Association between physical activity participation and perceived social isolation at older ages: Do social participation,age and sex differences matter?

BackgroundPhysical inactivity is a major risk factor for poor health. However, it is unclear how physical activity (PA) is associated with perceived social isolation (PSI) in older age. This study aims to explore 1) association between PA and PSI among older people in Ghana and 2) if social participation (SP), age and sex modify any associations.MethodsThe study focused on 1,201 men and women aged ≥50 years in the AgeHeaPsyWel-HeaSeeB Study. Multivariate ordinary least squares (OLS) models were specified to estimate the regression coefficients and standard errors for the associations of PA and SP with PSI adjusting for potential confounders.ResultsMultivariate OLS regressions showed that engagement in SP (b = -0.442; SE = 0.140; p < 0.001) and regular PA (b = -0.338; SE = 0.152; p < 0.005) were independently associated with decreasing PSI. Also, SP modified the PA—PSI association such that resourceful SP reinforced the link between PA and PSI (b = -0.709; SE = 0.276; p < .005). Finding revealed sex (men: b= -0.712; SE = 0.266; p < 0.005; women: p = 0.083) and age differences (65+: b = -0.437; SE = 0.206; p < 0.005; 50-64: b = -0.502; SE = 0.252; p < 0.05) in the effect of PA on PSI.ConclusionsFindings provide insight into the importance of specific and combined effects of SP and PA on PSI in older age. Public health, clinical practice, and social policy efforts should target social healing and group PA interventions to improve older adults' emotional health.     

Effect of home-based exercise intervention on fasting insulin and Adipocytokines in colorectal cancer survivors: a randomized controlled trial

Background and AimsElevated circulating insulin is associated with increased risk of recurrence and cancer mortality in early-stage colorectal cancer (CRC). We conducted a randomized controlled trial to determine the effect of a 12-week home-based exercise program on fasting insulin, adipocytokines, and physical function in CRC survivors.MethodsOne hundred and twenty-three stage II-III CRC patients were randomly assigned to either a home-based exercise (n = 62) or standard care control group (n = 61) for 12 weeks. Home-based exercise consisted of aerobic and resistance training, with a goal of obtaining ≥ 18 metabolic equivalent task (MET)-h/wk. Participants in the exercise group were instructed to participate in > 18 MET-h/wk. of aerobic and resistance exercise while the participants in the control group were asked to maintain their usual daily activity. The primary outcome was fasting insulin levels. Secondary outcomes were adiponectin, TNF-α levels and 6 min walk distance from baseline to post-intervention.ResultsAfter the 12-weeks, moderate-vigorous physical activity participation increased from 9.1 ± 14.7 MET-h/wk. to 26.6 ± 21.7 MET-h/wk. in the exercise group, with no change in the control group (p < 0.01 for group and time interaction). Circulating insulin level decreased by 1 μU/ml (6.0 ± 3.9 vs. 5.0 ± 3.5, p = 0.009) in the exercise group with no change in the control group (p = 0.022 for group and time interaction). A similar trend was observed in TNF-α (p = 0.030 for group and time interaction). Six minute walk distance increased by 25.2 m in the exercise group with no change in the control group (p = 0.061 for group and time interaction).ConclusionsThe 12 week home-based exercise program increased level of physical activity and decreased circulating insulin levels in CRC survivors.     

The association between physical activity time and neuropathy in longstanding type 1 diabetes: A cross-sectional analysis of the Canadian study of longevity in type 1 diabetes

AimPhysical activity (PA) is recommended to improve glycemic control in T1D; however, the effect of PA on distal symmetric polyneuropathy (DSPN) and cardiac autonomic function in longstanding T1D is unknown.MethodsData from 75 participants were collected as part of the Canadian Study of Longevity in T1D. Participants completed a physical exam, medical history, extensive complications phenotyping and reported their daily PA from the preceding 12-months. Pearson and Spearman correlations were used to assess PA time and complications variables. Linear regression was used to test associations between PA time, neurological and electrophysiological measures. Univariable regression was used to indicate the change in the given independent variables associated with a 30-min increase in PA per week.ResultsParticipants were 66 ± 8 years old with diabetes duration of 54 [52,58] years, HbA_1c was 7.3 ± 0.8, 65(89%) had DSPN. Weekly PA time was 156 ± 132 min, and 35(47%) reported ≧150 min/week. Participants with DSPN reported lower PA time compared to individuals without DSPN (141 ± 124 min/week vs. 258 ± 129 min/week; p = 0.015). PA time was associated with better cooling detection threshold (r = 0.24; p = 0.043), peroneal and sural amplitude (r = 0.36; p = 0.0017, r_s = 0.26; p = 0.024) and conduction velocity (r_s = 0.28; p = 0.015, r = 0.23; p = 0.050). Linear regression adjusting for age and HbA1c, showed that for each 30-min of PA there was a 0.09mv higher peroneal amplitude (p = 0.032) and 0.048 ms lower peroneal F-wave latency (p = 0.022).ConclusionIn longstanding T1D, PA time is associated with superior large nerve fibre function in the lower limbs and some better measures of small nerve fibre function.     

Fat distribution,physical activity and cardiovascular risk among adolescent girls

Background and aimsIt is not clear whether changes in waist circumference (WC), sums of skinfold thickness (SSF), or levels of physical activity (PA) during adolescence are associated with cardiovascular risk factors, or if associations are independent or interactive.Methods and resultsIn a US cohort of adolescent girls (n = 617–904) girls, examined at ages 12 and 14, WC, SSF, PA, systolic and diastolic blood pressure (SBP & DBP) were assessed. Fasting blood samples were used to determine concentrations of triglycerides (TG), cholesterol (TC), high and low density lipoproteins (HDL-C and LDL-C), and apolipoprotein A1 and B (Apo-A1 and Apo-B). After adjustment for change in SSF and PA, increases in WC were associated with change in TG (z = 1.73, 95% CI = 0.77, 2.69), TC (z = 0.45, 95% CI = 0.01, 0.90), HDL-C (z = ?0.18, 95% CI = ?0.37, ?0.01), LDL-C (z = 0.41, 95% CI = 0.03, 0.80), Apo-A1 (z = ?0.52, 95% CI = ?1.02, ?0.02), Apo-B (z = 0.60, 95% CI = 0.24, 0.97) and SBP levels (z = 0.31, 95% CI = 0.15, 0.47). Associations between changes in SSF and PA with cardiovascular risk were eliminated after adjustment for WC, and all interactions between WC, SSF and PA were non-significant at conventional levels.ConclusionsChanges in WC were independently associated with the development of cardiovascular risk factors, whereas changes in SSF and PA were not. Clinicians should consider the routine screening of WC to monitor cardiovascular health in adolescent girls.     

Physical activity intervention improved the number and functionality of endothelial progenitor cells in low birth weight children

Background and aimsThe purpose of this study was to investigate whether an intervention with physical activity (PA) would promote positive effects on the angiogenic factors, mobilization, and functionality of circulating endothelial progenitor cells (EPCs) in children with low birth weight (LBW).Methods and resultsThirty-five children participated in a 10-week PA program (intensity: 75–85% of heart rate reserve, frequency: four times/week, and duration: 45 min). Before and after the PA program, we evaluated anthropometric parameters, blood pressure levels, biochemical profile, number of EPCs, number of EPC colony forming units, and plasma levels of vascular endothelial growth factor-A (VEGF-A), nitric oxide (NO), and matrix metalloproteinases (MMPs) 2 and 9. We found a significant main effect of the PA program on waist circumference (η_p² = 0.489), cardiorespiratory fitness (η_p² = 0.463), and MMP-9 (η_p² = 0.582). Birth weight or the PA program produced significant independent effects on systolic blood pressure (birth weight: η_p² = 0.431; PA program: η_p² = 0.615) and EPC colony forming units (birth weight: η_p² = 0.541; PA program: η_p² = 0.698) with no significant interactions. The combination of birth weight and the PA program produced a significant interaction effect on the number of circulating EPCs (η_p² = 0.123), NO (η_p² = 0.258), and VEGF-A (η_p² = 0.175). The variation in the number of EPCs from baseline to 10 weeks of the PA program correlated positively with the change in NO (P = 0.002) and VEGF-A (P = 0.004).ConclusionsA 10-week PA program attenuates the adverse effect of LBW on the number and functionality of EPCs; this effect occurs through an improvement in circulating levels of NO and VEGF-A.Clinical trialshttps://www.clinicaltrials.gov. Unique Identifier: NCT02982967. Date: December/2016.     

Ergometer-cycling with strict versus minimal contact supervision among the oldest adults: A cluster-randomised controlled trial

ObjectiveTo evaluate the feasibility and short- and long-term effects of two 10-wk structured ergometer-cycling programs among elderly in assisted-living residences.Design, setting, and participantsEight assisted-living residences (N = 95; age = 81.2 ± 5.9 years) were randomly assigned to one of three conditions: 1) ergometer-cycling with strict coach-supervision (STRICT, N = 3; n = 35); 2) ergometer-cycling with autonomy-supportive minimal contact coach-supervision (AUT; N = 3; n = 36); or 3) control condition (CON; N = 2, n = 24).InterventionThree-weekly progressive ergometer-cycling sessions for 10 weeks.Main outcome measuresFeasibility, physical activity (PA), muscular strength, functional performance and quality of life (baseline, post-intervention (10weeks) and 6-month follow-up).Results83 participants were analyzed post-intervention, 75 at follow-up. Adherence was higher in STRICT than AUT during the intervention (p = 0.001), but not during follow-up. Compared with CON, both programs showed positive short- and long-term effects on moderate-intensity PA (p = 0.034). With regard to strength, functional performance and well-being, no time-by-group interaction effects were found. When comparing high-adherers (adherence ≥ 80%) to low-adherers, a greater increase in functional performance and in well-being and a trend towards a lower decrease in strength were found in the short-term (p = 0.047, p < 0.001 and p = 0.054, respectively).ConclusionBoth interventions were feasible and equally effective to increase long-term engagement in PA, irrespective of the type of supervision. When adherence is high, positive effects on strength, performance and well-being can be expected.     

Factors associated with falls in active older adults in Japan and Brazil

Background/PurposeAging populations are a global public health concern. The risk of falls increases with age, so fall prevention is becoming an important health issue. However, few studies have focused on cross-cultural analyses of falls. Therefore, we aimed to compare the incidence of falls and compare anthropometric measures and physical function between active Japanese and Brazilian older adults.Materials and methodsWe measured the incidence of falls (investigated by self-reported questionnaire), body mass index (BMI), waist circumference (WC), grip strength (GS), one-legged stance (BALANCE), frequency of physical activity (PA), medication use (MU), and hospitalization history in 114 physically active community-dwelling adults 65 years of age and older in Japan (73.9 ± 4.0 years, n = 40) and Brazil (70.7 ± 4.5 years, n = 74).ResultsThe Japanese elderly were older (p < 0.01), but had a better BALANCE score (p < 0.05) than the Brazilian elderly. Nevertheless, Brazilian elderly showed higher engagement in PA and had higher BMI and WC (p < 0.01). Despite the lack of a difference in the incidence of falls between the two cohorts, Japanese elderly who fell had decreased GS compared to Japanese elderly who did not fall [odds ratio (OR): 0.83, 95% confidence interval (CI) 0.72–0.97, p < 0.05]. In Brazil, those who fell had larger WC than those who did not fall (OR: 1.07, 95% CI 1.01 – 1.13, p < 0.01).ConclusionOur results indicate that physical function (i.e., grip strength) is a more important predictor of falls in Japanese elderly. However, increasing waist size is a predictor of falls in Brazilian elderly. These findings suggest that risk factors for falls are multifactorial and vary according to setting.     

Effects of dapagliflozin in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials

BackgroundDapagliflozin as a treatment option in patients with nonalcoholic fatty liver disease (NAFLD) has received increasing attention, however, the efficacy and safety of dapagliflozin for NAFLD has not been well assessed. This meta-analysis aimed to summarize these RCTs and evaluate the efficacy of dapagliflozin for patients with NAFLD.MethodsThe PubMed, Embase, Web of Science, and Cochrane Library databases were searched for RCTs comparing dapagliflozin with placebo or active comparator in patients with NAFLD from inception to Oct 2021.ResultsWe included seven trials with 390 randomized participants in total. Compared to the placebo or control group, dapagliflozin could reduce the levels of alanine aminotransferase(ALT) (WMD: -6.62U/L; 95%CI: -12.66,-0.58; p = 0.03) and aspartate aminotransaminase(AST) (WMD: -4.20U/L; 95%CI: -7.92,-0.47; p = 0.03). However, dapagliflozin produced a non-significant decrease in gamma-glutamyl transferase (GGT) levels (WMD: -7.28U/L; 95%CI: -16.26,1.71; p = 0.11). Additionally, we showed that dapagliflozin significantly affect Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (WMD: -0.88; 95%CI: -1.43,-0.33; p = 0.002). Metabolic outcomes, such as bodyweight (WMD: -3.79 Kg; 95%CI: -4.63,-2.95; p < 0.00001), body mass index (BMI) (WMD: -1.33 Kg/m²; 95%CI: -2.37,-0.28; p = 0.01), low-density lipoprotein cholesterol (LDL-C) (WMD: -2.66 mg/dL; 95%CI: -3.99,-1.32; p < 0.00001) and triglycerides (TG) (WMD: -16.77 mg/dL; 95%CI: -31.93,-1.61; p = 0.03) were also reduced. Meanwhile, we found that dapagliflozin increased total cholesterol (TC) (WMD: 9.77 mg/dL; 95%CI: 1.58,17.97; p = 0.02). There was no significant difference in the incidence of total adverse events between the dapagliflozin group and the control group (RR = 0.96; 95%CI: 0.60,1.54; p = 0.86).ConclusionOur results suggest that dapagliflozin effectively improves liver function parameters and metabolic outcomes among patients with NAFLD. At the same time, treatment with dapagliflozin may increase total cholesterol.     

Relationships among changes in C-reactive protein and cardiovascular disease risk factors with lifestyle interventions

Background and aimsInflammation plays a role in the development of cardiovascular disease (CVD). Elevated levels of the inflammatory marker, C-reactive protein (CRP), are cross-sectionally associated with traditional CVD risk factors and are being considered as an emerging CVD risk factor. In a secondary data analysis, we examined changes in CRP and several CVD risk factors after one-year diet and physical activity interventions to assess whether CRP changed concurrently with other risk factors, or was independent of the traditional risk factors.Methods and resultsData were analyzed from 143 men and 133 women with dyslipidemia who were randomized to one-year interventions of low-fat diet only, physical activity only, diet plus physical activity, or control. Plasma high-sensitivity CRP, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides (TG), fasting and 2-hr blood glucose and insulin, blood pressure (BP), and waist circumference were obtained at baseline and follow-up. Multiple linear regression models were used to predict CRP change based on other risk factor changes, controlling for age, race, alcohol intake, and hormone replacement therapy. Treatment groups were combined for analysis. Baseline mean (SD) CRP levels were 1.3 ± 1.3 (men) and 1.9 ± 1.8 mg/L (women), with mean changes of ?0.11 ± 1.3 and ?0.17 ± 1.5 mg/L, respectively. Plasma CRP change was negatively associated with TG change in men (p = 0.003) and women (p = 0.05), positively associated with change in systolic BP in men (p = 0.01), but was not associated with changes in the other risk factors.ConclusionDietary and/or physical activity induced changes in CRP may be largely independent of traditional CVD risk factors in persons with dyslipidemia.     

Physical activity and deconditioning of heart failure's patients followed at two Yaoundé's hospitals settings : A cross-sectional study in Cameroon

ObjectiveTo assess the basic physical condition of chronic heart failure's Cameroonian patients.Patients and methodsWe carried out a cross-sectional study from February to June 2020 at the Yaoundé Central and General Hospitals, including all consenting adults with stage I or II chronic heart failure of the New York Heart Association without sign of decompensation and received in outpatient consultation. Socio-demographic data and the level of physical activity assessed according to the International Questionnaire on PhysicalActivity were recorded. Quality of Life was evaluated using the “Minnesota Living with Heart Failure Questionnaire”. Associated factors were analysed using the Chi-square test, the strength of association expressed by the odds ratio, and its 95% confidence interval. The significance level was 0.05.ResultsWe recruited 102 participants, including 60 women with a median age of 64 [56,68]. Daily physical activity was moderate in 54% of participants and low in 45%, with no significant difference between the sexes (p = 0.3). About 39.2% of patients had an altered physical condition, and the most effective associated factors were obesity (p = 0.01), low daily physical activity (p = 0.002) and non-compliance to the treatment (p = 0.03). The mean Quality of Life score was low (36.7 ± 22.4), and the deterioration in physical condition harmed it (p < 0.001).ConclusionMore than a third of the study population had a poor physical condition, which negatively affected their Quality of Life. Therefore, we can suggest that prescribing appropriate physical activity should be an integral part of heart failure management in our context.     

Maintaining early diagnosis of pancreatic adenocarcinoma in Japan: Local resilience against COVID-19

Background and aimsThis study evaluated the impact of the coronavirus disease 2019 (COVID-19) pandemic on pancreatic adenocarcinoma (PA) practice in our region and discussed the effects of our institution's regional collaborative system, the “Early Stage Pancreatic Cancer Diagnosis Project," which was originally unrelated to this study's purpose.MethodsWe retrospectively investigated 150 patients with PA at Yokohama Rosai Hospital by defining three time periods: before (C0), during the first year (C1), and during the second year (C2) of the COVID-19 pandemic.ResultsAmong the three periods (C0, C1, and C2), there were significantly less patients with stage I PA (14.0%, 0%, and 7.4%, p = 0.032) in C1, and significantly more patients with stage III PA (10.0%, 28.3%, and 9.3%, p = 0.014) in C1. The pandemic significantly prolonged the median durations from disease onset to patients’ first visits (28, 49, and 14 days, p = 0.012). In contrast, there was no significant difference in the median durations from referral to first visit to our institution (4, 4, and 6 days, p = 0.391).ConclusionsThe pandemic advanced the stage of PA in our region. Although the pancreatic referral network remained functional during the pandemic, there were delays from disease onset to patients' first visit to healthcare providers, including clinics. While the pandemic caused temporary damage to PA practice, the routine regional collaboration provided by our institution's project allowed for early resilience. A notable limitation is that the impact of the pandemic on PA prognosis was not evaluated.     

Frequency of indeterminate colitis in children and adults with IBD — a metaanalysis

BackgroundIndeterminate colitis (IC) remains an enigmatic inflammatory bowel disease (IBD) phenotype. It is currently not clear whether it constitutes merely a problem of terminology, classification, or possibly an early stage of IBD distinct from Crohn's disease (CD) and ulcerative colitis (UC).MethodsWe analysed epidemiological data of studies comparing IC, UC and CD. We selected 14 studies investigating paediatric patients (10 prospective and 4 retrospective) and 18 studies investigating adult IBD patients (11 prospective and 7 retrospective) for this analysis.ResultsCompared to adults (n = 15,776) the frequency of IC is higher in children (n = 6262) (children 12.7% versus adults 6.0%, p < 0.0001). This difference between children and adults has been detected irrespective whether prospective or retrospective studies were selected. In both, children and adults IC was more frequent in prospective studies compared to retrospective studies (children p = 0.0004; adults p = 0.0024).ConclusionsIC has been detected in a substantial proportion of paediatric patients with IBD. IC is more frequently found in children compared to adults. Further studies are required to clarify whether IC represents an IBD phenotype associated with childhood disease onset or whether the high IC frequency is due to difficulties in establishing a UC or CD diagnosis.     

Distal Versus Conventional Transradial Artery Access for Coronary Angiography and Intervention: A Meta-Analysis

BackgroundDistal transradial artery access (dTRA) through the anatomical snuffbox is a novel approach for performing coronary angiography and interventions. However, the safety and efficacy of dTRA as compared to conventional TRA (cTRA) remains unknown. We aim to evaluate the outcomes of dTRA versus cTRA for coronary angiography and intervention.MethodsElectronic search of the National Library of Medicine PubMed and Cochrane Library databases was performed until April 2019 for studies comparing the clinical outcomes of dTRA approach versus conventional TRA (cTRA) approach in coronary angiography and interventions. Random-effects DerSimonian-Laird risk ratios (RR) were calculated. The main outcome was failure of access site utilization. Other outcomes included access site hematoma, radial artery spasm, dissection, and occlusion.ResultsFive studies (4 observational and 1 randomized controlled) with a total of 6746 patients (dTRA n = 3209 and cTRA n = 3537) were available for analysis. The failure rate was similar in dTRA and cTRA groups (5.26% versus 3.75%; RR = 1.36; 95%CI 0.41–4.48; p = 0.62). Similarly, no difference was observed between dTRA and cTRA in regards to access site hematoma (1.20% versus 1.24%, RR = 1.01; 95%CI 0.49–2.07; p = 0.99), radial artery spasm (1.42 versus 3.84%, RR = 0.91; 95%CI 0.32–2.62; p = 0.86), or radial artery dissection (0.11 versus 0.20%, RR = 0.63; 95%CI 0.18–2.16; p = 0.46). The rate of radial artery occlusion was lower with dTRA (2.30 versus 4.86%, RR = 0.51; 95%CI 0.32–0.81; p = 0.004) as compared to cTRA.ConclusionDistal TRA appears to be a safe and effective alternative to conventional TRA. The outcomes of this novel technique warrant further randomized studies.     

Effect of pulmonary rehabilitation programs including lower limb endurance training on dyspnea in stable COPD: A systematic review and meta-analysis

Pulmonary rehabilitation (PR) is recommended as an effective treatment for patients with chronic obstructive pulmonary disease (COPD). Previous meta-analyses showed that PR improves exercise capacity and health-related quality of life (HRQOL). However, they did not evaluate the effect of PR on the sensation of dyspnea.We searched six databases in May 2019 for randomized controlled trials (RCTs) that examined PR, including supervised lower limb endurance training as a minimal essential component that was continued for 4–12 weeks, in patients with stable COPD, with changes from baseline dyspnea as a primary outcome. Secondary outcomes were changes in exercise capacity, HRQOL, activity of daily life (ADL), physical activity (PA), and adverse events. We calculated the pooled weighted mean difference (MD) using a random effects model. We identified 42 studies with 2150 participants. Compared with the control, PR improved dyspnea, as shown using the British Medical Research Council (MRC) questionnaire (MD, −0.64; 95% CI, −0.99 to −0.30; p = 0.0003), transitional dyspnea index (MD, 1.95; 95% CI, 1.09 to 2.81; p = 0.0001), modified Borg score during exercise (MD, −0.62; 95% CI, −1.10 to −0.14; p = 0.01), and Chronic Respiratory Questionnaire (CRQ) dyspnea score (MD, 0.91; 95% CI, 0.39 to 1.44; p = 0.0007). PR significantly increased exercise capacity measured by the 6 min walking distance time, peak workload, and peak VO₂. It improved HRQOL measured by the St. George's Respiratory Questionnaire and CRQ, but not on PA or ADL. These results indicated that PR programs including lower limb endurance training improve dyspnea, HRQOL, and exercise capacity in patients with stable COPD.     

Effect of intensive counselling on physical activity in pregnant women at high risk for gestational diabetes mellitus. A clinical study in primary care

ObjectiveThe level of physical activity (PA) of pregnant women in Finland is unknown. Even more limited is our knowledge of PA of women at high risk for gestational diabetes mellitus (GDM).MethodsThe women (n = 54) were randomly assigned to a lifestyle intervention group (n = 27) including exercise advice by a physiotherapist six times during pregnancy or to a control group (n = 27) without additional exercise advice. Outcomes of the present study were required sample size, timing of counselling and change of PA. PA was retrospectively reported during 12 months before pregnancy and recorded one week monthly during pregnancy.ResultsIndividualized counselling by a physiotherapist resulted in small changes of recreational PA (2.7 MET hours/week, p = 0.056) up to gestational week 25 compared with the similar decreasing tendency of PA in the control group. The women decreased recreational PA after week 30. Sample size of 550 women at high risk for GDM per group would be needed for a PA study.ConclusionsThe optimal time window for increasing PA must be earlier than in the last trimester of pregnancy. Sample size for a study to increase PA by 2.7 MET hours/week on pregnant women at high risk of GDM should be about 550 per group.     

The associations between physical activity,health-related quality of life,regimen adherence,and glycemic control in adolescents with type 1 diabetes: A cross-sectional study

BackgroundAdolescents with Type 1 Diabetes (T1D) display a greater than two-fold higher risk of developing diabetes-related complications compared with their healthy peers and the risk increases markedly as glycated hemoglobin (HbA1c) increases. The majority of the known factors associated with improved glycemic control in adolescents with T1D are geared toward Western populations. Therefore, this study examined the associations between Physical Activity (PA), Health-Related Quality of Life (HRQoL), and regimen adherence on glycemic control in a Middle Eastern population of adolescents with T1DMethodsThe study utilized a cross-sectional design of Jordanian adolescents (aged 12–18) with T1D (n = 74). Self-reported measures used were the Pediatric Quality of Life-Diabetes Module, the International Physical Activity Questionnaire, and the Summary of Diabetes Self-Care Activities. HbA1c values were obtained from the medical records. Correlation analyses were conducted using Pearson’s and Spearman’s correlation tests. Multiple regression analyses were conducted to determine if HRQoL, PA, and regimen adherence predict glycemic control.ResultsOnly 14.8 % of the participants demonstrated good glycemic control (HbA1c ≤ 7.5 %). Participants with poor control had a statistically significant lower mean PA of MET-minutes/week (3531.9 ± 1356.75 vs. 1619.81 ± 1481.95, p < .001) compared to those with good control. The total sample was found to demonstrate low HRQoL (47.70 ± 10.32). Participants were within the acceptable range of PA (1885.38 ± 1601.13) MET-minutes/week. HbA1c significantly inversely correlated with PA (r = −0.328, p = .010) and regimen adherence (r = −0.299, p = .018). The regression analysis revealed that PA significantly predicted glycemic control (β = −0.367, p < .01) as adherence (β = −0.409, p < .01) and disease duration did (β = 0.444, p < .01).ConclusionBetter glycemic control was significantly associated with higher PA and regimen adherence levels. The correlation between PA and glycemic control depends highly on the level of regimen adherence or arguably, adherence acts as a buffer in the correlation between PA and glycemic control. There was no significant association between glycemic control and HRQoL.     

Efficacy of statins in treatment and development of non-alcoholic fatty liver disease and steatohepatitis: A systematic review and meta-analysis

BackgroundNon-Alcoholic Fatty Liver Disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. There is no universally accepted effective treatment for NAFLD. Although various studies propose statins effective in lowering liver enzymes and in improving liver histology, their potency in the treatment and development of NAFLD remains unknown.PurposeWe conducted this meta-analysis to evaluate the efficacy of statins in the treatment and the development of NAFLD.MethodsElectronic databases (MEDLINE and Cochrane CENTRAL) were searched from their inception until May 2021 for observational studies and randomized controlled trials (RCTs) that assessed the efficacy of statins for the treatment of NAFLD and its development. Studies were included irrespective of the dosage or duration, and their risk of bias was assessed. The outcomes of interest for our study were the effect of statins on liver histology (steatosis, fibrosis and necroinflammation, NAFLD activity score [NAS]) and liver enzymes (Alanine transaminase [ALT], Aspartate transaminase [AST], and Gamma-glutamyl transferase [GGT] levels). To pool continuous outcomes, a random-effects model was used to derive weighted mean difference (WMD) or standardized mean difference (SMD) and their corresponding 95% confidence intervals (CIs). Generic inverse variance was then used for different measurement units reported by the studies. For studies investigating the effects of statins on the development of NAFLD, generic inverse variance along with random effects model was used to derive odds ratio (ORs) and its corresponding 95% confidence interval (CI).ResultsA total of 14 studies including 1,247,503 participants were short-listed for our analysis. All the studies included in our analysis had a low to moderate risk of bias. The results of our analysis suggest that statins may significantly reduce the risk of developing NAFLD (OR:0.69, 95% CI [0.57,0.84]; p = 0.0002; I² =36%). Statin use significantly reduced ALT levels (WMD: -27.28, 95% CI [-43.06, -11.51]; p = 0.0007; I² =90%), AST levels (WMD: -10.99, 95% CI [-18.17, -3.81]; p = 0.003; I² =79%) and GGT levels (WMD: -23.40, 95% CI [-31.82, -14.98]; p < 0.00001; I² = 21%) in patients presenting with NAFLD at baseline. In liver histology outcomes, steatosis grade (SMD: -2.59, 95% CI [-4.61, -0.56]; p = 0.01; I² = 95%), NAS (WMD: -1.03, 95% CI [-1.33, -0.74]; p < 0.00001; I² = 33%), necro-inflammatory stage (WMD: -0.19, 95% CI [-0.26, -0.13]; p < 0.00001; I² = 0%) and significant fibrosis (OR:0.20, 95% CI [0.04, 0.95]; p = 0.04; I² = 97%) underwent notable reduction. However, fibrosis stage outcome (WMD: 0.07, 95% CI [-0.05, 0.20]; p = 0.27; I² = 0%) was non-significant.ConclusionThere was a significant decrease in transaminase and transferase levels. Marked improvement in liver histology of NAFLD patients was observed. Statin use also remarkably reduced the risk of developing NAFLD. Future large-scale trials can further aid in identifying the positive impact of statins in treatment for NAFLD and those at risk of developing it.     

Influence of major histocompatibility complex class I chain-related gene A polymorphisms on cytomegalovirus disease after allogeneic hematopoietic cell transplantation

Objective/BackgroundCytomegalovirus (CMV) infection and disease are common infectious complications after allogeneic hematopoietic cell transplantation (alloHCT). Major histocompatibility complex (MHC) class I chain-related gene A (MICA) is a ligand of the natural killer (NKG2D) receptor on immune effector cells that helps mediate NK cell alloreactivity. We hypothesized that MICA polymorphisms may influence CMV infection and disease incidence after alloHCT.MethodsWe conducted a retrospective analysis of 423 adults at the Cleveland Clinic with hematologic malignancies treated with a matched related or unrelated donor alloHCT. CMV cases analyzed included a compositive of instances of viral copy replication above detection limits as well as any biopsy-proven tissue invasive disease episodes. Genotypes at the MICA-129 position have been categorized as weak (valine/valine; V/V), intermediate (methionine/valine; M/V), or strong (methionine/methionine; M/M) receptor affinity.ResultsIn multivariable analysis, V/V donor MICA-129 genotype was associated with CMV infection and disease (hazard ratio [HR] = 1.40; 95% confidence interval [CI], 1.00–1.96; p = .05), but not MICA mismatch (HR = 1.38; 95% CI, 0.83–2.29; p = .22). There was no association of acute or chronic GVHD with MICA donor–recipient mismatch (HR = 1.05; 95% 95% CI, 0.66–1.68; p = .83 and HR = 0.94; 95% CI, 0.51–1.76; p = .85, respectively) or V/V donor MICA-129 genotypes (HR = 1.02; 95% CI, 0.79–1.31; p = .89 and HR = 0.89; 95% CI, 0.65–1.22; p = .47, respectively).ConclusionThese findings suggest that the donor MICA-129 V/V genotype with weak NKG2D receptor binding affinity is associated with an increased risk of CMV infection and disease after alloHCT.     

Urban-rural differences in physical performance and health status among older Japanese community-dwelling women

Background/PurposeAssessment of physical performance allows the identification of health and functional independence among older adults. Several factors, such as environmental conditions, influence the results; therefore our objective was to compare the physical performance and the health status between older Japanese women living in urban and rural communities.MethodsThe Japanese women were aged ≥65 years, and recruited in urban (n = 41, age = 73.8 ± 3.92 years) and rural (n = 54, age = 73.8 ± 4.15 years) locations through the local press. Physical performance was assessed by the Timed Up and Go (TUG), one leg stand (OLS), repeated chair stands (CS) and handgrip strength (HGS) tests. Health status was investigated using socio-demographic characteristics; anthropometric measures and body composition; physical activity, a pedometer, Life-Space Assessment (LSA); Geriatric Depression Scale; incidence of falls, fear of falling; and medical information. Variables were compared by χ² test, Independent-Samples t test and Mann Whitney U-test.ResultsRural individuals presented a better performance in the HGS test (p = 0.01) than urban individuals, who had a better performance in the CS test (p < 0.001). No statistical differences were found in the TUG or OLS tests. Rural women also had a higher body mass index (p = 0.04), waist circumference (p < 0.01), and body fat percentage (p = 0.014) than urban women, who showed higher scores in LSA (p < 0.001). Concerning medical information, more rural women complained of low back pain (p = 0.01) and gastrointestinal problems (p = 0.02).ConclusionOur findings showed that the physical performance and health status varied according to the place. Rural individuals had worse results in the CS test, but a better performance in the HGS test than urban individuals. We emphasize that health interventions should address the specific demand of each location.