Abstract only
Dramatically increasing rates of type 2 diabetes (T2D) underscore the need for successful long‐term approaches that halt progression of pre‐diabetes to T2D. We examined body mass (BM) ...and diet changes in subjects (mean age= 60.1 ± 7.4 y; 55% female) with pre‐diabetes (fasting blood glucose 95–124 mg/dL on 2 occasions) participating in a 6‐mo. (6WL; N=29) or a 12‐mo. (12WL; N=28) weight loss (WL) intervention. 6WL included 150 min/wk supervised moderate aerobic exercise plus a WL program. 12WL was 6 mo. supervised exercise only, followed by 6 mo. WL intervention plus (unsupervised) exercise. BM was assessed at baseline (B) and at end of treatment (ET). Diet intakes (24‐hr recall, 3‐d record) collected at B and ET were analyzed for calories (kcal) and macronutrients. Between B and ET, BM was reduced (p<0.001) in both groups: −6.2 ± 7.7 kg (−6.7%) and −6.8 ± 5.4 kg (− 7.7 %) in 6WL and 12WL, respectively. Likewise, kcal intakes were reduced (p<0.0001): −462 ± 463 and −428 ± 459 kcal in 6WL and 12WL. Both groups increased %kcal protein (+2.1 ± 3.3 and +1.9 ± 3.8) and decreased %kcal fat (−4.7 ± 7.0 and −3.4 ± 6.3), kcal from saturated fat (−97 ± 98 and −76 ± 91) and total cholesterol (mg) (−82 ± 107 and −56 ± 135) intakes. Thus, subjects on an intensive diet and exercise intervention for 12 mo. were able to sustain both their WL and a number of other healthy dietary changes.
Supported by NIDDK R01‐
DK081559
and NIA AG000029.
RationaleBronchiectasis is common among those with heavy smoking histories, but risk factors for bronchiectasis, including alpha-1 antitrypsin deficiency, and its implications for COPD severity are ...uncharacterized in such individuals.ObjectivesTo characterize the impact of bronchiectasis on COPD and explore alpha-1antitrypsin as a risk factor for bronchiectasis.MethodsSubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) participants (N=914; ages 40-80 years; ≥20-pack-year smoking) had high-resolution computed tomography (CT) scans interpreted visually for bronchiectasis, based on airway dilation without fibrosis or cicatrization. We performed regression-based models of bronchiectasis with clinical outcomes and quantitative CT measures. We deeply sequenced the gene encoding -alpha-1 antitrypsin, SERPINA1, in 835 participants to test for rare variants, focusing on the PiZ genotype (Glu366Lys, rs28929474).Measurements and Main ResultsWe identified bronchiectasis in 365 (40%) participants, more frequently in women (45% versus 36%, p=0.0045), older participants (mean age=66standard deviation (SD)=8.3 versus 64SD=9.1 years, p=0.0083), and those with lower lung function (forced expiratory volume in 1 second FEV1 percentage predicted=66%SD=27 versus 77%SD=25, p<0.0001; FEV1 to forced vital capacity FVC ratio=0.540.17 versus 0.63SD=0.16, p<0.0001). Participants with bronchiectasis had greater emphysema (%voxels ≤-950 Hounsfield units, 11%SD=12 versus 6.3%SD=9, p<0.0001) and parametric response mapping functional small airways disease (26SD=15 versus 19SD=15, p<0.0001). Bronchiectasis was more frequent in the combined PiZZ and PiMZ genotype groups compared to those without PiZ, PiS, or other rare pathogenic variants (N=21 of 40 52% versus N=283 of 70740%, odds ratio OR=1.97; 95% confidence interval CI=1.002, 3.90, p=0.049), an association attributed to White individuals (OR=1.98; 95%CI = 0.9956, 3.9; p=0.051).ConclusionsBronchiectasis was common in those with heavy smoking histories and was associated with detrimental clinical and radiographic outcomes. Our findings support alpha-1antitrypsin guideline recommendations to screen for alpha-1 antitrypsin deficiency in an appropriate bronchiectasis subgroup with a significant smoking history.
Individuals with chronic obstructive pulmonary disease (COPD) have a high prevalence of depression, which is associated with increased COPD hospitalizations and readmissions.
Examine the impact of ...depressive symptoms compared with FEV
% on COPD morbidity.
Using longitudinal data from individuals with COPD in the Subpopulations and Intermediate Outcome Measures in COPD Study, longitudinal growth analysis was performed to assess COPD morbidity by assessing differences in baseline 6-minute walk distance and patient reported outcomes (PROs) and their rate of change over time explained by depressive symptoms or lung function, as measured by Hospital Anxiety and Depression Scale or FEV
% respectively. PROs consisted of in-person completion of St. George's Respiratory Questionnaire, COPD Assessment Test, Functional Assessment of Chronic Illness Therapy Fatigue, and Modified Medical Research Council Dyspnea Scale measures.
Of the individuals analyzed (
= 1,830), 43% were female, 81% Caucasian with mean ± SD age of 65.1 ± 8.1, and 52.7 ± 27.5 pack-years smoking. Mean ± SD FEV
% was 60.9 ± 23.0% and 20% had clinically significant depressive symptoms. Adjusted models showed higher Hospital Anxiety and Depression Scale scores and lower FEV
% each were associated with worse PROs at baseline (
⩽ 0.001). Depression accounted for more baseline variance in St. George's Respiratory Questionnaire, COPD Assessment Test, and Functional Assessment of Chronic Illness Therapy Fatigue than FEV
%, explaining 30-67% of heterogeneity. FEV
% accounted for more baseline variance in Modified Medical Research Council Dyspnea Scale and 6-minute walk distance than depression, explaining 16-32% of heterogeneity. Depressive symptoms accounted for 3-17% variance in change over time in PROs. In contrast, FEV
% accounted for 1-4% variance over time in PROs.
Depression is more strongly associated with many PROs at baseline and their change over time compared with FEV
%. Recognizing and incorporating the impact of depressive symptoms into individualized care may improve COPD outcomes.
It has been suggested that patients with chronic obstructive pulmonary disease (COPD) experience considerable daily respiratory symptom fluctuation. A standardized measure is needed to quantify and ...understand the implications of day-to-day symptom variability.
To compare standard deviation with other statistical measures of symptom variability and identify characteristics of individuals with higher symptom variability.
Individuals in the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Exacerbations sub-study completed an Evaluating Respiratory Symptoms in COPD (E-RS) daily questionnaire. We calculated within-subject standard deviation (WS-SD) for each patient at week 0 and correlated this with measurements obtained 4 weeks later using Pearson's r and Bland Altman plots. Median WS-SD value dichotomized participants into higher versus lower variability groups. Association between WS-SD and exacerbation risk during 4 follow-up weeks was explored.
Diary completion rates were sufficient in 140 (68%) of 205 sub-study participants. Reproducibility (r) of the WS-SD metric from baseline to week 4 was 0.32. Higher variability participants had higher St George's Respiratory Questionnaire (SGRQ) scores (47.3 ± 20.3 versus 39.6 ± 21.5,
=.04) than lower variability participants. Exploratory analyses found no relationship between symptom variability and health care resource utilization-defined exacerbations.
WS-SD of the E-RS can be used as a measure of symptom variability in studies of patients with COPD. Patients with higher variability have worse health-related quality of life. WS-SD should be further validated as a measure to understand the implications of symptom variability.
Background Exercise training lowers blood pressure (BP), while BP increases and returns to pre-training values with detraining. Yet, there is considerable variability in these BP responses. We ...examined the relationship between the BP responses after 6 months of training followed by 2 weeks of detraining among the same people. Methodology/Principal Findings Subjects (n = 75) (X+SD, 50.2 plus or minus 10.6 yr) were sedentary, obese, and had prehypertension. They completed an aerobic (n = 34); resistance (n = 28); or aerobic + resistance or concurrent (n = 13) exercise training program. We calculated a metabolic syndrome z score (MetSz). Subjects were classified as BP responders (BP decreased) or non-responders (BP increased) to training and detraining. Linear and multivariable regression tested the BP response. Chi Square tested the frequency of responders and non-responders. The systolic BP (SBP, r = -0.474) and diastolic (DBP, r = -0.540) response to training negatively correlated with detraining (p<0.01), independent of modality (p>0.05). Exercise responders reduced SBP 11.5 plus or minus 7.8 (n = 29) and DBP 9.8 plus or minus 6.2 mmHg (n = 31); non-responders increased SBP 7.9. plus or minus 10.9 (n = 46) and DBP 4.9 plus or minus 7.1 mmHg (n = 44) (p<0.001). We found 65.5% of SBP training responders were SBP detraining non-responders; while 60.9% of SBP training non-responders were SBP detraining responders (p = 0.034). Similarly, 80.6% of DBP training responders were DBP detraining non-responders; while 59.1% of DBP training non-responders were DBP detraining responders (p<0.001). The SBP detraining response (r = -0.521), resting SBP (r = -0.444), and MetSz (r = 0.288) explained 44.8% of the SBP training response (p<0.001). The DBP detraining response (r = -0.553), resting DBP (r = -0.450), and MetSz (r = 0.463) explained 60.1% of the DBP training response (p<0.001). Conclusions/Significance As expected most subjects that decreased BP after exercise training, increased BP after detraining. An unanticipated finding was most subjects that increased BP after exercise training, decreased BP after detraining. Reasons why the negative effects of exercise training on BP maybe reversed with detraining among some people should be explored further. Trial Registration Information ClinicalTrials.gov 1R01HL57354; 2003-2008; NCT00275145
Introduction This study investigates social determinants of systemic inflammation, focusing on race, SES, and perceived discrimination. Methods Data on 884 white and 170 black participants were ...obtained from the Survey of Midlife in the U.S., a cross-sectional observational study combining survey measures, anthropometry, and biomarker assay. Data, collected in 2004–2009, were analyzed in 2016. Main outcome measures were fasting blood concentrations of C-reactive protein, interleukin 6, fibrinogen, and E-selectin. For each biomarker, series of multivariate linear regression models were estimated for the pooled sample and separately for blacks and whites. Full models included social determinants; psychological, lifestyle, and health factors; and demographic covariates. Results Bivariate analyses indicated higher concentrations of all inflammation markers among blacks compared with whites ( p <0.001). In fully adjusted models using the pooled sample, racial differences persisted for interleukin 6 ( p <0.001) and fibrinogen ( p <0.01). For E-selectin and C-reactive protein, racial differences were explained after adjusting for covariates. Education was linked to lower fibrinogen concentration ( p <0.05) in the fully adjusted model and C-reactive protein concentration ( p <0.01) after adjusting for demographic factors and income. Lifetime perceived discrimination was related to higher concentrations of fibrinogen ( p <0.05) in the fully adjusted model, and higher concentrations of E-selectin and interleukin 6 ( p <0.05) after adjusting for socioeconomic status (SES) and demographic factors. Conclusions This study clarifies the contributions of race, SES, and perceived discrimination to inflammation. It suggests that inflammation-reducing interventions should focus on blacks and individuals facing socioeconomic disadvantages, especially low education.
To define the amount of opioid analgesics prescribed and consumed after discharge after cesarean delivery.
We conducted a survey at six academic medical centers in the United States from September ...2014 to March 2016. Women who had undergone a cesarean delivery were contacted by phone 2 weeks after discharge and participated in a structured interview about the opioid prescription they received on discharge and their oral opioid intake while at home.
A total of 720 women were enrolled; of these, 615 (85.4%) filled an opioid prescription. The median number of dispensed opioid tablets was 40 (interquartile range 30-40), the median number consumed was 20 (interquartile range 8-30), and leftover was 15 (interquartile range 3-26). Of those with leftover opioids, 95.3% had not disposed of the excess medication at the time of the interview. There was an association between a larger number of tablets dispensed and the number consumed independent of patient characteristics. The amount of opioids dispensed did not correlate with patient satisfaction, pain control, or the need to refill the opioid prescription.
The amount of opioid prescribed after cesarean delivery generally exceeds the amount consumed by a significant margin, leading to substantial amounts of leftover opioid medication. Lower opioid prescription correlates with lower consumption without a concomitant increase in pain scores or satisfaction.
A multiplex polymerase chain reaction panel facilitated the more rapid institution of appropriate antimicrobial therapy in patients with acute gastroenteritis compared to traditional diagnostic ...methods.
Abstract
Background
Molecular syndromic diagnostic panels can enhance pathogen identification in the approximately 2-4 billion episodes of acute gastroenteritis that occur annually worldwide. However, the clinical utility of these panels has not been established.
Methods
We conducted a prospective, multi-center study to investigate the impact of the BioFire FilmArray Gastrointestinal polymerase chain reaction panel on clinical diagnosis and decision-making, and compared the clinical acuity of patients with positive results obtained exclusively with the FilmArray with those detected by conventional stool culture. A total of 1887 consecutive fecal specimens were tested in parallel by FilmArray and stool culture. Laboratory and medical records were reviewed to determine rates of detection, turnaround times, clinical features, and the nature and timing of clinical decisions.
Results
FilmArray detected pathogens in 35.3% of specimens, compared to 6.0% for culture. Median time from collection to result was 18 hours for FilmArray and 47 hours for culture. Median time from collection to initiation of antimicrobial therapy was 22 hours for FilmArray and 72 hours for culture. Patients diagnosed by FilmArray were more likely to receive targeted rather than empirical therapy, compared to those diagnosed by culture (P = .0148). Positive Shiga-like toxin-producing E. coli results were reported 47 hours faster with FilmArray and facilitated discontinuation of empirical antimicrobials. Patients diagnosed exclusively by FilmArray had clinical characteristics similar to those identified by culture.
Conclusions
FilmArray markedly improved clinical sensitivity in patients with acute diarrhea, identified cases with clinical acuity comparable to those identified by culture, and enabled clinicians to make more timely and targeted therapeutic decisions.
The Black church has long been seen as a crucial partner in addressing public health issues. This paper describes the development, implementation, and evaluation of a community-engaged church ...intervention addressing COVID-19 vaccine hesitancy in underserved Black communities in Jefferson County, Alabama. We partnered with churches to implement and evaluate the intervention between March and June of 2022 and found that our church partners were capable of significant messaging reach, particularly through electronic means. (
. 2024;114(S5):S392-S395. https://doi.org/10.2105/AJPH.2024.307683).
Early in the COVID-19 pandemic, unique challenges for vulnerable and underserved minority communities in the United States emerged, including greater risk of severe COVID-19 illness,1 ...disproportionate hospitalizations and deaths,2 limited access to care,3 lack of reliable sources of information regarding risk and preventive behaviors,4 and mistrust of medical providers and COVID-19 messaging.4The impact of COVID-19 and comorbidity disparities on African Americans in the South was particularly evident, with this region having the greatest prevalence of COVID-19 and the highest prevalence of chronic disease.5Compounding these issues was everevolving information from government officials regarding safety measures, leading to miscommunication and decreased trust in government messaging.6 Social media disinformation piggybacked on the confusing information to further sow seeds of distrust in public health recommendations, such as masking, social distancing, and testing.7To address the crisis of inequities in COVID-19, it became clear that models embracing both engagement and action were needed to guide the development of timely, trustworthy messaging to vulnerable communities. A Bidirectional Collaborative Community Engagement Alliance (CEAL) Response Model (BCRM) emerged from the collaboration of teams in Alabama, Mississippi, and Louisiana that can be used to create culturally sensitive messaging and strategies to address health crises rapidly and effectively in vulnerable communities. Inherent in this model are sustained community-academic partnerships.
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