Family caregivers who sought help to increase their coping skills (N = 158) and caregivers who volunteered for a longitudinal study of Alzheimer's disease (N = 58) were screened for depression. Among help-seekers, 46% had depression according to Research Diagnostic Criteria (RDC), but among non-help-seekers, only 18% met this criterion. In general, women were more depressed than men, but no major differences in the extent of depression were found in those who cared for more impaired persons.

Objective-To test the hypothesis that a problem-solving training program would lower depression, health complaints, and burden, and increase well-being reported by community-residing family caregivers of persons with traumatic brain injuries (TBIs). Design-Randomized controlled trial. Setting-General community.Participants-Of the 180 people who expressed interest in the study, 113 did not meet eligibility criteria. A consenting sample of family caregivers were randomized into a problem-solving training group (4 men, 29 women; average age, 51.3y) or an education-only control group (34 women; average age, 50.8y). Care recipients included 26 men and 7 women in the intervention group (average age, 36.5y) and 24 men and 10 women in the control group (average age, 37.2y).Intervention-Problem-solving training based on the D'Zurilla and Nezu social problem-solving model was provided to caregivers in the intervention group in 4 in-home sessions and 8 telephone follow-up calls over the course of their year-long participation. Control group participants received written educational materials and telephone calls at set intervals throughout their 12 months of participation.Main Outcome Measures-Caregiver depression, health complaints, well-being, and social problem-solving abilities.Results-Hierarchical linear models revealed caregivers receiving problem-solving training reported significant decreases in depression, health complaints, and in dysfunctional problem-solving styles over time. No effects were observed on caregiver well-being, burden, or constructive problemsolving styles.Conclusions-Problem-solving training provided in the home appears to be effective in alleviating distress and in decreasing dysfunctional problem-solving styles among family caregivers of persons Reprint requests to Patricia A. Rivera, PhD, Birmingham VAMC, 700 19th St S, Birmingham, AL 35233, No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. NIH Public Access KeywordsBrain injuries; Caregivers; Problem-solving; Randomized controlled trials; RehabilitationEvidence accumulating from decades of empirical research substantiates that many family caregivers of persons with traumatic brain injury (TBI) experience considerable distress and compromised quality of life, generally, in the wake of the neurobehavioral changes imposed by TBI. 1 To a great extent, this research has been content to describe the various demographic, social, and psychologic correlates of distress, depression, and burden reported by caregivers. Despite this evidence, a recent critical review identified only 4 published studies to date of interventions to alleviate caregiver distress, and it concluded that there is currently no evidence supporting the usefulness of any single psychosocial intervention for family caregivers of persons with TBI. 2Much of the available research on caregiver distress after TBI...

BACKGROUND AND PURPOSE The lack of safe and effective treatments for obesity has increased interest in natural products that may serve as alternative therapies. From this perspective, we have analysed the effects of daidzein, one of the main soy isoflavones, on diet‐induced obesity in rats. EXPERIMENTAL APPROACH Rats made obese after exposure to a very (60%) high fat‐content diet were treated with daidzein (50 mg·kg−1) for 14 days. The dose was selected on the basis of the acute effects of this isoflavone on a feeding test. After 14 days, animals were killed and plasma, white and brown adipose tissue, muscle and liver studied for the levels and expression of metabolites, proteins and genes relevant to lipid metabolism. KEY RESULTS A single treatment (acute) with daidzein dose‐dependently reduced food intake. Chronic treatment (daily for 14 days) reduced weight gain and fat content in liver, accompanied by high leptin and low adiponectin levels in plasma. While skeletal muscle was weakly affected by treatment, both adipose tissue and liver displayed marked changes after treatment with daidzein, affecting transcription factors and lipogenic enzymes, particularly stearoyl coenzyme A desaturase 1, a pivotal enzyme in obesity. Expression of uncoupling protein 1, an important enzyme for thermogenesis, was increased in brown adipose tissue after daidzein treatment. CONCLUSIONS AND IMPLICATIONS These results support the use of isoflavones in diet‐induced obesity, especially when hepatic steatosis is present and open a new field of use for these natural products.

Objective-To determine the percentage of family caregivers of persons with spinal cord injury (SCI) with probable depression and to test the hypothesis that dysfunctional problem-solving abilities would be significantly predictive of risk status after taking into account important demographic characteristics and caregiver health.Design-Correlational and logistic regression analyses of data collected in a cross-sectional design.Participants-Eighteen men and 103 women caregivers (mean age of caregivers = 45.66 years, SD = 12.88) of individuals with SCI. Main Outcome Measure-The Inventory to Diagnose Depression.Results-Nineteen caregivers (15.7%) met criteria on the Inventory to Diagnose Depression for a major depressive disorder. A dysfunctional problem-solving style was significantly predictive of caregiver depression, regardless of the severity of physical impairment of the care recipient or the physical health of the caregiver and caregiver demographic variables.Conclusions-The percentage of caregivers with probable depressive disorder may parallel that observed among persons with SCI, using a more conservative self-report measure designed to assess symptoms associated with a depressive syndrome. Family caregivers with a dysfunctional problemsolving style and assisting individuals with more severe injuries may have probable depression. As a result of recent advances in medical technology, persons surviving a spinal cord injury (SCI) are living longer lives and often require varied degrees of assistance over their life span (DeVivo & Stover, 1995;Eisenberg & Saltz, 1991;Lasfargues, Custis, Carswell, & Nguyen, 1995). In response, family members often become the primary sources of assistance for various activities of daily living, such as feeding, dressing, transfers, and bowel and bladder care (Robinson-Whelen & Rintala, 2003;Weitzenkamp, Gerhart, Charlifue, Whiteneck, & Savic, 1997). However, caregivers enter into this new role without formal preparation or training . As a result, family caregivers of persons with severe disabilities encounter a host of problems, including role overload, lack of information, financial strain, impaired quality of life, changes in health status, and emotional problems Vitaliano, Zhang, & Scanlan, 2003). Caregiver depression has been consistently associated with poor quality of life and other adverse outcomes (Covinsky, Fortinsky, Palmer, Kresevic, & Landefeld, 1997;Han & Haley, 1999;Schulz & Beach, 1999).For many individuals, the traumatic onset of a severe physical disability may be experienced as an "off time," nonnormative life event (Neugarten, 1979) that abruptly interferes with the routine pursuit of normative personal, social, and vocational roles (Moen, Robison, & Dempster-McClain, 1995). Family caregivers of persons with SCI may experience a wide range of lifestyle and quality of life changes after assuming the role as primary caregiver (Boschen, Tonack, & Gargaro, 2005;Kolakowsky-Hayner & Kishore, 1999;Unalan et al., 2001). Although descriptive studies have found...

The peroxisome proliferator-activated receptors (PPARs) are a group of nuclear receptor proteins that promote ligand-dependent transcription of target genes that regulate energy production, lipid metabolism, and inflammation. The PPAR superfamily comprises three subtypes, PPARa, PPARg, and PPARb/d, with differential tissue distributions. In addition to their different roles in the regulation of energy balance and carbohydrate and lipid metabolism, an emerging function of PPARs includes normal homeostasis of intestinal tissue. PPARa activation represses NF-kB signaling, which decreases the inflammatory cytokine production by different cell types, while PPARg ligands can inhibit activation of macrophages and the production of inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-a), interleukin (IL)-6, and Il-1b. In this regard, the anti-inflammatory responses induced by PPAR activation might restore physiopathological imbalances associated with inflammatory bowel diseases (IBD). Thus, PPARs and their ligands have important therapeutic potential. This review briefly discusses the roles of PPARs in the physiopathology and therapies of the most important IBDs, ulcerative colitis (UC), and Crohn's disease (CD), as well some new experimental compounds with PPAR activity as promising drugs for IBD treatment.

β-adrenergic receptor activation promotes brown adipose tissue (BAT) β-oxidation and thermogenesis by burning fatty acids during uncoupling respiration. Oleoylethanolamide (OEA) can inhibit feeding and stimulate lipolysis by activating peroxisome proliferator-activating receptor-α (PPARα) in white adipose tissue (WAT). Here we explore whether PPARα activation potentiates the effect of β3-adrenergic stimulation on energy balance mediated by the respective agonists OEA and CL316243. The effect of this pharmacological association on feeding, thermogenesis, β-oxidation, and lipid and cholesterol metabolism in epididymal (e)WAT was monitored. CL316243 (1 mg/kg) and OEA (5 mg/kg) co-administration over 6 days enhanced the reduction of both food intake and body weight gain, increased the energy expenditure and reduced the respiratory quotient (VCO2/VO2). This negative energy balance agreed with decreased fat mass and increased BAT weight and temperature, as well as with lowered plasma levels of triglycerides, cholesterol, nonessential fatty acids (NEFAs), and the adipokines leptin and TNF-α. Regarding eWAT, CL316243 and OEA treatment elevated levels of the thermogenic factors PPARα and UCP1, reduced p38-MAPK phosphorylation, and promoted brown-like features in the white adipocytes: the mitochondrial (Cox4i1, Cox4i2) and BAT (Fgf21, Prdm16) genes were overexpressed in eWAT. The enhancement of the fatty-acid β-oxidation factors Cpt1b and Acox1 in eWAT was accompanied by an upregulation of de novo lipogenesis and reduced expression of the unsaturated-fatty-acid-synthesis enzyme gene, Scd1. We propose that the combination of β-adrenergic and PPARα receptor agonists promotes therapeutic adipocyte remodelling in eWAT, and therefore has a potential clinical utility in the treatment of obesity.

The ECS (endocannabinoid system) plays an important role in the onset of obesity and metabolic disorders, implicating central and peripheral mechanisms predominantly via CB1 (cannabinoid type 1) receptors. CB1 receptor antagonist/inverse agonist treatment improves cardiometabolic risk factors and insulin resistance. However, the relative contribution of peripheral organs to the net beneficial metabolic effects remains unclear. In the present study, we have identified the presence of the endocannabinoid signalling machinery in skeletal muscle and also investigated the impact of an HFD (high-fat diet) on lipid-metabolism-related genes and endocannabinoid-related proteins. Finally, we tested whether administration of the CB1 inverse agonist AM251 restored the alterations induced by the HFD. Rats were fed on either an STD (standard/low-fat diet) or an HFD for 10 weeks and then treated with AM251 (3 mg/kg of body weight per day) for 14 days. The accumulated caloric intake was progressively higher in rats fed on the HFD than the STD, resulting in a divergence in body weight gain. AM251 treatment reduced accumulated food/caloric intake and body weight gain, being more marked in rats fed on the HFD. CB2 (cannabinoid type 2) receptor and PPARα (peroxisome-proliferator-activated receptor α) gene expression was decreased in HFD-fed rats, whereas MAGL (monoglyceride lipase) gene expression was up-regulated. These data suggest an altered endocannabinoid signalling as a result of the HFD. AM251 treatment reduced CB2 receptor, PPARγ and AdipoR1 (adiponectin receptor 1) gene expression in STD-fed rats, but only partially normalized the CB2 receptor in HFD-fed rats. Protein levels corroborated gene expression results, but also showed a decrease in DAGL (diacylglycerol) β and DAGLα after AM251 treatment in STD- and HFD-fed rats respectively. In conclusion, the results of the present study indicate a diet-sensitive ECS in skeletal muscle, suggesting that blockade of CB1 receptors could work towards restoration of the metabolic adaption imposed by diet.

The purpose of this study was to determine the feasibility of offering a psychoeducational intervention, in a group format, to Hispanic/Latino family caregivers of dementia victims. The final sample size was 70 primary caregivers who volunteered to participate in the study: 43 were in the intervention program and 27 were on a waiting list for 3 months. Pre/post comparisons were made between those participating in the specially designed culturally sensitive 8-week class (that taught several specific cognitive and behavioral skills for coping with the frustrations associated with caregiving) and those who remained on the waiting list for that same time period. Those in the class reported significantly fewer depressive symptoms, and showed a trend for increased control of feelings of anger and frustration, compared to those on the waiting list, who did not improve on any measure. Limitations of the study include lack of random Dolores Gallagher-Thompson