracy of ultrasonography in the diagnosis of upper extremity deep venous thrombosis. Multidetector spiral computed tomography (CT) continues to evolve as a state of the art imaging modality and our case demonstrates the role and value of multidetector spiral CT venography (CTV) in the diagnosis of upper extremity deep venous thrombosis.
NITRIC OXIDE, ERECTILE DYSFUNCTION AND BETA‐BLOCKER TREATMENT (MR NOED STUDY): BENEFIT OF NEBIVOLOL VERSUS METOPROLOL IN HYPERTENSIVE MEN
Authors: Brixius K , Middeke M , Lichtenthal A , Jahn E , Schwinger R H G
Published: August 2010

Hypertensive men treated with beta‐blockers frequently complain of erectile dysfunction. The present study investigated the effects of two β1‐adrenoceptor‐selective antagonists, namely nebivolol and metoprolol, on erectile function in hypertensive men.

Male out‐patients (age range 40–55 years) with newly diagnosed or existing stage 1 essential hypertension (mean seated systolic blood pressure 140–159 mmHg; diastolic blood pressure 90–99 mmHg) were enrolled in the study. All patients lived in a stable, heterosexual partnership and had no history of sexual dysfunction. After a 2 eek placebo run‐in period, patients were randomized double‐blind to either Treatment group A (comprising nebivolol 5 mg once daily for 12 weeks, followed by placebo for 2 weeks and then metoprolol succinate 95 mg once daily for 12 weeks) or Treatment group B (comprising metoprolol succinate 95 mg for 12 weeks, placebo for 2 weeks and then nebivolol 5 mg for 12 weeks). An international index of erectile function (IIEF) questionnaire and a diary documented patients’ sexual function and activity.

Nebivolol and metoprolol lowered blood pressure to a similar extent. Metoprolol, but not nebivolol, significantly decreased the IIEF erectile function subscore by 0.92 in the first 8 weeks after onset of beta‐blocker treatment. In contrast with metoprolol, nebivolol improved secondary sexual activity scores and other IIEF subscores.

Despite similar antihypertensive efficacy of the cardioselective β1‐adrenoceptor antagonists nebivolol and metoprolol, nebivolol may offer additional benefits by avoiding erectile dysfunction in male hypertensive patients on long‐term β‐adrenoceptor antagonist therapy.
INHIBITION OF INDUCIBLE NITRIC OXIDE SYNTHASE ATTENUATES ACUTE ENDOTOXIN‐INDUCED LUNG INJURY IN RATS
Authors: Su Chain Fa , Yang Fwu Lin , Chen Hsing I
Published: August 2010

In the present study, we investigated the effects of the inducible nitric oxide (iNOS) inhibitors S‐methylisothiourea (SMT) and l‐N6‐(1‐iminoethyl)‐lysine (l‐Nil) on endotoxin‐induced acute lung injury (ALI), as well as the associated physiological, biomedical and pathological changes, in anaesthetized Sprague‐Dawley rats and in rat isolated perfused lungs.

Endotoxaemia was induced by an intravenous (i.v.) infusion of lipopolysaccharide (LPS; Escherichia coli 10 mg/kg). Lipopolysaccharide produced systemic hypotension and tachycardia. It also increased the lung weight/bodyweight ratio, lung weight gain, exhaled nitric oxide (NO), the protein concentration in bronchoalveolar lavage and microvascular permeability.

Following infusion of LPS, plasma nitrate/nitrite, methyl guanidine, pro‐inflammatory cytokines (tumour necrosis factor‐α and interleukin‐1β) were markedly elevated. Pathological examination revealed severe pulmonary oedema and inflammatory cell infiltration. Pretreatment with SMT (3 mg/kg, i.v.) or l‐Nil (3 mg/kg, i.v.) significantly attenuated the LPS‐induced changes and ALI.

The results suggest that the inflammatory responses and ALI following infusion of LPS are due to the production of NO, free radicals and pro‐inflammatory cytokines through the iNOS system. Inhibition of iNOS is effective in mitigating the endotoxaemic changes and lung pathology. Inhibitors of iNOS may be potential therapeutic agents for clinical application in patients with acute respiratory distress syndrome.
INHIBITION OF NAD(P)H OXIDASE REDUCES FIBRONECTIN EXPRESSION IN STROKE‐PRONE RENOVASCULAR HYPERTENSIVE RAT BRAIN
Authors: Cui Chunmei , Chen Alex F , Jiang Zongpei , Wu Qingqing , Lin Jianwen , Wen Hongmei , Zeng Jinsheng
Published: August 2010

The aim of the present study was to test the hypothesis that in vivo chronic inhibition of NAD(P)H oxidase reduces cerebrovascular fibronectin expression in stroke‐prone renovascular hypertensive rats (RHRSP).

The RHRSP model was induced by two clips and NAD(P)H oxidase was inhibited with apocynin. The mRNA and protein expression of NAD(P)H oxidase subunit p22phox in brains of RHRSP and Sprague‐Dawley (control) rats was determined using real‐time reverse transcription–polymerase chain reaction, western blot and immunohistochemistry. The expression of fibronectin protein was localized immunohistochemically in cerebral vessels and then quantified by western blot.

Cerebrovascular fibronectin levels in RHRSP (n = 6) were significantly higher than control (n = 5) levels 8 weeks after operation (1.29 ± 0.04 vs 1.15 ± 0.02, respectively; P = 0.007). The p22phox immunopositive reactivity was localized in the cerebral vasculature of control rats and RHRSP. Furthermore, chronic treatment of RHRSP with apocynin, a selective NAD(P)H oxidase inhibitor, in the drinking water for 4 weeks (1.5 mmol/L, 5 weeks after operation) resulted in a significant decrease in the expression of p22phox protein (0.85 ± 0.01 vs 0.93 ± 0.01 in non‐treated RHRSP; n = 5; P = 0.002), with a concomitant reduction of fibronectin levels in the cerebral vasculature (1.31 ± 0.03 vs 1.56 ± 0.05 in non‐treated RHRSP; n = 5; P = 0.002). No significant differences were detected in the expression of p22phox mRNA and protein between RHRSP (4 and 8 weeks after renal artery constriction) and the control group.

These findings suggest that the chronic inhibition of NAD(P)H oxidase in vivo by apocynin reduces cerebrovascular fibronectin levels, which may lessen hypertensive cerebrovascular fibrosis.
EFFECT OF HIGH SALT INTAKE ON LOCAL RENIN–ANGIOTENSIN SYSTEM AND VENTRICULAR DYSFUNCTION FOLLOWING MYOCARDIAL INFARCTION IN RATS
Authors: De Resende Micheline M , Mill José G
Published: August 2010

This study was performed to evaluate the effect of chronic high salt intake on local cardiac and renal components of the renin–angiotensin system (RAS) and its impact on cardiac remodelling and function after myocardial infarction (MI).

Rats submitted to coronary artery ligation to produce MI or sham operation (SO) were randomized to receive 1% NaCl solution or tap water as drinking water for 4 weeks. Plasma renin activity (PRA) and angiotensin‐converting enzyme (ACE) activity were quantified. Tissue angiotensin (Ang) II and ACE activity were determined by ELISA and a fluorimetric assay, respectively. Renal and cardiac AT1 and AT2 receptor protein levels were quantified by western blot.

Independent of the lower PRA levels, MI promoted a significant increase in the left ventricular/bodyweight ratio and impaired cardiac function. The cardiac RAS was activated after MI with a significant increase in ACE activity, AngII and AT1 receptor levels. The RAS was slightly attenuated under high‐salt conditions.

Interestingly, high salt intake increased the expression of the AT2 receptor by approximately twofold in the kidney of MI rats compared with the SO control group. Because of its natriuretic effect, the AT2 receptor may counterbalance the salt overload and prevent the additional impairment of cardiac function.

The present study indicates that 4 weeks after MI, high salt intake did not further increase cardiac hypertrophy or further impair cardiac function in MI rats. A chronic increase in salt intake significantly suppressed PRA, but did not prevent activation of the local RAS or the progression of cardiac remodelling and left ventricular dysfunction caused by MI.

The present results show that inhibition of systemic renin production with salt overload does not affect ventricular remodelling after MI in rats. This suggests that local activation of the RAS in the heart, which was not suppressed by salt overload, exerts a predominant role for local adaptations of the heart after MI.
SPATIAL PULMONARY FLOW DISTRIBUTION IN RABBIT ISOLATED LUNGS IS A POOR REPRESENTATION OF THE SITUATION IN VIVO*
Authors: Hübler M , Heller AR , Bleyl JU , Rössel T , Stehr SN , Koch T
Published: August 2010

Isolated lung preparations are established to investigate effects on pulmonary vascular tone and spatial pulmonary flow (Q̇rel) distribution. In the present study, we hypothesized that Q̇rel distribution in isolated lungs is only poorly correlated with the in vivo situation.

Fourteen rabbits were anaesthetized and mechanically ventilated with room air. Animals were held in an upright position for 15 min and Q̇rel was assessed using fluorescent microspheres (Q̇rel‐in vivo). A second injection of microspheres was made after isolation of the lungs (Q̇rel‐ex vivo). Lungs were dried, cut into 1 cm3 cubes and spatial Q̇rel distributions were analysed.

The mean correlation of Q̇rel‐in vivo and Q̇rel‐ex vivo was 0.592 ± 0.188 (95% confidence interval 0.493–0.690). The Q̇rel was redistributed to more ventral (the mean slope of Q̇rel vs the dorsal–ventral axis changed from −0.289 ± 0.227 to −0.147 ± 0.114; P = 0.03), cranial (mean slope of Q̇rel vs the caudal–cranial axis changed from −0.386 ± 0.193 to −0.176 ± 0.142; P < 0.001) and central (mean slope of Q̇rel vs the hilus–peripheral axis changed from 0.436 ± 0.133 to −0.236 ± 0.159; P = 0.003) lung areas.

The results obtained from studies investigating Q̇rel distributions in isolated lung models must be interpreted cautiously because the isolated lung set‐up significantly affects the spatial distribution of pulmonary flow.
MORPHOLOGICAL AND FUNCTIONAL CHANGES IN P‐GLYCOPROTEIN DURING DEXAMETHASONE‐INDUCED HEPATOMEGALY
Authors: Micuda Stanislav , Fuksa Leos , Mundlova Lucie , Osterreicher Jan , Mokry Jaroslav , Cermanova Jolana , Brcakova Eva , Staud Frantisek , Pokorna Pavla , Martinkova Jirina
Published: August 2010

The effect of dexamethasone on hepatic and renal P‐glycoprotein (P‐gp) expression, localization and activity was investigated in rats after 4 days oral administration of two dose regimens (1 or 25 mg/kg per day). Simultaneous increases in liver weight were evaluated by quantitative histological examination.

In the liver, dexamethasone pretreatment produced hepatomegaly as a consequence of extensive periportal fat accumulation, which was quantified by densitometry of oil red O‐stained liver sections. Quantitative immunohistochemical analysis revealed preferential periportal zonation of P‐gp in control animals. Dexamethasone pretreatment resulted in spatially disproportional induction of P‐gp protein expression within the liver acinus characterized by preferential increase in pericentral areas, with consequent uniform panlobular distribution. Western blot analysis confirmed these results, showing increases in P‐gp protein. Quantitative reverse transcription–polymerase chain reaction analysis revealed no statistically significant change in liver mdr1b mRNA expression after either dexamethasone treatment regimen. The expression of mdr1a mRNA was significantly decreased by 85–87%.

In the kidney, dexamethasone reduced mdr1a mRNA expression by 69–89%, whereas mdr1b mRNA expression was increased in a dose‐dependent manner. However, despite tendencies, no significant increases in P‐gp expression were observed at the protein level.

The in vivo function of P‐gp was evaluated by measuring renal and biliary secretion of rhodamine‐123 (Rho123) under a steady state plasma concentration. The biliary, renal and tubular secretory clearance of Rho123 was significantly increased only after high‐dose dexamethasone.

In conclusion, the present study suggests that drug interactions observed during corticosteroid therapy may be mediated, at least in part, through increased biliary, and also renal, excretion of P‐gp substrates. Expression of P‐gp in the liver showed primary periportal zonation with differential changes during induction. Accompanying hepatomegaly may be explained by severe microvesicular steatosis selectively localized to the periportal areas.
METHODS OF ANALYSIS AND PHYSIOLOGICAL RELEVANCE OF RHYTHMS IN SYMPATHETIC NERVE DISCHARGE
Authors: Barman Susan M , Kenney Michael J
Published: August 2010

Like virtually all other physiological control systems, the sympathetic nervous system controlling cardiovascular function is characterized by the presence of rhythmic activity. Despite the prevalence of rhythms, their function is often not obvious, which leads to the question, what can one learn about the neural control of autonomic function by studying sympathetic nervous system rhythms?

Sympathetic nerve discharge (SND) is characterized by a mixture of periodicities ranging between approximately 0.04 and 10 Hz, depending on the physiological conditions, type of nerve being analysed and the species. The present article illustrates why frequency domain (power density spectral) analysis is more suitable than time domain (autocorrelation) analysis to quantify a complex signal (i.e. one with multiple frequency components) such as SND.

The present article entertains the possibilities that rhythmic activity may lead to more effective activation of sympathetic neurons than randomly occurring activity, that rhythmicity is important for coordinating activity in different sympathetic nerves and in formulating complex cardiovascular response patterns and that sympathetic rhythmicity may help maintain homeostasis.
SYMPATHETIC RHYTHMS AND NERVOUS INTEGRATION
Authors: Gilbey Michael P
Published: August 2010

The present review focuses on some of the processes producing rhythms in sympathetic nerves influencing cardiovascular functions and considers their potential relevance to nervous integration.

Two mechanisms are considered that may account for rhythmic sympathetic discharges. First, neuronal elements of peripheral or central origin produce rhythmic activity by phasically exciting and/or inhibiting neurons within central sympathetic networks. Second, rhythms arise within central sympathetic networks. Evidence is considered that indicates the operation of both mechanisms; the first in muscle and the second in skin sympathetic vasoconstrictor networks.

Sympathetic activity to the rat tail, a model for the nervous control of skin circulation, is regulated by central networks involved in thermoregulation and those associated with fear and arousal. In an anaesthetized preparation, activity displays an apparently autonomous rhythm (T‐rhythm; 0.4–1.2 Hz) and the level of activity can be manipulated by regulating core body temperature. This model has been used to study rhythm generation in central sympathetic networks and possible functional relevance.

A unique insight provided by the T rhythm, into possible physiological function(s) underlying rhythmic sympathetic discharges is that the activity of single sympathetic post‐ganglionic neurons within a population innervating the same target can have different rhythm frequencies. Therefore, the graded and dynamic entrainment of the rhythms by inputs, such as central respiratory drive and/or lung inflation‐related afferent activity, can produce graded and dynamic synchronization of sympathetic discharges. The degree of synchronization may influence the efficacy of transmission in a target chain of excitable cells.

The T‐rhythm may be generated within the spinal cord because the intrathecal application of 5‐hydroxytryptamine at the L1 level of the spinal cord of a rat spinalized at T10–T11 produces a T‐like rhythm. Thus, induction and modulation of spinal cord oscillators may be mechanisms that influence ganglionic and neuroeffector transmission.

The study of sympathetic rhythms may not only further understanding of sympathetic control, but may also inform on the relevance of rhythmic nervous activities in general.
DIFFERENTIAL EFFECTS OF VASOPRESSINERGIC AND OXYTOCINERGIC PRE‐AUTONOMIC NEURONS ON CIRCULATORY CONTROL: REFLEX MECHANISMS AND CHANGES DURING EXERCISE
Authors: Michelini Lisete Compagno
Published: August 2010

The role of vasopressinergic and oxytocinergic (VPergic and OTergic, respectively) projections to the brain stem in the modulation of heart rate control is discussed on the basis of both changes in the peptide content of the dorsal brain stem (DBS) and functional effects following reflex‐ and exercise‐induced activation in the presence and/or absence of receptor blockade within the nucleus tractus solitarius (NTS) and/or peripheral autonomic block.

Experimental data showed a dual effect of NTS VPergic projections on reflex control: (i) to maintain tonically the reflex sensitivity; and (ii) to reset reflex bradycardia towards higher heart rate values when transiently activated. The VPergic drive causes less sympathetic inhibition during pressure increases, mainly by reducing peripheral information going to NTS second‐order neurons. Treadmill running increases the vasopressin content within the DBS. This activates NTS V1 receptors to cause a significant improvement of exercise tachycardia in both sedentary and trained rats.

The OTergic drive to DBS areas (NTS/dorsal motor nucleus of the vagus) is also tonic for baroreceptor reflex control: it improves reflex bradycardia by facilitating vagal outflow to the heart. An acute bout of exercise increases DBS oxytocin (OT) content in trained rats, causing a significant blunting of exercise tachycardia only in this group. In both sedentary and trained groups, basal heart rate varies inversely with DBS OT content, the resting bradycardia of trained rats being associated with higher OT content.

Specific coordinated activation of VPergic and OTergic suprabulbar pathways is essential to adjust heart rate and cardiac output to circulatory demand at rest and during exercise in both sedentary and trained individuals.
EXERCISE TRAINING AND SYMPATHETIC NERVOUS SYSTEM ACTIVITY: EVIDENCE FOR PHYSICAL ACTIVITY DEPENDENT NEURAL PLASTICITY
Authors: Mueller Patrick J
Published: August 2010

It has been generally accepted that regular physical activity is associated with beneficial effects on the cardiovascular system. In fact, the idea that exercise maintains cardiovascular health is evident by the direct links between a sedentary lifestyle and the risk of cardiovascular and other disease states.

Cardiovascular diseases, such as hypertension and heart failure, are often associated with sympathetic nervous system (SNS) overactivity. Conversely, exercise has been shown to reduce hypertension and decrease elevated SNS activity. In addition, there is evidence that exercise may reduce resting blood pressure and sympathetic outflow in normal individuals.

Although somewhat controversial in humans, evidence from animal studies also indicates that exercise training reduces baroreflex‐mediated and other forms of sympathoexcitation in normal individuals. Collectively, these data are consistent with the hypothesis that physical activity may decrease, and physical inactivity may increase, the incidence of cardiovascular disease via alterations in SNS activity. Despite the important clinical implications of this possibility, the mechanisms by which exercise alters control of SNS activity remain to be fully elucidated.

Recent evidence suggests that central nervous system (CNS) plasticity occurs under a variety of conditions, including varying levels of physical activity. The purpose of the present brief review is to provide evidence that changes within the CNS contribute importantly to altered regulation of the SNS observed following exercise training. The primary hypothesis is that physical activity versus inactivity produces plasticity within neural networks that regulate SNS activity. This hypothesis is supported by published and preliminary data that suggest that exercise training may reduce sympathoexcitation by reducing activation of neurons within cardiovascular regions of the brain. These mechanisms are likely to be important in disease states of sympathetic overactivity and in normal healthy individuals whose risk of cardiovascular disease is reduced by leading an active versus sedentary lifestyle.
SHRIMP U–Pb zircon chronology of ultrahigh‐temperature spinel–orthopyroxene–garnet granulite from South Altay orogenic belt, northwestern China
Authors: Li Zilong , Li Yinqi , Chen Hanlin , Santosh M. , Xiao Wenjiao , Wang Huihui
Published: August 2010

Diagnostic mineral assemblages, mineral compositions and zircon SHRIMP U–Pb ages are reported from an ultrahigh‐temperature (UHT) spinel–orthopyroxene–garnet granulite (UHT rock) from the South Altay orogenic belt of northwestern China. This Altay orogenic belt defines an accretionary belt between the Siberian and Kazakhstan–Junggar Plates that formed during the Paleozoic. The UHT rock examined in this study preserves both peak and retrograde metamorphic assemblages and microstructures including equilibrium spinel + quartz, and intergrowth of orthopyroxene, spinel, sillimanite, and cordierite formed during decompression. Mineral chemistry shows that the spinel coexisting with quartz has low ZnO contents, and the orthopyroxene is of high alumina type with Al2O3 contents up to 9.3 wt%. The peak temperatures of metamorphism were >950°C, consistent with UHT conditions, and the rocks were exhumed along a clockwise P–T path. The zircons in this UHT rock display a zonal structure with a relict core and metamorphic rim. The cores yield bimodal ages of 499 ± 8 Ma (7 spots), and 855 Ma (2 spots), with the rounded clastic zircons having ages with 490–500 Ma. Since the granulite was metamorphosed at temperatures >900°C, exceeding the closure temperature of U–Pb system in zircon, a possible interpretation is that the 499 ± 8 Ma age obtained from the largest population of zircons in the rock marks the timing of formation of the protolith of the rock, with the zircons sourced from a ∼500 Ma magmatic provenance, in a continental margin setting. We correlate the UHT metamorphism with the northward subduction of the Paleo‐Asian Ocean and associated accretion‐collision tectonics of the Siberian and Kazakhstan–Junggar Plates followed by rapid exhumation leading to decompression.
Total knee replacement in the morbidly obese: a literature review
Authors: Samson Anthony J. , Mercer Graham E. , Campbell David G.
Published: August 2010

Background:  The ‘obesity epidemic’ is expected to result in an increased incidence of knee osteoarthritis and hence total knee replacements (TKRs). Reviews have demonstrated the conflicting results of TKR for all obese (body mass index (BMI) >30). The aim of this literature review was to specifically evaluate outcomes of TKR in patients with morbid obesity (MO; BMI >40).

Methods:  A systematic review of medical databases (PubMed, Medline, Cochrane Library, ScienceDirect) by use of keywords from January 1990 to September 2009 was undertaken.

Results:  Clinical and functional Knee Society Scores (KSS) improve after TKR for patients with MO. The post‐operative functional KSS was, in general, less than in controls. Radiographic analysis was inconclusive because of small study populations and short duration of follow‐up. All studies reporting complications noted a greater prevalence in MO patients (10–30%). Of concern was the significantly higher prevalence of deep prosthetic infection (3–9‐times that of controls). The morbidly obese also had a significantly higher incidence of wound complications. TKR did not result in weight loss for MO patients, and therefore has no benefit on weight‐related medical conditions. Bariatric surgery in MO under 65 years of age has been shown to be a cost‐effective and clinically effective method of weight reduction. This surgery also results in significant improvement in weight‐related medical conditions, the KSS and knee pain.

Conclusions:  Given the increase in complications for MO patients after TKR, these patients should be advised to lose weight before surgery and, if suitable, would probably benefit from bariatric surgery.