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Brown L, Cambron C, Post WS, Brandt EJ. The Role of Social Determinants of Health in Atherosclerotic Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:451-461. [PMID: 38980573 DOI: 10.1007/s11883-024-01226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE OF REVIEW This review seeks to provide important information on each of the major domains of social determinants of health (SDOH) in the context of atherosclerotic cardiovascular disease. RECENT FINDINGS SDOH can be classified into five domains: social and community context, health care access and quality, neighborhood and built environment, economic stability, and education access and quality. SDOH are major drivers for cardiovascular health outcomes that exceed the impact from traditional risk factors, and explain inequities in health outcomes observed across different groups of individuals. SDOH profoundly impacts healthcare's receipt, delivery, and outcomes. Many patients fall within various disenfranchised groups (e.g., identify with minority race, low socioeconomic status, low educational attainment, LGBTQ+), which impact overall health status and care. Learning to understand, recognize, and address SDOH as the driving force of disparities are critical for achieving health equity in the prevention and adequate treatment of ASCVD.
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Affiliation(s)
- Logan Brown
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
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Muller RD, Driscoll MA, DeRycke EC, Edmond SN, Becker WC, Bastian LA. Factors associated with participation in a walking intervention for veterans who smoke and have chronic pain. J Behav Med 2024:10.1007/s10865-024-00511-4. [PMID: 39143444 DOI: 10.1007/s10865-024-00511-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/28/2024] [Indexed: 08/16/2024]
Abstract
This analysis was part of the Pain and Smoking Study (PASS), a randomized trial of a cognitive behavioral intervention (CBI) for Veterans with chronic pain who smoke. The objective of this study was to examine factors associated with participation in the walking component of the intervention. Demographics and clinical characteristics were obtained at baseline. Completion of two or more CBI counseling sessions was required to be included in analyses. Average daily step counts obtained via pedometer in the prior week were recorded in up to three telephone counseling sessions. Participants were then categorized as "sedentary" (≤ 4999 daily steps) or "not sedentary" (≥ 5000 daily steps). Multivariable logistic regression was used to model variance in activity categorization. Overall, 91.0% of participants were men, 70.5% were white, mean age was 58.4 years, mean BMI was 28.6, median pack years was 20.5, and 43.8% were depressed. Veterans reported moderate pain intensity (4.9/10) and pain interference (5.4/10). Pain locations included: lower extremity (67.4%), back (53.4%) and upper extremity (28.1%). Median daily steps were 2491 [IQR: 1720-3550] (sedentary) (n = 65), 7307 [IQR: 5952-8533] (not sedentary) (n = 24), and 3196 [IQR: 2237-5067] (overall) (n = 89). Veterans with older age (odds ratio (OR): 1.10, 95% confidence interval (CI): 1.04, 1.17) and presence of LE pain (OR: 5.98, 95% CI: 1.82, 19.65) had increased odds of being "sedentary." Integrated smoking cessation and chronic pain self-management interventions that include a walking component may need to consider the impact of age and pain location on participation.Trial registration: The trial is registered at www.ClinicalTrials.gov (NCT02971137). First posted on November 22, 2016.
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Affiliation(s)
- Ryan D Muller
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT, USA.
- Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Mary A Driscoll
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Eric C DeRycke
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT, USA
| | - Sara N Edmond
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - William C Becker
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, CT, USA
- Yale School of Medicine, Yale University, New Haven, CT, USA
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Yang Y, Wang Y, Mao Y, Zhu F, Zhang M, Pan M, Yin T, Xu J, Chen R, Zheng W. Association of life's essential 8 with mortality among the individuals with cardiovascular disease. Sci Rep 2024; 14:18520. [PMID: 39122961 PMCID: PMC11315880 DOI: 10.1038/s41598-024-69603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024] Open
Abstract
This study explores the association between LE8 scores and mortality risks among individuals diagnosed with cardiovascular disease (CVD). Utilizing data from the NHANES conducted between 2005 and 2018, survey-weighted multivariable Cox proportional hazards regression models were utilized. Life's Essential 8 (LE8) scores dose-response associations were assessed using restricted cubic spline regression. Sub-analyses were performed for different categories of CVD. The study consisted of 2164 participants diagnosed with CVD, ranging in age from 20 to 80 years (weighted mean [SE] age, 61.47 [0.34] years; The average total LE8 was 64.97 [0.54]. 499 participants experienced mortality, with 350 deaths attributed to CVD. After accounting for potential covariates, LE8 score was found to be associated with a decreased both all-cause mortality (OR 0.34, CI 0.22-0.51) and CVD mortality (OR 0.40, CI 0.23-0.68). A survey-weighted multivariable Cox model with restricted cubic splines identified the lowest all-cause mortality (P < 0.001) and CVD mortality (P < 0.001) risk when LE8 reach at 63.75 (P < 0.001). The results highlight the association between LE8 scores and reduced mortality in CVD patient population. The implementation of comprehensive initiatives that prioritize healthy dietary patterns, will play a crucial role in alleviating the impact of cardiovascular disease and improving cardiovascular health outcomes.
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Affiliation(s)
- Ying Yang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ye Wang
- Department of Psychiatry, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yanping Mao
- Department of Psychiatry, Zhejiang Cancer Hospital, Hangzhou, China
| | - Feiyun Zhu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Man Zhang
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Mengshan Pan
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Tongle Yin
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiamin Xu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Rucheng Chen
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China.
| | - Weijun Zheng
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China.
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Stephan-Recaido SC, Peckham TK, Hawkins D, Baker MG. Burden and social distribution of occupational psychosocial exposures in the United States workforce, 2022. Am J Ind Med 2024. [PMID: 39105659 DOI: 10.1002/ajim.23641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/01/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVE To characterize the burden and social distribution of occupational psychosocial exposures in the United States (US). METHODS We merged 2022 US employment and demographic data from the Current Population Survey (CPS) with occupational characteristic data from the Occupational Information Network (O*NET), wage data from the Occupational Employment and Wage Statistics Survey, and hours worked from the CPS, to estimate the number and proportion of US workers at risk of exposure to 19 psychosocial hazards. We additionally estimated the number and proportion of US workers over- or underrepresented in exposure burden. RESULTS Of the exposures examined, US workers were most commonly employed in occupations with high time pressure (67.5 million US workers exposed; 43.2% US workers exposed), high emotional labor (57.1 million; 36.6%), and low wages (47.8 million; 30.6%). The burden of exposures was uneven across sociodemographic strata, attributable to occupational segregation. The full data set is available online at https://deohs.washington.edu/us-exposure-burden. CONCLUSIONS Work-related psychosocial exposures are ubiquitous and should be considered in occupational and public health research, policy, and interventions to reduce the burden of disease and health inequities in the United States.
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Affiliation(s)
- Shelley C Stephan-Recaido
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Trevor K Peckham
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
- Hazardous Waste Management Program, King County, Washington, USA
| | - Devan Hawkins
- Public Health Program, School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Marissa G Baker
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
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Ayares G, Díaz LA, Fuentes-López E, Idalsoaga F, Cotter TG, Dunn W, Simonetto D, Shah VH, Kamath PS, Lazarus JV, Bataller R, Arrese M, Wong RJ, Singal AK, Arab JP. Racial and ethnic disparities in the natural history of alcohol-associated liver disease in the United States. Liver Int 2024. [PMID: 39096099 DOI: 10.1111/liv.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 06/14/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Outcomes in alcohol-associated liver disease (ALD) are influenced by several race and ethnic factors, yet its natural history across the continuum of patients in different stages of the disease is unknown. METHODS We conducted a retrospective cohort study of U.S. adults from 2011 to 2018, using three nationally representative databases to examine potential disparities in relevant outcomes among racial and ethnic groups. Our analysis included logistic and linear regressions, along with competing risk analysis. RESULTS Black individuals had the highest daily alcohol consumption (12.6 g/day) while Hispanic participants had the largest prevalence of heavy episodic drinking (33.5%). In a multivariable-adjusted model, Hispanic and Asian participants were independently associated with a higher ALD prevalence compared to Non-Hispanic White interviewees (OR: 1.4, 95% CI: 1.1-1.8 and OR: 1.5 95% CI:1.1-2.0, respectively), while Blacks participants had a lower ALD prevalence (OR: .7 95% CI: .6-.9), and a lower risk of mortality during hospitalization due to ALD (OR: .83 95% CI: .73-.94). Finally, a multivariate competing-risk analysis showed that Hispanic ethnicity had a decreased probability of liver transplantation if waitlisted for ALD (SHR: .7, 95% CI: .6-.8) along with female Asian population (HR: .40, 95% CI: .26-.62). CONCLUSIONS After accounting for key social and biological health determinants, the Hispanic population showed an increased risk of ALD prevalence, even with lower alcohol consumption. Additionally, Hispanic and Asian female patients had reduced access to liver transplantation compared to other enlisted patients.
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Affiliation(s)
- Gustavo Ayares
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Antonio Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Idalsoaga
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Thomas G Cotter
- Division of Gastroenterology and Hepatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Winston Dunn
- Division of Gastroenterology, Department of Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Douglas Simonetto
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vijay H Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey V Lazarus
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, New York, USA
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ramon Bataller
- Liver Unit, Hospital Clinic, Institut d'Investigacions August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marco Arrese
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ashwani K Singal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Juan Pablo Arab
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Plencner LM, Nalubega Ross J, Hall M, Hurley EA, Raphael JL, De Miranda ED, Colvin JD. Piloting Home Produce Delivery to Improve Food Security, Budget, and Diet in Families with Children: A Mixed-Methods Study. Acad Pediatr 2024:S1876-2859(24)00287-0. [PMID: 39098600 DOI: 10.1016/j.acap.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Few children in food insecure (FI) households meet dietary recommendations for fruit and vegetables ("produce"). Barriers include affordability, accessibility, and desirability. Home produce delivery may reduce FI, increase produce consumption, and decrease budget tradeoffs. OBJECTIVE Evaluate the acceptability and potential impact of delivering produce through home visiting programs on FI, diet, and budget tradeoffs. METHODS In this prospective pre/post mixed methods study, 51 parents engaged in home visiting programs were enrolled. Participants completed pre- and post-program surveys on FI (18-item Food Security Scale), produce consumption, and budget tradeoffs. Pre- and post-surveys were compared using McNemar's test and weighted kappas. Interview guides were based on Social Cognitive Theory and a previously published framework. Interviews were conducted in English or Spanish; thematic analysis was completed. RESULTS Twenty-nine (56.9%) participants completed both surveys. Most were female (96.3%) and Hispanic (79.3%) (Table 1). Food security improved in the post-period, with more participants reporting high food security (pre: 6.9%, post: 31.0%) and fewer reporting very low food security (pre: 20.7%, post: 6.9%, p<0.01) (Table 2). Budgetary tradeoffs decreased in the post-program period (pre: 71.4%, post: 48.1%, p=0.03). Fifteen participants were interviewed. Themes included 1) saved money, 2) increased fruit and vegetable consumption, and 3) interest in future participation. CONCLUSION This pilot study found that an intervention for delivery of produce through home visiting programs was acceptable to participants and resulted in potential improvements in FI and household budgets. This supports future studies to further explore the impact of this novel intervention. WHAT'S NEW In this prospective mixed-methods pilot, home delivered produce was acceptable and feasible with potentially improved food security and household budgets; evidence of potential change in produce consumption was mixed. Changes in budget tradeoffs is a novel outcome in food programs.
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Affiliation(s)
- Laura M Plencner
- Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, Missouri 64108 USA; University of Missouri-Kansas City School of Medicine, 2401 Gillham Rd, Kansas City, Missouri 64108 USA.
| | - J Nalubega Ross
- Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, Missouri 64108 USA.
| | - Matthew Hall
- Children's Hospital Association, 16011 College Blvd #250, Lenexa, KS, 66219, USA.
| | - Emily A Hurley
- Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, Missouri 64108 USA; University of Missouri-Kansas City School of Medicine, 2401 Gillham Rd, Kansas City, Missouri 64108 USA.
| | - Jean L Raphael
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
| | | | - Jeffrey D Colvin
- Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, Missouri 64108 USA; University of Missouri-Kansas City School of Medicine, 2401 Gillham Rd, Kansas City, Missouri 64108 USA.
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Roseen EJ, McNaughton DT, Harrison S, Downie AS, Øverås CK, Nim CG, Jenkins HJ, Young JJ, Hartvigsen J, Stone KL, Ensrud KE, Lee S, Cawthon PM, Fink HA. Association of back pain with all-cause and cause-specific mortality among older men: a cohort study. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:505-513. [PMID: 38741219 PMCID: PMC11292054 DOI: 10.1093/pm/pnae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/27/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE We evaluated whether more severe back pain phenotypes-persistent, frequent, or disabling back pain-are associated with higher mortality rate among older men. METHODS In this secondary analysis of a prospective cohort, the Osteoporotic Fractures in Men (MrOS) study, we evaluated mortality rates by back pain phenotype among 5215 older community-dwelling men (mean age, 73 years, SD = 5.6) from 6 sites in the United States. The primary back pain measure used baseline and Year 5 back pain questionnaire data to characterize participants as having no back pain, nonpersistent back pain, infrequent persistent back pain, or frequent persistent back pain. Secondary measures of back pain from the Year 5 questionnaire included disabling back pain phenotypes. The main outcomes measured were all-cause and cause-specific death. RESULTS After the Year 5 exam, during up to 18 years of follow-up (mean follow-up = 10.3 years), there were 3513 deaths (1218 cardiovascular, 764 cancer, 1531 other). A higher proportion of men with frequent persistent back pain versus no back pain died (78% versus 69%; sociodemographic-adjusted HR = 1.27, 95% CI = 1.11-1.45). No association was evident after further adjustment for health-related factors, such as self-reported general health and comorbid chronic health conditions (fully adjusted HR = 1.00; 95% CI = 0.86-1.15). Results were similar for cardiovascular deaths and other deaths, but we observed no association of back pain with cancer deaths. Secondary back pain measures, including back-related disability, were associated with increased mortality risk that remained statistically significant in fully adjusted models. CONCLUSION Although frequent persistent back pain was not independently associated with risk of death in older men, additional secondary disabling back pain phenotypes were independently associated with increased mortality rate. Future investigations should evaluate whether improvements in disabling back pain affect general health and well-being or risk of death.
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Affiliation(s)
- Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, MA 02131, United States
- Department of Physical Medicine & Rehabilitation and Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Jamaica Plain Campus, Boston, MA 02130, United States
| | - David T McNaughton
- School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Stephanie Harrison
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
| | - Aron S Downie
- Department of Chiropractic, Macquarie University, Sydney, 2109, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, 7034, Norway
| | - Casper G Nim
- Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, 5000, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, 5000, Denmark
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5000, Denmark
| | - Hazel J Jenkins
- Department of Chiropractic, Macquarie University, Sydney, 2109, Australia
| | - James J Young
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, 5000, Denmark
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, M5T 0S8, Canada
| | - Jan Hartvigsen
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, M5T 0S8, Canada
- The Chiropractic Knowledge Hub, University of Southern Denmark, Odense, 5000, Denmark
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158, United States
| | - Kristine E Ensrud
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55415, United States
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN 55417, United States
| | - Soomi Lee
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, United States
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA 94107, United States
| | - Howard A Fink
- Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55415, United States
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN 55417, United States
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN 55417, United States
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Tamargo JA, Strath LJ, Cruz-Almeida Y. High-Impact Pain Is Associated With Epigenetic Aging Among Middle-Aged and Older Adults: Findings From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae149. [PMID: 38855906 PMCID: PMC11226994 DOI: 10.1093/gerona/glae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Chronic pain has been associated with accelerated biological aging, which may be related to epigenetic alterations. We evaluated the association of high-impact pain (ie, pain that limits activities and function) with epigenetic aging, a measure of biological aging, in a nationally representative sample of middle-aged and older adults in the United States. METHODS Cross-sectional analysis of adults 50 years of age and older from the 2016 Health and Retirement Study. Epigenetic aging was derived from 13 epigenetic clocks based on DNA methylation patterns that predict aging correlates of morbidity and mortality. Ordinary least squares regressions were performed to test for differences in the epigenetic clocks, adjusting for the complex survey design, as well as biological, social, and behavioral factors. RESULTS The analysis consisted of 3 855 adults with mean age of 68.5 years, including 59.8% with no pain and 25.8% with high-impact pain. Consistent with its operational definition, high-impact pain was associated with greater functional and activity limitations. High-impact pain was associated with accelerated epigenetic aging compared to no pain, as measured via second (Zhang, PhenoAge, GrimAge) and third (DunedinPoAm) generation epigenetic clocks. Additionally, GrimAge was accelerated in high-impact pain as compared to low-impact pain. CONCLUSIONS High-impact pain is associated with accelerated epigenetic aging among middle-aged and older adults in the United States. These findings highlight aging-associated epigenetic alterations in high-impact chronic pain and suggest a potential for epigenetic therapeutic approaches for pain management and the preservation of physical function in older adults.
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Affiliation(s)
- Javier A Tamargo
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | - Larissa J Strath
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA
- Institute on Aging, University of Florida, Gainesville, Florida, USA
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Kempe K, Homco J, Nsa W, Wetherill M, Jelley M, Lesselroth B, Hasenstein T, Nelson PR. Analysis of Oklahoma amputation trends and identification of risk factors to target areas for limb preservation interventions. J Vasc Surg 2024; 80:515-526. [PMID: 38604318 DOI: 10.1016/j.jvs.2024.03.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall health care performance is ranked 50th in the country. But we know little about Oklahomans and their risk of limb loss. It is, therefore, imperative to look closely at this population to discover contemporary rates, trends, and state-specific risk factors for amputation due to diabetes and/or peripheral arterial disease (PAD). We hypothesize that state-specific groups will be identified as having the highest risk for limb loss and that contemporary trends in amputations are rising. To create implementable solutions to limb preservation, a baseline must be set. METHODS We conducted a 12-consecutive-year observational study using Oklahoma's hospital discharge data. Discharges among patients 20 years or older with a primary or secondary diagnosis of diabetes and/or PAD were included. Diagnoses and amputation procedures were identified using International Classification of Disease-9 and -10 codes. Amputation rates were calculated per 1000 discharges. Trends in amputation rates were measured by annual percentage changes (APC). Prevalence ratios evaluated the differences in amputation rates across demographic groups. RESULTS Over 5,000,000 discharges were identified from 2008 to 2019. Twenty-four percent had a diagnosis of diabetes and/or PAD. The overall amputation rate was 12 per 1000 discharges for those with diabetes and/or PAD. Diabetes and/or PAD-related amputation rates increased from 8.1 to 16.2 (APC, 6.0; 95% confidence interval [CI], 4.7-7.3). Most amputations were minor (59.5%), and although minor, increased at a faster rate compared with major amputations (minor amputation APC, 8.1; 95% CI, 6.7-9.6 vs major amputation APC, 3.1; 95% CI, 1.5-4.7); major amputations were notable in that they were significantly increasing. Amputation rates were the highest among males (16.7), American Indians (19.2), uninsured (21.2), non-married patients (12.7), and patients between 45 and 49 years of age (18.8), and calculated prevalence ratios for each were significant (P = .001) when compared within their respective category. CONCLUSIONS Amputation rates in Oklahoma have nearly doubled in 12 years, with both major and minor amputations significantly increasing. This study describes a worsening trend, underscoring that amputations due to chronic disease is an urgent statewide health care problem. We also present imperative examples of amputation health care disparities. By defining these state-specific areas and populations at risk, we have identified areas to pursue and improve care. These distinctive risk factors will help to frame a statewide limb preservation intervention.
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Affiliation(s)
- Kelly Kempe
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Surgery, Tulsa, OK.
| | - Juell Homco
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Medical Informatics, Tulsa, OK
| | - Wato Nsa
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Medical Informatics, Tulsa, OK
| | - Marianna Wetherill
- University of Oklahoma Health Sciences Center, Hudson College of Public Health, Tulsa, OK
| | - Martina Jelley
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Medicine, Tulsa, OK
| | - Blake Lesselroth
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Medical Informatics, Tulsa, OK
| | - Todd Hasenstein
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Surgery, Tulsa, OK
| | - Peter R Nelson
- University of Oklahoma Health Sciences Center, School of Community Medicine, Department of Surgery, Tulsa, OK
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10
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Ramirez A, Fox K, Melo Herrera Y, Gans KM, Risica PM, McCurdy K, Jennings E, Tovar A. Goals, Barriers, and Facilitators of Caregivers Who Participated in an In-Home Intervention to Improve Food Parenting Practices and Child Diet Quality. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:521-531. [PMID: 38691079 PMCID: PMC11305948 DOI: 10.1016/j.jneb.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To explore the goals, barriers, and facilitators set by caregivers of preschool-aged children to improve food parenting practices and household food environments. DESIGN Secondary qualitative analysis of collaborative goal sheets completed during in-home and telephone visits as part of a home-based pilot intervention. PARTICIPANTS Thirty-three Hispanic/Latinx caregivers, predominantly of low income. PHENOMENON OF INTEREST Patterns in goal content and anticipated barriers and facilitators. ANALYSIS Thematic analysis of goal sheets with a mixed inductive-deductive approach. RESULTS Almost half of the goals were to support a healthy environment (40.7%) by increasing the availability of healthy foods through food shopping and meal planning. Other goals were to increase structure (33.7%) by establishing food-related routines and decreasing distractions. Goals related to autonomy support (25.4%) included involving their children (eg, cooking together). Caregivers' perceived barriers encompass individual (eg, stress, lack of time), interpersonal (eg, other family members' eating behaviors), and environmental-level (eg, food availability) factors. Caregivers only identified facilitators at the individual and interpersonal levels (eg, motivation). CONCLUSIONS AND IMPLICATIONS Understanding goals, barriers, and facilitators can be used to tailor key messages to improve food parenting practices and children's diets. Future interventions can target broader environmental barriers while increasing awareness of individual, interpersonal, and environmental-level facilitators.
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Affiliation(s)
- Andrea Ramirez
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI.
| | - Katelyn Fox
- Weight Control and Diabetes Research Center, The Miriam Hospital & Alpert Medical School of Brown University, Providence, RI
| | | | - Kim M Gans
- Human Development and Family Sciences, University of Connecticut, Storrs, CT
| | | | - Karen McCurdy
- Department of Human Development and Family Science, University of Rhode Island, Kingston, RI
| | - Ernestine Jennings
- Department of Psychiatry and Human Behavior, The Miriam Hospital & Alpert Medical School of Brown University, Providence, RI
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI
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11
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Raji OE, Kyeremah EB, Sears DD, St-Onge MP, Makarem N. Chrononutrition and Cardiometabolic Health: An Overview of Epidemiological Evidence and Key Future Research Directions. Nutrients 2024; 16:2332. [PMID: 39064774 PMCID: PMC11280377 DOI: 10.3390/nu16142332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Chrononutrition is a rapidly evolving field of nutritional epidemiology that addresses the complex relationship between temporal eating patterns, circadian rhythms, and metabolic health, but most prior research has focused on the cardiometabolic consequences of time-restricted feeding and intermittent fasting. The purpose of this topical review is to summarize epidemiological evidence from observational and intervention studies regarding the role of chrononutrition metrics related to eating timing and regularity in cardiometabolic health preservation and cardiovascular disease prevention. Observational studies are limited due to the lack of time-stamped diet data in most population-based studies. Findings from cohort studies generally indicate that breakfast skipping or the later timing of the first eating occasion, a later lunch and dinner, and a greater proportion of caloric intake consumed in the evening are associated with adverse cardiometabolic outcomes, including higher risk for coronary heart disease, hypertension, type 2 diabetes, obesity, dyslipidemia, and systemic inflammation. Randomized controlled trials are also limited, as most in the field of chrononutrition focus on the cardiometabolic consequences of time-restricted feeding. Overall, interventions that shift eating timing patterns to earlier in the day and that restrict evening caloric intake tend to have protective effects on cardiometabolic health, but small sample sizes and short follow-up are notable limitations. Innovation in dietary assessment approaches, to develop low-cost validated tools with acceptable participant burden that reliably capture chrononutrition metrics, is needed for advancing observational evidence. Culturally responsive pragmatic intervention studies with sufficiently large and representative samples are needed to understand the impact of fixed and earlier eating timing schedules on cardiometabolic health. Additional research is warranted to understand the modifiable determinants of temporal eating patterns, to investigate the role of chrononutrition in the context of other dimensions of diet (quantity, quality, and food and nutrition security) in achieving cardiometabolic health equity, and to elucidate underlying physiological mechanisms.
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Affiliation(s)
- Oluwatimilehin E. Raji
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (O.E.R.); (E.B.K.)
| | - Esther B. Kyeremah
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (O.E.R.); (E.B.K.)
| | - Dorothy D. Sears
- College of Health Solutions, Arizona State University, Tempe, AZ 85287, USA;
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
- Department of Family Medicine, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
- Center for Circadian Biology, University of California San Diego, La Jolla, CA 92093, USA
| | - Marie-Pierre St-Onge
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA;
- Sleep Center of Excellence, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Nour Makarem
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (O.E.R.); (E.B.K.)
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12
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Ottone OK, Mundo JJ, Kwakye BN, Slaweski A, Collins JA, Wu Q, Connelly MA, Niaziorimi F, van de Wetering K, Risbud MV. Oral citrate supplementation mitigates age-associated pathological intervertebral disc calcification in LG/J mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.17.604008. [PMID: 39071393 PMCID: PMC11275755 DOI: 10.1101/2024.07.17.604008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Despite the high prevalence of age-dependent intervertebral disc calcification, there is a glaring lack of treatment options for this debilitating pathology. Here, we investigate the efficacy of long-term oral K3Citrate supplementation in ameliorating disc calcification in LG/J mice, a model of spontaneous age-associated disc calcification. K3Citrate successfully reduced the incidence of disc calcification in LG/J mice without deleterious effects on vertebral bone structure, plasma chemistry, and locomotion. Notably, a positive effect on grip strength was evident in treated mice. Spectroscopic investigation of the persisting calcified nodules indicated K3Citrate did not alter the mineral composition and revealed that reactivation of an endochondral differentiation program in endplates may drive LG/J disc calcification. Importantly, K3Citrate reduced calcification incidence without altering the pathological endplate chondrocyte hypertrophy, suggesting mitigation of disc calcification primarily occurred through Ca2+ chelation, a conclusion supported by chondrogenic differentiation and Seahorse metabolic assays. Overall, this study underscores the therapeutic potential of K3Citrate as a systemic intervention strategy for disc calcification.
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Affiliation(s)
- Olivia K. Ottone
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Graduate Program in Cell Biology and Regenerative Medicine, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jorge J. Mundo
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Boahen N. Kwakye
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amber Slaweski
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - John A. Collins
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Fatemeh Niaziorimi
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- PXE International Center of Excellence for Research and Clinical Care
| | - Koen van de Wetering
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- PXE International Center of Excellence for Research and Clinical Care
| | - Makarand V. Risbud
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Graduate Program in Cell Biology and Regenerative Medicine, Jefferson College of Life Sciences, Thomas Jefferson University, Philadelphia, PA, USA
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13
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Kang JM, Kim N, Yun SK, Seo HE, Bae JN, Kim WH, Na KS, Cho SE, Ryu SH, Noh Y, Youn JH, Kang SG, Lee JY, Cho SJ. Exploring transfer effects on memory and its neural mechanisms through a computerized cognitive training in mild cognitive impairment: randomized controlled trial. Psychogeriatrics 2024. [PMID: 39014538 DOI: 10.1111/psyg.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Computerized cognitive training (CCT) has been proposed as a potential therapy for cognitive decline. One of the benefits of CCT is a transfer effect, but its mechanism on the memory domain is unclear. This study aimed to investigate the transfer effect of non-memory multidomain CCT on the memory domain and its neural basis in patients with mild cognitive impairment (MCI) through a randomized controlled trial. METHODS Patients with MCI recruited from memory clinics were randomly assigned to either the CCT or the control group. The CCT group received multidomain CCT training excluding memory training, while the control group read educational books with learning-based quizzes twice a week for 8 weeks. Participants underwent memory tests yielding a composite score, other cognitive domain tests, non-cognitive scales, and resting-state functional magnetic resonance imaging (rsfMRI), at baseline and after intervention. Within- and between-group comparisons, group × time interactions, and seed-to-voxel analyses in memory-involving brain networks were performed. RESULTS The CCT group showed improvement over the control group in memory domain (Group × time, F = 5.87, P = 0.03, η2 = 0.31), which was related with the increased connectivity in the hippocampal-frontal and fusiform-occipital network. No other cognitive and non-cognitive symptoms differed between groups after adjusting for covariates. CONCLUSION Eight weeks of multidomain CCT without memory training improved memory function and restored functional network in the hippocampal and medial temporal region in MCI patients. These results can provide evidence for the transferring ability of CCT on memory functioning with its neural basis.
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Affiliation(s)
- Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Nambeom Kim
- Department of Big Data & AI Master Business Administration, Sejong University, Seoul, Republic of Korea
| | - Seon Kyung Yun
- Department of Nursing, Saekyung University, Yeongwol, Republic of Korea
| | - Ha-Eun Seo
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jae Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seo-Eun Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Young Noh
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jung-Hae Youn
- Department of Counselling Psychology, Cha University, Seongnam, Republic of Korea
| | - Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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14
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Jin D, Lv T, Chen S, Chen Y, Zhang C, Wang X, Li J. Association between oxidative balance score and 10-year atherosclerotic cardiovascular disease risk: results from the NHANES database. Front Nutr 2024; 11:1422946. [PMID: 39077158 PMCID: PMC11284129 DOI: 10.3389/fnut.2024.1422946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Abstract
Introduction The oxidative balance score (OBS) is a holistic measure that represents the overall equilibrium between prooxidants and antioxidants in one's diet and lifestyle. Little research has been conducted on the correlation between OBS and 10-year atherosclerotic cardiovascular disease risk (ASCVD). Therefore, the objective of this investigation was to examine the potential correlation between OBS and 10-year risk. Methods A total of 11,936 participants from the NHANES conducted between 2001 and 2016 were chosen for the study and their dietary and lifestyle factors were used to assess the OBS score. Logistic regression and restricted cubic splines (RCS) were employed in the cross-sectional study to evaluate the correlation between OBS and the 10-year ASCVD risk. The cohort study utilized Cox proportional hazards models and RCS to assess the correlation between OBS and all-causes and cardiovascular disease (CVD) mortality in individuals with high ASCVD risk. Results The cross-sectional study found that the OBS (OR = 0.94, 95% CI = 0.93-0.98), as well as the dietary OBS (OR = 0.96, 95% CI = 0.92-0.96) and lifestyle OBS (OR = 0.74, 95% CI = 0.69-0.79), were inversely associated with the 10-year ASCVD risk. A significant linear relationship was observed between OBS, dietary OBS, lifestyle OBS, and the 10-year ASCVD risk. The cohort study found that the OBS was inversely associated with all-cause (aHRs = 0.97, 95% CI = 0.96-0.99) and CVD (aHRs = 0.95, 95% CI = 0.93-0.98) mortality in individuals with high ASCVD risk. A significant linear correlation was observed between OBS, dietary OBS, lifestyle OBS, and all-cause and CVD mortality in participants with high ASCVD risk. Conclusion The findings indicate that OBS, OBS related to diet, and OBS related to lifestyle were significantly inversely correlated with the 10-year ASCVD risk. Adopting a healthy eating plan and making positive lifestyle choices that result in increased OBS levels can help lower the likelihood of all-cause and CVD mortality in individuals with high ASCVD risk.
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Affiliation(s)
- Dekui Jin
- Department of General Practice, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tian Lv
- Department of Neurology, Zhuji Affiliated Hospital of Wenzhou Medical University, Shaoxing, Zhejiang, China
| | - Shiqin Chen
- Yuhuan Second People’s Hospital, Yuhuan, China
- Department of Neurology, Second People's Hospital of Yuhuan, Yuhan, China
| | - Yiqiao Chen
- Department of Neurology, Qingtian People’s Hospital, Qingtian, Lishui, China
| | - Chengying Zhang
- Department of General Practice, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Wang
- Department of Neurology, Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jie Li
- Department of Neurology, Lishui People's Hospital, Lishui, China
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15
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Goto R, Inoue K, Osawa I, Baicker K, Fleming SL, Tsugawa Y. Machine learning for detection of heterogeneous effects of Medicaid coverage on depression. Am J Epidemiol 2024; 193:951-958. [PMID: 38400644 DOI: 10.1093/aje/kwae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/07/2023] [Accepted: 02/20/2024] [Indexed: 02/25/2024] Open
Abstract
In 2008, Oregon expanded its Medicaid program using a lottery, creating a rare opportunity to study the effects of Medicaid coverage using a randomized controlled design (Oregon Health Insurance Experiment). Analysis showed that Medicaid coverage lowered the risk of depression. However, this effect may vary between individuals, and the identification of individuals likely to benefit the most has the potential to improve the effectiveness and efficiency of the Medicaid program. By applying the machine learning causal forest to data from this experiment, we found substantial heterogeneity in the effect of Medicaid coverage on depression; individuals with high predicted benefit were older and had more physical or mental health conditions at baseline. Expanding coverage to individuals with high predicted benefit generated greater reduction in depression prevalence than expanding to all eligible individuals (21.5 vs 8.8 percentage-point reduction; adjusted difference = +12.7 [95% CI, +4.6 to +20.8]; P = 0.003), at substantially lower cost per case prevented ($16 627 vs $36 048; adjusted difference = -$18 598 [95% CI, -156 953 to -3120]; P = 0.04). Medicaid coverage reduces depression substantially more in a subset of the population than others, in ways that are predictable in advance. Targeting coverage on those most likely to benefit could improve the effectiveness and efficiency of insurance expansion. This article is part of a Special Collection on Mental Health.
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Affiliation(s)
- Ryunosuke Goto
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Itsuki Osawa
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | | | - Scott L Fleming
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, United States
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, United States
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, United States
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16
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Wang Y, Tang Y, Li Z, Jiang C, Jiang W, Hu Z. Sugar-sweetened beverage intake and chronic low back pain. Front Nutr 2024; 11:1418393. [PMID: 39021606 PMCID: PMC11252024 DOI: 10.3389/fnut.2024.1418393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background The consumption of sugar-sweetened beverages (SSBs) has become a major public health problem globally. However, no studies have specifically examined the relationship between SSB intake and chronic low back pain (CLBP). Therefore, the present study aimed to investigate the relationship between SSB intake and the risk of CLBP. Methods This cross-sectional study enrolled participants aged 20 to 69 from the National Health and Nutrition Examination Survey. CLBP was defined as persistent LBP for a consecutive three-month period. Furthermore, SSB intake was assessed and calculated based on dietary recall interviews. Moreover, survey-weighted logistic regression models were employed to evaluate the association between SSB intake and the risk of CLBP, while the restricted cubic spline (RCS) analysis was used to determine whether there were nonlinear associations between SSB intake and CLBP risk. In addition, subgroup analysis was performed using stratification and interaction analysis for all covariates. Results A total of 4,146 participants (mean age: 43.405 years) were enrolled in the final analysis. The results of survey-weighted logistic regression models showed that SSB consumption was significantly associated with an increased risk of CLBP among individuals aged 20 to 69 years. Moreover, the results of subgroup analysis and interaction analysis demonstrated that the association between SSB intake and the risk of CLBP was modified by smoking status and hypertension. Specifically, the SSB intake-associated CLBP risk was more pronounced among current smokers or individuals with hypertension. Conclusion Reduction of SSB consumption might contribute to the prevention of CLBP for individuals aged 20 to 69 years. Moreover, current smokers or individuals with hypertension should be more vigilant about the SSB intake-associated CLBP risk. Nevertheless, caution should be exercised when interpreting the results of this study, as further research is necessary to explore the association between SSB consumption and CLBP, given the limitations of the current study.
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Affiliation(s)
- Yanting Wang
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Orthopedics, The People’s Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan, China
| | - Yuchen Tang
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhichun Li
- Department of General Surgery, Caoxian People's Hospital, Heze, Shandong, China
| | - Changhai Jiang
- Department of Orthopedics, The People’s Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan, China
| | - Wei Jiang
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhenming Hu
- Department of Orthopedics, Orthopedic Laboratory of Chongqing Medical University, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Orthopedics, University-Town Hospital of Chongqing Medical University, Chongqing, China
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17
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Beneciuk JM, Michener LA, Sigman E, Harrison T, Buzzanca-Fried KE, Lu X, Shan G, Hill JC. Validation of the Keele STarT MSK Tool for Patients With Musculoskeletal Pain in United States-based Outpatient Physical Therapy Settings. THE JOURNAL OF PAIN 2024; 25:104475. [PMID: 38242334 DOI: 10.1016/j.jpain.2024.01.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
The STarT MSK tool was developed to enable risk stratification of patients with common musculoskeletal (MSK) pain conditions and help identify individuals who may require more targeted interventions or closer monitoring in primary care settings, however, its validity in U.S.-based outpatient physical therapy settings has not been investigated. The 10-item Keele STarT MSK risk stratification tool was tested for construct (convergent and discriminant) and predictive validity using a multicenter, prospective cohort study design. Participants (n = 141) receiving physical therapy for MSK pain of the back, neck, shoulder, hip, knee, or multisite regions completed intake questionnaires including the Keele STarT MSK tool, Functional Comorbidity Index (FCI), Optimal Screening for Prediction of Referral and Outcome Review-of-Systems and Optimal Screening for Prediction of Referral and Outcome Yellow Flag tools. Pain intensity, pain interference, and health-related quality of life (Medical Outcomes Study 8-item Short-Form Health Survey (SF-8) physical [PCS] and mental [MCS] component summary scores) were measured at 2- and 6-month follow-up. Participants were classified as STarT MSK tool low (44%), medium (39%), and high (17%) risk. Follow-up rates were 70.2% (2 months) and 49.6% (6 months). For convergent validity, fair relationships were observed between the STarT MSK tool and FCI and SF-8 MCS (r = .35-.37) while moderate-to-good relationships (r = .51-.72) were observed for 7 other clinical measures. For discriminant validity, STarT MSK tool risk-dependent relationships were observed for Optimal Screening for Prediction of Referral and Outcome Review-of-Systems, Optimal Screening for Prediction of Referral and Outcome Yellow Flag, pain interference, and SF-8 PCS (low < medium < high; P < .01) and FCI, pain intensity, and SF-8 MCS (low < medium-or-high; P < .01). For predictive validity, intake STarT MSK tool scores explained additional variability in pain intensity (11.2%, 20.0%), pain interference (7.5%, 14.1%), and SF-8 PCS (8.2%, 12.8%) scores at 2 and 6 months, respectively. This study contributes to the existing literature by providing additional evidence of STarT MSK tool cross-sectional construct validity and longitudinal predictive validity. PERSPECTIVE: This study presents STarT MSK risk stratification tool validity findings from a U.S. outpatient physical therapy sample. The STarT MSK tool has the potential to help physical therapists identify individuals presenting with the most common MSK pain conditions who may require more targeted interventions or closer monitoring.
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Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Gainesville, Florida; Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Erica Sigman
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Trent Harrison
- Brooks Institute of Higher Learning, Brooks Rehabilitation, Jacksonville, Florida
| | - Katherine E Buzzanca-Fried
- Clinical Research Center, Brooks Rehabilitation, Jacksonville, Florida; Rehabilitation Science Doctoral Program, College of Public Health & Health Professions, University of Florida, Gainesville, Florida
| | - Xinlin Lu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Guogen Shan
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Jonathan C Hill
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
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18
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Conrad Z, DiStaso C, Korol M, Rose D. Augmenting the National Nutrition Data System to Promote Diet Sustainability Analyses. Curr Dev Nutr 2024; 8:103793. [PMID: 39045145 PMCID: PMC11262171 DOI: 10.1016/j.cdnut.2024.103793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 07/25/2024] Open
Abstract
Research on sustainable diets has become an important and growing area of the nutrition field, but recent studies have pointed to a lack of sustainability metrics and methods that are hindering research and policy progress. To fill this gap, the White House National Strategy on Hunger, Nutrition, and Health calls for increased funding to improve metrics, data collection, and research to address all domains of sustainability, which include nutrition/health, economic, environmental, and social domains. Commodity recipe databases, such as the Food Commodity Intake Database (FCID), are important tools for conducting diet sustainability analyses because they translate mixed dishes from dietary surveys, such as the National Health and Nutrition Examination Survey (NHANES), into commodity ingredients. These ingredients have been linked to data on environmental impacts and economic costs from other databases, thus facilitating collaboration between nutrition researchers, environmental scientists, economists, and others. These linkages cannot be made with other components of the national nutrition data system, such as the Food Patterns Equivalents Database (FPED), because the disaggregated food groups from them are not relevant for examining environmental impacts. Although the NHANES is conducted on an ongoing basis, and FPED is continually updated, the FCID has not been officially updated since 2010. This severely limits advancements in sustainability research and related policy analyses. In this commentary, we argue that the federal government should promote this diet sustainability work by integrating a commodity recipe database into the national nutrition data system, and updating it on a regular basis, as it does with other component databases.
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Affiliation(s)
- Zach Conrad
- Department of Kinesiology, William & Mary, Williamsburg, VA, United States
- Global Research Institute, William & Mary, Williamsburg, VA, United States
| | - Chloe DiStaso
- College of Arts & Sciences, William & Mary, Williamsburg, VA, United States
| | - Madison Korol
- College of Arts & Sciences, William & Mary, Williamsburg, VA, United States
| | - Donald Rose
- Tulane Nutrition, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
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Collins AB, Tan M, Smith M, Becker SJ. 'Everywhere I call, there's nothing available': Understanding the alcohol treatment landscape and needs among unstably housed people who use alcohol in Rhode Island. Drug Alcohol Rev 2024; 43:1235-1246. [PMID: 38623042 PMCID: PMC11223957 DOI: 10.1111/dar.13852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Alcohol is a leading cause of morbidity and mortality in the United States and people who are unstably housed are disproportionately impacted by adverse alcohol-related health outcomes. Addressing the needs of unstably housed people with high-intensity alcohol use (i.e., heavy episodic use or binge drinking), including those whose goal is not abstinence, is critical to reducing harms among this population. This study explores the alcohol-related treatment and support needs among unstably housed people who use alcohol. METHODS Data collection included participant observation and semi-structured interviews (n = 25) with unstably housed people with high-intensity alcohol use. Data were analysed thematically, with attention to structural vulnerability and social-structural forces at shaping perceptions of and experiences with alcohol treatment. RESULTS Participants underscored how housing instability was critical in precipitating and maintaining heavy alcohol use, with alcohol often used to manage the stress and anxiety related to housing instability. While participants regularly engaged with alcohol treatment programs, program design and barriers to access undermined the effectiveness of these services for participants. Participants described the need for a range of program and service options across a continuum of care to be implemented to support participants in meeting their diverse needs and identified goals regarding alcohol use. DISCUSSION AND CONCLUSIONS Alcohol treatment and supports need to be modified so that they include a range of harm reduction and abstinence-based models to better meet people's diverse needs. Furthermore, treatment must be paired with permanent and affordable housing to address underlying drivers of alcohol-related harm for unstably housed people.
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Affiliation(s)
- Alexandra B Collins
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Michael Tan
- Department of Epidemiology, Brown University School of Public Health, Providence, USA
| | - Megan Smith
- School of Social Work, Rhode Island College, Providence, USA
- House of Hope Community Development Corporation, Warwick, USA
- Warren Alpert Medical School, Providence, USA
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, USA
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Brandt EJ, Kirch M, Ayanian JZ, Chang T, Thompson MP, Nallamothu BK. Dietary Counseling Documentation Among Patients Recently Hospitalized for Cardiovascular Disease. J Acad Nutr Diet 2024; 124:883-895. [PMID: 38462127 DOI: 10.1016/j.jand.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/22/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Diet intervention forms the cornerstone for cardiovascular disease (CVD) management. OBJECTIVE The objective was to measure the frequency of dietary counseling documentation for patients recently hospitalized with CVD. DESIGN This was an observational study. PARTICIPANTS AND SETTING Patients were included from the Michigan Value Collaborative Multipayer Claims Registry from October 2015 to February 2020. MAIN OUTCOME MEASURE The study measured the frequency of medical claims that document dietary counseling ≤90 days after hospitalization (ie, an episode of care) for CVD events (coronary artery bypass grafting, acute myocardial infarction, congestive heart failure, and percutaneous coronary intervention). Dietary counseling documentation was defined as having an encounter-level International Classification of Diseases 10th Revision code for dietary counseling or current procedural terminology code for medical nutrition therapy or cardiac rehabilitation. STATISTICAL ANALYSES PERFORMED Multivariable logistic regression was used to measure variation in documentation across gender, age, comorbidities, hospital geography, CVD event, and insurer. RESULTS There were 175,631 episodes of care (congesitve heart failure 47.1%, acute myocardial infarction 28.7%, percutaneous coronary intervention 17.0%, and coronary artery bypass grafting 7.3%) among 146,185 individuals. Most episodes occurred among men (55.8%) and those older than age 65 years (71.9%). Dietary counseling was documented for 22.8% of episodes and was more common as cardiac rehabilitation (18.6%) than other encounter types (5.1%). In multivariable analysis, there was lower odds for dietary counseling documentation among those older than age 65 years (odds ratio [OR] 0.77; P < .001), women (OR 0.83; P < .001), with chronic kidney disease (OR 0.74; P < .001), or diabetes (OR 0.95; P < .001), but greater odds for those with obesity (OR 1.28; P < .001) and nonmetropolitan hospitals (OR 1.31; P < .001). Compared with coronary artery bypass grafting, acute myocardial infarction (OR 0.29; P < .001), confestive heart failure (OR 0.12; P < .001), and percutaneous coronary intervention (OR 0.36; P < .001) episodes had lower odds to have dietary counseling coded. Compared with Traditional Medicare, Medicaid and Medicare Advantage health maintenance organization plans had lower odds, whereas Commercial or Medicare Advantage preferred provider organization and Commercial health maintenance organization plans had higher odds to have dietary counseling documented. Results were mostly similar when evaluated by race. CONCLUSIONS Dietary counseling was infrequently documented after hospitalization for CVD episodes in medical claims in a Michigan-based multipayer claims database with large variation by reason for hospitalization and patient factors.
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Affiliation(s)
- Eric J Brandt
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - John Z Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael P Thompson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Section of Health Services Research and Quality, Department of Cardiac Surgery, Unversity of Michigan, Ann Arbor, Michigan; Michigan Value Collaborative, Ann Arbor, Michigan
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Albin JL, Mignucci AJ, Siler M, Dungan D, Neff C, Faris B, McCardell CS, Harlan TS. From Clinic to Kitchen to Electronic Health Record: The Background and Process of Building a Culinary Medicine eConsult Service. J Multidiscip Healthc 2024; 17:2777-2787. [PMID: 38863766 PMCID: PMC11166169 DOI: 10.2147/jmdh.s461377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
Diet plays a pivotal role in health outcomes, influencing various metabolic pathways and accounting for over 20% of risk-attributable disability adjusted life years (DALYs). However, the limited time during primary care visits often hinders comprehensive guidance on dietary and lifestyle modifications. This paper explores the integration of electronic consultations (eConsults) in Culinary Medicine (CM) as a solution to bridge this gap. CM specialists, with expertise in the intricate connections between food, metabolism, and health outcomes, offer tailored dietary recommendations through asynchronous communication within the electronic health record (EHR) system. The use of CM eConsults enhances physician-patient communication and fosters continuous medical education for requesting clinicians. The benefits extend directly to patients, providing access to evidence-based nutritional information to address comorbidities and improve overall health through patient empowerment. We present a comprehensive guide for CM specialist physicians to incorporate CM eConsults into their practices, covering the historical context of eConsults, their adaptation for CM, billing methods, and insights from the implementation at UT Southwestern Medical Center. This initiative delivers expanded access to patient education on dietary risks and promotes interprofessional collaboration to empower improved health.
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Affiliation(s)
- Jaclyn Lewis Albin
- Departments of Internal Medicine and Pediatrics, University of Texas at Southwestern, Dallas, Texas, USA
| | - Alexandra J Mignucci
- Department of Family Medicine, University of California San Diego, San Diego, CA, USA
| | - Milette Siler
- Moncrief Cancer Institute and the University of Texas Southwestern Medical Center, Fort Worth and Dallas, TX, USA
| | - David Dungan
- Departments of Internal Medicine and Pediatrics, Duly Health and Care, Lombard and Downers Grove, IL, USA
| | - Cary Neff
- Conscious Food Solutions, Inc, Oro Valley, AZ, USA
| | - Basma Faris
- Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Timothy S Harlan
- Department of Medicine, George Washington University School of Medicine, Washington, DC, USA
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22
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Ganti A, Fornari A, Izard SM, Whitson MJ. Increasing Trainee Comfort with Nutrition. South Med J 2024; 117:330-335. [PMID: 38830587 DOI: 10.14423/smj.0000000000001695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Nutrition counseling is necessary for the prevention and treatment of many chronic diseases. US survey data demonstrate that 61% of Internal Medicine (IM) residents receive little to no nutrition training. The objective of our study was to develop a curriculum to increase IM resident comfort and ability in conducting a nutritional assessment. METHODS Categorical IM residents at a large academic medical center participated in a curriculum that included a lecture, a small-group discussion, and a skills exercise. Residents completed pre- and posttest surveys that evaluated their attitudes and comfort level with nutritional assessment. RESULTS Eighty percent (84/105) of the residents participated in the curriculum and 48% (40/84) of them completed both pre- and postsession surveys. Residents who considered themselves moderately to extremely comfortable completing a nutritional assessment increased after the program (27.5% to 87.5%, P < 0.0001). The proportion of those who agreed or strongly agreed with the statement, "Nutritional counseling should be included in any routine appointment, just like diagnosis and treatment," increased from 62.50% to 80.00% (P = 0.012). The proportion of residents who considered lack of individual knowledge to be a barrier for nutrition counseling decreased from 65.79% to 42.11% (P = 0.0126). CONCLUSIONS This curriculum was successful in increasing IM resident comfort with conducting a nutritional assessment.
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Affiliation(s)
- Anita Ganti
- From the Division of General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Alice Fornari
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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23
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Bellissimo MP, Hundley WG. Low-Carbohydrate High-Fat Diets, Lipid Levels, and Cardiovascular Risk. JACC. ADVANCES 2024; 3:100975. [PMID: 39081654 PMCID: PMC11286988 DOI: 10.1016/j.jacadv.2024.100975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Moriah P. Bellissimo
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - W. Gregory Hundley
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Pottkotter K, Hazlett M, Mansfield CJ, Rethman K, Fritz JM, Quatman-Yates CC, Briggs MS. Understanding social determinants of health and physical therapy outcomes in patients with low back pain: A scoping review. Musculoskeletal Care 2024; 22:e1888. [PMID: 38747557 DOI: 10.1002/msc.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Low back pain (LBP) is the number one cause of disability worldwide; however, it is not clear how social determinants of health (SDOH) impact care management and outcomes related to physical therapy (PT) services for patients with LBP. OBJECTIVE The purposes of this scoping review are to examine and assimilate the literature on how SDOH and PT care relate to non-specific LBP outcomes and identify gaps in the literature to target for future research. METHODS Data were extracted from eight electronic databases from January 2011 to February 2022. Reviewers independently screened all studies using the PRISMA extension for scoping review guidelines. Data related to study design, type of PT, type of non-specific LBP, patient demographics, PT intervention, SDOH, and PT outcomes were extracted from the articles. RESULTS A total of 30,523 studies were screened, with 1961 articles undergoing full text review. Ultimately, 76 articles were identified for inclusion. Sex and age were the most frequent SDOH examined (88% and 78% respectively) followed by education level (18%). Approximately half of the studies that examined age, sex, and education level identified no effect on outcomes. The number of studies examining other factors was small and the types of outcomes evaluated were variable, which limited the ability to pool results. CONCLUSIONS Sex and age were the most frequent SDOH examined followed by education level. Other factors were evaluated less frequently, making it difficult to draw conclusions. Study design and heterogeneity of determinants and outcomes were barriers to examining the potential impact on patients with LBP.
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Affiliation(s)
- Kristy Pottkotter
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Miriam Hazlett
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Cody J Mansfield
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Katherine Rethman
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
| | - Julie M Fritz
- College of Health, The University of Utah, Salt Lake City, Utah, USA
| | - Catherine C Quatman-Yates
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
| | - Matthew S Briggs
- The Ohio State University Wexner Medical Center, Ambulatory Rehabilitation, Columbus, Ohio, USA
- The Ohio State University Wexner Medical Center, Sports Medicine Research Institute, Columbus, Ohio, USA
- The Ohio State University School of Health and Rehabilitation Sciences, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
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25
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Ruckle DE, Dahan A, Jesurajan J, Nayak R, Rice RC, Wongworawat MD, Johnson JP, Rajfer R. A Look Into How the "Blue Zone" Lifestyle May Affect Patients' Lives Before and After Hip Fracture: A Propensity-Matched Cohort Study. J Am Acad Orthop Surg 2024:00124635-990000000-01011. [PMID: 38833726 DOI: 10.5435/jaaos-d-23-00723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Hip fractures are life-changing injuries with associated one-year mortality up to 30%. Five locations in the world have been termed "blue zones," where the longevity of the population is markedly higher than that of surrounding areas and there are 10 times more centenarians. The United States has one blue zone (Loma Linda, California), which is believed to be because of the lifestyle of the Seventh-day Adventist population living there. We hypothesized that patients from the blue zone experience low-energy, frailty-driven, osteoporotic hip fractures later in life and an increased postinjury longevity relative to non-blue zone control subjects. METHODS A review of patients treated for hip fracture between January 2010 and August 2020 from a single institution was conducted. Demographic data were collected, and the end point of mortality was assessed using death registry information, queried in April 2024. Groups were divided into blue zone and non-blue zone. Statistical analysis was conducted with P < 0.05 considered significant. RESULTS Complete data were available for 1,032 patients. The blue zone cohort sustained low-energy hip fractures 12 years later in life (83.2 versus 71.1, P < 0.01). Propensity score matching was used to account for this difference. After propensity score matching, age, body mass index, American Society of Anesthesiologists score, surgery performed, sex, mechanism, ethnicity, diabetes, chronic obstructive pulmonary disease, CHF, chronic kidney disease grade, dementia, surgical time, and drug/tobacco/marijuana use were similar between groups. Blue zone patients had lower mortality at both 1 and 2 years postoperatively (12% versus 24%, P = 0.03 and 20% versus 33%, P = 0.03, respectively), had more hypertension (76% versus 62%, P = 0.03), reported lower alcohol use (7% versus 20%, P < 0.01), and included more Seventh-day Adventists (64% versus 15%, P < 0.01). CONCLUSION The blue zone lifestyle affected the onset of frailty and delayed osteoporotic hip fracture by 12 years in this propensity-matched cohort study. Postoperative mortality was also markedly lower in the blue zone cohort.
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Affiliation(s)
- David E Ruckle
- From the Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, CA (Ruckle, Jesurajan, Nayak, Rice, Wongworawat, and Rajfer), the Department of Anesthesiology, University of California San Diego, San Diego, CA (Dahan), Department of Orthopedic Surgery, University of Alabama Birmingham Medicine, Birmingham, Alabama (Johnson)
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26
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Urbin MA. Adaptation in the spinal cord after stroke: Implications for restoring cortical control over the final common pathway. J Physiol 2024. [PMID: 38787922 DOI: 10.1113/jp285563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Control of voluntary movement is predicated on integration between circuits in the brain and spinal cord. Although damage is often restricted to supraspinal or spinal circuits in cases of neurological injury, both spinal motor neurons and axons linking these cells to the cortical origins of descending motor commands begin showing changes soon after the brain is injured by stroke. The concept of 'transneuronal degeneration' is not new and has been documented in histological, imaging and electrophysiological studies dating back over a century. Taken together, evidence from these studies agrees more with a system attempting to survive rather than one passively surrendering to degeneration. There tends to be at least some preservation of fibres at the brainstem origin and along the spinal course of the descending white matter tracts, even in severe cases. Myelin-associated proteins are observed in the spinal cord years after stroke onset. Spinal motor neurons remain morphometrically unaltered. Skeletal muscle fibres once innervated by neurons that lose their source of trophic input receive collaterals from adjacent neurons, causing spinal motor units to consolidate and increase in size. Although some level of excitability within the distributed brain network mediating voluntary movement is needed to facilitate recovery, minimal structural connectivity between cortical and spinal motor neurons can support meaningful distal limb function. Restoring access to the final common pathway via the descending input that remains in the spinal cord therefore represents a viable target for directed plasticity, particularly in light of recent advances in rehabilitation medicine.
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Affiliation(s)
- Michael A Urbin
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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27
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Ahn SJG, Schmidt MD, Tate AD, Rathbun S, Annesi JJ, Hahn L, Novotny E, Okitondo C, Grimsley RN, Johnsen K. Virtual fitness buddy ecosystem: a mixed reality precision health physical activity intervention for children. NPJ Digit Med 2024; 7:134. [PMID: 38773297 PMCID: PMC11109260 DOI: 10.1038/s41746-024-01133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/08/2024] [Indexed: 05/23/2024] Open
Abstract
6-11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact.
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Affiliation(s)
- Sun Joo Grace Ahn
- Grady College of Journalism and Mass Communication, University of Georgia, Athens, GA, USA.
| | | | - Allan D Tate
- Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Stephen Rathbun
- Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - James J Annesi
- Kinesiology Department, California State University, Monterey Bay, Seaside, CA, USA
| | - Lindsay Hahn
- Department of Communication, University at Buffalo, Buffalo, NY, USA
| | - Eric Novotny
- Workplace Research and Insights, Haworth, Inc., Holland, MI, 49424, USA
| | - Christian Okitondo
- Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Rebecca N Grimsley
- Center for Advanced Computer-Human Ecosystems, University of Georgia, Athens, GA, USA
| | - Kyle Johnsen
- College of Engineering, University of Georgia, Athens, GA, USA
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Yan X, Wang X, Zhang J, Ming Z, Zhang C, Ma P, Liu Q, Xu Y, Cheng L, Pang X, Li Y. National trends in nine key minerals intake (quantity and source) among U.S. adults, 1999 to march 2020. Nutr J 2024; 23:52. [PMID: 38760828 PMCID: PMC11100034 DOI: 10.1186/s12937-024-00950-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/11/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Changes in economy and dietary guidelines brought a great shock to diet quality and meal behaviors, but if these transformations have extended to minerals intake and their sources was still poorly understood. It is essential to evaluate time trends in minerals intake and their sources to inform policy makers. OBJECTIVE To investigate trends in minerals intake and their sources among U.S. adults. METHODS This analysis used dietary data collected by 24-h recalls from U.S. adults (≥ 20 years) in NHANES (1999-March 2020). Minerals intake, age-adjusted percentage of participants meeting recommendations, and minerals sources were calculated among all participants and by population subgroups in each NHANES survey cycle. Weighted linear or logistic regression models were used to examine the statistical significance of time trends. RESULTS A total of 48223 U.S. adults were included in this analysis. From 1999 to March 2020, intake of calcium (from 0.94 to 1.02 g/day), magnesium (from 308.07 to 321.85 mg/day), phosphorus (from 1.24 to 1.30 g/day), and sodium (from 3.24 to 3.26 mg/day) from food and beverages (FB) and dietary supplements (DSs) significantly increased, and intake of iron (from 19.17 to 16.38 mg/day), zinc (from 16.45 to 14.19 mg/day), copper (from 1.79 to 1.38 mg/day), and potassium (from 2.65 to 2.50 g/day) from FB + DSs decreased (all FDR < 0.05). Additionally, age-adjusted percentage of participants meeting recommendations for calcium, phosphorus, sodium, and selenium significantly increased, that for iron, potassium, zinc, and copper decreased (all FDR < 0.05). Minerals intake and time trends in minerals intake were highly variable depending on age, gender, race/ethnicity, education, and income. For example, white, higher socioeconomic status participants had a higher minerals intake (e.g. iron, zinc, and copper), but had a greater decrease in minerals intake. Furthermore, the percentage of minerals from milks and DSs decreased, and that from beverages increased. CONCLUSION From 1999 to March 2020, both minerals intake and their sources experienced a significant alteration among U.S. adults. Many differences in minerals intake and their food sources across sociodemographic characteristics appeared to narrow over time. Although some improvements were observed, important challenges, such as overconsumption of sodium and underconsumption of potassium, calcium, and magnesium, still remained among U.S. adults.
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Affiliation(s)
- Xuemin Yan
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Xuanyang Wang
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Jia Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Zhu Ming
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Can Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Pingnan Ma
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Qianmin Liu
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Yuanyuan Xu
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Licheng Cheng
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Xibo Pang
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China
| | - Ying Li
- Department of Nutrition and Food Hygiene, School of Public Health, the National Key Discipline, Harbin Medical University, 157 Baojian Road Harbin, P. R. 150081, Harbin, China.
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Matthews ED, Kurnat-Thoma EL. U.S. food policy to address diet-related chronic disease. Front Public Health 2024; 12:1339859. [PMID: 38827626 PMCID: PMC11141542 DOI: 10.3389/fpubh.2024.1339859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/18/2024] [Indexed: 06/04/2024] Open
Abstract
Poor diet is the leading cause of mortality in the U.S. due to the direct relationship with diet-related chronic diseases, disproportionally affects underserved communities, and exacerbates health disparities. Evidence-based policy solutions are greatly needed to foster an equitable and climate-smart food system that improves health, nutrition and reduces chronic disease healthcare costs. To directly address epidemic levels of U.S. diet-related chronic diseases and nutritional health disparities, we conducted a policy analysis, prioritized policy options and implementation strategies, and issued final recommendations for bipartisan consideration in the 2023-24 Farm Bill Reauthorization. Actional recommendations include: sugar-sweetened beverage taxation, Supplemental Nutrition Assistance Program (SNAP) fruit and vegetable subsidy expansion, replacement of ultra-processed foods (UPF) with sustainable, diverse, climate-smart agriculture and food purchasing options, and implementing "food is medicine."
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Affiliation(s)
- Emily D. Matthews
- Emergency Department, Holy Cross Hospital, Holy Cross Health, Silver Spring, MD, United States
| | - Emma L. Kurnat-Thoma
- Georgetown Institute for Women, Peace and Security, Walsh School of Foreign Service, Georgetown University, Washington, DC, United States
- Precision Policy Solutions, LLC, Bethesda, MD, United States
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Grant WB. Cancer Incidence Rates in the US in 2016-2020 with Respect to Solar UVB Doses, Diabetes and Obesity Prevalence, Lung Cancer Incidence Rates, and Alcohol Consumption: An Ecological Study. Nutrients 2024; 16:1450. [PMID: 38794688 PMCID: PMC11123752 DOI: 10.3390/nu16101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
This article reports the results of an ecological study of cancer incidence rates by state in the US for the period 2016-2020. The goals of this study were to determine the extent to which solar UVB doses reduced cancer risk compared to findings reported in 2006 for cancer mortality rates for the periods 1950-1969 and 1970-1794 as well as cancer incidence rates for the period 1998-2002 and to determine which factors were recently associated with cancer risk. The cancer data for non-Hispanic white (European American) men and women were obtained from the Centers for Disease Control and Prevention. Indices were obtained for solar UVB at the surface for July 1992, and alcohol consumption, diabetes, and obesity prevalence near the 2016-2020 period. Lung cancer incidence rates were also used in the analyses as a surrogate for smoking, diet, and air pollution. The cancers for which solar UVB is significantly associated with reduced incidence are bladder, brain (males), breast, corpus uteri, esophageal, gastric, non-Hodgkin's lymphoma, pancreatic, and renal cancer. Lung cancer was significantly associated with colorectal, laryngeal, and renal cancer. Diabetes was also significantly associated with breast, liver, and lung cancer. Obesity prevalence was significantly associated with breast, colorectal, and renal cancer. Alcohol consumption was associated with bladder and esophageal cancer. Thus, diet has become a very important driver of cancer incidence rates. The role of solar UVB in reducing the risk of cancer has been reduced due to people spending less time outdoors, wearing sunscreen that blocks UVB but not UVA radiation, and population increases in terms of overweight and obese individuals, which are associated with lower 25-hydroxyvitamin D concentrations and the generation of systemic inflammation, which is a risk factor for cancer. A dietary approach that would reduce the risk of diabetes, obesity, lung cancer, and, therefore, cancer, would be one based mostly on whole plants and restrictions on red and processed meats and ultraprocessed foods. Solar UVB exposure for a few minutes before applying sunscreen and taking vitamin D supplements would also help reduce the risk of cancer.
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Affiliation(s)
- William B Grant
- Sunlight, Nutrition, and Health Research Center, 1745 Pacific Ave., Suite 504, San Francisco, CA 94109, USA
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Miller S, Pickering TA, Bruine de Bruin W, Valente TW, Wilson JP, de la Haye K. Socio-ecological factors linked with changes in adults' dietary intake in Los Angeles County during the peak of the coronavirus 2019 pandemic. Public Health Nutr 2024; 27:e133. [PMID: 38711182 PMCID: PMC11148824 DOI: 10.1017/s1368980024001034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Comprehensive studies examining longitudinal predictors of dietary change during the coronavirus disease 2019 pandemic are lacking. Based on an ecological framework, this study used longitudinal data to test if individual, social and environmental factors predicted change in dietary intake during the peak of the coronavirus 2019 pandemic in Los Angeles County and examined interactions among the multilevel predictors. DESIGN We analysed two survey waves (e.g. baseline and follow-up) of the Understanding America Study, administered online to the same participants 3 months apart. The surveys assessed dietary intake and individual, social, and neighbourhood factors potentially associated with diet. Lagged multilevel regression models were used to predict change from baseline to follow-up in daily servings of fruits, vegetables and sugar-sweetened beverages. SETTING Data were collected in October 2020 and January 2021, during the peak of the coronavirus disease 2019 pandemic in Los Angeles County. PARTICIPANTS 903 adults representative of Los Angeles County households. RESULTS Individuals who had depression and less education or who identified as non-Hispanic Black or Hispanic reported unhealthy dietary changes over the study period. Individuals with smaller social networks, especially low-income individuals with smaller networks, also reported unhealthy dietary changes. After accounting for individual and social factors, neighbourhood factors were generally not associated with dietary change. CONCLUSIONS Given poor diets are a leading cause of death in the USA, addressing ecological risk factors that put some segments of the community at risk for unhealthy dietary changes during a crisis should be a priority for health interventions and policy.
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Affiliation(s)
- Sydney Miller
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
- Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Trevor A Pickering
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Wändi Bruine de Bruin
- Center for Economic and Social Research, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
- Sol Price School of Public Policy and Dornsife Department of Psychology, University of Southern California, Los Angeles, CA, USA
- Schaeffer Center for Health Policy and Economics, University for Southern California, Los Angeles, CA, USA
| | - Thomas W. Valente
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - John P Wilson
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
- Spatial Sciences Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
- Viterbi School of Engineering and the School of Architecture, University of Southern California, Los Angeles, CA, USA
| | - Kayla de la Haye
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
- Center for Economic and Social Research, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
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Lin J, Rivadeneira AP, Ye Y, Ryu C, Parvin S, Jang K, Garraway SM, Choi I. Sodium Bicarbonate Decreases Alcohol Consumption in Mice. Int J Mol Sci 2024; 25:5006. [PMID: 38732226 PMCID: PMC11084513 DOI: 10.3390/ijms25095006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
We previously reported that mice with low neuronal pH drink more alcohol, demonstrating the importance of pH for alcohol reward and motivation. In this study, we tested whether systemic pH affects alcohol consumption and if so, whether it occurs by changing the alcohol reward. C57BL/6J mice were given NaHCO3 to raise their blood pH, and the animals' alcohol consumption was measured in the drinking-in-the-dark and two-bottle free choice paradigms. Alcohol consumption was also assessed after suppressing the bitterness of NaHCO3 with sucrose. Alcohol reward was evaluated using a conditioned place preference. In addition, taste sensitivity was assessed by determining quinine and sucrose preference. The results revealed that a pH increase by NaHCO3 caused mice to decrease their alcohol consumption. The decrease in high alcohol contents (20%) was significant and observed at different ages, as well as in both males and females. Alcohol consumption was also decreased after suppressing NaHCO3 bitterness. Oral gavage of NaHCO3 did not alter quinine and sucrose preference. In the conditioned place preference, NaHCO3-treated mice spent less time in the alcohol-injected chamber. Conclusively, the results show that raising systemic pH with NaHCO3 decreases alcohol consumption, as it decreases the alcohol reward value.
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Affiliation(s)
| | | | | | | | | | | | | | - Inyeong Choi
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA; (J.L.); (Y.Y.); (C.R.); (S.P.); (K.J.); (S.M.G.)
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Houghtaling B, Zhang N, Yaroch A, Milburn Atkinson C, Byker Shanks C. How does eligibility for GusNIP produce prescriptions relate to fruit and vegetable purchases and what factors shape the relationship? A protocol for a secondary analysis of nationally representative data in the USA. BMJ Open 2024; 14:e085322. [PMID: 38697763 PMCID: PMC11085977 DOI: 10.1136/bmjopen-2024-085322] [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: 02/12/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION US Department of Agriculture (USDA) Gus Schumacher Nutrition Incentive Programme (GusNIP) produce prescription programme (PPR) 'prescriptions' provide eligible participants with low income, risk for diet-related chronic disease and food insecurity a healthcare issued incentive to purchase lower to no cost fruits and vegetables (FVs). However, GusNIP requirements specify that PPR prescriptions can only be redeemed for fresh (not frozen, canned or dried) FVs. This requirement may prevent participants from fully engaging in or benefiting from GusNIP PPR, given communities with lower healthy food access may have reduced fresh FV accessibility. METHODS AND ANALYSIS We will use the nationally representative 2012-2013 National Household Food Acquisition and Purchase Survey (FoodAPS) and complementary FoodAPS Geography Component data in a secondary data analysis to examine how household GusNIP PPR eligibility relates to the quantity and variety of fresh, frozen, canned and dried FV purchases and to what extent individual, household and food environment factors shape the relationship. FoodAPS data include household food purchasing and acquisition information across a 7 day period from 14 317 individuals among 4826 households and was collected between April 2012 and January 2013. The FoodAPS Geography Component provides information about the local community/environment relative to FoodAPS households. This study will examine the correlation or association of selected variables between different quantities and varieties of fresh, frozen, canned and dried FVs, as well as correlations among multilevel predictors. ETHICS AND DISSEMINATION We are following data integrity standards as outlined by agreements with the USDA Economic Research Service. All results of analyses will undergo a thorough disclosure review to ensure no identifiable data are shared. Results will be disseminated to research, practice and policy communities using an Open Access peer-reviewed manuscript(s), scientific and practice presentations, and a public facing report and infographic.
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Affiliation(s)
- Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Amy Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA
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DeCarli C, Maillard P, Pase MP, Beiser AS, Kojis D, Satizabal CL, Himali JJ, Aparicio HJ, Fletcher E, Seshadri S. Trends in Intracranial and Cerebral Volumes of Framingham Heart Study Participants Born 1930 to 1970. JAMA Neurol 2024; 81:471-480. [PMID: 38526486 PMCID: PMC10964161 DOI: 10.1001/jamaneurol.2024.0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/05/2024] [Indexed: 03/26/2024]
Abstract
Importance Human brain development and maintenance is under both genetic and environmental influences that likely affect later-life dementia risk. Objective To examine environmental influences by testing whether time-dependent secular differences occurred in cranial and brain volumes and cortical thickness over birth decades spanning 1930 to 1970. Design, Setting, and Participants This cross-sectional study used data from the community-based Framingham Heart Study cohort for participants born in the decades 1930 to 1970. Participants did not have dementia or history of stroke and had magnetic resonance imaging (MRI) obtained from March 18, 1999, to November 15, 2019. The final analysis dataset was created in October 2023. Exposure Years of birth ranging from 1925 to 1968. Main Measures Cross-sectional analysis of intracranial, cortical gray matter, white matter, and hippocampal volumes as well as cortical surface area and cortical thickness. The secular measure was the decade in which the participant was born. Covariates included age at MRI and sex. Results The main study cohort consisted of 3226 participants with a mean (SD) age of 57.7 (7.8) years at the time of their MRI. A total of 1706 participants were female (53%) and 1520 (47%) were male. The birth decades ranged from the 1930s to 1970s. Significant trends for larger intracranial, hippocampal, and white matter volumes and cortical surface area were associated with progressive birth decades. Comparing the 1930s birth decade to the 1970s accounted for a 6.6% greater volume (1234 mL; 95% CI, 1220-1248, vs 1321 mL; 95% CI, 1301-1341) for ICV, 7.7% greater volume (441.9 mL; 95% CI, 435.2-448.5, vs 476.3 mL; 95% CI, 467.0-485.7) for white matter, 5.7% greater value (6.51 mL; 95% CI, 6.42-6.60, vs 6.89 mL; 95% CI, 6.77-7.02) for hippocampal volume, and a 14.9% greater value (1933 cm2; 95% CI, 1908-1959, vs 2222 cm2; 95% CI, 2186-2259) for cortical surface area. Repeat analysis applied to a subgroup of 1145 individuals of similar age range born in the 1940s (mean [SD] age, 60.0 [2.8] years) and 1950s (mean [SD] age, 59.0 [2.8] years) resulted in similar findings. Conclusion and Relevance In this study, secular trends for larger brain volumes suggested improved brain development among individuals born between 1930 and 1970. Early life environmental influences may explain these results and contribute to the declining dementia incidence previously reported in the Framingham Heart Study cohort.
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Affiliation(s)
- Charles DeCarli
- Department of Neurology & Imaging of Dementia and Aging Laboratory, University of California Davis, Sacramento, California
| | - Pauline Maillard
- Department of Neurology & Imaging of Dementia and Aging Laboratory, University of California Davis, Sacramento, California
| | - Matthew P. Pase
- Framingham Heart Study, Framingham, Massachusetts
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Alexa S. Beiser
- Framingham Heart Study, Framingham, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
- Department of Neurology, Boston University Chonbanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Daniel Kojis
- Framingham Heart Study, Framingham, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Claudia L. Satizabal
- Framingham Heart Study, Framingham, Massachusetts
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas
| | - Jayandra J. Himali
- Framingham Heart Study, Framingham, Massachusetts
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio
- Department of Population Health Sciences, UT Health San Antonio, San Antonio, Texas
| | - Hugo J. Aparicio
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University Chonbanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Evan Fletcher
- Department of Neurology & Imaging of Dementia and Aging Laboratory, University of California Davis, Sacramento, California
| | - Sudha Seshadri
- Framingham Heart Study, Framingham, Massachusetts
- Department of Neurology, Boston University Chonbanian and Avedisian School of Medicine, Boston, Massachusetts
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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Meisel MK, Merrill JE, Rosen RK, Jones RN, Haikalis M, Carey KB, Orchowski LM, Bradley K, Doucette H, Barnett NP. How Do Bystanders Help in Drinking Situations: The Bystanders to Alcohol Risk Scale--Strategies. J Stud Alcohol Drugs 2024; 85:404-415. [PMID: 38270912 PMCID: PMC11095492 DOI: 10.15288/jsad.23-00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE Bystander intervention (BI) is a promising approach for promoting collective behavior change that has been applied to several domains, including sexual assault, bullying, and more recently, problematic alcohol use. Accurately measuring the strategies that bystanders use to reduce others' alcohol-related risk is an essential step toward improving bystanders' ability to reduce alcohol-related harm in their communities, but current measures of BI are not easily modifiable and applicable for alcohol-related BI. The current study aimed to develop a valid and reliable measure of the bystander construct most proximal to the reduction of risk: bystander strategies. METHOD Young adults (N = 1,011) who reported being around someone who showed signs of alcohol intoxication in the past 3 months were recruited via Qualtrics Panels to participate in an online survey; a subsample (n = 345) completed a 2-week follow-up. Psychometric evaluation included exploratory and confirmatory factor analyses, item response theory analyses, convergent validity, and test-retest reliability. RESULTS An initial set of 52 items was reduced to 17 items, representing two different factors. The first factor, Level 1, reflected strategies used during circumstances of acute risk. The second factor, Level 2, reflected strategies used to reduce risk for more longstanding problems with alcohol. Both factors demonstrated good model fit, strong internal consistency, evidence of convergent validity, and moderate test-retest reliability. CONCLUSIONS This novel measure can contribute to the production of knowledge about the use and efficacy of peer-focused strategies and the value of BI training for alcohol use.
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Affiliation(s)
- Matthew K. Meisel
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Jennifer E. Merrill
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Rochelle K. Rosen
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Michelle Haikalis
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Kate B. Carey
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Lindsay M. Orchowski
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Kelli Bradley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Hannah Doucette
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
| | - Nancy P. Barnett
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
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Gibson LA, Stephens-Shields AJ, Hua SV, Orr JA, Lawman HG, Bleich SN, Volpp KG, Bleakley A, Thorndike AN, Roberto CA. Comparison of Sales From Vending Machines With 4 Different Food and Beverage Messages: A Randomized Trial. JAMA Netw Open 2024; 7:e249438. [PMID: 38717775 PMCID: PMC11079689 DOI: 10.1001/jamanetworkopen.2024.9438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/27/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Point-of-sale food messaging can encourage healthier purchases, but no studies have directly compared multiple interventions in the field. Objective To examine which of 4 food and beverage messages would increase healthier vending machine purchases. Design, Setting, and Participants This randomized trial assessed 13 months (February 1, 2019, to February 29, 2020) of vending sales data from 267 machines and 1065 customer purchase assessments from vending machines on government property in Philadelphia, Pennsylvania. Data analysis was performed from March 5, 2020, to November 8, 2022. Interventions Study interventions were 4 food and beverage messaging systems: (1) beverage tax posters encouraging healthy choices because of the Philadelphia tax on sweetened drinks; (2) green labels for healthy products; (3) traffic light labels: green (healthy), yellow (moderately healthy), or red (unhealthy); or (4) physical activity equivalent labels (minutes of activity to metabolize product calories). Main Outcomes and Measures Sales data were analyzed separately for beverages and snacks. The main outcomes analyzed at the transaction level were calories sold and the health status (using traffic light criteria) of each item sold. Additional outcomes were analyzed at the monthly machine level: total units sold, calories sold, and units of each health status sold. The customer purchase assessment outcome was calories purchased per vending trip. Results Monthly sales data came from 150 beverage and 117 snack vending machines, whereas 1065 customers (558 [52%] male) contributed purchase assessment data. Traffic light labels led to a 30% decrease in the mean monthly number of unhealthy beverages sold (mean ratio [MR], 0.70; 95% CI, 0.55-0.88) compared with beverage tax posters. Physical activity labels led to a 34% (MR, 0.66; 95% CI, 0.51-0.87) reduction in the number of unhealthy beverages sold at the machine level and 35% (MR, 0.65; 95% CI, 0.50-0.86) reduction in mean calories sold. Traffic light labels also led to a 30-calorie reduction (b = -30.46; 95% CI, -49.36 to -11.56) per customer trip in the customer purchase analyses compared to physical activity labels. There were very few significant differences for snack machines. Conclusions and Relevance In this 13-month randomized trial of 267 vending machines, the traffic light and physical activity labels encouraged healthier beverage purchases, but no change in snack sales, compared with a beverage tax poster. Corporations and governments should consider such labeling approaches to promote healthier beverage choices. Trial Registration ClinicalTrials.gov Identifier: NCT06260176.
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Affiliation(s)
- Laura A. Gibson
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Alisa J. Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Jennifer A. Orr
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
| | - Hannah G. Lawman
- Division of Chronic Disease and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
- Now with Novo Nordisk Inc, Plainsboro Township, New Jersey
| | - Sara N. Bleich
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kevin G. Volpp
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
- Department of Health Care Management, University of Pennsylvania Wharton School, Philadelphia
| | - Amy Bleakley
- Department of Communication, University of Delaware, Newark
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, Philadelphia
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Vameghestahbanati M, Kingdom L, Hoffman EA, Kirby M, Allen NB, Angelini E, Bertoni A, Hamid Q, Hogg JC, Jacobs DR, Laine A, Maltais F, Michos ED, Sack C, Sin D, Watson KE, Wysoczanksi A, Couper D, Cooper C, Han M, Woodruff P, Tan WC, Bourbeau J, Barr RG, Smith BM. Airway tree caliber heterogeneity and airflow obstruction among older adults. J Appl Physiol (1985) 2024; 136:1144-1156. [PMID: 38420676 DOI: 10.1152/japplphysiol.00694.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
Smaller mean airway tree caliber is associated with airflow obstruction and chronic obstructive pulmonary disease (COPD). We investigated whether airway tree caliber heterogeneity was associated with airflow obstruction and COPD. Two community-based cohorts (MESA Lung, CanCOLD) and a longitudinal case-control study of COPD (SPIROMICS) performed spirometry and computed tomography measurements of airway lumen diameters at standard anatomical locations (trachea-to-subsegments) and total lung volume. Percent-predicted airway lumen diameters were calculated using sex-specific reference equations accounting for age, height, and lung volume. The association of airway tree caliber heterogeneity, quantified as the standard deviation (SD) of percent-predicted airway lumen diameters, with baseline forced expired volume in 1-second (FEV1), FEV1/forced vital capacity (FEV1/FVC) and COPD, as well as longitudinal spirometry, were assessed using regression models adjusted for age, sex, height, race-ethnicity, and mean airway tree caliber. Among 2,505 MESA Lung participants (means ± SD age: 69 ± 9 yr; 53% female, mean airway tree caliber: 99 ± 10% predicted, airway tree caliber heterogeneity: 14 ± 5%; median follow-up: 6.1 yr), participants in the highest quartile of airway tree caliber heterogeneity exhibited lower FEV1 (adjusted mean difference: -125 mL, 95%CI: -171,-79), lower FEV1/FVC (adjusted mean difference: -0.01, 95%CI: -0.02,-0.01), and higher odds of COPD (adjusted odds ratio: 1.42, 95%CI: 1.01-2.02) when compared with the lowest quartile, whereas longitudinal changes in FEV1 and FEV1/FVC did not differ significantly. Observations in CanCOLD and SPIROMICS were consistent. Among older adults, airway tree caliber heterogeneity was associated with airflow obstruction and COPD at baseline but was not associated with longitudinal changes in spirometry.NEW & NOTEWORTHY In this study, by leveraging two community-based samples and a case-control study of heavy smokers, we show that among older adults, airway tree caliber heterogeneity quantified by CT is associated with airflow obstruction and COPD independent of age, sex, height, race-ethnicity, and dysanapsis. These observations suggest that airway tree caliber heterogeneity is a structural trait associated with low baseline lung function and normal decline trajectory that is relevant to COPD.
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Affiliation(s)
| | - Leina Kingdom
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Norrina B Allen
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, United States
| | - Elsa Angelini
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Medicine, Columbia University, New York, New York, United States
| | - Alain Bertoni
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, United States
| | - Qutayba Hamid
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R Jacobs
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
| | - Andrew Laine
- Department of Medicine, Columbia University, New York, New York, United States
| | - Francois Maltais
- Faculty of Medicine , University of Laval, Laval, Quebec, Canada
| | - Erin D Michos
- Faculty of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Coralynn Sack
- Department of Medicine, University of Washington, Seattle, Washington, United States
| | - Don Sin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Artur Wysoczanksi
- Department of Medicine, Columbia University, New York, New York, United States
| | - David Couper
- Department of Biostatistics, University of North Carolina, North Carolina, United States
| | - Christopher Cooper
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Meilan Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, United States
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, New York, United States
| | - Benjamin M Smith
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Columbia University, New York, New York, United States
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Albert SL, Massar RE, Kwok L, Correa L, Polito-Moller K, Joshi S, Shah S, McMacken M. Pilot Plant-Based Lifestyle Medicine Program in an Urban Public Healthcare System: Evaluating Demand and Implementation. Am J Lifestyle Med 2024; 18:403-419. [PMID: 38737881 PMCID: PMC11082870 DOI: 10.1177/15598276221113507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Lifestyle interventions that optimize nutrition, physical activity, sleep health, social connections, and stress management, and address substance use, can reduce cardiometabolic risk. Despite substantial evidence that healthful plant-based diets are beneficial for long-term cardiometabolic health and longevity, uncertainty lies in how to implement plant-based lifestyle programs in traditional clinical settings, especially in safety-net contexts with finite resources. In this mixed-methods implementation evaluation of the Plant-Based Lifestyle Medicine Program piloted in a large public healthcare system, we surveyed participants and conducted qualitative interviews and focus groups with stakeholders to assess program demand in the eligible population and feasibility of implementation within the safety-net setting. Program demand was high and exceeded capacity. Participants' main motivations for joining the program included gaining more control over life, reducing medication, and losing weight. The program team, approach, and resources were successful facilitators. However, the program faced administrative and payor-related challenges within the safety-net setting, and participants reported barriers to access. Stakeholders found the program to be valuable, despite challenges in program delivery and access. Findings provide guidance for replication. Future research should focus on randomized controlled trials to assess clinical outcomes as a result of program participation.
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Affiliation(s)
- Stephanie L. Albert
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Rachel E. Massar
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Lorraine Kwok
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Lilian Correa
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Krisann Polito-Moller
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Shivam Joshi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Sapana Shah
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
| | - Michelle McMacken
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA (SLA, REM, LK); Department of Medicine, NYC Health + Hospitals/Bellevue, New York, NY, USA (LC, KP, SJ, SS, MM); Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA (SJ, SS, MM); and Office of Ambulatory Care and Population Health, NYC Health + Hospitals, New York, NY, USA (MM)
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Zhou T, Zhao J, Ma Y, He L, Ren Z, Yang K, Tang J, Liu J, Luo J, Zhang H. Association of cognitive impairment with the interaction between chronic kidney disease and depression: findings from NHANES 2011-2014. BMC Psychiatry 2024; 24:312. [PMID: 38658863 PMCID: PMC11044494 DOI: 10.1186/s12888-024-05769-1] [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: 07/30/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Cognitive impairment (CoI), chronic kidney disease (CKD), and depression are prevalent among older adults and are interrelated, imposing a significant disease burden. This study evaluates the association of CKD and depression with CoI and explores their potential interactions. METHOD Data for this study were sourced from the 2011-2014 National Health and Nutritional Examination Survey (NHANES). Multiple binary logistic regression models assessed the relationship between CKD, depression, and CoI while controlling for confounders. The interactions were measured using the relative excess risk of interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (S). RESULTS A total of 2,666 participants (weighted n = 49,251,515) were included in the study, of which 700 (16.00%) had CoI. After adjusting for confounding factors, the risk of CoI was higher in patients with CKD compared to non-CKD participants (odds ratio [OR] = 1.49, 95% confidence interval [CI]:1.12-1.99). The risk of CoI was significantly increased in patients with depression compared to those without (OR = 2.29, 95% CI: 1.73-3.03). Furthermore, there was a significant additive interaction between CKD and depression in terms of the increased risk of CoI (adjusted RERI = 2.01, [95% CI: 0.31-3.71], adjusted AP = 0.50 [95% CI: 0.25-0.75], adjusted S = 2.97 [95% CI: 1.27-6.92]). CONCLUSION CKD and depression synergistically affect CoI, particularly when moderate-to-severe depression co-occurs with CKD. Clinicians should be mindful of the combined impact on patients with CoI. Further research is needed to elucidate the underlying mechanisms and assess the effects specific to different CKD stages.
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Affiliation(s)
- Tong Zhou
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan Road, Nanchong city, Sichuan Province, 637000, China
| | - Jiayu Zhao
- Department of physician, Nanchong Psychosomatic Hospital, Nanchong, China
| | - Yimei Ma
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan Road, Nanchong city, Sichuan Province, 637000, China
| | - Linqian He
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan Road, Nanchong city, Sichuan Province, 637000, China
| | - Zhouting Ren
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan Road, Nanchong city, Sichuan Province, 637000, China
| | - Kun Yang
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan Road, Nanchong city, Sichuan Province, 637000, China
| | - Jincheng Tang
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan Road, Nanchong city, Sichuan Province, 637000, China
| | - Jiali Liu
- Department of Clinical Medicine, North Sichuan Medical University, Nanchong, China
| | - Jiaming Luo
- Mental Health Center, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- School of Psychiatry, North Sichuan Medical College, Nanchong, China
| | - Heping Zhang
- Department of Nephrology, Affiliated Hospital of North Sichuan Medical College, 1 Maoyuan Road, Nanchong city, Sichuan Province, 637000, China.
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Idnay B, Liu J, Fang Y, Hernandez A, Kaw S, Etwaru A, Juarez Padilla J, Ramírez SO, Marder K, Weng C, Schnall R. Sociotechnical feasibility of natural language processing-driven tools in clinical trial eligibility prescreening for Alzheimer's disease and related dementias. J Am Med Inform Assoc 2024; 31:1062-1073. [PMID: 38447587 PMCID: PMC11031244 DOI: 10.1093/jamia/ocae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) affect over 55 million globally. Current clinical trials suffer from low recruitment rates, a challenge potentially addressable via natural language processing (NLP) technologies for researchers to effectively identify eligible clinical trial participants. OBJECTIVE This study investigates the sociotechnical feasibility of NLP-driven tools for ADRD research prescreening and analyzes the tools' cognitive complexity's effect on usability to identify cognitive support strategies. METHODS A randomized experiment was conducted with 60 clinical research staff using three prescreening tools (Criteria2Query, Informatics for Integrating Biology and the Bedside [i2b2], and Leaf). Cognitive task analysis was employed to analyze the usability of each tool using the Health Information Technology Usability Evaluation Scale. Data analysis involved calculating descriptive statistics, interrater agreement via intraclass correlation coefficient, cognitive complexity, and Generalized Estimating Equations models. RESULTS Leaf scored highest for usability followed by Criteria2Query and i2b2. Cognitive complexity was found to be affected by age, computer literacy, and number of criteria, but was not significantly associated with usability. DISCUSSION Adopting NLP for ADRD prescreening demands careful task delegation, comprehensive training, precise translation of eligibility criteria, and increased research accessibility. The study highlights the relevance of these factors in enhancing NLP-driven tools' usability and efficacy in clinical research prescreening. CONCLUSION User-modifiable NLP-driven prescreening tools were favorably received, with system type, evaluation sequence, and user's computer literacy influencing usability more than cognitive complexity. The study emphasizes NLP's potential in improving recruitment for clinical trials, endorsing a mixed-methods approach for future system evaluation and enhancements.
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Affiliation(s)
- Betina Idnay
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Jianfang Liu
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Yilu Fang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Alex Hernandez
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Shivani Kaw
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Alicia Etwaru
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Janeth Juarez Padilla
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Sergio Ozoria Ramírez
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- New York University Steinhardt School of Culture, Education, and Human Development, New York, NY 10003, United States
| | - Karen Marder
- Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Rebecca Schnall
- School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- Mailman School of Public Health, Columbia University, New York, NY 10032, United States
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Wang T, Wang L, Yao Y, Liu N, Peng A, Ling M, Ye F, Sun J. Building and Validation of an Acute Event Prediction Model for Severe Mental Disorders. Neuropsychiatr Dis Treat 2024; 20:885-896. [PMID: 38645710 PMCID: PMC11032721 DOI: 10.2147/ndt.s453838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/09/2024] [Indexed: 04/23/2024] Open
Abstract
Background The global incidence of acute events in psychiatric patients is intensifying, and models to successfully predict acute events have attracted much attention. Objective To explore the influence factors of acute incident severe mental disorders (SMDs) and the application of Rstudio statistical software, and build and verify a nomogram prediction model. Methods SMDs were taken as research objects. The questionnaire survey method was adopted to collect data. Patients with acute event independent factors were screened. R software multivariable Logistic regression model was constructed and a nomogram was drawn. Results A total of 342 patients with SMDs were hospitalized, and the number of patients who encountered acute events was 64, which accounted for 18.70% of all patients. Statistical significances were found in many aspects (all P ˂ 0.05). Such aspects included Medication adherence, disease diagnosis, marital status, caregivers, social support and the hospitalization environment (odds ratio (OR) = 4.08, 11.62, 12.06, 10.52, 0.04 and 0.61, respectively) were independent risk factors for the acute events of patients with SMDs. The prediction model was modeled, and the AUC was 0.77 and 0.80. The calibration curve shows that the model has good calibration. The clinical decision curve shows that the model has a good clinical effect. Conclusion The constructed risk prediction model shows good prediction effectiveness in the acute events of patients with SMDs, which is helpful for the early detection of clinical mental health staff at high risk of acute events.
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Affiliation(s)
- Ting Wang
- Affliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou Mental Health Center, Yangzhou, Jiangsu, People’s Republic of China
- School of Medicine & Nursing, Huzhou University, Huzhou, Zhejiang, People’s Republic of China
| | - Lin Wang
- Affliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou Mental Health Center, Yangzhou, Jiangsu, People’s Republic of China
| | - Yunliang Yao
- School of Medicine & Nursing, Huzhou University, Huzhou, Zhejiang, People’s Republic of China
| | - Nan Liu
- Affliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou Mental Health Center, Yangzhou, Jiangsu, People’s Republic of China
| | - Aiqin Peng
- Affliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou Mental Health Center, Yangzhou, Jiangsu, People’s Republic of China
| | - Min Ling
- School of Medicine & Nursing, Huzhou University, Huzhou, Zhejiang, People’s Republic of China
| | - Fei Ye
- Affliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou Mental Health Center, Yangzhou, Jiangsu, People’s Republic of China
| | - JiaoJiao Sun
- Affliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou Mental Health Center, Yangzhou, Jiangsu, People’s Republic of China
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Song X, He K, Xu T, Tian Z, Zhang J, He Y, Fang J, Jiang K, Fan X, Tao Y, Jin L. Association of macronutrient consumption quality, food source and timing with depression among US adults: A cross-sectional study. J Affect Disord 2024; 351:641-648. [PMID: 38309482 DOI: 10.1016/j.jad.2024.01.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Growing evidence suggests that meal timing may influence dietary choices and mental health. Thus, this study examined the association between macronutrient consumption quality, food source, meal timing, and depression prevalence in Americans. METHODS 23,313 National Health and Nutrition Survey participants from 2007 to 2016 were included in this cross-sectional study. Macronutrient intake was calculated for all day, dinner, and breakfast and subtypes into 4 classes. Based on the Patient Health Questionnaire, depression was defined as a 9-item score ≥ 10 on the PHQ-9. The correlation between macronutrients and depression prevalence was estimated with multivariable logistic regression models and isocaloric substitution effects. RESULTS Low-quality carbohydrates (OR = 1.54, 95 % CI: 1.11, 2.12) were positively linked to depression compared with the lowest quartile, after adjusting for age and other covariates. In contrast, total high-quality carbohydrate (OR = 0.52, 95 % CI: 0.40, 0.66), total animal protein (OR = 0.60, 95 % CI: 0.45, 0.80), and total vegetable protein (OR = 0.61, 95 % CI: 0.43, 0.85) were negatively associated with depression was negatively associated. Replacing low-quality carbohydrates with high-quality carbohydrates throughout the day reduced the risk of depression by approximately 15 %. LIMITATIONS Cross-sectional data. CONCLUSION All in all, diet plays a crucial role in the prevention and treatment of depression. Especially in terms of macronutrient intake, high-quality, moderate intake can reduce the risk of depression. However, different subtypes of macronutrient consumption may have different effects on depression, so it becomes crucial to carefully consider the selection and combination of macronutrients.
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Affiliation(s)
- Xingxu Song
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Kai He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China
| | - Tong Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Zhong Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Jiaqi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Jiaxin Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Kexin Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Xiaoting Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Yuchun Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
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Robinson K, Reilly JM. Assessing the Impact of Nutrition Training Among Medical Students. PRIMER (LEAWOOD, KAN.) 2024; 8:24. [PMID: 38681811 PMCID: PMC11051701 DOI: 10.22454/primer.2024.834650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Introduction Nutrition education remains inadequate in American medical schools, and physicians often cite lack of nutrition knowledge as a barrier to counseling patients. The goal of this study was to evaluate the impact of additional nutrition curriculum on first-year medical students. Methods We created a 1-hour nutrition lecture, delivered to first-year medical students. Using pre-, post-, and 3-month follow-up surveys, we assessed the following: (1) change in student knowledge; (2) confidence in counseling patients; (3) motivation to change their personal dietary behaviors; and (4) satisfaction with the curriculum. We assessed objectives using multiple choice questions and 10-point Likert scale questions. Results Of the 142 students who attended the live lecture, 105 (73.9%) completed both pre- and postsurveys, and 65 (45.8%) completed the 3-month follow-up survey. Students' knowledge of the material increased from 37% to 82%, but retention dropped to 65% at the 3-month mark (P<.001). Comfort in assessing and counseling patients improved across the three survey iterations, from 3.53 to 5.90 to 8.00 (P<.001). Motivation to change personal behaviors was high overall at 8.04, 8.36 and 8.25 [P<.05]). Moreover, students were satisfied with the lecture, with a rating of 8.58/10. Conclusions This study supports the value of additional medical student nutrition education. This curriculum significantly increases student knowledge, comfort with the material, and confidence in counseling their future patients. A longitudinal curriculum that reinforces concepts over time will help improve long-term retention.
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Affiliation(s)
| | - Jo Marie Reilly
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Zeng C, Schlueter DJ, Tran TC, Babbar A, Cassini T, Bastarache LA, Denny JC. Comparison of phenomic profiles in the All of Us Research Program against the US general population and the UK Biobank. J Am Med Inform Assoc 2024; 31:846-854. [PMID: 38263490 PMCID: PMC10990551 DOI: 10.1093/jamia/ocad260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
IMPORTANCE Knowledge gained from cohort studies has dramatically advanced both public and precision health. The All of Us Research Program seeks to enroll 1 million diverse participants who share multiple sources of data, providing unique opportunities for research. It is important to understand the phenomic profiles of its participants to conduct research in this cohort. OBJECTIVES More than 280 000 participants have shared their electronic health records (EHRs) in the All of Us Research Program. We aim to understand the phenomic profiles of this cohort through comparisons with those in the US general population and a well-established nation-wide cohort, UK Biobank, and to test whether association results of selected commonly studied diseases in the All of Us cohort were comparable to those in UK Biobank. MATERIALS AND METHODS We included participants with EHRs in All of Us and participants with health records from UK Biobank. The estimates of prevalence of diseases in the US general population were obtained from the Global Burden of Diseases (GBD) study. We conducted phenome-wide association studies (PheWAS) of 9 commonly studied diseases in both cohorts. RESULTS This study included 287 012 participants from the All of Us EHR cohort and 502 477 participants from the UK Biobank. A total of 314 diseases curated by the GBD were evaluated in All of Us, 80.9% (N = 254) of which were more common in All of Us than in the US general population [prevalence ratio (PR) >1.1, P < 2 × 10-5]. Among 2515 diseases and phenotypes evaluated in both All of Us and UK Biobank, 85.6% (N = 2152) were more common in All of Us (PR >1.1, P < 2 × 10-5). The Pearson correlation coefficients of effect sizes from PheWAS between All of Us and UK Biobank were 0.61, 0.50, 0.60, 0.57, 0.40, 0.53, 0.46, 0.47, and 0.24 for ischemic heart diseases, lung cancer, chronic obstructive pulmonary disease, dementia, colorectal cancer, lower back pain, multiple sclerosis, lupus, and cystic fibrosis, respectively. DISCUSSION Despite the differences in prevalence of diseases in All of Us compared to the US general population or the UK Biobank, our study supports that All of Us can facilitate rapid investigation of a broad range of diseases. CONCLUSION Most diseases were more common in All of Us than in the general US population or the UK Biobank. Results of disease-disease association tests from All of Us are comparable to those estimated in another well-studied national cohort.
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Affiliation(s)
- Chenjie Zeng
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - David J Schlueter
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- Department of Health and Society, University of Toronto, Scarborough, Toronto, ON, Canada
| | - Tam C Tran
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Anav Babbar
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Thomas Cassini
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Lisa A Bastarache
- Center for Precision Medicine, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Josh C Denny
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
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Liu W, Jia K, Wang Z. Graph-based EEG approach for depression prediction: integrating time-frequency complexity and spatial topology. Front Neurosci 2024; 18:1367212. [PMID: 38633266 PMCID: PMC11022962 DOI: 10.3389/fnins.2024.1367212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Depression has become the prevailing global mental health concern. The accuracy of traditional depression diagnosis methods faces challenges due to diverse factors, making primary identification a complex task. Thus, the imperative lies in developing a method that fulfills objectivity and effectiveness criteria for depression identification. Current research underscores notable disparities in brain activity between individuals with depression and those without. The Electroencephalogram (EEG), as a biologically reflective and easily accessible signal, is widely used to diagnose depression. This article introduces an innovative depression prediction strategy that merges time-frequency complexity and electrode spatial topology to aid in depression diagnosis. Initially, time-frequency complexity and temporal features of the EEG signal are extracted to generate node features for a graph convolutional network. Subsequently, leveraging channel correlation, the brain network adjacency matrix is employed and calculated. The final depression classification is achieved by training and validating a graph convolutional network with graph node features and a brain network adjacency matrix based on channel correlation. The proposed strategy has been validated using two publicly available EEG datasets, MODMA and PRED+CT, achieving notable accuracy rates of 98.30 and 96.51%, respectively. These outcomes affirm the reliability and utility of our proposed strategy in predicting depression using EEG signals. Additionally, the findings substantiate the effectiveness of EEG time-frequency complexity characteristics as valuable biomarkers for depression prediction.
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Affiliation(s)
- Wei Liu
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
- Beijing Laboratory of Advanced Information Networks, Beijing, China
- Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing, China
| | - Kebin Jia
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
- Beijing Laboratory of Advanced Information Networks, Beijing, China
- Beijing Key Laboratory of Computational Intelligence and Intelligent System, Beijing University of Technology, Beijing, China
| | - Zhuozheng Wang
- Faculty of Information Technology, Beijing University of Technology, Beijing, China
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Mitchell E, Comerford K, Knight M, McKinney K, Lawson Y. A review of dairy food intake for improving health among black adults in the US. J Natl Med Assoc 2024; 116:253-273. [PMID: 38378306 DOI: 10.1016/j.jnma.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
The adult life stage encompasses a range of new experiences, opportunities, and responsibilities that impact health and well-being. During this life stage, health disparities continue to increase for Black Americans, with Black adults having a disproportionate burden of obesity, chronic diseases, comorbidities, and worse treatment outcomes compared to their White peers. While many of the underlying factors for these disparities can be linked to longstanding sociopolitical factors such as systemic racism, food insecurity, and poor access to healthcare, there are also several modifiable risk factors that are known to significantly impact health outcomes, such as improving diet quality, increasing physical activity, and not smoking. Of all the modifiable risk factors known to impact health, improving dietary habits is the factor most consistently associated with better outcomes for body weight and chronic disease. Of the major food groups recommended by the 2020-2025 Dietary Guidelines for Americans (DGA) for achieving healthier dietary patterns, dairy foods have a nutrient profile which matches most closely to what Black Americans are inadequately consuming (e.g., vitamin A, vitamin D, calcium, magnesium). However, Black adults tend to consume less than half the recommended daily servings of dairy foods, in part, due to issues with lactose intolerance, making higher intake of dairy foods an ideal target for improving diet quality and health in this population. This review examines the current body of evidence exploring the links between dairy intake, obesity, cardiometabolic disease risk, chronic kidney disease, and the most common types of cancer, with a special focus on health and disparities among Black adults. Overall, the evidence from most systematic reviews and/or meta-analyses published in the last decade on dairy intake and health outcomes has been conducted on White populations and largely excluded research on Black populations. The findings from this extensive body of research indicate that when teamed with an energy-restricted diet, meeting or exceeding the DGA recommended 3 daily servings of dairy foods is associated with better body weight and composition outcomes and lower rates of most common chronic diseases than lower intake (<2 servings per day). In addition to the number of daily servings consumed, the specific types (e.g., milk, yogurt, cheese) and subtypes (e.g., low-fat, fermented, fortified) consumed have also been shown to play major roles in how these foods impact health. For example, higher intake of fermented dairy foods (e.g., yogurt) and vitamin D fortified dairy products appear to have the most protective effects for reducing chronic disease risk. Along with lactose-free milk and cheese, yogurt is also generally low in lactose, making it an excellent option for individuals with lactose intolerance, who are trying to meet the DGA recommendations for dairy food intake.
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Affiliation(s)
- Edith Mitchell
- Sidney Kimmel Cancer at Jefferson, Philadelphia, PA, United States
| | - Kevin Comerford
- OMNI Nutrition Science, California Dairy Research Foundation, Davis, CA, United States.
| | - Michael Knight
- The George Washington University School of Medicine and Health Sciences, Washington D.C., United States
| | - Kevin McKinney
- University of Texas Medical Branch, Department of Internal Medicine, Division of Endocrinology, Galveston, TX, United States
| | - Yolanda Lawson
- Baylor University Medical Center, Dallas, TX, United States
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Mossakowski K, Darrah-Okike J. Why does local identity influence mental health among university students in Hawai'i? JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:743-752. [PMID: 35348425 DOI: 10.1080/07448481.2022.2056418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/10/2022] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
Objective: This study examines local identity and mental health at one of the most ethnically diverse universities in the United States to move beyond the dichotomy between international and domestic students. Participants: Undergraduate students (N = 1,098) attending a university in Hawai'i completed anonymous surveys during class. Results: Self-identified local students who were born and/or raised in Hawai'i had lower levels of depressive symptoms than non-local students, over and above their nativity status, gender, age, race/ethnicity, multiracial status, and socioeconomic background. Sobel tests further confirmed significant mediators, which suggested that locals were less psychologically distressed than non-locals because of their stronger familiarity with the "aloha spirit," rooted in Native Hawaiian culture, and their lower risk of discrimination. Conclusions: These new findings can inform mental health services and interventions to better target non-local (international and out-of-state domestic) students by considering the stress of discrimination and the protective role of cultural values.
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Grummon AH, Zeitlin AB, Lee CJY. Developing messages to encourage healthy, sustainable dietary substitutions: A qualitative study with US emerging adults. Appetite 2024; 195:107223. [PMID: 38246428 PMCID: PMC10923059 DOI: 10.1016/j.appet.2024.107223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
Prior research shows that adopting simple dietary substitutions (e.g., replacing beef with poultry or plant-based entrees) can improve dietary quality and reduce the negative environmental consequences of food production, but little is known about how to encourage people to adopt these substitutions. This study aimed to examine reactions to messages encouraging healthy, sustainable dietary substitutions among emerging adults ages 18-25. We conducted four online focus groups with a diverse sample of US emerging adults (n = 28; 61% female). Focus groups explored emerging adults' reactions to messages encouraging them to adopt three target dietary substitutions: replacing beef and pork with poultry and plant-based entrees; replacing juice with whole fruit; and replacing dairy milk with non-dairy milk. We transcribed discussions verbatim and adopted a thematic approach to analyzing the transcripts. Results showed that participants perceived messages to be most effective at encouraging the target dietary substitutions when the messages: encouraged specific, achievable dietary changes; linked these dietary changes to clear consequences; included personally relevant content; included statistics; were succinct; and used a positive tone. Across the target dietary substitutions, two message topics (small changes, big benefits, which emphasized how small dietary changes can have large positive health and environmental impacts, and warning, which discussed the negative health and environmental impacts of dietary choices) were generally perceived to be most effective. A few participants expressed doubt that the target dietary substitutions would have meaningful environmental impacts. Results suggest that campaign messages to encourage healthy, sustainable dietary substitutions may be more effective if the messages make the target dietary substitutions seem achievable and use statistics to clearly describe the positive impacts of making these changes.
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Affiliation(s)
- Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, 3145 Porter Dr., Palo Alto, CA 94304, United States; Department of Health Policy, Stanford University School of Medicine, 615 Crothers Way, Encina Commons, Stanford, CA 94305, United States.
| | - Amanda B Zeitlin
- Department of Pediatrics, Stanford University School of Medicine, 3145 Porter Dr., Palo Alto, CA 94304, United States; Department of Medicine, Stanford University School of Medicine, 3180 Porter Dr., Palo Alto, CA 94304, United States.
| | - Cristina J Y Lee
- Department of Pediatrics, Stanford University School of Medicine, 3145 Porter Dr., Palo Alto, CA 94304, United States.
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Stephenson BJK, Wu SM, Dominici F. Identifying dietary consumption patterns from survey data: a Bayesian nonparametric latent class model. JOURNAL OF THE ROYAL STATISTICAL SOCIETY. SERIES A, (STATISTICS IN SOCIETY) 2024; 187:496-512. [PMID: 38617597 PMCID: PMC11009925 DOI: 10.1093/jrsssa/qnad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 04/16/2024]
Abstract
Dietary assessments provide the snapshots of population-based dietary habits. Questions remain about how generalisable those snapshots are in national survey data, where certain subgroups are sampled disproportionately. We propose a Bayesian overfitted latent class model to derive dietary patterns, accounting for survey design and sampling variability. Compared to standard approaches, our model showed improved identifiability of the true population pattern and prevalence in simulation. We focus application of this model to identify the intake patterns of adults living at or below the 130% poverty income level. Five dietary patterns were identified and characterised by reproducible code/data made available to encourage further research.
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Affiliation(s)
- Briana J K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephanie M Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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