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Liu H, Li X, Chen R, Liu D, Tong C. Effect of left gastric artery embolization on obesity and ghrelin/leptin levels in pigs. Am J Transl Res 2021; 13:5368-5373. [PMID: 34150132 PMCID: PMC8205667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the influence of left gastric artery embolization (LGAE) on obesity and Ghrelin/Leptin levels in pigs. METHODS Healthy female Wuzhishan piglets aged 3-4 months were allocated into obesity + LGAE group, obesity group, control group (fed with a normal diet; n=8 for each group). Body weight, serum Ghrelin, Leptin, glucose and insulin levels were compared before surgery, 1 month and 3 months after surgery. RESULTS Piglets in obesity group and obesity + LGAE group were heavier than those in control group before and 1 month after surgery (P<0.001), and in obesity group were heavier than those in obesity + LGAE group 1 month after surgery (P<0.05). A significant decrease in body weight was observed in obesity + LGAE group 3 months after surgery (P<0.05), and the obesity group showed heavier weight than the other two groups (P<0.001). Ghrelin levels in obesity group and obesity + LGAE group were higher than those in control group before and 1 month after surgery (P<0.001), and in obesity group were higher than those in obesity + LGAE group 1 month after surgery (P<0.05). They showed an evident decrease in obesity + LGAE group 3 months after surgery (P<0.05), and in obesity group were higher than that in the other two groups (P<0.01). Leptin levels in obesity group and obesity + LGAE group were higher than those in control group before surgery (P<0.01) and 1 month after surgery (P<0.05). They decreased significantly in obesity + LGAE group 3 months after surgery (P<0.01), and in obesity group were higher than those in the other two groups (P<0.01). CONCLUSION LGAE greatly contributes to weight loss possibly by reducing the secretion of Ghrelin and Leptin.
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Affiliation(s)
- Hui Liu
- Department of Interventional Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
| | - Xiangying Li
- Department of Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
| | - Rihui Chen
- Department of Interventional Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
| | - Dingcheng Liu
- Department of Interventional Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
| | - Chao Tong
- Department of Interventional Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
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Liu H, Li X, Chen R, Liu D, Tong C. Effect of left or right gastric artery interventional embolization on obesity and ghrelin/leptin expression in pigs. Am J Transl Res 2021; 13:5444-5451. [PMID: 34150142 PMCID: PMC8205808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effect of left or right gastric artery interventional embolization on obesity and ghrelin/leptin expression in pigs. METHODS Thirty-two female Wuzhishan pigs aged 3-4 months were randomly divided into four groups, with eight pigs in each group: obesity + left gastric artery embolization group, obesity + right gastric artery embolization group, obesity + sham surgery group and healthy control group. The body weight and serum levels of ghrelin, leptin, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) before the operation, one month and three months after the operation, and the gastric pathology three months after the operation were compared. RESULTS The preoperative body weight, ghrelin level, leptin level, IL-6 level and TNF-α level of the obesity + sham surgery group, obesity + left gastric artery embolization group and obesity + right gastric artery embolization group were higher than those of the healthy control group (all P<0.05). One month after the operation, the body weight, ghrelin level, leptin level, IL-6 level and TNF-α level of the obesity + sham surgery group, obesity + left gastric artery embolization group and obesity + right gastric artery embolization group were higher than those of the healthy control group. The body weight, ghrelin level, IL-6 level and TNF-α level of the obesity + sham surgery group were higher than those of the obesity + left artery embolization group and obesity + right gastric artery embolization group (all P<0.05). Three months after the operation, the body weight, ghrelin level, leptin level, IL-6 level and TNF-α level of the obesity + sham surgery group were higher than those of the obesity + left artery embolization group, obesity + right artery embolization group and the healthy control group (all P<0.05). CONCLUSION Left or right gastric artery interventional embolization in pigs can effectively reduce body weight, which may be related to the reduced secretion of ghrelin, leptin and inflammatory factors. However, the clinical application and safety of left or right gastric artery embolization still need further study.
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Affiliation(s)
- Hui Liu
- Department of Interventional Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
| | - Xiangying Li
- Department of Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
| | - Rihui Chen
- Department of Interventional Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
| | - Dingcheng Liu
- Department of Interventional Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
| | - Chao Tong
- Department of Interventional Radiology, Central South University, Xiangya School of Medicine Affiliated Haikou HospitalHaikou, Hainan Province, China
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Goldstein-Piekarski AN, Wielgosz J, Xiao L, Stetz P, Correa CG, Chang SE, Lv N, Rosas LG, Lavori PW, Snowden MB, Venditti EM, Simmons JM, Smyth JM, Suppes T, Lewis MA, Ajilore O, Ma J, Williams LM. Early changes in neural circuit function engaged by negative emotion and modified by behavioural intervention are associated with depression and problem-solving outcomes: A report from the ENGAGE randomized controlled trial. EBioMedicine 2021; 67:103387. [PMID: 34004422 PMCID: PMC8141669 DOI: 10.1016/j.ebiom.2021.103387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/17/2021] [Accepted: 04/23/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Depression exerts a staggering toll that is worsened with co-occurring chronic conditions such as obesity. It is imperative to develop more effective interventions for depression and to identify objective and biological plausible neural mechanisms to understand intervention outcomes. The current study uses functional neuroimaging to determine whether a behavioural intervention changes the negative affect circuit and whether these changes relate to subsequent improvements in both symptom and problem-solving outcomes in depressed patients with co-occurring obesity. METHODS This study ('ENGAGE') was a pre-planned element of the randomized controlled trial, 'RAINBOW' (ClinicalTrials.gov NCT02246413). 108 depressed patients with obesity were randomized to receive an integrated collaborative care intervention (I-CARE) or usual care. Participants underwent functional neuroimaging using an established facial emotion task at baseline and two months (coinciding with the first two months of intervention focused on problem-solving therapy ('PST')). Amygdala, insula and anterior cingulate cortex activation was extracted using pre-planned definitions and standardized methods. The primary health and behavioural outcomes were depression symptom severity and problem-solving ability respectively, assessed at baseline, the main 6-month outcome point and at 12-month follow up. Mediation analyses used an intent-to-treat approach. FINDINGS PST, relative to usual care, reduced amygdala activation engaged by threat stimuli at two months. This reduction mediated subsequent improvements in depression severity in an intervention-dependent manner. PST did not change insula activation at two months but did temper the strength of the relationship between insula activation and improvements in problem-solving ability. INTERPRETATION The negative affect circuit may be an important neural target and potential mediator of PST in patients with comorbid obesity. FUNDING US National Institutes of Health/National Heart Lung and Blood Institute R01 HL119453 and UH2/UH3 HL132368.
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Affiliation(s)
- Andrea N Goldstein-Piekarski
- Stanford University, Stanford, CA, United States; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
| | - Joseph Wielgosz
- Stanford University, Stanford, CA, United States; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Lan Xiao
- Stanford University, Stanford, CA, United States
| | | | | | | | - Nan Lv
- University of Illinois at Chicago, United States
| | - Lisa G Rosas
- Stanford University, Stanford, CA, United States
| | | | | | | | - Janine M Simmons
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, United States
| | | | - Trisha Suppes
- Stanford University, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | | | | | - Jun Ma
- University of Illinois at Chicago, United States
| | - Leanne M Williams
- Stanford University, Stanford, CA, United States; Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
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Nujić D, Musić Milanović S, Milas V, Miškulin I, Ivić V, Milas J. Association between child/adolescent overweight/obesity and conduct disorder: A systematic review and meta-analysis. Pediatr Obes 2021; 16:e12742. [PMID: 33348469 DOI: 10.1111/ijpo.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 09/12/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research findings of the association and its pattern between obesity and psychiatric/psychological comorbidities are not consistent across the types of comorbidities or the study subgroups. OBJECTIVES We aimed to perform meta-analysis of cross-sectional studies and longitudinal studies analysing obesity as a risk factor for conduct disorder in order to assess the association between child/adolescent overweight/obesity and conduct disorder. METHODS Systematic literature search, study selection and data extraction were performed independently by the two authors. Data were analysed by Comprehensive Meta-analysis software. RESULTS Analysis of 13 high-quality cross-sectional studies including 79 027 children and adolescents indicated a significant association between overweight/obesity and conduct disorder among children and adolescents (OR 1.32 [95% CI, 1.18-1.49], I2 = 86.68), with no publication bias. Subgroup analyses yielded a significant difference (P < .01) between boys and girls. Analysis of four low- to moderate-quality longitudinal studies (OR 1.11 [95% CI, 0.89-1.38], I2 = 57.69) showed no prospective association between overweight/obesity and conduct disorder. Subgroup analysis according to gender revealed a significant positive association for boys and negative association for girls. CONCLUSIONS Based on the high-quality cross-sectional data, overweight and obesity are associated with conduct disorder among children and adolescents, affecting boys more frequently than girls. Results of the longitudinal analysis indicated possible association in boys, while girls seem to be protected from conduct disorder. However, these results are very unreliable, indicating the need of well-designed longitudinal studies to elucidate the pattern of association between these disorders.
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Affiliation(s)
- Danijela Nujić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Sanja Musić Milanović
- Division for Health Promotion, Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, Andrija Štampar School of Public Health, University of Zagreb, Zagreb, Croatia
| | - Vesna Milas
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Pediatrics, Osijek University Hospital Centre, Osijek, Croatia
| | - Ivan Miškulin
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Vedrana Ivić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Josip Milas
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Department of Epidemiology, Institute of Public Health of Osijek-Baranja County, Osijek, Croatia
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Rosas LG, Xiao L, Lv N, Lavori PW, Venditti EM, Snowden MB, Smyth JM, Lewis MA, Williams LM, Suppes T, Goldstein-Piekarski AN, Ma J. Understanding mechanisms of integrated behavioral therapy for co-occurring obesity and depression in primary care: a mediation analysis in the RAINBOW trial. Transl Behav Med 2021; 11:382-392. [PMID: 32203569 PMCID: PMC7963297 DOI: 10.1093/tbm/ibaa024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The RAINBOW trial demonstrated that an integrated collaborative care intervention was effective for improving weight and depression. This study examined mediation of the treatment effect by a priori specified lifestyle behaviors and cognitive functioning. Participants were randomized to a 12-month integrated intervention (n = 204) or usual care (n = 205). Body mass index (BMI) and 20-item Depression Symptom Check List (SCL-20) were co-primary outcomes (Y). To examine mediation, we assessed (a) the effect of the integrated intervention (X) on lifestyle behaviors (diet and physical activity) and cognitive functioning (problem-solving; M, X→M path a) and (b) the association of these behaviors with BMI and SCL-20 (M→Y path b). Mediation existed if paths a and b were significant or if path a and the product of coefficients test (paths a and b) were significant. Compared with usual care, the intervention led to significant improvements in leisure time physical activity (201.3 MET minutes/week [SD, 1,457.6]) and total calorie intake (337.4 kcal/day [818.3]) at 6 months but not 12 months (path a). These improvements were not significantly associated with improvements in BMI or SCL-20 (path b). However, avoidant problem-solving style score and increased fruit and vegetable intake significantly correlated with improvements in BMI at 6 and 12 months, respectively. Also, increased fruit and vegetable intake, higher dietary quality, and better problem-solving abilities significantly correlated with improvements in SCL-20 at 6 and 12 months. These findings did not support the hypothesized mediation, but suggest lifestyle behaviors and cognitive functioning to target in future intervention optimization.
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Affiliation(s)
- Lisa G Rosas
- Epidemiology and Population Health, Stanford School of Medicine, Palo Alto, CA
| | - Lan Xiao
- Epidemiology and Population Health, Stanford School of Medicine, Palo Alto, CA
| | - Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Phillip W Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, CA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA
| | - Joshua M Smyth
- Departments of Biobehavioral Health and of Medicine, The Pennsylvania State University, University Park, PA
| | - Megan A Lewis
- Center for Communication Science, RTI International, Seattle, WA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) VA Palo Alto Health Care System, Palo Alto, CA
| | - Trisha Suppes
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
- Department of mental health, VA Palo Alto Health Care System, Palo Alto, CA
| | - Andrea N Goldstein-Piekarski
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC) VA Palo Alto Health Care System, Palo Alto, CA
| | - Jun Ma
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL
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Lewis MA, Wagner LK, Rosas LG, Lv N, Venditti EM, Steinman LE, Weiner BJ, Goldhaber-Fiebert JD, Snowden MB, Ma J. Using RE-AIM to examine the potential public health impact of an integrated collaborative care intervention for weight and depression management in primary care: Results from the RAINBOW trial. PLoS One 2021; 16:e0248339. [PMID: 33705465 PMCID: PMC7951877 DOI: 10.1371/journal.pone.0248339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An integrated collaborative care intervention was used to treat primary care patients with comorbid obesity and depression in a randomized clinical trial. To increase wider uptake and dissemination, information is needed on translational potential. METHODS The trial collected longitudinal, qualitative data at baseline, 6 months (end of intensive treatment), 12 months (end of maintenance treatment), and 24 months (end of follow-up). Semi-structured interviews (n = 142) were conducted with 54 out of 409 randomly selected trial participants and 37 other stakeholders, such as recruitment staff, intervention staff, and clinicians. Using a Framework Analysis approach, we examined themes across time and stakeholder groups according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. RESULTS At baseline, participants and other stakeholders reported being skeptical of the collaborative care approach related to some RE-AIM dimensions. However, over time they indicated greater confidence regarding the potential for future public health impact. They also provided information on barriers and actionable information to enhance program reach, effectiveness, adoption, implementation, and maintenance. CONCLUSIONS RE-AIM provided a useful framework for understanding how to increase the impact of a collaborative and integrative approach for treating comorbid obesity and depression. It also demonstrates the utility of using the framework as a planning tool early in the evidence-generation pipeline.
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Affiliation(s)
- Megan A. Lewis
- Center for Communication Science, RTI International, Seattle, WA, United States of America
| | - Laura K. Wagner
- Center for Communication Science, RTI International, Research Triangle Park, NC, United States of America
| | - Lisa G. Rosas
- Department of Epidemiology and Population Health, Stanford School of Medicine, Palo Alto, CA, United States of America
| | - Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Elizabeth M. Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Lesley E. Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, United States of America
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Health Services, University of Washington, Seattle, WA, United States of America
| | - Jeremy D. Goldhaber-Fiebert
- Stanford Health Policy, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Palo Alto, CA, United States of America
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Jun Ma
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America
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Martins LB, Braga Tibães JR, Sanches M, Jacka F, Berk M, Teixeira AL. Nutrition-based interventions for mood disorders. Expert Rev Neurother 2021; 21:303-315. [PMID: 33487078 DOI: 10.1080/14737175.2021.1881482] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: 'Nutritional Psychiatry' is an emerging area of research that has great potential as an adjunctive tool for the prevention and treatment of diverse neuropsychiatric disorders. Several nutrition-related aspects, such as obesity, dietary patterns, gut microbiome composition and gut permeability, bioactive food compounds, and nutrients can influence pathways implicated in the pathophysiology of mood disorders.Areas covered: Here, the authors review the current evidence on nutrition-mood interaction and nutrition-based treatments for the two main mood disorders, i.e., major depressive disorder and bipolar disorder.Expert opinion: Consistent evidence from observational studies has pointed out the association between a 'healthy' diet, generally characterized by a higher intake of fruits, vegetables, legumes, nuts, whole grains, and good quality sources of protein (i.e. fish and/or seafood), and decreased risk of mood disorders and the parallel association between a 'Western' diet pattern and increased risk. However, only a few clinical trials have evaluated the effect of nutritional interventions on the treatment of these conditions. The bidirectional interaction between the brain and the gut, named 'brain-gut-microbiome axis' or 'gut-brain axis', plays a key role in the link between nutrition and mood disorders. Therefore, nutrition-based strategies for gut microbiota modulation are promising fields in mood disorders.
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Affiliation(s)
- Lais B Martins
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States.,Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Jenneffer Rayane Braga Tibães
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Alberta, Canada
| | - Marsal Sanches
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States
| | - Felice Jacka
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.,College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Black Dog Institute, Randwick, New South Wales, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Antônio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States.,Instituto de Ensino e Pesquisa, Santa Casa, Belo Horizonte, Minas Gerais, Brazil
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Lv N, Xiao L, Rosas LG, Venditti EM, Smyth JM, Lewis MA, Snowden MB, Ronneberg CR, Williams LM, Gerber BS, Ajilore OA, Patel AS, Ma J. Sex Moderates Treatment Effects of Integrated Collaborative Care for Comorbid Obesity and Depression: The RAINBOW RCT. Ann Behav Med 2021; 55:1157-1167. [PMID: 33616188 DOI: 10.1093/abm/kaaa125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sex influences health and related behaviors due to biological and psychosocial/socioeconomic factors. Assessing sex-specific responses to integrated treatment for comorbid obesity and depression could inform intervention targeting. PURPOSE To test (a) whether sex moderates the effects of integrated collaborative care on weight and depression outcomes through 24 months and (b) whether treatment response at 6 months predicts 12 and 24 month outcomes by sex. METHODS Secondary data analyses on weight and depression severity (SCL-20) measured over 24 months among 409 adults with obesity and depression in the Research Aimed at Improving Both Mood and Weight trial. RESULTS Men achieved significantly greater weight reductions in intervention versus usual care than women, whereas women achieved significantly greater percentage reductions in SCL-20 than men at both 12 and 24 months. In logistic models, at 80% specificity for correctly identifying participants not achieving clinically significant long-term outcomes, women who lost <3.0% weight and men who lost <4.1% weight at 6 months had ≥84% probability of not meeting 5% weight loss at 24 months. Similarly, at 80% specificity, women who reduced SCL-20 by <39.5% and men who reduced by <53.0% at 6 months had ≥82% probability of not meeting 50% decrease in SCL-20 at 24 months. CONCLUSIONS Sex modified the integrated treatment effects for obesity and depression. Sex-specific responses at 6 months predicted clinically significant weight loss and depression outcomes through 24 months. Based on early responses, interventions may need to be tailored to address sex-specific barriers and facilitators to achieving healthy weight and depression outcomes at later time points. CLINICAL TRIAL REGISTRATION NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413).
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Affiliation(s)
- Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua M Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Megan A Lewis
- Center for Communication Science, RTI International, Seattle, WA, USA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Corina R Ronneberg
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Olusola A Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Aashutos S Patel
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jun Ma
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Medicine, College of Medicine, University of Illinois at Chicago, 1747 W. Roosevelt Rd, Room 586 (MC 275), Chicago, IL 60608, USA
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Ronneberg CR, Lv N, Xiao L, Rosas LG, Shrestha R, Dosala S, Eckley T, Wittels N, Ma J. Weight loss effects in usual primary care: Findings from 5 behavioral weight loss RCTs. Obes Res Clin Pract 2021; 15:180-183. [PMID: 33589391 DOI: 10.1016/j.orcp.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 11/18/2022]
Abstract
Primary care is an important setting for obesity treatment and behavior therapy is considered the first line. However, current practice often does not meet clinical guidelines and, furthermore, effects of usual care (UC) on weight loss are unclear. This makes it difficult to design sufficiently powered weight loss trials in primary care. This study analyzed data from UC control participants across 5 primary care-based randomized clinical trials of behavioral weight loss interventions to assess UC effects for 4 weight outcomes: body mass index (BMI), weight change (kg and %), and percent of participants achieving clinically significant 5% weight loss. Results indicated modest UC effects, suggesting modest weight loss is possible in usual primary care.
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Affiliation(s)
| | - Nan Lv
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Lan Xiao
- Stanford University, United States.
| | | | - Rohit Shrestha
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Sushanth Dosala
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Tessa Eckley
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Nancy Wittels
- Institute for Health Research and Policy, University of Illinois Chicago, United States.
| | - Jun Ma
- Department of Medicine, University of Illinois Chicago, United States.
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Aldossari KK, Shubair MM, Al-Ghamdi S, Al-Zahrani J, AlAjmi M, Mastour Alshahrani S, Alsalamah M, Al-Khateeb BF, Bahkali S, El-Metwally A. The association between overweight/obesity and psychological distress: A population based cross-sectional study in Saudi Arabia. Saudi J Biol Sci 2021; 28:2783-2788. [PMID: 34012319 PMCID: PMC8116972 DOI: 10.1016/j.sjbs.2021.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives The objective of this study was to compare the association between mental well-being between obese (classes 1 and 2), over-weight and non-obese population-based individuals Methods A population-based cross-sectional study was conducted in Al-Kharj, Saudi Arabia. A total of 1019 Saudi nationals aged ≥ 18 years participated in the survey. BMI scores were used to categorize participants into three groups: Obese, overweighted and non-obese/non-overweight. Mental well-being was evaluated by using the validated Arabic version of the General Health Questionnaire version 12 (GHQ-12). Results We used total GHQ score (Mean=12; SD=5.23) to compare mental well-being between the four BMI class categories. The overall one-way ANOVA model was statistically significant (F = 7.018, d = 6, P < 0.001). In multivariate analysis, after adjusting for sociodemographic variables, diabetes and smoking statuses we found that higher psychological distress (as evident by a higher total GHQ score) was associated with higher BMI. The unstandardized Beta regression coefficient = 2.627; P = 0.034). Females were more likely to have higher psychological distress than males (unstandardized Beta = 1.466, P = 0.003). Job status whether being unemployed or ‘civilian’ (civil worker) was significantly associated with higher psychological distress (unstandardized Beta = 1.405, P = 0.041). Being diabetic has a 1.6 times higher risk of psychological distress (unstandardized Beta = 1.604, P = 0.027). Conclusion The study highlights the public health implications of psychological distress amongst individuals with overweight and obesity in Saudi Arabia. Future longitudinal studies should explore the temporality of this relationship.
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Affiliation(s)
- Khaled K Aldossari
- Family & Community Medicine Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mamdouh M Shubair
- School of Health Sciences, University of Northern British Columbia (UNBC), 3333 University Way, Prince George, BC V2N 4Z9, Canada
| | - Sameer Al-Ghamdi
- Family & Community Medicine Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Jamaan Al-Zahrani
- Family & Community Medicine Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Mansour AlAjmi
- Family & Community Medicine Department, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | | | - Majid Alsalamah
- Department of Emergency Medicine, King Abdulaziz Medical City, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Badr F Al-Khateeb
- Department of Family Medicine, King Abdulaziz Medical City, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Salwa Bahkali
- Princess Nourah Bint Abdulrahman University, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ashraf El-Metwally
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Marx W, Lane M, Hockey M, Aslam H, Berk M, Walder K, Borsini A, Firth J, Pariante CM, Berding K, Cryan JF, Clarke G, Craig JM, Su KP, Mischoulon D, Gomez-Pinilla F, Foster JA, Cani PD, Thuret S, Staudacher HM, Sánchez-Villegas A, Arshad H, Akbaraly T, O'Neil A, Segasby T, Jacka FN. Diet and depression: exploring the biological mechanisms of action. Mol Psychiatry 2021; 26:134-150. [PMID: 33144709 DOI: 10.1038/s41380-020-00925-x] [Citation(s) in RCA: 256] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/01/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023]
Abstract
The field of nutritional psychiatry has generated observational and efficacy data supporting a role for healthy dietary patterns in depression onset and symptom management. To guide future clinical trials and targeted dietary therapies, this review provides an overview of what is currently known regarding underlying mechanisms of action by which diet may influence mental and brain health. The mechanisms of action associating diet with health outcomes are complex, multifaceted, interacting, and not restricted to any one biological pathway. Numerous pathways were identified through which diet could plausibly affect mental health. These include modulation of pathways involved in inflammation, oxidative stress, epigenetics, mitochondrial dysfunction, the gut microbiota, tryptophan-kynurenine metabolism, the HPA axis, neurogenesis and BDNF, epigenetics, and obesity. However, the nascent nature of the nutritional psychiatry field to date means that the existing literature identified in this review is largely comprised of preclinical animal studies. To fully identify and elucidate complex mechanisms of action, intervention studies that assess markers related to these pathways within clinically diagnosed human populations are needed.
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Affiliation(s)
- Wolfgang Marx
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Geelong, VIC, Australia.
| | - Melissa Lane
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Geelong, VIC, Australia
| | - Meghan Hockey
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Geelong, VIC, Australia
| | - Hajara Aslam
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Geelong, VIC, Australia
| | - Michael Berk
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Geelong, VIC, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Melbourne, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Ken Walder
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Metabolic Research Unit, Geelong, VIC, Australia
| | - Alessandra Borsini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kirsten Berding
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - John F Cryan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Gerard Clarke
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Jeffrey M Craig
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Kuan-Pin Su
- Departments of Psychiatry and Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - David Mischoulon
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Fernando Gomez-Pinilla
- Departments of Neurosurgery and Integrative Biology and Physiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Jane A Foster
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Patrice D Cani
- UCLouvain, Université catholique de Louvain, WELBIO-Walloon Excellence in Life Sciences and BIOtechnology, Louvain Drug Research Institute, Metabolism and Nutrition Research Group, Brussels, Belgium
| | - Sandrine Thuret
- Basic and Clinical Neuroscience Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Heidi M Staudacher
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Geelong, VIC, Australia
| | - Almudena Sánchez-Villegas
- Nutrition Research Group, Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Gran Canaria, Spain
- Biomedical Research Center Network on Obesity and Nutrition (CIBERobn) Physiopathology of Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Husnain Arshad
- Université Paris-Saclay, UVSQ, Inserm, CESP, "DevPsy", 94807, Villejuif, France
| | - Tasnime Akbaraly
- Université Paris-Saclay, UVSQ, Inserm, CESP, "DevPsy", 94807, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Adrienne O'Neil
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Geelong, VIC, Australia
| | - Toby Segasby
- Basic and Clinical Neuroscience Department, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Felice N Jacka
- Deakin University, IMPACT (the Institute for Mental and Physical Health and Clinical Translation), Food & Mood Centre, Geelong, VIC, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Black Dog Institute, Randwick, NSW, Australia
- James Cook University, Townsville, QLD, Australia
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Stark EL, Miller ES. Diabesity and Perinatal Mental Health: Evidence-based Recommendations for Screening and Intervention. Clin Obstet Gynecol 2020; 64:204-213. [PMID: 33284142 DOI: 10.1097/grf.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perinatal mental illness, obesity, and diabetes mellitus are common complications of the perinatal period that are becoming ever more prevalent and frequently co-occur. This review seeks to examine the prevalence of comorbid obesity/diabetes (termed "diabesity") and mental illness in the perinatal period and current understandings of the psychosocial and pathophysiological relationships between these diseases. We will present current guidelines for screening and make recommendations for adaptations of mental health treatment in patients with this comorbidity. Finally, we present future directions for research and clinical intervention.
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Affiliation(s)
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Robinson E, Roberts C, Vainik U, Jones A. The psychology of obesity: An umbrella review and evidence-based map of the psychological correlates of heavier body weight. Neurosci Biobehav Rev 2020; 119:468-480. [PMID: 33086131 DOI: 10.1016/j.neubiorev.2020.10.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/17/2022]
Abstract
Psychological factors may explain why some people develop obesity and others remain a normal weight during their life course. We use an umbrella review approach to build an evidence-based map of the psychological correlates of heavier body weight. Synthesising findings from 42 meta-analyses that have examined associations between psychological factors and heavier body weight, we assessed level of evidence for a range of cognitive, psychosocial and mental health individual difference factors. There is convincing evidence that impaired mental health is associated with heavier body weight and highly suggestive evidence that numerous cognitive factors are associated with heavier body weight. However, the relatively low methodological quality of meta-analyses resulted in lower evidential certainty for most psychosocial factors. Psychological correlates of heavier body weight tended to be small in statistical size and on average, people with obesity were likely to be more psychologically similar than different to people with normal weight. We consider implications for understanding the development of heavier body weight and identifying effective public health interventions to reduce obesity.
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Affiliation(s)
- Eric Robinson
- Department of Psychological Sciences, University of Liverpool, UK.
| | - Carl Roberts
- Department of Psychological Sciences, University of Liverpool, UK
| | - Uku Vainik
- Institute of Psychology, Faculty of Social Sciences, University of Tartu, Näituse 2 50409, Tartu, Estonia; Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, 3801 Rue Université, Montréal, Québec, H3A 2B4, Canada
| | - Andrew Jones
- Department of Psychological Sciences, University of Liverpool, UK
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Nepper MJ, McAtee JR, Chai W. Effect of a Workplace Weight-Loss Program for Overweight and Obese Healthcare Workers. Am J Health Promot 2020; 35:352-361. [PMID: 32969262 DOI: 10.1177/0890117120960393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Examining the effect of a workplace weight-loss program on weight loss, and physical, behavioral and mental well-being among overweight/obese healthcare workers. DESIGN Quasi experimental design. SETTING Single healthcare setting. PARTICIPANTS Forty-one (48.0 ± 11.2 years) day-time shift healthcare employees with body mass index [BMI] >29 kg/m2. INTERVENTION Sixteen-week program with weekly group meetings/activities and individual appointments with nutrition/health experts. MEASURES Objective (weight, BMI, blood pressure) and self-reported measures were collected at baseline, conclusion of the intervention and 3 to 6 months post-intervention. ANALYSIS Repeated measure analysis accounting for confounders. RESULTS Participants had an average of 13 pounds (5.6%) weight loss (224.2 ± 6.4 vs. 211.6 ± 6.4 lbs.; P < 0.0001) upon program completion with significant decreases in BMI (37.7 ± 1.0 vs. 35.1 ± 1.0 kg/m2; P < 0.0001). Extreme obesity (BMI≥40 kg/m2) rate was reduced from 36.6% to 17.1% (P < 0.0001). There were decreases in diastolic blood pressure (76.0 ± 1.4 vs. 68.7 ± 1.5 mmHg; P = 0.001) and self-reported blood glucose (119.9 ± 4.4 vs. 105.5 ± 4.6 mg/dL; P = 0.03). Participants had improvements in weekly physical activity (25% change; P = 0.01), nutrition behavior (33% change, P < 0.0001), sleep quality (23% change, P = 0.005), and depression (72% change, P < 0.0001). Twenty-seven participants had post-intervention follow-up data. On average participants regained 8 pounds, which was less than the initial weight loss (16 lbs., N = 27). CONCLUSION The results suggest the program may benefit healthcare employees. Further emphasis should be placed on post-intervention weight management to prevent weight regain.
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Affiliation(s)
| | - Jennifer R McAtee
- Department of Nutrition and Health Sciences, 14719University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Weiwen Chai
- Department of Nutrition and Health Sciences, 14719University of Nebraska-Lincoln, Lincoln, NE, USA
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65
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Matthews EB, Bond L, Stanhope V. Understanding Health Talk in Behavioral Health Encounters: A Qualitative Analysis. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:551-563. [PMID: 32964333 DOI: 10.1007/s10488-020-01088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
Although physical and behavioral health conditions commonly cooccur, best practices making behavioral health treatment responsive to clients' health needs are limited. Particularly little is known about how physical health is addressed by clinicians within routine therapeutic treatment. This study describes the frequency and type of health talk occurring within integrated behavioral health sessions, and explores how this talk functions within ongoing therapeutic work. Participants in this study included 51 dyads of clinical social workers (n = 13) and clients (n = 51) receiving therapy within an integrated community health and behavioral health center. Therapy sessions were recorded and transcribed verbatim. Content analysis determined the frequency and content of health talk in sessions. Thematic analysis was used to understand the function of health talk within these visits. Health talk occurred in 92% (n = 47) of sessions. Clients initiated the majority of discussions. Talk about sleep (40%, n = 19), diet/exercise (35%, n = 16), and chronic health conditions (28%, n = 13) were most common. Health talk either complimented or conflicted with therapeutic work, depending on the topic discussed and when it occurred during session. Health talk changed the scope of therapeutic work by integrating care coordination into routine practice. Health talk was pervasive and was frequently initiated by clients, signaling its relevance to clients' recovery. Providers leveraged heath talk to complement their therapeutic work, but these strategies were not universally applied. Care coordination activities were a part of routine therapy. Practice and policy changes that support a more interdisciplinary approach to clinical work are needed.
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Affiliation(s)
- Elizabeth B Matthews
- Graduate School of Social Service, Fordham University, 113 W 60th St, New York, NY, 10023, USA.
| | - Lynden Bond
- New York University Silver School of Social Work, 1 Washington Plaza, New York, NY, 10003, USA
| | - Victoria Stanhope
- New York University Silver School of Social Work, 1 Washington Plaza, New York, NY, 10003, USA
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66
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Hayes JF, Hoggatt KJ, Breland JY. Mental Health Diagnostic Patterns in Behavioral Weight Loss Program Attendees. Mil Med 2020; 185:e1263-e1270. [PMID: 32328624 DOI: 10.1093/milmed/usaa046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/28/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Individuals with obesity have higher rates of mental health disorders, both singly and in combination, than individuals of normal weight. Mental health disorders may negatively impact weight loss treatment outcomes; however, little is known about the mental health burden of individuals using weight loss programs. The current study identifies common mental health diagnostic profiles among participants of MOVE!-the Veterans Health Administration's behavioral weight loss program. MATERIAL AND METHODS We used national VHA administrative data from fiscal year 2014 to identify veteran primary care patients who participated in at least one MOVE! session the previous year (n = 110,830). Using latent class analysis, we identified patient types (classes) characterized by the presence or absence of mental health diagnoses, both overall and stratified by age and gender. RESULTS There were several patient types (classes), including psychologically healthy, predominantly depressed, depressed with co-occurring mental disorders, and co-occurring mental disorders with no predominant psychological condition. Additional patient types were found in men of different ages. The majority of patients had at least one psychiatric disorder, particularly younger patients. CONCLUSIONS Efforts to improve patients' engagement in the MOVE! program may need to address barriers to care associated with mental health disorders or incorporate care for both obesity and mental health diagnoses in MOVE! A holistic approach may be particularly important for younger patients who have a higher comorbidity burden and longer care horizons. Future work may address if patient types found in the current study extend to non-VHA obesity treatment seekers.
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Affiliation(s)
- Jacqueline F Hayes
- VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025.,Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA San Francisco Healthcare System, San Francisco, CA, 94121.,Department of Medicine, University of California, San Francisco, CA, 94143
| | - Jessica Y Breland
- VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA 94025
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67
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Confronting the Post-ACA American Health Crisis: Designing Health Care for Value and Equity. J Ambul Care Manage 2020; 42:202-210. [PMID: 31136391 DOI: 10.1097/jac.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The United States is in the midst of a health crisis marked by unprecedented 3-year declines in life expectancy. Addressing this national crisis requires alignment of public policies, public health policies, and health care policies, with the overarching aim of improving national health and health equity. Aligning national polices to support human needs provides a foundation for implementing post-Affordable Care Act national health care reform. Reform should start with the twin goals of improving health care value and equity. A focus on value, that is, outcomes and processes desired by patients, is critical to ensuring that resources are judiciously deployed to optimize individual and population health. A focus on health care equity ensures that the health care system is intentionally designed to minimize inequities in health care processes and outcomes, particularly for member of socially disadvantaged groups. All sectors related to the health care system-from policies and payment mechanisms to delivery design, measurement, patient engagement/democratization, training, and research-should be tightly aligned with improving health care value and equity during this next era of health care reform.
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Owens M, Watkins E, Bot M, Brouwer IA, Roca M, Kohls E, Penninx BWJH, Grootheest G, Hegerl U, Gili M, Visser M. Nutrition and depression: Summary of findings from the EU‐funded MooDFOOD depression prevention randomised controlled trial and a critical review of the literature. NUTR BULL 2020. [DOI: 10.1111/nbu.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- M. Owens
- Department of Psychology University of Exeter Exeter UK
| | - E. Watkins
- Department of Psychology University of Exeter Exeter UK
| | - M. Bot
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - I. A. Brouwer
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - M. Roca
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - E. Kohls
- Department of Psychiatry and Psychotherapy Medical Faculty University Leipzig Leipzig Germany
| | - B. W. J. H. Penninx
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - G. Grootheest
- Amsterdam UMC Vrije Universiteit, Psychiatry Amsterdam Public Health Research Institute GGZ in Geest Specialized Mental Health Care Amsterdam The Netherlands
| | - U. Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy Goethe‐University Frankfurt Germany
| | - M. Gili
- Institut Universitari d’ Investigació en Ciències de la Salut (IUNICS/IDISBA) Rediapp University of Balearic Islands Palma de Mallorca Spain
| | - M. Visser
- Department of Health Sciences Faculty of Science Amsterdam Public Health Research Institute Vrije Universiteit Amsterdam Amsterdam The Netherlands
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The ENGAGE-2 study: Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes in a randomized controlled trial (Phase 2). Contemp Clin Trials 2020; 95:106072. [PMID: 32621905 DOI: 10.1016/j.cct.2020.106072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/02/2020] [Accepted: 06/12/2020] [Indexed: 01/07/2023]
Abstract
Despite evidence for effective integrated behavior therapy for treating comorbid obesity and depression, treatment response is highly variable and the underlying neurobiological mechanisms remain unknown. This hampers efforts to identify mechanistic targets in order to optimize treatment precision and potency. Funded within the NIH Science of Behavior Change (SOBC) Research Network, the 2-phased ENGAGE research project applies an experimental precision medicine approach to address this gap. The Phase 1 study focused on demonstrating technical feasibility, target engagement and potential neural mechanisms of responses to an integrated behavior therapy. This therapy combines a video-based behavioral weight loss program and problem-solving therapy for depression, with as-needed intensification of antidepressant medications, and its clinical effectiveness was demonstrated within a parent randomized clinical trial. Here, we describe the ENGAGE Phase 2 (ENGAGE-2) study protocol which builds on Phase 1 in 2 ways: (1) pilot testing of an motivational interviewing-enhanced, integrated behavior therapy in an independent, primarily minority patient sample, and (2) evaluation of a priori defined neural targets, specifically the negative affect (threat and sadness) circuits which demonstrated engagement and malleability in Phase 1, as mediators of therapeutic outcomes. Additionally, the Phase 2 study includes a conceptual and methodological extension to explore the role of microbiome-gut-brain and systemic immunological pathways in integrated behavioral treatment of obesity and depression. This protocol paper documents the conceptualization, design and the transdisciplinary methodologies in ENGAGE-2, which can inform future clinical and translational research in experimental precision medicine for behavior change and chronic disease management. Trial registration: ClinicalTrials.gov #NCT 03,841,682.
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Abstract
Poor nutrition may be a causal factor in the experience of low mood, and improving diet may help to protect not only the physical health but also the mental health of the population, say Joseph Firth and colleagues
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Affiliation(s)
- Joseph Firth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Oxford Road, University of Manchester, Manchester M13 9PL, UK
- NICM Health Research Institute, Western Sydney University, Westmead, Australia
| | - James E Gangwisch
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Alessandra Borisini
- Section of Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, UK
| | - Robyn E Wootton
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Oakfield House, Bristol, UK
- NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Emeran A Mayer
- G Oppenheimer Center for Neurobiology of Stress and Resilience, UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
- UCLA Microbiome Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
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Goldhaber-Fiebert JD, Prince L, Xiao L, Lv N, Rosas LG, Venditti EM, Lewis MA, Snowden MB, Ma J. First-Year Economic and Quality of Life Effects of the RAINBOW Intervention to Treat Comorbid Obesity and Depression. Obesity (Silver Spring) 2020; 28:1031-1039. [PMID: 32320533 PMCID: PMC7245568 DOI: 10.1002/oby.22805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/21/2020] [Accepted: 02/23/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obesity and depression are prevalent and often co-occurring conditions in the United States. The Research Aimed at Improving Both Mood and Weight (RAINBOW) randomized trial demonstrated the effectiveness of an integrated intervention for adults with both conditions. Characterizing the intervention's economic effects is important for broader dissemination and implementation. METHODS This study evaluated the cost (2018 US dollars) and health-related quality of life (HRQoL) impacts during RAINBOW's first year, comparing intervention (n = 204) and usual-care groups (n = 205). Outcomes included intervention delivery costs, differential changes in antidepressant medication spending compared with the pretrial year, differential changes in medical services spending compared with the pretrial year, and HRQoL changes from baseline using Euroqol-5D US utility weights. RESULTS RAINBOW's 1-year delivery cost per person was $2,251. Compared with usual care, annual antidepressant medication days increased more (38 days [95% CI: 4 to 72]; P = 0.027). Annual antidepressant medication spending had a larger, nonsignificant increase ($89 [95% CI: -$20 to $197]; P = 0.109). Annual spending on medical care services had a smaller, nonsignificant decrease (-$54 [95% CI: -$832 to $941]; P = 0.905). HRQoL had a nonsignificant increase (0.011 [95% CI: -0.025 to 0.047]; P = 0.546). CONCLUSIONS The RAINBOW intervention's economic value will depend on how its 1-year improvements in obesity and depression translate into long-term reduced morbidity, delayed mortality, or averted costs.
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Affiliation(s)
- Jeremy D Goldhaber-Fiebert
- Stanford Health Policy Group, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
| | - Lea Prince
- Stanford Health Policy Group, Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, USA
| | - Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, California, USA
- Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Elizabeth M Venditti
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Megan A Lewis
- Center for Communications Science, RTI International, Seattle, Washington, USA
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jun Ma
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Lv N, Xiao L, Majd M, Lavori PW, Smyth JM, Rosas LG, Venditti EM, Snowden MB, Lewis MA, Ward E, Lesser L, Williams LM, Azar KMJ, Ma J. Variability in engagement and progress in efficacious integrated collaborative care for primary care patients with obesity and depression: Within-treatment analysis in the RAINBOW trial. PLoS One 2020; 15:e0231743. [PMID: 32315362 PMCID: PMC7173791 DOI: 10.1371/journal.pone.0231743] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/27/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The RAINBOW randomized clinical trial validated the efficacy of an integrated collaborative care intervention for obesity and depression in primary care, although the effect was modest. To inform intervention optimization, this study investigated within-treatment variability in participant engagement and progress. METHODS Data were collected in 2014-2017 and analyzed post hoc in 2018. Cluster analysis evaluated patterns of change in weekly self-monitored weight from week 6 up to week 52 and depression scores on the Patient Health Questionnaire-9 (PHQ-9) from up to 15 individual sessions during the 12-month intervention. Chi-square tests and ANOVA compared weight loss and depression outcomes objectively measured by blinded assessors to validate differences among categories of treatment engagement and progress defined based on cluster analysis results. RESULTS Among 204 intervention participants (50.9 [SD, 12.2] years, 71% female, 72% non-Hispanic White, BMI 36.7 [6.9], PHQ-9 14.1 [3.2]), 31% (n = 63) had poor engagement, on average completing self-monitored weight in <3 of 46 weeks and <5 of 15 sessions. Among them, 50 (79%) discontinued the intervention by session 6 (week 8). Engaged participants (n = 141; 69%) self-monitored weight for 11-22 weeks, attended almost all 15 sessions, but showed variable treatment progress based on patterns of change in self-monitored weight and PHQ-9 scores over 12 months. Three patterns of weight change (%) represented minimal weight loss (n = 50, linear β1 = -0.06, quadratic β2 = 0.001), moderate weight loss (n = 61, β1 = -0.28, β2 = 0.002), and substantial weight loss (n = 12, β1 = -0.53, β2 = 0.005). Three patterns of change in PHQ-9 scores represented moderate depression without treatment progress (n = 40, intercept β0 = 11.05, β1 = -0.11, β2 = 0.002), moderate depression with treatment progress (n = 20, β0 = 12.90, β1 = -0.42, β2 = 0.006), and milder depression with treatment progress (n = 81, β0 = 7.41, β1 = -0.23, β2 = 0.003). The patterns diverged within 6-8 weeks and persisted throughout the intervention. Objectively measured weight loss and depression outcomes were significantly worse among participants with poor engagement or poor progress on either weight or PHQ-9 than those showing progress on both. CONCLUSIONS Participants demonstrating poor engagement or poor progress could be identified early during the intervention and were more likely to fail treatment at the end of the intervention. This insight could inform individualized and timely optimization to enhance treatment efficacy. TRIAL REGISTRATION ClinicalTrials.gov# NCT02246413.
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Affiliation(s)
- Nan Lv
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Lan Xiao
- Department of Medicine, Stanford University, Palo Alto, California, United States of America
| | - Marzieh Majd
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Philip W. Lavori
- Department of Biomedical Data Science, Stanford University, Stanford, California, United States of America
| | - Joshua M. Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Lisa G. Rosas
- Department of Health Research and Policy and Medicine, Stanford University, Palo Alto, California, United States of America
| | - Elizabeth M. Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, United States of America
| | - Megan A. Lewis
- Center for Communications Science, RTI International, Seattle, Washington, United States of America
| | - Elizabeth Ward
- Pacific Coast Psychiatric Associates, San Francisco, California, United States of America
| | - Lenard Lesser
- One Medical, San Francisco, California, United States of America
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
| | - Kristen M. J. Azar
- Sutter Health Research Enterprise, Center for Health Systems Research, Walnut Creek, California, United States of America
| | - Jun Ma
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
- * E-mail:
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Rosas LG, Azar KMJ, Lv N, Xiao L, Goldhaber-Fiebert JD, Snowden MB, Venditti EM, Lewis MM, Goldstein-Piekarski AN, Ma J. Effect of an Intervention for Obesity and Depression on Patient-Centered Outcomes: An RCT. Am J Prev Med 2020; 58:496-505. [PMID: 32067873 PMCID: PMC7089815 DOI: 10.1016/j.amepre.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION An integrated collaborative care intervention was successful for treating comorbid obesity and depression. The effect of the integrated intervention on secondary outcomes of quality of life and psychosocial functioning were examined, as well as whether improvements in these secondary outcomes were correlated with improvements in the primary outcomes of weight and depressive symptoms. STUDY DESIGN This RCT compared an integrated collaborative care intervention for obesity and depression to usual care. Data were analyzed in 2018. SETTING/PARTICIPANTS Adult primary care patients (n=409) with a BMI ≥30 (≥27 if Asian) and 9-Item Patient Health Questionnaire score ≥10 were recruited from September 30, 2014 to January 12, 2017 from primary care clinics in Northern California. INTERVENTION The 12-month intervention integrated a behavioral weight loss program and problem-solving therapy with as-needed antidepressant medications for depression. MAIN OUTCOME MEASURES A priori secondary outcomes included health-related quality of life (Short Form-8 Health Survey), obesity-specific quality of life (Obesity-Related Problems Scale), sleep disturbance and sleep-related impairment (Patient-Reported Outcomes Measurement Information System), and functional disability (Sheehan Disability Scale) at baseline and 6 and 12 months. RESULTS Participants randomized to the intervention experienced significantly greater improvements in obesity-specific problems, mental health-related quality of life, sleep disturbance, sleep-related impairment, and functional disability at 6 months but not 12 months. Improvements in obesity-related problems (β=0.01, 95% CI=0.01, 0.02) and sleep disturbance (β= -0.02, 95% CI= -0.04, 0) were associated with lower BMI. Improvements in the physical (β= -0.01, 95% CI= -0.01, 0) and mental health components (β= -0.02, 95% CI= -0.03, -0.02) of the Short Form-8 Health Survey as well as sleep disturbance (β=0.01, 95% CI=0.01, 0.02) and sleep-related impairment (β=0.01, 95% CI=0, 0.01) were associated with fewer depressive symptoms. CONCLUSIONS An integrated collaborative care intervention for obesity and depression that was shown previously to improve weight and depressive symptoms may also confer benefits for quality of life and psychosocial functioning over 6 months. TRIAL REGISTRATION This study is registered at clinicaltrials.gov NCT02246413.
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Affiliation(s)
- Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California; Department of Medicine, Stanford University, Palo Alto, California
| | | | - Nan Lv
- Department of Medicine and Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | | | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Megan M Lewis
- Center for Communications Science, RTI International, Seattle, Washington
| | | | - Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.
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Hoerster KD, Tanksley L, Simpson T, Saelens BE, Unützer J, Black M, Greene P, Sulayman N, Reiber G, Nelson K. Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study. Am J Health Promot 2020; 34:587-598. [PMID: 32162528 DOI: 10.1177/0890117120908505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. DESIGN Single-arm pre-post pilot to iteratively develop MOVE!+UP (2015-2018). SETTING Veterans Affairs Medical Center. PARTICIPANTS Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = "Development" and cohort 5 [n = 8] = "Final" MOVE!+UP). INTERVENTION MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. MEASURES To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. ANALYSIS Baseline to 16-week paired t tests and template analysis. RESULTS Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight (M = -14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD (M = -17.9 [SD = 12.2]) improvements, P < .05. CONCLUSIONS The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.
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Affiliation(s)
- Katherine D Hoerster
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Lamont Tanksley
- Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Tracy Simpson
- Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Brian E Saelens
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Marissa Black
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Preston Greene
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Nadiyah Sulayman
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Gayle Reiber
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.,Health Services Research Center of Innovation, Salt Lake City, UT, USA
| | - Karin Nelson
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,General Internal Medicine Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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Avalos LA, Caan B, Nance N, Zhu Y, Li DK, Quesenberry C, Hyde RJ, Hedderson MM. Prenatal Depression and Diet Quality During Pregnancy. J Acad Nutr Diet 2020; 120:972-984. [PMID: 32063456 DOI: 10.1016/j.jand.2019.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Maternal nutrition during pregnancy has a significant effect on the health of the offspring and mother, highlighting the need for identifying factors that may affect diet during pregnancy. Research in nonpregnant and pregnant populations suggest depression may play a role. OBJECTIVE To investigate the relationship between prenatal depression and diet quality during pregnancy overall and by race/ethnicity and to explore the relationships between prenatal depression and the 12 Healthy Eating Index 2010 dietary components. DESIGN A cross-sectional secondary analysis of a cohort study of Kaiser Permanente Northern California women entering prenatal care between October 2011 and April 2013. PARTICIPANTS/SETTING Participants included 1,160 adult pregnant women. MAIN OUTCOME MEASURES Poor diet quality was defined as a Healthy Eating Index 2010 score in the lowest quartile. STATISTICAL ANALYSES PERFORMED Logistic regression was used to assess the relationship between prenatal depression (defined as a depression diagnosis, Patient Health Questionnaire score of 10 or greater or antidepressant medication dispensing between the last menstrual period and completion of the food frequency questionnaire) and poor diet quality overall and by race/ethnicity. Relationships between prenatal depression and each of the 12 Healthy Eating Index 2010 dietary components were assessed using t-tests and linear regression analyses. RESULTS One hundred fifty-nine (14%) participants had prenatal depression. Women with prenatal depression had nearly two times the odds of poor diet quality (odds ratio 1.80, 95% CI 1.23 to 2.60) compared with women without prenatal depression, after adjusting for potential confounders. Differences emerged by race/ethnicity; after adjusting for potential confounders the adjusted odds of poor diet quality were significant only among Hispanic women. Hispanic women with prenatal depression had an increased odds of poor diet quality compared with Hispanic women without prenatal depression (odds ratio 2.66, 95% CI 1.15 to 6.06). Women with prenatal depression had a higher consumption of empty calories (from solid fats, alcohol, and added sugars; threshold for counting alcohol >13 g/1,000 kcal) (P=0.01) and lower consumption of greens and beans (P<0.05), total fruit (P<0.01), and whole fruit (P<0.01), compared with women without prenatal depression. Except for empty calories, these findings remained after adjusting for potential confounders. CONCLUSIONS Study findings suggest that women with prenatal depression are at a higher risk of poor diet quality compared with women without prenatal depression, and the relationship is stronger among Hispanic women. Nutrition counseling interventions for women with depression should consider the use of culturally sensitive materials and target limiting empty calories from solid fats, alcohol, and added sugars and encourage eating more greens, beans, and fruit.
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Lim CAR, Nightingale TE, Elliott S, Krassioukov AV. Lifestyle modifications and pharmacological approaches to improve sexual function and satisfaction in men with spinal cord injury: a narrative review. Spinal Cord 2019; 58:391-401. [PMID: 31857687 DOI: 10.1038/s41393-019-0404-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN A narrative review describing various components of sexual dysfunction in men with spinal cord injury (SCI), as well as addressing potential therapeutic approaches. OBJECTIVES Restoration of sexual function is considered one of the most important health priorities for individuals with SCI. The purpose of this review is to provide information regarding the factors that are less appreciated when considering changes to sexual function in men with SCI. We also propose therapeutic approaches, with a focus on lifestyle modifications, which have been shown to improve sexual function. METHODS A literature search was performed and limited evidence for therapeutic approaches in individuals with SCI was supplemented by consistent findings from the able-bodied population. RESULTS We evaluated the less addressed factors known to contribute to sexual dysfunction in men with SCI, including hormonal influences (i.e., testosterone deficiency, thyroid hormone, and cortisol), psychological factors (i.e., pain, fatigue, depression, and body image), and secondary SCI complications (i.e., urinary tract infection, pressure sores, and autonomic dysreflexia). To address these factors beyond standard medical treatments for sexual dysfunction, options include physical activity/exercise, diet, and specific medications for symptom relief (i.e., testosterone replacement therapy and selective serotonin reuptake inhibitors for depression). CONCLUSIONS Physical activity's potential application, efficacy across multiple aspects of sexuality, and the lack of side effects, suggests that long-term exercise is a viable solution to directly or indirectly improve sexual function in males with SCI. Diet and supplemental medications may further promote body composition changes, which more broadly affect sexuality.
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Affiliation(s)
- Chloe A R Lim
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Tom E Nightingale
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Stacy Elliott
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,BC Centre for Sexual Medicine, Vancouver Coastal Health, Vancouver, BC, Canada.,Departments of Psychiatry and Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada. .,GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 718] [Impact Index Per Article: 143.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Affiliation(s)
- Jun Ma
- Department of Medicine, University of Illinois, Chicago
| | - Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mark B Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
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Moulton CD, Tharmaraja T, Hopkins CWP. Collaborative Care for Adults With Obesity and Depression. JAMA 2019; 322:367-368. [PMID: 31334784 DOI: 10.1001/jama.2019.6774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Calum D Moulton
- Department of Psychological Medicine, King's College London, London, England
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Affiliation(s)
- Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Cristina Cusin
- Depression Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Andrew A Nierenberg
- Harvard Medical School, Boston, Massachusetts
- Dauten Family Center for Bipolar Treatment Innovation, Department of Psychiatry, Massachusetts General Hospital, Boston
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Alonso A, Anderson MD, Bancks MP, Brown S, Caughey MC, Chang AR, Delker E, Foti K, Gingras V, Nanna MG, Razavi AC, Scott J, Selvin E, Tcheandjieu C, Thomas AG, Turkson‐Ocran RN, Webel A, Young DR, DeBarmore BM. Highlights From the American Heart Association's EPI|LIFESTYLE 2019 Scientific Sessions. J Am Heart Assoc 2019; 8:e012925. [PMID: 31433702 PMCID: PMC6585352 DOI: 10.1161/jaha.119.012925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Madison D. Anderson
- Division of Epidemiology and Community HealthUniversity of Minnesota, School of Public HealthMinneapolisMN
| | - Michael P. Bancks
- Division of Public Health SciencesDepartment of Epidemiology & PreventionWake Forest School of MedicineWinston‐SalemNC
| | | | | | - Alex R. Chang
- Kidney Health Research InstituteGeisinger Health SystemDanvillePA
| | - Erin Delker
- Joint Doctoral Program Public Health EpidemiologySan Diego State University and University of California at San DiegoSan DiegoCA
| | - Kathryn Foti
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Véronique Gingras
- Division of Chronic Disease Research Across the LifecourseDepartment of Population MedicineHarvard Medical School and Harvard Pilgrim Health Care InstituteBostonMA
| | - Michael G. Nanna
- Duke Clinical Research InstituteDurhamNC
- Division of CardiologyDuke University School of MedicineDurhamNC
| | - Alexander C. Razavi
- Department of MedicineTulane University School of MedicineNew OrleansLA
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLA
| | | | - Elizabeth Selvin
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
- Welch Center for Prevention, Epidemiology, and Clinical ResearchJohns Hopkins UniversityBaltimoreMD
- Division of General Internal MedicineDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMD
| | - Catherine Tcheandjieu
- Department of Pediatric CardiologyStanford Cardiovascular InstituteStanford School of MedicineStanfordCA
| | - Alvin G. Thomas
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
| | | | - Allison Webel
- Frances Payne Bolton School of NursingCase Western Reserve UniversityClevelandOH
| | - Deborah R. Young
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Bailey M. DeBarmore
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina at Chapel HillNC
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