Disparities of care among stroke survivors are well documented. Effective interventions to improve recurrent stroke preventative care in vulnerable populations are lacking.
In a randomized controlled ...trial, we tested the efficacy of components of a chronic care model-based intervention versus usual care among 404 subjects having an ischemic stroke or transient ischemic attack within 90 days of enrollment and receiving care within the Los Angeles public healthcare system. Subjects had baseline systolic blood pressure (SBP) ≥120 mm Hg. The intervention included a nurse practitioner/physician assistant care manager, group clinics, self-management support, report cards, decision support, and ongoing care coordination. Outcomes were collected at 3, 8, and 12 months, analyzed as intention-to-treat, and used repeated-measures mixed-effects models. Change in SBP was the primary outcome. Low-density lipoprotein reduction, antithrombotic medication use, smoking cessation, and physical activity were secondary outcomes. Average age was 57 years; 18% were of black race; 69% were of Hispanic ethnicity. Mean baseline SBP was 150 mm Hg in both arms. SBP decreased to 17 mm Hg in the intervention arm and 14 mm Hg in the usual care arm; the between-arm difference was not significant (-3.6 mm Hg; 95% confidence interval, -9.2 to 2.2). Among secondary outcomes, the only significant difference was that persons in the intervention arm were more likely to lower their low-density lipoprotein <100 md/dL (2.0 odds ratio; 95% confidence interval, 1.1-3.5).
This intervention did not improve SBP control beyond that attained in usual care among vulnerable stroke survivors. A community-centered component could strengthen the intervention impact.
URL: https://clinicaltrials.gov. Unique identifier: NCT00861081.
The current study reports the results of a study examining the relationship between classroom climate and the development of the student-teacher relationship for young children at-risk. Participants ...were 267 children and 93 early educators. All children were from low income backgrounds and were experiencing developmental concerns in the area of language, cognition or social-emotional development. Teacher surveys were administered twice during the academic year (fall and spring) during a child’s first preschool year, and observations of classroom climate were conducted in the spring of the same year. Findings indicated that classroom emotional support predicted the development of the student-teacher relationship, such that children in classrooms characterized by higher levels of emotional support experienced greater improvement in the overall relationship and closeness in the relationship, and greater decreases in conflict in the relationship relative to peers in less emotionally supportive classrooms. Classroom organization and instructional support were not found to predict changes in the student-teacher relationship. Implications for research and practice are discussed.
Abstract Purpose Although sexual risk behavior has negative consequences in adolescence and early adulthood, little is known about pathways of sexual risk across development and their correlates. ...Study goals were to examine trajectories of number of sexual partners across adolescence and into early adulthood, and to investigate hypothesized individual and family-level predictors. Methods A subset of 8,707 white, black, and Mexican American participants in the National Longitudinal Study of Adolescent Health reported on their motivations to have sex, family warmth, and perceptions of maternal attitudes about sex at Wave 1 and on their sexual relationships at each year of age across the three waves of the study. Results Multilevel growth curves of number of sexual partners between ages 11 and 27 showed increases in sexual risk across adolescence and deceleration in early adulthood, but differed somewhat as a function of demographic characteristics. As expected, adolescent motivations to have sex and perceptions of permissive maternal attitudes about sex predicted more sexual partners in adolescence, whereas family warmth predicted fewer sexual partners across gender and racial/ethnic groups. Predictors did not differentiate youth as strongly in early adulthood. Interactions between predictors supported a cumulative risk framework, such that perceived permissive maternal attitudes or low family warmth combined with high adolescent motivations to have sex predicted the highest number of sexual partners in adolescence. Conclusions This study advances our understanding of change in sexual behavior across development and the individual and contextual correlates of such change. Findings document the cumulative implications of individual cognitions, family experiences, and social contexts for adolescent and young adult sexual experiences.
Genetic variants in bitter-taste receptor genes have been hypothesized to negatively impact health outcomes and/or influence dietary intake and, consequently, could increase the risk of colorectal ...neoplasia. Using a case-control study of 914 colorectal adenoma cases/1188 controls, we explored associations among colorectal adenoma risk, dietary intake, and genetic variation in 3 bitter-taste receptor genes: TAS2R38 (rs713598, rs1726866, rs10246939), TAS2R16 (rs846672), and TAS2R50 (rs1376251). Analysis of covariance was conducted to detect trends in dietary intake across TAS2R genotypes/haplotypes. Odds ratios and 95% confidence intervals were estimated by logistic regression to test gene-adenoma risk associations. No significant associations were observed between the TAS2R38 PAV/PAV diplotype or the TAS2R16 (rs846672) polymorphism with the selected diet variables. We observed weak inverse associations between the TAS2R50 (rs1376251) C allele and dietary fiber and vegetable intake (P s < 0.015). Odds ratios for adenoma risk were not significantly different from the null. Our findings do not support a link between these TAS2R genotypes/haplotypes and dietary intake that could impact colorectal adenoma risk. However, given the paucity of data, we cannot dismiss the possibility that these genes may influence colorectal adenoma risk in other ways, such as through impaired gastrointestinal function, particularly in subgroups of the population.
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Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The diet quality of US adults is poor and cross-sectional analyses suggest self-perception of healthful dietary intake may be overestimated. This analysis assessed the concordance between calculated ...and perceived diet quality and changes in diet quality among adults seeking weight loss and enrolled in a 12-month randomized behavioral trial. Healthy Eating Index-2015 diet quality (HEI) was calculated from self-administered 24-hour recalls. Perceived diet quality (PDQ) was measured on a 100-point scale. Higher scores indicate better diet quality. Concordance was assessed using the concordance correlation coefficient and Bland-Altman plots. The one hundred and five participants with complete dietary data were mostly female and white. There was good agreement between HEI and PDQ scores at 12 months for less than a third of participants. Most of the disagreement arose from PDQ scores being higher than HEI scores. Even fewer participants had good agreement between HEI changes and PDQ changes. Participants perceived greater improvement in diet quality than indicated by HEI score changes. Concordance was low at 12 months and for change in diet quality. Despite the diet quality of adults seeking weight loss being suboptimal and not improving, many perceived their diet quality and diet quality improvements as better than calculated. Future studies might explore the effect of misperceptions on weight loss outcomes.
This analysis examined whether a community-based intervention produced measurable improvements in dietary habits. MOVE UP combined translational, evidence-based weight management and healthy aging ...interventions using a non-randomized design. This 13-month intervention included 32 group sessions, explicit calorie and physical activity goals, self-monitoring, and nutrition education. Participants were (N = 297) older adults (mean = 68.0 years) with overweight and obesity. Diet was measured using Rate Your Plate (RYP)-Heart. Changes in scores from baseline to 5, 9, and 13 months were assessed using mixed models. MOVE UP successfully shifted eating patterns from baseline (mean = 50.9) to 5 months (mean = 55.1) (p < .0001) adjusted for age, sex, and race. Improvements persisted through 9 (mean = 54.7) and 13 months (mean = 55.0) (p < .0001). Although participants were not prescribed a specific diet, RYP-Heart indicated positive dietary shifts. Community-implemented behavioral weight loss interventions may assess the modifiability of dietary habits with a simple, easy-to-administer tool.
Background: Behavioral interventions targeting weight loss may be affected by socio-environmental factors that influence physical activity (PA) and cardiometabolic outcomes.
Purpose: To evaluate the ...relation of neighborhood walkability on PA levels and glucose control in a sample of adults participating in a weight loss study.
Methods: Secondary analysis of a prospective observational study providing a 12-month behavioral weight loss intervention to examine lapses after intentional weight loss. Neighborhood walkability was assessed via Walk Score (0-100), PA via waist-worn ActiGraph GT3X, and blood glucose via phlebotomy. Study variables included car-dependent and walkable neighborhoods (Walk Score < vs. ≥50), prediabetes (fasting blood glucose from 100-126mg/dL) and recommended PA (moderate-to-vigorous PA MVPA >22 minutes/day; steps ≥7500/day). Standard descriptive and group comparative statistics were employed. Regression results are reported as adjusted odds ratios (OR) with 95% confidence intervals (CI).
Results: The sample (N=112) was mostly female (90.2%), white (90.2%), well educated (75.9% with ≥4 years of college) and on average 51.5±9.8 years of age. At baseline, no differences existed between persons from car-dependent vs. walkable neighborhoods across all metrics. At 12 months, PA and glucose control were improved for the entire sample, with no differences across walkability categories. Neighborhood walkability did not predict attainment of recommended MVPA (OR=1.16, 95% CI: 0.97-1.39) or steps (OR=1.08, 95% CI: 0.90-1.30) at 12 months. However, those from walkable neighborhoods had 17% lower odds of having prediabetes compared to those from car-dependent neighborhoods (OR=0.83, 95% CI: 0.72-0.97).
Conclusion: Our findings corroborate previous studies showing an inverse relation between neighborhood walkability and prediabetes. The key drivers of this association warrant further investigation in a study with a larger, more diverse sample.
Disclosure
J. K. Kariuki: None. J. Cheng: None. L. E. Burke: None. Z. Bizhanova: None. B. Rockette-wagner: None. B. B. Gibbs: None. S. M. Sereika: None. C. Kline: None. K. Erickson: None. D. Mendez: None. I. Pulantara: None.
Funding
National Heart, Lung, and Blood Institute (HL107370S to J.K.K.)
It is estimated that short association fibers running immediately beneath the cortex may make up as much as 60 % of the total white matter volume. However, these have been understudied relative to ...the long-range association, projection, and commissural fibers of the brain. This is largely because of limitations of diffusion MRI fiber tractography, which is the primary methodology used to non-invasively study the white matter connections. Inspired by recent anatomical considerations and methodological improvements in superficial white matter (SWM) tractography, we aim to characterize changes in these fiber systems in cognitively normal aging, which provide insight into the biological foundation of age-related cognitive changes, and a better understanding of how age-related pathology differs from healthy aging. To do this, we used three large, longitudinal and cross-sectional datasets (N = 1293 subjects, 2711 sessions) to quantify microstructural features and length/volume features of several SWM systems. We find that axial, radial, and mean diffusivities show positive associations with age, while fractional anisotropy has negative associations with age in SWM throughout the entire brain. These associations were most pronounced in the frontal, temporal, and temporoparietal regions. Moreover, measures of SWM volume and length decrease with age in a heterogenous manner across the brain, with different rates of change in inter-gyri and intra-gyri SWM, and at slower rates than well-studied long-range white matter pathways. These features, and their variations with age, provide the background for characterizing normal aging, and, in combination with larger association pathways and gray matter microstructural features, may provide insight into fundamental mechanisms associated with aging and cognition.
Background
Socio-environmental factors may affect uptake and utility of behavioral interventions targeting weight loss and cardiometabolic health. To evaluate the relation of neighborhood walkability ...to physical activity (PA) and glucose control in a sample of adults with overweight/obesity participating in a weight loss study.
Methods
Secondary analysis of a 12-month behavioral weight loss intervention (2011–2015) using one-group pretest–posttest design. Neighborhood walkability was assessed via residential Walk Score (0–100) at study entry. Fasting plasma glucose (FPG) via phlebotomy and PA via waist-worn ActiGraph GT3X were assessed at baseline and end of study. Study variables included neighborhood walkability (car-dependent: Walk Score < 50 vs. walkable: Walk Score ≥ 50), prediabetes (FPG 100–125 mg/dL), and recommended PA (moderate to vigorous PA MVPA > 22 min/day). Generalized linear model with logit link results were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI).
Results
The sample (
N
= 114) was mostly female (88.6%), white (83.3%), college educated (73.7%), and on average 51.4 ± 1.0 years of age. At baseline, persons residing in car-dependent neighborhoods tended to have higher income than those in walkable neighborhoods. Neighborhood walkability interacted with household income at study entry to predict participants’ ability to meet the MVPA goal at 12 months (AOR = 13.52, 95% CI: 1.86–119.20). Those from walkable neighborhoods had 67% lower odds of having prediabetes compared to those from car-dependent neighborhoods (AOR = 0.33, 95% CI: 0.10–0.87) at 12 months.
Conclusion
Our findings corroborate previous research characterizing the relationship between neighborhood walkability, PA, and prediabetes status. Key drivers of this impact warrant further investigation in a study with a larger, more diverse sample.
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