Theories of schizophrenia: a genetic-inflammatory-vascular synthesis

BACKGROUND: Schizophrenia, a relatively common psychiatric syndrome, affects virtually all brain functions yet has eluded explanation for more than 100 years. Whether by developmental and/or degenerative processes, abnormalities of neurons and their synaptic connections have been the recent focus of attention. However, our inability to fathom the pathophysiology of schizophrenia forces us to challenge our theoretical models and beliefs. A search for a more satisfying model to explain aspects of schizophrenia uncovers clues pointing to genetically mediated CNS microvascular inflammatory disease. DISCUSSION: A vascular component to a theory of schizophrenia posits that the physiologic abnormalities leading to illness involve disruption of the exquisitely precise regulation of the delivery of energy and oxygen required for normal brain function. The theory further proposes that abnormalities of CNS metabolism arise because genetically modulated inflammatory reactions damage the microvascular system of the brain in reaction to environmental agents, including infections, hypoxia, and physical trauma. Damage may accumulate with repeated exposure to triggering agents resulting in exacerbation and deterioration, or healing with their removal. There are clear examples of genetic polymorphisms in inflammatory regulators leading to exaggerated inflammatory responses. There is also ample evidence that inflammatory vascular disease of the brain can lead to psychosis, often waxing and waning, and exhibiting a fluctuating course, as seen in schizophrenia. Disturbances of CNS blood flow have repeatedly been observed in people with schizophrenia using old and new technologies. To account for the myriad of behavioral and other curious findings in schizophrenia such as minor physical anomalies, or reported decreased rates of rheumatoid arthritis and highly visible nail fold capillaries, we would have to evoke a process that is systemic such as the vascular and immune/inflammatory systems. SUMMARY: A vascular-inflammatory theory of schizophrenia brings together environmental and genetic factors in a way that can explain the diversity of symptoms and outcomes observed. If these ideas are confirmed, they would lead in new directions for treatments or preventions by avoiding inducers of inflammation or by way of inflammatory modulating agents, thus preventing exaggerated inflammation and consequent triggering of a psychotic episode in genetically predisposed persons

ISSN exercise & sport nutrition review: research & recommendations

Sports nutrition is a constantly evolving field with hundreds of research papers published annually. For this reason, keeping up to date with the literature is often difficult. This paper is a five year update of the sports nutrition review article published as the lead paper to launch the JISSN in 2004 and presents a well-referenced overview of the current state of the science related to how to optimize training and athletic performance through nutrition. More specifically, this paper provides an overview of: 1.) The definitional category of ergogenic aids and dietary supplements; 2.) How dietary supplements are legally regulated; 3.) How to evaluate the scientific merit of nutritional supplements; 4.) General nutritional strategies to optimize performance and enhance recovery; and, 5.) An overview of our current understanding of the ergogenic value of nutrition and dietary supplementation in regards to weight gain, weight loss, and performance enhancement. Our hope is that ISSN members and individuals interested in sports nutrition find this review useful in their daily practice and consultation with their clients

Shifting from car to active transport : a systematic review of the effectiveness of interventions

Introduction A promising way to stimulate physical activity is to promote the choice for active modes of transport (walking and cycling). Over the past years, several interventions and policies have been implemented to stimulate this mode shift. However, information concerning the effectiveness of these interventions and policies is still limited. The aim of the present study was to systematically review the effectiveness of interventions designed to stimulate a shift from car use to cycling or walking and to obtain insight into the intervention tools that have been used to promote and/or implement these interventions. Methods Five databases were searched and articles published in English, Dutch, German, Danish, Norwegian and Swedish were included. Only studies that focussed on a mode shift from car use towards active transport in a general adult population, which were published in peer reviewed journals and which investigated effectiveness were included. Intervention tools used were categorized by using the model of Hoogerwerf & Herweijer, as either legal, economic (subsidy, reward system, penalty), communicative (written materials, behavioural tools) and physical tools (providing bicycles, providing better bicycle facilities at work, adjustment of the environment). Results Nineteen studies met our inclusion criteria. Studies included described work-place-based interventions, architectural and urbanistic adjustments, population-wide interventions, and bicycle-renting systems. Nearly all studies (except three) showed positive effects concerning a mode shift. Most of the included studies used more than one intervention tool and the tools used differed between types of interventions. However, information about the statistical significance of these results was often lacking and the study methodologies used were not of high quality. Conclusion Nearly all studies showed results in a positive direction. However, the quality of the included studies was mostly low and intervention characteristics were poorly described