Dietary changes associated with industrialization increase the prevalence of chronic diseases, such as obesity, type II diabetes, and cardiovascular disease. This relationship is often attributed to ...an 'evolutionary mismatch' between human physiology and modern nutritional environments. Western diets enriched with foods that were scarce throughout human evolutionary history (e.g. simple sugars and saturated fats) promote inflammation and disease relative to diets more akin to ancestral human hunter-gatherer diets, such as a Mediterranean diet. Peripheral blood monocytes, precursors to macrophages and important mediators of innate immunity and inflammation, are sensitive to the environment and may represent a critical intermediate in the pathway linking diet to disease. We evaluated the effects of 15 months of whole diet manipulations mimicking Western or Mediterranean diet patterns on monocyte polarization in a well-established model of human health, the cynomolgus macaque (
). Monocyte transcriptional profiles differed markedly between diets, with 40% of transcripts showing differential expression (FDR < 0.05). Monocytes from Western diet consumers were polarized toward a more proinflammatory phenotype. The Western diet shifted the co-expression of 445 gene pairs, including small RNAs and transcription factors associated with metabolism and adiposity in humans, and dramatically altered behavior. For example, Western-fed individuals were more anxious and less socially integrated. These behavioral changes were also associated with some of the effects of diet on gene expression, suggesting an interaction between diet, central nervous system activity, and monocyte gene expression. This study provides new molecular insights into an evolutionary mismatch and uncovers new pathways through which Western diets alter monocyte polarization toward a proinflammatory phenotype.
A comprehensive cardiovascular disease (CVD) prevention approach should address patients' medical, behavioral, and psychological issues. The aim of this study was to understand the clinician-reported ...availability of a pertinent CVD preventive workforce across various specialties using a survey study in the southeastern United States, an area with a disproportionate burden of CVD and commonly known as the Stroke Belt.
We surveyed physicians, advanced practice providers (APPs), and pharmacists in internal medicine, family medicine, endocrinology, and cardiology regarding available specialists in CVD preventive practice. We examined categorical variables using the χ
test and continuous variables using the
test/analysis of variance.
A total of 263 clinicians from 21 health systems participated (27.6% response rate, 91.5% from North Carolina). Most were women (54.5%) and physicians (72.5%) specializing in cardiology (43.6%) and working at academic centers (51.3%). Overall, most clinicians stated having adequate specialist services to manage hypertension (86.6%), diabetes mellitus (90.1%), and dyslipidemia (84%), with >50% stating having adequate specialist services for obesity, smoking cessation, diet/nutrition, and exercise counseling. Many reported working with an APP (69%) or a pharmacist (56.5%). Specialist services for exercise therapy, psychology, behavioral counseling, and preventive cardiology were less available. When examined across the four specialties, the majority reported having adequate specialist services for hypertension, diabetes mellitus, obesity, dyslipidemia, and diet/nutrition counseling. Providers from all four specialties were less likely to work with exercise therapists, psychologists, behavioral counselors, and preventive cardiologists.
A majority of providers expressed having adequate specialists for hypertension, diabetes mellitus, dyslipidemia, obesity, smoking cessation, diet/nutrition, and exercise counseling. Most worked together with APPs and pharmacists but less frequently with exercise therapists, psychologists, behavioral counselors, and preventive cardiologists. Further research should explore approaches to use and expand less commonly available specialists for optimal CVD preventive care.
This article compared the effect of dietary weight loss administered alone (WL) or in combination with aerobic training (WL + AT) or resistance training (WL + RT) on health related quality of life, ...walking self-efficacy, stair climb self-efficacy, and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome. Participants (
N
= 249;
M
age
= 66.9) engaged in baseline assessments and were randomly assigned to one of three interventions, each including a 6-month intensive phase and a 12-month follow-up. Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly. All participants engaged in weekly group behavioral weight loss sessions with a goal of 7–10% reduction in body weight. Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL. At month 6, WL + AT reported greater walking self-efficacy relative to WL + RT and WL, and maintained higher scores compared to WL at month 18. WL + AT and WL + RT reported greater stair climbing efficacy at month 6, and WL + RT remained significantly greater than WL at month 18. The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss. This underscores the important role of exercise in WL for older adults, and suggests health care providers should give careful consideration to exercise mode when designing interventions.
Background.
Diagnostic criteria for sarcopenia from appendicular lean mass (ALM), strength, and performance have been proposed, but little is known regarding the progression of sarcopenia.
We ...examined the time course of sarcopenia and determinants of transitioning toward and away from sarcopenia.
Methods.
ALM, gait speed, and grip strength were assessed seven times over 9 years in 2,928 initially well-functioning adults aged 70–79. Low ALM was defined as less than 7.95 kg/m2 (men) or less than 6.24 kg/m2 (women), low performance as gait speed less than 1.0 m/s, low strength as grip strength less than 30 kg (men) or less than 20 kg (women). Presarcopenia was defined as low ALM and sarcopenia as low ALM with low performance or low strength. Hidden Markov modeling was used to characterize states of ALM, strength, and performance and model transitions leading to sarcopenia and death. Determinants of transitioning toward and away from sarcopenia were examined with logistic regression.
Results.
Initially, 54% of participants had normal ALM, strength, and performance; 21% had presarcopenia; 5% had sarcopenia; and 20% had intermediate characteristics. Of participants with normal ALM, strength, and performance, 1% transitioned to presarcopenia and none transitioned to sarcopenia. The greatest transition to sarcopenia (7%) was in presarcopenic individuals. Low-functioning and sarcopenia states were more likely to lead to death (12% and 13%). Higher body mass index (p < .001) and pain (p = .05) predicted transition toward sarcopenia, whereas moderate activity predicted transition from presarcopenia to more normal states (p = .02).
Conclusions.
Pain, physical activity, and body mass index, potentially modifiable factors, are determinants of transitions. Promotion of health approaching old age is important as few individuals transition away from their initial state.
Objective
The Lee‐Jones model posits that antecedent individual and interpersonal factors predicate the development of fear of cancer recurrence (FCR) through cognitive and emotional processing, ...which further to behavioral, emotional, and/or physiological responses. We analyzed data from FoRtitude, a FCR intervention grounded in the Lee‐Jones FCR model, to evaluate associations between FCR antecedents, resources (e.g., breast cancer self‐efficacy, BCSE) and psychological and behavioral consequences.
Methods
Women with breast cancer who completed treatment and reported clinically elevated levels of FCR were randomized into a 4‐week online psychosocial intervention or contact control group. We assessed BCSE, FCR, and physical activity, anxiety and depression, or symptoms at baseline, 4 and 8 weeks. Separate structural equation models were constructed with both baseline data and change scores (baseline‐8 weeks) to examine the pathways linking BCSE, FCR and: (1) physical activity; (2) anxiety and depression; and (3) symptoms (fatigue, sleep disturbance, cognitive concerns).
Results
At baseline, higher levels of BCSE were associated with lower levels of FCR. Higher FCR was associated with worse psychological effects and symptoms but not behavioral response. Change models revealed that an increase in BCSE was associated with a decrease in FCR at 8‐week assessment, which was associated with reductions in psychological effects. A change in BCSE was also directly associated with reductions in psychological effects.
Conclusions
Results support the Lee‐Jones model as a foundation for FCR interventions among breast cancer survivors. Replicability among varied populations is needed to examine effects on behavioral outcomes of FCR such as health care utilization.
Clinical Trials Registration: NCT03384992.
The linear composite direction represents, theoretically, where the unidimensional scale would lie within a multidimensional latent space. Using compensatory multidimensional IRT, the linear ...composite can be derived from the structure of the items and the latent distribution. The purpose of this study was to evaluate the validity of the linear composite conjecture and examine how well a fitted unidimensional IRT model approximates the linear composite direction in a multidimensional latent space. Simulation experiment results overall show that the fitted unidimensional IRT model sufficiently approximates linear composite direction when correlation between bivariate latent variables is positive. When the correlation between bivariate latent variables is negative, instability occurs when the fitted unidimensional IRT model is used to approximate linear composite direction. A real data experiment was also conducted using 20 items from a multiple-choice mathematics test from American College Testing.
•Recent technological advances in media, data, and methods have created a unique opportunity for marketers to better control to whom, when, and how much to discount.•To determine the optimal value ...and timing of the discount we model individual household purchase incidence and brand choice in response to the value and timing of a discount.•To select the customers who receive the discount we formulate a constrained multiple-knapsack model which picks the most valuable customers for a given marketing budget.•We illustrate the model using a Japanese dataset for customized temporal price-cut, a US dataset for customized temporal coupon and another US dataset for customized temporal discounts.
Customized temporal discounts are price cuts or coupons that are tailored by size, timing, and household to maximize profits to a retailer or manufacturer. The authors show how such discounts allow companies to optimize to whom, when, and how much to discount. Such a scheme allows firms to send just enough discounts just prior to the individual's purchase of a rival brand. To do so, the authors model household purchase timing and brand choice in response to discounts and use Bayesian estimation to obtain individual household parameters. They illustrate the model on a Japanese data set having price cuts, a US data set having coupons, and another US data set having discounts. They formulate the optimization task of customized temporal coupons as a constrained multiple-knapsack problem under a given budget. They use simulations of the empirical contexts to obtain optimal solutions and to assess improvement in profits relative to existing practice and alternate models in the literature. The proposed model yields increase in profits of 18–40 percent relative to a standard model that optimizes the value but not timing of discounts.
The cost of cancer care is rising and represents a stressor that has significant and lasting effects on quality of life for many patients and caregivers. Adolescents and young adults (AYAs) with ...cancer are particularly vulnerable. Financial burden measures exist but have varying evidence for their validity and reliability. The goal of this systematic review is to summarize and evaluate measures of financial burden in cancer and describe their potential utility among AYAs and their caregivers. To this end, the authors searched PubMed, Embase, the Cochrane Library, CINAHL, and PsycINFO for concepts involving financial burden, cancer, and self‐reported questionnaires and limited the results to the English language. They discarded meeting s, editorials, letters, and case reports. The authors used standard screening and evaluation procedures for selecting and coding studies, including consensus‐based standards for documenting measurement properties and study quality. In all, they screened 7250 s and 720 full‐text articles to identify relevant articles on financial burden. Eighty‐six articles met the inclusion criteria. Data extraction revealed 64 unique measures for assessing financial burden across material, psychosocial, or behavioral domains. One measure was developed specifically for AYAs, and none were developed for their caregivers. The psychometric evidence and study qualities revealed mixed evidence of methodological rigor. In conclusion, several measures assess the financial burden of cancer. Measures were primarily designed and evaluated in adult patient populations with little focus on AYAs or caregivers despite their increased risk of financial burden. These findings highlight opportunities to adapt and test existing measures of financial burden for AYAs and their caregivers.
Many self‐report measures of financial burden in cancer exist, but very few have adequate data to support robust psychometric properties or capture material, psychosocial, and behavioral domains. A particularly salient need is to adapt and test existing measures of financial burden for adolescents and young adults and their caregivers.
•Developed the Health Coaching Index to assess fidelity to practical coaching skills.•An interclass correlation among three coders of 0.81 showed excellent agreement.•Correlations with Roter ...Interaction Analysis System variables demonstrated validity.•The HCI may facilitate robust training of health coaches.
This study describes the development of the Health Coaching Index (HCI), an observational tool for assessing fidelity to implementing health coaching practical skills.
Initial HCI items were developed, adapted following cognitive interviews, and refined during coding training. Participants (n = 42) were trainees who completed a National Board for Health and Wellness Coaching (NBHWC)-approved training program and coached a standardized patient. Interrater reliability for the HCI was determined by calculating interclass correlations from ten videos coded by three raters. Construct validity was evaluated from 42 recordings using Spearman’s Rho between HCI and Roter Interaction Analysis System (RIAS) codes.
The interclass correlation (ICC) for HCI total score was 0.81, considered an excellent level of inter-rater agreement. Some significant correlations between HCI and RIAS codes supported construct validity (e.g., patient activation: Rho = 0.32; empathy: Rho = 0.36).
The HCI total score can reliably be used to assess fidelity to health coaching skills, and the HCI has construct validity similar to the RIAS as a measure of patient activation.
Adoption and further study of the HCI tool will allow for a more consistent implementation of health coaching skills, and may facilitate more robust training of health coaches for clinical practice and research.
Purpose
This longitudinal study sought to examine the reciprocal relationship between spirituality and physical health status among breast cancer survivors.
Methods
Breast cancer survivors (
N
= ...634) completed baseline assessments (T1) within 8 months of breast cancer diagnosis and 12 (T2) and 18 months (T3) after their baseline assessment. Spirituality was assessed by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale which consists of three subscales: meaning, peace, and faith. Physical health status was measured with the SF-36 Physical Component Summary (PCS). A cross-lagged structural equation model (SEM) was used to analyze the three-wave data to examine the reciprocal relationships between the observed variable, PCS, and the three subscales of the FACIT-Sp, treated as latent variables.
Results
The cross-lagged SEM yielded an adequate fit to the data: RMSEA = .036, CFI = 0.97, TLI = 0.96. After controlling for relevant sociodemographic and cancer-related variables, only higher PCS at T2 predicted greater meaning at T3. PCS at T1 did not predict meaning at T2 and the reciprocal relationship of meaning predicting PCS was not significant. Neither peace nor faith was reciprocally related to PCS.
Conclusions
Results provide evidence of a unidirectional relationship between self-reported physical health status and subsequent meaning among breast cancer survivors during the period of early to later survivorship. Additional studies are needed that examine the longitudinal and directional relationships between spirituality and physical health among diverse samples of cancer survivors.
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