Neuroprotection by leptin in a rat model of permanent cerebral ischemia: effects on STAT3 phosphorylation in discrete cells of the brain

In addition to its effects in the hypothalamus to control body weight, leptin is involved in the regulation of neuronal function, development and survival. Recent findings have highlighted the neuroprotective effects of leptin against ischemic brain injury; however, to date, little is known about the role performed by the signal transducer and activator of transcription (STAT)-3, a major mediator of leptin receptor transduction pathway in the brain, in the beneficial effects of the hormone. Our data demonstrate that systemic acute administration of leptin produces neuroprotection in rats subjected to permanent middle cerebral artery occlusion (MCAo), as revealed by a significant reduction of the brain infarct volume and neurological deficit up to 7 days after the induction of ischemia. By combining a subcellular fractionation approach with immunohistofluorescence, we observe that neuroprotection is associated with a cell type-specific modulation of STAT3 phosphorylation in the ischemic cortex. The early enhancement of nuclear phospho-STAT3 induced by leptin in the astrocytes of the ischemic penumbra may contribute to a beneficial effect of these cells on the evolution of tissue damage. In addition, the elevation of phospho-STAT3 induced by leptin in the neurons after 24 h MCAo is associated with an increased expression of tissue inhibitor of matrix metalloproteinases-1 in the cortex, suggesting its possible involvement to the neuroprotection produced by the adipokine

Non-Adherence in Patients on Peritoneal Dialysis: A Systematic Review

Background: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. Results: The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of nonadherence varied across studies: 2.6 1353% for dialysis exchanges, 3.9 1385% for medication, and 14.4 1367% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Conclusion: Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient populatio

Death in the Spanish fire services: a curriculum development study

noPurpose – The purpose of this paper is to understand the need and resources firefighters have to deal with death and dying (D&D) that they encounter whilst on duty and to present a curriculum to support D&D issues for firefighters. Design/methodology/approach – A qualitative methodology involving focus groups was conducted in two fire stations in Spain. The sample was 38 male participants with a mean age of 46 y/o (range: 30-59 years) and an average tenure of employment of 18 years (range: 6-35 years). Data were subjected to a thematic analysis. Dual coding of the transcripts in addition to member checking enhanced analysis. Findings – Nine themes emerged: witnessing D&D during rescue operations;memories about D&D and trauma; impact on firefighter’s families; decision-making process under stress; teamwork: protective and self-support; inadequate D&D preparation and training; adequate technical and physical training preparation; relationship between equipment, legal-moral obligation, and victims’ outcomes; communication issues: toward the victim and/or their relatives. These themes were subsequently framed into three basic domains: personal impact of D&D, team impact of D&D, and victim impact. Each domain, in its turn, is covered by three curriculum topics. The curriculum’s pedagogy is primarily based on experimental-reflective activities during 16 study-hours. Research limitations/implications – The absence of female participants. All fire stations were in cities with no more than 150,000 inhabitants. Practical implications – Individuals who take this curriculum will: increase their ability for self-care and resilience; improve teamwork, leadership skills, and to decrease burnout; provide more effective care for victims; provide skills to cope with compassion fatigue; reduced the levels of post-traumatic stress disorders. Originality/value – Understanding firefighters’ needs with relation to D&D, and assessing the resources available to mitigate these issues will provide a comprehensive approach to their education and promote health both personally and professionally. A comparable curriculum or proposal has not been previously identified