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Lee LJ, Han CJ, Saligan L, Wallen GR. Comparing symptom clusters in cancer survivors by cancer diagnosis: A latent class profile analysis. Support Care Cancer 2024; 32:308. [PMID: 38662054 PMCID: PMC11045444 DOI: 10.1007/s00520-024-08489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Research on symptom clusters in oncology is progressing, but knowledge gaps remain. One question is whether the number and types of symptom subgroups (i.e., latent classes) differ based on cancer diagnosis. The purpose of this study was to: (1) identify and compare latent class subgroups based on four highly prevalent symptoms (pain, fatigue, sleep disturbance, and depression), and (2) examine the differences in sociodemographic and clinical factors in the identified latent classes across the seven cancer types (i.e., prostate, non-small cell lung, non-Hodgkin's lymphoma, breast, uterine, cervical, and colorectal cancer). METHODS This study is a cross-sectional secondary analysis of data obtained from the My-Health study in partnership with four Surveillance, Epidemiology, and End Results (SEER) cancer registries located in California (two), Louisiana, and New Jersey. The sample included 4,762 cancer survivors 6-13 months following diagnosis of one of the seven cancer types mentioned. Latent class profile analysis was used. RESULTS Subjects were primarily young (59% age 21-64 years), Caucasian (41%), married/cohabitating (58%) and unemployed (55%). The number and types of symptom subgroups varied across these seven cancer populations: four-subgroups were the common in prostate, lung, non-Hodgkin's lymphoma, and breast cancer survivors. Unmarried, low education, and unemployment status were associated with high risk of symptom burden across the cancer types. CONCLUSION Identifying symptom subgroups by cancer diagnosis has the potential to develop innovative and effective targeted interventions in cancer survivors. Further research is needed to establish extensive knowledge in symptom clustering between treatment regimens, and short-term and long-term cancer survivors.
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Affiliation(s)
- Lena J Lee
- National Institutes of Health (NIH) Clinical Center, Bethesda, MD, USA.
| | - Claire J Han
- Ohio State University, College of Nursing, Columbus, OH, USA
| | - Leorey Saligan
- National Institute of Nursing Research (NINR), Bethesda, MD, USA
| | - Gwenyth R Wallen
- National Institutes of Health (NIH) Clinical Center, Bethesda, MD, USA
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Wossenseged F, Franklin K, Gordon T, Buscetta A, Wallen GR, Bonham VL, Farmer N. Bidirectional Relationship Between Sickle Cell Disease and Food Insecurity: Scoping Review. Health Equity 2024; 8:238-248. [PMID: 38595934 PMCID: PMC11002324 DOI: 10.1089/heq.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction In the United States, sickle cell disease (SCD)-the homozygous inheritance of a point mutation within the beta-globin chain of hemoglobin-affects between 80,000 and 100,000 people. Adequate nutrition can influence the pathophysiology of SCD, and individuals with SCD who are undernourished are more likely to have impaired immune function and disease exacerbation. Undernourishment is often caused by food insecurity (FI), which is defined as "a household-level economic and social condition of limited or uncertain access to adequate food" by the USDA. FI disproportionately affects African Americans, a population disproportionately affected by SCD in the United States. Objectives We performed a scoping review to better understand the relationship between FI and SCD severity. Methods A comprehensive search for peer-reviewed research articles and meeting abstracts was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selected studies were reviewed for descriptive analysis by three independent reviewers. Results In total, 72 studies were identified, 62 were excluded for meeting inclusion criteria. The remaining 10 studies, 5 of which were meeting abstracts, were reviewed. Although limited evidence is available, the results of this scoping review suggest a bidirectional relationship between SCD and FI. Seven key themes were identified to help elucidate this relationship: 1) prevalence of FI among individuals with SCD, 2) child versus caregiver experiences of FI, 3) psychosocial factors, 4) food assistance benefits, 5) dietary intake, 6) external spending, 7) healthcare utilization. Conclusion Findings from this scoping review suggest how SCD and FI work in tandem to exacerbate each other. Furthermore, the findings illustrate current gaps in the literature and opportunities for actions to address FI among individuals living with SCD.
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Affiliation(s)
- Faeben Wossenseged
- Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Kristina Franklin
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Talya Gordon
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Ashley Buscetta
- Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Vence L. Bonham
- Social and Behavioral Research Branch, National Institutes of Health, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
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Maki KA, Crayton CB, Butera G, Wallen GR. Examining the relationship between the oral microbiome, alcohol intake and alcohol-comorbid neuropsychological disorders: protocol for a scoping review. BMJ Open 2024; 14:e079823. [PMID: 38514150 PMCID: PMC10961520 DOI: 10.1136/bmjopen-2023-079823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Heavy alcohol use and alcohol use disorder (AUD) continues to rise as a public health problem and increases the risk for disease. Elevated rates of anxiety, depression, sleep disruption and stress are associated with alcohol use. Symptoms may progress to diagnosed neurophysiological conditions and increase risk for relapse if abstinence is attempted. Research on mechanisms connecting the gastrointestinal microbiome to neuropsychological disorders through the gut-brain axis is well-established. Less is known how the oral microbiome and oral microbial-associated biomarkers may signal to the brain. Therefore, a synthesis of research studying relationships between alcohol intake, alcohol-associated neurophysiological symptoms and the oral microbiome is needed to understand the state of the current science. In this paper, we outline our protocol to collect, evaluate and synthesise research focused on associations between alcohol intake and AUD-related neuropsychological disorders with the oral microbiome. METHODS AND ANALYSIS The search strategy was developed and will be executed in collaboration with a medical research librarian. Studies will be screened by two independent investigators according to the aim of the scoping review, along with the outlined exclusion and inclusion criteria. After screening, data will be extracted and synthesised from the included papers according to predefined demographic, clinical and microbiome methodology metrics. ETHICS AND DISSEMINATION A scoping review of primary sources is needed to synthesise the data on relationships between alcohol use, neuropsychological conditions associated with AUD and the oral microbiome. The proposed scoping review is based on the data from publicly available databases and does not require ethical approval. We expect the results of this synthesis will identify gaps in the growing literature and highlight potential mechanisms linking the oral-brain axis to addiction and other associated neuropsychological conditions. The study findings and results will be disseminated through journals and conferences related to psychology, neuroscience, dentistry and the microbiome.
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Affiliation(s)
- Katherine A Maki
- Clinical Center, Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Chelsea B Crayton
- Clinical Center, Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Gisela Butera
- Division of Library Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Gwenyth R Wallen
- Clinical Center, Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Bethesda, Maryland, USA
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Lee LJ, Son EH, Farmer N, Gerrard C, Tuason RT, Yang L, Kohn-Godbout J, Stephens C, Nahm ES, Smith L, Risch S, Wallen GR. Nature-based virtual reality intervention to manage stress in family caregivers of allogeneic hematopoietic stem cell transplant recipients: a two-phase pilot study protocol. Front Psychiatry 2024; 15:1295097. [PMID: 38516258 PMCID: PMC10954866 DOI: 10.3389/fpsyt.2024.1295097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Millions of family members and/or friends in the U.S. serve as unpaid caregivers for individuals with chronic conditions, such as cancer. Caregiving for someone undergoing an intense allogeneic hematopoietic stem cell transplant (HSCT) is particularly demanding, with accompanying physical and psychological stress. Increased stress and stress-related symptoms could make it difficult for caregivers to fulfill their roles and could negatively impact the health status and quality of life of themselves and the recipients. Virtual reality (VR) is a promising technology increasingly used for treatment and wellness in various medical settings. There is growing evidence that studies have reported the positive effects of the VR intervention in managing and reducing stress among diverse populations in various clinical scenarios; however, no published studies have focused on family caregivers of patients with cancer. The study aims to assess the feasibility and acceptability of a four-week nature-based VR intervention and to examine the effectiveness of the VR intervention on stress in HSCT caregivers. This study comprises two phases. Phase I of the study will be a single-arm pre-post design focused on assessing the feasibility and acceptability of the VR intervention. Phase II of the study will be a prospective randomized controlled group design to examine the effectiveness of the VR intervention on perceived stress. Adults (≥ 18 years) who serve as primary caregivers for a person who will undergo an allogeneic HSCT will be recruited. Fifteen participants will be enrolled for Phase I and 94 participants for Phase II (Active VR arm N=47; Sham VR arm N=47). The nature-based immersive VR program contains 360° high-definition videos of nature scenes along with nature sounds through a head-mounted display (HMD) for 20 minutes every day for four weeks. Primary outcome is perceived stress measured by the Perceived Stress Scale. Secondary/exploratory outcomes are stress-related symptoms (e.g., fatigue, sleep disturbance) and physiological biomarkers (e.g., cortisol, alpha-amylase). The importance and innovativeness of this study consist of using a first-of-its-kind, immersive VR technology to target stress and investigating the health outcomes assessed by validated objective biomarkers as well as self-report measures of the nature-based intervention in the caregiver population. Clinical trial registration ClinicalTrials.gov, identifier NCT05909202.
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Affiliation(s)
- Lena J. Lee
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Elisa H. Son
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Nicole Farmer
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Chantal Gerrard
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Ralph Thadeus Tuason
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Li Yang
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Julie Kohn-Godbout
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
| | - Cory Stephens
- University of Maryland Baltimore, School of Nursing, Baltimore, MD, United States
| | - Eun-Shim Nahm
- University of Maryland Baltimore, School of Nursing, Baltimore, MD, United States
| | - Leslie Smith
- National Institutes of Health, Clinical Center, Nursing Department, Bethesda, MD, United States
| | - Steve Risch
- National Institutes of Health, Clinical Center, Nursing Department, Bethesda, MD, United States
| | - Gwenyth R. Wallen
- National Institutes of Health, Clinical Center, Translational Biobehavioral and Health Disparities (TBHD), Bethesda, MD, United States
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Farmer N, Tuason R, Middleton KR, Ude A, Tataw-Ayuketah G, Flynn S, Kazmi N, Baginski A, Mitchell V, Powell-Wiley TM, Wallen GR. Assessing Acceptability: The Role of Understanding Participant, Neighborhood, and Community Contextual Factors in Designing a Community-Tailored Cooking Intervention. Nutrients 2024; 16:463. [PMID: 38337747 PMCID: PMC10857272 DOI: 10.3390/nu16030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Cooking is an identified dietary strategy that is positively associated with optimal diet quality. Prior to initiating cooking interventions, evaluating the prospective acceptability of the intervention among community members living within low food access areas and understanding geospatial food shopping locations may aid in designing community-tailored interventions. METHODS A sequential mixed methods study was conducted to determine the prospective acceptability of a planned community-located cooking intervention among African American adults living in a low food access area and with at least one cardiovascular disease risk factor. A semi-structured guide was used to conduct five virtual focus groups. Qualitative data were analyzed using thematic analysis and validated through participant check-in interviews. Survey responses were analyzed based on descriptive data. Geospatial analysis of participant locations that were reported for food shopping was conducted to show food environment utilization. RESULTS Focus groups with study participants (n = 20, all female, mean age 60.3, SD 9.3, mean cooking frequency per week 4.0, food insecure n = 7) were conducted between March and April, 2021. Thematic analysis of the focus group transcripts identified five main themes as follows: (A) Barriers to Cooking (family and caregiving, transportation, COVID-19 pandemic, time availability, household composition); (B) Motivators for Cooking (family, caregiving, health, enjoyment, COVID-19 pandemic); (C) Strategies (food shopping, social support, social media, meal planning); (D) Neighborhood (gentrification, perceived safety, stigmatization, disparities in grocery stores); (E) and Acceptability of the Intervention (reasons to participate, barriers, recruitment, intervention delivery). Participant validation interviews confirmed the themes and subthemes as well as the illustrative quotes. Geospatial analysis showed a majority of locations were outside of the participants' residential areas. CONCLUSIONS Prospective acceptability of a community-tailored cooking intervention found that the planned intervention could be modified to address individual level factors, such as caregiving and health, community contextual factors, such as perceived safety, and the general health needs of the community.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Ralph Tuason
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Kimberly R. Middleton
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Assumpta Ude
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Gladys Tataw-Ayuketah
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Sharon Flynn
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Alyssa Baginski
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA; (V.M.); (T.M.P.-W.)
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA; (V.M.); (T.M.P.-W.)
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
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Hopkins D, Walker SC, Wilson C, Siaki L, Phillips AK, Wallen GR. The Experience of Living With Polycystic Ovary Syndrome in the Military. Mil Med 2024; 189:e188-e197. [PMID: 37405691 PMCID: PMC11022330 DOI: 10.1093/milmed/usad241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/15/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is the most prevalent reproductive endocrinopathy in women, ranging from 5% to 26% depending on diagnostic criteria applied. Common manifestations of PCOS include overweight and obesity, abnormal menstrual cycles, pelvic pain, increased facial and body hair, acne, and infertility. These abnormalities and associated complications have significant military operational and readiness implications. There is a large gap in research regarding active duty servicewomen (ADW) with PCOS. Therefore, the purpose of this study is to describe ADW's experience of living with PCOS and to describe the service-branch-specific differences among these women. MATERIALS AND METHODS Moderator's guide, audiotapes, transcripts, and field notes. This was a qualitative descriptive study using focus groups and individual interviews. The David Grant Medical Center Institutional Review Board at Travis AFB, CA, USA, approved the study protocol. Women with PCOS were recruited from U.S. Air Force, Army, and Navy locations. Data were analyzed using constant comparative content analysis. RESULTS Twenty-three servicewomen from 19 occupations across the Army, Navy, Air Force, and Marine Corps participated. Three overarching categories emerged: (1) challenges managing PCOS symptoms, (2) navigating the military health care system, and (3) navigating PCOS as a service member. CONCLUSIONS Servicewomen may have significant career consequences related to PCOS sequelae, such as overweight, obesity, uncontrolled menstrual cycle, and pain. Managing the myriad of symptoms can distract women while deployed, in austere conditions, or at their home stations. As one of the most common cardiometabolic, reproductive endocrinologic conditions in women, PCOS has not received the attention, awareness, education, or research necessary to sufficiently support ADW with this condition. It is imperative that evidence-based strategies are developed to inform relevant and high-quality care for these warfighters. Future qualitative studies are needed to further describe specific stressors and needs of ADW with PCOS. Future intervention studies are also needed to evaluate effective management options for ADW with PCOS.
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Affiliation(s)
| | | | - Candy Wilson
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 28040, USA
| | - Leilani Siaki
- Center for Nursing Science and Clinical Inquiry, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA
| | - Angela K Phillips
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Gwenyth R Wallen
- National Institutes of Health Clinical Center, Bethesda, MD 28400, USA
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Farmer N, Maki KA, Barb JJ, Jones KK, Yang L, Baumer Y, Powell-Wiley TM, Wallen GR. Geographic social vulnerability is associated with the alpha diversity of the human microbiome. mSystems 2023; 8:e0130822. [PMID: 37642431 PMCID: PMC10654076 DOI: 10.1128/msystems.01308-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/26/2023] [Indexed: 08/31/2023] Open
Abstract
IMPORTANCE As a risk factor for conditions related to the microbiome, understanding the role of SVI on microbiome diversity may assist in identifying public health implications for microbiome research. Here we found, using a sub-sample of the Human Microbiome Project phase 1 cohort, that SVI was linked to microbiome diversity across body sites and that SVI may influence race/ethnicity-based differences in diversity. Our findings, build on the current knowledge regarding the role of human geography in microbiome research, suggest that measures of geographic social vulnerability be considered as additional contextual factors when exploring microbiome alpha diversity.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Katherine A. Maki
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Jennifer J. Barb
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Kelly K. Jones
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Li Yang
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Tiffany M. Powell-Wiley
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
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Son EH, Wallen GR, Flynn S, Yang L, Lee LJ. Patterns of health-promoting behaviors and associated factors in family caregivers of people receiving cancer treatment: A latent class profile analysis. Psychooncology 2023; 32:1038-1047. [PMID: 37157152 PMCID: PMC10590684 DOI: 10.1002/pon.6145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Family caregivers tend to neglect their health while prioritizing the needs of their care recipients. Identifying subgroups of caregivers based on the patterns of health-promoting behaviors (HPBs) may help develop tailored interventions for them, yet little is known. The purpose of this study was: (1) to identify latent classes with distinct patterns of HPBs in family caregivers of people with cancer; and (2) to investigate factors associated with the latent class membership. METHODS We performed a cross-sectional data analysis using the baseline dataset from a longitudinal survey study that assessed HPBs of family caregivers of individuals who received cancer treatment at a national research hospital (N = 124). Latent class profile analysis was conducted to identify latent classes based on the subdomains of the Health-Promoting Lifestyle Profile II, followed by multinomial logistic regression analysis to investigate factors associated with the latent class membership. RESULTS Three latent classes were identified: a high level of HPB (Class 1, 25.8%); a moderate level of HPB (Class 2, 53.2%); and a low level of HPB (Class 3, 21.0%) of HPBs. Controlling for caregiver age and sex, caregiver burden due to lack of family support, perceived stress, self-efficacy and body mass index were factors associated with the latent class membership. CONCLUSIONS HPBs of our caregiver sample appeared in relatively stable patterns at different levels. Higher caregiver burden and perceived stress and lower self-efficacy were associated with the lower practice of HPBs overall. Our findings may serve as a reference for screening caregivers who need support and developing person-centered interventions.
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Affiliation(s)
- Elisa H. Son
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Sharon Flynn
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland, USA
| | - Li Yang
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Lena J. Lee
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
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Farmer N, Baginski A, Alkhatib J, Maki KA, Baumer Y, Powell-Wiley TM, Wallen GR. Neighbourhood environment as a risk factor for adverse health outcomes through association with the microbiome: protocol for a scoping review. BMJ Open 2023; 13:e066913. [PMID: 36898756 PMCID: PMC10008260 DOI: 10.1136/bmjopen-2022-066913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION The connection of the microbiome to human health intersects with the physical environment of humans. Each microbiome location can be influenced by environmental conditions that relate to specific geographical locations, which in turn are influenced by social determinants of health such as a neighbourhood. The objective of this scoping review is to explore the current evidence on the relationships between microbiome and neighbourhood to explain microbiome-related health outcomes. METHODS AND ANALYSIS Arksey and O'Malley's literature review framework will be employed throughout the process, as well as Page, et al's 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis updated workflow to process search results. The literature search will be completed using PubMed/Medline (NLM), Embase (Elsevier), Web of Science, Core Collection (Clarivate Analytics), Scopus (Elsevier), medRxiv preprint server and Open Science Framework server. The search will be conducted using a list of pre-identified Medical Subject Headings (MeSH) terms relating to neighbourhood, microbiome and individual characteristics. There will be no date or language restrictions used in the search. In order to be included in the study, a piece must include an evaluation of the relationship between microbiome diversity and neighbourhood (including at least one measurement of the neighbourhood and at least one human microbiome site). Excluded from the review will be those works that do not include all of these measures, literature reviews based on secondary sources and postmortem populations with no report of premortem health factors. The review itself will be an iterative process completed by two reviewers, with a third individual identified to break ties. Documents will be undergoing a risk assessment of bias in order for the authors to comment on the quality of the literature in this area. Finally, results will be discussed with identified stakeholders, including individuals connected to neighbourhoods facing structural inequity and experts in the topics of study through a community advisory board, for their feedback and knowledge transfer. ETHICS AND DISSEMINATION This review does not require ethical approval. Results of this search will be disseminated through peer-reviewed publications. Furthermore, this work is completed in conjunction with a community advisory board so as to ensure dissemination to multiple stakeholders.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Alyssa Baginski
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Jenna Alkhatib
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Katherine A Maki
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Yvonne Baumer
- The Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
| | - Tiffany M Powell-Wiley
- The Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Gwenyth R Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
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10
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Lee LJ, Son H, Wallen GR, Flynn S, Cox R, Yang L, Ross A. Symptom Clusters in Family Caregivers of Hematopoietic Stem Cell Transplantation Recipients: Loneliness as a Risk Factor. Transplant Cell Ther 2023; 29:50.e1-50.e8. [PMID: 36202335 PMCID: PMC9825650 DOI: 10.1016/j.jtct.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
A symptom cluster is a group of 2 or more symptoms that occur together and are related to each other. Family caregivers of allogeneic hematopoietic stem cell transplantation (HSCT) recipients experience multiple concurrent symptoms, but the majority of symptom research in this population has focused on assessing and managing individual symptoms. The purpose of this analysis was to determine (1) whether clusters of 5 highly prevalent symptoms (fatigue, sleep disturbance, depression, anxiety, and cognitive impairment) in allogeneic HSCT caregivers could be identified and (2) which caregiver and patient characteristics influence membership in the identified symptom cluster groups. Baseline cross-sectional data were collected from allogeneic HSCT caregivers participating in a randomized controlled trial at the National Institutes of Health Clinical Center. Measures included the Caregiver Reaction Assessment (CRA), Health-Promoting Lifestyle Profile II (HPLP-II), Fatigue Symptom Inventory (MFSI), Pittsburgh Sleep Quality Index (PSQI), and Patient-Reported Outcomes Measurement Information System (PROMIS). Cluster analysis was used to identify symptom clusters, and univariate analyses and multiple logistic regression were performed to identify factors that contribute to symptom clusters. The average age of caregivers (n = 44) was 45.20 ± 15.05 years; primarily white (52.3%) and female (88.6%) and often the spouse/partner of the patient (50.0%). Two symptom cluster groups were identified: low symptom burden (n = 24; 54.5%) and high symptom burden (n = 20; 45.5%). Caregivers with higher levels of loneliness (odds ratio, 1.12; 95% confidence interval, 1.04 to 1.22; P = .004) were more likely to be in the high symptom burden group. This study provides evidence that 5 symptoms commonly found in family caregivers-fatigue, sleep disturbance, depression, anxiety, and cognitive impairment-tend to occur in clusters. Therefore, clinicians should be aware that caregivers with 1 or more of these symptoms may be at higher risk for developing the others, and caregivers reporting high levels of loneliness may be at particular risk. Future research is needed to identify novel interventions that target multiple, co-occurring symptoms. Such interventions also might include components that decrease loneliness. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Lena J Lee
- National Institutes of Health Clinical Center, Bethesda, Maryland.
| | - Hyojin Son
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Gwenyth R Wallen
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sharon Flynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Robert Cox
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Li Yang
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Alyson Ross
- National Institutes of Health Clinical Center, Bethesda, Maryland
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11
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Farmer N, Tuason RT, Kazmi N, Flynn S, Mitchell V, Middleton K, Cox R, Franklin K, Gordon T, Baginski A, Wallen GR. Going virtual during the COVID-19 pandemic: adaptation of a mixed-methods dietary behavior study within a community-based participatory research study of African-American adults at risk for cardiovascular disease. BMC Med Res Methodol 2022; 22:330. [PMID: 36550396 PMCID: PMC9773576 DOI: 10.1186/s12874-022-01806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Identifying mechanisms to maintain CBPR studies during an infectious disease pandemic is vital. The current paper describes the changes in methods and processes conducted within a CBPR mixed-methods study to a virtual setting during the novel coronavirus (COVID-19) pandemic. METHOD The DC Community Organizing for Optimal Culinary Knowledge study with Heart (DC COOKS with Heart) was designed to assess the feasibility of a dietary behavior intervention among African-American adults that are at risk for cardiovascular disease (CVD). The study is under the umbrella of an ongoing CBPR study and community advisory board that facilitates community involvement in study design and promotes ongoing engagement with community members and leaders. The study population for D.C. COOKS with Heart consists of adult African-American individuals who live in two low-resource neighborhoods in Washington, D.C., which were impacted disproportionately by COVID. Eligible study participants who previously participated in the DC CHOC community-based studies were contacted to participate in Phase 1. The quantitative part of the mixed-methods included survey data collection. RESULTS Due to the pandemic, the mode of data collection for surveys changed from self-administered face-to-face to internet-based. All virtual study procedures were conducted between March and April, 2021. Anticipated benefits of the virtual setting included participant safety during the pandemic, ease of logistics for participants. Anticipated challenges included administration of electronic devices to participants, research team training, and potential threats to established trust related to the privacy and confidentiality of participants. CONCLUSION The transition to a virtual setting for study procedures in a mixed-methods study was conducted successfully in terms of recruitment, retention of participants, and training of research team members. The virtual transition required established and ongoing engagement through the community advisory board and CBPR practices, institutional support through virtual research policies, collaborations with information technology-based teams, and equipment administration for the study. TRIALS REGISTRATION NCT04305431 . Registered on March 12, 2020.
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Affiliation(s)
- Nicole Farmer
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Ralph Thadeus Tuason
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Narjis Kazmi
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Sharon Flynn
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Valerie Mitchell
- grid.279885.90000 0001 2293 4638Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, Bethesda, MD USA
| | - Kimberly Middleton
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Robert Cox
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Kristina Franklin
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Talya Gordon
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Alyssa Baginski
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Gwenyth R. Wallen
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD USA
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12
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Maki KA, Ganesan SM, Meeks B, Farmer N, Kazmi N, Barb JJ, Joseph PV, Wallen GR. The role of the oral microbiome in smoking-related cardiovascular risk: a review of the literature exploring mechanisms and pathways. J Transl Med 2022; 20:584. [PMID: 36503487 PMCID: PMC9743777 DOI: 10.1186/s12967-022-03785-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality. Oral health is associated with smoking and cardiovascular outcomes, but there are gaps in knowledge of many mechanisms connecting smoking to cardiovascular risk. Therefore, the aim of this review is to synthesize literature on smoking and the oral microbiome, and smoking and cardiovascular risk/disease, respectively. A secondary aim is to identify common associations between the oral microbiome and cardiovascular risk/disease to smoking, respectively, to identify potential shared oral microbiome-associated mechanisms. We identified several oral bacteria across varying studies that were associated with smoking. Atopobium, Gemella, Megasphaera, Mycoplasma, Porphyromonas, Prevotella, Rothia, Treponema, and Veillonella were increased, while Bergeyella, Haemophilus, Lautropia, and Neisseria were decreased in the oral microbiome of smokers versus non-smokers. Several bacteria that were increased in the oral microbiome of smokers were also positively associated with cardiovascular outcomes including Porphyromonas, Prevotella, Treponema, and Veillonella. We review possible mechanisms that may link the oral microbiome to smoking and cardiovascular risk including inflammation, modulation of amino acids and lipids, and nitric oxide modulation. Our hope is this review will inform future research targeting the microbiome and smoking-related cardiovascular disease so possible microbial targets for cardiovascular risk reduction can be identified.
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Affiliation(s)
- Katherine A. Maki
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, 10 Center Drive, Building 10, Bethesda, MD 20814 USA
| | - Sukirth M. Ganesan
- grid.214572.70000 0004 1936 8294Department of Periodontics, The University of Iowa College of Dentistry and Dental Clinics, 801 Newton Rd., Iowa City, IA 52242 USA
| | - Brianna Meeks
- grid.411024.20000 0001 2175 4264University of Maryland, School of Social Work, Baltimore, MD USA
| | - Nicole Farmer
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, 10 Center Drive, Building 10, Bethesda, MD 20814 USA
| | - Narjis Kazmi
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, 10 Center Drive, Building 10, Bethesda, MD 20814 USA
| | - Jennifer J. Barb
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, 10 Center Drive, Building 10, Bethesda, MD 20814 USA
| | - Paule V. Joseph
- grid.420085.b0000 0004 0481 4802National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD USA ,grid.280738.60000 0001 0035 9863National Institute of Nursing Research, National Institutes of Health, Bethesda, MD USA
| | - Gwenyth R. Wallen
- grid.410305.30000 0001 2194 5650Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, 10 Center Drive, Building 10, Bethesda, MD 20814 USA
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13
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Farmer N, Powell-Wiley TM, Middleton KR, Brooks AT, Mitchell V, Troncoso M, Ceasar J, Claudel SE, Andrews MR, Kazmi N, Johnson A, Wallen GR. Use of a focus group-based cognitive interview methodology to validate a cooking behavior survey among African-American adults. Front Nutr 2022; 9:1000258. [PMID: 36545469 PMCID: PMC9760831 DOI: 10.3389/fnut.2022.1000258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/21/2022] [Indexed: 12/08/2022] Open
Abstract
Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent's interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved African-American adults (n = 11) at risk for cardiovascular disease who were recruited from a community-based participatory research study in Washington, D.C., to participate in a focus group-based cognitive interview. Cognitive interview methodologies included the verbal think-aloud protocol and the use of retrospective probes. Thematic analysis and evaluation of verbalized cognitive processes were conducted using verbatim transcripts. Five thematic themes related to the survey were generated: (1) Clarity and relevancy of question items; (2) influence of participants' perspectives and gender roles; (3) participant social desirability response to questions; (4) concern regarding question intent. Eleven survey items were determined as difficult by participants. Cooking topics for these items were: cooking practices, cooking skills, cooking perception (how one defines cooking), food shopping skills, and socialization around cooking. Question comprehension and interpreting response selections were the most common problems identified. Cognitive interviews are useful for cooking research as they can evaluate survey questions to determine if the meaning of the question as intended by the researcher is communicated to the respondents-specific implications from the results that apply to cooking research include revising questions on cooking practice and skills. Focus-group-based cognitive interviews may provide a feasible method to develop culturally grounded survey instruments to help understand disparities in behavior for culturally relevant diet behaviors such as cooking.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States,*Correspondence: Nicole Farmer,
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States,Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Kimberly R. Middleton
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Alyssa T. Brooks
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Melissa Troncoso
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Joniqua Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Sophie E. Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marcus R. Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Allan Johnson
- Department of Nutritional Sciences, Division of Allied Health Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, United States
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
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14
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Yang S, Ratteree K, Turner SA, Tuason RT, Brooks A, Wallen GR, Barb JJ. Dietary Intakes of Patients with Alcohol Use Disorder During a 4-Week Protocol on an Inpatient Treatment Unit Found to Meet Dietary Reference Intakes for Macronutrients, but Have Variability in Energy Balance and Adequacy of Micronutrient Intake. J Acad Nutr Diet 2022; 122:2311-2319. [PMID: 35659642 PMCID: PMC9691517 DOI: 10.1016/j.jand.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite literature supporting the importance of diet during rehabilitation, minimal research quantifies dietary intake during treatment for alcohol use disorder (AUD). OBJECTIVE The aim was to quantify dietary intake and energy balance of patients with AUD during inpatient treatment. DESIGN This was a secondary analysis of data from a 4-week observational protocol. Participants self-selected food from a room service menu. Dietary intake was recorded by patients and reviewed by nutrition staff. To quantify nutrient and food group intake, data were coded into Nutrition Data Systems for Research software, versions 2016 and 2017. Daily average intake was calculated for all dietary variables. PARTICIPANTS/SETTING Participants (n = 22) were adults seeking treatment for AUD at the National Institutes of Health Clinical Center (Bethesda, MD) between September 2016 and September 2017 and who were enrolled in a study examining the microbiome during AUD rehabilitation. Four participants discontinued protocol participation before study week 4 and were not included in analyses examining change over time. MAIN OUTCOME MEASURES Weight change, daily energy, and macronutrient and select micronutrient intakes were the main outcome measures included. STATISTICAL ANALYSES PERFORMED Mean differences in intake and weight were assessed using nonparametric tests. RESULTS Sixty-four percent of participants were male; mean ± SD age was 46.3 ± 13.0 years, mean ± SD body mass index (calculated as kg/m2) was 23.9 ± 2.5, and mean intake was 2,665 kcal/d (consisting of 45.9% carbohydrate, 34.9% fat, and 19.1% protein). Eighty percent or more of this sample met the Estimated Average Requirement for 10 of 16 micronutrients assessed. Male participants consumed more energy than estimated needs (P = .003) and gained a mean ± SD of 2.67 ± 1.84 kg (P = .006) when an outlier with weight loss and acute pancreatitis was removed from analysis. Female participants did not gain weight or consume more than estimated energy needs. CONCLUSIONS Overall macronutrient intake was within recommended ranges, but intake of other dietary components and weight gain were variable, supporting the need for individualized nutrition care during AUD treatment.
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Affiliation(s)
- Shanna Yang
- Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Kelly Ratteree
- Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Sara A Turner
- Nutrition Department, Clinical Center, National Institutes of Health, Bethesda, MD.
| | | | - Alyssa Brooks
- Center for Scientific Review, National Institutes of Health, Bethesda, MD
| | - Gwenyth R Wallen
- Center for Scientific Review, National Institutes of Health, Bethesda, MD
| | - Jennifer J Barb
- Center for Scientific Review, National Institutes of Health, Bethesda, MD
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15
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Vijayakumar NP, Neally SJ, Potharaju KA, Curlin K, Troendle JF, Collins BS, Mitchell VM, Tamura K, Ayers C, Pita MA, Tarfa H, Thompson K, Baah FO, Baez AS, Ortiz-Whittingham L, Gallagher JW, McCoy R, Heist M, Gutierrez-Huerta CA, Turner BS, Baumer Y, Farmer N, Wallen GR, Dodge T, Powell-Wiley TM. Customizing Place-Tailored Messaging Using a Multilevel Approach: Pilot Study of the Step It Up Physical Activity Mobile App Tailored to Neighborhood Environment. Circ Cardiovasc Qual Outcomes 2022; 15:e009328. [PMID: 36378765 PMCID: PMC9680010 DOI: 10.1161/circoutcomes.122.009328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nithya P. Vijayakumar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sam J. Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kameswari A. Potharaju
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kaveri Curlin
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - James F. Troendle
- Office of Biostatistics Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Billy S. Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valerie M. Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Colby Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mario A. Pita
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hannatu Tarfa
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Keitra Thompson
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Foster Osei Baah
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew S. Baez
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lola Ortiz-Whittingham
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Wills Gallagher
- Connected Health for Applications and Interventions Core, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Regina McCoy
- Connected Health for Applications and Interventions Core, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Michael Heist
- Connected Health for Applications and Interventions Core, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Cristhian A. Gutierrez-Huerta
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Briana S. Turner
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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16
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Baginski A, Farmer N, Baumer Y, Wallen GR, Powell‐Wiley T. Interleukin‐8 (IL‐8) as a Potential Mediator of an Association Between Trimethylamine N‐Oxide (TMAO) and Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) among African‐Americans at Risk for Cardiovascular Disease. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r2185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory Cardiovascular Branch, Division of Intramural Research National Heart, Lung, and Blood InstituteNational Institutes of HealthNIHBethesdaMD
| | | | - Tiffany Powell‐Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory Cardiovascular Branch, Division of Intramural Research National Heart, Lung, and Blood InstituteNational Institutes of HealthNIHBethesdaMD
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Abstract
Social determinants of health (SDoH), which encompass the economic, social, environmental, and psychosocial factors that influence health, play a significant role in the development of cardiovascular disease (CVD) risk factors as well as CVD morbidity and mortality. The COVID-19 pandemic and the current social justice movement sparked by the death of George Floyd have laid bare long-existing health inequities in our society driven by SDoH. Despite a recent focus on these structural drivers of health disparities, the impact of SDoH on cardiovascular health and CVD outcomes remains understudied and incompletely understood. To further investigate the mechanisms connecting SDoH and CVD, and ultimately design targeted and effective interventions, it is important to foster interdisciplinary efforts that incorporate translational, epidemiological, and clinical research in examining SDoH-CVD relationships. This review aims to facilitate research coordination and intervention development by providing an evidence-based framework for SDoH rooted in the lived experiences of marginalized populations. Our framework highlights critical structural/socioeconomic, environmental, and psychosocial factors most strongly associated with CVD and explores several of the underlying biologic mechanisms connecting SDoH to CVD pathogenesis, including excess stress hormones, inflammation, immune cell function, and cellular aging. We present landmark studies and recent findings about SDoH in our framework, with careful consideration of the constructs and measures utilized. Finally, we provide a roadmap for future SDoH research focused on individual, clinical, and policy approaches directed towards developing multilevel community-engaged interventions to promote cardiovascular health.
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Affiliation(s)
- Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (T.M.P.-W., Y.B., F.O.B., A.S.B., C.T.M., M.A.P., K.A.P.), National Institutes of Health, Bethesda, MD.,Intramural Research Program, National Institute on Minority Health and Health Disparities (T.M.P.-W.), National Institutes of Health, Bethesda, MD
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (T.M.P.-W., Y.B., F.O.B., A.S.B., C.T.M., M.A.P., K.A.P.), National Institutes of Health, Bethesda, MD
| | - Foster Osei Baah
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (T.M.P.-W., Y.B., F.O.B., A.S.B., C.T.M., M.A.P., K.A.P.), National Institutes of Health, Bethesda, MD
| | - Andrew S Baez
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (T.M.P.-W., Y.B., F.O.B., A.S.B., C.T.M., M.A.P., K.A.P.), National Institutes of Health, Bethesda, MD
| | - Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD (N.F., G.R.W.)
| | - Christa T Mahlobo
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (T.M.P.-W., Y.B., F.O.B., A.S.B., C.T.M., M.A.P., K.A.P.), National Institutes of Health, Bethesda, MD.,The Pennsylvania State University (C.T.M.)
| | - Mario A Pita
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (T.M.P.-W., Y.B., F.O.B., A.S.B., C.T.M., M.A.P., K.A.P.), National Institutes of Health, Bethesda, MD
| | - Kameswari A Potharaju
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (T.M.P.-W., Y.B., F.O.B., A.S.B., C.T.M., M.A.P., K.A.P.), National Institutes of Health, Bethesda, MD
| | - Kosuke Tamura
- Neighborhood Social and Geospatial Determinants of Health Disparities Laboratory, Population and Community Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities (K.T.), National Institutes of Health, Bethesda, MD
| | - Gwenyth R Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD (N.F., G.R.W.)
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Farmer N, Osei Baah F, Williams F, Ortiz-Chapparo E, Mitchell VM, Jackson L, Collins B, Graham L, Wallen GR, Powell-Wiley TM, Johnson A. Use of a community advisory board to build equitable algorithms for participation in clinical trials: a protocol paper for HoPeNET. BMJ Health Care Inform 2022; 29:bmjhci-2021-100453. [PMID: 35185011 PMCID: PMC8860013 DOI: 10.1136/bmjhci-2021-100453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Participation from racial and ethnic minorities in clinical trials has been burdened by issues surrounding mistrust and access to healthcare. There is emerging use of machine learning (ML) in clinical trial recruitment and evaluation. However, for individuals from groups who are recipients of societal biases, utilisation of ML can lead to the creation and use of biased algorithms. To minimise bias, the design of equitable ML tools that advance health equity could be guided by community engagement processes. The Howard University Partnership with the National Institutes of Health for Equitable Clinical Trial Participation for Racial/Ethnic Communities Underrepresented in Research (HoPeNET) seeks to create an ML-based infrastructure from community advisory board (CAB) experiences to enhance participation of African-Americans/Blacks in clinical trials. Methods and analysis This triphased cross-sectional study (24 months, n=56) will create a CAB of community members and research investigators. The three phases of the study include: (1) identification of perceived barriers/facilitators to clinical trial engagement through qualitative/quantitative methods and systems-based model building participation; (2) operation of CAB meetings and (3) development of a predictive ML tool and outcome evaluation. Identified predictors from the participant-derived systems-based map will be used for the ML tool development. Ethics and dissemination We anticipate minimum risk for participants. Institutional review board approval and informed consent has been obtained and patient confidentiality ensured.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, Maryland, USA
| | - Foster Osei Baah
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, NHLBI, Bethesda, Maryland, USA
| | | | - Erika Ortiz-Chapparo
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, NHLBI, Bethesda, Maryland, USA
| | - Valerie M Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, NHLBI, Bethesda, Maryland, USA
| | - Latifa Jackson
- Department of Pediatrics, Howard University, Washington, DC, USA
| | - Billy Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, NHLBI, Bethesda, Maryland, USA
| | - Lennox Graham
- Department of Health Sciences and Management, College of Nursing and Allied Health Sciences, Howard Unversity, Washington, DC, USA
| | - Gwenyth R Wallen
- Translational Biobehavioral and Health Disparities Branch, NIH Clinical Center, Bethesda, Maryland, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, NHLBI, Bethesda, Maryland, USA .,Intramural Research Program, NIMHD, Bethesda, Maryland, USA
| | - Allan Johnson
- Department of Nurtritional Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
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19
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Kazmi N, Wallen GR, Yang L, Alkhatib J, Schwandt ML, Feng D, Gao B, Diazgranados N, Ramchandani VA, Barb JJ. An exploratory study of pro-inflammatory cytokines in individuals with alcohol use disorder: MCP-1 and IL-8 associated with alcohol consumption, sleep quality, anxiety, depression, and liver biomarkers. Front Psychiatry 2022; 13:931280. [PMID: 36032219 PMCID: PMC9405018 DOI: 10.3389/fpsyt.2022.931280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND High levels of sleep disturbances reported among individuals with alcohol use disorder (AUD) can stimulate inflammatory gene expression, and in turn, may alter pro-inflammatory cytokines levels. We aimed to investigate associations between pro-inflammatory cytokine markers with subjective measures of sleep quality, psychological variables and alcohol consumption among individuals with AUD. METHODS This exploratory study is comprised of individuals with AUD (n = 50) and healthy volunteers (n = 14). Spearman correlation was used to investigate correlations between plasma cytokine levels and clinical variables of interest (liver and inflammatory markers, sleep quality, patient reported anxiety/depression scores, and presence of mood and/or anxiety disorders (DSM IV/5); and history of alcohol use variables. RESULTS The AUD group was significantly older, with poorer sleep quality, higher anxiety/depression scores, and higher average drinks per day as compared to controls. Within the AUD group, IL-8 and MCP-1 had positive significant correlations with sleep, anxiety, depression and drinking variables. Specifically, higher levels of MCP-1 were associated with poorer sleep (p = 0.004), higher scores of anxiety (p = 0.006) and depression (p < 0.001), and higher number of drinking days (p = 0.002), average drinks per day (p < 0.001), heavy drinking days (p < 0.001) and total number of drinks (p < 0.001). The multiple linear regression model for MCP-1 showed that after controlling for sleep status and heavy drinking days, older participants (p = 0.003) with more drinks per day (p = 0.016), and higher alkaline phosphatase level (p = 0.001) had higher MCP-1 level. CONCLUSION This exploratory analysis revealed associations with cytokines MCP-1 and IL-8 and drinking consumption, sleep quality, and anxiety and depression in the AUD group. Furthermore, inflammatory and liver markers were highly correlated with certain pro-inflammatory cytokines in the AUD group suggesting a possible relationship between chronic alcohol use and inflammation. These associations may contribute to prolonged inflammatory responses and potentially higher risk of co-morbid chronic diseases.
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Affiliation(s)
- Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Gwenyth R Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Li Yang
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Jenna Alkhatib
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Melanie L Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Dechun Feng
- Laboratory of Liver Diseases, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Bin Gao
- Laboratory of Liver Diseases, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Nancy Diazgranados
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Vijay A Ramchandani
- Human Psychopharmacology Laboratory, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Jennifer J Barb
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, United States
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20
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Barb JJ, Maki KA, Kazmi N, Meeks BK, Krumlauf M, Tuason RT, Brooks AT, Ames NJ, Goldman D, Wallen GR. The oral microbiome in alcohol use disorder: a longitudinal analysis during inpatient treatment. J Oral Microbiol 2021; 14:2004790. [PMID: 34880965 PMCID: PMC8648028 DOI: 10.1080/20002297.2021.2004790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Alcohol use disorder (AUD)-induced disruption of oral microbiota can lead to poor oral health; there have been no studies published examining the longitudinal effects of alcohol use cessation on the oral microbiome. Aim To investigate the oral microbiome during alcohol cessation during inpatient treatment for AUD. Methods Up to 10 oral tongue brushings were collected from 22 AUD patients during inpatient treatment at the National Institutes of Health. Alcohol use history, smoking, and periodontal disease status were measured. Oral microbiome samples were sequenced using 16S rRNA gene sequencing. Results Alpha diversity decreased linearly during treatment across the entire cohort (P = 0.002). Alcohol preference was associated with changes in both alpha and beta diversity measures. Characteristic tongue dorsum genera from the Human Microbiome Project such as Streptococcus, Prevotella, Veillonella and Haemophilus were highly correlated in AUD. Oral health-associated genera that changed longitudinally during abstinence included Actinomyces, Capnocytophaga, Fusobacterium, Neisseria and Prevotella. Conclusion The oral microbiome in AUD is affected by alcohol preference. Patients with AUD often have poor oral health but abstinence and attention to oral care improve dysbiosis, decreasing microbiome diversity and periodontal disease-associated genera while improving acute oral health.
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Affiliation(s)
- J J Barb
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - K A Maki
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - N Kazmi
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - B K Meeks
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - M Krumlauf
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - R T Tuason
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - A T Brooks
- Center for Scientific Review, National Institutes of Health, Bethesda, Md, USA
| | - N J Ames
- National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - D Goldman
- Office of the Clinical Director, Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Md, USA
| | - G R Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
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21
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Farmer N, Gordon T, Middleton KR, Brooks AT, Wallen GR. Reigniting Dr. Martin Luther King's call to action: the role of the behavioral scientist in the movement for social justice and racial equity. Transl Behav Med 2021; 12:6359855. [PMID: 34459912 DOI: 10.1093/tbm/ibab108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Talya Gordon
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Kimberly R Middleton
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Alyssa T Brooks
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA.,Center for Scientific Review, National Institutes of Health, Division of AIDS, Behavior, and Population Sciences, Bethesda, MD, USA
| | - Gwenyth R Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health, Clinical Center, Bethesda, MD, USA
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22
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Ulrich CM, Knafl K, Foxwell AM, Zhou Q, Paidipati C, Tiller D, Ratcliffe SJ, Wallen GR, Richmond TS, Naylor M, Gordon TF, Grady C, Miller V. Experiences of Patients After Withdrawal From Cancer Clinical Trials. JAMA Netw Open 2021; 4:e2120052. [PMID: 34374772 PMCID: PMC8356063 DOI: 10.1001/jamanetworkopen.2021.20052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Cancer clinical trials (CCTs) provide patients an opportunity to receive experimental drugs, tests, and/or procedures that can lead to remission. For some, a CCT may seem like their only option. Little is known about experiences of patient-participants who withdraw or are withdrawn from CCTs. OBJECTIVE To examine patient-participants' experiences during withdrawal from CCTs. DESIGN, SETTING, AND PARTICIPANTS This qualitative, descriptive study used a semistructured interview designed specifically for it, with open-ended and probing questions. The study took place at a National Cancer Institute-designated comprehensive cancer center affiliated with the University of Pennsylvania. The need for a sample of 20 interviewees was determined by code and meaning saturation (ie, no new themes revealed and identified themes fully elaborated). Interviews were transcribed verbatim and analyzed with a qualitative software program. Data coded with the software were refined into categories reflecting broad themes. A criterion-based sampling approach was used to select a subset of adult patients with cancer who were former CCT participants and who agreed on exit from those CCTs to a later interview about withdrawal experiences. They were contacted one by one by telephone from September 2015 through June 2019 until 20 agreed. Data analysis was completed in October 2020. MAIN OUTCOMES AND MEASURES Themes characterizing patient-participants' perceptions of their withdrawal experiences. RESULTS Respondents' mean (SD) age was 64.42 (8.49) years; 12 (63.2%) were men. Most respondents were White (18 respondents [94.7%]) and college educated (11 respondents [55.0%]). Cancer stage data were available for 17 participants, 11 of whom (64.7%) had stage IV cancer at CCT enrollment. Thirteen respondents reported withdrawal as a result of disease progression, and 5 withdrew because of adverse effects. Other reasons for withdrawal included acute illness and participant uncertainty about the reason. Analysis of interview data yielded 5 themes: posttrial prognostic awareness, goals of care discussions, emotional coping, burden of adverse effects, and professional trust and support. Subthemes included regrets or hindsight, urgency to start next treatment, and weighing benefits and burdens of treatment. Limited discussions about patient-participants' immediate posttrial care needs left many feeling that there was no clear path forward. CONCLUSIONS AND RELEVANCE Patient-participants transitioning from a CCT described feeling intense symptoms and emotions and awareness that their life span was short and options seemed to be limited. Communication that includes attention to posttrial needs is needed throughout the CCT to help patient-participants navigate posttrial steps. Research should focus on components of responsible and ethical CCT transitions, including types and timing of discussions and who should begin these discussions with patient-participants and their families.
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Affiliation(s)
- Connie M. Ulrich
- School of Nursing, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kathleen Knafl
- School of Nursing, University of North Carolina, Chapel Hill
| | | | - Qiuping Zhou
- School of Nursing, George Washington University, Washington, DC
| | - Cynthia Paidipati
- Department of Family and Community Health, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois
| | - Deborah Tiller
- School of Nursing, University of Pennsylvania, Philadelphia
| | | | | | | | - Mary Naylor
- School of Nursing, University of Pennsylvania, Philadelphia
| | | | - Christine Grady
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Victoria Miller
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Graves LY, Tamez P, Wallen GR, Saligan LN. Defining the role of individuals prepared as a doctor of nurse practice in symptoms science research. Nurs Outlook 2021; 69:542-549. [PMID: 33750612 DOI: 10.1016/j.outlook.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 11/13/2022]
Abstract
PURPOSE The Doctor of Nursing Practice (DNP) programs have grown exponentially for the last 10 years across the United States. However, the intra-professional collaboration among DNP and PhD scholars is not clearly demonstrated in the literature as it relates to frequency, training models, and the outcomes of these collaborations on translation. The purposes of this paper are to: (1) examine the role for DNP nurses in symptom science research and (2) describe training models to cultivate the PhD-DNP collaboration to strengthen the translation of discoveries from nursing research, to facilitate implementation of discoveries, and to improve clinical practice of nurses. METHODS A targeted review of the literature was conducted to identify, (1) the role of the DNP, (2) examples of PhD-DNP collaborations, (3) training models that support collaborations, and (4) the outcomes of these intra-professional collaborations. RESULTS Two articles reported on PhD-DNP collaboration within a university setting; however, they did not address how the partnership was modeled. One additional article described an academic-hospital partnership model aimed at MSN-prepared advanced practice nurses (APRN) by which outcomes were measured. No examples were found outside of academic settings. The National Institute of Nursing Research (NINR) has established the Symptom Science Center (SSC) with an interest in training the next generation of symptom scientists. By developing a training curriculum through the NINR SSC, DNP-prepared students and practitioners can be exposed to the research enterprise and potentially develop early partnerships with PhD-prepared students and scholars that lead to research translation. CONCLUSION The NINR Department of Intramural Research (DIR) and National Institutes of Health Clinical Center are dedicated to building stronger ties between PhD- and DNP-prepared scientists. The SSC can serve as an optimal platform to promote the collaboration of PhD and DNP nurses to advance symptom science translation. CLINICAL RELEVANCE Nurses have a remarkable role in early detection of disease progression. Training opportunities to cultivate the PhD-DNP collaboration have significant relevance for expediting the translation of nursing science to nursing practice.
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Affiliation(s)
- Letitia Y Graves
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Pamela Tamez
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | - Gwenyth R Wallen
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD; National Institutes of Health, Clinical Center, Nursing Department, Bethesda, MD
| | - Leorey N Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
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Abstract
OBJECTIVES To identify symptom clusters in breast cancer survivors and to determine sociodemographic and clinical characteristics influencing symptom cluster membership. SAMPLE AND SETTING The authors performed a cross-sectional secondary analysis of data obtained from a community-based cancer registry-linked survey with 1,500 breast cancer survivors 6-13 months following a breast cancer diagnosis. METHODS AND VARIABLES Symptom clusters were identified using latent class profile analysis of four patient-reported symptoms (pain, fatigue, sleep disturbance, and depression) with custom PROMIS® short forms. RESULTS Four distinct classes were identified. IMPLICATIONS FOR NURSING Common symptom clusters may lead to better prevention and treatment strategies that target a group of symptoms. Results also suggest that certain factors place patients at high risk for symptom burden, which can guide tailored interventions.
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Affiliation(s)
- Lena Lee
- National Institutes of Health Clinical Center
| | - Alyson Ross
- National Institutes of Health Clinical Center
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25
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Soundararajan S, Kazmi N, Brooks AT, Krumlauf M, Schwandt ML, George DT, Hodgkinson CA, Wallen GR, Ramchandani VA. FAAH and CNR1 Polymorphisms in the Endocannabinoid System and Alcohol-Related Sleep Quality. Front Psychiatry 2021; 12:712178. [PMID: 34566715 PMCID: PMC8458733 DOI: 10.3389/fpsyt.2021.712178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 12/02/2022] Open
Abstract
Sleep disturbances are common among individuals with alcohol use disorder (AUD) and may not resolve completely with short-term abstinence from alcohol, potentially contributing to relapse to drinking. The endocannabinoid system (ECS) is associated with both sleep and alcohol consumption, and genetic variation in the ECS may underlie sleep-related phenotypes among individuals with AUD. In this study, we explored the influence of genetic variants in the ECS (Cannabinoid receptor 1/CNR1: rs806368, rs1049353, rs6454674, rs2180619, and Fatty Acid Amide Hydrolase/FAAH rs324420) on sleep quality in individuals with AUD (N = 497) and controls without AUD (N = 389). We assessed subjective sleep quality (from the Pittsburgh Sleep Quality Index/PSQI) for both groups at baseline and objective sleep efficiency and duration (using actigraphy) in a subset of individuals with AUD at baseline and after 4 weeks of inpatient treatment. We observed a dose-dependent relationship between alcohol consumption and sleep quality in both AUD and control groups. Sleep disturbance, a subscale measure in PSQI, differed significantly among CNR1 rs6454674 genotypes in both AUD (p = 0.015) and controls (p = 0.016). Only among controls, neuroticism personality scores mediated the relationship between genotype and sleep disturbance. Objective sleep measures (sleep efficiency, wake bouts and wake after sleep onset), differed significantly by CNR1 rs806368 genotype, both at baseline (p = 0.023, 0.029, 0.015, respectively) and at follow-up (p = 0.004, p = 0.006, p = 0.007, respectively), and by FAAH genotype for actigraphy recorded sleep duration at follow-up (p = 0.018). These relationships suggest a significant role of the ECS in alcohol-related sleep phenotypes.
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Affiliation(s)
- Soundarya Soundararajan
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Narjis Kazmi
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Alyssa T Brooks
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Melanie L Schwandt
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - David T George
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Colin A Hodgkinson
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
| | - Gwenyth R Wallen
- National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Vijay A Ramchandani
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, United States
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26
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Tamura K, Vijayakumar NP, Troendle JF, Curlin K, Neally SJ, Mitchell VM, Collins BS, Baumer Y, Gutierrez-Huerta CA, Islam R, Turner BS, Andrews MR, Ceasar JN, Claudel SE, Tippey KG, Giuliano S, McCoy R, Zahurak J, Lambert S, Moore PJ, Douglas-Brown M, Wallen GR, Dodge T, Powell-Wiley TM. Multilevel mobile health approach to improve cardiovascular health in resource-limited communities with Step It Up: a randomised controlled trial protocol targeting physical activity. BMJ Open 2020; 10:e040702. [PMID: 33371027 PMCID: PMC7754642 DOI: 10.1136/bmjopen-2020-040702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women. METHODS AND ANALYSIS An mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named 'tailored-to-place') to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervention for 3 months, at which point the intervention strategy will adapt based on individuals' PA levels. Those who do not meet the PA goal will be rerandomised to more intensive treatment. Participants will be followed for another 3 months to determine the contribution of each mHealth intervention to PA level. This protocol will use novel statistical approaches to account for the adaptive strategy. Finally, effects of PA changes on CVD risk biomarkers will be characterised. ETHICS AND DISSEMINATION This protocol has been developed in partnership with a Washington, DC-area community advisory board to ensure feasibility and acceptability to community members. The National Institutes of Health Intramural IRB approved this research and the National Heart, Lung, and Blood Institute provided funding. Once published, results of this work will be disseminated to community members through presentations at community advisory board meetings and our quarterly newsletter. TRIAL REGISTRATION NUMBER NCT03288207.
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Affiliation(s)
- Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nithya P Vijayakumar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James F Troendle
- Office of Biostatistics Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kaveri Curlin
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Valerie M Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Billy S Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cristhian A Gutierrez-Huerta
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rafique Islam
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Briana S Turner
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus R Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joniqua N Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sophie E Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathryn G Tippey
- University of North Carolina, Nutrition Obesity Research Center, Lineberger Comprehensive Cancer Center, Connected Health Applications and Interventions (CHAI) Core, Chapel Hill, North Carolina, USA
| | - Shayne Giuliano
- University of North Carolina, Nutrition Obesity Research Center, Lineberger Comprehensive Cancer Center, Connected Health Applications and Interventions (CHAI) Core, Chapel Hill, North Carolina, USA
| | - Regina McCoy
- University of North Carolina, Nutrition Obesity Research Center, Lineberger Comprehensive Cancer Center, Connected Health Applications and Interventions (CHAI) Core, Chapel Hill, North Carolina, USA
| | - Jessica Zahurak
- University of North Carolina, Nutrition Obesity Research Center, Lineberger Comprehensive Cancer Center, Connected Health Applications and Interventions (CHAI) Core, Chapel Hill, North Carolina, USA
| | - Sharon Lambert
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Philip J Moore
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | | | - Gwenyth R Wallen
- National Institutes of Health Clinical Center, Nursing Department, Bethesda, Maryland, USA
| | - Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
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Ames NJ, Barb JJ, Schuebel K, Mudra S, Meeks BK, Tuason RTS, Brooks AT, Kazmi N, Yang S, Ratteree K, Diazgranados N, Krumlauf M, Wallen GR, Goldman D. Longitudinal gut microbiome changes in alcohol use disorder are influenced by abstinence and drinking quantity. Gut Microbes 2020; 11:1608-1631. [PMID: 32615913 PMCID: PMC7527072 DOI: 10.1080/19490976.2020.1758010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/26/2020] [Accepted: 04/13/2020] [Indexed: 02/08/2023] Open
Abstract
Many patients with alcohol use disorder (AUD) consume alcohol chronically and in large amounts that alter intestinal microbiota, damage the gastrointestinal tract, and thereby injure other organs via malabsorption and intestinal inflammation. We hypothesized that alcohol consumption and subsequent abstinence would change the gut microbiome in adults admitted to a treatment program. Stool and oral specimens, diet data, gastrointestinal assessment scores, anxiety, depression measures and drinking amounts were collected longitudinally for up to 4 weeks in 22 newly abstinent inpatients with AUD who were dichotomized as less heavy drinkers (LHD, <10 drinks/d) and very heavy drinkers (VHD, 10 or more drinks/d). Next-generation 16 S rRNA gene sequencing was performed to measure the gut and oral microbiome at up to ten time points/subject and LHD and VHD were compared for change in principal components, Shannon diversity index and specific genera. The first three principal components explained 46.7% of the variance in gut microbiome diversity across time and all study subjects, indicating the change in gut microbiome following abstinence. The first time point was an outlier in three-dimensional principal component space versus all other time points. The gut microbiota in LHD and VHD were significantly dissimilar in change from day 1 to day 5 (p = .03) and from day 1 to week 3 (p = .02). The VHD drinking group displayed greater change from baseline. The Shannon diversity index of the gut microbiome changed significantly during abstinence in five participants. In both groups, the Shannon diversity was lower in the oral microbiome than gut. Ten total genera were shared between oral and stool in the AUD participants. These data were compared with healthy controls from the Human Microbiome Project to investigate the concept of a core microbiome. Rapid changes in gut microbiome following abstinence from alcohol suggest resilience of the gut microbiome in AUD and reflects the benefits of refraining from the highest levels of alcohol and potential benefits of abstinence.
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Affiliation(s)
- Nancy J. Ames
- Clinical Center Nursing Department, NIH, Bethesda, MD, USA
| | - Jennifer J. Barb
- Clinical Center Nursing Department, NIH, Bethesda, MD, USA
- Center for Information Technology, NIH, Bethesda, MD, USA
| | - Kornel Schuebel
- Office of the Clinical Director, Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Sarah Mudra
- Clinical Center Nursing Department, NIH, Bethesda, MD, USA
| | | | - Ralph Thadeus S. Tuason
- Clinical Center Nursing Department, NIH, Bethesda, MD, USA
- Unites States Public Health Service Commissioned Corps, Bethesda, MD, USA
| | | | - Narjis Kazmi
- Clinical Center Nursing Department, NIH, Bethesda, MD, USA
| | - Shanna Yang
- Clinical Center Nutrition Department, NIH, Bethesda, MD, USA
| | - Kelly Ratteree
- Unites States Public Health Service Commissioned Corps, Bethesda, MD, USA
- Clinical Center Nutrition Department, NIH, Bethesda, MD, USA
| | - Nancy Diazgranados
- Office of the Clinical Director, Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Michael Krumlauf
- Clinical Center Nursing Department, NIH, Bethesda, MD, USA
- Unites States Public Health Service Commissioned Corps, Bethesda, MD, USA
| | | | - David Goldman
- Office of the Clinical Director, Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
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Farmer N, Lee LJ, Powell-Wiley TM, Wallen GR. Cooking Frequency and Perception of Diet among US Adults Are Associated with US Healthy and Healthy Mediterranean-Style Dietary Related Classes: A Latent Class Profile Analysis. Nutrients 2020; 12:nu12113268. [PMID: 33113837 PMCID: PMC7693972 DOI: 10.3390/nu12113268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/1970] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Meal habits are associated with overall dietary quality and favorable dietary patterns determined by the Healthy Eating Index (HEI). However, within dietary patterns, complexities of food combinations that are not apparent through composite score determination may occur. Also, explorations of these food combinations with cooking and perceived diet quality (PDQ) remain unknown. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 were utilized to determine the frequency of cooking at home and PDQ, along with sociodemographic variables. Latent class profile analysis was performed to determine person-centered data-driven analysis using the dietary index, HEI-2010, at both the daily and dinner meal-time levels. Multinomial logistic regression analysis was utilized to evaluate the association of dietary patterns with all covariates. Results: For daily HEI, five distinct dietary classes were identified. For dinner HEI, six classes were identified. In comparison to the standard American diet classes, home cooking was positively associated with daily (p < 0.05) and dinner (p < 0.001) dietary classes that had the highest amounts of total vegetable and greens/beans intake. PDQ was positively associated with these classes at the daily level (p < 0.001), but negatively associated with healthier classes at the dinner level (p < 0.001). Conclusion: The use of latent class profile analysis at the daily and dinner meal-time levels identified that food choices coalesce into diverse intakes, as shown by identified dietary classes. Home cooking frequency could be considered a positive factor associated with higher vegetable intake, particularly greens/beans, at the daily and dinner levels. At the same time, the perception of diet quality has a positive association only with daily choices.
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Affiliation(s)
- Nicole Farmer
- National Institutes of Health Clinical Center, Bethesda, MD 20814, USA; (L.J.L.); (G.R.W.)
- Correspondence:
| | - Lena J. Lee
- National Institutes of Health Clinical Center, Bethesda, MD 20814, USA; (L.J.L.); (G.R.W.)
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA;
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD 20892, USA
| | - Gwenyth R. Wallen
- National Institutes of Health Clinical Center, Bethesda, MD 20814, USA; (L.J.L.); (G.R.W.)
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Farmer N, Powell-Wiley TM, Middleton KR, Roberson B, Flynn S, Brooks AT, Kazmi N, Mitchell V, Collins B, Hingst R, Swan L, Yang S, Kakar S, Harlan T, Wallen GR. A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart. Pilot Feasibility Stud 2020; 6:158. [PMID: 33088581 PMCID: PMC7574184 DOI: 10.1186/s40814-020-00697-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cooking interventions have increased in popularity in recent years. Evaluation by meta-analyses and systematic reviews show consistent changes in dietary quality reports and cooking confidence, but not of cardiovascular (CVD) biomarkers. Interventions evaluating or reporting behavioral mechanisms as an explanatory factor for these outcomes has been sparse. Moreover, evaluations of cooking interventions among communities with health disparities or food access limitations have received little attention in the literature. Methods This study will occur over two phases. Phase 1 will assess acceptability among the target population of African-American adults living within an urban food desert. Phase 2 will consist of a 6-week cooking intervention delivered at a community kitchen setting. Pre and post intervention visits for clinical examinations and biomarker collection will be conducted, as well as dietary and cooking skill assessments. Primary outcomes include cooking behavior and feasibility measures. Secondary outcomes are related to dietary quality, psychosocial factors, CVD biomarkers, and food environment measures. Discussion This study seeks to demonstrate feasibility of a community-based cooking intervention and to provide necessary information to plan future interventions that identify cooking behavior as an outcome of participation in cooking interventions among African-American adults, especially in relation to dietary and biomarker outcomes. Trial registration This study was registered at ClinicalTrials.gov (NCT04305431) on March 12, 2020.
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Affiliation(s)
- Nicole Farmer
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA.,Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD USA
| | | | - Brenda Roberson
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Sharon Flynn
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Alyssa T Brooks
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Narjis Kazmi
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Billy Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Rachel Hingst
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Lucy Swan
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Shanna Yang
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Seema Kakar
- George Washington University School of Health Sciences, Washington, DC, USA
| | - Timothy Harlan
- George Washington University School of Health Sciences, Washington, DC, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Bethesda, MD USA
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Baumer Y, Farmer N, Premeaux TA, Wallen GR, Powell-Wiley TM. Health Disparities in COVID-19: Addressing the Role of Social Determinants of Health in Immune System Dysfunction to Turn the Tide. Front Public Health 2020; 8:559312. [PMID: 33134238 PMCID: PMC7578341 DOI: 10.3389/fpubh.2020.559312] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/31/2020] [Indexed: 12/28/2022] Open
Abstract
It is evident that health disparities exist during the COVID-19 pandemic, a pandemic caused by the novel coronavirus SARS-CoV-2. Underlying reasons for COVID-19 health disparities are multi-factorial. However, social determinants, including those regarding socioeconomic status, social inequalities, health behaviors, and stress, may have implications on these disparities. Exposure to one or more of these social determinants is associated with heightened inflammatory responses, particularly increases in the cytokine interleukin-6 (IL-6), as well as immune system dysfunction. Thus, an amplified effect during COVID-19 could occur, potentially resulting in vulnerable patients experiencing an intensified cytokine storm due to a hyperactive and dysfunctional immune response. Further understanding how social determinants play a mechanistic role in COVID-19 disparities could potentially help reduce health disparities overall and in future pandemics.
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Affiliation(s)
- Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Nicole Farmer
- National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Thomas A. Premeaux
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Gwenyth R. Wallen
- National Institutes of Health, Clinical Center, Bethesda, MD, United States
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
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31
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Claudel SE, Ceasar JN, Andrews MR, El-Toukhy S, Farmer N, Middleton KR, Sabado-Liwag M, Mitchell VM, Tamura K, Brooks AT, Wallen GR, Powell-Wiley TM. Time to listen: a mixed-method study examining community-based views of mobile technology for interventions to promote physical activity. BMJ Health Care Inform 2020; 27:e100140. [PMID: 32830106 PMCID: PMC7445338 DOI: 10.1136/bmjhci-2020-100140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION A mixed-method, co-design approach to studying the adoption of mobile health (mHealth) technology among African-American (AA) women has not been fully explored. Qualitative data may contextualise existing knowledge surrounding perceptions of mHealth among AA women as part of formative work for designing a physical activity application (app). METHODS A convenience sample of 16 AA women completed an informatics survey prior to participating in focus groups exploring their use of mobile technology and health apps. Survey responses provided frequency data, while iterative transcript analysis of focus groups identified themes. RESULTS The majority of participants (mean age=62.1 years, SD=6.6) felt comfortable using a tablet/smartphone (75.0%). Most (68.8%) reported using health-related apps, primarily focused on physical activity and nutrition. Focus groups revealed four overarching concepts, including (1) user attachment, (2) technology adoption, (3) potential facilitators and (4) potential barriers. Important features which may serve as facilitators or barriers to future adoption of a mobile app for an mHealth intervention include individual app tailoring and software concerns, respectively. DISCUSSION Thematic analysis revealed high user attachment to smartphones and described participants' process for adopting new mHealth technology. CONCLUSION Early engagement of target end users as a part of a broader co-design and community-based participatory research process for developing mHealth technologies may be useful for sustained adoption of these tools in future mHealth behavioural interventions.
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Affiliation(s)
| | | | | | - Sherine El-Toukhy
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
| | | | | | - Melanie Sabado-Liwag
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
- Public Health Department, California State University Los Angeles, Los Angeles, California, USA
| | | | - Kosuke Tamura
- Cardiovascular Branch, NHLBI, Bethesda, Maryland, USA
| | | | | | - Tiffany M Powell-Wiley
- Cardiovascular Branch, NHLBI, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
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32
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Ross A, Perez A, Wehrlen L, Lee LJ, Yang L, Cox R, Bevans M, Ding A, Wiener L, Wallen GR. Factors influencing loneliness in cancer caregivers: A longitudinal study. Psychooncology 2020; 29:1794-1801. [PMID: 32672866 DOI: 10.1002/pon.5477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe levels of loneliness in cancer caregivers over a 6 month time period, and to examine factors that influence changes in loneliness in caregivers over time. METHODS Prospective, repeated measures design was utilized to examine levels of loneliness and factors that influence loneliness in 129 family caregivers of individuals undergoing cancer treatment at three time points over a 6 month period. Measures included: PROMIS global health and sleep disturbance; NIH Toolbox loneliness, self-efficacy and perceived stress; Family Care Inventory mutuality scale; and Caregiver Reaction Assessment. RESULTS Approximately one third (30.2%, n = 39) of the caregivers had high levels of loneliness, and levels of loneliness did not change over the three time points (P = .985). For any given time point, caregivers who were not married (P = .008), not working (P = .027), with worse mental health (P = .015), more perceived-stress (P < .0001), and more caregiver burden (P = .003) reported higher levels of loneliness. CONCLUSION This study provides guidance for clinicians attempting to identify at-risk caregivers by confirming the findings of previous research that caregivers with higher burden, stress and in poor mental health are at increased risk for loneliness. This study provides preliminary evidence that continuing to work during the caregiving trajectory may be beneficial to caregivers by reducing levels of loneliness. Future research is needed to confirm these findings and to examine novel interventions to reduce loneliness in cancer caregivers.
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Affiliation(s)
- Alyson Ross
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Avery Perez
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Leslie Wehrlen
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Lena J Lee
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Li Yang
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Robert Cox
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Margaret Bevans
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Alice Ding
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
| | - Lori Wiener
- National Cancer Institute Center for Cancer Research Pediatric Oncology Branch, Bethesda, Maryland, USA
| | - Gwenyth R Wallen
- National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, USA
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Farmer N, Wallen GR, Baumer Y, Powell-Wiley TM. COVID-19: Growing Health Disparity Gaps and an Opportunity for Health Behavior Discovery? Health Equity 2020; 4:316-319. [PMID: 32775940 PMCID: PMC7410284 DOI: 10.1089/heq.2020.0026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2020] [Indexed: 11/12/2022] Open
Abstract
Recently, racial and ethnic disparities within the current coronavirus disease-2019 (COVID-19) pandemic at the state level have received attention and notably highlight the ongoing issues surrounding health disparities within the United States. Among the discussions around health disparities lies a discussion on the role of psychosocial stress during this pandemic, especially with broadly applied social distancing and isolation recommendations. In nonpandemic times, psychosocial stressors have a significant association with physiological responses and behavioral responses. Within the current pandemic, increased attention on health-promoting behaviors, such as cooking and physical activity, has occurred. However, based on disparities from structural racism and socioeconomic effects on neighborhood environments, we may see a limiting value to the possible mitigating role of health behaviors within some disparate communities. We present in this perspective that there may be a role for behavioral interventions to mitigate psychosocial stressors and promote health behaviors. It may also be important to consider the use of multilevel behavioral interventions designed in the context of environmental and perceptual barriers during the COIVD-19 pandemic.
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Affiliation(s)
- Nicole Farmer
- National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Gwenyth R. Wallen
- National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
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Brooks AT, Raju S, Barb JJ, Kazmi N, Chakravorty S, Krumlauf M, Wallen GR. Sleep Regularity Index in Patients with Alcohol Dependence: Daytime Napping and Mood Disorders as Correlates of Interest. Int J Environ Res Public Health 2020; 17:ijerph17010331. [PMID: 31947749 PMCID: PMC6982308 DOI: 10.3390/ijerph17010331] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 01/06/2023]
Abstract
Alcohol use disorder (AUD) is often accompanied by comorbid conditions, including sleep disturbances related to sleep regularity and timing. The Sleep Regularity Index (SRI) is a novel measure that assesses the probability that an individual is awake (vs. asleep) at any two time points 24 h apart. We calculated actigraphy-based SRI on 124 participants with alcohol dependence to capture the effects of changes in sleep timing and duration among patients enrolled in an inpatient alcohol treatment program. During the course of the study, the mean SRI increased between weeks 1 and 3 (75.4 to 77.8), thus indicating slightly improved sleep quality and regularity during alcohol treatment. Individuals within the bottom quartile of SRI scores at week 1 improved significantly over time. Average total SRI for individuals with no mood disorders was slightly higher than that for individuals with one or more mood disorders. Increased SRI scores were associated with lower total nap duration from week 1 to week 3. Increased SRI scores were associated with decreased mental/physical exhaustion scores from week 1 to week 3. The SRI could be a target for assessment/intervention in certain sub-groups of individuals undergoing inpatient treatment for AUD.
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Affiliation(s)
- Alyssa T. Brooks
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
- Correspondence:
| | - Shravya Raju
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Jennifer J. Barb
- Mathematical and Statistical Computing Lab/CIT/NIH, 12 South Drive Bldg 12A Room 2001, Bethesda, MD 20892, USA;
| | - Narjis Kazmi
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Subhajit Chakravorty
- Corporal Michael J. Crescenz VA Medical Center, Perelman School of Medicine, MIRECC, 2nd Floor, Mail stop 116, 3900 Woodland Avenue, Philadelphia, PA 19104, USA;
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
| | - Gwenyth R. Wallen
- National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA; (S.R.); (N.K.); (M.K.); (G.R.W.)
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Meeks BK, Barb J, Mudra SE, Kazmi N, Tuason, RTS, Schuebel K, Brooks AT, Krumlauf M, Brenchley L, Gardner PJ, Goldman D, Wallen GR, Ames NJ. 2577. Periodontal Disease and the Oral Microbiome in Alcohol-Dependent Individuals. Open Forum Infect Dis 2019. [PMCID: PMC6809552 DOI: 10.1093/ofid/ofz360.2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Periodontal disease results from a polymicrobial infection composed of pathogenic bacteria that colonize the oral cavity, resulting in loss of periodontal attachment and alveolar bone. Periodontitis can increase the risk or exacerbate other comorbidities. Alcohol use increases the risk of periodontitis, but there is little knowledge about periodontitis among people who misuse alcohol.
Methods
As part of a larger oral and gut microbiome study, this analysis examines the oral microbiome in the occurrence and severity of periodontitis among alcohol-dependent (AD) subjects undergoing a 28-day inpatient alcohol treatment program. Tongue brushings were collected from 22 subjects within the first week of admission, and 16S rDNA sequencing was performed. All subjects had a dental examination during the inpatient stay. This analysis divided periodontal disease status into three major groups–no disease, mild or moderate disease, and severe disease. One-way ANOVA was used to compare microbial genera across the 3 groups.
Results
Nineteen (86%) of the subjects had periodontitis: 16 had mild or moderate disease, and 3 had severe disease. Statistically different microbial genera in at least one of the three groups (P ≤ 0.05 corresponding to FDR ≤ 0.25) that had a relative abundance of at least 0.5% include: Bifidobacterium, Lactobacillus, Parvimonas, Peptostreptococcus, Porphyromonas, and Treponema. Surprisingly, the subjects with no periodontitis had increased abundances of genera that are often pathogens, Porphyromonas and Peptostreptococcus. Subjects with severe periodontitis had increased abundances of known pathogens Treponema and Parvimonas, as well as Lactobacillus, which has been associated with dental caries.
Conclusion
We observed that periodontitis accompanies chronic AD, given that 86% of our subjects had the disease. While some microbiome differences for individuals with and without periodontitis were not consistent with the existing literature, this may have many explanations. Future studies should consider how chronic AD could change the microbial ecology of the mouth and lead to further infection as well as utilizing multiple oral sites and a larger sample size to better understand the relationship between AD and periodontal disease.
Intramural funds from NIH
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Brianna K Meeks
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Jen Barb
- National Institutes of Health, Bethesda, Maryland
| | - Sarah E Mudra
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Narjis Kazmi
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | | | - Kornel Schuebel
- National Institutes of Alcohol Abuse and Alcoholism, Baltimore, Maryland
| | - Alyssa T Brooks
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | | | - Pamela J Gardner
- National Institute of Dental and Craniofacial Research, Bethesda, Maryland
| | - David Goldman
- National Institute of Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Gwenyth R Wallen
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Nancy J Ames
- National Institutes of Health Clinical Center, Bethesda, Maryland
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Farmer N, Wallen GR, Yang L, Middleton KR, Kazmi N, Powell-Wiley TM. Household Cooking Frequency of Dinner Among Non-Hispanic Black Adults is Associated with Income and Employment, Perceived Diet Quality and Varied Objective Diet Quality, HEI (Healthy Eating Index): NHANES Analysis 2007-2010. Nutrients 2019; 11:E2057. [PMID: 31480746 PMCID: PMC6769568 DOI: 10.3390/nu11092057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 01/16/2023] Open
Abstract
Home cooking is associated with improved diet quality. Non-Hispanic Blacks, a population with diet-quality related health disparities, report lower home cooking than other racial/ethnic groups. Factors and subsequent dietary outcomes associated with this cooking disparity are relatively unknown. A secondary analysis was performed using demographic and consumer behavior data from the 2007-2010 cycles of the National Health and Nutrition Examination Survey (NHANES) to identify factors associated with household cooking frequency of dinner among Non-Hispanic Blacks. Self-reported dietary data were used to calculate Healthy Eating Index-2010 (HEI-2010) to determine cooking related objective diet quality. Lower income, unemployment, and higher perceived diet quality were significantly associated with higher cooking frequency (p < 0.05). For diet quality, higher vegetable (p = 0.031), lower empty calorie intake (p = 0.002), higher dinner time protein (p = 0.004) and lower dinner time dairy intake (p = 0.003) were associated with cooking. Total HEI scores were associated with higher cooking frequency for middle income (p = 0.007), but not higher or lower income categories (p = 0.306; p = 0.384), respectively. On average, factors associated with cooking frequency were psychosocial, income, and employment related. Objective diet quality as measured by HEI was variable. Future dietary studies among Non-Hispanic Blacks should include cooking, socioeconomic status and perceived diet quality as particularly relevant factors of interest.
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Affiliation(s)
- Nicole Farmer
- National Institute of Health Clinical Center; Bethesda, MD 20811, USA.
| | - Gwenyth R Wallen
- National Institute of Health Clinical Center; Bethesda, MD 20811, USA
| | - Li Yang
- National Institute of Health Clinical Center; Bethesda, MD 20811, USA
| | | | - Narjis Kazmi
- National Institute of Health Clinical Center; Bethesda, MD 20811, USA
| | - Tiffany M Powell-Wiley
- National Heart, Lung and Blood Institute; Bethesda, MD 20811, USA
- National Institute on Minority and Health Disparities, Bethesda, MD 20811, USA
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Ames NJ, Barb JJ, Ranucci A, Kim H, Mudra SE, Cashion AK, Townsley DM, Childs R, Paster BJ, Faller LL, Wallen GR. The oral microbiome of patients undergoing treatment for severe aplastic anemia: a pilot study. Ann Hematol 2019; 98:1351-1365. [PMID: 30919073 DOI: 10.1007/s00277-019-03599-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/07/2019] [Indexed: 12/11/2022]
Abstract
The microbiome, an intriguing component of the human body, composed of trillions of microorganisms, has prompted scientific exploration to identify and understand its function and role in health and disease. As associations between microbiome composition, disease, and symptoms accumulate, the future of medicine hinges upon a comprehensive knowledge of these microorganisms for patient care. The oral microbiome may provide valuable and efficient insight for predicting future changes in disease status, infection, or treatment course. The main aim of this pilot study was to characterize the oral microbiome in patients with severe aplastic anemia (SAA) during their therapeutic course. SAA is a hematologic disease characterized by bone marrow failure which if untreated is fatal. Treatment includes either hematopoietic stem cell transplantation (HSCT) or immunosuppressive therapy (IST). In this study, we examined the oral microbiome composition of 24 patients admitted to the National Institutes of Health (NIH) Clinical Center for experimental SAA treatment. Tongue brushings were collected to assess the effects of treatment on the oral microbiome. Twenty patients received standard IST (equine antithymocyte globulin and cyclosporine) plus eltrombopag. Four patients underwent HSCT. Oral specimens were obtained at three time points during treatment and clinical follow-up. Using a novel approach to 16S rRNA gene sequence analysis encompassing seven hypervariable regions, results demonstrated a predictable decrease in microbial diversity over time among the transplant patients. Linear discriminant analysis or LefSe reported a total of 14 statistically significant taxa (p < 0.05) across time points in the HSCT patients. One-way plots of relative abundance for two bacterial species (Haemophilus parainfluenzae and Rothia mucilaginosa) in the HSCT group, show the differences in abundance between time points. Only one bacterial species (Prevotella histicola) was noted in the IST group with a p value of 0.065. The patients receiving immunosuppressive therapy did not exhibit a clear change in diversity over time; however, patient-specific changes were noted. In addition, we compared our findings to tongue dorsum samples from healthy participants in the Human Microbiome Project (HMP) database and found among HSCT patients, approximately 35% of bacterial identifiers (N = 229) were unique to this study population and were not present in tongue dorsum specimens obtained from the HMP. Among IST-treated patients, 45% (N = 351) were unique to these patients and not identified by the HMP. Although antibiotic use may have likely influenced bacterial composition and diversity, some literature suggests a decreased impact of antimicrobials on the oral microbiome as compared to their effect on the gut microbiome. Future studies with larger sample sizes that focus on the oral microbiome and the effects of antibiotics in an immunosuppressed patient population may help establish these potential associations.
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Affiliation(s)
- N J Ames
- Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA.
| | - J J Barb
- Mathematical and Statistical Computing Lab, Center for Information Technology, National Institutes of Health, Bethesda, MD, USA
| | - A Ranucci
- Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA.,Tulane University School of Medicine, New Orleans, LA, USA
| | - H Kim
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - S E Mudra
- Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA.,University of Louisville School of Medicine, Louisville, KY, USA
| | - A K Cashion
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
| | - D M Townsley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - R Childs
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - B J Paster
- Forsyth Institute, Cambridge, MA, USA.,Harvard School of Dental Medicine, Boston, MA, USA
| | - L L Faller
- Forsyth Institute, Cambridge, MA, USA.,Ginkgo Bioworks, Boston, MA, USA
| | - G R Wallen
- Clinical Center Nursing Department, National Institutes of Health, Bethesda, MD, USA
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Ceasar JN, Claudel SE, Andrews MR, Tamura K, Mitchell V, Brooks AT, Dodge T, El-Toukhy S, Farmer N, Middleton K, Sabado-Liwag M, Troncoso M, Wallen GR, Powell-Wiley TM. Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study. JMIR Form Res 2019; 3:e10944. [PMID: 30684422 PMCID: PMC6682281 DOI: 10.2196/10944] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. OBJECTIVE This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. METHODS We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants' experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. RESULTS In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). CONCLUSIONS Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population.
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Affiliation(s)
- Joniqua Nashae Ceasar
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Sophie Elizabeth Claudel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marcus R Andrews
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Kosuke Tamura
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Valerie Mitchell
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alyssa T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Tonya Dodge
- Department of Psychology, George Washington University, Washington, DC, United States
| | - Sherine El-Toukhy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Nicole Farmer
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Kimberly Middleton
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Melanie Sabado-Liwag
- Department of Public Health, California State University, Los Angeles, CA, United States
| | - Melissa Troncoso
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Gwenyth R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Tiffany M Powell-Wiley
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Wallen GR, Park J, Krumlauf M, Brooks AT. Identification of Distinct Latent Classes Related to Sleep, PTSD, Depression, and Anxiety in Individuals Diagnosed With Severe Alcohol Use Disorder. Behav Sleep Med 2019; 17:514-523. [PMID: 29377714 PMCID: PMC6289902 DOI: 10.1080/15402002.2018.1425867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective/Background: Alcohol use disorders (AUDs) are often accompanied by comorbid physiologic and psychosocial conditions, including sleep disturbances. Sleep disturbances in these individuals may be associated with increased risk of relapse to drinking following detoxification and rehabilitation. Participants: The sample of inpatient treatment-seeking individuals with AUDs (N = 164) was 70.1% male and 47.6% African American with a mean age of 45.6 years (±9.5 years). Methods: Latent class analysis (LCA) was used to identify unmeasured class membership based on seven indicators: maximum Clinical Institute Withdrawal Assessment (CIWA) scores; sleep efficiency (actigraphy); sleep disturbances (Pittsburgh Sleep Quality Index-PSQI); anxiety or depression (Comprehensive Psychopathological Rating Scale [CPRS]); and current and lifetime posttraumatic stress disorder (PTSD). Results: The average number of drinking days in the 90 days preceding admission was 72.0 (±22.0 days), with an average of 13.16 drinks per day (±5.70 drinks). Nearly one quarter (24.4%) of respondents reported lifetime PTSD. Three latent classes were identified: Sleep Disturbance (SD); Sleep Disturbance, Anxiety and Depression (SD/AD); and Sleep Disturbance, Anxiety and Depression, and PTSD (SD/AD/PTSD). Members of the SD/AD/PTSD group were more likely to be female and had the highest withdrawal and sleep disturbance scores of all three groups. Conclusion: Findings support the use of LCA to identify subgroups of individuals with AUDs and accompanying sleep disturbances. Class identification may provide clinicians with insight into the integrative tailoring of interventions that meet the varied needs of individuals with AUDs, accompanying comorbidities, and sleep disturbances.
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Affiliation(s)
- Gwenyth R. Wallen
- Corresponding author. National Institutes of Health Clinical Center, 10 Center Drive Room 2B09, MSC-1151, Bethesda, MD 20892, USA. address:
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Brooks AT, Tuason RT, Chakravorty S, Raju S, Ritterband LM, Thorndike FP, Wallen GR. Online cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia among individuals with alcohol use disorder: study protocol for a randomized controlled trial. Pilot Feasibility Stud 2018; 4:183. [PMID: 30555713 PMCID: PMC6287341 DOI: 10.1186/s40814-018-0376-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/25/2018] [Indexed: 12/16/2022] Open
Abstract
Abstract Alcohol use disorder (AUD) is characterized by problematic drinking that becomes severe. Individuals with AUD often experience insomnia and other sleep disturbances at various phases of recovery. Cognitive behavioral therapy for insomnia (CBT-I) is an efficacious non-pharmacological treatment for insomnia and is recommended as a first-line treatment for adults with chronic insomnia. Internet-based CBT-I could play a key role in the dissemination of this behavioral sleep intervention, given the paucity of trained clinicians able to provide CBT-I in person and other logistical/cost concerns. SHUTi (Sleep Healthy Using The Internet) is the most tested and empirically-sound Internet intervention for insomnia. Despite the promise of Internet-based CBT-I interventions, to date, no randomized controlled trials (RCTs) exist examining the feasibility/efficacy of an Internet-based CBT-I program among treatment-seeking individuals recovering from AUD. This is a two-phase RCT assessing feasibility/acceptability and efficacy of the SHUTi program among individuals with AUD in recovery with insomnia. Phase I will focus on assessing the feasibility and acceptability of program delivery and data collection (n = 10). Phase II will be an RCT powered to examine preliminary intervention efficacy (n = 30 per group). Participants for this study must meet criteria for “moderate to severe” insomnia. Individuals randomized to the intervention group will receive the SHUTi intervention (initiated while inpatient and completed while outpatient), and individuals randomized to the control group will receive an educational web-based program. The goals of the study are as follows: (1) assess the feasibility and acceptability of Internet-based CBT-I among individuals with AUD in recovery with insomnia (phase I), (2) compare the preliminary efficacy of CBT-I versus control group with respect to primary and secondary outcome variables (phase II), and (3) explore specific domains associated with improved outcomes, e.g., demographic, psychiatric, and drinking-related factors (phase II). Primary outcome measures include changes in insomnia severity over time and changes in actigraphy-recorded sleep efficiency over time. Trial registration NCT#03493958; registered 1 June 2018. Electronic supplementary material The online version of this article (10.1186/s40814-018-0376-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alyssa T Brooks
- 1National Institutes of Health Clinical Center, Bethesda, USA
| | - Ralph T Tuason
- 1National Institutes of Health Clinical Center, Bethesda, USA
| | - Subhajit Chakravorty
- 2Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Shravya Raju
- 1National Institutes of Health Clinical Center, Bethesda, USA
| | - Lee M Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, PO Box 801075, Charlottesville, VA 22908 USA
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Middleton KR, Haaz Moonaz S, Hasni SA, Magaña López M, Tataw-Ayuketah G, Farmer N, Wallen GR. Yoga for systemic lupus erythematosus (SLE): Clinician experiences and qualitative perspectives from students and yoga instructors living with SLE. Complement Ther Med 2018; 41:111-117. [PMID: 30477826 PMCID: PMC6279250 DOI: 10.1016/j.ctim.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/23/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease associated with widespread inflammation and tissue damage. It is more common and severe among Blacks, Hispanics, and Asians; with higher incidence in women. While the goals of medical treatment are to prevent flares and reduce organ damage, up to 50% of patients perceive their health to be suboptimal with unaddressed needs including fatigue and pain. Recent SLE treatment guidelines focus on improving quality of life. Yoga has shown improvements in quality-of-life and fatigue in various diagnoses. While there is growing evidence that yoga therapy may help osteoarthritis and rheumatoid arthritis symptoms, there is only one reference in the literature related to SLE. METHODS/SETTING An adjunct study was undertaken to evaluate adapting the Yoga as Self Care for Arthritis in Minority Communities study for a bilingual population living with SLE in the Washington, DC area. Informants included 7 patients enrolled onto the study, and 3 yoga instructors living with SLE. Qualitative methods included journals and semi-structured interviews. RESULTS Enrolling patients clarified revisions for intake questionnaires, and symptoms that may impact class participation. Participants demonstrated increased balance, body awareness, and tolerated a faster-paced yoga class when compared to those in the parent study. Yoga instructors' recommendations included modifying yoga based on energy levels and frequent changes in physical ability. CONCLUSION This paper shares perspectives from various informants and affirms the feasibility of progressing to a larger study. It summarizes our findings and recommendations towards creating a randomized controlled trial, as there are currently none in the literature.
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Affiliation(s)
- Kimberly R Middleton
- National Institutes of Health (NIH), Clinical Center, Nursing Research and Translational Science, 10 Center Drive, Room 2B-01, Bethesda, MD 20892, United States.
| | | | - Sarfaraz A Hasni
- National Institute of Arthritis and Musculoskeletal and Skin, Disease (NIAMS), Bethesda, MD 20892, United States.
| | | | | | - Nicole Farmer
- National Institutes of Health (NIH), Clinical Center, Nursing Research and Translational Science, 10 Center Drive, Room 2B-01, Bethesda, MD 20892, United States.
| | - Gwenyth R Wallen
- National Institutes of Health (NIH), Clinical Center, Nursing Research and Translational Science, 10 Center Drive, Room 2B-01, Bethesda, MD 20892, United States.
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Fowler LA, Yingling LR, Brooks AT, Wallen GR, Peters-Lawrence M, McClurkin M, Wiley KL, Mitchell VM, Johnson TD, Curry KE, Johnson AA, Graham AP, Graham LA, Powell-Wiley TM. Digital Food Records in Community-Based Interventions: Mixed-Methods Pilot Study. JMIR Mhealth Uhealth 2018; 6:e160. [PMID: 30021705 PMCID: PMC6068385 DOI: 10.2196/mhealth.9729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/11/2018] [Accepted: 05/29/2018] [Indexed: 01/18/2023] Open
Abstract
Background A pressing need exists to understand and optimize the use of dietary assessment tools that can be used in community-based participatory research (CBPR) interventions. A digital food record, which uses a mobile device to capture the dietary intake through text and photography inputs, is a particularly promising mobile assessment method. However, little is understood about the acceptability and feasibility of digital food records in CBPR and how to best tailor dietary assessment tools to the needs of a community. Objective The objective of our study was to evaluate the acceptability and feasibility of digital food records among church-based populations in resource-limited wards of Washington, DC, USA, using a mixed-methods approach. Methods This community-based pilot study was conducted as part of the Washington, DC Cardiovascular Health and Needs Assessment. Participants (n=17) received a mobile device (iPod Touch) to photodocument their dietary intake for a 3-day digital food record using a mobile app, FitNinja (Vibrent Health). The acceptability of the digital food record was explored through the thematic analysis of verbatim transcripts from a moderated focus group (n=8). In addition, the feasibility was evaluated by the percentage of participants complying with instructions (ie, capturing both before and after meal photos for at least 2 meals/day for 3 days). Results Qualitative themes identified were related to (1) the feasibility and acceptability of the mobile device and app, including issues in recording the dietary information and difficulty with photodocumentation; (2) suggestions for additional support and training experiences; and (3) comparisons with other mobile apps. Overall, the participants accepted the digital food record by demonstrating satisfaction with the tool and intent to continue the use (eg, participants recorded an average of 5.2, SD 7, consecutive days). Furthermore, of the 17 participants, 15 photodocumented at least 1 meal during the study period and 3 fully complied with the digital food record instructions. Conclusions This study demonstrated digital food records as an acceptable tool in CBPR and identified contributors and barriers to the feasibility of digital food records for future research. Engaging community members in the implementation of novel assessment methods allows for the tailoring of technology to the needs of the community and optimizing community-based interventions. Trial Registration ClinicalTrials.gov NCT01927783; https://www.clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/70WzaFWb6)
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Affiliation(s)
- Lauren A Fowler
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States.,Columbian College of Arts and Sciences, George Washington University, Washington, DC, United States
| | - Leah R Yingling
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alyssa T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Gwenyth R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Marlene Peters-Lawrence
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Michael McClurkin
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Kenneth L Wiley
- Division of Genomic Sciences, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Valerie M Mitchell
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Twanda D Johnson
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | | | - Allan A Johnson
- College of Nursing and Allied Sciences, Howard University, Washington, DC, United States
| | - Avis P Graham
- College of Nursing and Allied Sciences, Howard University, Washington, DC, United States
| | - Lennox A Graham
- College of Nursing and Allied Sciences, Howard University, Washington, DC, United States
| | - Tiffany M Powell-Wiley
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Gartrell K, Brennan CW, Wallen GR, Liu F, Smith KG, Fontelo P. Clinicians' perceptions of usefulness of the PubMed4Hh mobile device application for clinical decision making at the point of care: a pilot study. BMC Med Inform Decis Mak 2018; 18:27. [PMID: 29739392 PMCID: PMC5941474 DOI: 10.1186/s12911-018-0607-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although evidence-based practice in healthcare has been facilitated by Internet access through wireless mobile devices, research on the effectiveness of clinical decision support for clinicians at the point of care is lacking. This study examined how evidence as abstracts and the bottom-line summaries, accessed with PubMed4Hh mobile devices, affected clinicians' decision making at the point of care. METHODS Three iterative steps were taken to evaluate the usefulness of PubMed4Hh tools at the NIH Clinical Center. First, feasibility testing was conducted using data collected from a librarian. Next, usability testing was carried out by a postdoctoral research fellow shadowing clinicians during rounds for one month in the inpatient setting. Then, a pilot study was conducted from February, 2016 to January, 2017, with clinicians using a mobile version of PubMed4Hh. Invitations were sent via e-mail lists to clinicians (physicians, physician assistants and nurse practitioners) along with periodic reminders. Participants rated the usefulness of retrieved bottom-line summaries and abstracts and indicated their usefulness on a 7-point Likert scale. They also indicated location of use (office, rounds, etc.). RESULTS Of the 166 responses collected in the feasibility phase, more than half of questions (57%, n = 94) were answerable by both the librarian using various resources and by the postdoctoral research fellow using PubMed4Hh. Sixty-six questions were collected during usability testing. More than half of questions (60.6%) were related to information about medication or treatment, while 21% were questions regarding diagnosis, and 12% were specific to disease entities. During the pilot study, participants reviewed 34 abstracts and 40 bottom-line summaries. The abstracts' usefulness mean scores were higher (95% CI [6.12, 6.64) than the scores of the bottom-line summaries (95% CI [5.25, 6.10]). The most frequent reason given was that it confirmed current or tentative diagnostic or treatment plan. The bottom-line summaries were used more in the office (79.3%), and abstracts were used more at point of care (51.9%). CONCLUSIONS Clinicians reported that retrieving relevant health information from biomedical literature using the PubMed4Hh was useful at the point of care and in the office.
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Affiliation(s)
- Kyungsook Gartrell
- Department of Nursing, Towson University, Linthicum Hall Room 201J, 8000 York Road, Towson, MD 21252 USA
| | - Caitlin W. Brennan
- National Institutes of Health Clinical Center Nursing Department, 10 Center Drive, Bldg. 10/6-3523, Bethesda, MD 20892-1151 USA
| | - Gwenyth R. Wallen
- National Institutes of Health Clinical Center Nursing Department, 10 Center Drive, 6-1484, Bethesda, MD 20892 USA
| | - Fang Liu
- National Library of Medicine, Lister Hill National Center for Biomedical Communications, B1N30N, 38A, 8600 Rockville Pike, Bethesda, MD 20894 USA
| | - Karen G. Smith
- National Institutes of Health/Library, 10 Center Drive, Bethesda, MD 20892 USA
| | - Paul Fontelo
- National Library of Medicine, Lister Hill National Center for Biomedical Communications, B1N30L, 38A, 8600 Rockville Pike, Bethesda, MD 20894 USA
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Ulrich CM, Zhou QP, Ratcliffe SJ, Knafl K, Wallen GR, Richmond TS, Grady C. Development and Preliminary Testing of the Perceived Benefit and Burden Scales for Cancer Clinical Trial Participation. J Empir Res Hum Res Ethics 2018; 13:230-238. [PMID: 29631487 DOI: 10.1177/1556264618764730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We developed measures of benefits and burdens of research participation in cancer clinical trials using a sequential mixed methods design with a qualitative ( n = 32) and quantitative sample ( n = 110) of cancer clinical trial participants. Benefit-burden items (22 for benefits, 23 for burdens) were subsequently developed and assessed through cognitive interviewing for content, clarity, and meaning. Preliminary psychometric analyses support the internal consistency reliability and construct validity of Benefit (α = .90) and Burden (α = .87) research participation scales. Item response theory models supported the discrimination ability of the items on the scales. Participants who had thoughts of dropping out had lower Benefit scale scores ( p < .001) and higher Burden scores ( p < .001) than those who had no thoughts of dropping out, supporting construct validity. With further psychometric testing, the scale can be used to develop appropriate interventions to address recruitment and retention of human participants in clinical research.
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Brooks AT, Krumlauf M, Beck KH, Fryer CS, Yang L, Ramchandani VA, Wallen GR. A Mixed Methods Examination of Sleep Throughout the Alcohol Recovery Process Grounded in the Social Cognitive Theory: The Role of Self-Efficacy and Craving. Health Educ Behav 2018; 46:126-136. [DOI: 10.1177/1090198118757820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sleep disturbances can accompany alcohol use disorders during various phases of the disease. This analysis utilized a mixed methods approach to assess whether sleep-related beliefs and/or behavior of individuals who are alcohol dependent were associated with sleep quality both pre- and postdischarge from a clinical research facility providing inpatient alcohol rehabilitation treatment. Individuals with higher self-efficacy for sleep (SE-S) reported better sleep quality at both time points. Individuals with fewer dysfunctional beliefs about sleep had poorer sleep quality at both time points. Individuals with higher unhealthy sleep-related safety behaviors had poorer sleep quality at both time points. In a linear regression model, only the difference in SE-S scores from pre- to postdischarge (β = −.396, p = .01) and the postdischarge Penn Alcohol Craving Score (β = .283, p = .019) significantly predicted the change in sleep quality. Thus, those whose SE-S scores increased and those with lower postdischarge craving scores were more likely to experience a decrease on Pittsburgh Sleep Quality Index scores from pre- to postdischarge even after controlling for covariates. References to behavior or personal factors were often discussed during the qualitative interviews in tandem with the environment. Participants reported both (1) self-medicating anxiety with alcohol and (2) self-medicating the inability to fall asleep with alcohol. Given the success of behavioral sleep interventions in various populations and the unique potential contributions of mixed methods approaches to examine sleep and alcohol use, assessing sleep-related cognitions and behaviors of individuals with severe alcohol use disorders may be important in understanding sleep quality and subsequent relapse.
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Affiliation(s)
- Alyssa T. Brooks
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kenneth H. Beck
- University of Maryland School of Public Health, College Park, MD, USA
| | - Craig S. Fryer
- University of Maryland School of Public Health, College Park, MD, USA
| | - Li Yang
- National Institutes of Health Clinical Center, Bethesda, MD, USA
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Middleton KR, Ward MM, Haaz Moonaz S, Magaña López M, Tataw-Ayuketah G, Yang L, Acevedo AT, Brandon Z, Wallen GR. Feasibility and assessment of outcome measures for yoga as self-care for minorities with arthritis: a pilot study. Pilot Feasibility Stud 2018; 4:53. [PMID: 29484197 PMCID: PMC5819213 DOI: 10.1186/s40814-018-0248-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 02/02/2018] [Indexed: 11/30/2022] Open
Abstract
Background While there is a growing interest in the therapeutic benefits of yoga, minority populations with arthritis tend to be under-represented in the research. Additionally, there is an absence of guidance in the literature regarding the use of multicultural teams and sociocultural health beliefs, when designing yoga studies for a racially diverse population with arthritis. This pilot study examined the feasibility of offering yoga as a self-care modality to an urban, bilingual, minority population with osteoarthritis (OA) or rheumatoid arthritis (RA), in the Washington, DC area. Methods The primary objective of the study was to assess the feasibility of offering an 8-week, bilingual yoga intervention adapted for arthritis to a convenience sample of primarily Hispanic and Black/African-American adults. A racially diverse interdisciplinary research team was assembled to design a study to facilitate recruitment and retention. The second objective identified outcome measures to operationalize potential facilitators and barriers to self-care and self-efficacy. The third objective determined the feasibility of using computer-assisted self-interview (CASI) for data collection. Results Enrolled participants (n = 30) were mostly female (93%), Spanish speaking (69%), and diagnosed with RA (88.5%). Feasibility was evaluated using practicality, acceptability, adaptation, and expansion of an arthritis-adapted yoga intervention, modified for this population. Recruitment (51%) and participation (60%) rates were similar to previous research and clinical experience with the study population. Of those enrolled, 18 started the intervention. For adherence, 12 out of 18 (67%) participants completed the intervention. All (100%), who completed the intervention, continued to practice yoga 3 months after completing the study. Using nonparametric tests, selected outcome measures showed a measurable change post-intervention suggesting appropriate use in future studies. An in-person computerized questionnaire was determined to be a feasible method of data collection. Conclusions Findings from this pilot study confirm the feasibility of offering yoga to this racially/ethnically diverse population with arthritis. This article provides recruitment/retention rates, outcome measures with error rates, and data collection recommendations for a previously under-represented population. Suggestions include allocating resources for translation and using a multicultural design to facilitate recruitment and retention. Trial registration ClinicalTrials.gov, NCT01617421
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Affiliation(s)
- Kimberly R Middleton
- 1National Institutes of Health, Clinical Center, 10 Center Drive, Room 2B01, Bethesda, MD 20892 USA
| | - Michael M Ward
- 2National Institute of Arthritis and Musculoskeletal and Skin Diseases, 10 Center Drive, Bethesda, MD 20892 USA
| | | | - Miriam Magaña López
- 4University of California Berkeley School of Public Health, Berkeley, CA 94720 USA
| | - Gladys Tataw-Ayuketah
- 1National Institutes of Health, Clinical Center, 10 Center Drive, Room 2B01, Bethesda, MD 20892 USA
| | - Li Yang
- 1National Institutes of Health, Clinical Center, 10 Center Drive, Room 2B01, Bethesda, MD 20892 USA
| | - Ana T Acevedo
- 5NIH/Rehabilitation Medicine Department, Bethesda, MD USA
| | - Zavera Brandon
- 5NIH/Rehabilitation Medicine Department, Bethesda, MD USA
| | - Gwenyth R Wallen
- 1National Institutes of Health, Clinical Center, 10 Center Drive, Room 2B01, Bethesda, MD 20892 USA
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Leaver CA, Yuan H, Wallen GR. Apoptotic Activities of Sanguinaria canadensis: Primary Human Keratinocytes, C-33A, and Human Papillomavirus HeLa Cervical Cancer Lines. Integr Med (Encinitas) 2018; 17:32-37. [PMID: 30962774 PMCID: PMC6380990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Sanguinarine is a benzophenanthridine alkaloid derived from the root of Sanguinaria canadensis. Multiple published, preclinical studies have demonstrated that sanguinarine causes apoptosis in human cancer cells. An expert panel of naturopathic doctors identified sanguinarine as a component for consideration in cervical atypia management protocols. Clinical studies have identified positive outcomes when Sanguinaria is a constituent of escharotic treatment in cervical atypia management protocols. Therefore, further investigation and development of sanguinarine as a potential cancer treatment is recommended. Thus, the aim of this study is to further elucidate the signaling pathways of sanguinarine-induced cell death. METHODS Cell cultures of cervical cancer line C-33A (human papillomavirus [HPV] negative), HeLa (HPV positive), and normal primary human keratinocytes were established. Microscopic plate inspection, cell viability, initiator and effector caspase assays were completed in triplicate on C-33A (HPV negative), HeLa (HPV positive), and normal primary human keratinocytes cells exposed to incremental doses of sanguinarine. RESULTS Sanguinarine induced dose-dependent cell death in cervical cancer lines as well as in normal human keratinocytes. Microscopic plate inspection confirmed morphologic changes of cell death in normal keratinocytes, C-33A, and HeLa including cell shrinkage, round up, and detachment from plate surface. Caspase assays demonstrated that sanguinarine treatment of C-33A cells resulted in an induction of caspase-3/7 when compared with vehicle-treated controls. CONCLUSIONS Sanguinarine demonstrates potential as an agent with therapeutic impact because of the capacity to eliminate cancerous cells through apoptosis, the process of programed cell death. Further elucidation of signaling pathways of sanguinarine-induced cell death is necessary when considering sanguinarine as a treatment for cervical cancer.
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Affiliation(s)
- Cynthia Ann Leaver
- Corresponding author: Cynthia Ann Leaver, PhD, APRN, FNP-BC E-mail address:
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Brooks AT, Magaña Lòpez M, Ranucci A, Krumlauf M, Wallen GR. A Qualitative Exploration of Social Support during Treatment for Severe Alcohol Use Disorder and Recovery. Addict Behav Rep 2017; 6:76-82. [PMID: 29430516 PMCID: PMC5800591 DOI: 10.1016/j.abrep.2017.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Severe alcohol use disorder (AUD) affects multiple aspects of an individual's life as well as their loved ones' lives. Perceived social support has the potential to help or hinder recovery efforts. Methods In this analysis we seek to understand the changes of social networks among individuals with severe AUD (n = 33) throughout their recovery process and the potential relationship between the quality and nature of those networks and sustained sobriety as they transition from an inpatient research facility providing rehabilitation treatment back to the community. Interviews were conducted in 2014 and 2015. We conducted in-depth thematic analysis of themes related to social support using an exploratory approach. Results The most common types of social support mentioned in both inpatient and outpatient settings were instrumental and emotional. Participants most frequently mentioned Alcoholics Anonymous (AA), an abstinence-based support system, as a source of support and often used the inpatient program as an exemplar when describing their ideal social networks. Conclusion These data provide insight into the complexity of the issues and barriers that individuals in recovery may be facing across “transition periods.” From an intervention standpoint, it may be beneficial to focus on helping people choose environments and their accompanying social contexts and networks that are most conducive to recovery. Further elucidating the concept of social support and its role in recovery could provide information on unique needs of individuals and guide clinicians in engaging patients to develop new or sustain healthy existing social networks that result in continued sobriety. Individuals with AUD cited varying types/sources of social support in recovery. Participants outlined social network-related barriers to sustained sobriety. Understanding social support/networks provides insight into the recovery process.
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Yingling LR, Mitchell V, Ayers CR, Peters-Lawrence M, Wallen GR, Brooks AT, Troendle JF, Adu-Brimpong J, Thomas S, Henry J, Saygbe JN, Sampson DM, Johnson AA, Graham AP, Graham LA, Wiley KL, Powell-Wiley T. Adherence with physical activity monitoring wearable devices in a community-based population: observations from the Washington, D.C., Cardiovascular Health and Needs Assessment. Transl Behav Med 2017; 7:719-730. [PMID: 28097627 PMCID: PMC5684058 DOI: 10.1007/s13142-016-0454-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Wearable mobile health (mHealth) technologies offer approaches for targeting physical activity (PA) in resource-limited, community-based interventions. We sought to explore user characteristics of PA tracking, wearable technology among a community-based population within a health and needs assessment. In 2014-2015, we conducted the Washington, D.C., Cardiovascular Health and Needs Assessment in predominantly African-American churches among communities with higher obesity rates and lower household incomes. Participants received a mHealth PA monitor and wirelessly uploaded PA data weekly to church data collection hubs. Participants (n = 99) were 59 ± 12 years, 79% female, and 99% African-American, with a mean body mass index of 33 ± 7 kg/m2. Eighty-one percent of participants uploaded PA data to the hub and were termed "PA device users." Though PA device users were more likely to report lower household incomes, no differences existed between device users and non-users for device ownership or technology fluency. Findings suggest that mHealth systems with a wearable device and data collection hub may feasibly target PA in resource-limited communities.
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Grants
- HHSN268201400023C NHGRI NIH HHS
- ZIA HL006168 Intramural NIH HHS
- ZIA HL006168 Intramural NIH HHS
- ZIA HL006168 Intramural NIH HHS
- Division of Intramural Research, National Heart, Lung, and Blood Insitute, USA
- Division of Intramural Research, National Heart, Lung, and Blood Institute, USA
- Office of Intramural Training and Education, National Institutes of Health, USA
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Affiliation(s)
- Leah R Yingling
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Valerie Mitchell
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Colby R Ayers
- Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marlene Peters-Lawrence
- Office of the Clinical Director, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gwenyth R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Alyssa T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - James F Troendle
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Adu-Brimpong
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Samantha Thomas
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - JaWanna Henry
- Office of the National Coordinator for Health Information Technology, Washington, DC, USA
| | - Johnetta N Saygbe
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA
| | - Dana M Sampson
- Office of Minority Health, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Allan A Johnson
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Avis P Graham
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Lennox A Graham
- College of Nursing and Allied Health Sciences, Howard University, Washington, DC, USA
| | - Kenneth L Wiley
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany Powell-Wiley
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Suite 5-3330, Bethesda, MD, 20892, USA.
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